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PSYC3020 > Wk 12 - Clinical Assessment > Flashcards

Wk 12 - Clinical Assessment Flashcards

1
Q

What are three key areas of clinical psych?

A

Psych assessment of diagnosis
Treatment
Research

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2
Q

What is clinical assessment? (x1)

It provides info that is crucial for… (x4)

A 
The process by which clinicians gather info on their clients
Diagnosis
Formulation
Treatment planning
Predicting course of a mental disorder
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3
Q

What to tasks make up the beginning of the clinical assessment process?
Which are designed to assess functioning across which three dimensions?
And clinicians should also consider the … (x1)

A

Clinical intake interview
Mental Status Examination
Emotional, behavioural, cognitive
Bio-psycho-social model

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4
Q

What are the two main diagnostic manuals used in clinical practice, and in which contexts? (x3 and x2)

A

DSM-5 in private practice and in the US
• Constantly changes – eg in version 2-3, homosexuality was a pathology
• So need to remember that they’re not perfect

ICD-10 used in hospitals and also in the UK

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5
Q

In what ways can clinical diagnosis be helpful?(x5)

A

Communication between clinicians - Ease of description/communication

Helps guide questioning, differential diagnoses - Some diagnoses very complex, so helpful to whittle down areas
• Overlap between diagnoses, a lot of depression for example looks like bi-polar, looks like PTSD, looks like alzheimers

Helps with treatment options

Make client feel at ease – normalisation, understanding

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6
Q

In what ways can clinical diagnosis be unhelpful?(x5)

A

Potential stigma/added burden

Self-fulfilling prophecy
• “I am a depressed person, nothing I can do to change this”

Use as an ‘excuse’
• As in anxiety, ‘I can’t do that, I’ve got anxiety’

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7
Q

What constitutes a major depressive episode?

A

Need five of following for 2 weeks (at least 1 of first 2):
Depressed mood most of the day, nearly every day (In children and adolescents, can be irritable mood)
• Subjective report – feel sad; Observation – appears tearful

Diminished interest or pleasure in activities most of the day, nearly every day (subjective or observation)

Significant weight loss or weight gain or decrease or increase in appetite nearly every day
(In children, failure to make expected weight gains)

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation

Fatigue or loss of energy

Feelings of worthlessness or inappropriate guilt

Diminished ability to concentrate

Recurrent thoughts of death, suicide ideation

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8
Q

What are 7 different clinical assessment options?

A 
Interview = parent, child, teacher 
Self-Report Questionnaires 
Self-Monitoring
Behavioural Observation = coding system
Standardised Neuropsychology Assessments
Medical examination
Collateral information
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9
Q

What kind of interview measures might be used in clinical assessment? (x3)

A

o Intake – first session
o Structured Clinical Interviews – if eg work cover
o Anxiety and Related Disorders Interview Schedule for DSM-5 – DSM takes about an hour, but higher accuracy

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10
Q

What kind of self-report measures might be used in clinical assessment? (x4)

A

Beck Depression Inventory -

Depression, Anxiety, Stress Scale

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11
Q

What kind of self-monitoring measures might be used in clinical assessment? (x1 plus explain)

A

Thought diary – underline the most pressing thought of the time, and what the consequences were, eg left an event

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12
Q

What kind of behavioural observation/coding system measures might be used in clinical assessment? (x1 plus e.g.)

A

Family Observation Scale
o Kids on Speed: multidisciplinary team to help parents of kids with ADHD - hese kind of tests are very time consuming and expensive…

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13
Q

What kind of neuropsych measures might be used in clinical assessment? (x3)

A

E.g., WAIS & WISC
Neuropsych for cognitive deficits
o Eg dementia, difficult learning disorders, can be better to refer on

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14
Q

What kind of medical measures might be used in clinical assessment? (x1)

A

eg if they’re not listening to you, check their hearing

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15
Q

What kind of collateral information measures might be used in clinical assessment? (x3)

A

Report Cards – if child or adolescent
Previous reports or referral information (e.g., GPs, OTs, Speech)
Psychiatrist referrals– eg medication allows day to day functioning, but then psych helps build skills for that

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16
Q

What is it important for clients and clinicians to communicate during the assessment process? (x5)

A

Ensuring honest, detailed and comprehensive reporting from client
Explaining purpose and role of assessment
Explaining your role/client’s role
If using psychometric tools, ensure client understands what is expected of them
Assessment can be very burdensome for the client, so you want to make sure they understand the rationale, and what’s going on, and the conditions under which you’ll be testing

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17
Q

What are the two broad aims of the clinical psych interview? (x4 and x2)
Why is it challenging? (x1)
What happens if you don’t do both properly? (x1)

A

Gather Information
• Diagnosis
• Formulation
• Implementation of appropriate assessment strategies
Establish therapeutic relationship
• Micro-counselling skills (active listening, sensitivity)

Constantly tricky - can’t just manualise it…
Blowing it impacts on likelihood of client return

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18
Q

What biographical info are you trying to get in a clinical interview? (x7)

A 
o	Name
o	Age
o	Marital status
o	Gender
o	Occupation
o	Religion
o	Current circumstances of living
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19
Q

What referral info are you trying to get in a clinical interview? (x3)

A

o Referring agency
o Reason for referral
o Client often has gone through a series of referrals/obstacles befo getting to you…
Eg GP, then you get 6, review with potential for another 4 in year
• It’s great, but eg no cure for major depression shown to work over such short times – sets up dodgy expectations for the client

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20
Q

What presenting problem areas are you trying to get a handle on during a clinical interview? (x4)

A

Identifying problems in all symptom domains
Their typography
Recent precipitants
Impact of problems

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21
Q

What are the symptom domains that you try to access during a clinical interview> (x5)

A
  • Cognitive
  • Behavioral
  • Affective
  • Physiological
  • Medical
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22
Q

What do you try and find out about the typography of presenting problems during a clinical interview? (x5)

A 
Frequency
Duration
Intensity (subjective units of distress – getting them to rate eg anxiety in particular situation out of 100)
Contexts
Course and duration
23
Q

What might recent precipitants of presenting problems be? (x2)

A

Loss

Conflict

24
Q

What areas might presenting clinical problems be impacting? (x4)

A

Occupation
Family
Social relationships
Interests

25
What domains are you trying to cover in a clinical interview? (x13)
``` Biographical information Referral Presenting problems History of past psychiatric problems Medical history/drug and alcohol use Family history Personal and social history Strengths, resources and needs Mental State exam (MSE) Appearance Behaviour Mood and Affect Insight, judgement, reliability ```
26
What details about history of past psychiatric problems might you try to cover in a clinical assessment interview? (x4)
Past episodes of illness not already covered Previous treatment Effects and compliance with treatment (particularly in hospital settings - may have had troublesome relationships with prior clinicians) Acknowledging their experience and history
27
What details about medical history/drug and alcohol use might you try to cover in a clinical assessment interview? (x6)
General health Major illnesses Hospitalisations Prescribed or over-counter drugs and when last taken Recreational drugs used (tobacco, alcohol, caffeine) Gotta be careful how you frame responses – so as not to bring worries over judgement
28
What details about family history might you try to cover in a clinical assessment interview? (x4)
Psychiatric or medical illness in relative Family membership and atmosphere Parental occupational status • Can be important among kids and adolescents particularly Family history can give you a chance to look into relationship between mum and dad – patterned responses from childhood?
29
What details about childhood personal and social history might you try to cover in a clinical assessment interview? (x8)
``` Prenatal & Perinatal History Early and Middle Childhood • Any behavioral problems, friendships, intellectual and motor development Late Childhood • Social relations • School history • Sexuality ``` With kids, you're doing most of the time with the parents Gets hard with teens – as they often have been forced to come by parents or school pressure • Gotta deal with confidentiality - teens get rights, as do parents
30
What details about adult personal and social history might you try to cover in a clinical assessment interview? (x6)
``` Educational history Occupational history Relationship history Forensic history Religious history Sexual history ```
31
What details about client strengths, resources and needs might you try to cover in a clinical assessment interview? (x5)
Support system Coping skills – what are they doing now? Friendships/social relationships – what kinda friends? Any support? General health Emotional, spiritual and cultural needs - often older adults might use prayer
32
What is the Mental Status Exam (MSE)? (x1) | What categories does it cover? (x8)
``` Therapists observations and impressions of client’s mental functioning at time of interview o Appearance o Behaviour o Mood and Affect o Speech o Perceptual Disturbance – hallucinations etc o Thought Process and Content o Cognition o Insight and Judgement and Reliability ```
33
What aspects of appearance might you note during the clinical interview process? (x4)
Physical characteristics (body type and physique) Facial features Grooming/hygiene – eg in depression, everything is hard, so it tends to slide Dress
34
What aspects of client behaviour might you note during the clinical interview? (x4, but x3, x2, x4, and x5 respectively)
``` Posture • Tense, rigid, poised, slumped Facial Expression • Appropriateness • Variability of expression General Body Movements • Activity level (agitation, acceleration, retardation, stupor) • Gait, balance, co-ordination • Peculiar or inappropriate • E.g., Tic (involuntary, spasmodic motor movements) Attitude Toward Examiner • Co-operative • Friendly • Attentive • Defensive or hostile • Level of rapport established ```
35
What aspects of mood and affect might you note during a clinical interview? (x5)
Mood = Predominant mood subjectively experienced and reported by client. • Depressed, anxious, irritable, angry, guilty Affect = Expression of emotion as observed by others. • Eg affect could appear friendly, while actual mod is anxious or irritability Appropriateness: is affect appropriate to thought content Range of affect: flat, blunted, restricted Lability – changing, or able to?
36
What elements of insight might you consider/note during a clinical interview? (x4)
Insight is essential for talking therapy, so maybe refer to psychiatrist if eg delusions appear to be interfering with it Awareness of being unwell Awareness of nature of problem Blames others/circumstances for problems
37
What elements of client judgement might you consider/note during a clinical interview? (x2)
Ability to assess a situation correctly and | Act appropriately within that situation.
38
What elements of client reliability might you consider/note during a clinical interview? (x2)
Client’s capacity to report accurately | Collaborative info, eg ask mum, teacher about teenager
39
What three things most guide the selection of clinical treatment?
Theoretical orientation of clinician, eg CBT Presenting problems • eg may expect cognitive gains through treating depression, whereas neuropsych might approach differently Resources available
40
Self-report measures for clinical assessment include... (x2) | Plus three considerations...
DASS and BDI-II Not necessarily the most reliable Are they comfortable with putting their feelings down on paper? But they have given us norms for comparison…
41
Self-monitoring measures for clinical assessment include... | Plus two considerations...
Classic CBT thought diaries - A = activating event B = beliefs about it C = consequences People tend to think it's the event, but it's generally the belief that guides the consequence… Trying to build flexible perspective taking
42
Neuropsych assessment in clinical evaluation are used to identify... (x1) And includes tests of... (4)
Cognitive based problems Verbal and Performance Functioning • Word processing, visuo-spatial tasks, etc Attention Intelligence/academic performance • Can't give praise, except for effort, and even the amount of that is regulated • It's hard work for a kid to do, and they may not give best effort Working Memory
43
What is the purpose/process of case formulation? (x4) | Which is influenced by... (x1)
The reason for all that assessment – to make the formulation Explains processes that caused and maintained the problems Provides guides for intervention Active and ongoing process, responsive to new data Theoretical orientation
44
What are the elements of the 7P formulation process?
Presentation Pattern Predisposition – length of time/history, any eg health issues… Precipitation Perpetuation Potentials – strengths that you can draw on to build skill/health Prognosis – never say cured, as you never know when depression, PTSD can spring back, but you can talk about hopeful stats
45
What are the 8 proposed/theoretical stages of the therapeutic process?
``` Initial contact First session Assessment Formulation Goal setting Therapy sessions - homework? Termination ```
46
What does therapeutic process often look like? (x6)
``` Assessment Then feedback loops through... Diagnosis Formulation Treatment Evaluation ```
47
What are potential difficulties with clinical case formulation? (2 areas, x3 and x3)
Client does not understand: o Too complex o Too abstract o Not well explained Client does not agree with formulation: o Explore areas of concern o Modify formulation o If no agreement, discuss options
48
Therapy consists of... (x2)
``` Content = WHAT Process = HOW ```
49
Why is process important in therapy? (x2 plus e.g.)
Can significantly impact on outcome of therapy If therapist simply responds to the content, could miss the important process issues Eg noticing their eyes drift off while talking – process is honing in on that
50
What might some process issues be for client at first meeting? (x9)
``` Expectations of role as client Anxious to be understood Fearful of being judged, labelled Uncomfortable with perceived power differential Is this going to be worthwhile Costs? Commitment? Expectations based on prior counselling Any knowledge of counselling Trust, confidentiality? ```
51
What are some ways of setting the scene for the client/establishing the therapeutic framework during the first meeting? (x4)
Explaining goals of initial session Roles of client and therapist Communicating hope Setting boundaries
52
What are some ways of establishing the therapeutic relationship at the first meeting? (x4)
Sensitivity Empathy Unconditional positive regard Genuineness
53
What aspects of therapy do clients report as most helpful? (x6)
``` Talking (to someone who listens) Being understood Hope Warmth Calmness and objectivity Truthfulness and honesty ```
54
What process issues do you need to bear in mind in the following e.g.? (x6) A mother who worked as a successful lawyer before having her child 4 years ago, believes he is gifted and brings him in for assessment. o Your results show that he is average on most aspects of cognitive functioning, and below average on some.
First establish what the purpose is of this assessment – is the mother hoping for advanced classes? Process issues at assessment o Extra burden o Is my private information going to be secure? o Client’s report may be different from others’ reports o What is the meaning of the assessment findings for the client? Dealing with any distress caused by the results

PSYC3020 (14 decks)

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