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Individual Differences > Week 4 Clinical Assessments- Methods and Purpose > Flashcards

Week 4 Clinical Assessments- Methods and Purpose Flashcards

1
Q

Purpose of a clinical interview

A
  • Mental status examination
  • Diagnosis
  • Risk assessment
  • Formulation
  • Understand client’s goals for assessment or therapy
  • Understand process issues that might guide the course of therapy
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2
Q

Things that influence a treatment plan

A
  • Diagnosis
  • Formulation
  • Risk assessment
  • Demographics
  • Evidence base
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3
Q

Three phases of a semi structured clinical interview: Opening

A

o Warm up and rapport building

o Assess the suffering, emphasise

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4
Q

Three phases of a semi structured clinical interview: Middle

A

o History, mental status, assessment, determine client’s level of insight

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5
Q

Three phases of a semi structured clinical interview: End

A

o Summarise conclusions

o Focus on goals and hope for the future

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6
Q

Areas covered by a clinical interview

A
  • Ask about presenting problem (what brings them in today)
  • Explore current psychological functioning and symptom formation (identify diagnoses and differential diagnoses)
  • Mental status examination throughout interview
  • Risk assessment
  • Personal history, including critical developmental incidents, as well as family, education, medical, psychiatric and social histories – looking for psychological mechanisms as well as events
  • Current social systems
  • Strengths, competencies and abilities
  • Client’s goals for assessment or therapy
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7
Q

Mental Status Examination (MSE): A structured summary of your own observation of the client

A
  • Appearance
  • Behaviour
  • Thought form
  • Thought content
  • Perception
  • Affect/mood
  • Orientation
  • Judgement
  • Insight
  • Intelligence
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8
Q

Mental Status Examination (MSE): Appearance and behaviour

A
  • Dress
  • Self-care
  • Eye contact
  • Motor activity
    o Agitation
    o Retardation
  • Movements
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9
Q

Mental Status Examination (MSE):Mood and affect

A
  • Cues: behaviour, appearance, facial expression, expression, presentation
  • Mood: sustained internal feeling – tone
    o Range: depressed – to eurhythmic – to elevated
  • Affect refers to characteristics communicated during the interview – the interpersonal dimension in the here and now
    o E.g. of descriptors: flat, blunted or labile
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10
Q

Mental Status Examination (MSE): Thought

A
  • Content
    o Unusual content
    o Overvalued ideas
    o Delusions
  • Form
    o Rate, responsivity and spontaneity
    o Coherence – use of standard grammatical forms and sentence structure
    o Capacity to sustain train of thought
    o Circumstantiality (when answering a question, goes around in circles before actually answering it)
    o tangentiality (goes on tangents)
    o Flight of ideas (whole lot of thoughts popping into the head really quickly, totally unrelated)
    o Thought block (no thoughts coming through)
    o Word salad (random words being generated)
    o Unusual word usage – neologisms (coming up with made up words)
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11
Q

Mental Status Examination (MSE): Perception

A
  • Sensory distortions and illusions (not quite hallucination, temporary, often when someone wakes up)
  • Hallucinations
    o Hearing
    o Vision (implications)
    o Smell, taste and touch
  • Other abnormal perceptions
  • Depersonalisation and derealisation (associated with trauma. Feelings associated with the world not being real, depersonalisation is feeling that they are not real)
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12
Q

Mental Status Examination (MSE): Cognition

A
  • Orientation to time, place and person
  • Attention and concentration
    o Distraction due to intrusive thoughts
    o Impaired reasoning
    o Impaired concentration
  • Memory and whether a good historian
  • Capacity for abstraction and reasoning
  • Current functioning in relation to previous functioning
  • Tools – MMSE, proverbs, serial 7s
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13
Q

Mental Status Examination (MSE): Insight

A
  • Understanding and attitudes
    o Towards the problem
    o Towards the consequences and limitations imposed by the problem/disorder
    o Towards any help offered
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14
Q

Mental Status Examination (MSE): Suicide Risk Assessment

A 
-	Risk factors e.g.
o	Ideation, plans, intent to act, means
o	Acute stress
o	Depression
o	Impulse control problems
o	Humiliation/embarrassment
o	Hopelessness
o	Use of substances
o	Previous models of self-harm
-	Protective factors
o	Beliefs (e.g. moral or religious)
o	Family (e.g. children)
o	Social support
o	Upcoming positive experiences to look forward to
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15
Q

MSE: The purpose of diagnosis

A
  • Description of levels of psychopathology
  • Communication
  • Guide treatment
  • Inform prognosis
  • Guides research
  • Identifying capacity of someone to stand trial
  • Cognitive or functional impairment
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16
Q

MSE: Key questions for diagnosis

A
  • What are the primary symptoms
  • What is the approximate duration of the disorder
  • How severe are the symptoms
  • Has a specific cause of precipitant for the symptoms been identified
  • Are there differential diagnoses
17
Q

MSE: What is a mental disorder?

A
  • Normative/statistical
  • Impaired functioning/adaptability
  • Distress
    A significant behaviour that occurs in an individual that is associated with distress or disability, or an increased risk for suffering death, pain, disability, or an important loss of freedom. This syndrome must not be due to a culturally sanctioned response
18
Q

Categorical vs. Dimensional: - Categorical e.g. DSM

A

o Presence/absence of a disorder

• Either you are anxious or you are not anxious

19
Q

Categorical vs. Dimensional: Dimensional

A

o Rank on a continuous quantitative dimension
• How anxious are you on a scale of 1 to 10
- Dimensional systems may better capture an individual’s functioning but the categorical approach has advantages for research and understanding

20
Q

Reliability and Validity

A
  • Reliability refers to the consistency of measurements, including diagnostic decisions
  • Inter-rater reliability
  • Validity refers to whether or not accurate statements and predictions can be made from knowledge of membership class
21
Q

The importance of reliability and validity: Rosenhan’s Experiment

A

Mental hospital experiment to determine validity of mental hospitals
“it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals”

22
Q

Formulation

A
  • A diagnosis describes and a formulation explains
  • Integrates diagnostic and non-diagnostic clinical information from history
  • Provides a basis for a treatment plan
  • Based on a theoretical framework
  • Identify critical events in a person’s life and link these to the presenting problems by key psychological mechanisms
  • Balance between comprehensive and parsimonious
23
Q

7 P’s

A
  1. Presentation – current expression of problem
  2. Pattern of behaviour
  3. Predisposition – pre-morbid events that have lead to the presentation
  4. Precipitation – triggers for current presentation
  5. Perpetuation – maintaining factors of problems
  6. Potentials – client/family/system strengths
  7. Prognosis
24
Q

Example of 7 P’s (only 3)

A

• Predisposing
– Relationship A à modelling of catastrophic cognitions
– Relationship B à modelling of avoidant behaviour
– Event A à behaviour A à -ve reinforcement of avoidant behaviour
• Precipitating
– Trigger event à catastrophic cognitions
• Perpetuation
– Catastrophic cognitions and low self-efficacy à avoidant behaviour
– Avoidant behaviour à -ve reinforcement, fails to challenge catastrophic cognitions and self-efficacy
– Avoidant behaviour à relationship problems à low self-worth à low self-efficacy

25
Q

Methods of clinical assessment

A
  • Clinical interview
  • Personality inventories
  • Questionnaires
    o E.g. BDI-II STAI, STAXI-II
  • Corroborative reports
    o Eg spouse, parents, doctors
  • Self report
    o Eg subjective unit of distress (SUDS)
  • Self monitoring forms
    o Eg ABC forms
  • Observation
    o Eg school visit
  • Process and outcome questionnaires

Individual Differences (11 decks)

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