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Chapter Outline
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  1. Introduction
    1. Psychological Assessment
      1. The collection, organization, and interpretation of information about a person and his or her situation
    2. Ancient Societies Sorted People
      1. For the purposes of the prediction of behavior
    3. Ancient Societies Practiced Psychiatry
      1. The classification of people by disorder
  2. Assessment: The Issues
    1. Why Assessment?
      1. Assessment has two (2) major goals
        1. Description of personality, cognitive functioning, mood, and behavior
        2. Prediction and its values relate to practical applications
      2. Reassessment of patients is important in managed health care
    2. The Diagnosis of Mental Disorders
      1. Diagnosis occurs when a problem is classified within a set of categories and labeled accordingly
      2. The Classification of Abnormal Behavior
        1. Several classification systems have been used; the first comprehensive one was developed by Emil Kraepelin
        2. American Psychiatric Association published its first classification system in 1952
        3. DSM-IV was published in 1994
        4. DSM-IV-TR was published in 2000
      3. The Practice of Diagnosis
        1. Each category has a description and set of specific criteria
        2. Diagnosis supplies description of patient's problem and prognosis or prediction of its future course
        3. A common vocabulary is important and diagnostic labeling is required
      4. Criticisms of Diagnosis
        1. Diagnosis is tied to medical model
        2. Diagnosis falsifies reality
        3. Diagnosis may discount gradations between forms of abnormality
        4. Diagnosis gives illusion of explanation
        5. Diagnostic labeling may be harmful
    3. Categorical vs. Dimensional Classification
      1. Categorical classification places patients into diagnostic dimensions of psychopathology
      2. Dimensional classification could offer more information
      3. Defending diagnosis
        1. Research depends on diagnosis
        2. Research requires consistent and meaningful diagnosis
      4. DSM-IV (APA, 1994) and DSM-IV-TR (APA, 2000)
        1. Specific diagnostic criteria
          1. essential features
          2. associated features
          3. diagnostic criteria
          4. differential diagnosis
        2. Five axes of diagnosis
          1. Axis I--Clinical syndrome(s)
          2. Axis II--Personality disorders or mental retardation
          3. Axis III--General medical disorders and conditions
          4. Axis IV--Psychosocial and environmental stressors
          5. Axis V--Global assessment of functioning (GAF)
        3. Unspecified etiology
    4. Assessing the Assessment: Reliability and Validity
      1. Reliability
        1. Reliability is a measure of consistency
        2. Three criteria of reliability
          1. internal consistency
          2. test-retest reliability
          3. interjudge reliability
          4. Reliability of psychiatric diagnosis is low
        3. Specific diagnostic criteria increases reliability
        4. Low coverage results in higher reliability
        5. More patients are put into residual categories
        6. More diagnostic categories have been added
      2. Validity
        1. Validity refers to extent to which test measures what it is suppose to measure
        2. Descriptive validity is extent to which it provides significant information
          1. Pattern of symptoms is important
          2. Most patients show cormorbidity by meeting diagnostic criteria for more than one Axis I disorder
        3. Predictive validity refers to degree to which questions of cause, prognosis, and treatment are answered
          1. High predictive validity requires high reliability
          2. Changes in DSM may result in improved validity
    5. Problems in Assessment
      1. Assessor's behavior, physical appearance, race, and sex can influence assessment
      2. Practical reasons, such as financial circumstance, can influence assessment
      3. Specific diagnosis criteria and decision rules minimize problems
      4. Assessment should rely more on actuarial judgment
      5. Some assessors do not follow diagnostic rules
  3. Methods of Assessment
    1. The Interview
      1. The interview consists of a face-to-face conversation
      2. Can vary from structured to unstructured and will depend on purpose of interview
      3. Can introduce interview's subjectivity and biases
      4. Diagnostic interviews are highly structured
        1. Mental status exam is a broad exam
        2. Purpose of MSE is to detect dementia and other organic brain disorders
    2. Psychological Tests
      1. Psychological test is a standard procedure in which patient responds to series of stimuli; scoring is more objective
      2. Psychometric approach identifies stable personality traits
      3. Intelligence tests
        1. First psychological assessment techniques were intelligence tests used in French school system by Binet
        2. Final score on the test presented as intelligence quotient (IQ)
        3. The Wechsler tests yield general IQ, performance IQ, and verbal IQ
        4. Intelligence tests are carefully designed and have high internal consistency, test-retest reliability, and predictive validity
        5. Intelligence tests may be culturally biased
        6. Intelligence testing may reflect a too narrow view of mental abilities
      4. Projective Personality Tests
        1. Projective personality tests based on assumption of psychodynamic in drawing out people's real motives by responding to ambiguous stimuli
        2. The Rorshach Inkblot Test
          1. Rorshach Psychodiagnostic Inkblot Test consists of 10 cards (5 chromatic, 5 achromatic) with inkblots to which the subject must react (Hermann Rorschach)
          2. Has a free-association phase and an inquiry phase
          3. Highly structured scoring methods using a detailed manual
        3. The TAT (Thematic Apperception Test)
          1. Thematic Apperception Test (TAT) is series of pictures (Henry Murray)
          2. Subject asked to describe picture, story, and character(s)
          3. Is used to detect specific kinds of information
        4. Evaluation of projective tests
          1. Poor interjudge reliability
          2. Supporters claim that projective tests are only method that is open and flexible enough to provide information about unconscious processes
      5. Self-Report Personality Inventories
        1. Self-report personality inventories ask subjects about themselves
        2. The MMPI and MMPI-2 (objective personality test)
          1. Minnesota Multiphasic Personality Inventory-2 compares subject responses to those with psychiatric diagnoses (McKinley and Hathaway)
          2. Test items that differentiate between normal and abnormal groups comprise the MMPI
          3. Test results in scores on ten clinical scales
          4. MMPI-2 consists of control scales to determine validity of responses and can be used to assist interpretation
          5. Pattern of scores is used for interpretation and indicating the degree of overall disturbance
          6. Some concern regarding response set such as social desirability and acquiescence
          7. Can be scored by computer
        3. The MCMI-III (Millon Clinical Multiaxial Inventory)
          1. Intended to assist in diagnosis of personality disorders
          2. Yields ratings on DSM personality disorders
      6. Psychological Tests of Organic Impairment
        1. Diagnosis must distinguish between psychogenic causes and biogenic causes
        2. Tests can determine the type of neurological problem
        3. Paper and pencil tests are valid measures
          1. Bender Visual-Motor Gestalt Test (BVMGT) requires subjects to reproduce designs (Laura Bender)
          2. Halstead-Reitan Neuropsychological Battery assesses functioning of specific areas of brain (Ward Halstead and Ralph Reitan)
    3. Laboratory Tests
      1. Direct testing of structure and function of nervous system
      2. Electroencephalogram (EEG) measures electrical activity of brain cells
      3. Sophisticated measures have been developed
        1. Computerized axial tomography (CAT) or computerized tomography (CT) uses a series of x-ray scans
        2. Positron emission tomography (PET) traces radioactive particles
        3. Magnetic resonance imaging (MRI) uses magnetic fields
      4. Using the relationship between emotion and physiology, psychogenic disorders may be detected
        1. Polygraph includes a number of sensors that pick up physiological changes
        2. Galvanic skin response (GSR) detects sweat gland activity
        3. Electromyogram (EMG) senses electrical activity of muscles
      5. Polysomnography uses several measures and can identify nature of subject's problem
      6. Physiological tests have several advantages
        1. Processes measured are those that subject cannot report
        2. More precision with good reliability and validity
        3. A problem is interpreting the psychological significance of results
    4. Observation in Natural Settings
      1. Situational variables influence behavior
      2. Person variables influence behavior
      3. To assess behavior accurately, assessment must occur in natural settings
      4. Direct observation has several advantages
        1. It does not depend on self-report
        2. Reduces assessment errors
        3. Observation provides workable answers
      5. Direct observation has several disadvantages
        1. It requires much time
        2. Presence of observer may be reactive
        3. Behavior being studied may change owing to observation
      6. Use of recording devices raises some ethical problems
  4. Cultural Bias in Assessment
    1. Cultural bias exists in assessment such as use of second language in interview
    2. DSM-IV-TR includes caution about misapplying diagnosis without considering cultural and ethnic differences
    3. Correcting bias may actually increase bias in diagnosis





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