User:Atcovi/Psychopathology/Chapter 4

Clinical Assessment, Diagnosis, and Treatment

 * Assessment: Bringing about relevant information to come up with a conclusion.
 * Clinical assessment: The whether, how, and reasoning behind a person behaving 'abnormally' and how a professional can assist them.

Idiographic information: info about a certain individual, rather than the population.

Clinical assessment tools range from clinical interviews, clinical tests, and clinical observations. These tools need to be standardized, be reliable and valid.

What does it mean to be standardized?

 * Common steps that need to be followed (fasting for glucose blood tests).
 * Standardize administration/scoring/conclusions (don't include skewed groups).

What does relaibility mean?

 * Consistency of a measured assessment (yield same results in same scenario).
 * Divided between test-retest reliability (same test results for same people) and interrater reliability (separate judges agree on how to score and conclude a certain tool).

What does validity mean?

 * Accuracy of a tool's result, so the tool must properly measure what it should measure (weight scale). An example is a broken weight that weights 200lb each time, which renders good reliability but poor validity.
 * Three types: face validity (a tool measures what makes sense [time spent smiling --> mood]), predictive validity (a tool that correctly/sufficiently predicts future consequences [SAT score --> college success]), and concurrent validity (a tool's results agree well with other measures of similar behavior [anxiety test --> evidence of anxiety]).

Clinical Interviews
Irl interviewers designed to get theoretical focus. Unstructed are open-ended, while structured ones are specfic (mental status exam).

Limitations

 * Lack accuracy
 * Interviewer may be bias or make judgemental errors.
 * Not very reliable
 * Interviewing may be too subjective to be used as a measuring stick.

Clinical tests
A device to gain info about certain parts of one's psycho functioning from which we can draw bigger conclusions.

6 kinds of clinical tests include:


 * 1) Clinical Tests: Projective Tests: Ambiguous material, people respond to it. They 'projects' parts of their persona. Used by psychodynamic clinicians to see 'unconscious drives'. This includes TAT (dramatic story of black and white pictures), Rorschach test (10 ink blots create an image that has a good idea of their psychology), sentence-completion tests, and drawings (draw human figures and talk about them). Strengths: Used popularily until 1950s, now used as an extra. Limitations: Not very reliable, not very valid either and could be prejudice.
 * 2) Personality Inventories: Measure broad persona characteristics, emphasis on behaviors, beliefs, and feelings. Is self-reported. Mostly uses the MMPI. MMPI is 500 statements, true/false/cannot say, above 70 is a "deviant". Use it to create a profile. Strengths: Easy, cheap, fast. Objective scoring, good reliability. Limitations: Not very valid, measured traits cannot be thoroughly assessed, and tests don't account for cultural differences.
 * 3) Response Inventories: Self-reported responses, focus on only ONE specific area of functioning. May meausre affective inventories, social skills inventories, or cognitive inventories. Weaknesses: Not very reliable, valid and have not been standardized.
 * 4) Psychophysiological Tests: Measure physiological response, indicates psycho problems (abnormal heart rate --> problem). Includes polygraphs: less trusted, MRI studies better, but still used. Strengths: Key role in certain assessments, but can eb expensive and inaccurate.
 * 5) Neuroimaging and Neuropsychological Tests: Direct testing to brain structure and activity, includes CAT scans, EEG, PET scans, MRI, and fMRI. Problem is they are expensive and can't detect ALL brain abnormalities, especially subtle ones.
 * 6) Intelligence Tests: Indirectly measures intellectual ability, such an IQ test (verbal and nonverbal skills being tested on a series of tests). Ratio of person's mental age to chronological age. Strengths: Most carefully produced clinical test, very reliable and valid, and highly standardized Weaknesses: Factors, like laziness, can influence this, tests may be bias in terms of language and may put minorities at a disadvantage.

Clinical Observations
This is just observing patients in their homes, schools or institutions. Everyday thing, but not sure if it is reliable or valid. If we can't do natural viewing, then we use analogue observations.

Weaknesses


 * Observer overload - observer can record all important behaviors/events.
 * Observer drift - decline in accuracy due to fatigue.
 * Observer bias - Bias may play into how they see someone act and behave.
 * Patient reactivity - "Oh, I'm being watched? I shouldn't do this".
 * HORRIBLE cross-situational validity

Self-monitoring could another option, but validity is an obvious problem.

Classification system
Gather symptoms, find out the syndrome (cluster of symptoms), and then make diagnosis. These are based on already documented classification systems. Example is generalized anxiety disorder, which carry a road of symptoms (poor focus, annoyed all the time, bad sleep, etc.). How many symptoms constitute GAD?

We look to the DSM (Diagnostic and Statistical Manual of Mental Disorders), for example, GAD must have horrible anxiety and worry for at least 5 months. Associated with 3+ symptoms.

Emil Kraepelin published a textbook that argued physical factors, such as fatigue, could be responsible for mental illness. In 1883, the classification system for abnormal behavior he founded soon became the stepping stones for the DSM. DSM has changed significantly over the years. Other countries rely on the ICD-11.

DSM-5-TR needs clinicians to bring categorical info (name of disorder by the client's symptoms) and dimensional info (how bad are the client's symptoms? how abnormal is the client's behavior across dimensions of persona?). See slide 45 to see this being applied to GAD. It provides incredible validity compared to previous editions, but is still an issue (procedures make it somewhat invalid and reliability is an issue). RDoC framework classifies disorders that go from research of the current diagnostic system to simpler means.

HiTOP serves to deal with psychiatric comorbidity.

But midsagnosis cause harm, and labeling may lead to more 'abnormality'.

Treatment (slide 48+)
Treatment: procedure created to change odd/abnormal behavior to more normal behavior.

Consists of:

Use info and diagnostic decisions to come up with a treatment plan, using idiographic and nomothetic information. Other factors included are therapist's theoretical orientation, current research, and general state of clinical knowledge (empirically supported, evidence-based treatment).
 * 1) Patient
 * 2) Trained therapist
 * 3) Number of therapeutic contacts between therapist and patient.

Outcome

 * Is the therapy effective?
 * Which therapies are more effective?
 * Are certain therapies better for certain problems?

Effectiveness

 * How is success measured?
 * How do we see objective improvement?
 * Variety and complexity of treatment, how do we determine if those things influence effectiveness evaluation?
 * These factors are more likely to influence the outcome of treatment: client's expectations, client-therapist relationhip, client's current life.

What's Ahead?
See slide 55