What is clinical assessment?
The systematic evaluation and measurement of psychological, biological, and social factors in someone with a possible disorder
What is a diagnosis?
It is determining whether the problem meets the criteria for a psychological disorder
What is the purpose of a clinical assessment?
- To understand the individual
- To predict behavior
- To plan treatment
- To evaluate treatment outcome
What values does assessment depend on?
- Reliability: the degree to which a measurement is consistent
- Validity: the degree to which a technique measures what it is designed to measure
Standardization: application of certain standards to ensure consistency across different measurements
What is Analogous to a Funnel?
Starts broad- collecting information across a range of the individual’s functioning to determine where the source of a problem may lie.
Multidimensional in approach. Narrow to specific problem areas.
In the mental status exam, what are areas of assessment for appearance and behavior? Examples?
- Clothing, hygiene, psychomotor activity, posture, facial expression, eye contact.
- Disheveled, intense eye contact, psychomotor agitation
In the mental status exam, what are the areas of assessment for thoughts? Examples?
- Content and Process Organization of thoughts in goal-oriented pattern
- Delusions, hallucinations, obsessions, SI/HI Disorganized, tangential, flight of ideas
In the mental status exam, what are the areas of assessment for mood and affect? Examples?
- Mood: subjective report of emotional state of patient
- Affect: objective observation or patient’s emotional state
- Sad, manic, angry
Is it congruent? Appropriate? Flat or blunted affect?
In the mental status exam, what are the areas of assessment for speech? Examples?
- Appropriateness of conversation, rate of speech, tone, volume.
- Hyperverbal, rapid speech, pressured
In the mental status exam, what are the areas of assessment for Orientation?
- Alert and oriented to person, place, and date
In the mental status exam, what are the areas of assessment for Insight and Judgement? Examples?
- The extent to which the person recognizes and appraises their experiences and makes good decisions
- What would you do if you saw smoke in a theater?
What is the purpose behavioral assessment?
- purpose is to identify problematic behaviors and situations
- Direct observations of behavior - environment relations
What is reactivity?
When your behavior is being observed, by yourself or someone else, it starts to change
What are the ABC’s of behavioral observation?
- Antecedents, Behaviors, Consequences
What is Neuroimaging and its purpose?
- pictures of the brain
- To understand brain structure and function
- Allows researchers to examine noninvasively how structural and/or functional brain abnormalities contribute to relapse and other important clinical outcomes.
What are some examples of Neuroimaging Procedures?
- Magnetic resonance imaging (MRI)
- Electroencephalography (EEG),
- Positron Emission (PET)
What is a Functional MRI
- Detects changes in the local magnetic field that occur as a result of changes in the ratio of oxygenated to deoxygenated hemoglobin in arterial blood vessels in specific brain regions during a cognitive task.
- The rationale for interpreting these changes as cellular activity is that cells in the brain, like those elsewhere in the body, use oxygen as fuel. (BOLD Blood-Oxygen-Level Dependent).
- As cells increase in activity, they increase their demand for oxygen, and the arterial blood vessels respond by delivering more oxygenated hemoglobin to the region.
In a Functional MRI, how do Researchers compare multiple images of a single individual?
- At rest and then performing a task, or before and after exposure to a drug.
- Or map which brain regions he or she activates to perform mental tasks or in response to experiences or chemical exposures.
In a Functional MRI, how do Researchers compare different individuals?
- From different groups—for example, drug-addicted and nonaddicted.
- This can reveal differences in brain regions the two groups use to perform identical tasks or respond to stimuli or exposures.
What is the Foundations in Classification for Diagnosing Psychological Disorders?
- System for describing categories or dimensions of a disorder.
- Classification is not a diagnosis.
What is Classification?
-Categorical and dimensional approaches
-Classical (or pure) categorical approach—strict categories (e.g., you either have social anxiety disorder or you don’t)
- Dimensional approach—classification along dimensions (e.g., different people have varying amounts of anxiety in social situations)
- Prototypical approach—combines classical and dimensional views
What are some Drawbacks to Classification?
- Labeling
- Contributes to stigma.
- Stigma contributes to discrimination in housing, employment, relationships, treatment, etc.
- Imperfect diagnostic categories
- The same label may be applied to similar behaviors that have varying causes.
What are some Benefits to Classification?
- Provides information about the cause(s) of a condition.
- Provides common language.
- Realistic prognoses, founded in research.
- Indicates treatment options.
- Provides outlines for possible prevention programs.
What is DSM?
- Diagnostic and Statistical Manual of Mental Disorders
- Developed by the American Psychiatric Association.
- Prototypical Approach
- Latest: DSM 5 tr
- Committees/Boards- Voting
- Socio-cultural factors determine what is a disorder.
- Example - Sexual orientation and the DSM
