Talking about clinical judgement let’s start with the whole process and accuracy of it.

And
this discussion starts with the basic element interpretation.

Clinical interpretation – the methodai in where you make a statement and derive a
conclusion. Theoretical framework, influences interpretation. Which basically means you
cannot make a statement without the knowledge of any sort of theory.
The interpretation steps come after the assessment step, write on board step 1:
assessment, step 2: interpretation
Next to step 1 you will write interviews and psychological tests.
Next to step 2 you will write, what does this mean, what decisions can be made?

Then you obtain clinical interpretation through sample signs and correlates.
Number 1 is sample of general behavior
Number 2 is sign of underlying state or condition
Number 3 is behavioral attitudinal or emotional correlate

THEORY AND INTERPRETATION

We have three levels of interpretation,
Level 1: data prediction and it involves very little inference.
Level 2: inference about person in general, descriptive generalization, hypothetical
construct, HC is an explanatory variable which is not directly observable. For
example, the concepts of intelligence and motivation are used to explain phenomena
in psychology, but neither is directly observable
Level 3: ---involves inference about individual in a particular situation

Now, let’s think of the three categories clinicians are divided into.

First, we have behavioral clinicians, who avoid making statements about the internal states of
behavior and focus on the behavior that is the overt responses of an individual.

A second group of clinicians, who are empirical and objective and use objective tests for prediction.
They approach these clinicians opt for is called psychometric approach who are focused on
standardized tests and their norms, regression equations etc.

Then we have the third group of clinicians who opt for a psychodynamic approach where the inner
states of an individual are determined. So projective tests, unstructured clinical interviews are helpful
in this case.

Now I have the levels of interpretations on one side and the categories of clinicians one side, I want
all of us to corelate these two and tell me what levels will be used by each category of clinicians.
Okay so behavioral clinicians will focus on level 1 and 2, then the psychometric clinicians will focus
on level 1 and 2 as well and the third group will focus on level 3 alone.

So in a nutshell, a clinical psychologist must collect, integrate(combine) and interpret data from
multiple sources.
Now we have few common mental health problems, such as depression, OCD, panic disorder, GAD,
PTSD, social phobia etc. And these problems can affect upto 15% of the population, at any one time.
The severity of symptoms, experiences will vary considerably, but all of these conditions can be
associated with significant long-term disability. There are few effects of mental health problems being
long term and they are emotional instability, behavior regulation, relationship
difficulties, substance abuse, and even physical illness .

For example, depression is estimated to be the second greatest contributor to disability-

adjusted life years throughout the developed world. DALY is a time-based measure that
combines years of life lost due to premature death(YLLs) and years of healthy life
lost due to disability (YLDs).

Many anxiety disorders particularly once established tend to have a chronic course. The
majority of people diagnosed with depression or anxiety disorders (up to 90%) are treated in
primary care.

However, many individuals do not seek treatment, and both anxiety and depression often go
undiagnosed. It is likely that only 30% of people presenting in the community have their
condition recognized and treated. A reason why people do not go seeking treatment or help is
because they are unable to see that they are suffering from anxiety or depression, and do not
feel the need to seek professional help. Or it could also be because of fear and shame.

Recognition of anxiety disorders by GPs has been variable, and in some cases particularly
poor, and only a small minority of people who experience anxiety disorders ever receive
treatment. In part this may stem from GPs' difficulties in recognizing the disorder, but it may
also be caused by worries about stigma which may make people more reluctant to disclose
their symptoms.

CORE PRINCIPLES

Principles to be kept in mind while providing a clincal judgment or clinical interpretation.

• Good communication skills including active listening are key components for
building a trusting relationship with patients, for example through demonstrating
empathy, by making eye contact and explaining and talking through diagnoses,
symptom profiles and possible treatment options.
• The evidence base shows that adopting a collaborative approach with patients can
help facilitate a greater engagement from them in any resulting treatments.

In this chapter we will talk about two tools called PHQ-9 and GAD-7 that can help support
the formulation of a diagnosis and establish how severe the patient’s symptoms are, also a
comprehensive assessment that does not rely on the no.of symptoms alone. In addition,
assessment of risk (potential risks and what happens of the risks occur) is vital. A more
rounded assessment can be achieved by exploring lifestyle factors.These can include a
person’s accommodation status or living conditions, social isolation, family challenges,
cultural issues, financial problems, or any other pressures that they may have. Also there may
be protective factors that can be taken into consideration, such as social support or a person’s
spirituality.
THE FIRST ONE IS THE

The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and

measuring the severity of depression: n The PHQ-9 incorporates DSM-IV
depression diagnostic criteria with other leading major depressive symptoms into a
brief self-report tool. appropriate to be used with individuals 12 years of age and
older.

The Generalised Anxiety Disorder Assessment (GAD-7) is a seven-item instrument

that is used to measure or assess the severity of generalised anxiety disorder
(GAD). Each item asks the individual to rate the severity of his or her symptoms over
the past two weeks. 12 YEARS AND ABOVE

A KEY ABILITY

• is to be able to detect emotional distress and it has been found that where practitioners
used skills to enable patients to disclose their distress during a session, this enhanced
the opportunity for it to be detected and manage.
• When a patient initiates a discussion regarding their mental health, this may create
additional anxiety for them.
• By being mindful of the approach, for example through a measured tone of voice or
through the use of sensitive questioning, this may help the person to engage better
within the consultation.
• Sometimes people will experience distress or anxiety in response to challenging life
events, as a result of workplace pressures or job insecurity. In such cases the
communication skills and clinical judgement of their Psy, in the discussion with the
patient, will be crucial in ensuring that this distress is not medicalized.

The Millon Clinical Multiaxial Inventory–IV (MCMI–IV) is a 195 item self-report

instrument designed to help clinicians assess personality and psychopathology in adults
age 18 years or older who are undergoing psychological or psychiatric assessment or
treatment. Research indicates that the Millon Clinical Multiaxial Inventory (MCMI-
I) lacks diagnostic accuracy when compared to clinically generated DSM-III-
R diagnoses. This shortcoming is most evident for the identification of psychotic
disorders. It is considered to be reliablew and valid. The MCMI was intended to
improve upon the long-established MMPI.

Invented by theodore milan