week 2 - signs & symptoms of psychopathology Flashcards
Assessment: The Intake Interview
Objectives
Identify, evaluate & explore client’s presenting problems
Gather info related to interpersonal style & relevant personal history
Evaluate current life situation & functioning
Intake Interview Components
Basic Demographics
—Age, relationship status, —job/study, living circumstances
Presenting Problem/s
History of Presenting Problem/s
-Onset, course, precipitants
Previous History
- Psychological
- Medical
- Drug/alcohol
Intake Interview Components for each presenting problem:
Descriptions
-Physiology, emotions,
cognitions, behaviours
Frequency & duration
Severity & fluctuations
Cessation
Onset
Contexts (& exceptions)
Impact on functioning
-social, occupational,
recreational
Coping attempts & ability
…and why now? (Precipitating)
Clarifies specific precipitating factors
Tells you what is personally important/relevant for this client
May reflect underlying values
- This is not the person I want to be
- I don’t want to miss out on x
- Y is too important to me
Help to assess stages of change
- My girlfriend threatened to leave me
- I realise I have to actually do something…this won’t go away on its own
Taking a History: the Content
Personal History
- Prenatal/perinatal
- Early Childhood
- Middle Childhood
- Adolescence
- Adulthood:
- –Occupational
- –Relationship
- –Educational
- –Social
- –Forensic
Family History Developmental milestones Academic performance Managing transitions Making friends & fitting in Puberty& sexual development Seeing parents as flawed Deciding on career path Family history of psychopathology Family dynamics: past & current Family conflict How did family express/support emotions – who did you go to? Identity development
Other relevant info
Medical history
- Current/past illnesses
- Current medications
- Brain injuries/concussions
- Family medical history
- Lifestyle factors
Previous counselling/therapy
- When
- Who
- What worked
- What didn’t work
- Reasons for termination
Drug/alcohol use
- Age at onset
- Fluctuations in patterns
- Previous/current use
- Has it ever caused problems
- Have you ever wanted to cut -down, but couldn’t?
- Usage patterns of –family/friends
Under-reporting is common
Your approach may influence accuracy of report
Taking a History: The process
Where do you start: earliest or most recent?
Potentially tricky bits:
-I don’t really remember much of primary school
-There was something that happened, but I don’t really want to focus on it
-This is confidential, right?
-I’ve never told anyone this before…
-Unexpectedly “hot” topics
-I feel really bad talking about my father this way…he really did love me
How do you manage this?
Goals
What would you like to have happen?
What is important to you?
What would you like more of/less of?
What do you think would make a difference?
Assessment: Mental Status Exam
A ‘snapshot’ description of how the client/patient appears to the examiner in the intake interview
Routine part of clinical chart for hospital patients
Included in psychological reports
Components of MSE:(1) General Description
Appearance
- Body type
- Posture
- Clothes, hair, grooming
- Congruence with chronological age
- Other notable features, e.g. perspiration
- Eye contact
Behaviour & Psychomotor Activity
- Mannerisms, tics
- Hyperactivity
- Restlessness
- Psychomotor retardation
- Fidgeting
- Agitation
Attitude toward Examiner
- Hostile
- Guarded/suspicious
- Cooperative
- Friendly
Components of MSE:(2) Mood & Affect
MOOD (Subjective)
Depressed Anhedonic (cannot experience pleasure)
Irritable
Euthymic
Euphoric
Anxious
Alexithymic (unable to identify mood)
Appropriateness of Affect
Congruence of mood & affect
Components of MSE:(2) Mood & Affect
AFFECT
observable affect from examiner’s perspective
Observable Affect (from examiner’s perspective)
Range & Amount:
- constricted
- blunted
- flat
- Normal
Components of MSE:(3) Speech
Quantity Rate of Production Clarity Prosody (tune & rhythm) Volume Spontaneity Pressure
Components of MSE:4) Perceptual Disturbances
Nil
Hallucinations : auditory, visual, olfactory, etc
Depersonalisation
Formication: insects crawling over/under skin
Components of MSE:(5) Thought Form
Overabundance or poverty of ideas
Flight of ideas (continuous flow)
Tangentiality
Circumstantiality (delay in getting to the point)
Perseveration
Loose Associations : series of ideas with loose or unrelated logical connections
Thought Blocking
Neologisms: use of words only the person understands
