Chapter 3

Clinical Assessment,
Diagnosis and Research in
Psychopathology
  Purpose of clinical assessment
 understand the individual
diagnosis
 To predict behavior prognosis
Assessment  To plan treatment
 To evaluate treatment outcome
 1.A behavioral or psychological syndrome or pattern
that occurs in an individual
2.Reflects an underlying psychobiological
dysfunction
3.The consequences of which are clinically significant
A distress (e.g., a painful symptom) or disability (i.e.,
psychologic impairment in one or more important areas of
functioning)
al disorder 4.Must not be merely an expected response to
is common stressors and losses (ex. the loss of a loved
one) or a culturally sanctioned response to a
particular event (ex. trance states in religious rituals)
5.Primarily a result of social deviance or conflicts with
society
 The global assessment of an individual’s cognitive,
affective, and behavioral state
for the purpose of establishing or ruling out
Mental pathology.
Status  Appearance and behavior
 Sensorium: Awareness of surroundings
Exam  Thought processes (Speech)
 Intellectual functioning
 Mood and affect
 Appearance and behavior
Mental  Eye contact
Status  Psychomotor retardation
 Psychomotor agitation
Exam  Repetitive motor movements
 Sensorium
 Orientation to person; place; time; and situation.
Mental  Orientation is sometimes referred to as "awake, alert,
and oriented" (AAO). It is usually followed by the
Status multiplication symbol (x) and a number. For example,
it may be written like "AOx3" or "AAOx4."
Exam  The level—x1, x2, x3, or x4—is a way of measuring
the extent of a person's awareness.
 Thought Processes
Mental  Speech rate and fluency
Status  Speech content
 Coherence
Exam
 Intellectual functioning
Mental  Math
 Spelling (forward and backward)
Status  Interpreting proverbs
Exam  Vocabulary
 Mood and Affect
 Mood: Patient reports
 dysphoric (sad), euphoric, or euthymic
Mental (normal range); labile, angry, irritable, or
anxious
Status  Affect: Subjective, observed
 facial expression, tone of voice, body
Exam language
 constricted (sad), bright, or normal range
 Mood congruent/incongruent
  Clinical Interview
 Behavioral Observation and Assessment

Assessment  Psychological Testing

 Intelligence
Tools  Personality
 Neuropsychological
 Neuroimaging ang psychophysiological assessment
 Clinical Interview
 Most common clinical assessment method
 Structured or semistructured
 The Structured Clinical Interview for DSM-5
 Research version (SCID-5-R), Clinician
Assessment Version (SCID-5-CV) and Clinical Trials
Version (SCID-5-CT)
Tools  Anxiety Disorders Interview Schedule for DSM-
5 (ADIS-5) has modules pertaining to anxiety,
mood, and related disorders, designed to
assess DSM-5 criteria
 Behavioral Observation and Assessment
 Direct observation of behavior-environment
relations
 Purpose is to identify problematic behaviors and
situations
Assessment  ABCs—identify antecedents, behaviors, and
Tools consequences
 Can be either formal or informal
 Self-monitoring vs. being observed by others
 Problem of reactivity using direct observation
 Psychological Testing: Intelligence
 Wechsler Tests (WAIS-IV, WISC-V, WPPSI-IV)
Assessment  Deviation IQ
Tools  Verbal and performance domains
 Psychological Testing: Personality
 Objective (MMPI-2, MMPI-2-RF, MMPI-2-A, BAI,
Assessment BDI..)
Tools  Projective (Rorschach, TAT)
 Psychological Testing: Neuropsychological
 Assess broad range of skills and abilities: Reading,
Attention, Memory, Learning
 Goal is to understand brain-behavior relations
 Designed to assess for brain damage
 Bender Visual Motor Gestalt Test: screens for
neurological impairments
Assessment  Comprehensive tests to determine extent and
location of brain damage and provide diagnostic
Tools information (e.g., Alzheimer’s, Autism, ADHD,
dyslexia, aphasia, epilepsy)
 The Luria-Nebraska battery (qualitative)
 Halstead-Reitan battery (quantitative)
 Neuroimaging
 Understand brain structure
 Computerized axial tomography (CAT or
CT scan)
 Utilizes X-rays
 Magnetic resonance imaging (MRI)
Assessment  Utilizes strong magnetic fields
Tools  Better resolution than CT scan
 Understand brain function
 Positron emission tomography (PET)
 Single photon emission computed tomography
(SPECT)
 Both involve injection of radioactive isotopes into
the blood stream
 Functional MRI (fMRI)—brief changes in brain activity
 Psychophysiological assessment
 Electroencephalogram (EEG)—brain wave activity.

 ERP—Event-related potentials = brain

response to a specific experience (e.g.,
hearing a tone)
Assessment  Heart rate and respiration—cardiorespiratory
activity
Tools  GSR-Electrodermal response and levels—sweat
gland activity-reflects intensity of our emotional
arousal
 Used in assessment of disorders involving a
strong physiological component : PTSD, sexual
dysfunctions, sleep disorders, headache and
hypertension
Required
Characterist  Validity

ics of  Reliability

Assessment  Standardization

Tools
Required
Validity
Characterist  Does it measure what it claims to?

ics of  Types of validity: construct (convergent and divergent),

content, criterion (concurrent and predictive validity)
Assessment
Tools
Required
Characterist Reliability
 Does the measure provide consistent scores?
ics of  Types of reliability: test-retest, split-half, internal
Assessment consistency (Cronbach’s alpha), inter-rater

Tools
Required
Characterist Standardization
ics of  Is the administration, scoring and interpretation
consistent?
Assessment
Tools
 Diagnostic classification
Diagnosing  Nomothetic strategy
Psychologic  Often used when identifying a specific
psychological disorder, to make a diagnosis
al Disorder
 Idiographic strategy
 What is unique about an individual’s personality,
cultural background, or circumstances
 Categorical and dimensional approaches
Diagnosing  Classical (or pure) categorical approach—strict
Psychologic categories (e.g., you either have depression or
you don’t)
al Disorder  Dimensional approach—classification along
dimensions (e.g., different people have varying
amounts of anxiety in social situations)
 Prototypical approach—combines classical and
dimensional views
 Widely used classification systems
Diagnosing  Diagnostic and Statistical Manual of Mental Disorders
(DSM)
Psychologic  Updated every 10–20 years

al Disorder  Current edition (released May 2013): DSM-5

 Previous edition called DSM-IV-TR
 Published by the American Psychiatric Association
 ICD-10
 International Classification of Diseases (ICD-10)
 Published by the World Health Organization
(WHO)
 Criticisms against the DSM-5
 The problem of comorbidity
Diagnosing  Defined as two or more disorders for the same person
 High comorbidity is extremely common
Psychologic  Emphasizes reliability, maybe at the expense of validity

al Disorder (i.e., may artificially “split” diagnoses that are very similar)
 Dimensional classification
 DSM was intended to move toward a more dimensional
approach, but critics say it does not improve much from
DSM-IV
 Labeling issues and stigmatization
 Some labels have negative connotations and may make
patients less likely to seek treatment
 Steps in doing research
 Research Question
 Hypothesis
 Research method

Research  Select measures

 Select sample
 Collect data
 Examine hypotheses
 Draw conclusions
 Research Question
 Refined by information from prior research

Research Hypothesis
 Educated guess
 Testable statistical hypothesis: alternative and null
 Research Question
 Refined by information from prior research

Research Hypothesis
 Educated guess
 Testable statistical hypothesis: alternative and null
 Research Methods
 Non-experimental
 Quasi-experimental
 Experimental
Research Differ in validity
Internal validity = the extent to which a cause
and effect relationship is provided
External validity = the extent to which the
results can be generalized to the population
 Non-experimental Method
 descriptive, case study, survey, archival,
correlations (positive or negative, ranges from -
1 to +1), percentages, frequencies, means,
variability
 No manipulation
 Only relationships described

Research  No inference of causation because direction of

relationship not known
 Low internal validity due to uncontrolled variables
(confounds)
 External validity is important and can be enhanced
through random sampling
 Useful to identify risk factors, predict course of
psychopathology, determine incidence and
prevalence of disorders (epidemiology)
 Quasi-experimental Method
 comparison of existing groups: e.g., males vs.
females, Asians vs. Europeans; Cross-cultural
psychopathology research
 Developmental studies: focus on age-related
changes
Research  Cross-sectional designs and the cohort effect
 Longitudinal designs and the cross-generational
effect
 Sequential designs—combine both strategies
 Low internal validity
 Good external validity
 Experimental Method
 Single/Multiple groups experiment: measurements
taken before an event compared with measurements
taken after the event; experimental group vs. control
or placebo group
 Single case experiments: variability, level, trend in
behavior are assessed by comparing assessments
made before and after an event (manipulation)
Research  Withdrawal design: baseline measurement of a
behavior multiple times over several days-
manipulation/treatment introduced-behavior is again
measured multiple times-treatment is withdrawn
(stopped) to see if behavior goes back to
baseline levels- reinstatement of treatment
 Multiple baseline: treatment of several behaviors or
same behavior in different settings or different people
with same behavior problems
 Repeated measurements
 Experimental Method
 Experiments identify causation
 Manipulation of the ‘cause’ = Independent variable;
Research effect = dependent variable
 High internal validity
 external validity not of concern
  Statistical significance—are results due to chance?
 Clinical significance—are results clinically
meaningful?
 Statistical significance does not imply clinical
Research meaningfulness
 Evaluate effect size
 Evaluate social validity
 Molecular genetics
study DNA of individuals with a disorder to
identify patterns that may be causing the disorder
Genetics  Behavioral genetics
 Twins
Research  Adoptees
 Family members
 Genetic linkage and association studies: examine why
certain characteristics occur together
  Institutional review boards (IRBs) & the APA ethics
Ethics in code
 Oversee the rights of human subjects participating in
Research research
 Make sure research and data are handled responsibly
  Ethical Principles
 Researcher competence
 No harm
 Participant competence—ability to provide consent
 Informed consent
Ethics in  Full information—necessary information to make an

Research informed decision

 Comprehension—understanding about benefits and risks
of participation
 Voluntary participation—lack of coercion