Mental HealthMade Simple ?

Simple Factoids

From Doc Ty

Why?

1993 Those with Severe Mental Illness discharged to the street by government

60-85% have mental health issues Misunderstood, stigmatized, ignored Interesting Fact:

The Human Brain can rewire

past damaged areas

Diagnosis Wheel(Gathering the Story)

Informants-Personal

Informants-Professional

PsychologicalTesting

LaboratoryTests/results

Family History

Socio-Cultural History

Medical History

Individual

Diagnosis Flow

Syndromes are ID Wide Range of diagnosis

are created One is chosen to move

forward on Comorbid diagnoses and

arrange in order of importance

Check up with a formulation Reevaluate as new data

emerges

Diagnosis Flow

AdjustIncitingIncident

DiagnosisWheel

DSM-IV-TR

The Diagnostic Statistical Manual Fourth Edition, Text Revision produced by the American Psychiatric Association

DSM-V due 2013 1 of 2 International Benchmarks for Diagnosis

ICD-9-CMGeneral

and Mental HealthCodes

Diagnosis Cross-

Referenced

DSM-IV-TR

Assessments FYI

Clinicians use codified assessment tools– Behavioural– Weschler Intelligence Scales– Weschler Memory Scales– Minnesota Multiphasic Personality Inventory (MMPI)– Millon Clinical Multiaxial Inventory– California Psychological Inventory– Rorschach– Thematic Apperception Test– Neuropsychological Impairment

Behavioural

Focuses on preceding events/resulting consequences as an understanding factor.

Typical includes: measures of behaviour (overt/covert); antecedents (internal/external); conditions surrounding behaviour; and consequences

Validity: Challenging because of a moving matrix dependent on clinician or team, need definitions to truly understand results.

Weschler Intelligence Scales

Provides 3 IQ: Full scale; Verbal; Performance Main thrust: Accuracy in predicting future behaviour,

long-term predictions however fall short. Bias towards logical thought patterns; middle to

upper-class Caucasian demographics. Norms may not be applicable to other cultures; lower

socio-economic stratas; Enormity of calculations lends to higher end false results due to clinician error.

Weschler Memory Scales

Core component of any thought cognitive assessment.

Diagnosis of: depression, anxiety, schizophrenia, head injuries, stroke, learning disabilities, and neurotoxic exposure stipulate memory complaints.

Administration time is upwards to 42 mins.

MMPI

Standardized questionnaire Provides wide range of self-description scores Quantitative Measure of emotional adjustments and attitude towards test taking. Areas: General health, occupational interests, preoccupations, morale, phobias,

and educational problems. Moderate levels of stability and internal consistency, high overlap with the

different scales, Bias: Gender, Age, Socio-economics, demographics, race, place of residence,

intelligence and education are all variables that if not properly taken into account can skewer results or produce false results.

Used to screen individuals for high stress or sensitive jobs (i.e. air traffic controller)

Primarily Axis I

Millon Clinical Multiaxial Inventory (MCMI)

Self-report assessment much like MMPI (personality, emotional adjustment and attitude towards test taking), is one of few that focuses on personality disorders.

Current one is 175 items, separated into 28 scales in these categories: Modifying Indices, Clinical Personality Patterns, Severe Personality Pathology, Clinical Syndromes, and severe syndromes.

Driving Theory: Millon believed in polarity (active-passive, self-other, and pleasure-pain) by ranking these can see if the person is typical or non-typical on the personality spectrum.

Individual’s age, gender and ethnicity should be taken into account, and separate scoring norms have been developed to mitigate false results.

Primarily Axis II

California Psychology Inventory (CPI)

Primarily for young adults with society avg. reading level of Gr. 4 Focused on “Folk Concepts” (culturally relevant), translated into 40

languages. Focuses on typical population and interpersonal behaviours. Assess enduring interpersonal personality characteristics in a typical

population. 20 Scales under general domains:

– Observable, interpersonal style, & orientation (i.e. Sociability, social presence)

– Internal normative orientation & values (i.e. responsibility, self-control)– Aspects of Cognitive intellectual functioning (i.e.achievement via

conformance, intellectual efficiency)– Measures of role and personal style (i.e flexibility, psychological-

Mindedness)

Rorschach

10 inkblots given systematically, individual’s responses tracked to uncover the structure of the personality.

3 General Categories: location (area of inkblot they focused on); determinants (specific properties of blot used in responses); content of response.

Excellent at bypassing an individual’s cognitive inhibitions.

Challenges: Subjective nature, results need to be checked/re-checked,

Thematic Apperception Test (TAT)

Method of revealing dominant drives, emotions, sentiments, complexes and conflicts of personality.

20 pictures in which individual is asked to make up a story: what is happening, thoughts/feelings of characters, events that led up to picture, outcome of event.

2 sessions, given sequence of cards, upwards 2 hrs to administer,

Qualitative not quantitative analysis Up to Clinician Intuitive Clinical Judgment does not allow for

universal standards, those who like say works well, those who detract says does not work.

Best results when apart of a battery of tests Requires for best results a specialized/trained administrator

Neuropsychological Impairment

A battery of tests Individual presents outside of test parameters can

create a false negative (or positive) Types:

– Visuocontructive Abilities– Mental Activity– Memory and Learning– Verbal Functions and Academic Skills– Motor Performance– Executive Functions– Emotional Status– P.518 (Table 12.1)

Axis I Clinical Disorders

Diagnosis pre-18 yrs Schizophrenia and other psychotic disorders

Factitious Disorders

Delirium, dementia, Amnestic and other Cognitive Disorders

Mood Disorders Dissociative Disorders

Mental disorders due to a General Medical Condition

Anxiety Disorders Sexual & Gender Identity Disorders

Substance related disorders

Somatoform Disorders

Eating Disorders

Sleep Disorders Impulse-Control Disorders Not Elsewhere Classified

Adjustment Disorders

•Other Conditions that May be a Focus of Clinical Attention

Axis II

Personality Disorders

Mental Retardation

Paranoid Schizoid Schizotypal Antisocial Borderline

Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive

Not Otherwise Specified

Axis III

General Medical Conditions (ICD-9-CM coded)-medical conditions that may cause Mental Disorders.

– Infectious/Parasitic (001-139)– Neoplasm (140-239)– Endocrine, nutritional, & Metabolic, Immunity (240-279)– blood & blood forming organs (320-389)– Circulatory system (390-459)– Respiratory (460-519)– Digestive Systems (520-579)– Genitourinary System (580-629)– Complications in pregnancy, childbirth, and the pueperium (630-676)– Skin and subcutaneous tissue (680-709)– Musculoskeletal System and connective tissue (710-739)– Congenital Anomalies (740-759)– Certain conditions originating in Perinatal Period (760-779)– Symptoms, Signs, and Ill defined Conditions (780-799)– Injury and Poisoning (800-999)

Axis IV

Psychosocial/ Environmental Problems-Used to report factors that may affect diagnosis for Axis I/II

Problems with:– Primary Support Group (Family. e.g.: death, health issues; abuse)– Related to Social Environment (e.g.: racism, retirement, death of friend)– Educational (e.g.: school environment, literacy)– Occupational (e.g.: un/underemployed; stressful work schedule)– Housing (e.g.: homelessness; safety)– Economic (e.g.: insufficient governmental supports; insufficient Income)– Access to health services (e.g.: inadequate, transportation, insurance)– Legal (e.g.: judicial involvement – perpetrator or victim)– Other (e.g.: disasters; war; famine; hostility; discord with professional supports; lack of governmental supports).

Axis V

Global Assessment of FunctioningCan they Function in Society?

1. The G.A.F. scale is a rating scale of 0 to 100 that is used over the time span an individual is receiving treatment to determine functionality.

2. Functioning impeded by physical or environmental limitations is not assessed.

3. These are averaged for the Axis V total and in brackets it is stated when score was e.g. (current), (at discharge) (highest level past year).

Example of DSM-IV Multiaxial Evaluation form

Example 1: (p.35 DSM-IV-TR)

Axis I: 296.23 Major Depressive Disorder, Single episode, Severe without Psychotic Features

305.00 Alcohol Abuse

Axis II: 301.6 Dependent Personality Disorder

Frequent use of denial

Axis III: None

Axis IV: Threat of Job Loss

Axis V: GAF = 35 (current)

Psychopharmacology

Work with a Pharmacist and consistent Pharmacy.

Questions

Any questions?Any Comments?