Chapter 1 Diagnosis and Clinical Interviewing Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

The Client: The person seeking psychological services. Prevalence of Psychological Disorders: 1 in 5 people during 2007 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Clinical Psychologists (PhD or PsyD) The Clinician: Mental health professional. There are many types taking many approaches. The Clinician: Mental health professional. There are many types taking many approaches. Psychiatrists (MD) An important distinction between psychiatrists and psychologists is that psychiatrists are licensed to administer medical treatment and prescribe medications, and psychologists are not.

The DSM-IV The Diagnostic and Statistical Manual of Mental Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. published by the American Psychiatric Association The DSM-IV (the fourth edition) or DSM-IV-TR (fourth edition, text revision) contains descriptions of all psychological disorders, alternatively referred to as mental disorders.

The DSM-IV The Diagnostic and Statistical Manual of Mental Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display DSM (a.k.a. DSM-I) 1968 DSM-II (based on ICD) 1980 DSM-III (more quantitative, objective) 1987 DSM-III-R

The DSM-IV The Diagnostic and Statistical Manual of Mental Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display DSM (a.k.a. DSM-I) 1968 DSM-II (based on ICD) 1980 DSM-III (more quantitative, objective) 1987 DSM-III-R 1994 DSM-IV 2000 DSM-IV-TR

Mental Disorder Clinically significant behavioral or psychological syndrome or pattern Distress or disability Significant risk Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Not accepted, culturally sanctioned response to a particular event

Assumptions of the DSM-IV Classification system based on medical model Descriptive rather than explanatory Atheoretical orientation Categorical approach Multiaxial system Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

The Five Axes of the DSM-IV Axis I: Clinical Disorders Axis II: Personality Disorders and Mental Retardation Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning (helps assess prognosis) Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Axis IV: Psychosocial Problems Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Axis V: GAF Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Diagnostic Process The Diagnostic Interview – Purpose – Mental Status Exam – Structured Interview Psychological Assessment – Intelligence Tests – Neuropsychological Tests – Personality tests – Projective vs. Objective – Behavioral Assessment – Cognitive Assessment – Relational Assessment Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Diagnostic Interview Identifying Data Chief Complaint/Referral Question History of Present Illness Past Illnesses Family History Personal History – Prenatal – Early childhood – Middle Childhood – Late childhood – Adolescence – Adulthood Educational history Occupational history Sexual history Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

decision tree: A series of simple yes/no questions in the DSM-IV-TR about a client’s symptoms that lead to a possible diagnosis. decision tree: A series of simple yes/no questions in the DSM-IV-TR about a client’s symptoms that lead to a possible diagnosis. differential diagnosis: Ruling out all possible alternative diagnoses. differential diagnosis: Ruling out all possible alternative diagnoses.

Case Formulation Based on theory Seeks to explain causes of symptoms Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Cultural Formulation culture-bound syndromes: particular patterns of behavior in certain cultures, perhaps reflecting cultural themes that date back for centuries. Example: “Ghost sickness” is a preoccupation with death and the deceased that is reported by members of Native American tribes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Planning Treatment Establish Treatment Goals – Immediate Goals – Short-Term Goals – Long-Term Goals Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Planning Treatment Determine Treatment Site – Psychiatric Hospitals – Outpatient Treatment – Halfway Houses and Day Treatment Programs – Guidance Counselors – Employee Assistance Program Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Treatment Modality Individual Psychotherapy Family Therapy Group Therapy Milieu Therapy Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.