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)