CHAPTER 3 CLASSIFICATION AND ASSESSMENT CLASSIFICATION CATEGORIES OF

CHAPTER 3 CLASSIFICATION AND ASSESSMENT

CLASSIFICATION: CATEGORIES OF MALADAPTIVE BEHAVIOR n ADVANTAGES OF CLASSIFICATION n n n 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 n n 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 n Axis I n n Axis II n n Most disorders except personality disorders and mental retardation. Personality disorders and mental retardation. Axis III n Relevant general medical conditions. Axis IV n Psychosocial and environmental problems. Axis V n 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 Mood disorders Anxiety disorders Somatoform disorders Factitious disorders Dissociative disorders Other conditions that are the focus of clinical attention Eating disorders Sexual and gender identity disorders Impulse-control disorders Adjustment disorders Sleep disorders

CLINICAL OBSERVATIONS AND SYMPTOMS USED IN DSM-IV CLASSIFICATION

RESEARCH ON CLASSIFICATION n RELIABILITY n n n VALIDITY n n Is system appropriate? CLINICAL JUDGMENT n n Is system reproducible? Kappa statistic Does system produce reliable diagnoses? CULTURAL CONTEXT n Is system culture-bound?

THE ASSESSMENT PROCESS n Interview n n Mental Status Examination Structured Interview Diagnostic Interview Schedule (DIS) Structured Clinical Interview for DSM (SCID)

FOUR COMPONENTS OF THE CLINICAL INTERVIEW n Rapport n n Technique n n Select techniques to build rapport. Mental Status n n How interviewer and client relate to each other. Evaluate client answers to questions. Diagnosis n A continuing, fluid process of formulating client’s problems and personality.

KEY FEATURES OF CLIENT BEHAVIOR OBSERVABLE IN MENTAL STATUS EXAMINATION n n n Appearance Consciousness or alertness Psychomotor behavior Attention and concentration Speech Thought patterns Orientation Memory Affect and mood Energy Perception Judgment and insight

INTELLIGENCE TESTS n Binet Tests n n n Wechsler Tests n n n Alfred Binet IQ= MA/CA x 100 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 (KABC)

NEUROPSYCHOLOGICAL TESTS Measure cognitive, sensorimotor, and perceptual consequences of brain abnormality

PERSONALITY ASSESSMENT n Personality Inventories n n n Rating Scales n n n Minnesota Multiphasic Personality Inventory (MMPI-2) Million Clinical Multiaxial Inventory (MCMI) Behavior Rating Scale for Children Visual Analogue Scale (VAS) Projective Techniques n n 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 n Behavioral Assessment n n Cognitive Assessment n n Information about thoughts and thought processes Relational Assessment n n Information about behaviors Information about key relationships, especially family. Bodily Assessment n n Physiological functioning Polygraph, galvanic skin response (GSR), brain imaging

BODILY ASSESSMENT – BLOOD PRESSURE

BODILY ASSESSMENT THE POLYGRAPH