Clinical Assessment Issues
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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
– Neuroimaging
CT,
PET, MRI, fMRI
Neuropsychological
Examination
– Behavioral tasks that reveal brain
function (or dysfunction)
Diagnosis
Idiographic vs. Nomothetic
Classification
–
–
–
–
Categories
Dimensions
Threshold Model
Prototype Model
Diagnostic and Statistical Manual
– Purpose?
– Utility?
– Real world reliability and validity?
DSM-IV and 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