29

CLINICAL ASSESSMENT AND DIAGNOSIS

Embed Size (px)

DESCRIPTION

CLINICAL ASSESSMENT AND DIAGNOSIS. Basics of Clinical Assessment. Multimethod & Multimodal. Like a Funnel. Start Broad. More Specific. Determining the Value of Clinical Assessment. Value Depends On. Reliability - PowerPoint PPT Presentation

Citation preview

Page 1: CLINICAL            ASSESSMENT           AND           DIAGNOSIS
Page 2: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Multimethod & MultimodalMultimethod & Multimodal Multimethod & MultimodalMultimethod & Multimodal

Like a FunnelLike a Funnel Like a FunnelLike a Funnel

Start BroadStart Broad Start BroadStart Broad

More SpecificMore SpecificMore SpecificMore Specific

Page 3: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Value Depends On

Value Depends On

ReliabilityReliabilityConsistency of our Assessment

ReliabilityReliabilityConsistency of our Assessment

ValidityValidityWhat are we measuring?

ValidityValidityWhat are we measuring?

StandardizationStandardization

Application of Standards to Ensure Consistency

StandardizationStandardization

Application of Standards to Ensure Consistency

Page 4: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Clinical InterviewClinical Interview– Structured vs. SemistructuredStructured vs. Semistructured– Mental Status ExamMental Status Exam

– Behavioral Observation

Clinical InterviewClinical Interview– Structured vs. SemistructuredStructured vs. Semistructured– Mental Status ExamMental Status Exam

– Behavioral Observation

Page 5: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Clinical InterviewClinical Interview Clinical InterviewClinical Interview

Physical ExamPhysical Exam Physical ExamPhysical Exam

Page 6: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

Clinical InterviewClinical Interview Clinical InterviewClinical Interview Physical ExamPhysical Exam Physical ExamPhysical Exam

Page 7: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

AAAA

BBBB

CsCsCsCs

Page 8: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Psychological TestingPsychological Testing– Projective vs. Objective

Psychological TestingPsychological Testing– Projective vs. Objective

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

Clinical InterviewClinical Interview Clinical InterviewClinical Interview Physical ExamPhysical Exam Physical ExamPhysical Exam

Page 9: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Projective TestsProjective Tests Projective TestsProjective Tests

Thematic Thematic Apperception Test (TAT)Apperception Test (TAT)Thematic Thematic Apperception Test (TAT)Apperception Test (TAT)

Page 10: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Projective TestsProjective Tests Projective TestsProjective Tests

Rorschach Inkblot TestRorschach Inkblot TestRorschach Inkblot TestRorschach Inkblot Test

Page 11: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Class lectures would be more stimulatingwith more _______ and lots of ____.

Class lectures would be more stimulatingwith more _______ and lots of ____.

Other Projective TestsOther Projective Tests Other Projective TestsOther Projective Tests

Sentence Completion Methods:Sentence Completion Methods:- - - -

Sentence Completion Methods:Sentence Completion Methods:- - - -

Page 12: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Other Projective TestsOther Projective Tests Other Projective TestsOther Projective Tests

Draw a PictureDraw a PictureDraw a PictureDraw a Picture

Page 13: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Other Projective TestsOther Projective Tests Other Projective TestsOther Projective Tests

Page 14: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Objective TestsObjective Tests Objective TestsObjective Tests

Minnesota Multiphasic Personality Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2)Inventory (MMPI, MMPI-2)

Minnesota Multiphasic Personality Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2)Inventory (MMPI, MMPI-2)

Page 15: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Objective TestsObjective Tests Objective TestsObjective Tests Minnesota Multiphasic Personality Minnesota Multiphasic Personality

Inventory (MMPI, MMPI-2) Inventory (MMPI, MMPI-2)

Minnesota Multiphasic Personality Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2) Inventory (MMPI, MMPI-2)

Intelligence TestsIntelligence Tests– Stanford-Binet IQ Test:

Intelligence Quotient– Wechsler IQ Tests

Intelligence TestsIntelligence Tests– Stanford-Binet IQ Test:

Intelligence Quotient– Wechsler IQ Tests

Page 16: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Neuropsychological TestingNeuropsychological Testing Neuropsychological TestingNeuropsychological Testing

Psychological TestingPsychological Testing Psychological TestingPsychological Testing

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

Clinical InterviewClinical Interview Clinical InterviewClinical Interview Physical ExamPhysical Exam Physical ExamPhysical Exam

Page 17: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Neuropsychological TestingNeuropsychological Testing Neuropsychological TestingNeuropsychological Testing Assess Broad AbilitiesAssess Broad Abilities Infer Brain DysfunctionInfer Brain Dysfunction Empirically DerivedEmpirically Derived ProblemsProblems

– False Positives and False Negatives– Long Time to Administer

Assess Broad AbilitiesAssess Broad Abilities Infer Brain DysfunctionInfer Brain Dysfunction Empirically DerivedEmpirically Derived ProblemsProblems

– False Positives and False Negatives– Long Time to Administer

Page 18: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

NeuroimagingNeuroimaging NeuroimagingNeuroimaging

Psychological TestingPsychological Testing Psychological TestingPsychological Testing

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

Clinical InterviewClinical Interview Clinical InterviewClinical Interview Physical ExamPhysical Exam Physical ExamPhysical Exam

Neuropsychological TestingNeuropsychological Testing Neuropsychological TestingNeuropsychological Testing

Page 19: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

NeuroimagingNeuroimaging NeuroimagingNeuroimaging

Structural AbnormalitiesStructural Abnormalities– Computerized Axial Tomography Computerized Axial Tomography

(CAT)(CAT)

– Magnetic Resonance Imaging Magnetic Resonance Imaging

(MRI)(MRI)

Structural AbnormalitiesStructural Abnormalities– Computerized Axial Tomography Computerized Axial Tomography

(CAT)(CAT)

– Magnetic Resonance Imaging Magnetic Resonance Imaging

(MRI)(MRI)

Page 20: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

NeuroimagingNeuroimaging NeuroimagingNeuroimaging

Functional AbnormalitiesFunctional Abnormalities– Positron Emission Tomography (PET)Positron Emission Tomography (PET)

– Single Photon Emission Computed Single Photon Emission Computed Tomography (SPECT)Tomography (SPECT)

– fMRIfMRI

Functional AbnormalitiesFunctional Abnormalities– Positron Emission Tomography (PET)Positron Emission Tomography (PET)

– Single Photon Emission Computed Single Photon Emission Computed Tomography (SPECT)Tomography (SPECT)

– fMRIfMRI

Page 21: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Psychophysiological AssessmentPsychophysiological Assessment Psychophysiological AssessmentPsychophysiological Assessment

Psychological TestingPsychological Testing Psychological TestingPsychological Testing

Behavioral AssessmentBehavioral Assessment Behavioral AssessmentBehavioral Assessment

Clinical InterviewClinical Interview Clinical InterviewClinical Interview Physical ExamPhysical Exam Physical ExamPhysical Exam

Neuropsychological TestingNeuropsychological Testing Neuropsychological TestingNeuropsychological Testing NeuroimagingNeuroimaging NeuroimagingNeuroimaging

Page 22: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Measure Nervous System ActivityMeasure Nervous System Activity

Some Problems and LimitationsSome Problems and Limitations

Measure Nervous System ActivityMeasure Nervous System Activity

Some Problems and LimitationsSome Problems and Limitations

Psychophysiological AssessmentPsychophysiological Assessment Psychophysiological AssessmentPsychophysiological Assessment

Page 23: CLINICAL            ASSESSMENT           AND           DIAGNOSIS
Page 24: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

NosologyNosology____________________________________________________________

Nomenclature Nomenclature ____________________________________________________________________________________________________________________________________________________________________________________________________________

Two widely used classification systems: ICD-10 & DSM

NosologyNosology____________________________________________________________

Nomenclature Nomenclature ____________________________________________________________________________________________________________________________________________________________________________________________________________

Two widely used classification systems: ICD-10 & DSM

Page 25: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

DSM-I (1952) DSM-II (1968) DSM-III (1980) DSM-III-R (1987) DSM-IV (1994) DSM-5 (2013)

DSM-I (1952) DSM-II (1968) DSM-III (1980) DSM-III-R (1987) DSM-IV (1994) DSM-5 (2013)

Page 26: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Classical or CategoricalClassical or CategoricalClassical or CategoricalClassical or Categorical

DimensionalDimensionalDimensionalDimensional

PrototypicalPrototypicalPrototypicalPrototypical

Page 27: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

Thresholds for Diagnosis of DisordersThresholds for Diagnosis of Disorders Multiaxial FormatMultiaxial Format

– Axis I:Axis I: Most Major Disorders

– Axis II:Axis II: Personality Disorders / MR

– Axis III:Axis III: Medical Diseases or Conditions

– Axis IV:Axis IV: Psychosocial / Environment Problems

– Axis V:Axis V: Global Assessment of Functioning

Some Problems With the DSM-IVSome Problems With the DSM-IV

Thresholds for Diagnosis of DisordersThresholds for Diagnosis of Disorders Multiaxial FormatMultiaxial Format

– Axis I:Axis I: Most Major Disorders

– Axis II:Axis II: Personality Disorders / MR

– Axis III:Axis III: Medical Diseases or Conditions

– Axis IV:Axis IV: Psychosocial / Environment Problems

– Axis V:Axis V: Global Assessment of Functioning

Some Problems With the DSM-IVSome Problems With the DSM-IV

Page 28: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

The general consensus is that DSM-5 is largely unchanged from DSM-IV although some new disorders are introduced and other disorders have been reclassified

– Divided into three main sections How to use the manual Disorders Description of disorders

Most notable change: ____________________________ More emphasis on ______________________________

Page 29: CLINICAL            ASSESSMENT           AND           DIAGNOSIS

• Continuing criticisms & controversies:

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________