There are a plethora of tests and assessment techniques that can be used to assist in the diagnosis of mental health disorders.
 
This article will discuss the general categories of assessment techniques and give examples of each. The information in this article is designed to be used for educational purposes. Only licensed mental health care professionals formally trained in the use of the following techniques are qualified to administer, score, and interpret these assessment techniques and tests.

Clinical Assessment

doctor_patientFor purposes of this article, we can define clinical assessment as the evaluation of a person’s physical, medical, cognitive, psychological (personality, emotions, beliefs, and attitudes), and behavioral history and current condition in order to determine the presence of any mental health disorder. The assessment process is typically initiated by a referral either from a physician, mental health worker, or other person, or it can be directly initiated by the individual.

When people come into an assessment, they have some set of presenting issues or problems that they, or some other party, wish to address, understand, and change, if possible. The clinical assessment process is aimed at making a specific diagnostic determination that will help with understanding these issues, conceptualizing them into an organized and meaningful format, and developing a formal intervention strategy to assist the individual.

There are a number of assessment techniques and formal tests that can be used during the clinical assessment process. Assessment techniques and formal tests are tools used to gather information. A person is not defined by a score on a test. The score or performance on a test helps the clinician understand something about the person, and during the assessment process, it contributes to understanding what the potential diagnostic issues may be.

 
 

The Clinical Interview

By far the most important tool to gather information in the assessment process is the clinical interview. Without the clinical interview data, any other information collected from other tests or assessment techniques has limited value. The interview provides the context for the rest of the assessment. The interview data provides potentially valuable information that may not otherwise be obtainable from tests, such as observing the individual’s behavior and reactions to current life situation, understanding idiosyncratic features of the individual, and so forth.

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    Clinical interviews are not simple conversations but have some sort of focus and direction. At its basic level, the clinical interview must ascertain:

     

    • The history of the problem being evaluated: This includes a complete understanding about the current issue that is being assessed, including its history, development, and current presentation.
    • The person’s family background. As much information regarding the person’s family, family history, family medical history, relationship issues, and so forth should be obtained.
    • The personal history of the individual: This includes developmental history, academic achievement, relationship issues with friends and family, legal issues, current and past medical history, medications used, substance abuse issues, etc. As much information about the person as possible, as related to the presenting issue, must be gleaned in the clinical interview.
    • Behavioral observations: These observations include how the person reacts to being asked questions, the quality of the person’s responses, physical limitations, the person’s mood and behavior during the interview, etc.
    • A brief mental status examination: This part of the clinical interview should at a minimum include information about the person’s presentation (e.g., level of consciousness, general appearance, attitudes, other issues, etc.), motor functioning (e.g., being jittery, irritable, hyperactive, sedated, etc.), affect (e.g., the outward presentation that infers the individual’s mood state, such as rate of speech, facial expressions, etc.), mood (the person’s self-report about their mood), and cognitive issues, such as ability to pay attention, memory as related to being able to recall recent and past events, expressive and receptive language abilities, conceptualization issues, and so forth.

    Clinical interviews take on a number of different forms. The most general distinction between the different types of clinical interviews designates the difference between a structured and an unstructured clinical interview.

    • An unstructured interview uses questions that have no prearranged format. This is not to mean that there is no organization, but there is no specific direction for the clinician to follow. The clinician follows their instincts based on answers given by the client. There are several general topic areas that need to be addressed in a clinical interviews (see above) and the clinician will attempt to cover these. Unstructured interviews are not as reliable and useful as structured interviews; however, using an approach that allows for some variability in questions can be useful.
    • A structured interview follows a prearranged format. The questions are standardized and often meant to be read verbatim. These interviews target specific types of information that are useful in the diagnostic process. However, only using structured interview questions can result in missed information. Most so-called structured interview formats are actually semi structured interviews where there is an overall structured interview with specific questions and directions, and the opportunity for the clinician to get clarification depending on certain answers and to ask questions that they feel are relevant to the situation (even if the question is not be in the structured interview format). Structured interviews may be prepared by a specific clinic or may take the form of a standardized empirically validated questionnaires developed for specific purposes. Examples of some structured questionnaires include:

Psychometric Testing

Psychometric tests or psychological tests consist of a number of formalized tests that tap nearly every domain of psychological, personality, emotional, behavioral, and cognitive functioning. These tests can be extremely useful in assisting in the diagnosis of mental health disorders; however, these tests require special training to assess, score, and interpret properly. There are literally thousands of psychological tests in use. The basic domains that psychological tests cover include:

  • Personality tests are formal psychological tests that measure aspects of an individual’s personality or measure specific personality variables. There are literally hundreds of these tests available. In general, these tests can be divided into two major categories:
    • Projective personality tests are tests that provide some sort of ambiguous stimulus or task, and the individual is required to give a subjective opinion of the stimulus or to complete the task, such as a drawing task. There are no right or wrong answers to these tests; the data gleaned from these tests consists of the individual’s interpretation and expression to the stimulus or task. These tests are designed to tap personality variables that individuals are not overtly aware of (in the unconscious mind). The most well-known of these tests is the Rorschach or ink blot test.
    • Objective personality tests have a specific type of question-and-answer format that may consist of choosing an appropriate answer from several choices that relates to the individual’s self-perception, rating appropriate feeling on a scale, or some other concrete response. There is also an option for individuals who know the patient to take certain types of objective personality tests and rate the patient on specific personality indices. Perhaps the most used of the objective personality tests is the Minnesota Multi-Phasic Personality Inventory (MMPI) that is used to rate individuals on personality, psychological, and emotional variables.
  • Intelligence tests are used to rate the individual’s level of overall intellect compared to others in their peer group. Intelligence tests are important in determining various cognitive strengths and weaknesses in individuals that may be associated with certain types of mental health disorders. There are a number of different formal intelligence tests. The most utilized intelligence tests are the Wechsler Intelligence Scales. These tests are separately developed for both adults and children, and give a number of different IQ scores (intelligence quotient scores) for different intellectual domains (e.g., full scale IQ, verbal IQ, nonverbal IQ, and so forth).
  • Neuropsychological tests are specialized tests administered by psychologists trained in brain behavior relationships (neuropsychologists). These tests can be used to determine the presence of cognitive strengths and weaknesses that may be the result of brain damage, a psychological disorder, a neurological disorder, or a developmental disorder. There are literally thousands of different neuropsychological tests that can be administered to cover these domains. Neuropsychological functioning generally covers issues such as intelligence, language abilities (expressive and receptive language abilities), attention, learning and memory, visual perception, planning and judgment, abstract thinking, motor functioning, personality, and other psychological domains.
  • A number of other tests are specifically designed to measure aspects of an individual’s mood (e.g., the presence of depression), other emotional states and psychological states such as the presence of anxiety or psychosis, and to measure a person’s adaptive abilities.
Physical and Laboratory Testing

An important part of the assessment process is to ensure that the individual has a full physical workup to rule out any physical causes/associations that may be related to the presenting psychological problem. Although there are no laboratory or medical tests that can determine the presence of the vast majority of psychological or psychiatric disorders, there are a number of physical conditions and diseases that either present very similarly to certain psychological disorders or produce side effects that are similar to the symptoms of certain psychological disorders.

For instance, individuals with certain cardiovascular issues often experience panic attacks. Not assessing the individual for these cardiac issues could lead to the misdiagnosis of panic disorder in the person and result in a treatment approach that would be relatively ineffective in addressing that person’s panic attacks. Individuals with hypothyroidism will often present with the symptoms of severe depression. Attempting to treat their depression with therapy or by other means will not fully address the issue and certainly will not treat the thyroid condition. Only treating the hypothyroidism will fully address the issue in this case.

A number of different physical and laboratory techniques are available. Some of the more relevant ones in the assessment of mental health issues include the following:

  • A full physical exam performed by a physician can help to ascertain any physical issues that may be contributing to symptoms.
  • Neurological evaluations are useful in determining specific types of neurological disorders that may be presenting as psychological issues. Neurological evaluations typically include such techniques as neuroimaging and psychophysiological assessment (see below).
  • Neuroimaging techniques that look at the structure or functioning of the brain can be useful. There are two basic categories of neuroimaging techniques: structural neuroimaging (e.g. magnetic resonance imaging [MRI]) that focuses on changes in the structure of the brain and functional neuroimaging (e.g., positron emission tomography [PET]) that focuses on blood flow and areas of activation in the brain during specific physical, cognitive, and emotional states. Neurologists and psychiatrist can choose the specific neuroimaging test they feel is most appropriate for the particular case.
  • Psychophysiological assessment techniques can be useful, and these include such procedures as the electroencephalogram (EEG) and evoked potentials that measure changes in the nervous system. For instance, EEGs are useful in determining if an individual has a seizure disorder. Often, individuals with chronic seizure disorders experience symptoms similar to individuals with psychotic disorders such as schizophrenia.
  • Laboratory tests, such as blood and urine tests, can help to determine the presence of any medical conditions, infections, or substance use disorders that contribute to the individual’s presentation.

 
 

Multidisciplinary Assessment

Of course, using medical doctors (e.g., psychiatrists, neurologists, and other physicians) and psychologists can be useful in ascertaining the exact nature of the presenting issue. However, in many cases, it is important to broaden the range of assessment services in order to develop a picture of the whole person. Using assessment techniques and professionals from other disciplines can widen the assessment process. Professionals that could be utilized include:

  • Speech therapists, physical therapists, and occupational therapists to determine functional issues
  • Social workers, case managers, and vocational rehabilitation specialists for lifestyle and practical issues
  • Other specialists, such as audiologists, other medical specialists, religious and spiritual influences, and so forth

Conclusions

The process to assess and diagnose a mental health issue is complicated and should be as thorough as possible. Tests and assessments aimed at diagnosing mental health disorders should cover several basic domains of functioning and present a comprehensive picture of the individual.