Upload
others
View
10
Download
0
Embed Size (px)
Citation preview
Chapter9:Clinical&MentalHealthtesting&assessment:• Mentalhealthservices(public/private)oneoflargestemployersof
psychologists• Startingpoint:referralquestion• Psychologicalassessmenttechniques:historytaking,clinicalinterview,
MSE&psychologicaltesting• Commonlyusedpsychologicaltests:intelligence,personality,
psychopathology,depression,anxiety&stress• Referralquestionprovidesjustification/rationalefortesting&
assessment• Formulationofaclear&specificreferralquestionfacilitatesderivationof
hypothesesaboutacase,selectionofappropriatepsychologicalassessmentinstruments,interpretationofresults&provisionofrecommendations(canbefacilitatedbyareferralformwithexplicitquestionsaboutreasonforreferral,useofassessmentresults&client’swillingnesstoundertakeassessment)
• Beginacasebycollectingdemographic&biographicdata-providecontexttounderstandreferralquestion,interpretresultofotherdatacollectionprocedures,makerecommendations&preparepsychreport
• Casehistorydatacanbeobtainedinclinicalinterview• Collectcasehistorydatafromnumberofsourcesforverification• Standardizedformsfacilitatecasehistorydatacollection• Whengatheringcasehistorydata:consider-privacypoliciesofvarious
organizations,legalrequirementsðicalguidelines• Clinicalinterviewistheoldestpsychologicalassessmenttechniqueused
tocollectinfo(mostlyusedbyclinicalpsychinmentalhealthsetting)• Clinicalinterviewprovidesopportunitytobuildrapport,provide
importantinfo,&establishifclienthasreasonableunderstandingofwhatishappeningtothem&why
• Infothepsychcanconveyduringinterviewinclude:1. Purpose&natureofpsychassessment2. Whatclientisexpectedtodo3. Confidentialityofinfocollected4. Needforinformedconsent5. Whowillhaveaccesstocollectedinfo&howitwillbeused• Toconductsuccessfulclinicalinterview:psychmustestablishgood
rapportbybeingsincere&supportive• Toengageclient-techniques:1. Don’tdominateinterview2. Reflectwhatwassaid3. Paraphrasing4. Summarizing5. Clarifying6. Confronting7. Eyecontact8. Positiveposture9. Nodding• Mostinfocollectedinclinicalinterviewisverbal
• Non-verbalinfoprovidedbyclient:1. Demeanor2. Howquestionsanswered3. Whatisnotsaid(e.g.matter-of-fact/flippantstyleofresponding-maybe
inconsistentwithseriousnessofcontentbeingrevealed)• Clinicalpsychinmentalhealthsettingobtaininfo:1. Demographicdata2. Medicalhistory(self&family)3. Familyhistory4. Educational&vocationalhistory5. Psychologicalhistory• MSEuniquetomentalhealthsetting• Structuredclinicalinterviewschedules:e.g.StructuredClinicalInterview
forDMSDisorders(SCID)-toensurerelevantinforelatingtovariousdisordersareadequatelycovered&asked
v MentalStatusExam(MSE):• Comprehensivesetofquestions&observationstosystematicallyassess
mentalstateofclient• Includes:1. Appearance2. Behaviour3. Orientation:isclientawareofwho&wherehe/sheis?Doestheclient
knowwhattime(year,month,date,day,time)itis?4. Memory:immediate,recent,remote5. Sensorium:cantheclientattend&concentrate?Hearing,vision,touch,
smell6. Affect7. Mood8. Thoughtcontent&thoughtprocess9. Intellectualresources10. Insight11. Judgment• InfogainedfromMSE&clinicalinterview-psychcan
formulate/conceptualizeclient’sproblembyreferringtosystematicclarificationsystem(DSMorInternationalClarificationofDiseasesbyWHO-furtherclarifyideas&narrowdown/testhypotheses)
• Mayadministerpsychteststofinaliseassessment• DSMcommonlyusedinUSA,Australasia,Asia• DSM1stedition:1952• DSMpurposetofacilitatecommunicationamongmentalhealth
professionals• DSMbasedonobservedbehaviouralsymptoms-canbeusedby
professionalswithdifferenttheoreticalorientations• NoinfoabouttreatmentorAetiologyincludedinDSM• Clientisclassifiedintermsofasetoffiveaxes/clinicallyimportant
factors(DSM):1. AxisI:clinicaldisorders(e.g.dementia,substance-relateddisorders,
schizophrenia,mooddisorders,anxiety&eatingdisorders)
2. AxisII:mentalretardation&personalitydisorders:(e.g.antisocialpersonalitydisorder,paranoidpersonality,borderlinepersonality)
3. AxisIII:physicalormedicalconditionsthatmayberelevanttomentaldisorders:(e.g.epilepsy,cancer,Alzheimer’s,Parkinson’s)
4. AxisIV:psych&environmentalproblems:(e.g.stress,financial,marital,occupational)thatmayaffectdiagnosis,treatment&prognosis
5. AxisV:globalassessmentoffunctioningfrom1to100• DSMcriticizedforbeingatheoretical,toomuchbasedonmedicalmodel,<
reliability&validity• NewDSM-5publishedin2013v Psychologicaltests:v Intelligence:• Binet:intelligenceinchildren• Psychusemeasureofgeneralintellectualability• DavidWeschler:batteryoftestsforadultintelligence(allowclassification
ofintelligencelevel&aidinnarrowingdownnatureofproblem)• Weschlerintelligencedefinition:aggregateorglobalcapacityofthe
individualtoactpurposefully,thinkrationally,dealeffectivelywithenvironment
• IQ:impliesintelligencesisaunitaryconstruct• Recentmodels:suggestintelligenceiswhereindividualsdisplayaprofile
ofabilitieswithstrengths&weaknessesv WeschlerAdultIntelligenceScale:• OriginalpublishedasWeschler-BellevueIntelligenceScalein1939• WAIS1995• WAIS-Revised(WAIS-R;1981)• WAIS-ThirdEdition(WAIS-III;1997)• Adultsages16-90years• WAIS-IV:2008-assess:psychoeducationaldisability,neuropsychiatric&
organicdysfunction&giftedness(purpose:updatenorms,co-normwithWeschlerMemoryScale4thed&WeschlerIndividualAchievementTest2nded,reducetestingtime&improvepsychometricproperties)
• WAIS-IV:comprises10coresubtests&5supplementarysubtests• InWAIS-IV:2subtestsinWAIS-III(picturearrangement&object
assembly)weredropped,3newsubtestsadded(visualpuzzles,figureweights&cancellation)
• WAIS-IV:67min• 5compositescorescanbeobtainedfromcoresubtests:1. FullscaleIQ2. Verbalcomprehension3. Perceptualreasoning4. Workingmemory5. Processingspeed• VerbalIQ&performanceIQreplacedbyverbalcomprehensionindex&
perceptualreasoningindex• Generalabilityindexcanbederivedfromthe3verbalcomprehension&3
perceptualreasoningcoresubtests