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Week 9: Clinical Psychology Testing (DSM-V & MD (Formulation (4P's…
Week 9: Clinical Psychology Testing
Clinical & screening tests
SCID
Structured Clinical Interview for DSM-5 - most common, 15 min - 1 hour, 9 modules w an entry question
outputs - presence or absence of MD, x need to do all the modules & has separate one for PDs
Dep
Beck Depression Inventory - x available publicly, 21 items, meas dep over 2 week period
CESD - Centre for Epidemiological Studies of Dep - publicly available, similar to Beck, 20 item self report, rel & valid, screening tool, some groups prefer this
K10 - Kessler Psychological Distress Scale - 10 items, assesses functioning over 4 weeks, very easy & quick to score, commonly used by GPs as screening tool
select relevant tests based on referral q, use evidence based, commonly used tests
Anx
STAI - State Trait Anxiety - many measures for anx, disgustingly dif from dep, 10 q for state, 10 q for trait anx
GAD 7 - Generalised Anx Disorder 7 - only 7 items, assesses anx over 2 weeks, use with care, oft as screening tool
used to assist w diagnosis or assessment of special traits, states, interests or attitudes, can include pers, intell, diagnostic & neuropsych tests
Clinical Assessment
MSE
Assesses
state of consciousness (disorientation, delirious, confused), affect (blunted, ok, approp), mood
thought form (conherent thoughts, preoccupied thoughts, flight of ideas, thought content), risk to self/others
perception, intelligence, insight & judgement about their functioning
includes - appearance, behav (rate & quality of speech), orientation (know who they are, know place & time), mem, psychomotor (shaking, figiting),
Mental Status Exam - one of most common parts of clinical assessment, includes objective & subjective data, gives very rich description, must be able to 'see' the person
Considerations
Referral question, context for int setting (where, hosp, clinic, prison, other pax there?)
client motivation & willingness for interview (e.g. prison, courts = less motivation), clinician motivation (some clients can be difficult)
interview validity - halo effect (better assessment if you like the person), general standoutishness (judge pax based on one salient characteristic
int rel - increase rel w supplement measures (e.g MDD scale), limiting q can also increase rel
be culturally & individually aware (incl age, disability, religion, sex, SES, Indig heritage, gender)
Clinical Interview
single most comm assessment tool, used to give diagnosis, pinpoint prob areas, case formulation, elicit emotions, thoughts, attitudes, guide dec about actions & interventions
must establish therapeutic contact - agreement bet psych & client about goals, limits of confidentiality, set expectations for the relationship
can be narrow or wide depending on referral q, can be structured, unstructured or semi structured, tone is very important & must tailor tone to client
gathers lots of info at same time & psych must inegrate it (demographiscs, reason for referral, current, past, med & psych history, fam MH history,
use social facilitation - you set the tone, you model behav/mood, pax will follow
Perf Clinic Int
folow by closed q to get specific info needed
have interested, warm, non-judgmental stance (bod lang, actual lang, use silence appropriately), balance conversation & sticking to an agenda
do in quiet room, x distractions, start w open ended q, give pax freedom to choose to start the topic (learn a lot about what pax choose to talk about first/whats most important)
Clinical int techniques
non-verb - body lang, eye contact, posture, eye movements, head nods, verbal - traditional phrases, verbatim feedback, clarification, summarise, empathy & understanding
dif lvls of comm on 5 poing scaling socre, must be at least lvl 3 for psychs
Lvl 1 - psych comment x relate to response or topic
Lvl 2 - shows superficial awareness
Lvl 3 - says an interchangeable statement that accurately reflects the initial expression
Lvl 5 - adding significantly to the response, reflects deep understanding and emotional awareness
Lvl 4 - adding noticeably to statement & identifying underlying implicit feelings
Special applications
Forensic areas
aims to assess risk and likelihood of violence, need for interventions, risk for offending, harming pax, pax ready for patrol
Stalking Risk Profile (SRP), Risk for Sexual Violence Protocol (RSVP), HCR-20 Violence Risk Assessment
Abuse/neglect, childhood trauma
high rates of child abuse in pax w MD, trauma history informs reasons
use Childhood Trauma Questionnaire (CTQ), Brief Trauma Questionnaire (BTQ)
must detect abuse/neglect in kids (poor hyygent, phys, emot probs), continously assess and talk w others
signs of abuse include low self-esteem, inapprop moods, aggression, withdrawal ec, use interviews, behav observation & psych tests to assess
Addiction
Spec tests
Alcohol Use Disorders Identification Test (AUDIT)
Alcohol, Smoking, and Substance Involvement
Screening Test (ASSIST)
Addiction Potential Scale (APS)
Addiction Severity Index (ASI)
EMA - Ecological moment assessment - assesses pax day to day functioning via an app, can track behav ev day, more reliable & objective
Assess of substance use/abuse - many dif frameworks for AOD assessment, v common so often asked about, v imp in young pax, can do phys test bt x common
Psych report
common elements - demographics, referral reason, tests administers, findings, recommendations, summary
example: history of presenting probs, past psychiatric history, safety, medical history, relationship w family & personal history, MSE, formulation & recommendation, summary
writing the report is different to the assessment, components vary depending on reason for assessment & who's using it (e.g. clinician vs teacher)
tips - use appropriate language (avoid Barnum effect, vague, generalised statements) write promptly, report well organsised & clear, presenting findings respectfully towards client, only include relevant info, use lots of direct examples
only include relevant info, x have to include everything
DSM-V & MD
Diagnosis
Diagnosis: good for determining nature of disorder by identifying signs & sympts, good when clear cause & effect (e.g. in medicine) bt more complex in psych
not strong rel bet etiology and MDs, criteria are made of symptoms, not etiology
DSM-V (2013) many dif working groups discuss changes to the DSM, has descriptions, symptoms, includes prevalences, trajectory, cultural applications, risk factors, differential diagnosis
DSM-I (first pub in 1952), classifies MD into 2 groups & then assigns sympts, constantly updated
DSM pros: wealth of info, descriptions, symptoms w lots of detail, consistency for better comm bet prof, comprehensive & useful classifying system, things can be grouped
Mental disorder - syndrome characterised by sig distress, disturbance to cog, emot regulation & effects functioning
DSM cons: issues of reliability, dif psychs can give dif diagn for same person, no guidance for treatment, high comorbidity/overlap of conditions, overlaps w normal behavior, cut offs are arbitrary (e.g. 4 sympt instead of 5 still meaningful?), not sensitive enough to cultural difs
Diagnosis Pros for clinicians & res: good for res, allows group of pax w similar symptoms to be grouped 2g, good for clinicians to share info, gives some treatment outlines, suggests etiology, treatment and prognosis, evidence based guidelines can be dev around diagnosis, gives idea of whats assoc w ea disorder
Diagnosis Cons for clinicians & res: however bc high comorbidity can confound studies, also a lot of heterogeneity w/i groups, diagnosis can be oversimplistic, stigma associated, x take other models (bio-psych-soc) into account
Formulation
create working hyp abot what make up pax internal selves, explore everything that shapes their world view, is a constant work in progress, best after 10 sessions
more informative, often collaborative proc which is better bt takes longer
Formulation: hyptohese of predisposing (risk factors), precipiant (just before) and maintaining (keeping it going) of MD
4P's
Predisposing factors - factors that make client vulnerable to MD
Precipitating factors - immediate factors that cause clients to present as they do now, why are they coming to you
Perpetuating factors - whats maintaining or worsening their symptoms
Protective factors - their strengths and soc support
Diagnosis pros for client: help make sense of sympt, enable to find support, can put a name to the symptoms
Diagnosis cons for client: may be too simplistic, x fit cultural aspects, can cause stigma, self-fulfilling prophecy
Clinical assessm & diagnosis
involved in assesm, inteverntion, cosultation & res and can work in many settings (hospital, clinci, community, early psychosis centers, aged care, uni, private practice
Clinical Psych - focuses on assessment, diagnosis & treatment of MDs, must keep up to date on res & translate it into practice, use evidence based res to guide treatment & planning
Clinical Assessment - objective to diagnose, dev case formulations, implement treatment plan
many dif types of psychs, clinical, counselling, community, edu, dev'ment, forensic, health, org, sports/exercise psych
Assessm process
referral q - does this pax have x?
assessor prepares & selects approp tools, then assessm takes place
feedback w client or family
assessor writes psych report which aims to answer referral question