CHAPTER 3 CLASSIFICATION AND ASSESSMENT
CLASSIFICATION: CATEGORIES OF MALADAPTIVE BEHAVIOR ADVANTAGES OF CLASSIFICATION Bridges gap between research and treatment. Allows communication between clinicians. Valuable for statistical purposes. Categories contribute to planning of treatment programs and facilities. DISADVANTAGES OF CLASSIFICATION Labeling may result in stigma. Diagnostic categories are imperfect.
CHARACTERISTICS OF A GOOD CLASSIFICATION SYSTEM 1. Provides information about the cause or causes of a condition. 2. Provides a common language for communication among clinicians and researchers. 3. Enables clinicians to give patients and their families a short- and long-term outlook. 4. Indicates possible treatment. 5. Suggests paths to prevention.
THE DSM-IV Axis I Most disorders except personality disorders and mental retardation. Axis II Personality disorders and mental retardation. Axis III Relevant general medical conditions. Axis IV Psychosocial and environmental problems. Axis V Global assessment of psychological, social, and occupational functioning.
MAJOR AXIS I DIAGNOSTIC CATEGORIES Disorders first diagnosed in infancy and childhood Delirium, dementia, amnestic, and other cognitive disorders Mental disorders due to a general medical condition Substance-related disorders Schizophrenia and other psychotic disorders Mood disorders Anxiety disordersSomatoform disorders Factitious disordersDissociative disorders Other conditions that are the focus of clinical attention Eating disorders Sexual and gender identity disorders Impulse-control disorders Adjustment disordersSleep disorders
CLINICAL OBSERVATIONS AND SYMPTOMS USED IN DSM-IV CLASSIFICATION
RESEARCH ON CLASSIFICATION RELIABILITY Is system reproducible? Kappa statistic VALIDITY Is system appropriate? CLINICAL JUDGMENT Does system produce reliable diagnoses? CULTURAL CONTEXT Is system culture-bound?
THE ASSESSMENT PROCESS Interview Mental Status Examination Structured Interview Diagnostic Interview Schedule (DIS) Structured Clinical Interview for DSM (SCID)
FOUR COMPONENTS OF THE CLINICAL INTERVIEW Rapport How interviewer and client relate to each other. Technique Select techniques to build rapport. Mental Status Evaluate client answers to questions. Diagnosis A continuing, fluid process of formulating client’s problems and personality.
KEY FEATURES OF CLIENT BEHAVIOR OBSERVABLE IN MENTAL STATUS EXAMINATION Appearance Consciousness or alertness Psychomotor behavior Attention and concentration Speech Thought patterns Orientation Memory Affect and mood Energy Perception Judgment and insight
INTELLIGENCE TESTS Binet Tests Alfred Binet IQ= MA/CA x 100 Wechsler Tests Wechsler Adult Intelligence Scale (WAIS-III) Wechsler Intelligence Scale for Children (WISC-III) Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R) Full Scale IQ=Performance IQ+Verbal IQ Kaufman Assessment Battery for Children (K- ABC)
NEUROPSYCHOLOGICAL TESTS Measure cognitive, sensorimotor, and perceptual consequences of brain abnormality
PERSONALITY ASSESSMENT Personality Inventories Minnesota Multiphasic Personality Inventory (MMPI-2) Million Clinical Multiaxial Inventory (MCMI) Rating Scales Behavior Rating Scale for Children Visual Analogue Scale (VAS) Projective Techniques Rorschach Inkblots Thematic Apperception Test (TAT) Word Association Test Sentence Completion Test
THE MMPI-2: CLINICAL AND VALIDITY SCALES
ASSESSING AXIS II PERSONALITY DISORDERS
THE THEMATIC APPERCEPTION TEST (TAT)
VISUAL ANALOGUE SCALES
OTHER FORMS OF ASSESSMENT Behavioral Assessment Information about behaviors Cognitive Assessment Information about thoughts and thought processes Relational Assessment Information about key relationships, especially family. Bodily Assessment Physiological functioning Polygraph, galvanic skin response (GSR), brain imaging
BODILY ASSESSMENT – BLOOD PRESSURE
BODILY ASSESSMENT THE POLYGRAPH