Assessment

In general, screening is important because it is often brief and can be applied
to a large number of people with little effort, saving expensive time on
evaluation and yet efficiently identifying individuals most likely to have a
formal mental health condition. It is much less costly than the next step in a
diagnostic workup after being screened as positive: the process of assessment,
a lengthier process in which detailed information is gathered in a systematic
way about the patient’s probable condition. Assessment procedures
may include formal diagnostic interviewing, in which the psychologist or clinician
asks a step-by-step series of questions to get a clear picture of what the symptoms are and how they developed. Interviewing can be used to assess
not only the individual affected but also family members or significant others,
as sometimes these individuals have valuable information related to the
history or development of the symptoms. These informants can also be
helpful if the individual is not able or willing to speak about or to describe
the condition.

Assessment procedures may also include the use of questionnaires, surveys,
or checklists about symptoms. They may include observation by the
psychologist in interpersonal interactions or under certain other conditions.
They may also include formal medical tests, such as blood tests, urine
toxicology, and tests of psychomotor performance.
Overall, assessment procedures seek to reveal the course of the symptoms
present or how they have changed over time. Assessment also seeks to show
how the most prominent symptoms relate to one another and to less prominent
symptoms. This is particularly important to a process called differential
diagnosis, in which disorders that may appear alike in some features are diagnostically
separated from one another in order to determine if one or
more conditions are present.

If, in the process of assessment, it is found that the number, severity, and
duration of the individual’s symptoms and signs meet the diagnostic criteria,
or standards of required evidence to warrant a diagnosis, then a diagnosis
is rendered. If the signs and symptoms are all manifest but fall short of being
present in the right number, severity, or duration, then the condition
might be thought of as subclinical. This would mean that although the
symptoms do not meet the formal criteria necessary to warrant a diagnosis,
they are problematic and may still require some clinical observation and attention.
Finally, sometimes a client may have one disorder that is clearly present
but also has what might be called leftover symptoms that do not seem to fit.
In some cases, these symptoms may be what are known as associated features,
or symptoms associated with disorders but not part of the disorder in a
formal diagnostic way. For example, many people who suffer from agoraphobia
also experience symptoms of depression. In some cases, these individuals
also qualify for a diagnosis of depression. In other cases, they are experiencing
depressed mood as a consequence of having agoraphobia, and
the depression is an associated feature. Once these aspects of a diagnosis are
understood, the information can be put to use.