EXAM CLINICAL ASSESSMENT

Prof. Dr. Laurence Claes

Dear students,

Please find in attach 5 exam questions based on the courses of clinical assessment.

The exam will take place from 1 PM till 4 PM and is closed-book. Please write your answers in

the space which is provided below each question. Please write your name on each page and

write as clearly as possible!

I wish you much luck and success!!!

Laurence Claes

K.U.Leuven 1
SURNAME: Martínez Moreno FAMILY NAME: Sara
 1. Describe the main differences between the DSM-IV and DSM-V AXIS-II Personality Disorder
classifications, more specific, how do Criteria A and Criteria B differ?
The DSM-IV organizes each psychiatric diagnosis into five dimensions (axis) relating to different
aspects of disorder or disability. Axis II in the DSM-IV corresponds to personality disorders and
intellectual disabilities. Personality disorders are classified in three clusters:
- cluster A (odd/eccentric)
- cluster B (impulsive/emotional)
- cluster C (fearful/anxious).

So, in conclusion, the classification in DSM-IV is mainly categorical.

The DSM-V changes the system of classification, being organized in several sections – the axis
classification disappears.
- Section I describes DSM-V chapter organization and its change from the multiaxial system, which
is no longer used.
- Section II is about diagnostic criteria and codes, and it’s related to Axis II in the DSM-IV.
- Section III is about emerging measures and models, and it’s related to a New Personality Disorder
Model. In section III, it is stated that there should be a categorical and dimensional approach to
Personality Disorders. Between the criteria to classify a Personality Disorder, criterion C, D and E
remain the same - but criterion A and B change.The difference between Criteria A and B is that:
- Criterion A is dimensional
Before we diagnose, there has to be impairment in self-functioning (identity) and
interpersonal (empathy or intimacy) functioning.
- Criterion B is categorical  one or more pathological personality trait domains or trait
facets
It is a kind of a pathological variance of the Big Five:
- Negative affectivity  neuroticism
- Detachment  introversion (low on extraversion)
- Antagonism  reversed agreeableness
- Disinhibition  reversed conscientiousness
- Psychoticism  openness to experience

K.U.Leuven 2
SURNAME: Martínez Moreno FAMILY NAME: Sara
 2. Please explain this graph in terms of the determination of the antisocial personality
disorder in function of temperamental traits.
- All personality disorders are
characterized by low levels of effortful control (low
emotional self-regulation). In this graph, effortful
control is measured by the Attentional Control Scale.
- Specifically, cluster B – dramatic,
emotional or erratic - PDs (such as antisocial, histrionic,
borderline and narcissistic) are characterized by high
BAS – which is the sensitivity to reward, an approach
tendency. We can see in the graph that a high level of
BAS is modulated by the level of Effortful Control (BAS
x ACS).
- Even though we cannot see any
information about the BIS in the graph, we know that
the antisocial PD was characterized by a negative
correlation with BIS – which is the sensitivity to
punishment, an avoidance tendency – that is, there was
an absence of anxiety, an absence of this sensitivity.

To summarize, the low score on Effortful Control (EC) confirms that participants with personality
psychopathology lack a self-regulatory capacity that normally emerges throughout development and that
allows persons to gain active control over reactive behavioural and emotional responses. Furthermore, and
even though is not in the graph, several PDs are characterized by an interaction of BIS and EC (such as the
antisocial personality disorder) which shows us that BIS only relates to severe PD pathology, if EC is low.

Two groups: HIGH BAS AND LOW BAS

Depending on their score in ACS you make another two groups.

K.U.Leuven 3
SURNAME: Martínez Moreno FAMILY NAME: Sara
 3. Please describe the main differences between the personality model of A. Beck and J. Young?

Unlike Young’s (1990) model, Beck et al. suggest that each personality disorder is characterized by a
distinct cognitive profile  a composite of beliefs, attitudes, and affects organised around a general thema
of the nature of self and others that dictates a generalized behaviour strategy. E.g., Person with a
dependent personality disorder:

- Cognitive schema

o Others = protective and strong

o Self = weak and requiring help and protection

- Behavioral strategy

o Overdeveloped: Seeking reassurance and dependence on others

o Underdeveloped: Autonomy

K.U.Leuven 4
SURNAME: Martínez Moreno FAMILY NAME: Sara
 4. Nigg (2006) described three types of effortful inhibition (1) interference control, (2)
cognitive inhibition, and (3) behavioral inhibition. Please describe each of these processes
+ one assessment instrument/task to measure it.
(1) Definition Interference control + instrument
Interference control can refer
a. to suppressing a stimulus that pulls for a competing response so as to carry out a primary
response,
b. to suppressing distractors that might slow the primary response
c. to suppressing internal stimuli that may interfere with the current operations of working
memory.

An instrument that can measure interference control is the Stroop task

(2) Definition Cognitive Inhibition + instrument

Interference control can also be cited when one considers keeping unwanted thoughts out of
mind even when not blocking a competing motor response  cognitive inhibition.

An instrument used is the procedure of the directed forgetting paradigm:

a. Word list A:

i. Condition A: forget

ii. Condition B: remember

b. Word list B

c. Remember word list A: Condition A < Condition B

i. Cognitive inhibition mechanism suppressed the information from working

memory but not from recognition memory

d. Recognition word list A

Cognitive inhibition problems related with the obsessions in OCD and also with ADHD.

(3) Definition Behavioral Inhibition + instrument  motor cortex

Deliberate control of a primary motor response in compliance with changing context
cues.

An instrument used is the Go/No Go task

K.U.Leuven 5
SURNAME: Martínez Moreno FAMILY NAME: Sara
 5. Please interpret the validity and clinical subscales of patient ‘Larry’ (shortly).

5A. Please describe the interpretation of the following validity scales (see Table below,
left side).

F  infrequency: T = 79

Psychotic/severe neurotic. Highly Deviant Social/ Political beliefs. Moody, restless, dissatisfied,
unpredictable. Because it is on the edge of the upper classification, we could consider that either the
profile is invalid (he is faking the symptoms) or he has a serious psychopathology.

K  correction: T = 30

It is below 40 so we can consider the profile invalid.

TRIN  True response infrequency: T = 57

T <80  suggest nay saying (is always answering no)

K.U.Leuven 6
SURNAME: Martínez Moreno FAMILY NAME: Sara
 5B. Please describe the interpretation of the following clinical scales.

D  depression: T = 68  Moderate depression, worried. Dissatisfaction with life, withdrawn.

Somatic complaints, low self-confidence.

Pd  Psychopathic deviate: T= 59  Average (but on the edge  possible use of drugs)

Hy  hysteria: T = 47  average hysteria

Sc  schizophrenia: T = 84  T>75 CONSIDER SCHIZOPHRENIA DIAGNOSIS  Z-score (standard

deviation)  84-50/10=3,4

Two point codes:  why do we look at these punctuations when in the slides it says we have
to look at the 2 or 3 highest points? The two highest are Paranoia (Pa  83) and Schizophrenia
(Sc  84), but the only one that coincides it’s 68/86, which doesn’t fit Pa

- Psychopathic deviate “Pd” (48) and schizophrenia “Sc” (84) vs 59/84

- Psychasthenia “Pt” and (78) and schizophrenia (87) vs 77/84

5C. Which Axis I diagnoses would you suggest based on these findings?

Axis I  paranoid schizophrenia

K.U.Leuven 7
SURNAME: Martínez Moreno FAMILY NAME: Sara