Clinical Assessment Purposes To understand the individual To predict behavior To plan treatment To evaluate treatment outcome
Clinical Assessment Issues Reliability Validity Standardization Clinical Utility or Clinical Significance
Diagnostic Reliability Present Absent Disorder Present Diagnosis Given
Methods of Clinical Assessment Clinical Interview Structured vs. Semistructured Behavioral Observation Mental Status Exam Testing Objective Tests Projective Tests
Additional Methods Physical Examination Neurological Examination Neurological Imaging CT, PET, MRI, fMRI Neuropsychological Examination Tasks that reveal brain function (or dysfunction)
Diagnosis Idiographic vs. Nomothetic Classification Categories Dimensions Threshold Model Prototype Model
Diagnostic and Statistical Manual Evolving Document Currently DSM-IV-TR DSM-V expected in 2013 Purpose? Utility? Real world reliability and validity?
DSM-IV-TR Multiaxial System Axis I – Clinical Syndromes Axis II – Personality and Developmental Disorders Axis III – Medical Conditions Axis IV – Psychosocial Stressors Axis V – Global Assessment of Functioning (GAF; scale 1 - 100)
Unresolved Issues in the DSM-IV Thresholds for Diagnosis? For example, level of distress, impairment, number of required symptoms Somewhat Arbitrary Time Periods Should Other Axes Be Included? Such as premorbid history, treatment response, family functioning, GARF Optimal for Designing Treatments or Research? The Problem of Comorbidity
Issues of Diagnosing Reliability, Validity, and Comoribity Problems Cause Reification Treatment Cure Relief Labeling Stigma Self-fulfilling prophecy Social Constructions