LECTURE 2

Clinical Assessment and Diagnosis

Assessing Psychological Disorders Purpose Understanding the individual Predicting behavior Treatment planning Evaluating outcomes Funnel Analogy Broad, multidimensional start Narrows to specific problems

Assessing Psychological Disorders Clinical Assessment Systematic evaluation and measurement Psychological Biological Social Diagnosis Degree of fit between symptoms and diagnostic criteria

Key Concepts in Assessment Reliability Measurement consistency Agreement Several types: Test-retest Inter-rater

Key Concepts in Assessment Validity Does the test measure what its supposed to? Several types: content concurrent discriminant construct predictive face validity

Key Concepts in Assessment Standardization Consistent use of techniques Provides normative population data Examples Administration procedures Scoring Evaluation of data

Three Concepts Determine the Value of Assessment

The Clinical Interview Clinical Interview Clinical core Structured Assesses multiple domains Current and past behavior Attitudes Emotions Detailed history Presenting problem

The Clinical Interview Mental Status Exam Appearance Behavior Thought processes Mood and affect Intellectual functioning Sensorium

Mental Status Exam

The Clinical Interview Other Interviews Unstructured Semi structured Assess most critical items Departures from format

The Clinical Interview Physical Examinations Diagnose or rule out physical etiologies Toxicities Medication side effects Allergic reactions Metabolic conditions

Assessing Psychological Disorders Behavioral Assessment Identification and observation of target behaviors Here and now focus Direct observations Minimally inferential

Behavioral Assessment

Focus on interactions between events

Assessing Psychological Disorders Behavioral Observation Formal vs. informal Self-monitoring vs. others observing Reactivity

Assessing Psychological Disorders Psychological Testing Reliability Validity Specific tools for assessment Cognition Emotion Personality Behavior

Psychological Testing Projective Tests Presentation of ambiguous stimuli Projection of personality and the unconscious Psychoanalytic roots Examples Rorschach Inkblot Test Thematic Apperception Test

Rorschach Test

Psychological Testing Projective Tests Criticisms and controversies Scoring and interpretation Reliability and validity

Strengths Qualitative data Icebreakers Standardization efforts

Psychological Testing Personality Inventories Face vs. construct validity Empirically-based Minimally ambiguous stimuli Minimal inference Scoring Interpretation

Psychological Testing Minnesota Multiphasic Personality Inventory 567 items (MMPI-2) True/false responses Adolescent version Extensive normative data Reliability and validity Interpretation Individual scales Profiles

Psychological Testing

Assessment: Intelligence Testing Initial purpose: academic prediction Intelligence quotient (IQ) Mental vs. chronological age Deviation IQ Domains Verbal Performance IQ versus intelligence

Psychological Testing and Neuropsychology Neuropsychological tests assess Broad base of skills and abilities Brain-behavior relations Assets and deficits Methods Fixed versus flexible batteries Concerns False Positives False Negatives

Neuroimaging: Pictures of the Brain

Utility: locating tumors, injuries, structural or anatomical abnormalities

Neuroimaging: Pictures of the Brain

Neuroimaging: Images of Brain Function

Neuroimaging: Images of Brain Function

Neuroimaging
Advantages and Limitations Yield detailed information Expense Lack adequate norms Limited clinical utility

Assessing Psychological Disorders

Psychophysiological Assessment Emotional or psychological events reflected by changes in the nervous system EEG Brain wave activity Evoked potentials Alpha and delta waves Ex. Nocturnal panic attacks

Psychophysiological Assessment
Other bodily responses Cardiorespiratory Heart rate and respiration Electrodermal Galvanic skin response Electromyography Muscle tension

Psychophysiological Assessment
Assessing response to stimuli is useful in disorders strong emotional component PTSD Sexual dysfunctions Sleep disorders Headache Hypertension

Diagnosing Psychological Disorders Approaches Idiographic Nomothetic Diagnostic Classification Categories based on commonalities Terminology of Classification Systems Taxonomy Nosology Nomenclature

Classification Issues

Nature and Forms of Approach Classical (or pure) categorical Dimensional Prototypical Two Widely Used Classification Systems ICD-10 DSM

The DSM System Critical Issues Reliability Decreases bias Validity Improved coherence Purposes Communication Prognosis Treatment planning

Diagnosis Before 1980 Emil Kraepelins Psychiatry: A textbook (1913)

ICD 6 (1948)
DSM-I (1952) and DSM-II (1968) Low precision Based on unproven theories Poor reliability

Diagnosis: The 1980s DSM-III (1980) and DSM-III-R (1987) Atheoretical Increased criterion specificity and detail Multiaxial system Low reliability Reliance on consensus

The Present: The DSM-IV Basic Characteristics Comprehensive Clear inclusion and exclusion criteria Broad categorization headings Empirically grounded Prototypic approach

The Present: The DSM-IV The Five DSM-IV Axes I major disorders II Stable, enduring problems III Medical conditions (related) IV Psychosocial problems V rating of adaptive functioning

The DSM-IV - Social and Cultural Considerations Cultural features Culture-bound syndromes ataque de nervios vs panic attacks Outline of Cultural Formulation Identity Explanations Factors Axis IV "V codes"

Criticisms of the DSM-IV Thresholds

Time
Other Axes? Treatment Comorbidity Validity?

A Caution About Labeling Problems and pitfalls with labels Negative connotations Pejorative associated Stigmas Over-identification Reification

Creating a Diagnosis Sub-clinical or atypical presentations Presentations outside current categories Clear impairments Treatment is indicated Insurance coverage is needed Examples Mixed Anxiety-Depression Premenstrual Dysphoric Disorder