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Chapter 3 Clinical Assessment and Diagnosis

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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand ... Approach, 4th Edition, David H. Barlow, V. Mark Durand ... – PowerPoint PPT presentation

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Title: Chapter 3 Clinical Assessment and Diagnosis


1
Chapter 3Clinical Assessment and Diagnosis
2
Assessing Psychological Disorders
  • Purposes of Clinical Assessment
  • To understand the individual
  • To predict behavior
  • To plan treatment
  • To evaluate treatment outcome
  • Analogous to a Funnel
  • Starts broad
  • Multidimensional in approach
  • Narrow to specific problem areas

3
Three Concepts Determine the Value of Assessment
  • Reliability
  • Consistency in measurement
  • Examples include test-retest, inter-rater
    reliability
  • Validity
  • What the test measures and how well it does so
  • Examples include content, concurrent,
    discriminant, construct, and face validity
  • Standardization and Norms
  • Foster consistent use of techniques
  • Provide population benchmarks for comparison
  • Examples include administration procedures,
    scoring, and evaluation of data

4
Three Concepts Determine the Value of Assessment
  • Figure 3.1 Concepts that determine the value of
    clinical assessments.

5
Domains of AssessmentThe Clinical Interview and
Physical Exam
  • Clinical Interview
  • Most common clinical assessment method
  • Structured or semi-structured
  • Mental Status Exam
  • Appearance and behavior
  • Thought processes
  • Mood and affect
  • Intellectual functioning
  • Sensorium
  • Physical Exam

6
Mental Status Exam
Figure 3.2 Components of the mental status exam.
7
Domains of AssessmentBehavioral Assessment and
Observation
  • Behavioral Assessment
  • Focus on here and now
  • Tends to be direct and minimally inferential
  • Target behaviors are identified and observed
  • Focus on antecedents, behaviors, and consequences
  • Behavioral Observation and Behavioral Assessment
  • Can be either formal or informal
  • Self-monitoring vs. others observing
  • Problem of reactivity using direct observation

8
Domains of AssessmentBehavioral Assessment and
Observation
Figure 3.3 The ABCs of observation.
9
Domains of AssessmentPsychological Testing and
Projective Tests
  • Psychological Testing
  • Must be reliable and valid
  • Projective Tests
  • Project aspects of personality onto ambiguous
    stimuli
  • Roots in psychoanalytic tradition
  • High degree of inference in scoring and
    interpretation
  • Examples include the Rorschach Inkblot Test,
    Thematic Apperception Test
  • Reliability and validity data tend to be mixed

10
Rorschach Test
Figure 3.4 This inkblot resembles the ambiguous
figures presented in the Rorschach test.
11
Thematic Apperception Test
Figure 3.5 Example of a picture resembling those
in the Thematic Apperception Test.
12
Domains of Assessment PsychologicalTesting and
Objective Tests
  • Objective Tests
  • Test stimuli are minimally ambiguous
  • Roots in empirical tradition
  • Require minimal inference in scoring and
    interpretation
  • Objective Personality Tests
  • Minnesota Multiphasic Personality Inventory
    (MMPI, MMPI-2, MMPI-A)
  • Over 549 true or false items
  • Extensive reliability, validity, and normative
    database
  • Objective Intelligence Tests
  • Nature of intellectual functioning and IQ
  • The deviation IQ
  • Verbal and performance domains

13
Domains of Assessment PsychologicalTesting and
Neuropsychology
  • Neuropsychological Tests
  • Assess broad range of skills and abilities
  • Goal is to understand brain-behavior relations
  • Used to evaluate a persons assets and deficits
  • Examples include the Luria-Nebraska and
    Halstead-Reitan Batteries
  • Overlap with intelligence tests
  • Problems with Neuropsychological Tests
  • False Positives Saying you have a brain
    problem, but you do not
  • False Negatives Saying you do not have a brain
    problem, but you do

14
Domains of AssessmentNeuroimaging and Brain
Structure
  • Neuroimaging Pictures of the Brain
  • Allows examination of brain structure and
    function
  • Imaging Brain Structure
  • Computerized axial tomography (CAT or CT scan)
  • CAT utilizes X-rays of brain pictures in slices
  • Magnetic resonance imaging (MRI)
  • MRI has better resolution than CAT scan
  • MRI operates via strong magnetic field around
    head

15
Domains of AssessmentNeuroimaging and Brain
Function (cont.)
  • Imaging Brain Function
  • Positron emission tomography (PET)
  • Single photon emission computed tomography
    (SPECT)
  • Both involve injection of radioactive isotopes
  • Radioactive isotopes react with oxygen, blood,
    and glucose in the brain
  • Functional MRI (fMRI) Brief changes in brain
    activity
  • Advantages and Limitations
  • Provide detailed information regarding brain
    function
  • Procedures are expensive, lack adequate norms
  • Procedures have limited clinical utility

16
Domains of AssessmentPsychophysiological
Assessment
  • Psychophysiological Assessment
  • Methods used to assess brain structure, function,
    and activity of the nervous system
  • Psychophysiological Assessment Domains
  • Electroencephalogram (EEG) Brain wave activity
  • Heart rate and respiration Cardiorespiratory
    activity
  • Electrodermal response and levels Sweat gland
    activity
  • Electromyography (EMG) Muscle tension
  • Uses of Routine Psychophysiological Assessment
  • Disorders involving a strong emotional component
  • Examples include PTSD, sexual dysfunctions, sleep
    disorders, headache, and hypertension

17
Diagnosing Psychological DisordersFoundations
in Classification
  • Clinical Assessment vs. Psychiatric Diagnosis
  • Assessment Idiographic approach
  • Diagnosis Nomothetic approach
  • Both are important in treatment planning and
    intervention
  • Diagnostic Classification
  • Classification is central to all sciences
  • Develop categories based on shared attributes
  • Terminology of Classification Systems
  • Taxonomy Classification in a scientific context
  • Nosology Taxonomy in psychological / medical
    contexts
  • Nomenclature Nosological labels (e.g., panic
    disorder)

18
Diagnosing and Classifying Psychological Disorders
  • The Nature and Forms of Classification Systems
  • Classical (or pure) categorical approach
    Categories
  • Dimensional approach Classification along
    dimensions
  • Prototypical approach Both classical and
    dimensional
  • Two Widely Used Classification Systems
  • International Classification of Diseases and
    Health Related Problems (ICD-10) published by
    the World Health Organization
  • Diagnostic and Statistical Manual of Mental
    Disorders (DSM) published by the American
    Psychiatric Association currently the DSM-IV and
    DSM-IV-TR

19
Purposes and Evolution of the DSM
  • Purposes of the DSM System
  • Aid communication
  • Evaluate prognosis and need for treatment
  • Treatment planning
  • DSM-I (1952) and DSM-II (1968)
  • Both relied on unproven theories and were
    unreliable
  • DSM-III (1980) and DSM-III-R
  • Were atheoretical, emphasizing clinical
    description
  • Multiaxial system with detailed criterion sets
    for disorders
  • Problems included low reliability, and reliance
    on committee consensus

20
The DSM-IV
  • Basic Characteristics
  • Five axes describing full clinical presentation
  • Clear inclusion and exclusion criteria for
    disorders
  • Disorders are categorized under broad headings
  • Empircally grounded prototypic approach to
    classification
  • The Five DSM-IV Axes
  • Axis I Most major disorders
  • Axis II Stable, enduring problems (e.g.,
    personality disorders, mental retardation)
  • Axis III Medical conditions related to abnormal
    behavior
  • Axis IV Psychosocial problems
  • Axis V Global clinician rating of adaptive
    functioning
  • Other Unique Features of the DSM-IV

21
Unresolved Issues in the DSM-IV
  • What Are the Optimal Thresholds for Diagnosis?
  • Examples include level or distress, impairment,
    number of required symptoms
  • Arbitrary Time Periods in the Definitions of
    Diagnoses
  • Should Other Axes Be Included?
  • Examples include premorbid history, treatment
    response, family functioning
  • Is the DSM-IV System Optimal for Treatment or
    Research?
  • The Problem of Comorbidity
  • Defined as two or more disorders for the same
    person
  • High comorbidity is the rule clinically
  • Comorbidity threatens the validity of separate
    diagnoses

22
Summary of Clinical Assessment and Diagnosis
  • Clinical Assessment and Diagnosis
  • To provide a complete picture of the client
  • To aid understanding and ameliorating human
    suffering
  • Require reliable, valid, and standardized
    information
  • Dangers of Diagnosis
  • Problem of reification
  • Problem of stigmatization
  • Assessment and Diagnosis
  • The core of abnormal psychology
  • Requires a multidimensional perspective
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