Identify the tests and techniques used in assessing mental illness.
4.4 Discuss diagnostic considerations in approaching psychopathology.
4.5 Explain the significance of the DSM–5 and RDoC in the classification of mental disorders.
Elyn Saks told of her time as a graduate student at Oxford after graduating from Vanderbilt University. As a student at Oxford, she began to have a hard time concentrating on academic work and lectures. She turned in papers that her tutor did not understand. A friend of hers who was a nurse asked her fiancé, who was a physician who specialized in neurology, to talk with Elyn. Elyn Saks remembers the conversation as follows:
“Jean and I are very concerned about you,” he said quietly. “We think you may be quite sick. Would you mind if I asked you some questions?”
“I’m not sick,” I responded. “I’m just not smart enough. But questions, yes. Ask me questions.”
“Are you feeling down?”
“Yes.”
“Loss of pleasure in daily activities?”
“Yes.”
“Difficulty sleeping?”
“Yes.”
“Loss of appetite?”
“Yes.”
“How much weight have you lost in the last month?”
“About fifteen pounds.”
“Do you feel like a bad person?”
“Yes.”
“Tell me about it.”
“Nothing to tell. I’m just a piece of shit.”
“Are you thinking of hurting yourself?”
I waited a moment before answering, “Yes.”
From The Center Cannot Hold: My Journey Through Madness by Elyn Saks. © 2007 by Elyn Saks. By permissions of Hachette Book Group, Inc. All rights reserved.
After a number of other questions, Elyn Saks was referred to a mental health professional to diagnose her distress and formulate a treatment plan. In this chapter, I will introduce you to the ways in which mental health professionals clarify the type of problems a person is describing. This will include methods of assessment that have been developed to maximize reliability and validity. I will then discuss the major classification systems used throughout the world.
Elyn Saks
Initial Assessment and the Mental Status Exam
As a clinician, people come to see you in a variety of ways. Some people set up an appointment and tell you about how they are feeling distressed. They may tell you about feeling anxious or sad. If you work in a hospital, people may be brought to you by others who are concerned by the behaviors they display or the experiences they describe. As a clinician, it is your job to make sense of the information you are given. The first task is that of assessment.
During the clinical interview, mental health professionals gather information about the status of an individual they are working with.
© iStockphoto.com/Izabela Habur
Psychological assessment is simply the process of gathering information about a person so that you can make a clinical decision about that person’s symptoms. In the process, you may create a variety of hypotheses about the possible causes of the symptoms. Had the person taken drugs that were causing the behavior? Did the person suffer a negative experience such as being robbed or raped? Is the behavior part of an underlying physical or mental disorder? Part of the task of the clinical assessment is to gather data necessary to rule out or support the possible causes of the symptoms.
The Clinical Interview
Most mental health professionals use a clinical interview to initially gather information concerning the status of an individual with whom they are working. Since the interview is also an interaction between two people, it is a chance for the professional to establish rapport, which will lead to more complete information. The information gained from this interview includes not only the individual’s present symptoms but also the social and cultural context in which these symptoms appear. This context includes the individual’s social support, family relationships, and connections within his or her community. It is also important to assess the individual’s attitudes, emotions, and experiences of others in his or her world. The clinical interview further offers the opportunity to assess the current ability of the individual to care for him- or herself.
psychological assessment: the process of gathering information about a person so that you can make a clinical decision about that person’s symptoms
Overall, the major areas of consideration in a clinical interview are (1) the current areas of distress and their history; (2) any past mental health problems; (3) social history including social support; (4) the manner in which cultural factors may influence the current condition; and (5) any way in which previous family, medical, or psychological factors may influence the current situation.
The Mental Status Exam
Throughout the world, the clinical interview has been organized into major categories and referred to as the mental status exam. This exam is often given quickly to gain initial information.
mental status exam: clinical interview organized into major categories designed to determine a person’s cognitive processes
The first major category of the exam is the individual’s appearance and behavior. In the report, the mental health professional would note such factors as the individual’s clothing, grooming, and posture. Motor activity, such as slow movements, may be part of a later diagnosis of depression, whereas quick, abrupt movements may be associated with mania.
The second major category of the exam is mood and affect. Affect refers to the emotions that the individual is expressing during the interview. The person might seem happy or sad. The professional might note that the person laughs or cries in describing situations, where other individuals would not laugh or cry. Such affect would be described as inappropriate. It should also be noted if the individual shows no affect when describing situations such as receiving a large raise in pay or losing a friend, where others would be happy or sad. Such affect is said to be flat. Mood, as compared with present affect, is more long term. To assess this, the professional notes how the individual reports he or she has been feeling recently. Has the individual been feeling blue or angry?
The next category is speech quality. Here, the professional notes the manner in which an individual speaks. Is the person speaking quickly or very slowly? Does the person’s manner of speaking feel pressured? Does the person
