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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

  • 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 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
  • 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
  • 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.
  • 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)
  • 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 DisordersAxis 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)

  • Work with a Pharmacist and consistent Pharmacy.
  • Any questions?
  • Any Comments?