Slide 1

Report
Assessment and Diagnosis
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Chapter Outline
Clinical Assessment
Assessment Instruments
Diagnosis and Classification
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Clinical Assessment
Process of gathering information about a
person and his/her environment to make
decisions about the nature and treatment
of psychological problems
-referral questions determine goals of assessment
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Goals of Assessment
Differential diagnosis is
a process in which a
clinician weighs how
likely it is that a person
has one diagnosis
instead of another.
Deciding what
Screening (identify psychological
problems or predict the risk for future
assessment
problems) (give PHQ-9, for an
procedures and
example)
instruments to
Diagnosis (identification of illness)
administer
Treatment plan (individual’s plan
Tailoring an
of care to meet mental health needs)
assessment to types
of symptoms, age,
and medical status
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How to choose a good
screening tool…
Figure 3.1 Evaluating a
screening tool for depression
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How do you
interpret false
negatives versus
false positives?
Poor or incomplete assessment
can lead to cases of misdiagnosis
(from Ch. 3)
Mental Retardation was really…
Schizophrenia was really…
Depression was really…
Anorexia Nervosa was really…
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Properties of Assessment Instruments
Standardization
Normative comparisons
Reliability
-Test-retest reliability
-Interrater agreement
Validity
-Construct, criterion, concurrent, predictive
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Assessing
abnormality using
the normal curve…
Figure 3.2 The Normal Curve
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Assessment Instruments
Self-report measures (ask patients to evaluate their
own symptoms)
Clinician-rated measures (clinician rates symptoms)
Subjective responses vs. objective responses
Types of assessments
-Clinical interviews
-Psychological tests
-Behavioral Assessments
-Psychophysiological Assessments
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Psychological Tests
Personality tests:
Minnesota Multiphasic Personality Inventory
(MMPI; Hathaway & McKinley, 1943).
The Million Clinical Multiaxial Inventory
(MCMI)
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Figure 3.3 Sample MMPI Profile
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Neuropsychological Testing
Used to detect
impairment in
cognitive
functioning
Measures: memory,
attention and attention,
motor skills, perception,
abstraction, and learning
abilities
 Halstead-Reitan
Neuropsychological Battery
(Reitan & Davidson, 1974)
 Wisconsin Card Sorting Test
(WCST)
 Bender Visual Motor Gestalt
Test
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Figure 3.5 The Wisconsin
Card Sorting Test
This instrument
measures set
shifting or the
ability to display
flexibility in
thinking as the goal
of the task changes.
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From Nevid/Rathus/Greene, Abnormal Psychology in
a Changing World, 5e, p. 91 . Copyright © 2008
Pearson/Prentice Hall. Reprinted by permission.
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Figure 3.6 The Bender Visual
Motor Gestalt Test
Intelligence Tests
Used to measure
“intelligence”
Intelligence
Quotient (an
assessment of cognitive
functioning that
compares a person’s
performance to his or
her age-matched peers)
 Stanford -Binet Intelligence
Scale
 Wechsler Adult Intelligence
Scale (WAIS-IV; Wechsler,
2008)
 Wechsler Intelligence Scale for
Children (WISC-IV, 7-16
years)
 Wechsler Preschool and
Primary Scale of Intelligence
(WPPS-III, 2 ½-7 years)
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Projective Tests
Tests derived from psychoanalytic theory in
which people are asked to respond to
ambiguous stimuli
Rorschach Inkblot Test (Rorschach, 1921)
-The patient is exposed to ambiguous stimuli and then
projects a unique interpretation onto them that reflects
his/her underlying unconscious processes and conflicts.
Thematic Apperception Test (TAT; 1935)
-Consists of thirty-one black-and-white pictorial cards and
the patient is asked to make up a story about the image
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What might
this be?
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The Rorschach Inkblot Test
Let’s examine the
evidence
Examine the Evidence: It’s important to
remember 25% of the CS scores are
Fact: 75% of the Exner’s not considered reliable, “the norms”
Comprehensive System published by Exner is extremely
outdated (from the 1970s and 1980s),
(CS) scores warrant
and adequate validity only exists for 20
internal validity which
of the 180 CS scores.
is based on sums of
individual scores.
Some previous studies found that
validity increases when clinicians use
their clinical judgment to incorporate
the Rorschach results with information
gathered from other sources.
Conclusion: There continues to be critics
and advocates for the utility of the
Rorschach; however no sound
empirical data exists.
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The goal of behavioral
assessments is to understand
behavior within the context
of learning, “learned
behavior.”
Behavioral Assessment
Functional analysis -- where a clinician identifies
causal links between behavior and environment
Self-monitoring -- a patient records and observes his
or her own behavior
Behavioral observation -- measurement of
behavior by a trained observer.
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Pass around example of monitoring anxiety and worry book for clients
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Psychophysiological and NeuroAssessment
Assessment strategies that measure brain and
nervous system activity (EEG, EMG)
Imaging systems (fMRI, PET-scan)
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Sample Report (to illustrate selection and
use of assessment tools)
Dr. Lechman’s sample report
My sample report (L.B.)
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Your turn: Assessment exercise
Case studies in small groups. Decide what
you will use to assess your patient and why.
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The Historical Roots of Diagnosis…
American Psychiatric Association (APA,
1952)
Diagnostic and Statistical Manual of
Mental Disorders (DSM, current edition
DSM-IV-TR)
Multiaxial system of diagnosis and
classification
International Classification of Diseases
(ICD)
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Axis I = Major mental
illnesses
Axis II =
Personality
disorders and
Mental
retardation
(MR)
Axis III =
Other
general
medical
conditions
Axis IV =
Social,
occupational,
and
educational
stressors
Axis V =
Global
Assessment
of
Functioning
(GAF)
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Comorbidity
The presence of
With each new
more than one
edition of the DSM
disorder
new diagnostic
categories arise
50% of people who
meet diagnostic
The DSM has
criteria for one
tripled in size since
mental disorder meet the 1st edition
Why do you think so many individuals meet
criteria for at least
diagnostic criteria for more than one mental
disorder? How do you feel about the increasing
one other disorder
number of disorders with each new DSM?
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Developmental and Cultural
Considerations
Diagnostic criteria may need to vary across the
life span
Differences in prevalence (men vs. women)
-Women and depression vs. men and substance abuse
disorders
Differences in symptoms and disorders (based
on ethnicity and race)
Culture-bound syndrome (sets of symptoms that
occur together uniquely in certain ethnic or racial groups)
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When is a diagnostic system harmful?
Stereotypes &
labels
Premature or
inaccurate
assumptions by
clinicians
Self-fulfilling
prophecies
Prevention of a
thorough evaluation
or comprehensive
treatment plan
Stigma
DSM (limited knowledge
of an era and too many
disorders)
Over-medicalization
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Dimensional Systems vs. Categorical
Systems
Dimensional (suggests that people with disorder are not
qualitatively distinct from people without disorders)
-Psychiatric illness conceptualized as dimensions of
functioning versus discrete clinical conditioning
Features that support the value of dimensional
approaches
-High frequency of comorbidity and within category
variability
-“Common language” of classification
Cons of dimensional system
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Critical Issues to Remember
1. Clinical assessments are both used as an informationgathering instrument and to make decisions around the
treatment of one’s psychological problems.
2. When evaluating the scores from clinical assessments, it is
important to compare the score with the normed group and
review the validity and reliability of the instrument for
usability.
3. Clinical interviews occur early in the treatment process and
can include a variety of modalities.
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Critical Issues to Remember
4. Classifying symptoms into a diagnosis allows a common
language for clinicians and researchers as well as
maintaining appropriate treatment for the patient.
5. When conducting an assessment, it is important to take
into consideration the age, developmental level, and
cultural implications of the test-taker.
6. An alternative to the categorical system is the dimensional
model that conceptualizes abnormal behavior along
dimensions of functioning versus categories.
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