Transcript Clinical Assessment, Diagnosis and research Methods

Clinical Assessment, Diagnosis
and research Methods
Raw data to half baked ideas
Assessing Psychological
Disorders
Diagnosis is a essential tool
 Consistent framework and set of
criteria for describing mental disorders
 Helps clinicians develop treatment
plans
 Common language
 Less vulnerable to law suits
 3rd party payments
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Assessment….
Useful information for clients
 Knowing who you can treat and who
you need to refer
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Assessment: Key Concepts
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Reliability:
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consistency
Validity
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Measures what it is designed to measure
Can be reliable but not valid , but
cannot be valid unless reliable
 Standardization: testing, treatment
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Clinical interviews
Primary tool
 Past/present behavior
 Attitudes
 Emotions
 History
 Life circumstances: job, social support,
etc
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Mental Status Exam
Appearance and behavior
 Thought processes
 Mood and affect
 Intellectual functioning
 Sensorium
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Oriented in the 4 spheres (date, time,
place, person)
Physical Examination
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Multitude of physical problems that
show up as mental/emotional problems
Drugs
 Hyperthyroidism: anxiety
 Hypothyroidism: depression
 Brain tumors
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Behavioral Assessment
ABC’s: Antecedents, Behaviors,
Consequences
 Both formal and informal
 Self-monitoring
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Psychological Testing
Evaluate cognitive, emotional and
behavioral functioning
 Can help in diagnosis
 Help determine severity (Beck
Depression Inventory)
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Projective Tests
Psychodynamic perspective
 Ambiguous stimuli leads to projections
of unconscious thoughts and fears
 Controversial: weak psychometric
qualities
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Projective Testing
Rorschach Inkblock Test
 Thematic Apperception Test (TAT)
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Personality Testing
MMPI: Minnesota Multiphasic
Personality Inventory
 549 questions
 Lots of research on this instrument
 Looking for patterns of responses
 Lie factor
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Myers Briggs Type Indicator
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Where, primarily, do you direct your
energy?
How do you prefer to process
information?
How do you prefer to make decisions?
How do you prefer to organize your
life?
Intelligence Tests
Stanford-Binet
 Weschler Intelligence Scale for Children
(WISC-R)
 Weschler Adult Intelligence Survey
(WAIS)
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Neuropsychological testing
Language skills
 Attention and concentration
 Memory
 Motor skills
 Perceptual abilities
 Learning
 Abstract thought
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Neuropsych..
Guesses about brain impairment
 Assess abilities and liabilities
 Bender Gestalt
 Luria
 Halstead
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Neuropsych..
Shortcomings:
 False positives
 False negatives
 Very expensive and highly specialized
training
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Neuroimaging
Measurements of brain structure and
function
 The new frontier
 Structural abnormalities, tumors,
injuries: MRI, CAT
 Function: interactions of blood, oxygen
and glucose in active parts of brain:
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PET, SPECT, functional MRI
Psychophysiological assessment
Electroencephalogram: electrical
activity in the brain (EEG)
 Electromyograph: muscle tension
(EMG)
 Heart rate, respiration, skin
temperature
 Used in the assessment of disorders
with strong emotional component
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Diagnosing Psychological
Disorders
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“Faced with chaos and pain, we fall
back on the human impulse to label as
a way of distancing ourselves while
giving ourselves the illusion that we are
doing something.”
Salvador Minuchin
Classification
Construct categories and assign people
to those categories on the basis of
shared attributes
 Taxonomy: scientific classification
 Nosology: taxonomic system classifying
psychological and medical phenomena
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DSM IV-TR
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Diagnostic and Statistical Manual of the
American Psychiatric Association, 4th
edition, Text Revision
Approaches to classification
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Categorical
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Assumption that conditions are unique.
One set of criteria and all must be met.
Common in medicine but not
psychopathology
Dimensional
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Scales, ratings, degrees of symptoms.
Great idea but hard to accomplish
Approaches to classification..
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Prototypical approach
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Categorical but allows for variation.
Identifies essential features and then
offers a variety of symptoms that person
could have. DSM based on this approach.
Diagnosis of Major Depressive Disorder, Single
Episode
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A. The person experiences a single major
depressive episode:
For a major depressive episode a person
must have experienced at least five of the
nine symptoms below for the same two
weeks or more, for most of the time almost
every day, and this is a change from his/her
prior level of functioning. One of the
symptoms must be either (a) depressed
mood, or (b) loss of interest.
Diagnosis of Major Depressive Disorder, Single
Episode
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Depressed mood. For children and adolescents,
this may be irritable mood.
A significantly reduced level of interest or
pleasure in most or all activities.
A considerable loss or gain of weight (e.g., 5% or
more change of weight in a month when not
dieting). This may also be an increase or decrease
in appetite. For children, they may not gain an
expected amount of weight.
Difficulty falling or staying asleep (insomnia), or
sleeping more than usual (hypersomnia).
Behavior that is agitated or slowed down. Others
should be able to observe this.
Diagnosis of Major Depressive Disorder, Single
Episode
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Feeling fatigued, or diminished energy.
Thoughts of worthlessness or extreme guilt (not about
being ill).
Ability to think, concentrate, or make decisions is
reduced.
Frequent thoughts of death or suicide (with or without a
specific plan), or attempt of suicide.
The persons' symptoms do not indicate a mixed episode.
The person's symptoms are a cause of great distress or
difficulty in functioning at home, work, or other important
areas.
The person's symptoms are not caused by substance use
(e.g., alcohol, drugs, medication), or a medical disorder.
Diagnosis of Major Depressive Disorder, Single
Episode
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The person's symptoms are not due to
normal grief or bereavement over the death
of a loved one, they continue for more than
two months, or they include great difficulty in
functioning, frequent thoughts of
worthlessness, thoughts of suicide,
symptoms that are psychotic, or behavior
that is slowed down (psychomotor
retardation).
Multiaxial system
Axis I: Clinical disorder
 Axis II: Personality Disorders, Mental
Retardation
 Axis III: General Medical Conditions
 Axis IV: Psychosocial and
Environmental Problems
 Axis V: Global Assessment of
Functioning
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Problems with DSM
Fuzzy boundaries
 Comorbidity
 Misuse “reification”
 People who don’t fit categories
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Exp: Depressive Disorder, NOS
a.
B. Another disorder does not better
explain the major depressive episode.
C. The person has never had a manic,
mixed, or a hypomanic Episode (unless
an episode was due to a medical disorder
or use of a substance).
Key Questions for Diagnosis
What are the primary symptoms?
 What is the approximate duration of
the disorder?
 How severe are the symptoms?
 Has a specific cause or precipitant for
the symptoms been identified?
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Seligman (1996)