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78 Cards in this Set
- Front
- Back
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What should assessment procedures include?
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1. A Clinical Interview
2. Mental Status Exam 3. Collateral Information 4. Psychological Testing |
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Clinical Interview (adults)
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1. Presenting Problem
2. Personal hx (includes Psychiatric) 3. Family Background 4. Current Functioning |
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Mental Status Exam
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1. Psychiatric functioning
2. Current Sxs |
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Collateral Information
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Input about the pt from:
1. Family Members 2. Mental Health Records 3. Medical Records 4. Legal Records 5. Employers 6. Teachers and related |
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Clinical Interview (children)
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1. Hx from parents
a. presenting prob b. hx of present illness c. developmental hx 2. Interview of Child 3. Family Eval |
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mental status exam
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1. orientation/consciousness
2. general appearance and behavior 3. mood and affect 4. attention, concentration, memory 5. intellectual functioning 6. insight and judgment 7. thought content, process, and perception |
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purposes of an assessment intrument
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1. General Personality functioning
2. intelligence 3. achievement 4. neuropsych testing 5. symptoms 6. specific assessments of functioning (BDI, BAI, etc) |
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Types of intruments
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1. Objective (scored test)
2. Subjective (rater judgment) |
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Methods of assessment
Direct vs Indirect |
1. Direct (self-report tools)
2. Indirect (projectives) |
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norm-referenced vs criterion-referenced scores
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1. norm ref - how does a person perform in reference to others
2. criterion ref - how much content has the person mastered |
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validity
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Does the test measure what it says it measures?
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Reliability
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obtained scores differing true scores (error)
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MMPI scores (mean, SD, significant score cut-off)
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Mean 50
SD 10 Significant at 65 |
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MMPI validity scales
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L = Lie scale (high = faking good; Low = frank and relaxed)
F= infrequently endorse items (high = uncoventional thinking/dissatisfaction K = openness (high = guarded) |
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MMPI 10 clinical Scales
(HS, D, HY, PD, MF, PA, PT, SC, MA, SI) |
HS = Hypochondriasis
D = Depression HY = Hysteria PD = Psychopathic deviate MF = Masculinity/Femininity PA = Paranoia PT = Psychasthenia SC = Schizophrenia MA = Hypomania SI = Social Introversion |
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Who is the WAIS appropriate for?
What three scores does it calculate? What are the four factor indices that it caluculates? What is the mean and SD? What is the mean and SD of subtests? |
- 16 to 89 years of age
- VIQ, PIQ, and overall IQ - Verbal Comprehension, Perceptual Org, Working Memory, Processing Speed - Mean is 100 and SD is 15 - Subtests mean is 10 and SD is 3 |
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VIQ =
What type of intelligence is VIQ? PIQ = What type of intelligence is PIQ? |
Verbal Comprehension Intelligence, which is part of crystalized intelligence
Perceptual Organizational abilities, which is Fluid intelligence |
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What sociocultural and psychological factors can affect VIQ and PIQ?
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People who are higher SES and highly educated have higher VIQ than PIQ
People who are lower SES show the reverse pattern Verbal subtests are culturally loaded and affect ESL individuals Performance subtests are not good for people with poor motor functioning |
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Should feedback for an assessment include a diagnosis?
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-unless contraindicated
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What does the term prevalence in epidemiology mean?
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specific condition observed at a point in time (i.e. 1 year or lifetime prevalence)
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1 year prevalence for mental disorders in adults
-Percentage of mental d.o.? -Percentage of addiction alone and addiction with comorbidity? -Percentage with a serious mental illness? What part of that has a severe and persistent? |
20-25% (about one in five had a mental d.o. during a year)
6% - have an addiction alone 3% - mental and addiction 5.4% = have a serious mental illness with half having a severe and persistent 16% - anxiety d.o. |
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1 year prevalence for mental disorders for children
-not as well documented - what is the percentage for mental d.o. -Percentage with a serious mental disturbance? |
- about 20%
- 5 - 9% - |
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what are three different categorizations of mental disorders that affect children?
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1. internalization d.o. (i.e. depression, anxiety, eating d.o.
2. Disruptive Behavior D.O. (ADHD, conduct d.o., Oppositional defiant, substance use) 3. Developmental d.o. - mental retardation, pervasive developmental d.o., LD, elimination d.o.) |
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What is the range of mental retardation diagnoses
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- mild, moderate, severe, profound, severity unspecified
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What are the essential features?
- below what IQ threshold? - when is onset? - what do you need to look for? |
- IQ below 70
- before age 18 - concurrent deficits or impairments in adaptive functioning |
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What are the indicators for mental retardation?
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1. Inability to function independently, reliance on caretakers, history of failure in school, special placement
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What is the prevalence rate for mental retardation?
What is the likelihood that indviduals with mental retardation have comorbid disorders? What are the most commonly associated mental d.o. with mental retardation? |
- 1%
- 3 to 4 times more likely - ADHD, mood d.o., pervisive dev, stereotype movement d.o. |
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What are the Learning Disorder diagnoses?
When are LD diagnosed? What are some indicators? What is the prevlance? |
- reading d.o., mathematics, written expression, learning d.o. NOS
- when achievement scores are substantially below for age, schooling, and level of intelligence - poor academic performance, low self esteem, withdrawal, behavioral disturbances - 2 to 10% |
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What is autistics d.o. characterized by?
What are the indicators? |
- impairment in social interaction
-impairment in communications - restricted repetoire of activities - indicators: lack of friends, lack of desire to interact with others, head banging or rocking, difficulty talking |
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What is aspergers d.o. characterized by?
What are the indicators? |
- impairment in social interaction
-restricted repetoire of activities -NO LANGUAGE DELAYS Indicators: lack of friends, lack of desire to interact, stereotyped interests. |
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What are the essential features of ADHD?
HOw many settings do sxs need to be in? How long do sxs need to be present for? At what age do some sxs need to appear by? |
- persistent period of: inattention and/or hyperactivity/impulsivity
-in at least 2 settings - symptoms present for at least 6 months - some of which were present before age 7 |
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Types of ADHD
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-inattentive type (6+ sxs of inattention)
-hyperactive-impulsive type(6 + symptoms of impulsivity -combined (6 sxs of combined) |
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What are the indicators of ADHD
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- Inability to complete tasks
- poor grades - restlessness - acting out - aggressiveness - poor social skills - boredom with many activities - parents inability to manage child's behavior |
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What is the prevalence of ADHD in school children?
What are the gender differences? IQ differences? What are the most common comorbid disorders? |
3-7 %
6-9 times more common in males IQ is lower ODD, Conduct DO, and Mood do, anxiety do, LD, |
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What are the essential features of Conduct DO
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- violates right of others
- age appropriate societal normals or rules are broken - aggression to people or animals -destruction of property - theft |
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What are the indicators of Conduct D.O.
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- criminal activity
- severe acting out - school problems - substance abuse - severe family discord |
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What is the prevalence of Conduct D.O.
Gender difference in CD? Concommitant Diagnoses? |
- 1 to 10%
- more common in males - LD, Mood DO, Anxiety, AOD |
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What are the essential features and the sxs of ODD?
How many sxs present for how long |
- negativistic, defiant, disobedient, and hostile behaviors toward authority figures. 4 sxs must be present for 6 months
SXS = loss of temper, arguing with adults, actively defying adults, annoying others on purpose, blaming others for own mistakes, frequent anger and resentfulness, spitefulness |
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What are the indicators of ODD?
What is the prevlance of ODD? Gender of ODD? Age of onset? |
- 2-16%
- Before puberty it is more prevalent in males, rates are equal after puberty |
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What are some elimination d.o.
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encompresis and enuresis
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What are the essential features of separation anxiety d.o.
What are the duration and age of onset of sxs? What are the sxs? |
- developmentally inappropriate and excessive anxiety about being away from home or away from caretakers
-duration of sxs is 4 weeks before 18 y.o. -distress when separation from home or attachment figure -excessive worry about loosing an attachment figure -excessive worry that an event will cause separation -reluctance to go to school -relectance to be alone -reluctance to go to sleep without being near the attachment figure - nightmares about separation -complaints of physical sxs when separation occurs - |
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What are the indicators of separation anxiety
What is the prevalence What is the comorbid d.o. |
- refusal to go to school
- nightmares -clinginess -4% -mood d.o., anxiety d.o., panic d.o. |
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What are the essential features of delirium?
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- disturbance of consciousness and change in cognition or perceptual disturbance.
- Develops over a short period of time and has a fluctuating course |
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What are the indicators of delirium?
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- incoherence
- inattention - disorientation - transient hallucinations |
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What are the essential features of dementia?
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- impairments in memory
- One of the following - aphasia - apraxia - agnosia - disturbance in executive functioning |
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What is the prevalence over the ages?
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- 1.5% 65-69
- 16-25% of people over 85 |
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What are the essential features of an amnestic disorder?
What are the indicators? |
- memory impairment in the absence of other cognitive sxs
- forgetfulness, long hx of AOD, Hx of head trauma |
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substance dependence
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The following sxs of a 12mon period:
- tolerance - withdrawal - progression in amount - taking substances over a longer period than intended - desire to reduce - spending a great deal of time obtaining the substance - impairment in social, interpersonal,or occupational functioning -continued use despite consequences |
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Sxs of substance abuse. How long do sxs have to persist?
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Sxs over a 12 mon period
- failure to fulfill obligations - repeated use in physically hazardous situations. mulitple legal problems, recurrent social and interpersonal problems |
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What is the life time prevalaence of alcohol dependence?
What is the prevalence at any given point in time? |
-15%
- 5% |
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Race/ethnicity in alcohol dependence
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- equal in black and white
- higher in Latin@ - lowest in Asians - highest in Native Americans |
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What are the essential features of schizophrenia?
What are active phase sxs? |
- disturbance that lasts at least 6 months
- includes one month of active phase which are: - delusions - hallucinations - disorganized speech - disorganized or catatonic beahvior - negative sxs |
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What are the subtypes of schizophrenia?
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- paranoid
- disorganized - catatonic - undifferentiated - residual |
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Delusional Disorder
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One month of non bizarre delusions without other active phas sxs of schiizophrenia
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Types of Delusional disorder
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- erotomanic - an individual of higher status is in love with you.
- Grandiose - inflated self worth, power, knowledge, special relationship with a person of high status - jealous- partner is being unfaithful - persecutory- person or close persons are being threatened - somatic- having a personal defect or medical problem - mixed type - unspecified type |
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Prevalence Rate of delusion do
Indicators of delusion do |
.03%
Functioning is generally unimpaired except for the delusion |
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Mood Disorders, what are the types
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MD episode
Manic episodes Mixed episode hypomanic |
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What are the essential features of dysthymia
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Chronically depressed mood most of the day, more days than not for almost two years. Only two basic sxs of depression
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Essential Features of Bipolar do
What are the indicators? |
1 or more manic or mixed episodes. MD episodes not required for dx
- shifts in mood, inability to meet responsibility - bizarre and erratic behavior - reckless behavior - legal problems - irritability - impatience - excessive confidence |
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Base rate for bipolar do?
What is the percentage of those that have a manic episode that tend to go one and have more? |
- 0.4% to 1.6%
- 90% of those who have a manic episode have another. |
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BiPolar I vs Bipolar II
What is lifetime prevalence of BiPolar II |
- Biolar II has a MD episode and a hypomanic NOT manic
- 0.5%. Twice as common in women than men |
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Manic vs hypomanic
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- Hypomanic does not cause marked impairment in social or occupational functioning
- does not require hospitalization - No psychotic features - Sxs only present for 3 - 4 days |
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What are the essential features of somatization do?
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- multiple somatic complaints that begin before age 30
-four sxs must be met at some time during the course of the do: 2 gastroinestinal sxs, 1 sexual sxs, 1 pseudoneurological |
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What is an undeifferentiated somatoform do? How long do the sxs need persist?
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one or more physical complaints that cannot be fully explained medically and lasts almost 6 months
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Essential features of a conversion do?
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- unconscious conflict are expressed through physical symptoms.
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Essential features of a pain do. What does it warrant before it is classified as a pain disorder?
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pain (case by psych factors) in one or more sites of sufficient severity to warrant clinical attention
i.e. back pain at work |
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Essential features of hypochondriasis?
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preoccuption with fear of having or belief that one has a serious disease based on a misperception of bodily sxs.
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essential features of factitious do
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intentially produced physical or psychological sxs to assume a sick role
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Dissociative Amnesia
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- inability to recall important person information, not forgetfulness
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Does DID involve distinct identities or personalities. At least two of these identities recurrently take control of a persons behavior.
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yes
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What does exhibitionism, frotteurism, fetishism, or sexual masochism have in common?
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they are paraphilias
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- refusal to maintain body weight 85% of normal
- intense fear of gaining weight - misperception of body size or shape - denial of seriousness of current low body weight - absence of menstruation How many more times are females likely to be dx than men? |
- What is anorexia
-10x more likely |
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What is binge eating followed by inappropriate compensatory behavior?
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Bulimia Nervose
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What is a disturbance in the amount, quality, or timing of sleep?
What is abnoaml behavior or physiological events that occur in association with sleep (such as a nightmare do)? |
-Dysomnia
-Parasomnias |
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Cluster A personality do
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- Paranoid
- Schizoid - Schizotypal |
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Cluster B personality do
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- antisocial
- borderline - histrionic - narcissistic |
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Cluster C personality do
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- avoidant
- dependent - OC personality do (uncle tom) |
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what is the likelihood that someone that had one major depressive episode is going to have another? if they had a second episode? and a third?
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60%, 70%, 90%
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