Clinical Assessment, Diagnosis and research Methods
Clinical Assessment, Diagnosis and research MethodsRaw data to half baked ideasRaw data to half baked ideas
Assessing Psychological Disorders
Assessing Psychological Disorders
Diagnosis is a essential toolConsistent framework and set of
criteria for describing mental disorders
Helps clinicians develop treatment plans
Common languageLess vulnerable to law suits3rd party payments
Diagnosis is a essential toolConsistent framework and set of
criteria for describing mental disorders
Helps clinicians develop treatment plans
Common languageLess vulnerable to law suits3rd party payments
Assessment….Assessment….
Useful information for clientsKnowing who you can treat and
who you need to refer
Useful information for clientsKnowing who you can treat and
who you need to refer
Assessment: Key Concepts
Assessment: Key Concepts
Reliability:consistency
ValidityMeasures what it is designed to
measureCan be reliable but not valid , but
cannot be valid unless reliableStandardization: testing,
treatment
Reliability:consistency
ValidityMeasures what it is designed to
measureCan be reliable but not valid , but
cannot be valid unless reliableStandardization: testing,
treatment
Clinical interviewsClinical interviews
Primary toolPast/present behaviorAttitudesEmotionsHistoryLife circumstances: job, social
support, etc
Primary toolPast/present behaviorAttitudesEmotionsHistoryLife circumstances: job, social
support, etc
Mental Status ExamMental Status Exam
Appearance and behaviorThought processesMood and affect Intellectual functioningSensorium
Oriented in the 4 spheres (date, time, place, person)
Appearance and behaviorThought processesMood and affect Intellectual functioningSensorium
Oriented in the 4 spheres (date, time, place, person)
Physical ExaminationPhysical Examination
Multitude of physical problems that show up as mental/emotional problemsDrugsHyperthyroidism: anxietyHypothyroidism: depressionBrain tumors
Multitude of physical problems that show up as mental/emotional problemsDrugsHyperthyroidism: anxietyHypothyroidism: depressionBrain tumors
Behavioral AssessmentBehavioral Assessment
ABC’s: Antecedents, Behaviors, Consequences
Both formal and informalSelf-monitoring
ABC’s: Antecedents, Behaviors, Consequences
Both formal and informalSelf-monitoring
Psychological TestingPsychological Testing
Evaluate cognitive, emotional and behavioral functioning
Can help in diagnosisHelp determine severity (Beck
Depression Inventory)
Evaluate cognitive, emotional and behavioral functioning
Can help in diagnosisHelp determine severity (Beck
Depression Inventory)
Projective TestsProjective Tests
Psychodynamic perspectiveAmbiguous stimuli leads to
projections of unconscious thoughts and fears
Controversial: weak psychometric qualities
Psychodynamic perspectiveAmbiguous stimuli leads to
projections of unconscious thoughts and fears
Controversial: weak psychometric qualities
Projective TestingProjective Testing
Rorschach Inkblock TestThematic Apperception Test (TAT)
Rorschach Inkblock TestThematic Apperception Test (TAT)
Personality TestingPersonality Testing
MMPI: Minnesota Multiphasic Personality Inventory
549 questionsLots of research on this instrumentLooking for patterns of responsesLie factor
MMPI: Minnesota Multiphasic Personality Inventory
549 questionsLots of research on this instrumentLooking for patterns of responsesLie factor
Myers Briggs Type Indicator
Myers Briggs Type Indicator
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?
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 TestsIntelligence Tests
Stanford-BinetWeschler Intelligence Scale for
Children (WISC-R)Weschler Adult Intelligence Survey
(WAIS)
Stanford-BinetWeschler Intelligence Scale for
Children (WISC-R)Weschler Adult Intelligence Survey
(WAIS)
Neuropsychological testing
Neuropsychological testing
Language skillsAttention and concentrationMemoryMotor skillsPerceptual abilitiesLearningAbstract thought
Language skillsAttention and concentrationMemoryMotor skillsPerceptual abilitiesLearningAbstract thought
Neuropsych..Neuropsych..
Guesses about brain impairmentAssess abilities and liabilitiesBender GestaltLuriaHalstead
Guesses about brain impairmentAssess abilities and liabilitiesBender GestaltLuriaHalstead
Neuropsych..Neuropsych..
Shortcomings:False positivesFalse negativesVery expensive and highly
specialized training
Shortcomings:False positivesFalse negativesVery expensive and highly
specialized training
NeuroimagingNeuroimaging
Measurements of brain structure and function
The new frontierStructural abnormalities, tumors,
injuries: MRI, CATFunction: interactions of blood,
oxygen and glucose in active parts of brain:PET, SPECT, functional MRI
Measurements of brain structure and function
The new frontierStructural abnormalities, tumors,
injuries: MRI, CATFunction: interactions of blood,
oxygen and glucose in active parts of brain:PET, SPECT, functional MRI
Psychophysiological assessment
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
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
Diagnosing Psychological Disorders
Diagnosing Psychological Disorders
“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
“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
ClassificationClassification
Construct categories and assign people to those categories on the basis of shared attributes
Taxonomy: scientific classificationNosology: taxonomic system
classifying psychological and medical phenomena
Construct categories and assign people to those categories on the basis of shared attributes
Taxonomy: scientific classificationNosology: taxonomic system
classifying psychological and medical phenomena
DSM IV-TRDSM IV-TR
Diagnostic and Statistical Manual of the American Psychiatric Association, 4th edition, Text Revision
Diagnostic and Statistical Manual of the American Psychiatric Association, 4th edition, Text Revision
Approaches to classification
Approaches to classification
CategoricalAssumption that conditions are
unique. One set of criteria and all must be met. Common in medicine but not psychopathology
DimensionalScales, ratings, degrees of
symptoms. Great idea but hard to accomplish
CategoricalAssumption that conditions are
unique. One set of criteria and all must be met. Common in medicine but not psychopathology
DimensionalScales, ratings, degrees of
symptoms. Great idea but hard to accomplish
Approaches to classification..Approaches to classification..
Prototypical approachCategorical but allows for variation.
Identifies essential features and then offers a variety of symptoms that person could have. DSM based on this approach.
Prototypical approachCategorical 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
Diagnosis of Major Depressive Disorder, Single Episode
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.
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
Diagnosis of Major Depressive Disorder, Single Episode
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.
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
Diagnosis of Major Depressive Disorder, Single Episode
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.
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
Diagnosis of Major Depressive Disorder, Single Episode
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).
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 systemMultiaxial system
Axis I: Clinical disorderAxis II: Personality Disorders,
Mental RetardationAxis III: General Medical ConditionsAxis IV: Psychosocial and
Environmental ProblemsAxis V: Global Assessment of
Functioning
Axis I: Clinical disorderAxis II: Personality Disorders,
Mental RetardationAxis III: General Medical ConditionsAxis IV: Psychosocial and
Environmental ProblemsAxis V: Global Assessment of
Functioning
Problems with DSMProblems with DSM
Fuzzy boundariesComorbidityMisuse “reification”People who don’t fit categories
Exp: Depressive Disorder, NOS
Fuzzy boundariesComorbidityMisuse “reification”People who don’t fit categories
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).
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
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? Seligman (1996)
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? Seligman (1996)