Assessment and Diagnosis

1. Assessment and Diagnosis

2. 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

3. 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

4. Validity • Extent to which test measures what it is supposed to measure • Face validity is not sufficient • Must do a series of validity studies

5. 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

6. 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

7. 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?

8. 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

9. Assessment • Will definitely involve • Clinical interview • Will probably involve • Psychological testing • May also involve • Referral for physical exam • Direct behavioral observation • Neuroimaging • Neuropsychological testing

10. Clinical Interview • Mental status exam • Presenting problem • History

11. Mental Status Exam • Appearance and behavior • Thought process • Mood and affect • Intellectual functioning • Sensorium

12. Presenting Problem • What’s prompting the person to seek treatment?

13. History • Family • Social/developmental • Family members with relevant medical or psychological problems • Educational • Occupational • Medical • Psychological

14. Psychological Testing • Projective • Based on projective hypothesis • Examples: Rorschach Inkblot Test, Thematic Apperception Test • Criticized for lacking reliability and validity

15. 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

16. 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

17. 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

18. Validity Scales (continued) • Defensiveness (K): • assesses whether person sees himself in an unrealistically positive way • Variable Response Inconsistency (VRIN) • measures random responding

19. Physical Exam • May need to rule out or treat some underlying health problem

20. Direct Behavioral Observation • Especially with children • Focus on • Antecedent • Behavior • Consequences

21. 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

22. Neuropsychological Testing • IQ, memory, attention, problem solving • Applications: • diagnosis • litigation • recommendations about school, work, independent living

23. 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

24. 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.

25. 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)

26. Sample Diagnosis Axis I: 296.33, Major depressive disorder, recurrent, severe without psychotic features 305.00, Alcohol abuse Axis II: 301.83, Borderline personality disorder Axis III: No diagnosis Axis IV: Occupational problems Axis V: Current GAF = 10, Highest GAF in past year = 55

27. 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