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Chapter 4: Clinical Assessment and Diagnosis Multiple-Choice Questions 1. Psychological assessment refers to the a. procedures used to summarize a client's problem. b. process used to arrive at a diagnosis. c. development of a treatment plan. d. determination of how environmental factors impact the course of a disorder. Answer: a. procedures used to summarize a client's problem. 2. A person comes to a mental health professional with a certain complaint. The professional attempts to understand the nature and extent of the problem. This process is called a. diagnosis. b. assessment. c. clinical treatment. d. screening. Answer: b. assessment. 3. Why is it important to have an appropriate classification of the presenting problem? a. A formal diagnosis may be needed for insurance purposes. b. A determination of the range of presenting symptoms is needed to ensure proper placement in a treatment facility. c. A recognition of what type of disorder is present will aid in the development of an effective treatment plan. d. All of the above. Answer: d. All of the above. 4. Dr. Vera says, "It may only provide a limited view of a person's problems, but it is important for planning appropriate treatment. Administratively, it is essential so that a facility can know what kinds of problems clients need help with. Even if we don't want to do it, insurance claims require it." What is Dr. Vera is referring to? a. Formal diagnosis b. Screening activities c. Taking a personal history d. Assessment Answer: a. formal diagnosis 5. Which of the following statements regarding assessment is true? a. Assessment should focus only on the client's current level of functioning. b. An adequate assessment includes a determination of the amount of danger the client poses to himself and others. c. An adequate assessment should include as much information as possible. d. Assessment should focus on biological concerns rather than social concerns. Answer: c. An adequate assessment should include as much information as possible. 6. What role does the social context play in assessment? a. Social context is not considered during assessment, only during diagnosis. b. An evaluation of the environment in which the client lives is necessary in order to understand the demands they face, as well as the supports that are present. c. Environmental factors are usually the proximal cause of mental disorders and frequently need to be addressed before any form of treatment commences. d. The social context need only be considered when a course of treatment is being selected; significant others in the client's life should be the primary decision makers. Answer: b. An evaluation of the environment in which the client lives is necessary in order to understand the demands they face, as well as the supports that are present. 7. Which of the following is a true statement about assessment and professional orientation? a. Regardless of whether a therapist is behaviorally or psychodynamically oriented, the same basic assessment procedures are employed. b. The focus of the assessment will be largely determined by the professional orientation of the clinician. c. While some assessment procedures will vary, a biological screening and administration of a personality test are components of all assessments. d. The assessment techniques employed will serve to reveal the causal factors that are most consistent with the clinician's orientation. Answer: b. The focus of the assessment will be largely determined by the professional orientation of the clinician. 8. The need for rapport between a clinician and a client means a. that the clinician and the client must feel friendly toward each other. b. that someone who is court ordered will be an easy client. c. clients don't need to be given any feedback about their test performance. d. the client must feel comfortable with the clinician and the assessment. Answer: d. the client must feel comfortable with the clinician and the assessment. 9. Which of the following demonstrates reliability? a. An IQ test is effective in predicting the academic performance of both males and females. b. Scores on an IQ test are not affected by mood. c. Scores on two different intelligence tests are highly correlated. d. When an IQ test is administered to the same person repeatedly, the results do not differ. Answer: d. When an IQ test is administered to the same person repeatedly, the results do not differ. 10. A valid test a. measures what it is designed to measure. b. yields consistent results. c. is standardized. d. rarely is reliable. Answer: a. measures what it is designed to measure. 11. Which of the following statements about reliability and validity is true? a. Reliable tests are usually valid. b. Valid tests are usually reliable. c. There is no relationship between reliability and validity. d. In order for a test to be reliable, it must be valid. Answer: b. Valid tests are usually reliable. 12. Psychological test results are often compared to each other to determine a mid-range, or normal point. In order to accomplish this, test administration must be completely consistent from one person to the next. What is this process called? a. validity b. standardization c. reliability d. T-score distribution Answer: b. standardization 13. Which of the following would be used to reveal a dysrhythmia in brain activity? a. CAT scan b. EEG c. MRI d. PET scan Answer: b. EEG 14. Which of the following makes it possible to see all but the most minute abnormalities of brain structure? a. CAT scan b. EEG c. MRI d. PET scan Answer: c. MRI 15. Dr. Smith believes that a decrease in frontal lobe function underlies the cognitive deficits seen in schizophrenia. He has hypothesized that effective drug therapy serves to selectively increase metabolic activity in this part of the brain. Which of the following is Dr. Smith most likely to use to test his hypothesis? a. Computerized axial tomography (CAT) scans b. Magnetic resonance imaging (MRI) c. Positron emission tomography (PET) scans d. An electroencephalogram (EEG) Answer: c. positron emission tomography (PET) scans 16. One advantage of magnetic resonance imaging (MRI) over the CAT scan is that the MRI a. is not an invasive procedure. b. provides better differentiation and clarity. c. measures the metabolic processes of the brain. d. does not require a claustrophobic cylinder-shaped machine. Answer: b. provides better differentiation and clarity. 17. Dr. Bruce says "Its beneficial features are the ability to map ongoing psychological activities of the brain without injecting radioactive substances into the patient's body. In addition, they are much more widely available procedures than what was used before." What is Dr. Bruce describing? a. Positron emission tomography (PET) scans b. Functional magnetic resonance imaging (fMRI) c. Electroencephalograms (EEGs) d. Computerized axial tomography (CAT) scans Answer: b. Functional magnetic resonance imaging (fMRI) 18. The fMRI technique cannot currently be used as a diagnostic tool. This is because a. the images it produces aren't sharp enough. b. the devices needed for the technique aren't readily available. c. it is very difficult to interpret the results. d. it has been shown to have very low reliability. Answer: c. it is very difficult to interpret the results. 19. Dr. Kim is a psychologist who uses a number of tests to measure a person's cognitive, perceptual, and motor performance to detect brain damage. Dr. Kim is probably a specialist in using a. neuropsychological assessment. b. functional magnetic resonance imaging. c. computerized axial tomography. d. functional electroencephalograms. Answer: a. neuropsychological assessment. 20. While neurological assessment procedures evaluate the brain's physical properties, neuropsychological assessment focuses on a. brain activity. b. brain functioning. c. client performance. d. self-reported changes in cognitive and perceptual functioning. Answer: c. client performance. 21. Because his psychologist suspects he might have substantial brain damage, Tony was given a five-hour battery of tests that included listening to rhythmic beats presented by tape recorder and putting different shaped blocks into grooves while blindfolded. The procedure Tony experienced is called the a. Rorschach. b. MMPI-2. c. Rhythm Test d. functional Magnetic Resonance Imaging (fMRI) test. Answer: c. Rhythm Test 22. Ed has suffered a head injury in a car accident. He is referred to a psychologist to see what types of impairment now exist and to get some suggestions for treatment. The best assessment strategy would be a. a CAT scan. b. neuropsychological tests. c. a PET scan. d. an fMRI. Answer: b. neuropsychological tests. 23. In which of the following circumstances would a psychosocial assessment clearly need to be used? a. Mr. Harvey has been having problems with his memory since his stroke. b. After a change in her hormone treatment regimen, Hillary began to show severe mood swings. c. Ever since the divorce, James has been sleeping less and less. d. Since the car accident, Jill has had nightmares. Answer: c. Ever since the divorce, James has been sleeping less and less. 24. A psychosocial assessment typically begins with a. a physical examination. b. an assessment of global level of functioning. c. administration of the MMPI. d. an interview. Answer: d. an interview. 25. Under what circumstances is a structured interview most likely to be used? a. When consistent information is needed for research purposes b. When an accurate diagnosis is needed to ensure appropriate treatment c. When the behavior of the client is erratic d. When the information provided in an unstructured interview is found to lack reliability Answer: a. When consistent information is needed for research purposes 26. Which of the following is a drawback of a structured interview? a. Important information is asked about in the same way. b. Information from one is hard to compare to information from another. c. Interviews may include questions about areas that are of no concern to the patient. d. Each person who uses interviews, uses them in different ways. Answer: c. Interviews may include questions about areas that are of no concern to the patient. 27. Which of the following best illustrates high reliability? a. An interviewer modifies the way she asks questions to fit the style of the client. b. Two interviewers diagnose the same disorder after talking to the same client. c. A clinician accurately predicts that a client will become violent when reunited with this family. d. A clinician uses both medical (e.g., MRI) and psychological (e.g., MMPI-2) information to decide a diagnosis. Answer: b. Two interviewers diagnose the same disorder after talking to the same client. 28. Dr. White is doing research in which she must diagnose clients at a mental health clinic. Because diagnostic reliability is of great concern in research, she will most likely establish diagnoses by using a. open-ended interviews. b. standardized structured interviews. c. the mental status exam. d. time-limited interviews that last the same length of time for each client, although the questions may differ. Answer: b. standardized structured interviews. 29. The reliability of the assessment interview may be enhanced by the use of a. a flexible, open-ended interview rather than a structured interview. b. the TAT. c. the Rorschach test. d. rating scales. Answer: d. rating scales. 30. Shanna goes to Dr. Henderson for a first interview. He diagnoses her with a depressive disorder. She then goes to Dr. Smithson, because her friend recommended her. Dr. Smithson diagnoses Shanna with an anxiety disorder. This demonstrates a problem with a. structured interviews. b. multiaxial diagnosis. c. reliability. d. flexibility. Answer: c. reliability. 31. A clinical psychologist notes that a client wears his clothes inside out, that his hair is matted, and there is dirt under his fingernails. This information is known as a. clinical observation. b. self-monitoring. c. a dynamic formulation. d. an observational decision tree. Answer: a. clinical observation. 32. Dr. Lo asks Julie to pretend that he is her father as part of his psychosocial assessment of Julie. Which of the following would this be an example of? a. an unstructured interview b. an analogue situation c. projective assessment d. self-monitoring Answer: b. an analogue situation 33. In which of the following circumstances would a clinician be most likely to use self-monitoring? a. When other forms of clinical observation have yielded no evidence of abnormal behavior b. To find out what situations are likely to elicit problematic behavior c. To evaluate the quality of the social environment d. When analogue situations have not served to provoke a demonstration of the presenting problem Answer: b. To find out what situations are likely to elicit problematic behavior 34. A behaviorally oriented clinician tells her alcohol dependent client: "Here is a checklist I want you to fill out each day. Whenever you feel you need a drink, you should indicate what you were thinking, where you were, who you were with, and whether you went ahead and drank." What procedure is the clinician using? a. Self-monitoring b. Rating scales c. Self-analysis d. Mental status exam Answer: a. Self-monitoring 35. Which of the following is NOT a reason for using rating scales in clinical observation and self-reports? a. To increase reliability b. To provide structure c. To decrease objectivity d. To allow standardized comparisons to be made Answer: c. to decrease objectivity 36. Danielle is having problems with drinking. She goes to a psychologist who gives her a form to fill out. It has a list of statements about drinking and problems associated with drinking. She is to rate each item between 1 and 3 - 1 meaning it is not a problem for her, 3 meaning it is a very big problem for her and 2 is in between. This is an example of a. a rating scale. b. a structured interview. c. an analogue situation. d. self-monitoring. Answer: a. a rating scale. 37. Joanne says that she cannot say "no" to her intrusive mother. Her therapist has her pretend to engage in such an interaction to assess how weak Joanne's assertiveness skills really are. This illustrates the use of a. a rating scale. b. role-playing. c. "thought reports." d. structured interviewing. Answer: b. role-playing. 38. The use of standardized psychological tests a. has made clinical observation a rarely used method of assessment. b. permits the clinician to determine how a client's behavior compares to some reference group. c. enables anyone to make accurate psychiatric diagnoses, provided they are trained in the interpretation of such tests. d. has made the diagnosis of mental illness an objective process. Answer: b. permits the clinician to determine how a client's behavior compares to some reference group. 39. Psychological tests a. are extremely reliable and valid. b. are dependent on the competence of the clinician who interprets them. c. are far superior to clinical observation for making diagnoses. d. can arrive at a person's diagnosis without the need for an interview. Answer: b. are dependent on the competence of the clinician who interprets them. 40. Intelligence and personality tests can best be described as a. indirect means of assessing psychological characteristics. b. unstructured means of assessing behavior. c. direct means of assessing behavior. d. observational means of assessing behavior. Answer: a. indirect means of assessing psychological characteristics. 41. What would determine whether the WISC-IV or the WAIS-IV is used to test intelligence? a. The suspected level of impairment b. The amount of time available for test administration c. The age of the client d. Whether organic brain damage is present Answer: c. The age of the client 42. There are two general categories of psychological tests used in clinical practice. They are a. intelligence tests and personality tests. b. projective tests and sentence completion tests. c. neuropsychological tests and standardized tests. d. intelligence tests and rating scales. Answer: a. intelligence tests and personality tests. 43. Which of the following statements about individually administered IQ tests is correct? a. They typically take less than an hour to give and interpret. b. They have low reliability. c. Many settings and cases don't require the kind of detailed knowledge they give. d. They are expensive. Answer: d. They are expensive. 44. Which of the following is an unstructured approach to studying personality? a. WISC-III b. the BPRS c. the Stanford-Binet d. the TAT Answer: d. the TAT 45. Which of the following would be an example of a projective technique? a. A troubled teen is asked to select statements that she feels describe her. b. An alcoholic is told to record the times at which she feels the greatest desire for a drink. c. An elderly woman is asked to recall the day her father died. d. A child is asked to draw her family. Answer: d. A child is asked to draw her family. 46. "Projective" and "objective" are two types of ___________ tests. a. neuro psychological b. intelligence c. personality d. psychodynamically oriented Answer: c. personality 47. The aim of a projective test is to a. predict a person's future behavior. b. assess the way a patient perceives ambiguous stimuli. c. compare a patient's responses to those of persons who are known to have mental disorders. d. assess the role of organic factors in a patient's thinking. Answer: b. assess the way a patient perceives ambiguous stimuli. 48. Which of the following is a type of test that tries to find ways in which a person's personality and past experiences cause them to understand and perceive their world? a. Structured interviews b. Objective tests c. Neuropsychological tests d. Projective tests Answer: d. Projective tests 49. Which of the following is a projective testing method that has been adapted for computer interpretation? a. The Rorschach Test b. The MMPI c. The Thematic Apperception Test d. The sentence completion test Answer: a. the Rorschach Test 50. Which of the following best explains why the Rorschach is less likely to be used today? a. Other projective approaches have been found to be more reliable. b. Treatment facilities often require other types of information than the Rorschach provides and insurance companies do not pay for it. c. It is inexpensive and time efficient in comparison to other projective techniques. d. The Rorschach is only useful as a means of aiding clients in self-discovery; it has no true clinical utility. Answer: b. Treatment facilities often require other types of information than the Rorschach provides and insurance companies do not pay for it. 51. Which statement about the Rorschach is accurate? a. The ambiguous stimuli it employs are pictures of people interacting in an unclear way. b. A considerable amount of training is required to administer and score it accurately. c. It assesses the kind of specific behavioral deficits that most mental health facilities require today. d. It is the quickest projective tests to administer and score. Answer: b. A considerable amount of training is required to administer and score it accurately. 52. Research by Exner and others has shown that the Rorschach a. is a test with weak reliability and absolutely no validity. b. is just as effective at identifying areas of brain damage as MRIs and PET scans. c. can be scored by computer, thereby increasing its reliability. d. is one of the least frequently researched clinical instruments despite its widespread use. Answer: c. can be scored by computer, thereby increasing its reliability. 53. The Thematic Apperception Test (TAT) has been used to assess all of the following EXCEPT a. needs. b. intelligence. c. perception of reality. d. fantasies. Answer: b. intelligence. 54. Several clinicians look at the TAT results of a hospitalized patient. The patient described the characters on the card as not speaking to each other. One clinician says this means the patient has a lot of unresolved anger. Another says it means the patient has a lot of social anxiety. The third says he thinks it means the patient is uninterested in people and prefers to be alone. This demonstrates the following problem with the TAT: a. Scoring and interpretation is very subjective. b. The pictures on the cards are new and updated. c. The amount of time it takes to score and interpret it. d. The lack of training of clinicians on using it. Answer: a. Scoring and interpretation is very subjective. 55. Which of the following would best address recent criticisms of the TAT? a. Make the images less ambiguous b. Allow more time for the client to respond c. Use more modern pictures d. Rely only on manuals for interpretation Answer: c. Use more modern pictures 56. Which of the following statements about projective tests is correct? a. Interpretation is based on standardized criteria b. Client responses are limited to closed-ended responses c. They require respondents to be able to read and write in English d. They are time-consuming Answer: d. They are time-consuming 57. The MMPI is a. a structured approach to personality assessment. b. the most commonly used test of intelligence. c. a rating scale used to determine how comparable one is to individuals with various psychiatric diagnoses. d. a recently developed objective approach to personality assessment. Answer: a. a structured approach to personality assessment. 58. Which of the following is an objective test? a. Rorschach Test b. Thematic Apperception Test c. Sentence-Completion Test d. MMPI-2 Answer: d. MMPI-2 59. The empirical keying approach to making a test like the MMPI involves a. subjective scoring of test items to assign items to different groups. b. the creation of ambiguous stimuli where there are many possible responses. c. picking items that differentiate between different groups, no subjective judgment is needed. d. using theoretically based concepts to develop questions for different groups. Answer: c. picking items that differentiate between different groups, no subjective judgment is needed. 60. What does it mean if Carol scores high on the Schizophrenia scale of the MMPI? a. Carol has schizophrenia. b. Carol's responses on this scale were similar to those of the Minnesota normal population. c. Carol is 30% more likely to develop schizophrenia than those who scored lower. d. Carol's answers were comparable to those given by a group of people with schizophrenia. Answer: d. Carol's answers were comparable to those given by a group of people with schizophrenia. 61. Mike decides he is going to try to look mentally ill when he goes for his disability evaluation. He takes the MMPI-2. He most likely a. will be able to fake mental illness convincingly. b. will still come out normal on the test. c. will be caught by specialized scales on the test. d. will come out seeming very insightful. Answer: c. will be caught by specialized scales on the test. 62. The text presented the case study of Andrea C, a twenty-one-year-old student from Colombia. The MMPI-2 computer-based report was typical of such reports because a. there was a large discrepancy between the report based on the MMPI and that based on the MMPI-2. b. the report was invalid because Esteban is a member of an ethnic minority. c. the report provided diagnostic and treatment considerations. d. the report was not used appropriately in Esteban's treatment. Answer: c. the report provided diagnostic and treatment considerations. 63. Why was the MMPI-2 needed? a. The original MMPI did not offer age-adjusted sub-scales. b. The original MMPI did not permit subjects to select "other." c. The original MMPI was not able to detect problems such as substance abuse and marital discord. d. The original MMPI was created over 50 years ago. Answer: d. The original MMPI was created over 50 years ago. 64. A key feature of the MMPI-2 is that a. the clinical scales measure the same properties of personality organization as they always have. b. the validity scales have been discarded. c. it has merged the adult and adolescent forms into one. d. it now includes open-ended questions to examine cognitive distortions. Answer: a. the clinical scales measure the same properties of personality organization as they always have. 65. One limitation of the MMPI-2 is that it a. cannot detect whether an individual is attempting to distort his or her responses. b. requires a clinical interview as a supplement to the test itself. c. is based on factor analysis, which often leads to measures that sacrifice validity for the sake of reliability without intending to do so. d. requires an individual to be literate. Answer: d. requires an individual to be literate. 66. Computers are excellent devices for storing information on large numbers of people's characteristics and test score patterns. Whenever a person turns up with a specific test score pattern, the computer can print out an appropriate description. This illustrates a. actuarial procedures. b. content interpretation. c. rational analysis. d. factor analysis. Answer: a. actuarial procedures. 67. One of the problems with actuarial data for an instrument like the MMPI is that a. it too frequently suggests that a client is "comorbid" for as many as three or more different disorders. b. there are only as many profiles as there are clinical scales. c. the profiles of many subjects do not "fit" the profile types for which actuarial data are available. d. while the profiles that are generated have high reliability they often have very low validity. Answer: c. the profiles of many subjects do not "fit" the profile types for which actuarial data are available. 68. Which of the following would be an important factor to keep in mind when assessing behaviors exhibited during an assessment and how those behaviors might be interpreted? a. validity of the instrument b. relevance of date to national sample c. not enough data about a person d. the theoretical orientation of the clinician Answer: d. The theoretical orientation of the clinician 69. Why is classification a necessary first step in developing an understanding about abnormal behavior? a. Abnormal behavior is not abnormal until it has been classified as such. b. Communication about abnormal behavior cannot be effective unless what is being discussed is clear. c. Only through development of a classification system can abnormal and normal behavior be differentiated. d. Unless an adequate classification system exists, all descriptions of abnormality will necessarily be subjective. Answer: b. Communication about abnormal behavior cannot be effective unless what is being discussed is clear. 70. Which of the following is an assumption of a categorical approach to abnormal behavior? a. Both normal and abnormal behavior lie on a continuum. b. Each disorder has unique symptoms. c. Disorders that share common symptoms have a common etiology. d. All behavior is the product of numerous interacting influences. Answer: b. Each disorder has unique symptoms. 71. Which approach to the classification of abnormal behavior uses statistical criteria to differentiate between normal and abnormal? a. Categorical b. Dimensional c. Prototypical d. Situational Answer: b. Dimensional 72. If a diagnosis is made by comparing subjects to a "model" of an illness, which type of classification scheme is being used? a. Categorical b. Dimensional c. Prototypal d. Evolutionary Answer: c. Prototypal 73. Dr. Hunter is studying personality. He decides that he will classify his subjects into varying levels of intensity on personality traits based on how far they statistically fall above the average score of a “normal person.” He is using a a. categorical approach. b. dimensional approach. c. prototypal approach. d. discrimination approach. Answer: b. dimensional approach. 74. While the DSM is designed to be a categorical classification scheme, a. in practice diagnoses are made on a dimensional basis. b. the high rate of comorbidity makes categorization impossible. c. the lack of objective criteria make accurate diagnosis impossible. d. the existing criteria tend to lead to a prototypal approach. Answer: d. the existing criteria tend to lead to a prototypal approach. 75. Symptoms are to signs as ___________ is to ________. a. subjective; objective b. complaints; treatment c. assessment; diagnosis d. projective; objective Answer: a. subjective; objective 76. Which of the following is an example of a symptom? a. The client's hands would not stop shaking. b. The client reported hearing voices. c. A large lesion was visible on the CAT scan. d. Her children reported that she had not been sleeping well. Answer: b. The client reported hearing voices. 77. Since it was first published, the DSM has a. become more objective. b. decreased in size. c. abandoned attempts to operationalize diagnosis. d. removed procedures originally employed to differentiate between psychological and biological causal factors. Answer: a. become more objective. 78. A clinician was in an assessment interview with a woman of Asian descent. The clinician realized there might be some cultural values and attitudes that could influence how questions were interpreted and answered. Which of the following would help the clinician obtain information about the potential impact of the woman’s culture on her mental health care? a. GAF b. DSM c. CFI d. ICD Answer: c. CFI 79. A clinician is in an assessment interview with a new client. The clinician is having trouble determining an exact diagnosis, but must put something down before the client can receive treatment. What is one reason for this? a. The clinician has no more questions to ask. b. The clinician has to become more decisive. c. The clinician has to show the evaluation took place. d. The clinician has to provide this information to the medical insurance agency. Answer: d. The clinician has to provide this information to the medical insurance agency. 80. Shondra is in fourth grade and has been having trouble sitting still and remaining focused on her schoolwork. Her teacher speaks with her parents about this, and suggests they see a clinician for an assessment. What is one problem with the DSM system that would make her parents reluctant to send her for an assessment? a. The diagnosis would become a label that would stick with Shondra. b. The diagnosis would not provide information on current functioning. c. The diagnosis would not provide enough information for treatment. d. The diagnosis would be a temporary measure that would not identify maladaptive behaviors. Answer: a The diagnosis would become a label that would stick with Shondra. 81. The number of disorders has ___________ from earlier versions of the DSM to the DSM-5. a. Decreased b. Stayed the same c. Increased d. Changed only in reference to depressive symptoms Answer: c. Increased 82. In DSM-5, criteria for Persistent Depressive Disorder combines criteria from Dysthymic Disorder and which other disorder? a. Generalized Anxiety Disorder b. Chronic Major Depression c. Obsessive Compulsive Disorder d. Specific Phobia Answer: b. Chronic Major Depression 83. A clinician sits down with an individual and conducts an assessment interview. The clinician arrives at a diagnosis of schizophrenia. While writing up the notes on this interview, the clinician is mindful of preferred terminology by mental health professionals. What is the preferred way to refer to the individual in the assessment? a. schizophrenic patient b. schizophrenic person c. client with schizophrenia d. patient with schizophrenia Answer: c. client with schizophrenia 84. One criticism of diagnostic labels is that a. they can influence both other people's and the diagnosed person's perception of themselves in negative ways. b. there are so many different systems of diagnosis that it is hard to understand what an individual diagnosis means. c. the DSM-5 wording is so complicated to use that few people are able to use it well. d. they make other information unnecessary, so restrict the type of services that insurance will cover. Answer: a. they can influence both other people's and the diagnosed person's perception of themselves in negative ways. 85. The DSM acknowledges that a. the classification system has low reliability. b. medical insurance dictates how most clinicians make a diagnosis. c. most clinicians do not agree with the DSM system. d. a DSM diagnosis is only the first step, much more is needed to determine treatment. Answer: d. a DSM diagnosis is only the first step, much more is needed to determine treatment. 86. As in assessment, diagnostic interviews can be a. structured or unstructured. b. projective or objective. c. difficult or easy. d. empirical or conceptual. Answer: a. structured or unstructured. Fill-in-the-Blank Questions 1. When a psychologist is informed of the issues involved in multicultural assessment, this is known as __________. Answer: cultural competence 2. The term MRI in assessment of the brain means __________. Answer: magnetic resonance imaging 3. The projective test called the __________ is the inkblot test used in personality assessments. Answer: Rorschach 4. Today, there are two major psychiatric classification systems in use: the ICD-10, and the ______. Answer: DSM-5 Short Answer Questions 1. Why is the establishment of trust important when conducting a psychological assessment? Answer: When conducting an assessment, a clinician wants to develop as clear of a picture of the client's situation as possible. The client needs to understand that the information gained in the assessment process will aid the clinician in determining how best to address his or her problem. Providing feedback to the client during the assessment process may even lead to some improvement as the client's self-understanding increases. By establishing a trusting relationship with the client, the clinician increases the likelihood of eliciting useful information. 2. What are the purposes of the initial clinical assessment of a person? Answer: To make a diagnosis, predict the course of the disorder, to decide on treatment, and for use in research. 3. What is validity? Answer: In the context of diagnosis, validity refers to the extent with which a diagnosis, a classification, provides useful information. If a label provides no meaningful information, if it offers no information with clinical utility, it is not valid. 4. What is the goal of psychosocial assessment? Answer: The goal of psychosocial assessment is to develop an understanding of how the client functions in his or her social environment. The focus is on how the client interacts with his or her social environment, as well as the elements that are present in that environment that might need to be addressed as part of treatment. 5. What is an analogue situation? Answer: An analogue situation is a controlled environmental setting in which a clinical observation is conducted. By creating such situations, the client's ability to function in specific types of interactions can be assessed. Examples of analogue situations include role playing, event re-enactment, and think-aloud procedures. 6. What is a projective test? Answer: A projective test is a test designed to measure personal characteristics. Projective tests are intended to be an unstructured means of revealing what is on someone's mind. Examples of projective tests include the TAT and the Rorschach Test. Both ask the client to provide an interpretation of an ambiguous stimulus. It is assumed that the explanation provided will involve some "projection" of the client's own issues. 7. What are the pros and cons of projective and objective personality tests? Answer: Projective tests have great strengths — they focus on unique aspects of personality and allow for exploration of many issues. They are often hard to interpret and can be subjective and unreliable. Objective tests are very reliable and do not require subjective interpretation. But they are limited in what they cover, require the cooperation of the test-taker, and may require above average reading levels. 8. What is comorbidity? Answer: Comorbidity refers to the occurrence of two or more disorders in an individual simultaneously. Comorbid diagnoses are quite common. 9. What does a diagnostic label describe? Answer: When a diagnosis is given, an attempt is being made to classify the current behavioral pattern and level of functioning that is observed. Diagnosis of a psychiatric condition is made based on the information that is obtained during the assessment process, thus a label serves to summarize what has been observed. Diagnostic labels do not describe people or underlying pathological conditions, as is often presumed. 10. What are two problems with diagnostic labeling? Answer: People, including professionals, may just accept the label as a complete description of a person and not inquire further. They can keep people from evaluating the person with the label in an objective manner. They can unfairly influence clinical expectations and treatment choices. They may cause the labeled person to lose morale and self-esteem. 11. What is the difference between an unstructured and a structured diagnostic interview? Which is preferable? Answer: Just as assessment interviews may be either unstructured or structured, so may diagnostic interviews. When an interview is unstructured, the clinician does not ask any standard set of questions, thus the information obtained with each client is likely to be very different. The clinician is free to take the questioning in whatever direction the responses lead. In a structured interview, the questions that are asked and the nature of the information obtained are predetermined. A structured diagnostic interview is preferable as its use is likely to improve diagnostic reliability. Essay Questions 1. Discuss some of the ethical issues that must be kept in mind when evaluating assessment findings. Answer: In the assessment process, information is gathered about the client. A variety of testing procedures may be employed, addressing both the physical and psychosocial status of the client. Assessment data are then used to plan or alter treatment plans. Such data, however, must be interpreted and the limitations of both the test instruments and the clinician need to be considered during this process. Cultural bias, for example, may be introduced by either a testing instrument or the clinician. In addition, the clinician may tend to interpret information in a manner that is consistent with his or her theoretical orientation, as opposed to striving to take a more objective view of the information presented. There may also be a tendency to focus on the client, as opposed to recognizing that the presenting symptoms may be more of a reflection of environmental circumstances, as opposed to some internal process. It also must be recognized that not all assessment procedures have been validated and that, in the end, more data may be needed to truly understand the client and his or her condition. The evaluation of assessment data is ultimately a subjective process, requiring caution to limit potential errors. 2. Compare and contrast the following: MRIs, PET scans, and fMRI. Answer: The MRI measures variations in magnetic fields. It then computes and depicts cross sections of organs such as the brain with great clarity. It is non-invasive and allows for visualization of all but the tiniest brain structures. Its major problem is the claustrophobic reaction some people have to the procedure. PET scans track substances as they are metabolized by the brain. They can show how the brain is functioning. They can help identify areas that aren't functioning normally that might not be obvious anatomically. Their major problem is low-fidelity pictures that have so far limited their value. The fMRI measures changes in blood flow in the brain. It is possible to map ongoing psychological activity and show which areas of the brain are involved in different activities. However, like MRIs, these are very sensitive to movement, which can cause false results. Also fMRIs are often very hard to interpret. 3. Describe the dimensional and the prototypical approaches to classification. Answer: The dimensional approach assumes that a person's typical behavior is produced by a combination of differing strengths of behaviors along several definable dimensions. These include emotional stability, anxiousness, and social introversion, among many others. The dimensions are the same for everyone. People differ in terms of how much they have of each trait, not because of an underlying dysfunction that causes disordered behavior. Abnormality is determined through statistical criteria by comparison to people in general. The prototypal approach classifies types by describing the idealized combination of personality characteristics that occur regularly together, based on observation. It is likely that no member of a defined group will have all of the characteristics of the defined prototype. There also is often much overlap between categories. 4. Discuss the difference between symptoms and signs, and explain why both concepts are important in DSM-5 diagnosis. Answer: The criteria that define the recognized categories of disorder consist for the most part of symptoms and signs. The term symptoms generally refers to the patient’s subjective description, the complaints she or he presents about what is wrong. Signs, on the other hand, are objective observations that the diagnostician may make either directly (such as the patient’s inability to look another person in the eye) or indirectly (such as the results of pertinent tests administered by a psychological examiner). To make any given diagnosis, the diagnostician must observe the particular critieria – the symptoms and signs that the DSM-5 indicates must be met. 6 point total. 2 for correctly identifying signs, 2 for correctly identifying symptoms, and 2 for correctly stating why both are important in diagnosis. Test Bank for Abnormal Psychology: DSM 5 James N. Butcher, Jill M. Hooley, Susan M. Mineka 9780205965090, 9780205944286

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