Copyright © 2010 Allyn & Bacon C HAPTER 4 Clinical Assessment and Diagnosis

Copyright © 2010 Allyn & Bacon T HE B ASIC E LEMENTS IN A SSESSMENT First, the presenting problem must be identified  Situational or pervasive?  Duration?  Prior attempts to help or treat?  Self-defeating or resourceful?  How does problem impact social roles?  Does problem match any DSM disorder criteria? 2

Copyright © 2010 Allyn & Bacon T HE R ELATIONSHIP B ETWEEN A SSESSMENT AND D IAGNOSIS Classifying the presenting problem is important for numerous reasons  Planning treatment  Knowledge of range of diagnostic problems in client population, which dictate needs for facilities  Insurance payment 3

Copyright © 2010 Allyn & Bacon T AKING A S OCIAL OR B EHAVIORAL H ISTORY A good assessment should include a social history noting:  Personality factors  The social context  A good assessment should be culturally sensitive  Cultural variables can include ethnicity, language, SES, gender, and others 4

Copyright © 2010 Allyn & Bacon T HE I NFLUENCE OF P ROFESSIONAL T HEORETICAL & T REATMENT O RIENTATION How clinicians go about the assessment process often depends on their basic treatment orientations 5

Copyright © 2010 Allyn & Bacon 6 Viewpoints:  Help professionals organize observations  Provide systems of thought  Suggest areas of focus Viewpoints are theoretical constructions devised to orient psychologists in the study of abnormal behavior

Copyright © 2010 Allyn & Bacon 7 W HAT THE A DOPTION OF A P ERSPECTIVE D OES AND D OES N OT D O All perspectives contribute to our understanding of psychopathology, but none can provide a complete explanation The adoption of a perspective influences  The perception of maladaptive behavior  The types of evidence we look for  The way in which we are likely to interpret data

Copyright © 2010 Allyn & Bacon 8 F IGURE 3.9: T HREE M AJOR P SYCHOLOGICAL P ERSPECTIVES ON A LCOHOL D EPENDENCE

Copyright © 2010 Allyn & Bacon 9 F IGURE 3.11: V IEWPOINTS ON P ARENTAL D EPRIVATION

Copyright © 2010 Allyn & Bacon 10 U NRESOLVED I SSUES None of the theories to date address the whole spectrum of abnormality Many psychologists have adopted an eclectic approach, but this is not successful at a theoretical level Many theorists are pushing for a more integrative biopsychosocial (spiritual) viewpoint - the biopsychosocial perspective is the only current attempt at a unified approach

Copyright © 2010 Allyn & Bacon T RUST AND R APPORT B ETWEEN THE C LINICIAN AND THE C LIENT For psychological assessment and/or treatment to proceed effectively, the client must feel comfortable with the clinician 11

Copyright © 2010 Allyn & Bacon A SSESSMENT OF THE P HYSICAL O RGANISM Assessment of the physical organism incorporates  The general physical examination  The neurological examination  The neuropsychological examination 12

Copyright © 2010 Allyn & Bacon T HE G ENERAL P HYSICAL E XAMINATION Many psychological problems have physical components either as  Causal factors  Symptom patterns Therefore, it is often important to refer clients for a medical examination 13

Copyright © 2010 Allyn & Bacon T HE N EUROLOGICAL E XAMINATION If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder The neurological examination may include:  An EEG  A CAT scan  A PET scan  A functional MRI 14

Copyright © 2010 Allyn & Bacon T HE N EUROPSYCHOLOGICAL E XAMINATION The neuropsychological examination involves the use of an expanding array of testing devices to measure a person’s cognitive, perceptual, and motor performance as clues to the extent and location of brain damage 15

Copyright © 2010 Allyn & Bacon P SYCHOSOCIAL A SSESSMENT Psychosocial assessment attempts to provide a realistic picture of an individual in interaction with his or her social environment Three procedures commonly used in psychosocial assessments include:  Assessment interviews (which may be structured or unstructured)  Clinical observation of behavior  Psychological tests 16

Copyright © 2010 Allyn & Bacon E THICAL I SSUES IN A SSESSMENT Ethical issues in assessment include:  Potential cultural bias  Theoretical orientation of the clinician  Underemphasis on the external situation  Insufficient validation  Inaccurate data or premature evaluation 17

Copyright © 2010 Allyn & Bacon C LASSIFYING A BNORMAL B EHAVIOR Classification involves the attempt to delineate meaningful sub-varieties of maladaptive behavior The benefits of classification include:  The introduction of order  The enabling of communication  The enabling of statistical research  Insurance issues 18

Copyright © 2010 Allyn & Bacon Mental health professionals should be aware of the downsides of labeling  It may close off further inquiry  Patients may play out the expectations of their “role”  Others may stigmatize the labeled person Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services 19

Copyright © 2010 Allyn & Bacon R ELIABILITY AND V ALIDITY A classification system’s usefulness depends largely on its reliability and validity 20

Copyright © 2010 Allyn & Bacon D IFFERING M ODELS OF C LASSIFICATION Three basic approaches include:  The categorical approach – a patient is healthy or disordered, but there is no overlap  The dimensional approach – the patient may fall along a range from superior functioning to absolutely impaired functioning  The prototypal approach – a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have 21

Copyright © 2010 Allyn & Bacon F ORMAL D IAGNOSTIC C LASSIFICATION OF M ENTAL D ISORDERS The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use  ICD is more commonly used in Europe  DSM is more commonly used in the U.S. DSM purports to be a categorical system, but it is in fact prototypal 22

Copyright © 2010 Allyn & Bacon F ORMAL D IAGNOSTIC C LASSIFICATION OF M ENTAL D ISORDERS DSM IV had five axes  Axis I: The particular clinical syndromes or other conditions that may be the focus of clinical attention  Axis II: Personality disorders, mental retardation  Axis III: General medical conditions  Axis IV: Psychosocial and environmental problems  Axis V: Global assessment of functioning 23

Copyright © 2010 Allyn & Bacon F ORMAL D IAGNOSTIC C LASSIFICATION OF M ENTAL D ISORDERS The DSM-5 More comprehensive and more subtypes & specifiers - finer differentiation Gender related differences in dx Provides structured interview regarding cultural influences – Cultural Formulation Interview (CFI) (DSM p. 750+) Cross-cutting measures (DSM p. 733+)