Assessment is an ongoing and essential step, not just in the beginning but also during the development and treatment of disorders. Assessment at every step of treatment is an essential act, as it keeps patients updated about their condition and as well as their issues, which ultimately helps in proper treatment.
Assessment of disorders is also referred to as clinical assessment or psychological assessment. Using different measures like psychological tests, observation, interviews, and case-study, psychological assessment is the procedure by which clinicians can form a comprehensive summary of the client's symptoms.
One of the goals of clinical assessment is to reach the diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the beginning, assessment helps make a pivotal decision about the immediate status of the disorder, whether hospitalization is required or not, whether it is an emergency, the type of treatment approach should be followed, and evaluate any additional risks during treatment. Therefore, assessment is used to keep track of changes in the symptoms, predict the course of the disorder, and evaluate the outcomes.
Clinical assessment involves the collection of information which includes the client's presenting problems, symptoms, skills, cognitive functioning, personality, social factors, cultural context, ethnicity, and language.
Clinical assessment involves the use of various strategies and procedures for collecting information about the patient. The methods are broadly divided into two categories but are used together integratively.
Medical assessment involves physical examination, neurological examination, and neurophysiological assessment. The medical assessment is used to measure the biological aspect of the patient, and it involves both structural (anatomical) and functional assessment of the brain. Neuroimaging techniques like CT scans and MRIs are used frequently, and these techniques help identify any brain dysfunction or damage to a particular part of the brain causing the symptoms.
Psychosocial assessment involves a clinical interview, behavioral assessment, and psychological tests. The clinician takes a mental status examination of the patient and a detailed interview which reveals in-depth information. Systematic observation is accompanied by interviews which are known as behavioral assessments. Other than this, psychological tests include personality tests, intelligence tests, and others. Personality tests may be projective and objective.
It includes−
Physical examination − Physical examination involves taking a detailed medical history along with an accurate assessment of the functions of the bodily systems. This is important to avoid any erroneous decision about the diagnosis. Sometimes behavior, cognition, and feeling may be due to hormonal imbalance, substance intake, the wrong dose of medication, consumption of unhealthy food, etc. For example, an over-active thyroid gland or hyperthyroidism mimics the symptoms of generalized anxiety disorder. Physical examination is essential in addictive disorders, organic brain syndromes, etc.
Neurological examination − The neurological examination helps in giving clarity in terms of anatomical and functional aspects of the brain. In many disorders, the brain is affected, which makes it vital to assess. The neurological examination comprises EEG (electroencephalograph), CT scans (Computed tomography), PET (Positron emission tomography), MRIs (Magnetic Resonance Imaging), and functional MRIs.
Neuropsychological tests − Neuropsychological tests aim to test various functioning of the patient, including cognitive, perceptual, motor, and specific brain lobes functions. Neuropsychological tests like Luria-Nebraska Neuropsychological Battery and Halstead-Reitan Neuropsychological Battery are widely used.
Interview − AAn interview involves a detailed face-to-face interaction between the clinician and the client. Interviews can be structured, unstructured, or semi-structured. Clinical interviews form the heart of any assessment because they yield rich information about past and present behavior and life. Mental status examination (MSE) is used as the blueprint to organize the information. MSE aims to gather information on general appearance and behavior, speech, mood and affect, thought, insight, perception, judgment, and orientation.
Behavioral Assessment − Observation is a behavioral assessment type that occurs when the patient visits the clinic or hospital. Observation is done concerning an objective and can take place both in natural settings and controlled settings. Clinicians not only engage in observation as an outsider but also help clients learn self-observation and systematic reporting of behavior, thoughts and feelings. To minimize the observer bias, clinicians also use rating scales which improve the reliability and validity of the assessment. An effective rating scale measures the presence or absence of behavior and its degree and prominence. One widely used rating scale is Brief Psychiatric Rating Scale (BPRS).
Psychological Tests − Psychological tests are standardized instruments that measure behavioral patterns, values, personality characteristics, cognitive functioning, coping patterns, etc. Clinicians most widely used intelligence tests and personality tests. Intelligence tests gauge information about the cognitive and intellectual functioning of the client. An example of an intelligence test is the Wechsler Intelligence Scale, which has a version for children and adults. Personality tests include objective and projective tests. Examples of objective personality tests are Minnesota Multiphasic Personality Inventory (MMPI), Myers Briggs Type Indicator, etc. Projective tests like Rorschach Ink Blot or Thematic Apperception Test help uncover unconscious details about the client's personality.
The assessment techniques are used integratively, leading to comprehensive data collection and eliminating the risk of errors and biases. The purpose of integrating data is to see if the information complements each other or if there are any gaps or misinterpretations in the presenting clinical picture. One of the essential concepts to understand while talking about assessment is reliability, validity, and standardization. Other than this, a key feature of effective assessment is the relationship between the clinician and the client. A good rapport and trust aid in the process of assessment of disorders. Lastly, there are some ethical issues in an assessment like the potential cultural bias, insufficient validity of the method of assessment, incomplete data interpretation, and the clinician's theoretical orientation.
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