180 lines
5.3 KiB
Markdown
180 lines
5.3 KiB
Markdown
# 3. Assessment of Mental Health Problems
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## Introduction to Basic Elements in Assessment
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Interaction of **Importance of trust and rapport** and **Impact on assessment** process.
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### Identification of presenting problem
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- Situational or pervasive?
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- Duration?
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- Prior attempts to help or treat?
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- Self-defeating or resourceful?
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- How does problem impact social roles?
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- Does problem match any DSM-5 disorder criteria?
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### Advantage of classification of presenting problem
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- Treatment planning
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- Knowledge of range of diagnostic problems
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- Insurance payment
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### Good assessment includes
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- social history noting:
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- Personality factors
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- Social context
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- various professional orientations:
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- May determine assessment techniques
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- Does not limit clinician to one type of assessment
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### Dynamic formulation
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Describes the current situation but also includes hypotheses about what is driving the person to behave in maladaptive ways.
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- Hypotheses about future behavior are derived.
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- Decisions about treatment are made collaboratively with the consent and approval of the individual.
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- Assessment may involve the coordinated use of physical, psychological, and environmental procedures.
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### Psychological Assessments are
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- Reliable
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- Valid
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- Standardized
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## Assessment of the Physical Conditions
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### General physical examination
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Many psychological problems have physical components either as
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- Causal factors
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- Symptom patterns
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### Neurological examination
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- **EEG:** graphical record of brain’s electrical activity
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- **CAT scan & MRI:** images of brain structures that may be damaged or diseased
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- **PET scan:** metabolic activity of specific compounds
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- **fMRI:** mapping psychological activity to specific regions in the brain
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### Neuro-psychological examination
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- Involves use of expanding array of testing devices
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- Measures cognitive, perceptual, and motor performance
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- Provides clues to extent and location of brain damage
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**Halstead-Reitan Neuropsychological Battery (HRNB) (10 tests in total):**
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- **Halstead Category Test:** Learn & remember
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- **Tactual Performance Test**: Motor function, response, tactile & kinesthetic cues
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- **Rhythm Test:** Attention, sustained concentration
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- **Speech Sounds Perception Test:** Identify spoken words
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- **Finger Oscillation Task:** Speed
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## Psychosocial Assessment
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### Assessment Interviews
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- Face-to-face interaction
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- Structured interviews
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- Unstructured interviews
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### Clinical Observation of Behavior
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- Clinical observation in natural environments
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- Clinical observations in therapeutic or medical settings
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- Self-monitoring
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### Psychological Tests
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#### Intelligence tests
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- WISC-IV(children); WAISIV (adults)
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- Stanford-Binet
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#### Personality tests
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##### Projective personality tests
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- Unstructured stimuli are presented
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- Meaning or structure projected onto stimuli
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- Projections reveal hidden motives
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**Projective personality tests examples:**
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- Rorschach Inkblot Test
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- Thematic Apperception Test (TAT)
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- Sentence Completion Test
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##### Objective personality tests
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Examples: NEO-PI, MMPI-2
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Objective personality tests offer several advantages, such as standardization, efficiency, and ease of administration, but also have limitations, including limited depth, potential response distortion, and cultural bias.
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## The Integration of Assessment Data
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- Developing integrated, coherent working model
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- Utilizing individual or team approach
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- Identifying definitive picture vs. discrepancie
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### Ethical Issues in Assessment
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- Potential cultural bias
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- Theoretical orientation of clinician
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- Underemphasis on external situation
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- Insufficient validation
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- Inaccurate data or premature evaluation
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## Classifying Abnormal Behavior
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- Classification involves attempts to delineate meaningful sub-varieties of maladaptive behavior.
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- Classification makes it possible to communicate about particular clusters of abnormal behavior in agreed-on and relatively precise ways.
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- Classification of some kind is a necessary first step toward introducing order into our discussion of the nature, causes, and treatment of such behavior.
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- Classification enables the clarification of insurance issues.
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### Differing Models of Classification
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Three basic approaches include:
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- Categorical approach:
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a patient is healthy or disordered, but there is no overlap
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- Dimensional approach:
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the patient may fall along a range from superior functioning
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to absolutely impaired functioning
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- Prototypal approach:
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a conceptual entity depicts an idealized combination of
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characteristics, some of which the patient may not have
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### Formal Diagnostic Classification of Mental Disorders
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- Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
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- International Classification of Disease (ICD-10)
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#### Definition criteria based on:
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- Symptoms (subjective)
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- Signs (objective)
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#### The DSM-5
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- More comprehensive and more subtypes of disorders
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- Allows for gender related differences in diagnosis
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- Provides structured interview regarding cultural influences
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#### Problem of diagnostic labeling
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- Allows label capturing more than a behavioral pattern
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- Creates assumptions among clinicians
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- Creates social identity (stigma)
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#### Diagnostic Interviews
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- Unstructured:
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- Freewheeling
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- Clinician can follow leads
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- Clinical picture may vary, based on interviewer
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- Structured
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- Controlled
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- Determine if symptoms fit diagnostic criteria |