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CLINICAL PSYCHOLOGY
What we study ?
I. Methodology in clinical psychology 1. Case history taking/ Case history method.
I.
1. Survey methods 2. Group designs 3. Single case designs 4. Experimental designs & makes use of Statistical
procedures
II. Clinical methods - Four important Clinical methods are1. 2. 3. 4. Case history taking Clinical interview Clinical observation Psychological testing/Assessments
CLINICAL ATTITUDE
1. Should have the psychopathology sound theoretical knowledge of
2.
3.
4.
Be an assertive listener
Develop the skill of establishing the rapport
6.
7. 8. 9.
skill
&
discuss
with
your
II.
III.
IV.
V. VI.
IX.
X. XI.
4.
5.
Religion
Language Spoken
(Age, Sex, Education, Occupation, Personality, Health, Relation with the client, Socio Economic Status, Socio-cultural background)
1. List of complaints list out chronologically with duration 2. Onset a. When? - age of onset b. How ? - mode of the onsetAbrupt/ Acute/insidious or gradual.
functioning
a. How
b. Which area education/occupation/family/ personal/ finance the clinical conditions/symptoms are disturbing his present life.
VII. Personal history 1. Birth and Developmental history- Prenatal, natal, post natal; early childhood traits
2. Educational: Early childhood, Middle childhood, late childhood and adolescence 3. Occupational history
Attitude to others
Attitude towards self Moral and religious beliefs Predominant mood Leisure activity and interest Reaction pattern to stress
1. Accessibility
2. Cognition
3. Motivation
Relatively less trained interviewer can also conduct the interview. Expensive and time consuming
Informal Interview
One where there are no predetermined questions nor is there any preset order of the questions and is left to the interviewer to ask some questions in a way he likes regarding the no. of key points around which the interview is to be built up.
CLINICAL INTERVIEW
Types of interviews - Based on the Purpose/Process
1. Diagnostic interview
The information about the patient and family will be collected according to the case history Proforma
2. Intake/ Therapeutic interview The client and family will be given orientation about the treatment/management after exploring their need, motivation and interest.
CLINICAL INTERVIEW
5. Consultation interview
6. Screening interview
When the number of patients are more in the O.P.D. set up this type of brief interview needs to be carried out.
7. Discharge interview This will be carried out at the time of termination /discharge of in- patient
3. STAGES
1. Opening phase
2. Middle phase 3. Final phase
CLINICAL INTERVIEW
Factors influencing the interview
CLINICAL INTERVIEW
Types of questions to be asked during interview 1. Open ended questions 2. Leading questions 3. Directive questions 4. Forced choice questions
Observation
Useful when the investigator wants to see the behaviour in natural situation and study the situation-based feature of conduct, such
Definition
Observation, as a fundamental technique of data collection, refers to watching and listening to the behaviour of other persons over time without manipulating and controlling it and record findings in ways that allow some degree of analytical interpretation and discussion.
Types:
1. Objective observation: Observation of the overt behaviors like speech, language, Fluency etc. 2. Subjective observation: Here the client observes his own behavior, which cant be observed directly by others (Introspection). 3. Naturalistic observation: Objectively observing the behaviors in the natural set- up.
Example: Therapist observing the fluency of a person with stuttering in the classroom or in the shopping
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Types contd. Systematic observation: one which is done according to some explicit procedures as well as in accordance with the logic of scientific inference. Unsystematic observation: Inference made by
More meaningful and convincing conclusions. Broader aspect of the human behaviour is assessed. Time consuming. Influenced by the subjectivity of the observer.
Non-participant observation: Observes the natural setting without becoming the member of the group to be observed. Usually structured.
Observer preplans the likely nature of the natural setting, representatives of the data, problems associated with the presence of the investigator etc. because the observation is structured, results are more reliable. Not influenced by the subjectivity of the observer. Observer misses the important aspect of the group. Participants become conscious that they are being observed.
Psychological tests are written, visual, or verbal evaluations administered to assess the cognitive
Psychological tests are used to assess a variety of mental abilities and attributes, including
Psychological tests are formalized measures of mental functioning. Also known as inventories, measurements, questionnaires, and scales,
psychological tests are administered in a variety of settings, including preschools, primary and
secondary schools, colleges and universities, hospitals, outpatient healthcare settings, social agencies, prisons, and employment or human resource offices.
PSYCHOLOGICAL ASSESSMENT/TESTING
1. Assessment of Cognitive functionsThe functions are attention and concentration, perception, memory, intelligence, thinking and reasoning. 2. Assessment of personality and interpersonal relationship (Extrovert, introvert, ambivert, shy, tense, extravagant, outgoing etc.) 16 PF, California Psychological inventory.
3. Diagnostic assessments: Used for the diagnostic purpose with the help of tests like- MPQ, Childhood Autism Rating scale, Adolescent Psychopathology
4. Neuropsychological assessments: Assessment of brain behavior relationship lateralization & localization of functions & structures
5. Vocational assessments and assessments of interests and Aptitudes. (Differential aptitude test, Wide Range achievement test.) 6. Behavioral assessment behavioral diagnosis
FACTORS INFLUENCING PSYCHOLOGICAL ASSESSMENT 1. 2. 3. 4. 5. 6. 7. 8. Age children/adolescence/adults/old aged Education Occupation type/nature of the work Sex Socio- cultural background Interest/ Motivation/ Co-operation Physical or sensory impediments- visual/hearing/orthopedic Theoretical orientation of the clinician
New terms
1. Classification: is a broad term, the action or process of classifying. 2. Taxonomy: (Chiefly Biology) the branch of science concerned with classification. Refers to the classification of entities like insects, rocks. 3. Nosology: the branch of medical sciences concerned with the classification of diseases. 4. Nomenclature: The term which describes the names or labels of the disorders.
HISTORY
Egypt and Sumeria, two conditions Melancholia & Hysteria were identified 2600 B.C. India, psychiatric nosology was contained within the medical classification system of Ayur-Veda written about 1400 B.C.
Hippocrates & Plato - classified mental disorders in Greece based on empirical observation.
European Renaissance, Carous Linneaus and Francois Boisser attempted to apply the taxonomic methods of biology to medical and psychiatric illness. Paradigms based on observation continued during the 19th century and theory
Emil Krapelin - Natural classification in which, cause, symptomatology & course were expected, but finally the classification ended up with the inclusion of mainly symptoms.
HISTORY
First modern attempt at classification was International list of causes of Death (1893). The first nosology of psychiatry - in USA by American Medico-Psychological association (1918) / American Psychiatric association - consisted 22 disorders
Following the World War II, WHO developed 6th revision of Manual of International Statistical Classification of Disease, Injuries and Causes of Death 1948 included psychiatric disorders for the first time. ICD 8 (1972) glossary ICD 9 (1978) glossary ICD 10 (1992) International Statistical classification of diseases & related health problems
ICD
The
American
Problem: based on the biological tradition hence is possible in case of medicine. Example: In Downs syndrome 21st extra chromosome
2. Dimensional approach - variety of cognitions, moods, behavior which the patient presents quantified in a scale.
Example: on a scale of 1 to 10 patient might be rated as severely anxious (10), moderately depressed (5) etc. This approach is applied in diagnosis.
Problem - most theories do not agree on how many dimensions are required- one or many?
3. Prototypical approach alternative approach in the classification of behavioral disorders gaining increasing support in recent years by experts all over the world. basically combines some of the essential features of first two approach. makes use of some non-essential features of clinical conditions in the classification. Example: DSM classification
5. To deal with any medico-legal issues 6. To avail any facilities or provisions made by law and govt.
DIAGNOSTIC AND STATISTICAL MANUAL OF DISORDERS (DSM ) This system was evolved and prevailing in USA,
1.Multi axial classification, I, II, III, IV & V axis 2.Provisions for the gradation of severity of
clinical conditions
3.Provisions for frequently used criteria and
associated features
(clinicians/familial
&
Since then
required to be revised. Since its foundation, the WHO ( 1948 ), assumed the responsibility of preparation of this system. The 6th revision taken place in 1948. In the 10th revision which was revised in the year 1992, there are three axis
Books of reference
Korchin, S.J. ( 1976). Modern Clinical Psychology, New York: Basic Books, Inc., Publishers. Gelder,M., Gath,D. & Mayou,R. (1983). Oxford Text book of Psychiatry. Oxford: Oxford University press. Sadock, B.J., & Sadock, V.A. (2000). Comprehensive text book of Psychiatry. New York: Lippinccott Williams & Wilkins. Franks, C.M. 9 1969). ( Ed.) Behavior therapy. New York: Mc Graw- Hill Book Ccompany Donna m. Gelfand & Donald P. Hartmann (1989) Child Behavior Analysis & Therapy II Ed.