Assessment 6

Front 1

Epistemology Umpires
1 "are balls and are stricks, and i can call them as they are
2 "are balls and are strikes, and i call them as i see them"
3 "are no balls and no strikes until i call them"

Back 1

1: psychiatric disordres exist as entities in natures

2: they are merely mental constructs

3: they are constructs but with considerable heuristic and practical value in predicting the course, family history, treatment response, and biologist test results and in making critical treatment and management decisions

... not clear cut reality of these disorders but doing our best-- no assumption that in reality, these are the way things really are

Front 2

Problem with Def

Back 2

-Descriptive syndromal diagnosis v. disease (some diagnoses are clearly diseases; some just circumsized symptom presentations; some clusters of correlated symptoms at sundromal level)

-syndrome is group/pattern of symptoms, affects, thoughts and behaviors that tend to appear together in clinical presentation

-follows categorical approach... but no assumption of absolute boundaries

-major depressive episode can range from symptoms-only to most severe disorder

-2 clients can meet criteria for a disorder without sharing a single criteria

Front 3

DSM IV R What is it?

Back 3

provides common language for professionals; helpful in conceptualizing cases

in what context use?
-improve treatment planning
-communication b/w professionals
-provide diagnosis for clients with insurance coverage
-inform clients if counseling will be covered by insurance
-anticipate nature/progress of counseling
-id issues beyond our expertise to help with referrals
-similar natural history

Front 4

Def mental disorder

Back 4

"clinically sig behavior or psyhcological syndrome that occurs and is associated with present distress/disability or with significant increased risk of suffering, death, pain, disability, important loss of freedom

Front 5

Four D's

Back 5

Deviance: differ from society's ideas about proper functioning; some abnormal functioning

Distress: suffer from distress from behavior (but sometimes do not suffer ie, antisocial; may or may not be present)

Dysfunction: interferes with daily functioning- home life, school, work,self care

Danger- to self or others

Front 6

Multiaxial Classification

Back 6

Axis I: Mental Disorders

Axis II: Personality Disorders and Mental Retardation

Axis III: Physical Conditions and Disorders

Axis IV: Psychosocial and Environmental Problems

Axis V: Global Assessment of Functioning

Front 7

Axis I

Back 7

Clinical disorders or conditions of focus of clinical attention (not necessarily mental disorders ie, child abuse)
may be multiple disorders/ more than 1 diagnosis
record first diagnosis most responsible for current evaluation
qualifiers: provisional, mild, moderate, severe, partial remission, full remission

Front 8

Axis II

Back 8

Personality disorders/ MR; conditions that persist throughout life
can't really get better from but can treat/cope
can be used to note maladaptive personality features, below threshold for personality disorder diagnosis

Front 9

Axis III

Back 9

General Medical Conditions
record conditions that may interface with mental heath treatment
not diagnosing physical illnesses, just recording them

Front 10

Axis IV

Back 10

Psychosocial and Environmental Prob.
Ie, family problems, abuse, neglect, social support, educational and occupational problems, housing, financial problems, problems with access to healthcare, legal or other
-occur in last year (unless contributed to dev't of disorder or focus of treatment)
If focus of clinical attention, then listed in Axis I using V-Code

Front 11

Axis V

Back 11

Global Assessment of Functioning
clinician's view of overall level of functioning at time of interview GAF scale ranges from 100 (high) to 1 (low)
do not consider impairment in functioning due to physical limitations or env problems
greatest use in tracking changes in client's level of functioning


41-70: outpatient setting
40 and below: partial or full hospitalization

Front 12

Diagnostic process using DSM IV TR

Back 12

Descriptive and avoids etiological theory
Principle of differential diagnosis (need judgment of deciding if a given symptom falls into 1 category or another)
History better than cross-sectional observation
Collateral info augments history from client (who else knows)
Disorders due to general medical conditions/ cognitive disorders pre-empt all other diagnoses that could produce same symptoms
Principle of parsimony (use as few diagnoses as possible)

Front 13

Sources of Info for Diagnostic Assessment

Back 13

Structure Interviews: validated instruments, questions in oragnized/ valid manner

Semi-structured interivew: template of basic questions or blen of instruments plus open-ended interviewing

Unstructured interviewing: diagnostic skill is tested most during unstructured interviewing. can make numerous inferences