193 people came through but NONE of the people were fake
patients
o 41 identified as fake
o Cant tell sane apart from insane
o Once you get diagnosis, you are attached to that diagnosis
o Our diagnosis system is subject to a lot of error and
therefore, diagnostic process cannot be too reliable
Labels are sticky
Staff fearful, hostile, suspicious towards the patients
Condescension
Walked away from patient
Did not answer patients questions
Privacy minimal going to bathroom even
Freedom of movement restricted stay where I can see you
Personal hygiene observed
Verbal/physical/sexual abuse
Talking about patients as if they arent present
All types of interviews provide an opportunity for the clinician or researcher to observe
and make inferences about different aspects of a patient:
o Appearance
In addition to obvious aspects of appearance (whether the person has
bathed recently and is dressed appropriately), signs of disorder can
sometimes be noted by carefully observing subtle aspects of a persons
appearance
o Behavior
Patients body language, facial expression, movements, and speech can
provide insights into different aspects of psychological functioning
o Emotions
What emotions does patient convey? The clinician can observe patients
expression of distress (or lack thereof) and emotional state (upbeat, low,
intense, uncontrollable, inappropriate to the situation, or at odds with the
content of what the patient says)
o Movement
Patients general level of movement physical restlessness or a complete
lack of movementmay indicate abnormal functioning
o Speech
Clinicians observe the rate and contents of the patients speech
Speaking very quickly may suggest anxiety, mania, or certain
kinds of substance abuse; speaking very slowly may suggest
depression or other kinds of substance abuse
o Mental processes
Some behaviors reveal characteristics of mental processes
Do the patients mental processes appear to be unusual or abnormal?
Does the patient appear to be talking to someone not in the room which
would suggest that he or she is having hallucinations?
Can the patient remember what the clinician just asked?
Does the patient flit from topic to topic, unable to stay focused on
answering a single question?
o Clinician must keep in mind that unusual behavior should perhaps be interpreted
differently for patients from different cultural background
Patients own report of his experiences is crucial part of clinical assessment (self-report)
o At some point in the interview process, clinician will ask patients history (past
factors or events) and the patient will report such info about himself or herself
Clinician will ask about current and past psychological or medical problems and about
how the patient understands these problems and possible solutions to them
o Clinician will inquire about substance use, sexual or physical abuse or other
traumatic experiences, economic hardships, relationships with family members
and others and thoughts about suicide
o Patients answers help the clinician put the patients current difficulties in context
and determine whether his or her psychological functioning is maladaptive or
adaptive, given environmental circumstances
Some patients intentionally report having symptoms that they dont actually have or
exaggerate symptoms that they do have, either for material gain or to avoid unwanted
events (such as criminal prosecution) malingering (lying)
Semistructured interview
o Mental status exam set of questions to assess patients mental state at time of
interview
Clinician asks the patient to describe the problem, its history, and the
patients functioning in different areas of life
Probe the patients ability to reason, to perform simple mathematical
computations, and to assess possible problems in memory and judgment
Example
As part of the exam, asked whether they remember their own
name, date, year and who is president
o Mental health researchers and clinicians learn about patients from assessing
psychological and social factors and neurological and biological factors
o Information about each type of factor should not be considered in isolation but
rather should influence how the clinician understands the other types of
information
ONLY LECTURE NOTES TUESDAY OCTOBER 7TH
Assessment
o In schizophrenia, have abnormally large ventricles
Interviews
o SCID structured interview, determining whether someone meets criteria for
diagnosis
SCID interview question being asked on depression, weight loss, loss of
appetite, and emotional state
o Unstructured interview Andy and psychiatrist, not completely unstructured but
slightly structured
Taking the history
Making a risk assessment
Went where interview took her
Between semi-structured and structure
o Clinical interview make observations and follow up on observations
Look at persons appearance
Are they clean, dressed appropriately?
Anything unusual about persons appearance?
o Ex: guy in video looked fine in terms of appearance
Being dressed inappropriately, disheveled, smells
o Ex: women dressed in hat and coat in 95C weather
(**zoned out around 2:39 pm)
Behavior
Emotional state
What is the emotional state? Calm, angry?
How do they express their state?
Is what you are seeing proportionate to what the person is
presenting?
o Ex: representing something tragic in a flat, monotone voice
Whats their movement like?
Are they restless?
Is there a lack of movement?
Listening to their speech
Are they talking really fast or slow?
o Is it noticeably slow? (unusual)
Nonsensical talk indicative of something unusual going on
Assessing their memory
Can be related to mental health issue
Persons judgment making sound decisions?
o Objective- facts
*Rorschach, TAT, and MMPI are personality tests
Cognitive test- intelligence tests (WAIS)
MMPI-2 profile: anything in box is average, anything above and below
box would have clinical significance
o Social factors
Some cultures may describe symptoms differently
Asian and latino cultures describe anxiety as nerves
Native American describe depression broken-hearted
Some cultures may minimize symptoms or not describe them at all
America has a high percentage of people with mental disordervery high
percentage
In African cultures, confined schizophrenic man in hut and took care of
himdid not go to hospital
Cultures differ