clinical scales Flashcards
how many clinical scales are there? what are their names?
10
1 hypocondriasis; 2 depression; 3 hysteria; 4 psychopathic deviate; 5 masc fem; 6 paranoia; 7 psychastenia; 8 sz; 9 hypomania; 0 socil introversion
what can oyu say about the scales internal consistency?
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
what are the best ones? i.e. the more internally consistent? the worst?
1, 7, 8, 0
5 and 6
how do you explain the poor IC?
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.
what are you doing when your interpreting the clincial scales
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
regarding the clinical scales what are the cut off and corresponding decriptor?
very high >75 high 66-75 moderate 56-65 modal 41-55 low <41
high scores
65-70, anything above 65 you ought to look at
refer to the textbook!!!!! refer to the literature!!!!!!
low scores
limited research on low scores
not the opposite of high scores
refer to the textbook and literature
organizing the information
SPIT-D Symptoms Personality/Temperament Interpersonal fucntioning Treatment repsonse Demographics
Scale 1
Hs - hypochondriasis
Scale 1 intent
Identify individuals presenting with hypochondriasis
Scale 1 score threshold
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)
high 1 sx’s T >60
(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
high 1 sx’s T >80
somatic delusions more likely and bizarre complaints, esp if Scale 8 is elevated
high 1 personality/temp
Selfish, self-centered, narcisstic Pessimistic, defeatist, cynical Complainers Demanding and critical Indirect expression of hostility Unambitious, dull, lack enthusiasm Problems verbalizing needs
high 1 interpersonal functioning
Make others miserable
Demanding and critical of others
Express anger indirectly
high 1 tx and dx considerations
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
scale 1 common Dx’s - extreme high scorers? and moderately high scorere?
extreme high = conversion do
mod high = somatoform, pain, anx, or dep do’s
whats unique about this scale?
its seen as more homogenous than the other scale – most of items deal wth somatic omcplaints
scale 1 correlated most highly with
sclaes 2 and 3 (e.g. conversion v)
scale 2
D - depression
considered pretty heterogeneous
with classic sx of depression along with physical problems, problems controlling thoughts, anxiety and irritabilty/hostility
scale 2 intent
Assess symptoms of depression
Good index of dissatisfaction with own situation
scale 2 score thresholds
T > 70 indicative of depression
T 60-70 indicative of general uninvolvement and poor attitude
scale two demographic considerations
Age (elderly 5-10 pts higher in norms)
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
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
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
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
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)
3 - intent
Intent
Assess hysterical reactions to stress; psychogenic loss or disorder of function
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
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
3 - deomgraphic considerations
More common presentation in women than men
3 - personality/temperament
Frequently overwhelmed
Immature and self-centered
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
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
scale 4
psychopathic deviate
REALLY important to look at the content scales and the Harris Lingoes scale to aid interpretation
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
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
4 - demo considerations
Age (younger score higher)
Race (Caucasians and Asians lower than African Americans, Hispanics, and Native Americans)
4 - symptoms
Dishonesty
Sexually aggressive
Substance issues
Absence of emotional responses generally but may experience sadness, fear and worry
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
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
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
scale 6
paranoia
6 - intent
Identify individual exhibiting significant paranoid symptomatology
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
6 - High scorers symptoms
Disturbance in thinking Delusions Ideas of reference Mood lability Social withdrawal
6 - personality/temp
Excessive sensitivity Believe being treated unfairly, getting a raw deal Guarded and suspicious Argumentative and hostile Use projection as a defense
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
6 - interpseonsal
Difficulties developing relationships
Poor relationships with family
Blame others for difficulties
Moralistic and rigid
scale 7
psychasthenia
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
7 - score threshold
Graham or MMPI-2 Manual general thresholds appropriate
i.e. 65-70
7 - symptoms
Anxious, tense, agitated Apprehensive, high-strung, fearful, ruminative Obsessive thinking Compulsive rituals Poor self-esteem Low mood Poor concentration Physical complaints
7 - personalty/temp
Anxious tense and agitated Fearful and apprehensive Pessimistic OCPD traits Lack confidence, self-degrading Experience guilt and depression
7 - interpersonal
Shy, worried about social acceptance
7 - tx dx
Tend to receive Anxiety D/O dxs
Likely to engage in treatment
scale 8
schizophrenia
Higher scores could relate to estrangement and social alienation.
8 - intent
Identify patients with Schizophrenia
Heterogeneous group of d/o with mood, thinking and behavioral disturbances
8 - score threshold
T > 75 indicative of a psychotic disorder
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)
8 - symptoms
Delusions
Hallucinations
Schizoid lifestyle
Bizarre behavior, confusion, disorientation
Ambivalent or constricted emotional responses
SI or active turmoil
8 - peronality and temp
Secretive Aggressive Eccentric Apprehension, self-doubt, feel inferior Moody, stubborn, opinionated
8 - interpsersonal
Few or no friends
Alienation, isolation, seclusion
May withdraw into fantasy, daydreams under stress
Poor problem-solvers
8 - tx dx
May have long history of tx
Candidates for long term treatment
scale 9
hypomania
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
9 - score threshold
T > 80 suggestive of a manic episode
if see high 4 and high 9
more likely to see acting out behaviors (sex, drugs, and so on)
9 - demo considerations
Age (younger persons 50-60 range, elderly <50)
Ethnicity (minorities 5-10 points higher)
9 - symptoms
Classic manic symptoms
Overactivity, unrealistic self-appraisal
Episodes of irritability, hostility and aggressive outbursts
Underlying dissatisfaction
Poor inhibition of impulses
9 - personality/temp
Wide range of interests
Little interest in routine
Low frustration tolerance
9 - interpersonal
Relationships are superficial
Manipulative and deceptive
9 - tx dx
High likelihood for substance abuse
Poor prognosis in treatment
Poor attendance
scale 0
social isolation
0 - intent
Assess social withdrawal
0 - scorethershold
Graham and MMPI-2 manual general guidelines appropriate
Low scorers – sociable and extroverted
0 - symptoms
Poor self-esteem, insecure
Frequent guilt
Worry
0 - personltyi/temp
Introverted
Sensitive to the opinions of others
Indecisive
0 - interpersonal
Desire relationships but do not have many interests
Difficult to get to know
Passive, submissive in relationships
0 - tx dx
May be prone to episodes of depression
Uncomfortable in treatment
