Читать книгу Abnormal Psychology - William J. Ray - Страница 187

Psychological assessment is the process of gathering information about a person to be able to make a clinical decision about that person’s symptoms. Most mental health professionals use a clinical interview to initially gather information concerning the status of an individual with whom they are working. Worldwide, the clinical interview, referred to as the mental status exam, has been organized into major assessment categories including the person’s appearance and behavior, mood and affect, speech quality, thought processes, perceptions and general awareness of surroundings, and intellectual functioning and insight. With the most recent edition of the DSM (DSM–5), the SCID has been developed to set forth specific assessment questions in a structured approach along with a decision tree for directing follow-up questions. Over the past 40 years, there has been an increasing awareness that mental illness takes place within the context of a particular culture, and a fuller understanding of psychopathology requires an understanding of this context. With DSM–5, a CFI has been developed to help mental health professionals obtain information concerning the person’s culture.

Concerns about the accuracy of assessment and classification of psychopathology require us to consider questions of reliability and validity: (1) whether the person being assessed is giving us accurate information and (2) whether the assessment instrument measures the construct consistently (reliability) and accurately (validity). In terms of assessment, there are a number of types of reliability: internal reliability, test–retest reliability, alternate-form reliability, and inter-rater reliability. Although measures such as neuropsychological tests, brain images, and molecular and genetic changes suggest possible variables to be considered, there is currently no exact measure by which to diagnose psychopathology. This makes validity an important but complex concept. In terms of assessment, there are a number of types of validity: content validity, predictive validity, concurrent validity, and construct validity.

There are several models of assessment that represent different ways of assessing signs and symbols. These include symptom questionnaires, personality tests, projective tests, and neuropsychological testing. Neuroscience techniques offer an additional level of analysis to the models of assessment that focus on signs and symbols. Scientists have sought to identify underlying markers associated with specific mental disorders. Using various brain imaging techniques such as MRI, fMRI, EEG, and MEG, there has been a search for structural and functional changes associated with psychopathology. There might be different underlying brain processes involved in what appears as a single disorder. Thus, neuroscience methods may lead to better diagnostic procedures. It is also possible to use these techniques to follow the course of a disorder over time. Another potential for neuroscience methods is that by knowing the underlying brain and genetic processes involved in a particular disorder for a particular person, it would be possible to create a treatment particular to a given individual.

Classification is a way to organize the diversity seen in mental disorders. Over the past 200 years, numerous systems have been developed; however, in the past 50 years, the emphasis has been on reliability of diagnosis. There has been a push for observable characteristics that would define a specific disorder—signs and symptoms delineated through observation of, and conversation with, the individual. In general, these types of criteria make up the structure of the DSM, published by the APA and used in North America, and the ICD, published by the WHO and used in Europe. One overall change in the most recent edition of DSM (DSM–5) is the use of dimensional assessments and spectrum-related disorders. Another change is in the placement of disorders based on underlying vulnerabilities as well as symptom characteristics to reflect how a variety of disorders may have some common underlying similarities. The National Institute of Mental Health (NIMH) has begun a program to better study, prevent, and treat mental disorders, which includes developing a new way to classify mental disorders, referred to as Research Domain Criteria (RDoC). Beginning with the next chapter, I will turn to focusing on particular disorders.