Psychopathology

1. CLINICAL ASSESSMENT AND
DIAGNOSIS

2. OVERVIEW
1) Introduction
2) Basic Elements in Assessment
3) Physical Assessment
a) The General Physical Examination
b) The Neurological Examination
c) The Neuropsychological Examination
3) Psychosocial Assessment
a) Assessment Interviews
b) The Clinical Observation of Behaviour
c)Psychological tests
4) Integration of Assessment Data

3. INTRODUCTION
• Psychological assessment- It refers to a
procedure by which clinicians, using
psychological tests, observation, and
interviews, develop a summary of the client’s
symptoms and problems
• The assessment gathers the necessary
information using various methods in order to
create a diagnosis.

4. • Once the assessment has been completed , a
diagnosis will be given
• Clinical diagnosis- is the process through
which a clinician arrives at a general
“summary classification” of the patient’s
symptoms by following clearly defined system
such as DSM-5 or ICD-10.

5. THE BASIC ELEMENTS IN ASSESSMENT
What does a clinician need to know?
• The presenting problem
• Is it a situational problem?, what is the
duration of the current complaint?, how is the
person dealing with the problem?, what prior
help has been sought? etc…

6. 1. The Relationship Between Assessment and
Diagnosis
2. Taking a Social or Behavioral History
- Clear understanding of the individual’s
behavioral history, intellectual functioning,
personality characteristics, and environmental
pressures and resources
a) Personality factors- Assessment should
include a description of any relevant long-
term personality characteristics.

7. b) The Social Context- Important to assess the
social context in which the individual
functions.
• Environmental stressors and supports are
identified
• Conflicting information – what may drive the
person (dynamic formulation)
• Hypotheses about future behavior
• Decision about treatment are made with
consent of the client.

8. 3. Ensuring Culturally Sensitive Assessment
Procedures
• Psychologists need to ensure that the test
procedures they employ are appropriate for
the particular client
• It is critical for the psychologist to be
informed of the issues involved in
multicultural assessment and to use testing
procedures that have been adapted and
validated for culturally diverse clients.

9. 4. The Influence of Professional Orientation
- The assessment process depends on the
basic treatment orientation of the clinicians
Eg: Psychiatrists are biologically oriented
practitioners.
Psychoanalytically oriented clinician may use
unstructured assessment method.

10. 5. Reliability ,Validity and Standardization
1) Reliability- it describes the degree to which
an assessment measure produce the same
result each time it is used to evaluate the
same thing
2) Validity- is the extent to which a measuring
instrument actually measures what it is
supposed to measure
3) Standardization- Is the process by which a
psychological test is administered, scored,
and interpreted in a standard way.

11. 6. Trust and Rapport Between the Clinician and
the Client
• The client must feel that the testing will help
the practitioner gain a clear understanding of
his/her problem.
• Assurances of confidentiality
• The clinician should explain what will happen
during assessment and how the information
gathered will help provide a clearer picture of
the problems the client is facing

12. PHYSICAL ASSESSMENT
• With certain psychological problem, medical
evaluation is necessary to rule out the
possibility that physical abnormalities may be
causing or contributing to the problem.
• It includes both general physical examination
and special examinations

13. 1) General Physical Examination – This medical
exam is needed when presenting problems
include physical symptoms, especially when
clients may be experiencing somatoform,
addictive, or organic brain disorders.
2) The Neurological Examination- Because brain
pathology is sometimes involved in some
mental disorders, a specialized neurological
examination can be administered in addition
to general medical examination, this involves

14.  EEG - to assess brain wave patterns in awake
and sleeping states, which reveals
dysrhythmia.
 Anatomical Brain Scans
• CAT Scan- can reveal diseased parts of the
brain through the use of X rays
• MRI- it allows visualization of the most minute
anatomical features of the brain. In addition,
the MRI procedure is normally far less
complicated to administer, and it does not
subject the patient to ionizing radiation

15.  PET scan- allows for an appraisal of how an
organ is functioning metabolic processes. It
enables a medical specialist to obtain more
clear-cut diagnosis of brain pathology.
 THE FUNCTIONAL MRI (fMRI) - is
a functional neuroimaging procedure using
MRI technology that measures brain activity
by detecting changes associated with blood
flow.

16. 3) The Neuropsychological Examination- is to
assess the clinical relationship between the
brain and cognitive/behavioral dysfunction.
The Neuropsychological Tests and assessment
procedures assess various aspects of
functioning including aspects of:
1. Perceptual functioning
2. Motor functioning
3. Verbal functioning
4. Memory functioning
5. Cognitive functioning

17. • Halstead- Reitan Neuropsychological Battery
consists of 5 subtests:
1. Halstead Category Test - Measures a subject’s
abstracting ability
2. Tactual Performance Test – Measures memory
and localization
3. Rhythm Test – Task is to discriminate between
like and unlike pairs of musical beats
4. Speech Sounds Perception Test – Task is to
discriminate spoken syllables
5. Finger Oscillation Task – Measures the speed
at which an individual can depress a lever with
the index finger

18. PSYCHOSOCIAL ASSESSMENT
Psychosocial assessment methods focus on
providing a realistic picture of how the client
interacts with his or her social environment.
The most widely used psychosocial
assessment methods are the clinical interview
and behavior observation.

19. Assessment Interviews
• Structured formats have been developed to
guide questions
• Structured assessment interview yields far
more reliable results than the flexible format
• Unstructured assessment interview is
typically subjective and does not follow a
predetermined set of questions
• Rating scales help focus inquiry and
quantify the interview data

20. • Reliability increases with structured
interviews
• All interviews need specific goals
• Rating scales can increase interview
reliability
• Interviews are subject to error as they rely
on human judgment

21. The Clinical Observation of Behavior
- Direct Observation
• Should occur ideally in the natural
environment
• Analogue situations are designed to yield
information about the person’s adaptive
strategies
• It involves such tasks as staged role-playing

22. • Self-monitoring or self-observations and
objective reporting of behavior are often used
in the natural environment, can also be used
in determining the kinds of situations in which
maladaptive behavior is likely evoked.
• The client can be an excellent source of
information.
• Methods such as electronic beepers to
remind clients to record thoughts are also
being developed.

23. - Rating Scales
• Help to organize observations and increase
reliability
• The Brief Psychiatric Ratings Scale (BPRS) is
widely used to record observations for clinical
research.
• Comparisons to other clients’ symptoms can
be made.

24. Psychological Tests
1) Psychological tests are standardized
procedures to sample behavior
• A client’s responses are compared to the
responses of others who have taken the same
test
• Often more precise and reliable than
interviews or some observational techniques
• Many tests are available in a computer-
administered and computer-interpreted
format

25. 2)Two general categories of psychological tests
for use in clinical practice are intelligence test
and personality test
 INTELLIGENCE TEST
a. Wechsler Intelligence Scale for Children-
Revised (WISC-IV)
b. Stanford-Binet Intelligence Scale
c. Wechsler Adult Intelligence Scales-
Revised (WAIS-IV)

26. a. Vocabulary (verbal)—subtest that consists
of a list of words to define that are presented
orally to the individual
b. Digit Span (performance)—test of short-
term memory a sequence of numbers is
administered orally.

27.  PROJECTIVE PERSONALITY TESTS
a. Underlying assumption in using projective
techniques is that people “project” their own
problems, motives and wishes onto the vague,
unstructured stimuli
1) The Rorschach Inkblot Test-named after
the Swiss psychiatrist Hermann Rorschach as a
personality assessment

28. 2) The Thematic Apperception Test (TAT)-
introduced in 1935 by Morgan and Murray of the
Harvard Psychological Clinic which uses simple
pictures where subject are constructed to make
up stories
3) Sentence Completion Test-these tests have
been designed for children, adolescents, and
adults which is related to free association in
where the client is asked freely based on the
answers the examiners can pinpoint the
individual’s problems, attitudes, and symptoms
through the interpretation of his or her responses

29. b. Interpretation of these tests is generally
subjective, unreliable, and difficult to validate
c. Administering and scoring these tests is
frequently time consuming and requires
advanced skills
d. These tests have an important place
particularly in clinical settings where it is
important to obtain information about one’s
personality and psychodynamic functioning

30.  OBJECTIVE PERSONALITY TESTS
a. More structured than projective techniques
leading to greater precision, typically use
questionnaires, self-report inventories, and
rating scales
1) MMPI: The Minnesota Multiphasic
Personality Inventory (MMPI) is the most
widely used personality test in the United
States

31. 2) The clinical scales of the MMPI were
developed through empirical keying
3) Clinical scales measure tendencies to
respond in psychologically deviant ways
4) Validity scales designed to detect whether a
patient has answered the questions in an
honest manner
5) Special problem scales have also been
developed

32. The Integration of Assessment Data
1. Integration of assessment data prior to
treatment allows the clinician to formulate a
plan for treatment and allows for the
discovery of gaps or discrepancies in
knowledge about the client.
2. Additional assessment data collected during
treatment can allow clinician to determine
how effective treatment is and allow for
modification to improve success.

33. 3. The information gathered may lead to a
tentative diagnosis.
4. Ethical Issues in Assessment
1. Potential cultural bias of the instrument or
the clinician
2. Theoretical orientation of the clinician
3. Underemphasis on the external situation
4. Insufficient validation
5. Inaccurate data or premature evaluation

34. REFERENCE
Butcher, James. N; Hooley, Jill M.; Mineka,
Susan (2014). Abnormal psychology,
16th edition.