CHAPTER 3

CLASSIFICATION AND ASSESSMENT

CLASSIFICATION: CATEGORIES OF MALADAPTIVE BEHAVIOR

ADVANTAGES OF CLASSIFICATION Bridges gap between research and treatment. Allows communication between clinicians. Valuable for statistical purposes. Categories contribute to planning of treatment

programs and facilities. DISADVANTAGES OF CLASSIFICATION

Labeling may result in stigma. Diagnostic categories are imperfect.

CHARACTERISTICS OF A GOOD CLASSIFICATION SYSTEM

1. Provides information about the cause or causes of a condition.

2. Provides a common language for communication among clinicians and researchers.

3. Enables clinicians to give patients and their families a short- and long-term outlook.

4. Indicates possible treatment.5. Suggests paths to prevention.

THE DSM-IV

Axis I Most disorders except personality disorders and

mental retardation. Axis II

Personality disorders and mental retardation. Axis III

Relevant general medical conditions. Axis IV

Psychosocial and environmental problems. Axis V

Global assessment of psychological, social, and occupational functioning.

MAJOR AXIS I DIAGNOSTIC CATEGORIES

Disorders first diagnosed in infancy and childhood

Delirium, dementia, amnestic, and other cognitive disorders

Mental disorders due to a general medical condition

Substance-related disorders

Schizophrenia and other psychotic disorders

Mood disorders

Anxiety disorders Somatoform disorders

Factitious disorders Dissociative disorders

Other conditions that are the focus of clinical attention

Eating disorders

Sexual and gender identity disorders

Impulse-control disorders

Adjustment disorders Sleep disorders

CLINICAL OBSERVATIONSAND SYMPTOMS USED

IN DSM-IV CLASSIFICATION

RESEARCH ON CLASSIFICATION

RELIABILITY Is system reproducible? Kappa statistic

VALIDITY Is system appropriate?

CLINICAL JUDGMENT Does system produce reliable

diagnoses? CULTURAL CONTEXT

Is system culture-bound?

THE ASSESSMENT PROCESS

Interview Mental Status Examination Structured Interview Diagnostic Interview Schedule

(DIS) Structured Clinical Interview for

DSM (SCID)

FOUR COMPONENTS OF THE CLINICAL INTERVIEW

Rapport How interviewer and client relate to each

other. Technique

Select techniques to build rapport. Mental Status

Evaluate client answers to questions. Diagnosis

A continuing, fluid process of formulating client’s problems and personality.

KEY FEATURES OF CLIENT BEHAVIOR OBSERVABLE IN MENTAL STATUS

EXAMINATION

Appearance Consciousness or alertness Psychomotor behavior Attention and concentration Speech Thought patterns Orientation Memory Affect and mood Energy Perception Judgment and insight

INTELLIGENCE TESTS

Binet Tests Alfred Binet IQ= MA/CA x 100

Wechsler Tests Wechsler Adult Intelligence Scale (WAIS-III) Wechsler Intelligence Scale for Children

(WISC-III) Wechsler Preschool and Primary Scale of

Intelligence (WPPSI-R) Full Scale IQ=Performance IQ+Verbal IQ

Kaufman Assessment Battery for Children (K-ABC)

NEUROPSYCHOLOGICAL TESTSMeasure cognitive, sensorimotor, and perceptual

consequences of brain abnormality

PERSONALITY ASSESSMENT

Personality Inventories Minnesota Multiphasic Personality Inventory

(MMPI-2) Million Clinical Multiaxial Inventory (MCMI)

Rating Scales Behavior Rating Scale for Children Visual Analogue Scale (VAS)

Projective Techniques Rorschach Inkblots Thematic Apperception Test (TAT) Word Association Test Sentence Completion Test

THE MMPI-2: CLINICAL AND VALIDITY SCALES

ASSESSING AXIS II PERSONALITY DISORDERS

THE THEMATIC APPERCEPTION TEST (TAT)

VISUAL ANALOGUE SCALES

OTHER FORMS OF ASSESSMENT

Behavioral Assessment Information about behaviors

Cognitive Assessment Information about thoughts and thought

processes Relational Assessment

Information about key relationships, especially family.

Bodily Assessment Physiological functioning Polygraph, galvanic skin response (GSR), brain

imaging

BODILY ASSESSMENT – BLOOD PRESSURE

BODILY ASSESSMENTTHE POLYGRAPH