Personality Assessment Assessment Interview

Goals of the Interview n Obtain a psychological portrait of the individual n Conceptualize current difficulties n Make a diagnosis n Formulate a treatment plan

Assessment Interview: Issues and terms n Reliability n Validity n Assets and limitations –Influences: Theoretical orientation Time constraints

Types of interviews n Structured vs. Unstructured –Semistructured n Diagnostic interview n Behavioral interview

Standardized Interviews n Structured Clinical Interview for DSM IV –SCID-I –SCID-II n Semi-structured, clinician administered n Impressive in its breadth of coverage n Close parallel to DSM IV n Reliability and validity varies

From the SCID-I Now I’m going to ask you some questions about your mood… In the last month.. Has there been a period of time when you were feeling depressed or down most of the day, nearly every day? (What was that like?) If yes, How long did it last? What about losing interest or pleasure in things you usually enjoyed? If yes, Was it nearly every day? How long did it last? (As long as two weeks?) n Major depressive episode criteria n A. Five (or more) of the following symptoms have been present during the same two- week period and represent a change from previous functioning; at least one of the symptoms is either –1) depressed mood most of the day, nearly every day as indicated by feelings of sadness or observation made by others –2) Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day

From the SCID II n You’ve said that you have (Have you)become frantic when you thought that someone you really cared about was going to leave you. –What have you done? (Have you threatened or pleaded with him/her?) n You’ve said that (Do) your relationships with people you really care about have lots of extreme ups and downs –tell me about them n BPD Criteria n A pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following: –1) frantic efforts to avoid real or imagined abandonment –2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

Structured Interviews (cont.) n Schedule for Affective Disorders and Schizophrenia (SADS) –KSADS n Clinician administered, semi-structured interview n Eight summary scales (based on Research Diagnostic Criteria) n Adequate reliability and validity n Requires extensive training

Structured Interviews n Diagnostic Interview Schedule (DIS) –DISC n Fully structured questionnaire designed to measure presence of DSM pathology n Developed by NIMH (1978) n Does not require clinicians to administer n More than 30 Axis 1 disorders and one Axis II (antisocial) n Excellent test retest reliability for certain disorders

Preliminaries to the Interview n Organize the interview setting n Introductions n Establishment of rapport –Convey a feeling of interest and warmth –use empathy and reflection n Purpose of the interview n Confidentiality n Types of activities/assessment tools n Discuss fee arrangements

Areas to Cover in Interview n Identifying data n Purpose of interview n Physical appearance n Behavior n Family n Medical history n Developmental history n Education and training n Employment n Legal problems n Sexual and Marital history n Interests and attitudes n Current Problems

Open-ended to specific n Open ended –What brings you here? n Specific –How often do you have these disturbing thoughts?

Do’s and don’ts n Don’t ask “why” n Pay attention to nonverbals n Adjust to cultural and educational background of the interviewee n Avoid psychiatric/psychological jargon n Avoid leading questions n Share personal information and experiences with the interviewee if appropriate and accurately timed n Use humor sparingly n Don’t overreact emotionally to content n Attend to what is said and how n Take notes or record as inconspicuously as possible n Summarize what you’ve covered at the end

Mental Status Exam n Adolf Meyer (1902) –Modeled after the physical exam –Examines the major psychiatric symptoms –A good screener for determining appropriateness fo testing –A lot of variability Structured vs. unstructured

Areas covered in a Mental Status Exam Appearance/behavior –Speech Feeling –Affect and Mood Perception Thinking –Thought processes –Thought content –Intellectual functioning –Memory –Attention –Insight –Judgment

Areas for MSE (cont.) n Appearance/behavior –clothing, posture, gestures, hygiene, unusual physical features (tics, handicaps), facial expressions, eye contact, attitude toward examiner, activity level, cooperation, bizarre behaviors –Speech quantity, rate of production and quality rapid/slow/loud/soft/mute/atypical n Feeling (Affect and Mood) –dominant emotion during the interview (mood) –range of emotions (affect) –Look at depth, intensity, duration, appropriateness

MSE (cont.) n Perception –illusions –hallucinations visual/auditory n Thinking –Intellectual functioning Reading/writing comprehension fund of knowledge ability to do arithmetic interpret meaning of proverbs

MSE (cont.) n Orientation –Person –Place –Time –“Oriented X3” n Memory, Attention, Concentration –Long term memory –Short term memory –Distractibility –Level of consciousness

MSE (cont.) n Insight and Judgement –Why referred –nature and extent of problems –Attitudes toward difficulties –Relate past to present difficulties –Problem solving and decision making n Impulse Control

MSE (cont.) n Thought content –delusions –obsessions n Thought processes –rapid changes in topic/flight of ideas –poverty of ideas –loose associations and tangential thinking –rambling –abstract thinking –perseveration