Assessment of Abnormal Behavior

Clinical Assessment: Basic Concept

the process of collecting, processing and interpreting information in
order to make judgments and decisions
Purposes of Clinical Assessment
Classification - to diagnose
Description
- to explain current condition
Prediction
- to analyze tendencies and future behavior
Tools and Methods of Assessment
Clinical Interview
Testing
intelligence Tests
non-intelligence Tests
Observation
Mental Status Exam
Symptom Checklist
Documents
DEFINITION of TERMS
Sign - Observation and objective finding
Symptom - Subjective experience described by patient
Syndrome - Group of signs and symptoms that make up a
recognizable condition
***

Areas of Functioning to observe:

1.
2.
3.
4.
5.
6.
7.
8.
9.

Consciousness
Emotion
Motor behavior
Thinking
Speech
Perception
Memory
Intelligence
Insight

1. Consciousness

State of awareness
Disturbances of consciousness
Impairment in perception and sensorium
Most often associated with brain pathology
Some disturbances of consciousness
Disorientation - disturbance of orientation in time,
place, or person
Clouding of consciousness incomplete clear
mindedness with disturbances in perception and
attitudes
Disturbances of attention
Inability to focus on certain portions of an experience
Inability to focus on one activity
Inability to concentrate
Some disturbances of attention
Distractibility attention is drawn to unimportant
external stimuli
Hypervigilance excessive inattention and focus on
all internal and external stimuli
Disturbances in suggestibility

2. Emotion

Complex feeling state with psychic, somatic and behavioral

components
Affect
Observed expression of emotion
Possibly inconsistent with description of emotion
Descriptions of affect
Appropriate emotional tone in harmony with
accompanying idea, thought or speech
Inappropriate disharmony between emotional
tone and idea, thought or speech
Blunted severe reduction in intensity of external
feeling tone
Restricted or constricted reduction in intensity
of feeling tone less severe than blunted affect
Labile rapid and abrupt changes in emotional
feeling tone, unrelated to external stimuli
Mood
Pervasive and sustained emotion
Subjectively experienced and reported
Descriptions of mood
Dysphoric unpleasant mood
Euthymic normal range of mood
Expansive expression of feelings without
restraint
Irritable easily annoyed and provoked to anger
Elation feelings of joy, triumph, intense selfsatisfaction or optimism

Euphoria intense elation with feelings of

grandeur
Anhedonia loss of interest in and withdrawal
from all regular and pleasurable activities
Alixethymia inability or difficulty in describing or
being aware of emotions or mood
Examples:
You cant keep me in this ward; I have to submit
my plans for the country to the President! Euphoria
I feel fine --- basically happy. - Euthymia
I feel better today than I ever have in my whole
life. - expansive
I dont know how I feel; I just cant say. Alixethymia
I have no sex drive and no appetite; I just dont
feel like doing anything. - Anhedonia
Other emotions
Anxiety feeling of apprehension caused by anticipation
of internal or external danger
Fear anxiety caused by consciously recognized and
realistic danger
Agitation severe anxiety associated with motor
restlesness
Apathy dulled emotional tone associated with
detachment or indifference
Some physiological disturbances associated with mood
Anorexia loss of or decrease in appetite
Bulimia insatiable hunger and voracious eating
Hyperphagia increase in appetite and intake of food
Insomnia lack or diminished ability to sleep
Hypersomnia excessive sleeping
Constipation inability to defecate or difficulty in
defecating

3. Motor behavior (conation)

Aspect of psyche that includes impulses, motivations, wishes, drives,

instincts and cravings
Expressed by behavior or motor activity
Some disturbances in motor behavior
Echopraxia pathological imitation of movements of one
person by another
Catalepsy immobile position that is constantly maintained

4. Thinking

Goal-directed flow of ideas, symbols and associations initiated by a

problem or task and leading toward a reality-oriented conclusion
Normal thinking is characterised by a logical sequence
Some general disturbances in form process of thinking

Some specific disturbances in form of thinking

Circumstantiality indirect speech that is delayed in reaching
the point but eventually gets from original point to desired goal
Tangentiality inability to have goal- directed associations of
thought
Loosening of associations flow of thought in which ideas
shift from one subject to another in a completely unrelated way
Flight of ideas rapid, continuous verbalisations or plays on
words produce constant shifting from one idea to another
Examples

Reality testing objective evaluation and judgment of the

world outside the self
Psychosis inability to distinguish reality from fantasy;
impaired reality testing
Autistic thinking preoccupation with inner, private world
Magical thinking similar to preoperational phase in children
(Jean Piaget); thoughts, words or actions assume power

I was grocery training; but, when I ride the grocery, I drive the food
everywhere on top of lollipops. - Magical thinking
Cain and Abel --- they were cannibals. You see brothers kill brothers
--- that is laudable. If you ask me, though, never name your son
Huxtibal. - Circumstantiality
A psychiatric patient who, although coherent, never gets to the point is
exhibiting.. - Loosening of association

Some specific disturbances in form of thought

Delusion - False belief, based on incorrect inference about
external reality; Not consistent with ones intelligence and
cultural background; Cannot be corrected by reasoning
Overvalued idea unreasonable, sustained false belief
maintained less firmly than a delusion
Obsession pathological persistence of an irresistible thought
or feeling that cannot be eliminated from consciousness by
logical effort
Phobia persistent, irrational, exaggerated and invariably
pathological dread of a specific stimulus or situation
Examples:

5. Speech

A 27-year-old man comes to the emergency room complaining

of having his thoughts controlled by the NBI. Such - overvalued
A 26-year-old man believes that the Abu Sayaf and his brother
are putting horrible thoughts into his head. - Delusion of
reference

Ideas, thoughts, feelings as expressed through language

Communication through the use of words and language
Some disturbances is speech
Pressure of speech rapid, increased in amount and difficult
to interrupt

Poverty of speech - restricted amount; replies may be

monosyllabic
Poverty of content of speech adequate in amount but
conveys little information because of vagueness, emptiness or
stereotyped phrases

6. Perception

Process of transferring physical stimulation into psychological

information
Mental process by which sensory stimuli are brought to awareness
Some disturbances of perception
Hallucination false sensory perception not associated w/ real
external stimuli
Illusion misperception / misinterpretation of real external
sensory stimuli
Depersonalization subjective sense of being unreal, strange
or unfamiliar
Derealization subjective sense that environment is strange or
unreal

Examples

A medical student begins to fall asleep in class and is startled

awake, thinking that the students name was called; in reality, it
was not. - hallucination

7. Memory

Function by which information stored in the brain is later recalled to

consciousness
Levels of memory
Immediate reproduction or recall of perceived material within
seconds to minutes
Recent recall of events over past few days
Recent past recall of events over past few months
Remote recall of events in distant past

8. Intelligence

Ability to understand, recall, mobilize and constructively integrate

previous learning in meeting new situations
Concrete thinking
Literal thinking
Limited use of metaphor without understanding of
nuances of meaning
One-dimensional thought
Abstract thinking
Ability to appreciate nuances of meaning
Multidimensional thinking with ability to use methaphors
and hypotheses appropriately
Some disturbances of intelligence
Mental retardation lack of intelligence resulting in
interference with social and vocational performance

Dementia organic and global deterioration of intellectual

functioning without clouding of consciousness
Examples

A 70-year-old woman can no longer remember her childrens

names. - dementia
People is glass houses should not throw stones means that
the glass will break if a stone hits it. - dementia
A rolling stone gathers no moss - abstract thinking

9. Insight

Ability to understand the true cause and meaning of a situation

Levels of insight
Intellectual understanding of objective reality of set of
circumstances without ability to apply understanding in any
useful way to master situation
True understanding of objective reality of a situation coupled
with motivation and emotional impetus to master situation
Impaired diminished ability to understand objective reality of
situation
Examples:

A 45-year-old man with alcohol dependence states that he will

die if he continues to drink alcohol. Thus, he starts on a
program to curb his drinking problem. - True emotional insight