Abnormal lecture 2 - clinical assessment

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DSM

 It provides a descriptive (and not explanatory) model for the classification of mental disorders    

• It represents a categorical model of classification   it classifies individuals in terms of whether they meet the criteria for particular categories of mental disorders   

• The diagnostic categories are based on grouping abnormal behaviour pattern according to the features or symptoms they share  

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DSM editions

 DSM I (APA, 1952) 130pp x 106 DS  

• DSM II (APA, 1968) 134pp x 182 DS  

• DSM III(APA, 1974)   134 pp X 182 DS  

• DSM III Revised (APA, 1980) 494 pp X 265 DS  

• DSM III R  (APA, 1987) 567pp x 292 DS   

• DSM IV (APA, 1994) 886pp x 297DS  

• DSM IV TR –text revision (APA, 2000) with axis   

• DSM V (APA, 2013) 947 pp 297 x 726 Ds  without axis 

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Aims of the clinical assessment

Having a clear understanding of the person’s suffering (if any)  

It helps to…  

– communicate clearly  with health professionals   – plan and deliver appropriate treatment programs – to undertake research

Disadvantages 

• Stigma  • Labelling  • Being unable to search for alternative disorders  • Cultural biases   

Consequence for the individual • Social exclusion  • The sick role • Loss of personal m

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Stages of Clinical Assessment

  •  A) Clinical interview (generally between 3-5 sessions)  

--> Observation (direct/ indirect)  

  • B) Psychological tests (2-3 sessions): – IQ tests – Personality tests   
  • C) Integration of the clinical data 
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Clinical Interview

• Interview setting • Body language  • Observation 

Areas of investigation  

• Self perception • Personal history • Socio-cultural factors  • Present/past family dynamics  • Social functioning • Drug use/misuse • Physical problems   

Looks ate past, present and future to see if this has any effect on emotion, social functioning or cognition

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Testing

• Input to the final diagnosis • The tests must be appropriated to the client’s age (chronological/mental), education & cultural background  

• This generally includes: – IQ tests – Personality test – Projective test 

Cognitive functioning & IQ testing:

• How the person perceives/makes sense of the real world   

– & how the person copes with everyday tasks

WAIS IV: Verbal subscales  

• A) Understanding: – Vocabulary – Similarities  – Information  – Comprehension   

• B) Working memory: – Arithmetic  – Digit span – Letter/ number sequencing     

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Testing cont

Non-Verbal  Subscales: processing speed   

• Picture Arrangement  – Logical/sequential reasoning, social insight  • Symbol Search  – Visual perception, speed  • Object Assembly  – Visual analysis, synthesis, and construction 

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The Bender Visual Motor Gestalt test

The Bender Visual Motor Gestalt Test 

• Nine figures (one at time)  

Task:   

• to make the best reproduction of the figure possible. The test is not timed - After testing is complete, the results are scored based on accuracy and organization

Herman Rorschach (1884-1922) 

• Swiss Freudian psychiatrist  • Created the test in 1921 – 300 individuals with MHDs – 100 ‘normal individuals’ – A lot of testing…. • Psychodiagnostik   

Evaluation:

• The clinician's personal impression • Objective evaluation of the parts  • Perception:  – Global, F+, D,Dd, DGd.. – Kinesthetic (humans/ animals) – Colors / shock to colors  – FC+ Cf  

• Contents  • Recurrent themes • Originality/ Banality

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Thematic Apperception Test (Projective) –Murray 19

• Picture interpretation techniques  • Conclusions drawn based on responses (and with aid of complex scoring manual) 

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Projection Tests

• E.g.: • The family test • The tree test • The human figure test  

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Integration of the assessment data: what can go wr

• Potential cultural bias in the clinician  

• Theoretical orientation of the psychologist   

• Lack of proper training   

• Underemphasise on the external situations  

• Insufficient validation of the assessment procedures  

• Inaccurate data or premature evaluation  

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Category fallacy in clinical assessment

• It occurs when diagnostic criteria from one culture are applied to another  (Kleiman, 1998)  

• Those criteria lack of coherence and relevance  

• E.g. Prince’s critical study of the prevalence of brain fag syndrome in Canadian students (1985)  

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Underlying assumptions in the Western’s approach t

• An individual sense of Self:  – a person should have a stable, individualist sense of self, independent and separated from others  

• Psychopathology is inside the individual   

• Disorders can be divided into discrete/defined categories   

• Mental disorders are universal and biologically caused  

• The whole world speaks a direct translation of English 

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The ethnographic approach to Mental Disorders (Sit

• MDs should be studied over time within certain cultural categories   

• The instruments to assess MDs should be developed locally   

• The diagnostic criteria should also be validated locallys 

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Summary of Lecture 2

• The aim of the clinical assessment is to have a clear understanding  of the person’s whole functioning  

• The clinical interview aims to assess the person’s social/cognitive/ emotive functioning   

• IQ tests are used  to assess if/how the person’s cognitive functioning is impaired   

• Personality tests are used mostly to confirm/expand the clinical interview  

• There are several elements that can go wrong in the diagnosis  

• The Western classification of mental disorders cannot be applied to other cultures 

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