Clinical Assessment, Diagnosis & Treatment Chapter 4 1

Clinical Assessment  Gathering idiographic (individual) information  Collecting information (~ job interview)  Find out what is going on  Can also be for follow-up 2

Assessment  A psychoanalyst might need a personality assessment  School psychologists, cognitive psychologists might need a behavioral assessment  Goal: functional assessment – does pt manage his/her life adequately  3 basic ways: interview, tests, observations  These should be standardized, reliable & valid 3

Assessment  Standardized – common way to do this; nothing random – other professionals should understand this process & results obtained  Reliability – process gets consistent results – duplicate or similar results  > test-retest  > inter-rater 4

Assessment  Validity – procedure measures what it is supposed to  - math test for math  Face validity – makes sense  Predictive & concurrent validity more important 5

Assessment  Clinical interview – intake  - personal hx  - sx  - what is happening to pt  Structured or unstructured interviews  Mental Status Exam – quick & useful  Interviews useful but limited – pt may not say much; misjudgments 6

Testing  Personality inventories  Projective tests  Intelligence tests  Neurological tests  Neuropsychological tests 7

Projective Tests  Reveals aspects of personality > esp unconscious  Asked about a vague stimulus – answer comes from the pt  Rorschach – ink-blot  Thematic Apperception Test (TAT) – tell story about a picture  Sentence completion tests  House-Tree-Person 8

Projective Tests  Good for getting the conversation going > way to learn about pt  Not ideal for making a diagnosis  Never for legal purposes 9

Personality Inventories  Self-administered  Minnesota Multiphasic Personality Inventory (MMPI-2)  500+ questions – T,F, neutral  Scales – 10 of them - people may have elevated scales (“spikes”) > may be a problem  Many people have spikes  Lie scale > some “fake good” or bad  Good validity & reliability 10

Intelligence Tests  Most popular ones developed by Wechsler  WAIS Wechsler Adult Intelligence Scale  WISC Wechsler Intelligence Scale for Children  Batteries – many aspects tested  IQ is a figure 11

Neurological Tests  Pt may have an organic problem (disease or injury)  Neurological tests  – electroencephalogram (EEG) > brain waves  - imaging MRI, fMRI, CAT, PET  Neuropsychological tests – Stroop, Rey, others 12

Neurological Tests  Imaging most common today  X-rays too old-fashioned  3 basic types of modern imaging:  A. CT (computerized tomography) scan – a PC processes many X-rays from multiple angles  B. MRI (magnetic resonance imaging) – no radiation, 3- dimensional, very clear 13

Neurological Tests  B’. fMRI (functional MRI) – can examine how brain uses blood, O  C. PET (positron emission tomography) scan – uses radioactive dyes > shows functions & activity (“lighting up”) > not as good & more risky than fMRI  TMS (transcranial magnetic stimulation) – not invasive – use magnetic paddle or wand to turn on/off parts of the brain – “virtual lesion” > no permanent damage - this could be a tx 14

Observation  Naturalistic or analog ?  Can pts self-monitor ? 15

Diagnosis  Dx  What is going on with a pt ? Have others had this before ?  Diagnosis ~ discrimination – recognizing a symptom (sx), condition or pattern  Assign a label  Prognosis – predict what will happen 16

Diagnosis - Labeling  How mental illness is classified  Sx – symptom  Syndrome – cluster of sx  Kraepelin had 1 st classification system in psychiatry in 1883  Current > DSM-5  Diagnostic and Statistical Manual of Mental Disorders  MDs, psychologists, scientists, MSWs, legal community & insurance  DSM is published by the American Psychiatric Assoc 17

DSM-5  Makes use of categories (depression not the same as anxiety)  Makes use of dimensions – how seriously ill or distressed is the pt ?  Comorbidity – more than one condition present  Concerns about DSM  - dx may not be effective because clinicians may be inconsistent  - how do pts function in their lives ? 18

DSM-5  Reliability questioned because making diagnoses can be subjective – many disorders are close to each other  How to “read” signs & symptoms  DSM controversies: labeling; too medicalized; political 19

Treatment  Sx  Important – tx must be “empirically validated” “empirically supported” “evidence-based” “manualized” tx  Effective tx  Research is supportive  But which is best ???  What about placebos ?  Therapy is not a unified area 20

Treatment  Why therapy fails ?  Happens possibly in 10% cases  Sx worsen  Pts leave  What to do ?  Keep up  Research > rapprochement movement – “unification” – find what works in all therapies  Team support – including pharmacologist 21