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Honours Exam > Clin Psych > Flashcards

Clin Psych Flashcards

1
Q

List some strategies for engaging Indigenous Youth

7 listed

A
  1. Location
  2. Side-by-side
  3. Intro: geneology + cultural mapping
  4. Acknowledge differences + invite comment
  5. Avoid disease model (‘not well in self’ instead of ‘anxious’)
  6. Attend to non-verbal expression
  7. Engage at cultural level
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2
Q

Name two semi-structured interviews that could be used for SAD and MDD in Children. Include references.

Are these validated?

A
  1. DIAMOND-KID (Tolin et al., 2023)
    Diagnostic Interview for Anxiety, Mood, and Obsessive Compulsive and Related Neuropsychiatric Disorders: Child and Adolescent Version
  2. Kid-SCID-1 (First et al., 1996)
    Structured interview for the DSM-IV Axis 1 disorder: Child version

Neither has been validated. Seek consultation/supervision to determine if questioning appropriate. Use caution and other validated questionnaires

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3
Q

What are the elements of informed cultural consent

(Westermann, 2010)

A
  1. Disclosure sacrosanct info = distress. Must be negotiated/patient led/seek consultation
  2. Avoid question/intervention around traditional lore
  3. Appropriate language
  4. Consider gender/culture differences
  5. Absolute transparency about possible disclosures (who/what etc.)
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4
Q

Name two questionnaire’s that could be used for MDD + SAD in Indigenous Adults. Provide references and information on validity in this group.

Note, there is only one for SAD.

A
  1. WASC-A (Westermann, 2003)
    Validated + clinician guidelines for interpreting
  2. APH-Q9 (Brown et al., 2013)
    Adapted Patient Health Questionnaire (Depression scale)
    Validated in one group. Unsure if generalises.
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5
Q

What does Strong Souls questionnaire measure?

There are 5

A
  1. Depression
  2. Anxiety
  3. Suicide
  4. SEWB
  5. Resiliance
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6
Q

What are the core CBT treatment categories for SAD. Give an example of each

There are 5

A
  1. Psychoeducation (normalise anxiety, discuss formulation/maintaining factors, and rationale/plan)
  2. Cognitive strategies: select situation, identify 2 automatic thoughts (look for errors)
  3. Exposure therapy: graded, in-session habituation
  4. Behavioural experiments: video-feedback phone call + behavioural strategies (social skills training)
  5. Physical relaxation techniques: prog muscle relaxation
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7
Q

Name one issue that may arise regarding the wording of the DIAMOND semi-structured interview

A

Questions use language referring to specific diagnostic symptoms (i.e., anxiety/depression) which is not appropriate language to use in initial assessment sessions with Aboriginal youth (Westermann, 2010)

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8
Q

What are screeners useful for?

What is the relationship between screeners and diagnostic criteria?

A
  • Early detection/indicate need for further assessment
  • Brief/simple so helpful for tracking progress
  • do not necessarily correlated with DSM - usually measuring severity rather than whether criteria are satisfied
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9
Q

Name two questionnaire’s that could be used for MDD + SAD in Indigenous Youth. Provide references and information on validity in this group.

A
  1. WASC-Y (Westermann, 2003)
    Westermann Aboriginal Symptom Checklist for Youth
    * validated + clinician guidelines for interpretation included
  2. Strong Souls (Thomas et al., 2010)
    * Good discriminative validity (shorter than WASC-Y)
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10
Q

What are non-diagnostic clinical features often associated with SAD

A
  • Fear of neg eval
  • Safety behaviours
  • Believe others see them as inept
  • Hypersensitivity to criticism
  • Low self-esteem
  • Lack intimate relationships
  • Live at home longer
  • Self-medication (drink before going out)
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11
Q

Describe cultural treatment for unresolved sorry time

A

Returning home to pay respect
Possibly sending representatives

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12
Q

List four key ways information is collected during assessment?

A
  1. Clin interviews (semi-structured)
  2. Questionnaire’s
  3. Observations (MSE)
  4. Neuropsych tests
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13
Q

Name two semi-structured interviews that could be used for SAD and MDD in Adults. Include references.

Which one of these measures has been validated for use with Indigenous people? What is the caveat here? How would you use these assessments?

A
  1. DIAMOND (Tolin et al., 2023)
    Diagnostic Interview for Anxiety, Mood, and Obsessive Compulsive and Related Neuropsychiatric Disorders
  2. SCID-1 (First et al., 1996; Toombs et al., 2019)
    Structured interview for the DSM-IV Axis 1 disorder

SCID-1 validated when conducted by culturally competent clinician. In both cases, consultation should be sought regarding phrasing of questions and interpretation of responses. Report findings qualitatively and identify bias throughout assessment.

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14
Q

Describe symptoms of wrong way relationships

A

Depression, suicidal ideation

Identity confusion and poor MH

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15
Q

Being ‘sung’ symptoms

A

depression
blindness
sadness
somatic complaints
spiritual visits

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16
Q

What are the 5 DSM criteria for SAD

A
  1. Fear social situations with potential scrutiny
  2. Fear of behaving in ways that show symptoms/lead to negative evaluation
  3. Situations always provokes anxiety
  4. Avoidance of situations
  5. Fear is out of proportion to threat in socio-cultural context
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17
Q

What does the WASC measure
(both Youth and Adult version)

There are 6

A
  1. Depression
  2. Suicide
  3. AOD
  4. Impulsivity
  5. Anxiety
  6. Cultural Resiliance
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18
Q

What are the nine DSM criteria for MDD

A
  1. Depressed mood (most days - or irritable in adolescents)
  2. Anhedonia
  3. Appetite
  4. Sleep
  5. Psychomotor
  6. Fatigue
  7. Concentration
  8. Guilt
  9. Suicidal ideation
19
Q

What are non-diagnostic clinical features associated with MDD

A
  • Social isolation
  • Anger
  • Crying
  • Complaints about pain
  • Rumination
  • Maladaptive coping (i.e., AOD)
  • Anxiety, phobias, worry
  • Gastrointestinal symptoms
20
Q

4 Domains Westermann

What are the key elements set out in the ‘Practitioner’ quadrant of culturally competent assessment

A
  1. Min standard cultural competency
  2. Bias/prejudice
  3. Adress differences in gender/culture. Mitigate through:
    * Location
    * Consultation
    * Awareness of variation/alt intrepretations
  4. Informed cultural consent
21
Q

For Indigenous clients, four treatment pathways include:

A
  1. Cultural solution
  2. Mainstream
  3. Both
  4. Mainstream adapted to treat cultural illness
22
Q

Describe considerations for treatment re ‘being sung’

A

Requires cultural treatment.
Depends on heirarchy.
Lore men who have been sung can only be treated by other lore men.
Appropriate consultation is crucial.

23
Q

What are the core CBT treatment categories for MDD. Give an example of each

A
  1. Psychoeducation (normalise, discuss formulation, and rationale)
  2. Behavioural strategies: i.e., behavioural activation (graded tasks to increase activity/high reward activity)
  3. Cognitive strategies: example - thought diary to identify/challenge unhelpful cognitions
24
Q

Name DSM differential diagnoses of MDD

A
  1. PDD
  2. Adjustment disorder
  3. Bereavement
  4. Bipolar
  5. Manic episode w irritable mood
  6. Disruptive mood dysregulation disorder
  7. MDE on schizophrenia spectrum disorders
  8. Schizoaffective disorder
  9. ADHD
25
Q

What are the key components of psychoeducation

A
  • Normalising
  • Explaining why symptoms are happening
  • Review formulation and maintaining factors
  • Provide rational for treatment
  • Set expectations
26
Q

(General western assessment)

List info to collect/ask about during assessment

There are

A
  • Presenting problems/symptoms
  • Recent salient event
  • Onset/course
  • Historical, Social, Enviro factors
  • Maintaining factors
  • Consequences of behaviours/symptoms
  • Beliefs, personality, values
  • Protective
  • Treatment goals
  • Cultural factors
27
Q

What are the key elements set out in the ‘Client connection to culture’ quadrant of culturally competent assessment.

In other words, what to consider when assessing whether symptoms are cultural at the individual level?

There are 7

A
  1. Assess status (heirarchy/cultural mapping)
  2. Assess normal/differential functioning (culture specific?)
  3. MSE - eye contact, time
  4. Assess beliefs: Acculturation scale - ASAA-Y (2003)
  5. Symptoms (i.e., visits seperate entity? manifestations spiritual/physical/mental?)
  6. Client perception of cause
  7. Client perception of treatment needed
28
Q

Describe cultural treatments for pathological grief

A

Facilitate returning to country
or bringing part of spirit to them

29
Q

What things should be considered in diagnosis when working with Indigenous clients?

A
  1. Cultural bound syndromes
  2. Whether symptoms are present in cultural contexts as well as mainstream (clinical spaces may cause distress and lead to misdiagnosis)
  3. Symptom variation in clinical conditions across cultures
  4. External attribution of symptoms + holistic SEWB
  5. If culture-related, is presentation within cultural norms and severity range?
30
Q

What is the benefit of observation in asssessment. List 5 + 1 specific to Indigenous clients

A
  1. Helpful when clients lack insight
  2. When clients lack language to explain problem
  3. When we receive discrepant information
  4. To assess antecedants/consequences of presenting problem
  5. To assess nervous system responses
  6. Symptoms can be physical/psychomatic and information may be communicated non-verbally
31
Q

What four things need to be considered when engaging a consultant

A
  1. Correct gender, and level
  2. Avoidance relationships
  3. Patients should nominate
  4. Community validate choice
32
Q

What are the 5 Ps

A
  1. Presenting
  2. Predisposing
  3. Precipitating
  4. Perpetuating
  5. Protective
33
Q

spiritual visits treatment

A

Treatment goal not to stop, but to reduce distress. Piece of hair comforting in some communities - consult needed

34
Q

Name DSM differential diagnoses of SAD

There are 9

A
  1. Agoraphobia
  2. Panic Disorder
  3. GAD
  4. Specific phobia
  5. MDD
  6. Delusion disorder
  7. ASD
  8. Personality disorder
  9. Body dysmporphic disorder
35
Q

What are the 4 domains of culturally competent assessment outlined by Westermann (2021)

A
  1. Competent Practitioner
  2. Client Connection to culture
  3. Cultural variance in context
  4. Community validation of client beliefs
36
Q

Longing for country symptoms

A
  • Depression
  • weakness/nausea
  • spiritual ill health
  • identity confusion
37
Q

Considerations for culturally informed assessment (re tools)

There are 5

A
  1. validated/low inference tests
  2. Modifying (triangulate)
  3. Qualitative interpretation
  4. Acknowledge bias
  5. Appropriate questioning - open ended story
  6. Recognise + incorporate strengths
38
Q

Explain behavioural strategies in MDD

A
  1. skills training: assertive communication
  2. Graded task assignment (breaking tasks down into small steps)
  3. Behavioural activation: activity monitoring/scheduling
    a. increase more generally
    b. increase high reward - improve balance of mastery + pleasure
39
Q

List one neuropsychological testing tool that could be used with Indigenous clients - describe what it is

A

Cogstate Assessment Battery

Non-verbal computer cog function test. Cards and game-like stimuli, intuitive and intrinsically motivating

40
Q

What needs to be validated when assessing cultural symptoms in context/community?

A
  1. Client perceptions match community knowledge about:
    * onset/etiology
    * language used to describe
    * how it manifests
    * validating client’s position in community
  2. whether community sees behaviour as normal?
  3. Whether severity of problem reflects cultural norms?
  4. Elders/lore men may have role in assessing/treating
41
Q

Differentiate spiritual visits from psychosis

A
  • In lore men often not associated with distress
  • For many, they bring comfort
  • Seperation from self and entity
  • Content of hallucination/delusion only related to specific cultural factors (i.e., relative)
42
Q

Describe absence from sorry time and associated symptoms. Plus possible intervention

A
  • coming into ‘bad luck’
  • distress that is increasing in intensity
  • Catatonic and clinical forms of depression
  • Spiritual visits that are troubling/distressing

Returning home to pay respect (sometimes sending representative)

43
Q

What are the 7 SEWB factors

A
  1. Body
  2. Mind/emotion
  3. Family/kinship
  4. Community
  5. Spirituality/ancestors
  6. Country
  7. Culture

Honours Exam (9 decks)

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