Clinical Assessment Diagnosis Treatment Chapter 4 1 Clinical

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, f. MRI, 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’. f. MRI (functional MRI) – can examine how brain uses blood, Oᴤ C. PET (positron emission tomography) scan – uses radioactive dyes > shows functions & activity (“lighting up”) > not as good & more risky than f. MRI 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