Transcript Clinical Assessment Issues

Clinical Assessment
 Purposes
– To
– To
– To
– To
understand the individual
predict behavior
plan treatment
evaluate treatment outcome
Clinical Assessment Issues
 Reliability
 Validity
 Standardization
 Clinical
Utility or Clinical Significance
Diagnostic Reliability
Disorder Present
Diagnosis Given
Present
Present
Absent
Absent
Methods of Clinical Assessment
 Clinical
Interview
– Structured vs. Semistructured
 Behavioral
Observation
– Mental Status Exam
 Testing
– Objective Tests
– Projective Tests
Additional Methods
 Physical
Examination
 Neurological Examination
– Neurological Imaging
 CT,
PET, MRI, fMRI
 Neuropsychological
Examination
– Tasks that reveal brain function (or
dysfunction)
Diagnosis
 Idiographic
vs. Nomothetic
 Classification
– Categories
– Dimensions
– Threshold Model
– Prototype Model
Diagnostic and Statistical Manual
 Evolving
Document
– Currently DSM-IV-TR
– DSM-V expected in 2013
 Purpose?
 Utility?
 Real
world reliability and validity?
DSM-IV-TR
 Multiaxial
System
– Axis I – Clinical Syndromes
– Axis II – Personality and Developmental
Disorders
– Axis III – Medical Conditions
– Axis IV – Psychosocial Stressors
– Axis V – Global Assessment of
Functioning (GAF; scale 1 - 100)
Unresolved Issues
in the DSM-IV

Thresholds for Diagnosis?
– For example, level of distress, impairment,
number of required symptoms
Somewhat Arbitrary Time Periods
 Should Other Axes Be Included?

– Such as premorbid history, treatment
response, family functioning, GARF

Optimal for Designing Treatments or
Research?
– The Problem of Comorbidity
Issues of Diagnosing
Reliability, Validity, and Comoribity
Problems
 Cause
 Reification
 Treatment
 Cure
 Relief
 Labeling

– Stigma
– Self-fulfilling prophecy

Social Constructions