333assessment.ppt

Assessment and Diagnosis

Major Points

• Treating mental health problems involves gathering sufficient information to– make an accurate diagnosis (descriptive label)– create a treatment plan that is likely to be helpful

• To be of any value, this information-gathering process (assessment) must be– reliable– valid– standardized

Reliability• Consistency of measurement• Inter-rater

– Consistency across raters– Extent to which different people scoring same test

get same result

• Test-retest– Consistency across time– Extent to which people get same results if take

test again

Validity

• Extent to which test measures what it is supposed to measure

• Face validity is not sufficient

• Must do a series of validity studies

Ways to measure validity

• Criterion validity– Correlation between test and concrete,

directly observable criterion– Example: correlate self-report of weight

with actual weight on scale

Ways to measure validity (continued)

• Concurrent validity– aka convergent validity– Agreement among alternative measures of

same construct– Example: correlation between standard IQ

test and newer, brief version

Ways to measure validity (continued)

• Predictive validity– How well assessment tells you what will

happen in future– Example: Does new, brief IQ test predict

who will succeed in school?

Standardization

• Certain set of procedures is used to ensure consistency in how test is given and how results are interpreted

• Applies to:– Procedures of testing/interview– Scoring:

• Test should be scored in reference to norms• Allow you to know which scores of are high,

low, average

Assessment

• Will definitely involve– Clinical interview

• Will probably involve– Psychological testing

• May also involve– Referral for physical exam– Direct behavioral observation– Neuroimaging– Neuropsychological testing

Clinical Interview

• Mental status exam

• Presenting problem

• History

Mental Status Exam

• Appearance and behavior

• Thought process

• Mood and affect

• Intellectual functioning

• Sensorium

Presenting Problem

• What’s prompting the person to seek treatment?

History• Family

– Social/developmental– Family members with relevant medical or

psychological problems

• Educational• Occupational• Medical• Psychological

Psychological Testing

• Projective– Based on projective hypothesis– Examples: Rorschach Inkblot Test,

Thematic Apperception Test– Criticized for lacking reliability and validity

Psychological Testing (continued)

• Objective– Less room for subjective interpretation– Examples: Minnesota Multiphasic

Personality Inventory-2 (MMPI-2), Symptom Checklist-90, Revised (SCL-90-R)

– Reliability and validity are good

MMPI-2• 567 T-F items• items distinguish between clinical groups and

normal individuals• scored in reference to norms• clinical and content scales assess various

clinical problems: depression, antisocial behavior, paranoia, anxiety, mania, psychotic sx

MMPI-2 (continued)

• has validity scales– Lie (L):

• Includes items such as “I have never had a bad night’s sleep”

• high scores suggest that the person is falsifying answers in an attempt to look good.

– Infrequency (F):• high scores suggest that the person is making

false claims about psychopathology or that the person has responded randomly

Validity Scales (continued)

• Defensiveness (K):– assesses whether person sees himself in

an unrealistically positive way

• Variable Response Inconsistency (VRIN)– measures random responding

Physical Exam

• May need to rule out or treat some underlying health problem

Direct Behavioral Observation

• Especially with children

• Focus on – Antecedent– Behavior– Consequences

Neuroimaging

• Brain structure– CT (computerized tomography)– MRI (magnetic resonance imaging)– used to diagnose stroke, tumor

• Brain function– PET (positron emission tomography)– Functional MRI (fMRI)– used primarily for research purposes

Neuropsychological Testing

• IQ, memory, attention, problem solving

• Applications:– diagnosis– litigation– recommendations about school, work,

independent living

DSM

• Diagnostic and Statistical Manual of Mental Disorders

• Has undergone multiple revisions– To increase reliability and validity

• Current version is DSM-IV-TR– 4th edition, text revision

DSM-IV-TR

• Symptoms for each diagnosis are clearly listed.– Number of symptoms necessary to receive

diagnosis is specified.

• Assumptions about causes not included.– Focus only on observable behavior.

• Person given diagnosis on 5 axes.

5 Axes

Axis I: disorder itself

Axis II: personality disorders and mental retardation

Axis III: medical conditions

Axis IV: psychosocial and environmental stressors

Axis V: global assessment of functioning (current and highest in past year)

Sample Diagnosis

Axis I: 296.33, Major depressive disorder, recurrent, severe without psychotic features305.00, Alcohol abuse

Axis II: 301.83, Borderline personality disorderAxis III: No diagnosisAxis IV: Occupational problemsAxis V: Current GAF = 10, Highest GAF in past

year = 55

Sample Diagnosis

• Axis I: 296.43, Bipolar disorder, most recent episode manic

• Axis II: Diagnosis deferred• Axis III: HIV positive • Axis IV: Problems with primary support

group, housing problems• Axis V: Current GAF = 40, Highest

GAF in past year = 80