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3. Assessment of Mental Health Problems

Introduction to Basic Elements in Assessment

Interaction of Importance of trust and rapport and Impact on assessment process.

Identification of presenting problem

  • Situational or pervasive?
  • Duration?
  • Prior attempts to help or treat?
  • Self-defeating or resourceful?
  • How does problem impact social roles?
  • Does problem match any DSM-5 disorder criteria?

Advantage of classification of presenting problem

  • Treatment planning
  • Knowledge of range of diagnostic problems
  • Insurance payment

Good assessment includes

  • social history noting:
    • Personality factors
    • Social context
  • various professional orientations:
    • May determine assessment techniques
    • Does not limit clinician to one type of assessment

Dynamic formulation

Describes the current situation but also includes hypotheses about what is driving the person to behave in maladaptive ways.

  • Hypotheses about future behavior are derived.
  • Decisions about treatment are made collaboratively with the consent and approval of the individual.
  • Assessment may involve the coordinated use of physical, psychological, and environmental procedures.

Psychological Assessments are

  • Reliable
  • Valid
  • Standardized

Assessment of the Physical Conditions

General physical examination

Many psychological problems have physical components either as

  • Causal factors
  • Symptom patterns

Neurological examination

  • EEG: graphical record of brain’s electrical activity
  • CAT scan & MRI: images of brain structures that may be damaged or diseased
  • PET scan: metabolic activity of specific compounds
  • fMRI: mapping psychological activity to specific regions in the brain

Neuro-psychological examination

  • Involves use of expanding array of testing devices
  • Measures cognitive, perceptual, and motor performance
  • Provides clues to extent and location of brain damage

Halstead-Reitan Neuropsychological Battery (HRNB) (10 tests in total):

  • Halstead Category Test: Learn & remember
  • Tactual Performance Test: Motor function, response, tactile & kinesthetic cues
  • Rhythm Test: Attention, sustained concentration
  • Speech Sounds Perception Test: Identify spoken words
  • Finger Oscillation Task: Speed

Psychosocial Assessment

Assessment Interviews

  • Face-to-face interaction
  • Structured interviews
  • Unstructured interviews

Clinical Observation of Behavior

  • Clinical observation in natural environments
  • Clinical observations in therapeutic or medical settings
  • Self-monitoring

Psychological Tests

Intelligence tests

  • WISC-IV(children); WAISIV (adults)
  • Stanford-Binet

Personality tests

Projective personality tests
  • Unstructured stimuli are presented
  • Meaning or structure projected onto stimuli
  • Projections reveal hidden motives

Projective personality tests examples:

  • Rorschach Inkblot Test
  • Thematic Apperception Test (TAT)
  • Sentence Completion Test
Objective personality tests

Examples: NEO-PI, MMPI-2

Objective personality tests offer several advantages, such as standardization, efficiency, and ease of administration, but also have limitations, including limited depth, potential response distortion, and cultural bias.

The Integration of Assessment Data

  • Developing integrated, coherent working model
  • Utilizing individual or team approach
  • Identifying definitive picture vs. discrepancie

Ethical Issues in Assessment

  • Potential cultural bias
  • Theoretical orientation of clinician
  • Underemphasis on external situation
  • Insufficient validation
  • Inaccurate data or premature evaluation

Classifying Abnormal Behavior

  • Classification involves attempts to delineate meaningful sub-varieties of maladaptive behavior.
  • Classification makes it possible to communicate about particular clusters of abnormal behavior in agreed-on and relatively precise ways.
  • Classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes, and treatment of such behavior.
  • Classification enables the clarification of insurance issues.

Differing Models of Classification

Three basic approaches include:

  • Categorical approach:
    a patient is healthy or disordered, but there is no overlap
  • Dimensional approach:
    the patient may fall along a range from superior functioning to absolutely impaired functioning
  • Prototypal approach:
    a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have

Formal Diagnostic Classification of Mental Disorders

  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • International Classification of Disease (ICD-10)

Definition criteria based on:

  • Symptoms (subjective)
  • Signs (objective)

The DSM-5

  • More comprehensive and more subtypes of disorders
  • Allows for gender related differences in diagnosis
  • Provides structured interview regarding cultural influences

Problem of diagnostic labeling

  • Allows label capturing more than a behavioral pattern
  • Creates assumptions among clinicians
  • Creates social identity (stigma)

Diagnostic Interviews

  • Unstructured:
    • Freewheeling
    • Clinician can follow leads
    • Clinical picture may vary, based on interviewer
  • Structured
    • Controlled
    • Determine if symptoms fit diagnostic criteria