Assessment and Diagnosis Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Chapter Outline Clinical Assessment Assessment Instruments Diagnosis and Classification Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Clinical Assessment Process of gathering information about a person and his/her environment to make decisions about the nature and treatment of psychological problems -referral questions determine goals of assessment Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Goals of Assessment Deciding what assessment procedures and instruments to administer Tailoring an assessment to types of symptoms, age, and medical status Screening (identify psychological problems or predict the risk for future problems) (give PHQ-9, for an example) Diagnosis (identification of illness) Treatment plan (individual’s plan of care to meet mental health needs) Differential diagnosis is a process in which a clinician weighs how likely it is that a person has one diagnosis instead of another. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

How to choose a good screening tool… Figure 3.1 Evaluating a screening tool for depression How do you interpret false negatives versus false positives? Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Poor or incomplete assessment can lead to cases of misdiagnosis (from Ch. 3) Mental Retardation was really… Schizophrenia was really… Depression was really… Anorexia Nervosa was really… Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Properties of Assessment Instruments Standardization Normative comparisons Reliability -Test-retest reliability -Interrater agreement Validity -Construct, criterion, concurrent, predictive Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Assessing abnormality using the normal curve… Figure 3.2 The Normal Curve Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Assessment Instruments Self-report measures (ask patients to evaluate their own symptoms) Clinician-rated measures (clinician rates symptoms) Subjective responses vs. objective responses Types of assessments -Clinical interviews -Psychological tests -Behavioral Assessments -Psychophysiological Assessments Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Psychological Tests Personality tests: Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943). The Million Clinical Multiaxial Inventory (MCMI) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Figure 3.3 Sample MMPI Profile Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Neuropsychological Testing Used to detect impairment in cognitive functioning Measures: memory, attention and attention, motor skills, perception, abstraction, and learning abilities Halstead-Reitan Neuropsychological Battery (Reitan & Davidson, 1974) Wisconsin Card Sorting Test (WCST) Bender Visual Motor Gestalt Test Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Figure 3.5 The Wisconsin Card Sorting Test This instrument measures set shifting or the ability to display flexibility in thinking as the goal of the task changes. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Figure 3.6 The Bender Visual Motor Gestalt Test From Nevid/Rathus/Greene, Abnormal Psychology in a Changing World, 5e, p. 91. Copyright © 2008 Pearson/Prentice Hall. Reprinted by permission. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Intelligence Tests Used to measure “intelligence” Intelligence Quotient (an assessment of cognitive functioning that compares a person’s performance to his or her age-matched peers) Stanford -Binet Intelligence Scale Wechsler Adult Intelligence Scale (WAIS-IV; Wechsler, 2008) Wechsler Intelligence Scale for Children (WISC-IV, 7-16 years) Wechsler Preschool and Primary Scale of Intelligence (WPPS-III, 2 ½-7 years) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Projective Tests Tests derived from psychoanalytic theory in which people are asked to respond to ambiguous stimuli Rorschach Inkblot Test (Rorschach, 1921) -The patient is exposed to ambiguous stimuli and then projects a unique interpretation onto them that reflects his/her underlying unconscious processes and conflicts. Thematic Apperception Test (TAT; 1935) -Consists of thirty-one black-and-white pictorial cards and the patient is asked to make up a story about the image Copyright © 2010 by Pearson Education, Inc. All rights reserved.

What might this be? Copyright © 2010 by Pearson Education, Inc. All rights reserved.

The Rorschach Inkblot Test Let’s examine the evidence Fact: 75% of the Exner’s Comprehensive System (CS) scores warrant internal validity which is based on sums of individual scores. Examine the Evidence: It’s important to remember 25% of the CS scores are not considered reliable, “the norms” published by Exner is extremely outdated (from the 1970s and 1980s), and adequate validity only exists for 20 of the 180 CS scores. Conclusion: There continues to be critics and advocates for the utility of the Rorschach; however no sound empirical data exists. Some previous studies found that validity increases when clinicians use their clinical judgment to incorporate the Rorschach results with information gathered from other sources. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Behavioral Assessment Functional analysis -- where a clinician identifies causal links between behavior and environment Self-monitoring -- a patient records and observes his or her own behavior Behavioral observation -- measurement of behavior by a trained observer. The goal of behavioral assessments is to understand behavior within the context of learning, “learned behavior.” Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Pass around example of monitoring anxiety and worry book for clients Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Psychophysiological and Neuro- Assessment Assessment strategies that measure brain and nervous system activity (EEG, EMG) Imaging systems (fMRI, PET-scan) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Sample Report (to illustrate selection and use of assessment tools) Dr. Lechman’s sample report My sample report (L.B.) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Your turn: Assessment exercise Case studies in small groups. Decide what you will use to assess your patient and why. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

The Historical Roots of Diagnosis… American Psychiatric Association (APA, 1952) Diagnostic and Statistical Manual of Mental Disorders (DSM, current edition DSM-IV-TR) Multiaxial system of diagnosis and classification International Classification of Diseases (ICD) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Axis III = Other general medical conditions Axis IV = Social, occupational, and educational stressors Axis V = Global Assessment of Functioning (GAF) Axis I = Major mental illnesses Axis II = Personality disorders and Mental retardation (MR) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Comorbidity The presence of more than one disorder 50% of people who meet diagnostic criteria for one mental disorder meet criteria for at least one other disorder With each new edition of the DSM new diagnostic categories arise The DSM has tripled in size since the 1 st edition Why do you think so many individuals meet diagnostic criteria for more than one mental disorder? How do you feel about the increasing number of disorders with each new DSM? Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Developmental and Cultural Considerations Diagnostic criteria may need to vary across the life span Differences in prevalence (men vs. women) -Women and depression vs. men and substance abuse disorders Differences in symptoms and disorders (based on ethnicity and race) Culture-bound syndrome (sets of symptoms that occur together uniquely in certain ethnic or racial groups) Copyright © 2010 by Pearson Education, Inc. All rights reserved.

When is a diagnostic system harmful? Stereotypes & labels Premature or inaccurate assumptions by clinicians Self-fulfilling prophecies Prevention of a thorough evaluation or comprehensive treatment plan Stigma DSM (limited knowledge of an era and too many disorders) Over-medicalization Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Dimensional Systems vs. Categorical Systems Dimensional (suggests that people with disorder are not qualitatively distinct from people without disorders) -Psychiatric illness conceptualized as dimensions of functioning versus discrete clinical conditioning Features that support the value of dimensional approaches -High frequency of comorbidity and within category variability -“Common language” of classification Cons of dimensional system Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Critical Issues to Remember 1.Clinical assessments are both used as an information- gathering instrument and to make decisions around the treatment of one’s psychological problems. 2.When evaluating the scores from clinical assessments, it is important to compare the score with the normed group and review the validity and reliability of the instrument for usability. 3.Clinical interviews occur early in the treatment process and can include a variety of modalities. Copyright © 2010 by Pearson Education, Inc. All rights reserved.

Critical Issues to Remember 4.Classifying symptoms into a diagnosis allows a common language for clinicians and researchers as well as maintaining appropriate treatment for the patient. 5.When conducting an assessment, it is important to take into consideration the age, developmental level, and cultural implications of the test-taker. 6.An alternative to the categorical system is the dimensional model that conceptualizes abnormal behavior along dimensions of functioning versus categories. Copyright © 2010 by Pearson Education, Inc. All rights reserved.