Come and study with me.

A little experiment I've been wanting to try since I picked up this blog, is to write as I study; rather than after I know my stuff. Clinical Psychology seems a brilliant module to try this with, as it has slotted into the worst 'introductory' style of lecturing. "Welcome" - "Now irrelevant historical perspectives" - "More irrelevant perspectives followed by an incredibly obvious segway we all saw coming from day one." 3 lecture slots out of 12 used up before we get into the meat of the module.

Not only is Clinical psychology a tremendously important part of the degree (since it leads most directly into patient care and research) but it seems like it is going to be very hard to learn well. After getting so keen on evolutionary psychology I'm not sure how much depth I want to go into with clinical, but I do know I want to pass the shit out of it. So here we go. I've opened my book (Abnormal Psychology, 2008, Susan Nolen-Hoeksema) at page 100. The beginning of a chapter called Assessing and diagnosing abnormality. Let's see where I can get in the nect couple of hours.

The chapter opens with a little summary of what is to come. There will be a section on gathering information (which, I am told, is the hunt for the symptoms and possible causes in the people one is assessing.) This will go into current symptoms, ways of coping with stress, recent events, and the physical condition of the assessee. There are many more, but we'll go into them later. After this, I will be given a lesson on the tools clinicians use during their assessments. Expect to hear something about neuropsychological tests, intellectual tests, structured interviews, personality inventories etc. After the basics are covered I will be introduced to some problems in the assessment process. Finally, a discussion on diagnosis will...happen. This will primarily involve an investigation into the Diagnostic and Statistical Manual of Mental Disorders version 4, text revision (DSM-IV TR).

The chapter hasn't started off with a cheerful tone. I took a moment just then to read a text box telling me about Michael J. Fox, the star of Back To The Future. It's commonly known the guy has Parkinson's disease, but this little section described the hasty onset of it beginning in his thirties. At first Fox attributed the twitching of his pinky and hand, weakness of the same hand and aches in the muscles of his shoulder and chest, all to an accidental hanging during a set of the aforementioned film. Eventually though things got worse both physically and mentally. The worst part for him was an increasing difficulty in expressing himself. He could form his ideas into sentences and phrases but has real trouble getting them out. Ugh...poor guy. I hate to imagine the frustration that led him to strong drinking, especially after seeing him so happy in his films. in the end he went to see a neurologist who, throughout the investigation, started to look more and more grave. The horrifying news of his eaqrly onset Parkinson's was not tempered by hearing he had at most 10 years of normal functioning left.

To cheer us all up, Nolen-H poses the question - If he came to us for a diagnosis before he had heard the truth how would we do it? My answer - "Bugger knows". By the end of this chapter it'd better be "Well, let me tell you in a smug and knowledgeably manner."

Assessement is the term to describe all the information gathering about a person's condition and situation in order to lead to a diagnosis; a label to attach to and connect all of their symptoms. Trained clinicians (and in many cases, those of us close enough to a person to understand them a bit) know which of these symptoms tend to come as a package, and which of them are outliers. In Fox's case, his alcoholism was probably caused by the frustration of his Parkinson's symptoms; not a trait of Parkinson's itself. In this chapter I'm going to be shown three types of information: Symptoms & history, physiological and neurophysiological factors, and sociocultural factors.

Let's start with symptoms and history. When interviewing an individual you would ask about their current symptoms, including their severity and chronicity (I had to look this up. It means the rate of onset and development of the symptoms). You would try to gauge how much the symptoms are messing with their normal life patterns in their different roles (at work, with their children, with a lover etc). From this you could work out if they were experiencing their symptoms in a variety of situations or just in specific areas. Nolen-H adds an important slice of information about diagnosis: Most of them require that the conditions be pervasive enough to utterly bollock-up the lifestyle severely before they will be counted as part of a psychological disorder.

As well as checking out the symptoms, it is important to understand how well the person is coping with the issues. In Fox's case he turned to alcohol rather than talk to those who cared for him. This created problems that only added to the weight of his others, and he developed psychological symptoms based purely on his abuse of the substance. You'd probably be safe in saying he didn't cope all that well. At this point, asking the person about the recent events in their life could reveal an event which tied in with the onset of symptoms. If so, they might be given a different diagnosis than if the problems came about with no apparant trigger. (E.g. a kid that got depressed after his parents split up might be diagnosed with adjustment disorder rather than a major depressive disorder. A significant factor in treatment and associated stigma!)

Learning about the person's history of psychological problems is as important as checking their family history. This could establish genetic root causes which would help in diagnosis and treatment, seeing as it could reduce confusion about which traits are part of the disorder and those which might be apart from it completely.

Physiological and Neurophysiological Factors are assessed alongside everything else so that clinicians can check whether a physical afflication is setting off the psychological symptoms. Nolen-H gives the example of some brain tumors being known to cause disorientation and agitation similar to those associated with schizophrenia.  Unfortunately there don't yet seem to be any biological tests that can identify a psychological disorder, so they are mainly used to check for side effects and their underlying medical conditions. Depression can be caused directly by a treatable thyroid disorder. By treating the thyroid the depression will clear without any need for extra anti-depressant treatment. Boom! The tests are important then, ken?

Similarly, the drugs currently being used, or those in the past, of the assessed individual need to be checked. They can affect both the main condition and side effects, through side effects of the actual drug, or withdrawl. Besides all that, if the drugs would clash with those necessary for treatment, it'd be fairly handy for the clinician to know beforehand. Lastly, checking the cognitive and intellectual abilities can assist in a differential diagnosis (a problem when a symptom can be assigned to one of a number of different disorders.) Determining whether certain symptoms are the cause of cognitive deficiencies (e.g. crappy short term memory) is helpful.

The last of the three areas of assessment covered in the book is Sociocultural Factors. Really everything that can influence a person needs to be assessed when going for a correct diagnosis of 'invisible' illnesses. Holen-H talks about the 'social resources' available to a client. This includes the number of friends and family they have for contact and support, plus the quality of their relationships. Clinicians working with patients from abroad are concerned with the culture their clients were raised in, the number of years they spent there and when/why they moved, how connected to their home they are and if they are currently living with people from their home country (Dana, 2001 is mentioned, but I've not read the source material yet.) Members of foreign groups differ in the extent to which they still identify with their 'home' groups and those of the mainstream culture they currently live in; their acculturation. That's a really cool word. Understanding the different levels informs a clinician about which problems the client(s) will feel comfortable revealling and the types of stress they will be exposed to.

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This is a decent place to ease off at for now. The next section is huge and I want to go to the gym before starting it. I'll update this as I carry on. Next to come, methods of assessment.