Clinical Assessment

1
Clinical Assessment

• Purposes
• To understand the individual
• To predict behavior
• To plan treatment
• To evaluate treatment outcome

2
Clinical Assessment Issues

• Reliability
• Validity
• Standardization
• Clinical Utility or Clinical Significance

3
Diagnostic Reliability
Present Absent
Present
Absent
Disorder Present
Diagnosis Given
4
Methods of Clinical Assessment

• Clinical Interview
• Structured vs. Semistructured
• Behavioral Observation
• Mental Status Exam
• Testing
• Objective Tests
• Projective Tests

5
Additional Methods

• Physical Examination
• Neurological Examination
• Neurological Imaging
• CT, PET, MRI, fMRI
• Neuropsychological Examination
• Tasks that reveal brain function (or dysfunction)

6
Diagnosis

• Idiographic vs. Nomothetic
• Classification
• Categories
• Dimensions
• Threshold Model
• Prototype Model

7
Diagnostic and Statistical Manual

• Evolving Document
• Currently DSM-IV-TR
• DSM-V expected in 2013
• Purpose?
• Utility?
• Real world reliability and validity?

8
DSM-IV-TR

• Multiaxial System
• Axis I Clinical Syndromes
• Axis II Personality and Developmental Disorders
• Axis III Medical Conditions
• Axis IV Psychosocial Stressors
• Axis V Global Assessment of Functioning (GAF
  scale 1 - 100)

9
Unresolved Issues in the DSM-IV

• Thresholds for Diagnosis?
• For example, level of distress, impairment,
  number of required symptoms
• Somewhat Arbitrary Time Periods
• Should Other Axes Be Included?
• Such as premorbid history, treatment response,
  family functioning, GARF
• Optimal for Designing Treatments or Research?
• The Problem of Comorbidity

10
Issues of Diagnosing

• Reliability, Validity, and Comoribity Problems
• Cause
• Reification
• Treatment
• Cure
• Relief
• Labeling
• Stigma
• Self-fulfilling prophecy
• Social Constructions