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21 Cards in this Set

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What are knowledge and skills of assessment and evaluation?
- 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)
What are the assessment procedures?
- 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)).
What is the purpose of the Clinical Interview versus the Mental Status Exam?
- 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
What are the components of the Clinical Interview for Adults?
- 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)
What are the components of the Mental Status Exam?
- 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)
What are the components of the Clinical Interview with Children and Adolescents?
- 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.)
What are the components of the Mental Status Exam?
- 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)
What are basic issues in Psychological Testing?
- 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)
What is the MMPI-2 and the Validity Scales?
- 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
What are the MMPI Clinical Scales?
- 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.
What are some combibation of scales on the MMPI-2 to be familiar with?
- 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.
Other testing Instruments
- 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.
What are the guidlines for Client feedback of testing?
- 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)
What is the Epidemiology of Mental Illness?
- 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
What is the Multiaxial System for Diagnosis?
- 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.
Mental Retardation
- 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
Learning Disorders
- 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.
Autistic Disorder
- 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
Asperger's Disorder
- 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.
ADHD
- 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
Conduct Disorder
- 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.