Week 6 PSYC 3083 Notes
Week 6 PSYC 3083 Notes PSYC 3083
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This 10 page Class Notes was uploaded by Madeline Meyer on Saturday October 8, 2016. The Class Notes belongs to PSYC 3083 at Louisiana State University taught by Copeland in Fall 2016. Since its upload, it has received 20 views. For similar materials see Psychological Counseling in Psychology at Louisiana State University.
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Date Created: 10/08/16
Psychological assessment: what is it like to be around this person I. Interviewing Obtain information and build rapport by using good listening skills and emphatic responses a) For emphatic responses, paraphrase content and emotion in order to show we are listening Take notes? They are going to feel judged, do not think that the therapist cares really (causes distance), and confidentiality discomfort a) Convey writing notes that it is not secretive, keep them open in a way that the patient can also see the notes Various formats Prepare client by describing questions (“I need to ask you a few more questions that we ask all clients” II. Interview Sections Reason for referral (do not say referred by husband or wife, say self-referred, his wife has suggested counseling) Background information (marital status, age, ethnicity, employment status, living situation, language spoken, sexual orientation only if relevant) a) Why do we need to know race? When prescribing medicine, it is important because certain races have rapid or slow metabolizing for different medications. Certain races are more prone to certain health disorders. Behavioral Observations/Mental Status Exam a) Behavior: 1. Appearance? Describe dress, how they look, is dress and appearance consistent with age, occupation, SES, etc.? Just say casually or appropriately or inappropriately dressed (if so, note it). Comment on make-up only if it is salient. Are they healthy or obese or emaciated? a. Ethnicity, actual vs. apparent age, sex, coordination, notable movements, adherence to social conventions, build, grooming, dress, psychomotor activity, description of how patient interacts with interviewer (interpersonal style) 2. Interview behavior: what is client doing during interview? Sitting with arms folders, where they are facing, sitting calmly, are they restless or pacing. Are they limping, walking with crutch or walker. Are they guarded, forthcoming, cooperative, angry, panicked? a. Speech: rate, rhythm, volume, and spontaneity– important because it shows thought process/content and emotion b. Speech patterns: clear, pressured, soft- spoken, stuttering, profanity, monotone, mumbled, spontaneous, poor articulation c. Eye contact: good, fleeting, avoided, intense/unwavering, none, sporadic b) Thinking: insight, memory, thought process through speech (racing thoughts due to mania) 1. Judgment: able to make effective and personal decisions a. Wechsler Adult Intelligence Scale (WAIS) questions: What would you do if… you were in a theatre and saw a fire or found a letter that someone had dropped that has a stamp on it? b. Your own questions: if your friends drink a lot, have you ever gotten into a car with a person who has been drinking? c. Responses to other parts of the interview (have you tried to solve your problem?) 2. Thought process: a. Form: degree of logic and organization i. Coherence: is what their saying making sense ii. Logic: are the patient’s conclusions based on sound or flawed logic iii. Goal directedness: does the patient get to the point 1. Circumstantiality: gives numerous non essential details but finally comes to conclusion 2. Tangentially: never comes to conclusion iv. Associations: how well connected are thoughts 1. Loose associations: cannot discern connections between ideas 2. Blocking: stops thought in between process 3. Flight of ideas: jumps randomly between ideas b. Rate: are thoughts slow? Racing? 3. Thought content: Check for: always include c and d a. Obsessions: non-permissive thoughts b. Homicidal ideation: thoughts about hurting someone else c. Suicidal ideation: thoughts about hurting oneself d. Perception: false perceptions, hallucinations i. Auditory ii. Visual iii. Tactile e. Illusions: misinterpretations of actual sensory stimuli f. Depersonalization: feeling of unreality or strangeness concerning oneself g. Derealization: feeling the external world is foreign or strange h. Distortion of body image: erroneous self- assessment of physique i. Delusions: somatic, persecution, jealousy, grandiosity i. Delusion/idea of reference or delusion of control ii. Thought broadcasting: feelings that one’s thoughts are being heard by everyone iii. Thought withdrawal: feeling that others can remove thoughts of them iv. Thought insertion: other’s putting thoughts in heads j. Impulse control 4. Intellectual functioning: a. Concrete vs. abstract thinking (checked by asking meaning of proverbs) b. Ability to concentration (digit span) c. Information (Name 3 presidents) 5. Memory: a. Immediate: repeating last question you asked or digit span (repeating given numbers) b. Recent: includes last 6 months c. Remote: includes anything longer than six months 6. Orientation: oriented to person, place, and times (ask them where they are, what date it is, and who they are); adjust expectations given content 7. Insight: whether person realizes they have a problem and to what they think contributed to their problems 8. Feeling : affect (what you observe, noting intensity) based on the terms full/broad or blunted/flat, mood (what they report, noting intensity) and how the intensity compares to each other (congruent vs. incongruent “superficial”) Feeling: objective portion Mood: describes the subjective state of the patients What is your mood right now? How do you feel? Euthymic (normal), anxious (tapping foot, restless, seem irritable, sweaty), depressed, elated/euphoric, calm, irritated, alexithymia (unable to recognize own mood and the moods of other people), dysphoric Affect: describes the objective portion (what you see and observe) Incongruent vs. congruent Range: amount of variation in behavior/emotion during the interview (enthusiasm that fluctuates with sadness) Lability: rapid, extreme, brief swings of emotion followed by a quick return to normal Appropriateness of affect: whether the emotion is expected for the patient’s current expressed thought 1. Full/broad: showing emotion 2. Blunted/flat: 3. Congruent vs. incongruent Mood: subjective state of patient 1. Depressed/dysphoric: sad 2. Euthymic: normal 3. Elated/euphoric: anxiety, irritability 4. Labile: capricious, unstable, quickly changing mood 5. Anhedonia: lack of interest 8. Sensorium: five senses functioning adequately? Note hearing impairments and blindness a. Perceptual processes: presence or absence of hallucinations b. Hallucinations (auditory, visual, paranoia, tactile, etc.) 9. Symptomatology: drug use, binging/purging, checking things compulsively Psychological symptoms or physical symptoms which might have their basis in psychological functioning because of their severity and/or frequency One especially notes depersonalization (one loses all sense of identity), derealization (surroundings are not real), phobias (fears), other anxiety states, depression, eating disorder, or drug abuse B. Interview Sections: -Reason for referral: -Background information: (age, marital status, ethnicity) - Behavioral Observations/Mental Status Exam Presenting Complaint “WHAT BRINGS YOU IN TODAY?” -Duration of symptoms/complaint -Circumstances surrounding onset (stressful event?) -Degree to which symptoms disrupts the personal life -Consequences of the symptom (feel less anxious after washing hands repeatedly? How do family members react?) -Has the person tried to solve their problem? - Want to see how resourceful someone is How did they come to this particular clinic/therapist (referral, pressured, there under the threat under an ultimatum, would be in jail)? -Expectations in terms of symptoms relief or other help with problem (do they believe in your therapy, will they believe medicine will help at all or think they’ll become addicted to it, or it will magically fix things for them) Current functioning and living situation What is a typical day like for you? -Where living and with whom? -How do they spend their leisure time? -Employment? -Suffering from significant disease? -What drugs (legal or illegal) are taken and in what amounts? Ex.) Do you have any problems with alcohol? Were there any recent significant events “life stressors” (job loss, new baby, moving, deaths, divorce, promotions)? Family History Now I’d like to ask you some questions about your family. Do you have much contact with your parents? Do you have any siblings? -Parents: ages, married/divorced? Remarried? Date of death if deceased, parental occupation. Did your biological parents raise you? -Siblings: number, ages, occupations, what was family environment like as a kid? -What were mother and father like? -Physiological problems in family? Personal History -History of operations or severe illness, marriages, divorces, birth of children -Legal difficulties or drug use -Development of interpersonal relationships -Sexual development and work/school history -Patient’s perceptions of his/her strengths and weaknesses, how these developed, and what events they see as contributing to the person he/she is today Previous Treatment -When? -What was it for? -What type (drugs, desensitization, electroshock)? How long did it last? Was it helpful? -What are the patient’s expectations for therapy as a result of this past experience? Provisional Diagnosis -things you observe in a patient and base a specific diagnoses Summary and Recommendations -Based on the information obtained, what do you recommend? VIDEO: Psychiatric Interview for Teaching: Depression Suicide assessment 1. What is history of previous attempts? -Often times people have repeated attempts -How many attempts? -Have history of suicidal ideation but reaches out? -Best predictor of future behavior is past behavior. 2. What is the frequency of suicidal ideation? -Generally, someone thinking about it 1X per month at less risk 3. What is the nature of the suicidal ideation? -Vague vs. specific -Is it something fleeting or lasts for hours? 4. What is the typical duration of the ideation? 5. How strong is the person’s ego? -Capable of resisting dangerous impulses? -Exhibit confidence in their judgments? -Appear confused? Intoxicated? 6. Is there a social network that the person perceives as caring? -Assumption is that clients who commit suicide are not well connected. 7. What is the individual’s assessment of his/her likelihood of committing suicide? 8. Is there a plan? 9. Is the plan specific? 10. Are the means readily available? -Patients who have collected enough medication vs. those who just started 11. How lethal is the plan? -Women have more suicide attempts, but men have more successful attempts. -Women often overdose(increased time for intervention), and men use guns often. 12. How likely is rescue? 13. What has been the person’s coping style in similar situations? -Do they reach out when they need help? -Do they self harm? 14. What is the person’s perception of the effects of suicide on others? 15. What diagnostic category comes closest to describing the person? -Substance abuse – because increases impulsivity -Psychotic depression or bipolar depression -Psychotic with command hallucinations -Paranoid 16. Is the person psychotic? -Makes prediction more difficult 17. Are there behavioral suggestions of suicide? -Making will -Giving away possessions -Checking insurance policies -Organizing business affairs -Even seeming less depressed - apathetic (because they have finally made the final decision to do it and are feeling relieved) 18. To what degree are helplessness, hopelessness and exhaustion present? -No control over what happening to them -No hope things will improve -Tired from struggle -Humans have a cognitive component of learned helplessness theory because they can blame themselves for the punishing behavior -Hopelessness: feeling that things will not get any better, explains variance in suicidal ideation 19. Can the client identify any reasons why she/he wants to live? -People with something positive to “hang onto” generally at less risk II. PSYCHOLOGICAL TESTING Designed to: Serve specific purposes: give tests with specific questions Measure specific aspects of people: depression, psychosis Be as objective as possible Be subject to empirical verification (psychometrically sound? Validity.) 1. Norms and Standardization Given to a large number of representative people Scores of this standardization group become the test norms – how most people perform on the test Score of an individual who later takes the test can then be compared to test norms 2. Reliability and Validity: help psychologists know if tests meet the criteria for scientific acceptability Reliability: “trustworthiness” or consistency of a measuring device, must have reliability to even look at validity Validity: appropriateness of the interpretation of the results of the measurement – the meaning of the results of the measurement Ex. Someone can get a consistent score of 10(reliability), doesn’t mean anything unless scale is truly measuring depression(validity). Ex2.) Minnesota Multiphasic Personality Inventory (MMPI-II) Clinical Scales: 70+ is clinically significant 1. Hypochondriasis (Hs): assess neurotic concern over bodily functioning 2. Depression (d): designed to identify depression, characterized by poor morale, lack of hope in the future, and a general dissatisfaction with ones own life situation. High scores indicate depression and moderate scores reveal general dissatisfaction. 3. Hysteria (H): identifies those who display hysteria in stressful situation. Women score higher 4. Psychopathic deviate (Pd): identifies psychopathic patients, measuring social deviation, lack of acceptance of authority, and amorality. Can be thought of measure of disobedience. High scores tend to be more rebellious, while low scorers accept authority. High scores are usually diagnosed with a personality disorder rather than a psychotic disorder. 5. Masculinity-femininity (Mf): identifies homosexual tendencies, but was found ineffective. High scores are related to intelligence, socioeconomic status, and education. Women scores low. 6. Paranoia (Pa): identify patients with paranoid symptoms such as suspiciousness, feelings of persecution, excessive sensitivity, rigid attitudes 7. Psychasthenia (Pt): no longer used today. Described are obsessive-compulsive disorders. Excessive doubts, compulsions, obsessions, and unreasonable fears 8. Schizophrenia (Sz): 9. Mania (Ma): identify hypomania, elevated mood, accelerated speech and motor activity, irritability, flight of ideas, and brief depression 10. Social Introversion (Si) MMPI-2 Validity Scales Lie Scale: developed to detect attempts by patients to present themselves in a favorable light. People who score high deliberately make themselves look very positive, rejecting shortcomings or unfavorable characteristics F scale: used to detect attempts at “faking bad.” People who score high on this are trying to appear worse than they really are. Designed to determine if test-takers are contradicting themselves in their responses K scale: “defensiveness scale” detects symptoms to present oneself in the best possible way. Higher educational level and socioeconomic status tend to score higher on K scale.