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Abpsych Lesson 3 - Barlow

Abnormal Psychology, notes from Barlow (7th edition) chapter and lesson 3

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Abnormal Psychology (PSY 9)

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LESSON 3: CLINICAL ASSESSMENT AND DIAGNOSIS

The processes of clinical assessment and diagnosis are central to the study of psychopathology and, ultimately, to the treatment of psychological disorders. Clinical assessment is the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder. Diagnosis is the process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Key Concepts in Assessment The clinician begins by collecting a lot of information across a broad range of the individual’s functioning to determine where the source of the problem may lie. A preliminary sense of the overall functioning of the person. The clinician narrows the focus by ruling out problems in some areas and concentrating on areas that seem most relevant. Assessment techniques are subject to a number of strict requirements, not the least of which is some evidence (research) that they actually do what they are designed to do. 3 Basic Concepts that help determine the value of assessment 1. Reliability - the degree to which a measurement is consistent  One-way psychologists improve their reliability is by carefully designing their assessment devices and then conducting research on them to ensure that two or more raters will get the same answers (called interrater reliability)  The assessment techniques are stable across time.  Test-retest reliability 2. Validity - something measures what it is designed to measure. Whether a technique assesses what it is supposed to.  Concurrent or Descriptive Validity - Comparing the results of an assessment measure under consideration with the results of others that are better known allows you to begin to determine the validity of the first measure.  Predictive Validity - how well your assessment tells you what will happen in the future 3. Standardization - the process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements  Standards might be applied to the procedures of testing, scoring and evaluating data.  Your score on a psychological test should be compared with the scores of others like you. Clinical Assessment consists of a number of strategies and procedures that help clinicians acquire the information they need to understand their patients and assist them. Includes:  Clinical Interview (Mental Exam)  Thorough physical examination  Behavioral Observation and Assessment  Psychological tests Clinical Interview – core of most clinical work. - The interview gathers information on current and past behavior, attitudes, and emotions, as well as a detailed history of the individual’s life in general and of the presenting problem. - Clinicians determine when the specific problem started and identify other events (for example, life stress, trauma, or physical illness) that might have occurred about the same time. - Clinicians gathered information on: current and past interpersonal and social history, family makeup, upbringing, sexual development religious attitudes, relevant cultural concerns and educational history. To organize information obtained during an interview, many clinicians use a mental status exam. Mental Status Exam - the mental status exam involves the systematic observation of an individual’s behavior. - This type of observation occurs when any one person interacts with another. Pseudo-mental status exams. - Can be structured and detailed but mostly they are performed relatively quickly by experienced clinicians in the course of interviewing or observing a patient. Covers 5 categories 1. Appearance and behavior – Overt physical behaviors  Overt behavior  Attire  Appearance, posture, expressions  Example: Slow and effortful motor behavior – psychomotor retardation, may indicate severe depression. 2. Thought processes – What is the rate or flow of the speech? Does the person talk quickly or slowly? What of continuity of speech? In other words, does the patient make sense when talking or are ideas presented with no apparent connection?  Rate of speech  Continuity of speech  Content of speech  Example:  Loose association or derailment – disorganized speech pattern in schizophrenia  Evidence of delusions (distorted view of reality)

 Delusions of Persecution – they think people are after them / out to get them all the time.  Delusions of grandeur – thinks she is all- powerful in some way (God) The individual might also have ideas of reference, in which everything everyone else does somehow relates back to the individual.  Hallucinations are things a person sees or hears when those things really aren’t there. 3. Mood and Affect  Mood – predominant feeling state of the individual. Does the person appear to be down in the dumps or continually elated?  Affect – feeling state that accompanies what we say at a given point. Our affect is “appropriate” that is, we laugh when we say something funny or look sad when we talk about something.  A person talking about a range of happy and sad things with no affect – “the affect is blunted or flat” 4. Intellectual functioning – Clinicians usually make a rough estimate of intelligence that is only noticeable only if it deviates from normal. “Below or above average intelligence”  Type of vocabulary  Use of abstractions and metaphor 5. Sensorium – Awareness of surroundings in terms of person (self and clinician), time, and place— “oriented times three”  Does the individual know what the date is?  The patient has good idea of himself, the clinician and the place – the sensorium is “clear” and is “oriented times three” (person, place and time)

Informal behavioral observations allow the clinician to make a preliminary determination of which areas of the patient’s behavior and condition should be assessed in more detail and perhaps more formally,
Psychologists and other mental health professionals are trained extensively in methods that put patients at ease and facilitate communication, including nonthreatening ways of seeking information and appropriate listening skill.
Information provided by the patients to psychologists and psychiatrists is protected by laws of “privileged communication” or confidentiality. Authorities cannot have access to it without the consent of the patient.
Semi structured Clinical Interviews - Semistructured interviews are made up of questions that have been carefully phrased and tested to elicit useful information in a consistent manner so that clinicians can be sure they have inquired about the most important aspects of particular disorders. Clinicians may also depart from set questions to follow up on specific issues—thus the label “semistructured.”
the wording and sequencing of questions has been carefully worked out over a number of years; the clinician can feel confident that a semi structured interview will accomplish its purpose Disadvantage: it robs the interview of some of the spontaneous quality of two people talking about a problem. Also, if applied too rigidly, a semistructured interview may inhibit the patient from volunteering useful information that is not directly relevant to the questions being asked. Physical Examination Many patients with problems first go to a family physician. Many problems presenting as disorders of behavior, cognition, or mood may, on careful physical examination, have a clear relationship to a temporary toxic state.
This toxic state could be caused by bad food, the wrong amount or type of medicine, or onset of a medical condition.
Example: Thyroid difficulties, particularly hyperthyroidism (overactive thyroid gland), may produce symptoms that mimic certain anxiety disorders, such as generalized anxiety disorder.
Hypothyroidism (underactive thyroid gland) might produce symptoms consistent with depression.
Certain psychotic symptoms, including delusions or hallucinations, might be associated with the development of a brain tumor. If a current medical condition or substance abuse situation exists, the clinician must ascertain whether it is merely coexisting or is causal, usually by looking at the onset of the problem. Behavioral Assessment
by using direct observation to formally assess an individual’s thoughts, feelings, and behavior in specific situations or contexts.
Behavioral assessment may be more appropriate than an interview in terms of assessing individuals who are not old enough or skilled enough to report their problems and experiences.
embarrassing or unintentionally because they aren’t aware it is important in a clinical setting to see how people might behave in similar situations in their daily lives. In behavioral assessment, target behaviors are identified and observed with the goal of determining the factors that seem to influence the Most clinicians assume that a complete picture of a person’s problems requires direct observation in naturalistic environments. But going into a person’s home, workplace, or school isn’t always possible or practical, so clinicians sometimes arrange analogue, or similar, setting

simulated situations
Comprehensive System

John Exner developed a standardized version of the Rorschach inkblot.
Exner’s system of administering and scoring the Rorschach specifies how the cards should be presented, what the examiner should say, and how the responses should be recorded
Varying these steps can lead to varying responses by the patient

Thematic Apperception Test (TAT)

perhaps the best-known projective test after the Rorschach
developed in 1935 by Christiana Morgan and Henry Murray at the Harvard Psychological Clinic
The TAT consists of a series of 31 cards—30 with pictures on them and 1 blank card— although only 20 cards are typically used during each administration
Ask the person to tell a dramatic story about the picture. “This is a test of imagination, one form of intelligence.” “Let your imagination have its way, as in a myth, fairy story, or allegory”
TAT is based on the notion that people will reveal their unconscious mental processes in their stories about the pictures.
Variations Children’s Apperception Test (CAT) Senior Apperception Test (SAT) These modifications have included changes not only in the appearance of people in the pictures but also in the situations depicted Pros: Unfortunately, the TAT and its variants continue to be used inconsistently. How the stories people tell about these pictures are interpreted depends on the examiner’s frame of reference
Their relative lack of reliability and validity, however, makes them less useful as diagnostic tests Personality Inventories Face validity - The wording of the questions seems to fit the type of information desired.
self-report questionnaires that assess personal traits
Paul Meehl
what is necessary from these types of tests is not whether the questions necessarily make sense on the surface but, rather, what the answers to these questions predict.
What matters is if people with certain disorders tend, as a group, to answer certain questions in a certain way, this pattern may predict who else has this disorder.
The importance lies in what the answers predict. Minnesota Multiphasic Personality Inventory (MMPI).
most widely used personality inventory in the United States
The MMPI was developed in the 1937 and early 1940s and first published in 1943 Starke R. Hathaway and neuropsychiatrist J. Charnley McKinley at the University of Minnesota.
Based on an empirical approach, that is, the collection and evaluation of data. The administration of the MMPI is straightforward. The individual being assessed reads statements and answers either “true” or “false” A problem with administering the MMPI, however, is the time and tedium of responding to the 550 items on the original version and now the 567 items on the MMPI-2 (published in 1989). A version of the MMPI that is appropriate for adolescents is also available—MMPI-A (published in 1992)—and other versions are being adapted for people in different cultures
Individual responses on the MMPI are not examined; instead, the pattern of responses is reviewed to see whether it resembles patterns from groups of people who have specific disorder
Each group is represented on separate standard scales. Fortunately, clinicians can have these responses scored by computer; the program also includes an interpretation of the results, thereby reducing problems of reliability. One concern that arose early in the development of the MMPI was the potential of some people to answer in ways that would downplay their problems; skilled individuals would ascertain the intent of statements such as “Worry about saying things that hurt people’s feelings,” and fake the answers.  To assess this possibility, the MMPI includes additional scales that determine the validity of each administration.  Lie Scale - when answered “false” might be an indication that the person may be falsifying answers to look good.  Infrequency scale - measures false claims about psychological problems or determines whether the person is answering randomly  Subtle Defensiveness scale - assesses whether the person sees herself in unrealistically positive way  Psychopathic Deviation Scale - measures the tendency to behave in antisocial ways. The MMPI is one of the most extensively researched assessment instruments in psychology 10 CLINICAL SCALES OF MMPI

SCALE 1—HYPOCHONDRIASIS

 This scale was designed to assess a neurotic concern over bodily functioning.  The items on this scale concern physical symptoms and well-being.  It was originally developed to identify people displaying the symptoms of hypochondria, or a tendency to believe that one has an undiagnosed medical condition. SCALE 2—DEPRESSION  This scale was originally designed to identify depression, characterized by poor morale, lack of hope in the future, and general dissatisfaction with one's own life situation.  Very high scores may indicate depression, while moderate scores tend to reveal a general dissatisfaction with one’s life. A SCALE 3—HYSTERIA  The third scale was originally designed to identify those who display hysteria or physical complaints in stressful situations.  Those who are well-educated and of a high social class tend to score higher on this scale. Women also tend to score higher than men on this scale. SCALE 4—PSYCHOPATHIC DEVIATE  Originally developed to identify psychopathic individuals, this scale measures social deviation, lack of acceptance of authority, and amorality (a disregard for morality).  This scale can be thought of as a measure of disobedience and antisocial behavior. SCALE 5—MASCULINITY-FEMININITY  This scale was designed by the original authors to identify what they referred to as "homosexual tendencies," for which it was largely ineffective.  Today, it is used to assess how much or how little a person identifies how rigidly an individual identifies with stereotypical male and female gender roles. SCALE 6—PARANOIA  This scale was originally developed to identify individuals with paranoid symptoms such as suspiciousness, feelings of persecution, grandiose self- concepts, excessive sensitivity, and rigid attitudes.  Those who score high on this scale tend to have paranoid or psychotic symptoms. SCALE 7—PSYCHASTHENIA  This diagnostic label is no longer used today and the symptoms described on this scale are more reflective of anxiety, depression, and obsessive- compulsive disorder.  This scale was originally used to measure excessive doubts, compulsions, obsessions, and unreasonable fears. SCALE 8—SCHIZOPHRENIA  This scale was originally developed to identify individuals with schizophrenia.  It reflects a wide variety of areas including bizarre thought processes and peculiar perceptions, social alienation, poor familial relationships, difficulties in concentration and impulse control, lack of deep interests, disturbing questions of self-worth and self-identity, and sexual difficulties. SCALE 9—HYPOMANIA  This scale was developed to identify characteristics of hypomania such as elevated mood, hallucinations, delusions of grandeur, accelerated speech and motor activity, irritability, flight of ideas, and brief periods of depression. Scale 0—Social Introversion  This scale was developed later than the other nine scales.  It's designed to assess a person’s shyness and tendency to withdraw from social contacts and responsibilities. Intelligence Testing

Intelligence tests were developed for one specific purpose: to predict who would do well in school
1904, Alfred Binet, and Théodore Simon, were commissioned by the French government to develop a test that would identify “slow learners” who would benefit from remedial help
The two psychologists identified a series of tasks that presumably measured the skills children need to succeed in school, including tasks of attention, perception, memory, reasoning, and verbal comprehension
predict academic success Stanford-Binet test.
1916 , Lewis Terman of Stanford University translated a revised version of this test for use in the United States.
The first published intelligence test to provide detailed administration and scoring instructions.
The test provided a score known as an intelligence quotient, or IQ.
IQ scores were calculated by using the child’s mental age. This mental age was then divided by the child’s chronological age and multiplied by 100 to get the IQ score.
It creates a test composite: test score or index derived from the combination of and/or a mathematical transformation of one or more subtest scores.
Current tests use what is called a deviation IQ. A person’s score is compared only with scores of others of the same age.

procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity Images of Brain Structure Computerized Axial tomography (CAT) scan or CT scan

takes 15 minutes
first neuroimaging technique, developed in the early 1970s
relatively non-invasive and has proved useful in identifying and locating abnormalities in the structure or shape of the brain
particularly useful in locating brain tumor, injuries, and other structural and anatomical abnormalities.
One difficulty, however, is that these scans, like all X-rays, involve repeated x-radiation, which poses some risk of cell damage. Nuclear magnetic resonance imaging (MRI).
Takes 45 minutes
allows the computer to view the brain in layers, which enables precise examination of the structure.
The patient’s head is placed in a high-strength magnetic field through which radio frequency signals are transmitted. These signals “excite” the brain tissue, altering the protons in the hydrogen atoms. The alteration is measured, along with the time it takes the protons to “relax” or return to normal. Where there are lesions or damage, the signal is lighter or darker. Neuroimaging procedures are useful for identifying damage to the brain, only recently have they been used to determine structural or anatomical abnormalities that might be associated with various psychological disorder Images of Brain Functioning Positron Emission Tomography (PET) Scan
Subjects undergoing a PET scan are injected with a tracer substance attached to radioactive isotopes, or groups of atoms that react distinctively. This substance interacts with blood, oxygen, or glucose. When parts of the brain become active, blood, oxygen, or glucose rushes to these areas of the brain, creating “hot spots” picked up by detectors that identify the location of the isotopes.
Thus, we can learn what parts of the brain are working and what parts are not. These images can be superimposed on MRI images to show the precise location of the active areas.
The PET scans are also useful in supplementing MRI and CT scans when localizing the sites of trauma resulting from head injury or stroke, as well as when localizing brain tumor. Single Photon Emission Computed Tomography (SPECT)
It works much like PET, although a different tracer substance is used; this procedure is somewhat less accurate.

- PECT is used more often than PET scans

functional MRI, or fMRI

Because these procedures measure the functioning of the brain
they allow researchers to see the immediate response of the brain to a brief event, such as seeing a new face. BOLD-fMRI (Blood-Oxygen-Level- Dependent fMRI) is currently the most common fMRI technique used to study psychological disorders. Psychophysiological Assessment
another method for assessing brain structure and function specifically and nervous system activity
psychophysiology refers to measurable changes in the nervous system that reflect emotional or psychological event Electroencephalogram (EEG)
Measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity; brain waves come from the low-voltage electrical current that runs through the neurons.
EEG patterns are often affected by psychological or emotional factors and can be an index of these reactions, or a psychophysiological measure  Psychophysiological assessment of other bodily responses may also play a role in assessment. These responses include heart rate, respiration, and electrodermal responding, formerly referred to as galvanic skin response (GSR), which is a measure of sweat gland activity controlled by the peripheral nervous system.  Stimuli such as sights and sounds associated with the trauma evoke strong psychophysiological responses, even if the patient is not fully aware that this is happening. Stimuli such as sights and sounds associated with the trauma evoke strong psychophysiological responses, even if the patient is not fully aware that this is happening.  Psychophysiological assessment is also used with many sexual dysfunctions and disorders.  Physiological measures are also important in the assessment and treatment of conditions such as headaches and hypertension they form the basis for the treatment we call biofeedback BRAIN DAMAGE is a general reference to any physical or functional impairment that results in sensory, motor, and cognitive, emotional, and/or related deficit. ORGANICITY came from the research of German neurologist Kurt Goldstein of brain-injured soldiers he diagnosed as having organic brain syndrome or organicity for short.

Signs signalling the need for a more thorough neuropsychological work-up can be classified as being hard or soft.  A HARD SIGN may be defined as a definite indicator of neurological deficit. Example: abnormal reflex performance.  A SOFT SIGN is an indicator merely suggestive of neurological deficit. An example is the apparent inability to copy a stimulus figure while attempting to draw it. CLOCK DRAWING TEST (CDT) - The task in this test is to draw the face of the clock usually with the hands of the clock indicating a particular time. - Observed abnormalities in the patient’s drawing may be reflective of cognitive dysfunction resulting from dementia or other neurological or psychiatric procedures. CONFRONTATION NAMING Naming each stimulus presented. This seemingly simple task entails 3 component operations:  a perceptual component (perceiving the visual features of the stimulus),  a semantic component (accessing the underlying conceptual representation or core meaning of whatever is pictured), and  a lexical component (accessing and expressing the appropriate name). PICTURE ABSURDITY ITEM - Task is to identify what is wrong or silly about the picture. - It can provide insight into the test taker’s social comprehension and reasoning abilities. (Similar to Picture Absurdity items on the Stanford- Binet Intelligence Test)

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Abpsych Lesson 3 - Barlow

Course: Abnormal Psychology (PSY 9)

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LESSON 3: CLINICAL ASSESSMENT AND DIAGNOSIS

The processes of clinical assessment and diagnosis are central to the study of

psychopathology and, ultimately, to the treatment of psychological disorders.

Clinical assessment is the systematic evaluation and measurement of

psychological, biological, and social factors in an individual presenting with a

possible psychological disorder.

Diagnosis is the process of determining whether the particular problem afflicting

the individual meets all criteria for a psychological disorder, as set forth in the fifth

edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.

Key Concepts in Assessment

The clinician begins by collecting a lot of information across a broad range of the

individual’s functioning to determine where the source of the problem may lie. A

preliminary sense of the overall functioning of the person.

The clinician narrows the focus by ruling out problems in some areas and

concentrating on areas that seem most relevant.

Assessment techniques are subject to a number of strict requirements, not the

least of which is some evidence (research) that they actually do what they are

designed to do.

3 Basic Concepts that help determine the value of assessment

1. Reliability - the degree to which a measurement is consistent

One-way psychologists improve their reliability is by carefully

designing their assessment devices and then conducting research

on them to ensure that two or more raters will get the same

answers (called interrater reliability)

The assessment techniques are stable across time.

Test-retest reliability

2. Validity - something measures what it is designed to measure. Whether a

technique assesses what it is supposed to.

Concurrent or Descriptive Validity - Comparing the results of

an assessment measure under consideration with the results of

others that are better known allows you to begin to determine the

validity of the first measure.

Predictive Validity - how well your assessment tells you what

will happen in the future

3. Standardization - the process by which a certain set of standards or

norms is determined for a technique to make its use consistent across

different measurements

Standards might be applied to the procedures of testing, scoring

and evaluating data.

Your score on a psychological test should be compared with the

scores of others like you.

Clinical Assessment consists of a number of strategies and procedures that help

clinicians acquire the information they need to understand their patients and assist

them. Includes:

Clinical Interview (Mental Exam)

Thorough physical examination

Behavioral Observation and Assessment

Psychological tests

Clinical Interview – core of most clinical work.

- The interview gathers information on current and past behavior, attitudes,

and emotions, as well as a detailed history of the individual’s life in general

and of the presenting problem.

- Clinicians determine when the specific problem started and identify other

events (for example, life stress, trauma, or physical illness) that might

have occurred about the same time.

- Clinicians gathered information on: current and past interpersonal and

social history, family makeup, upbringing, sexual development religious

attitudes, relevant cultural concerns and educational history.

To organize information obtained during an interview, many clinicians use a mental

status exam.

Mental Status Exam - the mental status exam involves the systematic observation

of an individual’s behavior.

- This type of observation occurs when any one person interacts with

another. Pseudo-mental status exams.

- Can be structured and detailed but mostly they are performed relatively

quickly by experienced clinicians in the course of interviewing or observing

a patient.

Covers 5 categories

1. Appearance and behavior – Overt physical behaviors

Overt behavior

Attire

Appearance, posture, expressions

Example: Slow and effortful motor behavior –

psychomotor retardation, may indicate severe

depression.

2. Thought processes – What is the rate or flow of the speech? Does the

person talk quickly or slowly? What of continuity of speech? In other words,

does the patient make sense when talking or are ideas presented with no

apparent connection?

Rate of speech

Continuity of speech

Content of speech

Example:

Loose association or derailment – disorganized

speech pattern in schizophrenia

Evidence of delusions (distorted view of reality)

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Abpsych Lesson 3 - Barlow

Abnormal Psychology (PSY 9)

Pamantasan ng Lungsod ng Valenzuela

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LESSON 3: CLINICAL ASSESSMENT AND DIAGNOSIS

SCALE 1—HYPOCHONDRIASIS

- PECT is used more often than PET scans

functional MRI, or fMRI

Abpsych Lesson 3 - Barlow

Course: Abnormal Psychology (PSY 9)

University: Pamantasan ng Lungsod ng Valenzuela

This is a preview

This is a preview

Why is this page out of focus?

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