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• Clinical assessment


  Collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine the person's problem and the presenting symptoms
• Clinical diagnosis


  The process of using assessment data to determine if the pattern of symptoms the person presents with is consistent with the diagnostic criteria for a specific mental disorder outlined in an established classification system such as the DSM-5-TR or ICD-11
• Before starting any type of treatment, the client/patient must be clearly diagnosed with a mental disorder
• Receiving a diagnosis does not necessarily mean the person requires treatment. This decision is made based upon how severe the symptoms are, level of distress caused by the symptoms, symptom salience such as expressing suicidal ideation, risks and benefits of treatment, disability, and other factors
• A patient may not meet the full criteria for a diagnosis but demonstrate a clear need for treatment or care, nonetheless
• Deviation


  Significant deviation from the individual's baseline state and what is deemed "normal" in the overall community
• Dysfunction


  If the person's ability to function in some of these roles are significantly and adversely impacted by psychological symptoms, a diagnosis may be warranted
• Distress


  The symptoms should be uncomfortable, irritating, and cause pain for the person. This isn't always the case, as in the manic phase of bipolar disorder, the early phases of eating disorders, and addiction disorders, the "symptoms" are not viewed as distressing or problematic by the sufferer
• Danger


  Safety risks worth considering during a psychological evaluation
• Duration


  Significant deviation from the individual's baseline state and what is deemed "normal" in the overall community
• Classification systems provide mental health professionals with an agreed-upon list of disorders falling into distinct categories for which there are clear descriptions and criteria for making a diagnosis
• ICD-11 (International Classification of Diseases) disorder categories

  • Neurodevelopmental disorders
  • Schizophrenia or other primary psychotic disorders
  • Catatonia
  • Mood disorders
  • Anxiety or fear-related disorders
  • Obsessive-compulsive or related disorders
  • Disorders specifically associated with stress
  • Dissociative disorders
  • Feeding or eating disorders
  • Elimination disorders
  • Disorders of bodily distress or bodily experience
  • Disorders due to substance use or addictive behaviours
  • Impulse control disorders
  • Disruptive behaviour or dissocial disorders
  • Personality disorders and related traits
  • Paraphilic disorders
  • Factitious disorders
  • Neurocognitive disorders
  • Mental or behavioural disorders associated with pregnancy, childbirth or the puerperium
• Mental disorder (DSM-5 definition)


  A clinically significant disturbance in cognition, emotion regulation, or behavior that indicates a dysfunction in mental functioning that is usually associated with significant distress or disability in work, relationships, or other areas of functioning
• Expectable reactions to common stressors are not mental disorders
• The most widely used classification system in the United States is the Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Hippocrates


  • Wrote extensively about abnormality, but unlike most of his predecessors, he did not offer supernatural explanations such as possession by demons or gods. Instead, his theories of abnormality emphasize natural causes
• Emile Kraepelin


  • His work has resulted in his reputation as a founding father of the current diagnostic system
• DSM-I and DSM-II


  • Definitions of disorders were not scientifically or empirically based, but represented the accumulated clinical wisdom of the small number of senior academic psychiatrists who staffed the DSM task forces
  • They were not lists of specific symptoms or criteria, but simply prose, typically one paragraph per disorder, offering relatively vague descriptions of clinical conditions
• DSM-III, III-R, IV, and IV-TR

  • They were significantly longer and more expansive diagnostic manuals than their predecessors
  • They included lists of specific symptoms or criteria for each disorder
• DSM-IV Multiaxial Assessment


  • Axis I: Clinical Disorders or Other Conditions (except personality disorder & mental retardation)
  • Axis II: Personality Disorders and Mental Retardation
  • Axis III: Medical Condition that are relevant to the treatment of Axis I and II
  • Axis IV: Psychosocial and Environmental Problems
  • Axis V: Global Assessment of Functioning (GAF) score on scale 1-100
• DSM-5 disorder categories


  • Neurodevelopmental disorders
  • Schizophrenia Spectrum
  • Bipolar and Related
  • Depressive
  • Anxiety
  • Obsessive-Compulsive
  • Trauma- and Stressor-Related
  • Dissociative
  • Somatic Symptom
  • Feeding and Eating
  • Elimination
  • Sleep-Wake
  • Sexual Dysfunctions
  • Gender Dysphoria
  • Disruptive, Impulse-Control, Conduct
  • Substance-Related and Addictive
  • Neurocognitive
  • Personality
  • Paraphilic
• Some of the most significant changes in DSM-5 do not focus on specific disorders but on the way the entire manual is organized or presented
• The multiaxial assessment system—a central feature of DSM since its introduction in DSM-III in 1980—was dropped altogether from DSM-5
• New Disorders in DSM-5

  • Premenstrual dysphoric disorder (PMDD)
  • Disruptive mood dysregulation disorder (DMDD)
  • Binge eating disorder (BED)
  • Mild neurocognitive disorder (mild NCD)
  • Somatic symptom disorder (SSD)
  • Hoarding disorder
• Psychopathologist


  Scientist that studies the cause of mental disorders and the factors that influence its development
• Abnormal behavior


  • No single descriptive feature is shared by all abnormal behavior
  • No one criteria are sufficient to define abnormal behavior
  • No discrete boundary between abnormal and normal behavior
• Mental Illness Definition


  • A behavioral or psychological syndrome (cluster of abnormal behaviors) must be linked to distress, disability or a risk of problems
  • Represents a dysfunction within an individual
  • Not all deviant behavior or conflicts in society are indicative of a mental disorder (e.g. cultural, religious, sexual deviance)
• Diagnosis


  • A type of categorization
  • Allows us to make distinctions for survival
• Advantages of Diagnosis


  • Communication - conveyed through a diagnostic term ("verbal shorthand")
  • Standardized criteria allow for comparison across states and clinicians
  • Promotes empirical research in psychopathology
  • Allows for research into the etiology/causes of abnormal behavior
  • Suggests which model of treatment is most likely to be effective
• Early Classification Systems


  • Emil Kraepelin - father of modern systems of psychiatric diagnostic criteria
  • 1889 - Congress of Mental Science adopted a classification system in Paris
  • 1948 - World Health Organization developed a classification system
  • 1952 - American Psychiatric Association developed Diagnostic and Statistical Manual (DSM-I)
  • 1968 - DSM-II
  • 1980 - DSM-III (Major change in diagnostic criteria)
  • 1987 - DSM-III-R
  • 1994 - DSM-IV; published an additional DSM for children aged 0-31
  • 2000 - DSM-IV-TR
  • 2013 - DSM-V
• DSM-IV-TR


  • Changes were based far more on empirical data than previous versions
  • Multiaxial Assessment: Complete diagnostic evaluation; clients are evaluated on 5 domains
  • Principal Diagnosis: Main diagnosis or condition for which patient seeks treatment
• Multiaxial Assessment Axes


  • Axis I: Clinical Disorders or Other Conditions (except personality disorder & mental retardation)
  • Axis II: Personality Disorders and Mental Retardation
  • Axis III: Medical Condition that are relevant to the treatment of Axis I and II
  • Axis IV: Psychosocial and Environmental Problems
  • Axis V: Global Assessment of Functioning (GAF) score on scale 1-100
• Assessment in Clinical Psychology

  • 1960's and 1970's - Decline in assessment measures and focus more on therapy
  • Clinical Assessment: Evaluation of an individual or family's strengths and weaknesses, conceptualization of the problem and prescription for alleviating it
  • Our capacity to understand a problem is based on our skill to diagnose it (diagnose before treatment)
  • Referral Question: Take into consideration what question was asked by the referral source and what the referral source is seeking
• Referral Question


  What question was asked by the referral source and what the referral source is seeking
• What Influences How the Clinician Addresses the Referral Question

  • The type of information asked is often based on the clinician's theoretical approach
  • Assessment Interview: Most basic and serviceable data gathering tools. It has a wide range of application and adaptability, but this again depends on the clinician's skills
• Interview


  • Interaction between at least 2 people in which each person contributes to the process and influences the other's response
  • Involves face-to-face interaction but the conversation is based on a specific set of goals in mind
  • Not based on personal satisfaction or prestige (used to gather data and information)
• Interviews vs Tests


  • More purposeful but less formalized than standardized psychological tests
  • Psychological tests - collection of data under standardized conditions using structured procedures
  • Interviews can use an individualized approach and are more flexible
• The Art of Interviewing

  • Except for diagnostic interviews have a degree of freedom to their structure
  • Clinician slowly learns to respond to patients cues over time
• Computer Interviewing


  • Asks all the questions that are assigned and has 100% reliability
  • May be less uncomfortable for patient to answer in private (dehumanizing to an extent)
  • Clarification of interview questions is not possible and there is no flexibility room
  • Computers can't assess non-verbal cues, can't assess free-form responses, can't apply clinical judgment to patients
• Interview Essentials and Techniques

  • The setting needs to consider privacy and protection from interruptions
  • Few key note phrases will aid the clinician in recalling client's responses
  • Rapport: Characterize the relationship between patient and clinician, involving comfortable atmosphere and mutual understanding of the purpose and goals of interview
  • Requires attitude of acceptance, understanding, respect for patient's integrity
  • Does not require the clinician to like or be friends with the patient
  • Allows for probing and confrontation once rapport has been established