Diagnostic Testing: Clinical Applications PSY 614 Fall 2007 Instructor: Emily E. Bullock, Ph.D.

Clinical Assessment & Diagnosis Clinical Assessment – systematic evaluation and measurement of psychological, biological, and social factors in someone with a possible psychological disorder Diagnosis – process of determining whether a presenting problems meets the criteria for a mental disorder in DSM-IV-TR

Goals of Clinical Assessment Description Understand the individual Decision-Making (Prediction) Predict behavior Plan treatment Evaluate treatment outcome

Multiaxial Diagnosis Using DSM-IV-TR Axis I – clinical disorders and conditions that may be the focus of clinical attention Axis II – personality disorders and mental retardation Axis III – general medical conditions Axis IV – psychosocial stressors Axis V – global assessment of functioning (GAF)

The Role of Diagnostic Testing Diagnosis is generally made based on an interview and a review of the client’s history Tests provide a norm-referenced supplement to these procedures May help guard against interviewer bias

Common Approaches to Diagnostic Testing Rationally-derived tests (symptom checklists) Empirically-derived tests (MMPI-2) Hybrid tests that use a combination of rational/theoretical and empirical procedures (MCMI-III, PAI)

Rationally-Derived Tests High face validity Symptom checklists OQ-45.2 Evaluation Advantages Disadvantages

OQ-45.2: An Overview Description and rationale Administration Scoring 45-item symptom checklist designed to track therapeutic progress and outcome Administration Adults 6th grade reading level Takes about 5 minutes Scoring

OQ-45.2: Interpretation Not intended for diagnostic purposes but as quick screen for severity of distress Step 1: Review critical items (8, 11, 26, 32, and 44) Step 2: Examine each scale score Total Symptom Distress Interpersonal Relations Social Role Performance

OQ-45.2: Interpretation cont. Clinical Cutoff Normal Adults Couns. Center Outp. Clinic RCI SD 36 25 (11) 41 (15) 49 (15) 10 IR 15 10 (5) 19 (4) 20 (6) 8 SR 12 10 (4) 15 (4) 14 (5) 7 Tot 63 45 (18) 75 (17) 83 (22) 14

OQ-45.2: Report Writing Start with the Total score and note whether any scales exceeded the cutoff “Mr. Johnson’s total score of 65 on the OQ-45 exceeded the clinical cutoff, indicating that his report of overall distress was clinically meaningful.” Indicate which norms are being used “Compared with college undergraduates, Mr. Johnson exceeded the 84th percentile on Symptom Distress.”

OQ-45.2: Report Writing cont. Provide the reader with item-level examples so they know what is producing scale elevation “Mr. Johnson reported that he is frequently bothered by feelings of loneliness, hopelessness about the future, and difficulty sleeping.” Be sure to note any critical items that were endorsed