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Mental Health Made 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.

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Mental health made simple

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
Diagnosis Wheel(Gathering the Story)


Diagnosis flow
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


Dsm iv tr
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


Assessments fyi
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
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
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
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
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
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
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
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
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

Axis I

  • Other Conditions that May be a Focus of Clinical Attention


Axis ii
Axis II

  • Personality Disorders

  • Mental Retardation


Axis iii
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
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
Axis V

Global Assessment of Functioning

Can they Function in Society?

  • 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.

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

  • 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 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
Psychopharmacology

  • Work with a Pharmacist and consistent Pharmacy.


Questions
Questions

  • Any questions?

  • Any Comments?


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