clinical scales Flashcards

1
Q

how many clinical scales are there? what are their names?

A

10
1 hypocondriasis; 2 depression; 3 hysteria; 4 psychopathic deviate; 5 masc fem; 6 paranoia; 7 psychastenia; 8 sz; 9 hypomania; 0 socil introversion

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2
Q

what can oyu say about the scales internal consistency?

A

not great; coeff alpha ranges from like .3-.8’s – for clinical settings you wanna see .9 and for research we’ll deal with .7 or .8

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3
Q

what are the best ones? i.e. the more internally consistent? the worst?

A

1, 7, 8, 0

5 and 6

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4
Q

how do you explain the poor IC?

A

Heterogeneity of item content
Lack of a theoretical underlying construct
High scale scores reflect different endorsement patterns
-Harris-Lingoes scales help sort this out
-Further breakdown the clinical scales in to more discrete components.

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5
Q

what are you doing when your interpreting the clincial scales

A

developing and testin hypotheses
making inferences about “extratest” characteristics
Symptoms
Personality traits
Diagnosis
Response to Treatment
Research shows the clinical scales correlate with these characteristics

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6
Q

regarding the clinical scales what are the cut off and corresponding decriptor?

A
very high >75
high 66-75
moderate 56-65
modal 41-55
low <41
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7
Q

high scores

A

65-70, anything above 65 you ought to look at

refer to the textbook!!!!! refer to the literature!!!!!!

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8
Q

low scores

A

limited research on low scores
not the opposite of high scores
refer to the textbook and literature

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9
Q

organizing the information

A
SPIT-D
Symptoms
Personality/Temperament
Interpersonal fucntioning
Treatment repsonse
Demographics
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10
Q

Scale 1

A

Hs - hypochondriasis

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11
Q

Scale 1 intent

A

Identify individuals presenting with hypochondriasis

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12
Q

Scale 1 score threshold

A

T > 60 consider interpreting (unless medical setting)
T > 80 = Extremely High
T > 60 –psychiatric and non-psychiatric pts have distinct personality characteristics
T = 60-typical of individuals with real physical problems
Elderly likely to score higher than normal populations (i.e. > 50)

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13
Q

high 1 sx’s T >60

A

(T > 60)
Non-specific but excessive body concerns
Chronic weakness, lack of energy, fatigue and sleep problems
Actual physical symptoms will exist and often a stress response
Chronic pain pts usually elevated on 1&3

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14
Q

high 1 sx’s T >80

A

somatic delusions more likely and bizarre complaints, esp if Scale 8 is elevated

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15
Q

high 1 personality/temp

A
Selfish, self-centered, narcisstic
Pessimistic, defeatist, cynical
Complainers
Demanding and critical
Indirect expression of hostility
Unambitious, dull, lack enthusiasm
Problems verbalizing needs
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16
Q

high 1 interpersonal functioning

A

Make others miserable
Demanding and critical of others
Express anger indirectly

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17
Q

high 1 tx and dx considerations

A

Major incapacitation not evident
Reduced efficiency in functioning over extended period
Lack insight and see themselves as medically ill
Poor candidates for psychotherapy-likely to terminate and reject psychological explanations and interventions
Criticize therapist as they do everyone else

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18
Q

scale 1 common Dx’s - extreme high scorers? and moderately high scorere?

A

extreme high = conversion do

mod high = somatoform, pain, anx, or dep do’s

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19
Q

whats unique about this scale?

A

its seen as more homogenous than the other scale – most of items deal wth somatic omcplaints

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20
Q

scale 1 correlated most highly with

A

sclaes 2 and 3 (e.g. conversion v)

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21
Q

scale 2

A

D - depression
considered pretty heterogeneous
with classic sx of depression along with physical problems, problems controlling thoughts, anxiety and irritabilty/hostility

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22
Q

scale 2 intent

A

Assess symptoms of depression

Good index of dissatisfaction with own situation

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23
Q

scale 2 score thresholds

A

T > 70 indicative of depression

T 60-70 indicative of general uninvolvement and poor attitude

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24
Q

scale two demographic considerations

A

Age (elderly 5-10 pts higher in norms)

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25
High Scorer Symptoms (T > 70)
``` Depressed or dysphoric mood Hopelessness around dealing with problems SI common w/ attempts more likely Sxs comprising depressive syndrome Irritable Frequent worry ```
26
2 - Personality Characteristics/ Temperament
Insecure Lack motivation to achieve Unable to function in a many settings/give up easily Over-controlled with regards to impulse control Might wanna look at scale 9 to check out the impulse control hypothesis
27
2 - Interpersonal Relationships/Behaviors
Often lack involvement in intimate relationships Maintain distance from people Feel uncared for and are hurt easily Acquiesce to avoid confrontation Conventional, lack creativity in problem-solving
28
2 - Tx-Dx Implications
Distress level drives to therapy; likely motivated for tx Depression interferes with active engagement Moderate relief of symptoms can prompt premature termination Most common diagnosis = Depression
29
Scale 3
Scale 3 –Hy Interpretation High correlation with scale 1. Question focus on endorsement of physical ailments and denial of psychological issues 1 & 3 = conversion V (extrememly careful about this diagnosis)
30
3 - intent
Intent | Assess hysterical reactions to stress; psychogenic loss or disorder of function
31
3 - score thershold
T > 80 may be indicative of classic hysteria T 70-80 common among chronic pain patients T 60-70 characteristics common to classic hysteria T = 60 common among medical patients w/o psychological component Its probably even higher than that
32
3 - High Scorer Symptoms (T > 80)
Overwhelmed by stress and react by developing physical symptoms Diffuse physical symptoms inconsistent with a known illness Mild sadness or anxiety Lack of energy Sleep problems Absence of experience of emotional distress/turmoil
33
3 - deomgraphic considerations
More common presentation in women than men
34
3 - personality/temperament
Frequently overwhelmed | Immature and self-centered
35
3 - interpersonal reltaionships
Need attention and can be manipulative to this end Indirect expression of anger when needs not met More social than most patients but relationships are superficial
36
3 - tx and dx
Development and alleviation correlated with stress Lack insight into origins of physical problems, motivation and feelings Desire for attention drives initial treatment seeking but psychotherapy incompatible with perceived problems Willing to talk about problems but not in context of physical ailments Addressing underlying issues may prompt termination
37
scale 4
psychopathic deviate | REALLY important to look at the content scales and the Harris Lingoes scale to aid interpretation
38
4 - intent
Diagnose individuals with “psychopathic personality, asocial or amoral type” Correlates moderately with scales 7 and 8 No major criminal types were included in original criterion group Can be conceptualized as a measure of rebelliousness
39
4 - score thershold
T > 75 = Extremely High; difficulty incorporating values and standards of society; cheating, stealing, sexual acting out, substance abuse Moderately high express rebellion in more socially accepted manner
40
4 - demo considerations
Age (younger score higher) | Race (Caucasians and Asians lower than African Americans, Hispanics, and Native Americans)
41
4 - symptoms
Dishonesty Sexually aggressive Substance issues Absence of emotional responses generally but may experience sadness, fear and worry
42
4 - personality/temp
``` Underachieve Rebellious towards authority Poor judgment and risk-takers Impatient and impulsive Immature Self-centered and use others for their own gain Do not perspective take Extroverted and outgoing May feel empty, bored and depressed ```
43
4 - interpersonal
``` Poor family relationships Disrespecting of authority and authority figures Shallow and superficial relationships Marital problems are common Do not learn from experience and poor means end thinking Initially likable Hostile and antagonistic Aggressive Manipulative ```
44
4 - tx dx
Common dx antisocial or passive aggressive personality disorder Typically agree to treatment to avoid a different consequence Poor engagement and little responsibility taking If there is an option, unlikely they will persist in treatment
45
scale 6
paranoia
46
6 - intent
Identify individual exhibiting significant paranoid symptomatology
47
6 - score threshold
T > 70 – may indicate notable psychotic experience T > 65 – does not mean clear psychotic sxs endorsed T 60-70 – psychotic sxs not that common Uncommon ways of thinking maybe, or maybe soe more of a personality feature
48
6 - High scorers symptoms
``` Disturbance in thinking Delusions Ideas of reference Mood lability Social withdrawal ```
49
6 - personality/temp
``` Excessive sensitivity Believe being treated unfairly, getting a raw deal Guarded and suspicious Argumentative and hostile Use projection as a defense ```
50
6 - tx dx
Dx of Schizophrenia or paranoid d/o most common in psychiatric patients Unlikely to meaningfully engage in therapy Previous hospitalization is common
51
6 - interpseonsal
Difficulties developing relationships Poor relationships with family Blame others for difficulties Moralistic and rigid
52
scale 7
psychasthenia
53
7 - intent
Measure of the construct as it existed at the time Presently most closely related to OCD Items deal w/ compulsions, obsessions, unreasonable fears and excessive doubt Reliable index of psychological turmoil and discomfort
54
7 - score threshold
Graham or MMPI-2 Manual general thresholds appropriate | i.e. 65-70
55
7 - symptoms
``` Anxious, tense, agitated Apprehensive, high-strung, fearful, ruminative Obsessive thinking Compulsive rituals Poor self-esteem Low mood Poor concentration Physical complaints ```
56
7 - personalty/temp
``` Anxious tense and agitated Fearful and apprehensive Pessimistic OCPD traits Lack confidence, self-degrading Experience guilt and depression ```
57
7 - interpersonal
Shy, worried about social acceptance
58
7 - tx dx
Tend to receive Anxiety D/O dxs | Likely to engage in treatment
59
scale 8
schizophrenia Higher scores could relate to estrangement and social alienation.
60
8 - intent
Identify patients with Schizophrenia | Heterogeneous group of d/o with mood, thinking and behavioral disturbances
61
8 - score threshold
T > 75 indicative of a psychotic disorder
62
8 - demo considerations
Race (African Americans, Native Americans, Hispanics all higher than Caucasians) Age (college students score slightly higher) Medication and medical disorders can impact score (brain injury, epilepsy, stroke)
63
8 - symptoms
Delusions Hallucinations Schizoid lifestyle Bizarre behavior, confusion, disorientation Ambivalent or constricted emotional responses SI or active turmoil
64
8 - peronality and temp
``` Secretive Aggressive Eccentric Apprehension, self-doubt, feel inferior Moody, stubborn, opinionated ```
65
8 - interpsersonal
Few or no friends Alienation, isolation, seclusion May withdraw into fantasy, daydreams under stress Poor problem-solvers
66
8 - tx dx
May have long history of tx | Candidates for long term treatment
67
scale 9
hypomania
68
9 - intent
Identify hypomania in patients Some directly inquire about manic symptoms Also assess family relationships, attitude and moral values, physical or bodily concerns Can be viewed as a measure of psychological or physical energy; high scorers may act out other traits indicated by MMPI
69
9 - score threshold
T > 80 suggestive of a manic episode
70
if see high 4 and high 9
more likely to see acting out behaviors (sex, drugs, and so on)
71
9 - demo considerations
Age (younger persons 50-60 range, elderly <50) | Ethnicity (minorities 5-10 points higher)
72
9 - symptoms
Classic manic symptoms Overactivity, unrealistic self-appraisal Episodes of irritability, hostility and aggressive outbursts Underlying dissatisfaction Poor inhibition of impulses
73
9 - personality/temp
Wide range of interests Little interest in routine Low frustration tolerance
74
9 - interpersonal
Relationships are superficial | Manipulative and deceptive
75
9 - tx dx
High likelihood for substance abuse Poor prognosis in treatment Poor attendance
76
scale 0
social isolation
77
0 - intent
Assess social withdrawal
78
0 - scorethershold
Graham and MMPI-2 manual general guidelines appropriate | Low scorers – sociable and extroverted
79
0 - symptoms
Poor self-esteem, insecure Frequent guilt Worry
80
0 - personltyi/temp
Introverted Sensitive to the opinions of others Indecisive
81
0 - interpersonal
Desire relationships but do not have many interests Difficult to get to know Passive, submissive in relationships
82
0 - tx dx
May be prone to episodes of depression | Uncomfortable in treatment