L5

• Clinical assessment


  The process of collecting relevant information and trying to formulate a conclusion on what might be happening with an individual
• Purpose of clinical assessments


  • Determine whether a person is behaving abnormally
  • Determine how a person is behaving abnormally
  • Determine why a person is behaving abnormally
  • Determine how they might be helped
  • Indicate progress after treatment
• Choice of assessment tool


  Influenced by clinician's theoretical orientation
• If the clinician is from a psychodynamic background, then it would be likely that the assessment would tap into unconscious influences on behaviour
• Other factors to consider

  • How long the patient has been experiencing symptoms
  • Whether the patient is already receiving treatment
  • How culture/beliefs may affect their behaviour
• Clinical interview

  A conversation between a clinician and a patient
• Types of clinical interviews

  • Structured
  • Semi-structured
  • Unstructured
• Clinician observations during clinical interview

  • Appearance
  • Behaviour
  • Emotions
  • Movement
  • Speech
  • Mental processes
• Patient's self-report is also crucial
• Malingering may occur during clinical interviews
• Clinical interviews are subject to reporting bias
• Children may lack insight or verbal ability to report reliably
• Assessing family functioning

  Various forms of assessment used e.g. interviewing family members, patient self report, observations, scales
• Assessing community

  Informs what's 'normal' in the patient's environment, not only where they live, but also where they work and spend most of their time
• Cultural variations exist in many forms e.g. manner of describing symptoms
• Assessing brain structure

  Disorders may involve abnormalities, assessed through images: X-Rays, CT Scans & MRIs
• Assessing brain function

  Functional neuroimaging is used to assess functioning: PET scans & fMRI
• Neuropsychological assessment

  Behavioural responses are used to infer brain functioning, can distinguish between effects of brain damage and those of psychological problems, can also be used to show whether brain damage is a contributing factor to psychological problems
• Cognitive assessment

  Intelligence tests like Weschler Adult Intelligence Scale (2008) or Weschler Intelligence Scale for Children (2003)
• Personality assessment

  Inventories used to assess general personality functioning e.g. Minnesota Multiphasic Personality Inventory (Butcher et al., 1989)
• Projective tests

  Involve interpretation of ambiguous stimuli in order to reveal facets of personality that cannot be revealed via self report e.g. Rorschach test
• Diagnosis

  The process of identifying the nature of a disorder
• Diagnostic classification systems

  Clusters of symptoms are classified in order to form distinct disorders
• To make a diagnosis, a clinical assessment is made by a trained clinician
• Uses of diagnostic classification systems

  • Provide researchers and clinicians with shorthand for communicating complex information
  • Allow grouping of symptoms (thoughts, feelings & behaviours) into unique constellations
  • Diagnosis may allude to other factors relating to the disorder (e.g. aetiology, prognosis etc)
  • Diagnosis may help identify those needing further help/input (e.g. Treatment, support, benefits)
  • Diagnosis may provide relief for individual experiencing the condition
• Diagnostic bias

  Systematic error in diagnosis, evidenced by disproportionate numbers of certain groups diagnosed based on unrelated factors
• Clinician's familiarity with certain cultural and other group social norms is influential in diagnostic bias
• Under-diagnosis may result from inappropriate classification system
• Stigma


  Diagnosis may be used as a label that stigmatises the individual with a disorder
• Some improvements with mental health stigma but not perfect, issue of 'sticky labels'
• Reliability


  Consistency of results each time the classification system is applied
• Issues with reliability may arise from unclear criteria for disorders or significant overlap among disorders
• Validity


  Classification systems actually characterise what they are supposed to characterise
• Diagnostic and Statistical Manual of Mental Disorders (DSM)


  Most commonly used classification system, published by the American Psychiatric Association
• Versions of the DSM


  • DSM (1952) - Psychodynamic oriented, focused on the clinicians needs
  • DSM-II (1968) - Minor revisions, still psychodynamic oriented
  • DSM-III (1980) - Major revision: reliability & validity focused, specific criteria for disorders listed
  • DSM-IV (1994) - New disorders specified & criteria revised for previous disorders
  • DSM-IV-TR (2000) - Expanded version with more information about each disorder
  • DSM-5 (2013) - Aimed to address weaknesses of DSM-IV-TR
• DSM-5 criticised for being less based on research than its predecessor (DSM-IV-TR)
• DSM-5 uses Arabic numerals in order to create web based releases/updates e.g. 5.1; 5.2 etc
• Criteria for disorders in DSM-5 require subjective judgement, e.g. criteria for adjustment disorders
• People with different symptoms can be diagnosed with the same disorder in DSM-5 (heterogeneous groups)
• DSM-5 criteria for substance use disorder


  • Substance often taken in larger amounts or over a longer period than was intended
  • Persistent desire or unsuccessful efforts to cut down or control use
  • Great deal of time spent in activities necessary to obtain substance, use or recover from substance effects
  • Craving or strong urge to use
  • Recurrent use leading to failure to fulfill major role obligations
  • Continued use despite persistent social/interpersonal problems
  • Giving up important social/occupational/ recreational activities
  • Repeated use in physically hazardous situations
  • Continued use despite physical/psychological problems caused or made worse by substance
  • Tolerance
  • Withdrawal