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Psychology 314 - F Gaffoor (22630961)Chapter 3 - Clinical Assessment and Diagnosis
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.
It is both a process and a conclusion.
It is the process of identifying a disorder by its manifestations – symptoms, signs and results of various special investigations.
Diagnosis therefore implies learning, or gaining knowledge by setting things apart, separating out elements of a whole and studying the
attributes of its phenomena and how they interrelate in order to form an opinion about the whole.
To reach a diagnostic conclusion, the process relies on two bodies of information.
Firstly, involves securing symptoms and signs and interpreting adjunctive sources of information – psychological tests, lab tests, reports by
third parties.
Secondly, diagnosis requires knowledge of normal functioning and behaviour and their pathological counterparts.
The experienced clinician integrates these two bodies of information.
Symptoms and signs are important to the psychologist as it is the food of clinical practice.
Symptoms characterises a state, condition or entity.
In clinical practice, a symptom constitutes any state that indicates the perceived presence, or absence, of something.
Symptoms especially indicate change from a former state.
, It is a manifestation of a state or condition conceptualised as indicating an abnormality as reported by the affected individual.
A sign is a manifestation of a condition that may indicate abnormality, that is observed by another person.
Distinguishing between signs and symptoms are not straightforward.
Pain is a symptom, tenderness a sign.
Who, Why and What?
Who is this person in the consultation?
Why is this person being consulted?
What is it that can be observed?
To answer this is to understand the person and the situation.
Psychologists examine by means of observing mental state and behaviour.
Supportive special investigations consist of standardised test instruments such as neuropsychological batteries, intelligence and
personality tests.
Important to understand that tests serve to confirm a diagnostic hypothesis more usually than detecting what the problem is in the first
place.
Paths to Diagnosis
In the process of diagnosis, we gather information and integrate this with what we understand to be normal behaviour and function and
how pathology presents.
It follows a decision tree in which all observations are considered against all their possible causes.
Hypo-thetico deductive method is which best exemplifies the logical underpinnings of the diagnostic process.
Clinician forms a hypothesis about the problem right from the outset.
The history presents the main substance of the hypothesis.
Focused, direct further enquiry confirms or refutes this hypothesis.
Pathognomonic diagnosis means that there is one symptom or sign, or a set of symptoms or signs, that uniquely define a condition.
Clinician collects a lot of information across a broad range of the individual’s condition to determine where the source of the problem may
lie.
, After getting a sense of the overall functioning of the person, the clinician narrows the focus by ruling out problems in some areas and
concentrating on areas that seem most relevant.
Diagnosis is only as good as the information available to the diagnostician.
If only observed and reported information is available, the diagnosis is experiential or phenomenological.
Phenomenological diagnosis is solely reliant on clinical information.
E.g. a patient who presents as psychotic and disorganised with intact consciousness can be described only phenomenologically, so without
more behavioural information and a history of how the condition developed, conclusions cannot be drawn.
Second level of diagnosis involves the recognition of the occurrence of predictable clusters of phenomena.
More is known about the presentation, as enough phenomena can be observed to recognize clustering.
This is called syndromal diagnosis.
For a phenomenon to constitute a syndrome, they must occur together at a higher rate than would be predicted by chance alone.
Pathogenic and aetiologic diagnoses, where the pathological process and cause are known.
Functional diagnosis is useful as it allows us to consider the functional implications of a condition.
As the diagnostic process unfolds, we gather more information and understanding about the presenting problem; the less information we
have, the more the diagnostic options are, and a differential diagnosis exists.
It is a list of possible conditions that conform to the available clinical information.
Final diagnosis is arrived at only after other disorders on this list have been eliminated through further investigations.
Key Concepts in Assessment and Diagnosis
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