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Chapter9:Clinical&MentalHealthtesting&assessment:• Mentalhealthservices(public/private)oneoflargestemployersof

psychologists• Startingpoint:referralquestion• Psychologicalassessmenttechniques:historytaking,clinicalinterview,

MSE&psychologicaltesting• Commonlyusedpsychologicaltests:intelligence,personality,

psychopathology,depression,anxiety&stress• Referralquestionprovidesjustification/rationalefortesting&

assessment• Formulationofaclear&specificreferralquestionfacilitatesderivationof

hypothesesaboutacase,selectionofappropriatepsychologicalassessmentinstruments,interpretationofresults&provisionofrecommendations(canbefacilitatedbyareferralformwithexplicitquestionsaboutreasonforreferral,useofassessmentresults&client’swillingnesstoundertakeassessment)

• Beginacasebycollectingdemographic&biographicdata-providecontexttounderstandreferralquestion,interpretresultofotherdatacollectionprocedures,makerecommendations&preparepsychreport

• Casehistorydatacanbeobtainedinclinicalinterview• Collectcasehistorydatafromnumberofsourcesforverification• Standardizedformsfacilitatecasehistorydatacollection• Whengatheringcasehistorydata:consider-privacypoliciesofvarious

organizations,legalrequirements&ethicalguidelines• Clinicalinterviewistheoldestpsychologicalassessmenttechniqueused

tocollectinfo(mostlyusedbyclinicalpsychinmentalhealthsetting)• Clinicalinterviewprovidesopportunitytobuildrapport,provide

importantinfo,&establishifclienthasreasonableunderstandingofwhatishappeningtothem&why

• Infothepsychcanconveyduringinterviewinclude:1. Purpose&natureofpsychassessment2. Whatclientisexpectedtodo3. Confidentialityofinfocollected4. Needforinformedconsent5. Whowillhaveaccesstocollectedinfo&howitwillbeused• Toconductsuccessfulclinicalinterview:psychmustestablishgood

rapportbybeingsincere&supportive• Toengageclient-techniques:1. Don’tdominateinterview2. Reflectwhatwassaid3. Paraphrasing4. Summarizing5. Clarifying6. Confronting7. Eyecontact8. Positiveposture9. Nodding• Mostinfocollectedinclinicalinterviewisverbal

• Non-verbalinfoprovidedbyclient:1. Demeanor2. Howquestionsanswered3. Whatisnotsaid(e.g.matter-of-fact/flippantstyleofresponding-maybe

inconsistentwithseriousnessofcontentbeingrevealed)• Clinicalpsychinmentalhealthsettingobtaininfo:1. Demographicdata2. Medicalhistory(self&family)3. Familyhistory4. Educational&vocationalhistory5. Psychologicalhistory• MSEuniquetomentalhealthsetting• Structuredclinicalinterviewschedules:e.g.StructuredClinicalInterview

forDMSDisorders(SCID)-toensurerelevantinforelatingtovariousdisordersareadequatelycovered&asked

v MentalStatusExam(MSE):• Comprehensivesetofquestions&observationstosystematicallyassess

mentalstateofclient• Includes:1. Appearance2. Behaviour3. Orientation:isclientawareofwho&wherehe/sheis?Doestheclient

knowwhattime(year,month,date,day,time)itis?4. Memory:immediate,recent,remote5. Sensorium:cantheclientattend&concentrate?Hearing,vision,touch,

smell6. Affect7. Mood8. Thoughtcontent&thoughtprocess9. Intellectualresources10. Insight11. Judgment• InfogainedfromMSE&clinicalinterview-psychcan

formulate/conceptualizeclient’sproblembyreferringtosystematicclarificationsystem(DSMorInternationalClarificationofDiseasesbyWHO-furtherclarifyideas&narrowdown/testhypotheses)

• Mayadministerpsychteststofinaliseassessment• DSMcommonlyusedinUSA,Australasia,Asia• DSM1stedition:1952• DSMpurposetofacilitatecommunicationamongmentalhealth

professionals• DSMbasedonobservedbehaviouralsymptoms-canbeusedby

professionalswithdifferenttheoreticalorientations• NoinfoabouttreatmentorAetiologyincludedinDSM• Clientisclassifiedintermsofasetoffiveaxes/clinicallyimportant

factors(DSM):1. AxisI:clinicaldisorders(e.g.dementia,substance-relateddisorders,

schizophrenia,mooddisorders,anxiety&eatingdisorders)

2. AxisII:mentalretardation&personalitydisorders:(e.g.antisocialpersonalitydisorder,paranoidpersonality,borderlinepersonality)

3. AxisIII:physicalormedicalconditionsthatmayberelevanttomentaldisorders:(e.g.epilepsy,cancer,Alzheimer’s,Parkinson’s)

4. AxisIV:psych&environmentalproblems:(e.g.stress,financial,marital,occupational)thatmayaffectdiagnosis,treatment&prognosis

5. AxisV:globalassessmentoffunctioningfrom1to100• DSMcriticizedforbeingatheoretical,toomuchbasedonmedicalmodel,<

reliability&validity• NewDSM-5publishedin2013v Psychologicaltests:v Intelligence:• Binet:intelligenceinchildren• Psychusemeasureofgeneralintellectualability• DavidWeschler:batteryoftestsforadultintelligence(allowclassification

ofintelligencelevel&aidinnarrowingdownnatureofproblem)• Weschlerintelligencedefinition:aggregateorglobalcapacityofthe

individualtoactpurposefully,thinkrationally,dealeffectivelywithenvironment

• IQ:impliesintelligencesisaunitaryconstruct• Recentmodels:suggestintelligenceiswhereindividualsdisplayaprofile

ofabilitieswithstrengths&weaknessesv WeschlerAdultIntelligenceScale:• OriginalpublishedasWeschler-BellevueIntelligenceScalein1939• WAIS1995• WAIS-Revised(WAIS-R;1981)• WAIS-ThirdEdition(WAIS-III;1997)• Adultsages16-90years• WAIS-IV:2008-assess:psychoeducationaldisability,neuropsychiatric&

organicdysfunction&giftedness(purpose:updatenorms,co-normwithWeschlerMemoryScale4thed&WeschlerIndividualAchievementTest2nded,reducetestingtime&improvepsychometricproperties)

• WAIS-IV:comprises10coresubtests&5supplementarysubtests• InWAIS-IV:2subtestsinWAIS-III(picturearrangement&object

assembly)weredropped,3newsubtestsadded(visualpuzzles,figureweights&cancellation)

• WAIS-IV:67min• 5compositescorescanbeobtainedfromcoresubtests:1. FullscaleIQ2. Verbalcomprehension3. Perceptualreasoning4. Workingmemory5. Processingspeed• VerbalIQ&performanceIQreplacedbyverbalcomprehensionindex&

perceptualreasoningindex• Generalabilityindexcanbederivedfromthe3verbalcomprehension&3

perceptualreasoningcoresubtests