CHAPTER 3: CLINICAL ASSESSMENT
AND DIAGNOSIS
“Adult Psychopathology” = Scientific study of psychological disorders in adulthood
(Examples: The nature, causes, and treatment of psychological disorders)
Clinical assessment and diagnosis are central to the study of psychopathology
ASSESSING PSYCHOLOGICAL DISORDERS
“Clinical assessment” = Systematic evaluation and measurement of psychological, biological,
and social factors in a person presenting with a possible psychological disorder
What is Diagnosis?
“Diagnosis” = Process of determining whether a presenting problem meets the established
criteria for a specific psychological disorder
Integration of:
• Signs (Observed by another person)
• Symptoms (Reported by the patient)
• Information from various other sources
• Knowledge of normal and abnormal functioning and behaviour
Involves securing symptoms and signs and interpreting supporting/subordinate sources of
information
Diagnosis requires knowledge of normal functioning and behaviour, as well as their
pathological counterparts
Symptom is a manifestation of a state/condition conceptualized as indicating an abnormality as reported
by affected individual
Sign is a manifestation of a condition that may indicate abnormality that is observed by another person
Examples: Pain is a symptom, tenderness is a sign
Most important questions to ask when diagnosing psychological disorders:
- Who is the person in the consultation?
- Why is this person being consulted?
- What can be observed?
To answer these basic questions is to understand the person and the situation- This process of
understanding/diagnosing is handled in a systemized way and consists of taking a history,
examination, special, and subordinate/supporting investigation
,Paths to diagnosis
Process of diagnosis- Gather information and integrate this with what we understand to be
normal behaviour and function, and how pathology presents
Decision tree/algorithm diagnosis: (Basic form)
- All observations are considered against all their possible causes
Hypothetical deductive method: (Intermediate approach)
- Best exemplifies logical underpinnings of the diagnostic process
- Clinician forms a hypothesis about the problem right from the beginning
- History presents the main substance of the hypothesis
Pathognomonic diagnosis:
- Pathognomonic means there is one symptom/sign, or a set of symptoms/signs that
uniquely define a condition
- Pathognomonic conditions are rare and relying on this approach is risky
Levels of understanding of abnormal psychology:
Term Level of understanding
Literally means ‘running together’
Implies the clustering of given symptoms, signs, and results of special
investigations that occur with sufficient regularity and predictability, as to
Syndrome
constitute an assumed disease entity
Set of clinical and supporting information that co-occurs at a frequency
greater than change
Consists of a syndrome merged with its clinical course
In addition to its presenting intentionality, we understand the behaviour of the
condition over time
Disorder
At this level, something is known about its pathogenesis, or how the
abnormality develops
Nothing is known about the cause
Consists of a combination of clinical intentionality, course behaviour,
Disease
pathogenesis and aetiology, or initial cause
What is Differential diagnosis?
As diagnostic process unfolds, we gather more information and understanding about the
presenting problem
Less information we have, the more the diagnostic options are and a differential diagnosis
exists
Is a list of possible conditions that conform to available clinical information
Final diagnosis is arrived at only after other disorders on this level have been eliminated
through further investigations
2
,Key concepts in assessment and diagnosis
Need to understand 3 basic concepts that help determine the value of our assessments:
a) “Reliability” = Degree to which a measurement is consistent (Example: Over time or
among different raters)
➢ Test-retest reliability- Consistency across time
➢ Inter-rater reliability- Consistency across two/more variables
b) “Validity” = Degree to which a technique measures what it intends to measure (whether
a technique assesses what it is supposed to)
➢ Concurrent validity- Extent to which the results of one assessment measure
corresponds with that of an existing measure
➢ Predictive validity- Ability of an assessment measure to predict a future outcome
c) “Standardisation” = Process of establishing specific norms and requirements for a
measuring technique to ensure it is used consistently across measurement occasions
➢ Includes instructions for administering the measure, evaluating its findings, and
comparing them to data for large numbers of people
➢ (Standards might apply to procedures of testing, scoring, and evaluating of data)
3
, ASSESSMENT TECHNIQUES
The clinical encounter
Systematic, structured, goal-directed, and rooted in scientific understanding
Encounter must be as natural and unthreatening as possible
Must avoid leading questions or questions that are closed- Must have open-ended questions
Must engage with the patient in the most relaxed and emphatic environment
Clinical encounter involves 3 components:
a) Clinical history
b) Mental status examination
c) Behavioural assessment
Clinical history (a)
Clinician asks questions to answer who, why, and what questions
In a conversational, non-confrontational style- Clinician asks about patient’s demographic
information, social and developmental background, experiences, and past and current
significant events
Asking who someone is informs you about:
➢ Name, age, where person resides, whom person lives with, relationships, education, ect
➢ Risks and possible precipitants
Why the person is seeing you tells you about:
➢ The primary complaint, what troubles that person, what is on the patient’s mind, or
sometimes how others perceive the problem to be
What is relevant to presenting complaint:
➢ What the symptom or symptom cluster is, what other features accompany it, what
aggravates and relieves it, its temporal pattern and when it first emerged
4
AND DIAGNOSIS
“Adult Psychopathology” = Scientific study of psychological disorders in adulthood
(Examples: The nature, causes, and treatment of psychological disorders)
Clinical assessment and diagnosis are central to the study of psychopathology
ASSESSING PSYCHOLOGICAL DISORDERS
“Clinical assessment” = Systematic evaluation and measurement of psychological, biological,
and social factors in a person presenting with a possible psychological disorder
What is Diagnosis?
“Diagnosis” = Process of determining whether a presenting problem meets the established
criteria for a specific psychological disorder
Integration of:
• Signs (Observed by another person)
• Symptoms (Reported by the patient)
• Information from various other sources
• Knowledge of normal and abnormal functioning and behaviour
Involves securing symptoms and signs and interpreting supporting/subordinate sources of
information
Diagnosis requires knowledge of normal functioning and behaviour, as well as their
pathological counterparts
Symptom is a manifestation of a state/condition conceptualized as indicating an abnormality as reported
by affected individual
Sign is a manifestation of a condition that may indicate abnormality that is observed by another person
Examples: Pain is a symptom, tenderness is a sign
Most important questions to ask when diagnosing psychological disorders:
- Who is the person in the consultation?
- Why is this person being consulted?
- What can be observed?
To answer these basic questions is to understand the person and the situation- This process of
understanding/diagnosing is handled in a systemized way and consists of taking a history,
examination, special, and subordinate/supporting investigation
,Paths to diagnosis
Process of diagnosis- Gather information and integrate this with what we understand to be
normal behaviour and function, and how pathology presents
Decision tree/algorithm diagnosis: (Basic form)
- All observations are considered against all their possible causes
Hypothetical deductive method: (Intermediate approach)
- Best exemplifies logical underpinnings of the diagnostic process
- Clinician forms a hypothesis about the problem right from the beginning
- History presents the main substance of the hypothesis
Pathognomonic diagnosis:
- Pathognomonic means there is one symptom/sign, or a set of symptoms/signs that
uniquely define a condition
- Pathognomonic conditions are rare and relying on this approach is risky
Levels of understanding of abnormal psychology:
Term Level of understanding
Literally means ‘running together’
Implies the clustering of given symptoms, signs, and results of special
investigations that occur with sufficient regularity and predictability, as to
Syndrome
constitute an assumed disease entity
Set of clinical and supporting information that co-occurs at a frequency
greater than change
Consists of a syndrome merged with its clinical course
In addition to its presenting intentionality, we understand the behaviour of the
condition over time
Disorder
At this level, something is known about its pathogenesis, or how the
abnormality develops
Nothing is known about the cause
Consists of a combination of clinical intentionality, course behaviour,
Disease
pathogenesis and aetiology, or initial cause
What is Differential diagnosis?
As diagnostic process unfolds, we gather more information and understanding about the
presenting problem
Less information we have, the more the diagnostic options are and a differential diagnosis
exists
Is a list of possible conditions that conform to available clinical information
Final diagnosis is arrived at only after other disorders on this level have been eliminated
through further investigations
2
,Key concepts in assessment and diagnosis
Need to understand 3 basic concepts that help determine the value of our assessments:
a) “Reliability” = Degree to which a measurement is consistent (Example: Over time or
among different raters)
➢ Test-retest reliability- Consistency across time
➢ Inter-rater reliability- Consistency across two/more variables
b) “Validity” = Degree to which a technique measures what it intends to measure (whether
a technique assesses what it is supposed to)
➢ Concurrent validity- Extent to which the results of one assessment measure
corresponds with that of an existing measure
➢ Predictive validity- Ability of an assessment measure to predict a future outcome
c) “Standardisation” = Process of establishing specific norms and requirements for a
measuring technique to ensure it is used consistently across measurement occasions
➢ Includes instructions for administering the measure, evaluating its findings, and
comparing them to data for large numbers of people
➢ (Standards might apply to procedures of testing, scoring, and evaluating of data)
3
, ASSESSMENT TECHNIQUES
The clinical encounter
Systematic, structured, goal-directed, and rooted in scientific understanding
Encounter must be as natural and unthreatening as possible
Must avoid leading questions or questions that are closed- Must have open-ended questions
Must engage with the patient in the most relaxed and emphatic environment
Clinical encounter involves 3 components:
a) Clinical history
b) Mental status examination
c) Behavioural assessment
Clinical history (a)
Clinician asks questions to answer who, why, and what questions
In a conversational, non-confrontational style- Clinician asks about patient’s demographic
information, social and developmental background, experiences, and past and current
significant events
Asking who someone is informs you about:
➢ Name, age, where person resides, whom person lives with, relationships, education, ect
➢ Risks and possible precipitants
Why the person is seeing you tells you about:
➢ The primary complaint, what troubles that person, what is on the patient’s mind, or
sometimes how others perceive the problem to be
What is relevant to presenting complaint:
➢ What the symptom or symptom cluster is, what other features accompany it, what
aggravates and relieves it, its temporal pattern and when it first emerged
4
