What is Clinical Assessment and Clinical Diagnosis?

Psychological assessment refers to a procedure by which clinicians, using psychological

tests, observation, and interviews, develop a summary of the client’s symptoms and
problems. Clinical diagnosis is the process through which a clinician arrives at a general
“summary classification” of the patient’s symptoms by following a clearly defined system
such as DSM-IV-TR or ICD-10 (International Classification of Diseases), the latter published
by the World Health Organization. Assessment is an ongoing process and may be important
at various points during treatment, not just at the beginning— for example, to examine the
client’s progress in treatment or to evaluate outcome. In the initial clinical assessment, an
attempt is usually made to identify the main dimensions of a client’s problem and to predict
the probable course of events under various conditions. It is at this initial stage that crucial
decisions have to be made—such as what (if any) treatment approach is to be offered,
whether the problem will require hospitalization, to what extent family members will need
to be included as co-clients, and so on. Sometimes these decisions must be made quickly, as
in emergency conditions, and without critical information. As will be seen, various
psychological measurement instruments are employed to maximize assessment efficiency in
this type of pretreatment examination process (Harwood & Beutler, 2009).
The Relationship Between Assessment and Diagnosis- It is important to have an adequate
classification of the presenting problem for a number of reasons. Clinically, knowledge of a
person’s type of disorder can help in planning and managing the appropriate treatment.
Administratively, it is essential to know the range of diagnostic problems that are
represented in the client population and for which treatment facilities need to be available.
If most clients at a facility have been diagnosed as having personality disorders, for example,
then the staffing, physical environment, and treatment facilities should be arranged
accordingly, for example, with appropriate security and clearly established rules. In many
cases, a formal diagnosis is necessary before insurance claims can be filed to cover the
client’s treatment costs. Thus the nature of the difficulty needs to be understood as clearly
as possible, including a diagnostic categorization if appropriate.The classification and
diagnosis is an important concern for both mental health providers and mental health
clients. While there is no single, definitive definition of mental disorders, some different
classification and diagnostic criteria have emerged. Clinicians utilize the Diagnostic and
Statistical Manual of Mental Disorders, published by the American Psychiatric Association,
to determine whether a set of symptoms or behaviours meets the criteria for diagnosis as a
mental disorder. The International Classification of Diseases, published by the World Health
Organization, is also frequently used.

Types of Clinical Assessment

CLINICAL INTERVIEWS
A. Interviews are face-to-face encounters and often are the first contact between a client
and a clinician/assessor
1. They are used to collect detailed information, especially personal history, about a client.
 2. They are useful because they allow the interviewer to focus on whatever topics he/she
considers most important.
B. The focus of an interview depends on the interviewer’s theoretical orientation
1. Interviews can be either unstructured or structured.
a. In unstructured interviews, clinicians ask open-ended questions.
b. In structured interviews, clinicians ask prepared questions, often from a published
interview schedule.
(a) These types of interviews also may include a mental status exam—a systematic
assessment of the client’s awareness, orientation to time and place, attention span,
memory, judgment and insight, thought content and processes, mood, and appearance
C. What are the limitations of clinical interviews?
1. Interviews may lack validity or accuracy; individuals may be intentionally misleading.
2. Interviewers may be biased or may make mistakes in judgment.
3. Interviews, particularly unstructured ones, may lack reliability.

CLINICAL TESTS :
Clinical tests are devices for gathering information about specific topics from which broader
information can be inferred There are more than 500 different tests in use, falling into six
categories:
1.Projective test is a personality test designed to let a person respond to ambiguous stimuli,
presumably revealing hidden emotions and internal conflicts projected by the person into
the test. This is sometimes contrasted with a so-called "objective test" / "self-report test",
which adopt a "structured" approach as responses are analyzed according to a presumed
universal standard (for example, a multiple choice exam), and are limited to the content of
the test. The responses to projective tests are content analyzed for meaning rather than
being based on presuppositions about meaning, as is the case with objective tests.
Projective tests have their origins in psychoanalysis, which argues that humans have
conscious and unconscious attitudes and motivations that are beyond or hidden from
conscious awareness.

2.Personality Inventories: Among the most common of self-report tests are personality
inventories. Their origins lie in the early history of personality measurement, when most
tests were constructed on the basis of so-called face validity; that is, they simply appeared
to be valid. Items were included simply because, in the fallible judgment of the person who
constructed or devised the test, they were indicative of certain personality attributes. In
other words, face validity need not be defined by careful, quantitative study; rather, it
typically reflects one’s more-or-less imprecise, possibly erroneous, impressions. Personal
judgment, even that of an expert, is no guarantee that a particular collection of test items
will prove to be reliable and meaningful in actual practice.
A widely used early self-report inventory, the so-called Woodworth Personal Data Sheet,
was developed during World War I to detect soldiers who were emotionally unfit for
combat. Among its ostensibly face-valid items were these: Does the sight of blood make you
sick or dizzy? Are you happy most of the time? Do you sometimes wish you had never been
born? Recruits who answered these kinds of questions in a way that could be taken to mean
that they suffered psychiatric disturbance were detained for further questioning and
evaluation. Clearly, however, symptoms revealed by such answers are exhibited by many
people who are relatively free of emotional disorder.
Rather than testing general knowledge or specific skills, personality inventories ask people
questions about themselves. These questions may take a variety of forms. When taking such
a test, the subject might have to decide whether each of a series of statements is accurate
as a self-description or respond to a series of true-false questions about personal beliefs.

Several inventories require that each of a series of statements be placed on a rating scale in
terms of the frequency or adequacy with which the statements are judged by the individual
to reflect his tendencies and attitudes. Regardless of the way in which the subject responds,
most inventories yield several scores, each intended to identify a distinctive aspect of
personality. One of these, the Minnesota Multiphasic Personality Inventory (MMPI), is
probably the personality inventory in widest use in the English-speaking world. Also
available in other languages, it consists in one version of 550 items (e.g., “I like tall women”)
to which subjects are to respond “true,” “false,” or “cannot say.” Work on this inventory
began in the 1930s, when its construction was motivated by the need for a practical,
economical means of describing and predicting the behaviour of psychiatric patients. In its
development efforts were made to achieve convenience in administration and scoring and
to overcome many of the known defects of earlier personality inventories. Varied types of
items were included and emphasis was placed on making these printed statements
(presented either on small cards or in a booklet) intelligible even to persons with limited
reading ability.

3.Response inventories: Response inventories usually are self-response measures that focus
on one specific area of functioning (a) Affective inventories: measure the severity of such
emotions as anxiety, depression, and anger. One of the most widely used affective inventories
is the Beck Depression Inventory (BDI). (b) Social skill inventories: ask respondents to
indicate how they would respond in a variety of social situations. These inventories usually
are used by behavioural and sociocultural clinicians. (c) Cognitive inventories: reveal a
person’s typical thoughts and assumptions. These inventories usually are used by cognitive
clinicians and researchers.

MERITS:(a) Response inventories have strong face validity (b) They rarely include questions
to assess careless or inaccurate responding (c) Few (BDI is one exception) have been
subjected to careful standardization, reliability, and/or validity procedures

4.Psychophysiological tests: Psychophysiological tests measure physiological response as an

indication of psychological problems. This includes measurement of heart rate, blood
pressure, body temperature, galvanic skin response, and muscle contraction
 The most popular psychophysiological test is the polygraph (lie detector)
MERITS(a) These tests require expensive equipment that must be tuned and maintained
(b) They also can be inaccurate and unreliable

5.Neurological and neuropsychological tests: Neurological tests directly assess brain function
by assessing brain structure and activity, Examples: EEG, PET scans, CAT scans, MRI.
Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual,
and motor functioning.

The most widely neuropsychological test is the Bender Visual-Motor Gestalt Test.
MERITS(a) These types of tests can be very accurate (b) These tests are, at best, only rough
and general screening devices. They are best when used in a battery of tests, each targeting a
specific skill area.

6.Intelligence tests: Intelligence tests are designed to indirectly measure intellectual ability
and are typically comprised of a series of tests assessing both verbal and nonverbal skills.
They generate an intelligence quotient (IQ). The most popular of the intelligence tests are the
Wechsler scales (WAIS, WISC).

MERITS(a) These are among the most carefully produced of all clinical tests (b) They are
highly standardized on large groups of subjects, and, as such, have very high reliability and
validity (c) Performance can be influenced by nonintelligence factors (e.g., motivation,
anxiety, test-taking experience) (d) Tests may contain cultural biases in language or tasks (e)
Members of minority groups may have less experience and be less comfortable with these
types of tests, influencing their results.

Clinical Observation

One of the traditional and most useful assessment tools that a clinician has available is direct
observation of a client’s characteristic behaviour (Hartmann et al., 2004). The main purpose
of direct observation is to learn more about the person’s psychological functioning by
attending to his or her appearance and behaviour in various contexts. Clinical observation is
the clinician’s objective description of the person’s appearance and behaviour—her or his
personal hygiene and emotional responses and any depression, anxiety, aggression,
hallucinations, or delusions she or he may manifest. Ideally, clinical observation takes place
in a natural environment (such as observing a child’s behaviour in a classroom or at home),
but it is more likely to take place upon admission to a clinic or hospital (Leichtman, 2009).
For example, a brief description is usually made of a subject’s behaviour upon hospital
admission, and more detailed observations are made periodically on the ward.

Some practitioners and researchers use a more controlled, rather than a naturalistic,
behavioural setting for conducting observations in contrived situations. These analogue
situations, which are designed to yield information about the person’s adaptive strategies,
might involve such tasks as staged role-playing, event renactment, family interaction
assignments, or think-aloud procedures (Haynes et al., 2009). In addition to making their own
observations, many clinicians enlist their clients’ help by providing them instruction in self-
monitoring: self-observation and objective reporting of behaviour, thoughts, and feelings as
they occur in various natural settings. This method can be a valuable aid in determining the
kinds of situations in which maladaptive behaviour is likely to be evoked, and numerous
studies also show it to have therapeutic benefits in its own right. Alternatively, a client may
be asked to fill out a more or less formal self-report or a checklist concerning problematic
reactions experienced in various situations. Many instruments have been published in the
professional literature and are commercially available to clinicians. These approaches
recognize that people are excellent sources of information about themselves. Assuming that
the right questions are asked and that people are willing to disclose information about
themselves, the results can have a crucial bearing on treatment planning.

Psychological testing as a Clinical Assessment Tool

What is a Psychological Test?
Interviews and behavioral observation are relatively direct attempts to determine a person’s
beliefs, attitudes, and problems. Psychological tests are a more indirect means of assessing
psychological characteristics. Scientifically developed psychological tests (as opposed to the
recreational ones sometimes appearing in magazines or on the Internet) are standardized
sets of procedures or tasks for obtaining samples of behavior. A subject’s responses to the
standardized stimuli are compared with those of other people who have comparable
demographic characteristics, usually through established test norms or test score
distributions. From these comparisons, a clinician can then draw inferences about how
much the person’s psychological qualities differ from those of a reference group, typically a
psychologically normal one. Among the characteristics that these tests can measure are
coping patterns, motive patterns, personality characteristics, role behaviors, values, levels of
depression or anxiety, and intellectual functioning. Impressive advances in the technology of
test development have made it possible to create instruments of acceptable reliability and
validity to measure almost any conceivable psychological characteristic on which people
may vary. Moreover, many procedures are available in a computer-administered and
computer-interpreted format.

What are it’s chief characterstics?

Types Of Psychological Tests?

Two General categories of psychological tests for use in clinical practice are intelligence
tests and personality tests (projective and objective).
INTELLIGENCE TESTS
A clinician can choose from a wide range of intelligence tests. The Wechsler Intelligence
Scale for Children-Revised (WISC-IV) (see Weiss et al., 2006) and the current edition of the
Stanford-Binet Intelligence Scale (Kamphaus & Kroncke, 2004) are widely used in clinical
settings for measuring the intellectual abilities of children (Wasserman, 2003). Probably the
most commonly used test for measuring adult intelligence is the Wechsler Adult Intelligence
Scale-Revised (WAIS-IV) (Benson et al., 2010; Lichtenberger & Kaufman, 2009). It includes
both verbal and performance material and consists of 15 subtests. A brief description of two
of the subtests will serve to illustrate the types of functions the WAIS-IV measures.
● Vocabulary (verbal): This subtest consists of a list of words to define that are presented
orally to the individual. This task is designed to evaluate knowledge of vocabulary, which has
been shown to be highly related to general intelligence.
● Digit Span (performance): In this test of short-term memory, a sequence of numbers is
administered orally. The individual is asked to repeat the digits in the order administered.
Another task in this subtest involves the individual’s remembering the numbers, holding
them in memory, and reversing the order sequence—that is, the individual is instructed to
say them backward (Lichtenberger & Kaufman, 2009).
Individually administered intelligence tests—such as the WISC-IV, the WAIS-IV, and the
Stanford-Binet—typically require 2 to 3 hours to administer, score, and interpret. In many
clinical situations, there is not enough time or funding to use these tests. In cases where
intellectual impairment or organic brain damage is thought to be central to a patient’s
problem, intelligence testing may be the most crucial diagnostic procedure in the test
battery. Moreover, information about cognitive functioning or deterioration can provide
valuable clues to a person’s intellectual resources in dealing with problems (Kihlstrom,
2002).

PROJECTIVE PERSONALITY TESTS

There are a great many tests designed to measure personal characteristics other than
intellectual ability. It is customary to group these personality tests into projective and
objective measures. Projective personality tests are unstructured in that they rely on various
ambiguous stimuli such as inkblots or vague pictures rather than on explicit verbal
questions, and in that the person’s responses are not limited to the “true,” “false,” or
“cannot say” variety. Through their interpretations of these ambiguous materials, people
reveal a good deal about their personal preoccupations, conflicts, motives, coping
techniques, and other personality characteristics. An assumption underlying the use of
projective techniques is that in trying to make sense out of vague, unstructured stimuli,
individuals “project” their own problems, motives, and wishes into the situation. Such
responses are akin to the childhood pastime of seeing objects or scenes in cloud formations,
with the important exception that the stimuli are in this case fixed and largely the same for
all subjects. It is the latter circumstance that permits determination of the normative range
of responses to the test materials, which in turn can be used to identify objectively deviant
responding. Thus, projective tests are aimed at discovering the ways in which an individual’s
past learning and personality structure may lead him or her to organize and perceive
ambiguous information from the environment. Prominent among the several projective
tests in common use are the Rorschach Inkblot Test, the Thematic Apperception Test (TAT),
and sentence completion tests.
OBJECTIVE PERSONALITY TESTS
Objective personality tests are structured—that is, they typically use questionnaires, self-
report inventories, or rating scales in which questions or items are carefully phrased and
alternative responses are specified as choices. They therefore involve a far more controlled
format than projective devices and thus are more amenable to objectively based
quantification. One virtue of such quantification is its precision, which in turn enhances the
reliability of test outcomes. There are a large number of available personality assessment
measures for use in personality and clinical assessment. For example, the NEO-PI
(Neuroticism-Extroversion-Openness Personality Inventory) provides information on the
major dimensions in personality and is widely used in evaluating personality factors in
normal-range populations (Costa & Widiger, 2002). There are also many objective
assessment instruments developed to assess focused clinical problems. For example, the
Millon Clinical Multiaxial Inventory (MCMI-III; see Choca, 2004) was developed to evaluate
the underlying personality dimensions among clients in psychological treatment. Today the
most widely used personality assessment instrument is the MMPI-2.

What is Personality?
Personality is the dynamic and organized set of characteristics possessed by a person that
uniquely influences his or her cognitions, motivations, and behaviours in various situations.
We can define personality as the distinctive and relatively enduring ways of thinking,
feeling, and acting that characterize a person’s responses to life situations.
The description of personality involves judgments regarding who the person truly is and
how she or he differs from other people. Particular biological tendencies and social and
cultural learning experiences combine to determine the person’s uniqueness.
It can also be thought of as a psychological construct—a complex abstraction that
encompasses the person’s unique genetic background (except in the case of identical twins)
and learning history, and the ways in which these factors influence his or her responses to
various environments or situations.
Thus, many investigators regard the study of personality as primarily the scientific analysis
of individual differences that help to account for why and how people react uniquely, and
often creatively, to various environmental or situational demands.

Types of Personality Tests

Personality testing refers to techniques that are used to accurately and consistently measure
personality. Personality, is something that we informally assess and describe every day.
When we talk about ourselves and others, we frequently refer to different characteristics of an
individual's personality. Psychologists ,do much the same thing when they assess personality
but on a much more systematic and scientific level.

 The first modern personality test was the Woodworth Personal Data Sheet, which was
first used in 1919. It was designed to help the United States Army screen out recruits
who might be susceptible to shell shock.
 The NEO PI-R, or the Revised NEO Personality Inventory, is one of the most significant
measures of the Five Factor Model (FFM). The measure was created by Costa and
McCrae and contains 240 items in the forms of sentences. Costa and McCrae had
divided each of the five domains into six facets each, 30 facets total, and changed the
way the FFM is measured.
 The Rorschach inkblot test was introduced in 1921 as a way to determine personality by
the interpretation of inkblots.
 The Thematic Apperception Test was commissioned by the Office of Strategic Services
(O.S.S.) in the 1930s to identify personalities that might be susceptible to being turned
by enemy intelligence.
 The Minnesota Multiphasic Personality Inventory was published in 1942 as a way to aid
in assessing psychopathology in a clinical setting. It can also be used to assess the
Personality Psychopathology Five (PSY-5),[50] which are similar to the Five Factor Model
(FFM; or Big Five personality traits). These five scales on the MMPI-2 include
aggressiveness, psychoticism, disconstraint, negative emotionality/neuroticism, and
introversion/low positive emotionality.
 Myers-Briggs Type Indicator (MBTI) is a questionnaire designed to
measure psychological preferences in how people perceive the world and make
decisions. This 16-type indicator test is based on Carl Jung's Psychological Types,
developed during World War II by Isabel Myers and Katharine Briggs. The 16-type
indicator includes a combination of Extroversion-Introversion, Sensing-Intuition,
Thinking-Feeling and Judging-Perceiving. The MBTI utilizes 2 opposing behavioural
divisions on 4 scales that yields a "personality type".
 The 16PF Questionnaire (16PF) was developed by Raymond Cattell and his colleagues in
the 1940s and 1950s in a search to try to discover the basic traits of human personality
using scientific methodology. The test was first published in 1949, and is now in its 5th
edition, published in 1994. It is used in a wide variety of settings for individual and
marital counselling, career counselling and employee development, in educational
settings, and for basic research.
 The DISC assessment is based on the research of William Moulton Marston and later
work by John Grier, and identifies four personality types: Dominance; Influence;
Steadiness and Conscientiousness. It is used widely in Fortune 500 companies, for-profit
and non-profit organizations.
Why is Personality assessed for Clinical Diagnostic purpose?
When should Psychological tests be used for Clinical Diagnosis?
Major Personality tests used for Clinical Diagnostic purpose:
Efficacy of Personality testing for Diagnostic purpose:
Advantages:
Disadvantages:

What are Response Bias and Response Styles?

DEFINE:
Mental Disorder-
Psychopathology-
Signs-
Symptoms-
Syndrome-
Disease-

Classification of Mental Disorders as per DSM 5/ ICD 10

Classification of Psychiatric signs and symptoms