Chapter 3

• Clinical assessment


  Systematic evaluation and measurement of psychological and social factors in individuals with potential psychological disorders
• Diagnosis


  Process of identifying a disease by its manifestations, including symptoms, signs, and investigative results
• Diagnosis (etymology)


  Derived from Greek roots meaning "knowing through setting apart," implying gaining knowledge by analyzing elements and their interrelations
• Diagnosis relies on


  • Gathering symptoms
  • Gathering signs
  • Psychological tests
  • Third-party reports
  • Laboratory investigations
• Symptoms


  Perceived changes indicating presence or absence of abnormality, reported by the individual
• Signs


  Observable manifestations of a condition, detected by another person
• Differentiating between symptoms and signs can be nuanced; emphasis is on observing and describing phenomena
• Diagnostic process seeks to answer


  • Who
  • Why
  • What
• Paths to diagnosis


  • Algorithmic approach
  • Pattern-recognition approach
  • Hypothetico deductive method
  • Pathognomonic diagnosis
• Levels of diagnosis


  • Experiential or phenomenological
  • Syndromal diagnosis
  • Disorder level
  • Anatomical diagnosis
  • Functional diagnosis
• Differential diagnosis


  Provides a list of possible conditions conforming to available clinical information
• Reliability


  Consistency of measurement; assessed through inter-rater reliability and test-retest reliability
• Validity


  Whether an assessment measures what it's designed to measure; includes concurrent and predictive validity
• Standardization


  Process ensuring consistent use of assessment techniques across different measurements, considering factors like age, race, gender, and diagnosis
• Clinical encounter


  Central to clinical work, emphasizing a natural, unthreatening interaction over a question-answer format
• Components of the clinical encounter

  • History
  • Mental state examination
  • Behavioral observations
• Scientist-practitioner role


  Balances systematic, structured approach with the need for natural human interaction
• Elements of clinical history

  • Who and why
  • Presenting complaint
  • Asking about psychotic phenomena
• Psychotic phenomena and delusional beliefs

  Hallucinations and delusions are subjective phenomena reported in the clinical history
• Clinician identifies abnormality of hallucinations and delusions; content reported in mental state examination
• Elements of clinical history

  • Primary complaint
  • Systematic enquiry
  • Reliance on other sources
• Practitioners must develop skills to seamlessly gather information from various sources, building a comprehensive understanding of the individual being assessed
• Mental state examination


  An essential part of clinical assessment, focusing on a person's state of consciousness, cognition, emotions, thoughts, communication, and behavior
• Domains of the mental state examination

  • General appearance
  • Cognition
  • Mood and affect
  • Reality testing and organization
  • Behavior
• Cognitive disturbances are prioritized due to their potential severity, risk to life, and reversibility
• Impaired attention, memory, and other cognitive functions may indicate serious physical disease and can account for other psychological phenomena
• Informal behavioral observations


  Preliminary observations guide further assessment and hypothesis-testing
• Informal behavioral observations provide insights into patient's vulnerabilities, strengths, and supports
• Conducting the clinical assessment emphasizes building trust and empathy with the patient to facilitate communication
• Other clinical aids


  • Physical examination
  • Semi-structured interviews
  • Psychometric and neuropsychological testing
  • Special medical investigations
• Standardized screening tools and rating scales aid in detecting and monitoring cognitive impairment and mental health conditions
• Many physical conditions manifest primarily with emotional, behavioral, or experiential disturbances
• Failure to recognize underlying physical causes may lead to serious consequences
• Psychologists and mental health professionals should be aware of medical conditions and substance abuse contributing to psychological problems
• Physical examination offers valuable insights into a patient's mental state and behavior
• Semistructured interviews involve carefully phrased and tested questions to elicit useful information consistently
• Integrating physical examination with clinical interviews enhances diagnostic accuracy and treatment planning
• Behavioral assessment


  Involves formally observing an individual's thoughts, feelings, and behavior in specific situations or contexts
• Types of behavioral assessment techniques

  • Direct observation in naturalistic environments
  • Analog settings
• Direct observation offers a more comprehensive understanding of a person's behavior than verbal reports alone