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Chapter 3. The Role of Psychiatric Measures in Assessment and Treatment

John F. Clarkin, Ph.D.; Diane B. Howieson, Ph.D.; Joel McClough, Ph.D.
DOI: 10.1176/appi.books.9781585623402.290392

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Excerpt

The current methodology and content of psychiatric diagnosis, the growing specificity of treatment planning in regard to both medication and psychosocial interventions, and the nature of the health care delivery system all influence the context that determines the use of psychological tests and rating scales to inform assessment and treatment planning. Two major forces have influenced treatment planning in the recent past: 1) the use of a diagnostic system, since 1980, that has been strong on reliability and relatively uneven on validity and 2) the impact of changes in the priorities and structure of the health care delivery system that place emphasis on cost saving and delivery of services deemed "medically necessary." Psychological assessment has evolved under these influences, resulting in a diversification of assessment approaches and foci.

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FIGURE 3–1. Rorschach, Card I.Source. Reprinted with permission from Rorschach H: Rorschach Test. Psychodiagnostics Plates. Copyright Verlag Hans Huber, Hoegrefe AG, Bern, Switzerland, 1921, 1948, 1994.
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TABLE 3–1. Three types of psychological assessment instruments
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TABLE 3–2. Types of reliability and validity
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TABLE 3–3. Specific objectives of assessment
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TABLE 3–4. The Multicultural Assessment Procedure
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TABLE 3–5. Instruments for the assessment of DSM-IV Axis I disorders and related symptom patterns
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TABLE 3–6. Scales of the Minnesota Multiphasic Personality Inventory—2
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TABLE 3–7. Instruments for the assessment of specific symptom areas
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TABLE 3–8. Representative instruments for examining various cognitive domains
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TABLE 3–9. Instruments for the assessment of personality traits and disorders
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TABLE 3–10. Instruments for the assessment of psychodynamics and patient enabling factors
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TABLE 3–11. Instruments for the assessment of environmental stressors
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Three types of instruments are used in the assessment of patient functioning: psychological tests, rating scales, and semistructured interviews.

Tests should meet the standards of both reliability and validity.

Establishing a test's reliability requires demonstration that the test items are sufficiently closely related to one another to provide relatively stable measurements. Three major types of reliability can be assessed: test–retest reliability, alternate form reliability, and split-half reliability.

Establishing a test's validity requires demonstration that the test measures what it is intended to measure. Three major types of validity can be assessed: content validity, criterion-related validity, and construct validity.

Assessment has the following objectives: 1) screening for psychiatric disturbance, 2) clarification of diagnostic uncertainty following clinical interview, 3) specification of the severity of symptoms and other difficulties, 4) assessment of patient strengths, 5) informing differential treatment assignment, 6) role-inducing the patient into a therapeutic stance, 7) monitoring the impact of treatment over time, 8) assessment of barriers to learning for educational planning, and 9) assessment of quality and cost-effectiveness of systems of care.

Cultural factors may influence subjects' response to assessment instruments.

Major content areas of assessment include symptoms, cognitive functioning, personality disorders and traits, psychodynamics, and environmental demands and social adjustment.

Therapeutic enabling factors are aspects of the patient that affect the acceptance, use, and absorption of the treatment.

The major therapeutic enabling factors are problem severity, motivational distress, problem complexity, reactance, and coping style.

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Sample questions:
1.
Demonstration of adequate test validity requires proof that the test measures what it is intended to measure. One major type of validity is criterion-related validity. Which of the following is the correct definition for this type of validity?
2.
A number of instruments have been developed for the assessment of a wide variety of psychiatric symptoms. These measures depend on either self-report or interview methods for data collection. Which of the following measures is administered by a physician?
3.
The Minnesota Multiphasic Personality Inventory (MMPI) and its successor, the MMPI-2, are probably the most widely used assessment instruments in existence. These instruments employ nine clinical scales. Which of the following is not one of the scales?
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