Transcript
Chapter 3 Notes
Assessment and diagnosis of symptoms:
Assessment is the process of gathering information about people’s symptoms and the possible causes of these symptoms.
Information gathered includes current symptoms and ways of coping with stress, recent events and physical condition, drug and alcohol use, and personal and family history of psychological disorders, cognitive functioning, and sociocultural background.
This information is used to determine the diagnosis: a label for a set of symptoms that often occur together.
Assessments tools help provide information about an individual’s personality characteristic, cognitive deficits, emotional well-being, and biological functioning.
Assessment tools help clinicians gather information, they must be valid reliable and standardized.
Validity: the test being used to determine a persons behaviors and feelings must be an accurate measure. This accuracy is called validity. Validity is seeing if results of the test yield the same info an objective and accurate indicator of what the test is measuring. Types of validities are:
Face validity: on face value, the items seem to measure what the rest is intended to measure.
Content validity: extent to which a test assesses all the important aspects of a phenomenon that it purports measure.
Concurrent validity: test yields the same results as other measures of the same behavior, thoughts, or feelings.
Predictive validity: test predicts the behavior it is supposed to measure.
Construct validity: test measures what it is supposed to measure, not something else.
Reliability: consistent information about a person indicates its consistency in measuring what it is supposed to measure. Types of reliabilities are:
Test-retest reliability: test produces similar results when given at two points in time
Alternate form reliability: two versions of the same test produce similar results
Internal reliability: different parts of the same test produce similar results
Interrater (interjudge) reliability: two or more raters or judges who administer and score a test come to similar conclusions
Standardization: standardizing the administration and interpretation of tests helps improve validity and reliability, using a standard method helps prevent the test from extraneous factors from affecting a persons response, test administrator cannot suggest the “right” answers.
Clinical interview: most information for an assessment is gathered in an initial interview, interview may include a mental status exam, which assesses the persons general functioning.
Mental status exam: first the clinician assesses the individuals appearance and behavior, if the individual is moving slowly, take note of the individuals thought processes, note the individuals mood and affect, observe the individuals intellectual functioning and how well the person speaks, does the individual seem appropriately oriented to place time and person
Structured interview: father information about the individual, the clinician asks the respondent questions about symptoms they have been experiencing in the present or past. These questions are standardized and a concrete criterion is used to score the persons answers, at the end of the interview the clinician should be able to gather symptoms and make diagnosis of major psychological problems.
Symptom questionnaires: determines symptoms, can cover a wide variety of symptoms representing several different disorders, one of the most common questionnaires is the Beck Depression Inventory (BDI) which has 21 items with four levels of each symptom of depression and the respondent is asked to best fit their level of depression with how they’ve been feeling the past week, people argue that the BDI does not differentiate between the clinical syndrome of depression and the general distress of anxiety disorder against other disorders. BDI is quick which is why it is widely used in research on depression and is easy to administer and has good test-retest reliability.
Personality inventories: questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving. These are used as part of an assessment procedure to obtain information on peoples well-being, self-concept, attitudes and beliefs, ways of coping, perceptions of their environment, and social resources and vulnerabilities. Most widely used one is the Minnesota Multiphasic Personality Inventory (MMPI), which has been translated into more than 150 languages and is used in more than 50 countries. Starke Hathaway and Charnley Mckinley developed it. It was later updated to MMPI-2. Scores are compared to that of the normal population. It includes a Lie Scale. It is useful as a general screening device for detecting people who are functioning very poorly psychologically. It has a test-retest reliability. It is questioned to be not culturally diverse.
Behavioral Observation and Self-monitoring: clinicians use behavioral observation of individuals to assess deficits in their skills or their ways of handling situations. The clinician will look for specific behaviors and what precedes and follow these behaviors. The clinician then uses this information to help the individual learn new skills, stop negative habits, and understand and change how he or she reacts to certain situations. Has the advantage of not relying on individuals’ reporting and interpretation of their own behaviors. The clinician sees firsthand how the individual handles important situations. There are disadvantages such as the individual may alter their behavior when being watched or that different observers may draw different conclusions about the individual’s skills. Has low interrater reliability. Behavioral observation used in research settings for this reason where situations are highly standardized and observers watch for a set list of behaviors. This may not be possible in some situations, in which role-play may come into the equation.
Self-monitoring: if direct observation or role playing is not an options, clinicians may use self-monitoring by individuals where they keep track of the number of times per day they engage in a specific behavior and the conditions in which these behaviors occur. This is open to biases in which the individual notices about their behavior and is willing to report. This can lead to change in behaviors.
Intelligence tests: These are used in clinical practices to get a sense of an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected. They are also used in schools to identify the gifted children and children with intellectual difficulties. They are used in occupational settings and the military to evaluate the adult’s capabilities for certain jobs or types of service. Examples are the Wechsler Adult Intelligence Scale, the Stanford-Binet Intelligence Test, and the Wechsler Intelligence Scale for Children. All of these tests were designed to measure basic intellectual abilities such as abstract reasoning, verbal fluency, and spatial memory. IQ is what we compare in intelligence tests; an IQ of 100 means the person is average in performance. These tests are controversial because there is little consensus as to what is meant by intelligence. Intelligence tests assess verbal and analytical abilities, not social or talent skills. These tests are also biased for the middle and upper classes because the educated are more familiar with reasoning assessments. This is not considered a “culture-fair” test.
Neuropsychological Tests: this is a paper and pencil tests used when a clinician suspects neurological impairment in a person. They may be useful in detecting specific cognitive deficits such as a memory problem, like dementia. A frequently used test is the Bender-Gestalt Test. This test assesses individuals sensorimotor skills by have them reproduce 9 drawings. People with brain damage may rotate or change parts of the drawings. When asked to remember the drawings they may show memory impairment. This test is good at differentiation people with brain damage from those without. It does not say the specific brain damage a person has. Types of brain damages can be detects by the Halstead-Reitan Test and the Luria Nebraska Test. These contain several tests that provide specific information about an individuals functioning in several skill areas such as concentration, dexterity, and speed comprehension.
Brain-imaging techniques: neurological tests are being used with brain imaging techniques to identify abnormalities and deficits. Specific tests are the computerized tomography (CT), which enhances X-rays, and a computer constructs a 3D image of the brains major structures, the positron-emission tomography (PET) that provides a picture of activity in the brain and requires injecting the patient with fluorodeoxyglucose to show differences in the activity level of specific areas of the brain, the single photon emission computed tomography (SPECT) which is the same as the PET scan but uses a different tracer substance to be injected and is less expensive and accurate, and the magnetic resonance imaging (MRI) which is the best imaging overall. It does not require radiation or injections and provides more finely detailed pictures of the brain and its activity. The MRI uses a magnetic field around the brain and reconstructs a 3D image used to study structural and functional brain abnormalities in every psychological disorder.
Psychological tests: these are alternative methods to detect changes in the brain and nervous system. The electroencephalogram (EEG) measures electrical activity along the scalp produced by the firing of specific neurons in the brain. It is used most often to detect seizure activity in the brain and to detect tumors and strokes. Heart rate and respiration are highly responsive to stress and can be easily monitored. Sweat gland activity known as electrodermal response can be assessed with a device that detects electrical conductivity between two points on the skin. This activity can reflect emotional arousal. Psychophysiological measures are used to test people’s emotional response to specific stimuli.
Projective tests: it is based on the assumption that when people are presented with an ambiguous stimulus they will interpret the stimulus in line with their current concerns and feelings, relationships with others, and conflicts or desires. Two most frequently used tests are the Rorschauch Inkblot Test, which was developed by Hermann Rorschach and uses 10 cards with symmetrical inkblots in black gray or white or color and asks what different things are shown in the pictures and what it makes the patient think of, their responses show signs of emotions and themes, and the Thematic Apperception Test (TAT), which consists of a series of pictures and the patient makes up a story about what is happening in the pictures which reveals emotional responses. Clinicians use these tests are tools for underlying conflicts and concerns within an individual.
Challenges in assessment: resistance to providing information is one of the greatest challenges due to not wanting to be treated, evaluating children is difficult because a distressed child may be hard to read and understand whereas the parent would have the most information about the child and may be the source of the child’s psychological problems, evaluating individuals across cultures is difficult
