3a Assessment of Mental Health Problems

PSYG2500 Abnormal Psychology/3a.md

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+# 3. Assessment of Mental Health Problems
+
+## Introduction to Basic Elements in Assessment
+
+Interaction of **Importance of trust and rapport** and **Impact on assessment** process.
+
+### Identification of presenting problem
+
+- Situational or pervasive?
+- Duration?
+- Prior attempts to help or treat?
+- Self-defeating or resourceful?
+- How does problem impact social roles?
+- Does problem match any DSM-5 disorder criteria?
+
+### Advantage of classification of presenting problem
+
+- Treatment planning
+- Knowledge of range of diagnostic problems
+- Insurance payment
+
+### Good assessment includes
+
+**social history noting:**
+
+- Personality factors
+- Social context
+
+**various professional orientations:**
+
+- May determine assessment techniques
+- Does not limit clinician to one type of assessment
+
+### Dynamic formulation
+
+Describes the current situation but also includes hypotheses about what is driving the person to behave in maladaptive ways.
+
+- Hypotheses about future behavior are derived.
+- Decisions about treatment are made collaboratively  with the consent and approval of the individual.
+- Assessment may involve the coordinated use of physical, psychological, and environmental procedures.
+
+### Psychological Assessments are
+
+- Reliable
+- Valid
+- Standardized
+
+## Assessment of the Physical Conditions
+
+### General physical examination
+
+Many psychological problems have physical components either as
+
+- Causal factors
+- Symptom patterns
+
+### Neurological examination
+
+- **EEG:** graphical record of brain’s electrical activity
+- **CAT scan & MRI:** images of brain structures that may be damaged or diseased
+- **PET scan:* metabolic activity of specific compounds
+- **fMRI:** mapping psychological activity to specific regions in the brain
+
+### Neuro-psychological examination
+
+- Involves use of expanding array of testing devices
+- Measures cognitive, perceptual, and motor performance
+- Provides clues to extent and location of brain damage
+
+**Halstead-Reitan Neuropsychological Battery (HRNB) (10 tests in total):**
+
+- **Halstead Category Test:** Learn & remember
+- **Tactual Performance Test**: Motor function, response, tactile & kinesthetic cues
+- **Rhythm Test:** Attention, sustained concentration
+- **Speech Sounds Perception Test:** Identify spoken words
+- **Finger Oscillation Task:** Speed
+
+## Psychosocial Assessment
+
+### Assessment Interviews
+
+- Face-to-face interaction
+- Structured interviews
+- Unstructured interviews
+
+### Clinical Observation of Behavior
+
+- Clinical observation in natural environments
+- Clinical observations in therapeutic or medical settings
+- Self-monitoring
+
+### Psychological Tests
+
+#### Intelligence tests
+
+- WISC-IV(children); WAISIV (adults)
+- Stanford-Binet
+
+#### Personality tests
+
+##### Projective personality tests
+
+- Unstructured stimuli are presented
+- Meaning or structure projected onto stimuli
+- Projections reveal hidden motives
+
+**Projective personality tests examples:**
+
+- Rorschach Inkblot Test
+- Thematic Apperception Test (TAT)
+- Sentence Completion Test
+
+##### Objective personality tests
+
+Examples: NEO-PI, MMPI-2
+
+Objective personality tests offer several advantages, such as standardization, efficiency, and ease of administration, but also have limitations, including limited depth, potential response distortion, and cultural bias.
+
+## The Integration of Assessment Data
+
+- Developing integrated, coherent working model
+- Utilizing individual or team approach
+- Identifying definitive picture vs. discrepancie
+
+### Ethical Issues in Assessment
+
+- Potential cultural bias
+- Theoretical orientation of clinician
+- Underemphasis on external situation
+- Insufficient validation
+- Inaccurate data or premature evaluation
+
+## Classifying Abnormal Behavior
+
+- Classification involves attempts to delineate meaningful sub-varieties of maladaptive behavior.
+- Classification makes it possible to communicate about particular clusters of abnormal behavior in agreed-on and relatively precise ways.
+- Classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes, and treatment of such behavior.
+- Classification enables the clarification of insurance issues.
+
+### Differing Models of Classification
+
+Three basic approaches include:
+
+- Categorical approach:  
+a patient is healthy or disordered, but there is no overlap
+- Dimensional approach:  
+the patient may fall along a range from superior functioning
+to absolutely impaired functioning
+- Prototypal approach:  
+a conceptual entity depicts an idealized combination of
+characteristics, some of which the patient may not have
+
+### Formal Diagnostic Classification of Mental Disorders
+
+- Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
+- International Classification of Disease (ICD-10)
+
+#### Definition criteria based on:
+
+- Symptoms (subjective)
+- Signs (objective)
+
+#### The DSM-5
+
+- More comprehensive and more subtypes of disorders
+- Allows for gender related differences in diagnosis
+- Provides structured interview regarding cultural influences
+
+#### Problem of diagnostic labeling
+
+- Allows label capturing more than a behavioral pattern
+- Creates assumptions among clinicians
+- Creates social identity (stigma)
+
+#### Diagnostic Interviews
+
+- Unstructured:
+	-  Freewheeling
+	-  Clinician can follow leads
+	-  Clinical picture may vary, based on interviewer
+- Structured
+	- Controlled
+	- Determine if symptoms fit diagnostic criteria