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Clinical Assessment, Diagnosis, and Research Methods
Clinical Assessment, Diagnosis, and Research Methods
Assessment,
Diagnosis, and
Research
Methods
Purposes of Clinical Assessment
Assessing To understand the individual
Psychological To predict behavior
Disorders
To plan treatment
To evaluate treatment
outcome
Analogous to a Funnel
Assessing
Psychological Starts broad
Disorders
Multidimensional in approach
(continued)
Narrow to specific problem
areas
Reliability
Consistency is measurement
Examples include test-retest
and inter-rater reliability
II.
Key Concepts Validity
in What an assessment approach
Assessment measures and how well it does
so
Examples include concurrent,
discriminant, and predictive
validity
Standardization and Norms
Ensures consistency in the use
of a technique
Key Concepts Provides population
in
benchmarks for comparison
Assessment
(continued) Examples include structured
administration, scoring, and
evaluation procedures
III.
Domains of
Assessment: Clinical Interview
The Clinical Most common clinical
Interview and assessment method
Physical
Exam Structured or semi-structured
Mental Status Exam
Domains of
Assessment: Appearance and behavior
The Clinical Thought processes
Interview and
Physical Mood and affect
Exam Intellectual functioning
(continued)
Sensorium
Physical Exam
Behavioral Assessment
Focus on the present – Here
and now
Domains of
Assessment: Direct observation of behavior-
Behavioral environment relations
Assessment Purpose is to identify
and
problematic behaviors and
Observation
situations
Identify antecedents,
behaviors, and consequences
Behavioral Observation and
Domains of
Assessment: Behavioral Assessment
Behavioral Can be either formal or
Assessment informal
and Self-monitoring vs. being
Observation
(continued) observed by others
Problem of reactivity using
direct observation
Psychological Testing
Domains of Must be reliable and valid
Assessment: Projective Tests – Roots in
Psychological Psychoanalytic Tradition
Testing and
Projective Project aspects of personality
Tests onto ambiguous test stimuli
Require high degree of
inference in scoring and
interpretation
Domains of
Assessment: Examples
Psychological
Testing and The Rorschach Inkblot Test,
Projective Thematic Apperception Test
Tests Reliability and validity data
(continued) tend to be mixed
Objective Tests – Roots in Empirical
Tradition
Domains of Test stimuli are less ambiguous
Assessment: Require minimal clinical inference in
Psychological scoring and interpretation
Testing and Objective Personality Tests
Objective
Tests Minnesota Multiphasic Personality
Inventory (MMPI, MMPI-2, MMPI-
A)
Extensive reliability, validity, and
normative database
Objective Intelligence Tests
Domains of
Nature of intellectual
Assessment:
Psychological functioning and IQ
Testing and The deviation IQ
Objective
Verbal and performance
Tests
(continued) domains
https://stanfordbinettest.com/
quiz/quick-quiz/question/1
Purpose and Goals
Assess broad range of skills and
Domains of abilities
Assessment:
Neuropsycholo Goal is to understand brain-
gical Testing behavior relations
Examples
The Luria-Nebraska and
Halstead-Reitan Batteries
Domains of
Assessment: Problems with Neuropsychological
Neuropsycholo Tests
gical Testing False Positives
(continued)
False Negatives
Neuroimaging: Pictures of the
Brain
Domains of
Assessment: Allows for a window on brain
Neuroimagin structure and function
g and Brain Imaging Brain Structure
Structure
Computerized axial
tomography (CAT or CT scan)
Utilizes X-rays
Domains of Magnetic resonance imaging
Assessment: (MRI)
Neuroimagin
g and Brain Utilizes strong magnetic
Structure fields
(continued) Better resolution than CT
scan
Imaging Brain Function
Positron emission tomography
(PET)
Domains of Single photon emission
Assessment: computed tomography (SPECT)
Neuroimagin Both involve injection of
g and Brain radioactive isotopes
Function Isotopes react with oxygen,
blood, and glucose in the brain
Functional MRI (fMRI) – Brief
changes in brain activity
Psychophysiological Assessment
Assess brain structure, function,
and activity of the nervous
system
Domains of Psychophysiological Assessment
Assessment: Domains
Psychophysiologic Electroencephalogram (EEG) –
al Assessment Brain wave activity
Heart rate and respiration –
Cardiorespiratory activity
Electrodermal response and
levels – Sweat gland activity
Uses of Routine
Psychophysiological Assessment.
Domains of
Assessment:
Disorders involving a strong
Psychophysiologica emotional component
l Assessment Examples
(continued)
PTSD, sexual dysfunctions, sleep
disorders
Headache and hypertension
IV.
Diagnosing Diagnostic Classification
Psychological Classification is central to all
Disorders: sciences
Foundations
in Assignment to categories
Classification based on shared attributes or
relations
Terminology of Classification
Diagnosing Systems
Psychological Taxonomy – Classification in a
Disorders:
Foundations scientific context
in Nosology – Taxonomy in
Classification psychological/medical
(continued) phenomena
Nomenclature – Nosological
Labels (e.g., panic disorder)
Categorical vs. Dimensional
V.
Issues with Approaches
Classifying Classical (or pure) categorical
and approach – Strict categories
Diagnosing Dimensional approach –
Psychological
Disorders Classification along dimensions
Prototypical approach – Combines
classical and dimensional views
Two Widely Used Classification
Systems
ICD-10
Issues with International Classification of
Classifying Diseases and Health Related
and Problems (ICD-10)
Diagnosing Published by the World Health
Psychological Organization
Disorders DSM-IV & DSM-IV-TR
(continued)
Diagnostic and Statistical
Manual of Mental Disorders
(DSM-IV and DSM-IV-TR)
Basic Characteristics
Five axes – Full clinical
VI. presentation
The DSM-IV-
Clear inclusion and exclusion
TR
criteria for disorders
Disorders are categorized under
broad headings
Empirically-grounded, prototypic
approach to classification
The Five DSM-IV Axes
Axis I
Axis II
Axis III
The DSM-IV-
TR Axis IV
(continued) Axis V
Other Unique Features of the
DSM-IV
The Problem of Comorbidity
Defined as two or more
disorders for the same person
Unresolved High comorbidity is the rule
Issues in the
clinically
DSM-IV-TR
Threatens the validity of
separate diagnoses
Labeling Issues and Stigmatization
Clinical Assessment and Diagnosis
VII.
Summary of Aims to fully understand the
Clinical client
Assessment Aids in understanding and
and
Diagnosis ameliorating human suffering
Based on reliable, valid, and
standardized information
Summary of Dangers of Diagnosis
Clinical Reification & stigmatization
Assessment
and Clinical Assessment and Diagnosis
Diagnosis The core of abnormal
(continued) psychology
A multidimensional perspective
Questions Driving a Science of
Psychopathology
What problems cause distress
VIII.
Conducting or impair functioning?
Research in Why do people behave in
Psychopathology
unusual ways?
How can we help people
behave in more adaptive ways?
Starts with a Hypothesis or
IX. “Educated Guess”
Basic
Components Not all hypotheses are testable
of Research Hypotheses in science are
formulated so that they are
testable
Research Design
A method to test hypotheses