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21 Cards in this Set
- Front
- Back
What are knowledge and skills of assessment and evaluation?
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- knowledge of assessment procedures (interviewing techniques, mental status exam methods, and psychological testing)
- Knowledge of procedures to collect collateral information - Awareness of limitations of assessment procedures (Test instruments (e.g., reliability, validity, normative sample); Factors that affect interpretation; Diversity factors; Patient's and thrapist's personal factors) - Ability to present assessment findings and make recommendations (Present assessment findings appropriately; Make recommendations that are sensitive to patient factors) - Knowlete of the DSM-IV (Differential diagnosis, knowledge of comorbidity, and awareness of the epidemiology and prevalence rates of mental disorders) - Understanding of legal and ethical responsibilities (Legal and ethical obligations related to confidentiality, test security, dissemination of data) |
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What are the assessment procedures?
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- Clinical interview and mental status exam
- Collateral information - appropriate releases of information are necessary to gather collateral information (Family members- spouse, siblings, children, parents, grandparents, especially family who are in regular contact with the patient; Mental health records/providers - prescribed psychotropic medications, use of illicit substancrs, past treatments, and hospitalizations, current and prior mental health providers; Medical records/providers; Legal records - when the patient has current legal problems or a history of past legal difficulties; Employers - when the referral comes from an employer or an EAP program; Teachers and persons involved with extracurricular activities - when evaluating a child.) - Psychological testing (More in-depth assessment of various areas of a person's functioning (e.g. intelligence, achievement, or personality)). |
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What is the purpose of the Clinical Interview versus the Mental Status Exam?
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- The clinical interview provides a comprehensive picture of a person, including his or her developmental history, background, relationships, as well as current functioning.
- The mental status exam (MSE) review the major systems of psychiatric functioning |
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What are the components of the Clinical Interview for Adults?
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- HIstory of presenting problem(Problem, onset, intensity and duration, antecedents and consequences, and previous treatments and attempts at solutions)
- Personal history (Childhood development, academic performance, work history, social history, intimate relationships, medical and psychiatric history (including substance use), and legal history) - Family nackground (Cultural/religious background, upbringing (including abuse and neglect), family constellation and relationships, parents' and siblings' history) - Current functioning (social relationships, family relationships, work/academic functioning, financial stability, spiritual involvement, and leisure activities) |
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What are the components of the Mental Status Exam?
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- Orientation and sensorium [level of consciousness] (Oriented to person, place and time; Level of consciousness can range from alert to drowsy, stuporous, or comatose)
- General appearance and behaviors (Brief physical description of the patient; Dress, posture, grooming, facial expressions, eye contact, speech, and interaction with the examiner) - Mood and affect ( Mood refers to the dominant emotions; Affect refers to the observable pattern of expressing feeling - range, intensity, lability, and appropriateness.) - Attention, concentration, and memory - Intellectual functioning (Assessed with the context of a client's ecucation, socioeconomic status, and cultural background; Vocabulary, general fund of knowledge, calculaation ability as well as ability to think abstractly) - Insight and judgment (Inight refers to the person's ability to introspect; Judgment looks at the choices and decisions as well as impulse control) - Thought content, process and perceptions ( Thought content refers to the themes that dominate and includes delusions as well as suicidal or homicidal ideation; Thought processes refer to the client's stream of thought, such as, logical and coherent, tangential, circumstantial; Perceptions reflect the intactness of the sensses, and presence of any illusions of hallucinations) |
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What are the components of the Clinical Interview with Children and Adolescents?
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- History from parents (chief complaint, history of present illness, current developmental status, past history, developmental history, parental history, and current family circumstance)
- Interview of child/adolescent - Family evaluation (Gathering data by direct observation and questions, gaining a better understanding of the family dynamics determining family members' views of the problem, establishing rapport, and making trial interventions.) |
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What are the components of the Mental Status Exam?
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- Orientation and sensorium [level of consciousness] (Oriented to person, place and time; Level of consciousness can range from alert to drowsy, stuporous, or comatose)
- General appearance and behaviors (Brief physical description of the patient; Dress, posture, grooming, facial expressions, eye contact, speech, and interaction with the examiner) - Mood and affect ( Mood refers to the dominant emotions; Affect refers to the observable pattern of expressing feeling - range, intensity, lability, and appropriateness.) - Attention, concentration, and memory - Intellectual functioning (Assessed with the context of a client's ecucation, socioeconomic status, and cultural background; Vocabulary, general fund of knowledge, calculaation ability as well as ability to think abstractly) - Insight and judgment (Inight refers to the person's ability to introspect; Judgment looks at the choices and decisions as well as impulse control) - Thought content, process and perceptions ( Thought content refers to the themes that dominate and includes delusions as well as suicidal or homicidal ideation; Thought processes refer to the client's stream of thought, such as, logical and coherent, tangential, circumstantial; Perceptions reflect the intactness of the sensses, and presence of any illusions of hallucinations) |
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What are basic issues in Psychological Testing?
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- Purpose of the instrument (Personality functioning, intelligence, achievement, neuropsychological status, symptoms, or specific aspects of functioning, such as depression)
- Type of test - objective or subjective (Based on the scoring procedures) - Method of assessment - direct or indirect (Self-report questionnaires, intelligence tests, and neuropsychological instruments involve direct assessment.) - Interpretation of scores (Norm-referenced versus criterion-referenced scores; Scoring and cutoffs for significance - interpret assessment data within the context of other clinical measures, the client's history, his or her current medical as well as psychological starus, and cultural considerarions; Standardization sample- to what extent the patient being asessed matches the normative sample, mismatches can occur with regard to race, age, SES, degree of acculturation, language, education, etc.; Reliability and validity) |
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What is the MMPI-2 and the Validity Scales?
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- The MMPI-2 consists of 13 standard scales; three relate to validity (L,F, and K) while 10 are clinical/personality indices (scale 1/HS through scale 0/Si)
- Validity Scales: * Scale L - high scores indicate a naiive or unsophisticated attempt to present oneself as virtuous or positive. * Scale F - infrequently endorsed items; high scores may suggest unconventional thinking and behavior, possible exaggeration, or significant distress or pathology. * Scale K - high scores indicate defensiveness |
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What are the MMPI Clinical Scales?
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- Scale 1 - Hypochondriasis (HS) - illness focus.
- Scale 2 - Depression (D) - Scale 3 - Hysteria (Hy) - physical complaints as well as a denial of emotional or interpersonal problems. - Scale 4 - Psychopathic Deviate (Pd) - indicates general level of social adjustment; problems with authority, commitments, and family. - Scale 5 - Masculinity-Femininity (MF) - Scale 6 - Paranoia (Pa) - Scale 7 - Psychasthenia (Pi) - fears, anxieties, compulsions, obsessions, and indecisiveness. Scale 8 - Schizophrenia (Sc) - alienation and misunderstanding, confusion and disorganization. Scale 9 - Hypomania (Ma) - overactivity, poor impulse control, excessive speech, flight of ideas, agitation. Scale 0 - Shy, unasserive, lack confidence. |
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What are some combibation of scales on the MMPI-2 to be familiar with?
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- Scale 1 & 3 = illness focused people
- Very high scale 4 or scale 4 & 9 = concern for harm to others - Scale 2 & 7 = best indicator for treatment. |
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Other testing Instruments
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- Millon Clinical Multiaxial Inventory (MCMI-III)- objective, self-report measure of personality.
- The Wechsler Adult Intelligence Scale (WAIS-III) - Appropriate for persons from 16 to 89 years of age. - The Wechsler Intelligence Scale for Children (WISC-IV) - measures intellectual ability and cognitive functioning in children from 6-0 to 16-11 years. - Achievement tests - Rorschach - Projective personality test designed to asses emotional, behavioral, interpersonal, perceptual, and cognitive aspects of the person's functioning. |
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What are the guidlines for Client feedback of testing?
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- Feedback should be relevant
- The evaluator should be open (Client's feedback and impressions about he test results are desired and should be solicited) - The focus should be on pain and distress rather than pathology - Feedback should include strenghts and weaknesses - Highlight consistencies and inconsistencies - Feedback should include the patient's diagnosis - Recommendations and referrals should be offered during feedback (positive benefits of medication; Need for treatment for substance abuse; Referral for social services such as financial or legal support; Referrals for vocational rehabilitation; Recommendations for inpatient or residential treatment; Community referrals; Culturally appropriate referrals; Referrals to support groups) - Address clinical concerns (abuse, suicide risk, violence risk) |
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What is the Epidemiology of Mental Illness?
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- Adults
* The 1 year Prevalence rate for mental disorders in adults is estimated to be between 20% to 25% * Prevalence rates are highest for Anxiety Disorders (about 16%) followed by Mood Disorders (about 7%) - Children and Adolescents * The annual prevalence rate is about 20% for mental disorders with at least mild functional impairment (GAF scores <70) * Prevalence rates are highest for Anxiety Disorders (13%), followed by Disruptive Disorders (about 10%), Mood Disorders (about 6%), and Substance Use Disorders (about 2%) - Older Adults * The annual prevalence of mental disorders among older adults (ages 55 and older) is estimated to be about 20% * Prevalence rates for Anxiety Disorder are about 11.5%. rates fpr Mood Disorders are about 4.5%, and about 6.6% of older adults have severe cognitive impairment such as Alzheimers Disease |
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What is the Multiaxial System for Diagnosis?
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- Axis I - includes Clinical Disorders and Other Conditions that may be a focus of clinical attention (e.g. V codes)
- Axis II - includes Personality Disorders and Mental Retardation (Borderline Intellectual Functioning is also coded Axis II) - Axis III - includes General Medical Conditions - Axis IV - describes psychosocial and environment problems that have occurred within the past year - Axis V - is a measure of Global Assessment of Funcitoning (GAF) ranging from 1-100. |
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Mental Retardation
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- The criteria for mental retardation are significantly subaverage intellectual functioning (IQ below 70), and concurrent deficits or impairments in adaptive functioning
* The prevalence rate of mental retardation is estimated at about 1% * Individuals with mental retardation have three to four times more comorbid mental disorders compared to the general population * Most commonly associated mental disorders include: ADHD, Mood Disorders, Pervasive Developmental Disorders, and Stereotypic Movement Disorders * The male-to-female ration is 1.5:1 |
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Learning Disorders
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- Diagnosed when the person's achievement on individually administered standardized tests is substantially below that expected, schooling and level of intelligence
* Prevalence of Learning Disorders range from 2% to 10% * Learning Disorders are diagnosed more commonly in males * Many persons with conduct disorder, ADHD, Oppositional Defiant Disorder, and Depressive Disorders also have Learning Disorders. |
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Autistic Disorder
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- Autistic Disorder is characterized by:
* impairment in social interaction * impairment in communication * a restricted repetoire of activities - Base rates, comorbidity data, and culture/age/gender features * about 75% of all children with autistic disorder are also diagnosed with mental retardation * Male to female ratio is abotu 4 or 5:1 |
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Asperger's Disorder
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- Aspergers's Disorder is characterized by:
* Impairment in social interaction * A restricted repertoire of activities * In Asperger's Disorder there are no language delays - Base rates, comorbitiy data, and culture/age/gender features * Males are diagnosed with Asperger's disorder at least five times more than females. |
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ADHD
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- ADHD involves a persistent pattern of inattention and/or hyperactivity-impulsivity in at least two settings
* The prevalence of ADHD is estimated to be between 3% - 7% in school age children * ADHD is six to nine times more common in males than females * Many children with ADHD have Concomintant Diagnoses of Oppositional Defiant Disorder or Conduct Disorder * Higher prevalence of Mood Disorders, Anxiety Disorders, and Learning Disorders in children with ADHD |
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Conduct Disorder
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- Conduct Disorder involves a repetitive and persistent pattern of behaviors in which the basic rights of others, and major age-appropriate societal norms or rules are violated
* The prevalence of Conduct Disorder ranges from 1% to 10% * Conduct Disorder is more common in males * Concomitant diagnoses may include ADHD, Learning Disorders, Mood Disorders, Anxiety Disorders and Substance-Related Disorders. |