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Assessing and

Diagnosing
Psychopathology
Learning Objectives

◦ Understand the process of assessment and tools


used in assessing psychopathology.
◦ Discuss specific challenges in assessing abnormal
behavior.
◦ Learn basic process of diagnosing a mental disorder.
Assessment
◦ Process of gathering information about people’s
symptoms and the possible causes of these
symptoms.
◦ Many types of information are gathered during an
assessment, including current symptoms, ways of
coping, recent events, physical condition, substance
use, personal and family history, cognitive functioning
and sociocultural background.
◦ Information gathered in assessment is used to
determine the appropriate diagnosis of a person’s
problem.
Diagnosis
◦ Label for a set of signs and symptoms that occur
together.
◦ A standardized system of diagnosis is crucial to
communication among mental health professionals in
order to not only produce an agreed-on definition of
psychopathology, but also in providing appropriate
treatment.
Validity in Assessment
◦ The accuracy of a test in assessing what it is
supposed to measure.
◦ A test is valid if the results of the test yield the same
information as an objective and accurate indicator of
what the test is supposed to measure.
◦ Face validity – test appears to measure what is it
supposed to measure.
◦ Content validity – test assesses all important aspects
of the phenomenon.
◦ Concurrent/Convergent 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 in Assessment
◦ Indicates its consistency in measuring what it is
supposed to measure.
◦ 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
produces similar results
◦ Interrater reliability – two or more raters who
administer and score a test come to similar
conclusions.
Standardization
◦ Improves the psychometric properties of a scale or
measure by improving its validity and reliability.
◦ A standardized test, when administered, prevents
extraneous factors from affecting a person’s
response.
◦ A standard way of interpreting results makes the
interpretation of the test more valid and reliable.
◦ There should be a standardized method of
administering and interpreting the tests to produce
good psychometric properties.
Assessment Tools
Clinical Interview
◦ One of the most important element in the evaluation
and care of individuals with mental disorders.
◦ Its purpose is to obtain information that will establish
a criteria-based diagnosis.
◦ This process helps in the prediction of the course of
the illness or prognosis, which in turn leads to
treatment decisions.
◦ A good clinical interview results in a multidimensional
understanding of the biopsychosocial elements of the
disorder and provides necessary information for the
mental health professional and the patient to develop
a person-centered treatment plan.
General Principles of a Clinical Interview
◦ Agreement as to process
◦ Privacy and confidentiality
◦ Respect and consideration
◦ Rapport and Empathy
◦ Patient-Clinician Relationship
◦ Transference and Countertransference
◦ Person-centered and Disorder-based Interviews
◦ Safety and comfort
Parts of the Clinical Interview
◦ Identifying data
◦ Source and reliability
◦ Chief complaint
◦ Present illness
◦ Past psychiatric history
◦ Substance use history
◦ Past medical history
◦ Family history
◦ Developmental and social history
◦ Review of systems (Mood, anxiety, psychosis, other)
◦ Mental Status Examination
◦ Physical examination
◦ Formulation
◦ DSM-5 Diagnosis and differential diagnosis
◦ Treatment plan
Mental Status Examination
◦ Explores all areas of mental functioning and denotes
evidence of signs and symptoms of mental illnesses.
◦ Most of the information does not require direct questioning,
and the information gathered from observation may give
the clinician a different dataset than the client’s responses.
◦ The mental status examination gives a snapshot of the
patient’s psychological state at the time of the interview.
Mental Status Examination
◦ Appearance and behavior – general description of how the
patient looks and behavior during the interview.
◦ Motor activity – can be described as normal, slowed,
agitated, freedom of movement, and gait can give clue to a
diagnosis.
◦ Speech - elements include fluency, amount, rate, tone, and
volume.
◦ Mood – patient’s internal and sustained emotional state.
◦ Affect – expression of mood observed by the clinician.
◦ Thought content – what thoughts are occurring in the
patient which is inferred by what the patient spontaneously
expresses and responses to specific questions aimed to
elicit a particular pathology.
◦ Thought process - describes how thoughts are formulated,
organized, and expressed.
Mental Status Examination
◦ Perceptual disturbances – includes hallucinations, illusions,
depersonalization and derealization.
◦ Cognition – elements of cognitive functioning that should be
assessed include alertness, concentration, memory,
calculation, fund of knowledge, abstract reasoning, insight
and judgment.
◦ Abstract reasoning – ability to shift back and forth between
general concepts and specific examples.
◦ Insight – refers to the patient’s understanding of how he or
she is feeling, presenting, and functioning as well as the
potential causes of psychological disturbance.
◦ Judgment – refers to the person’s capacity to make good
decisions and act on them.
Structured Interviews

◦ Clinicians ask the clients a series of questions about


symptoms he or she experienced from the past or is
experiencing in the present moment.
◦ The format of interviews is standardized and the clinician
uses concrete criteria to score the person’s answers.
Symptom Questionnaires
• Can cover a wide variety of symptoms representing several
different disorders.
• Other questionnaires focus on the symptoms of specific
disorders.
• Some examples of free and standardized symptoms
questionnaires:
• Generalized Anxiety Disorder Screener (GAD-7)
• Patient Health Questionnaire-9 (PHQ-9)
• Altman Self-Rating Mania Scale (ASRM)
• Borderline Evaluation of Severity over Time (BEST)
• The Suicide Behaviors Questionnaire - Revised (SBQ-R)
• The Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C)
Personality Inventories
◦ Questionnaires meant to assess people’s typical ways of
thinking, feeling and behaving.
◦ These inventories are used as part of an assessment
procedure to obtain information on people’s well-being,
self-concept, attitudes and beliefs, ways of coping,
perceptions of their environment, and social resources, and
vulnerabilities.
◦ Minnesota Multiphasic Personality Inventory (MMPI) – most
widely used personality inventory in professional clinical
assessment.
◦ The MMPI may be especially useful as a general screening
device for detecting people who are functioning very poorly
psychologically
◦ However, the MMPI is criticized for its norms do not reflect
variations across cultures in what is considered normal or
abnormal.
Behavioral Observation and Self-
Monitoring
◦ The clinician looks for specific behaviors and what precedes
and follows these behaviors in behavioral observation.
◦ The clinician will use the information from the behavioral
observation to help the individual learn new skills, stop
negative habits, and understand how he or she reacts to
certain situations.
◦ Self-monitoring is keeping track of the number of times per
day an individual engages in a specific behavior and the
conditions under which this behavior occurs.
◦ Self monitoring is open to biases to the individual, however
it opens an opportunity to discover triggers of unwanted
behaviors.
Intelligence Tests
• Used 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 to identify
gifted children and children with intellectual difficulties.
• These tests are designed to measure basic intellectual
abilities such as ability for abstract reasoning, verbal
fluency, and spatial memory.
• The term intelligence quotient (IQ) is used to describe a
method of comparing an individual’s score on an
intelligence test with the performance of individuals in the
same age group.
• Wechsler Adult Intelligence Scale
• Stanford-Binet Intelligence Scale
• Wechsler Intelligence Scale for Children
Neuropsychological Tests
◦ Used in detecting specific cognitive deficits and
neurological impairment in a person.
◦ The Bender-Gestalt Test appears to be good at
differentiating people with brain damage from those
without brain damage, but it does not reliably identify the
specific type of brain damage a person has.
Brain Imaging Techniques
◦ Used to determine if a patient has a brain injury or tumor;
also used to search for differences in brain activity or
structure between people with a psychological disorder and
people with no disorder.
◦ Computerized tomography (CT) – enhancement of x-ray
procedures, where narrow x-ray beams are passed through
the person’s head in a single plane from a variety of angles;
revealing the brain’s major structures.
◦ Positron-emission tomography (PET) – provides a picture of
activity in the brain. It shows differences in the activity level
of specific areas of the brain between healthy people and
people with disorders.
◦ Magnetic Resonance Imaging (MRI) – Involves creating a
magnetic field around the brain that causes a realignment
of hydrogen atoms in the brain. The hydrogen atoms
change in position case the emission of magnetic signals
which are read by a computer to reconstruct a three
dimensional image of the brain.
Psychophysiological Test
◦ Alternative methods to brain-imaging techniques use to
detect changes in the brain and nervous system that
reflects emotional and psychological changes.
◦ Electroencephalogram (EEG) – measures electrical activity
along the scalp produced by firing of specific neurons in the
brain.
◦ The EEG is used most often to detect seizure activity in the
brain and can also be used to detect tumors and stroke.
Projective Tests
◦ 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.
◦ People are thought to project these issues onto their
description of the content of the stimulus.
◦ Rorschach Inkblot Test – consists of 10 cards containing
symmetrical inkblots in black, gray, white or in color. The
responses to the inkblots may represent themes or
concerns like aggression or fear of abandonment.
◦ Thematic Apperception Test (TAT) – consists of a series of
pictures where individuals make up a story about what is
happening in the pictures. The stories reflect their concerns
and wishes as well as their personality traits and motives.
Challenges in Assessment
Resistance to Providing Information
◦ Sometimes the person does not want to be assessed or
treated.
◦ Even when a person is not completely resistant to being
assessed, he or she may have a strong interest in the
outcome of the assessment and therefore may be highly
selective in the information he or she provides, may bias his
or her presentation of the information, or may even lie to
the assessor.
Evaluating Children
◦ There are challenges and difficulties in self-reporting
emotional and behavioral concerns.
◦ Clinicians usually resort to parents as the primary source of
information, however parents are also not always accurate
about their children’s functioning.
◦ Parents may also be the source of the child’s psychological
problems and as a result they may be unwilling to
acknowledge or seek help for the child’s difficulties.
◦ Cultural norms can also be a challenge in assessment.
◦ Different sources of information can result in a discrepancy
in the information.
◦ The discrepancy may also arise because children function
differently in different settings.
Evaluating Individuals Across Cultures
◦ Symptoms can be both underdiagnosed or over-diagnosed
when the individual and the assessor do not share a
language.
◦ Cultural biases can arise when everyone supposedly is
speaking the same language but has a unique cultural
background.
◦ People from other cultures often think and talk about their
psychological symptoms differently than do members of
the clinician’s culture.
◦ Clinicians must be aware of cultural differences in the
manifestation of disorders and the presentation of
symptoms, and they must use this information correctly in
interpreting the symptoms clients report.
Diagnosis
◦ People tried to organize the confusing array of
psychological symptoms into a limited set of syndromes.
◦ A set of syndromes and the rules for determining whether
an individual’s symptoms are part of one of these
syndromes constitute a classification system.
◦ The official manual for diagnosis psychological disorders in
the United States has been the Diagnostic and Statistical
Manual of Mental Disorders (DSM) of the American
Psychiatric Association.