NPE - Chegg Flashcards
What is AHPRA
The Australian Health Practitioner Regulation Agency. It supports the National Boards to implement the National Scheme.
What is the National Registration & Accreditation Scheme
The Council of Australian Governments (COAG) decided in 2008 to establish a single National Registration and Accreditation Scheme (National Scheme) for registered health practitioners.
On 1 July 2010 (18 October for Western Australia), the following professions became nationally regulated by a corresponding National Board:
- chiropractors
- dental practitioners (including dentists, oral health therapists, dental hygienists, dental prosthetists & dental therapists)
- medical practitioners
- nurses and midwives
- optometrists
- osteopaths
- pharmacists
- physiotherapists
- podiatrists, and
- psychologists
On July 2012, four additional professions joined the National Scheme:
- Aboriginal and Torres Strait Islander health practitioners
- Chinese medicine practitioners (including acupuncturists, Chinese herbal medicine practitioners and Chinese herbal
- dispensers)
- medical radiation practitioners (including diagnostic radiographers, radiation therapists and nuclear medicine technologists), and
- occupational therapists
In December 2018, paramedicine became the newest profession to join the National Scheme, making the title ‘paramedic’ protected nationally:
- paramedics
8 Core Competencies
1) Knowledge of the discipline
2) Ethical, legal & professional matters
3) Assessment & measurement
4) Intervention strategies
5) Research & Evaluation
6) Communication & interpersonal relationships
7) Working cross-culturally
8) Practice across the lifespan
Reliability & Validity
- Reliability - consistency of scores.
- Validity - the ability of a test to measure what it’s supposed to measure.
What are interviews used for?
- To establish the nature of the problem.
- Obtain a history of the problem.
- Understand previous attempts at intervention.
Structured vs Unstructured Interviews
Structured:
Standardize the experience of interviews. Reduce the likelihood of missing information.
Unstructured:
Flexible.
Topics of interest can be explored more fully, hypotheses can be discussed. Important factors - warmth, sincerity, acceptance, understanding.
Attendance to body language is important (55% facial expression, 38% tone, 7% content). Weakness is the possibility if information variance and bias.
What are the signs & symptoms of burnout?
- Feelings of anger, resentment
- Thoughts related to failure or hopelessness
- Behaviours such as isolation, withdrawal, clock-watching
Symptoms of Work Burnout:
- wasting time at work
- lack of interest in work
- a negative attitude about work
- lack of inspiration/motivation/creativity
- building resentments towards the organization and/or coworkers.
Symptoms of Physical burnout:
- Feeling an inability to “take another step”
- Generalized pain or overall fatigue
- avoidance of physical effort
- injuring yourself easily when exercising
- injury isn’t healing effectively
Symptoms of Relationship Burnout:
- negative thoughts about the other person
- disgust about their behaviour
- thinking about if you would be happier without them in your life
- score-keeping
- not wanting to contribute emotionally to the relationship anymore
Symptoms of Parental Burnout:
- yelling at the kids
- needing to take a nap during a time of the day that is unusual
- envisioning yourself leaving
- using screen time to distract the children about boundaries you used to have with them
TREATMENT:
Physical Self Care
You need to take care of your body if you want it to run efficiently. Keep in mind that there’s a strong connection between your body and your mind. When you’re caring for your body, you’ll think and feel better too.
▵ Are you getting adequate sleep?
▵ Is your diet fueling your body well?
▵ Are you taking charge of your health?
▵ Are you getting enough exercise?
Social Self Care
Socialization is key to self-care because close connections are important to your well-being.
▵ Are you getting enough face-to-face time with your friends?
▵ What are you doing to nurture your relationships with friends and family?
Mental Self Care
Mental self-care involves doing things that help you stay mentally healthy – like practicing self-compassion and acceptance, to help you maintain a healthier inner dialogue.
Spiritual Self Care
Nurturing your spirit can involve anything that helps you develop a deeper sense of meaning, understanding, or connection with the universe.
▵ What questions do you ask yourself about your life and experience?
▵ Are you engaging in spiritual practices that you find fulfilling?
Emotional Self Care
It’s important to have healthy coping skills to deal with uncomfortable emotions, like anger, anxiety, and sadness. Emotional self-care may include activities that help you acknowledge and express your feelings on a regular basis.
▵ Do you have healthy ways to process your emotions?
▵ Do you incorporate activities into your life that help you feel recharged?
What can be considered CPD activities
- Training
- Education
- Workshop participation
- Individual study & scholarship(self-directed & practice-based learning activities).
Ethical Decision-Making Model
Defining the Problem:
- Step 1)* Define the problem
- Step 2)* Consider options
- Step 3)* Monitor actions
- Step 4)* Resolve the problem
Considering Options:
Step 5) Develop and consider alternative solutions to the problem:
Alternative 1 / Alternative 2 / Alternative 3
- analyze risks and benefits of each course of action.
- consider how your personal beliefs, values, and biases may affect your decision-making.
Monitoring Options:
- Step 6)* Choose and implement the most appropriate course of action.
- Step 7)* Monitor and assess the outcome chosen
Resolving the problem:
- Problem Resolved* - Yes
- Step 8a) Consider the need for an ethical action plan/practice modification.
- Problem Resolved* - No
- Step 8b) Repeat Step 5-7
How might one manage a dual relationship?
Question if the dual relationship is:
- necessary
- exploitative
- benefits anyone
- is likely to damage the client, or disrupt the therapeutic relationship
What are the 9 current endorsement areas?
- Clinical
- Counselling
- Forensic
- Clinical neuropsychology
- Organizational psychology
- Sport and exercise
- Education & developmental
- Health
- Community
What are the conditions of professional indemnity insurance for psychologists?
Psychologists are required to hold professional indemnity insurance at a minimum $2 million level for any one claim.
Conditions of mandatory reporting.
Psychologists’ mandatory notification obligations:
- practiced the practitioner’s profession while intoxicated by alcohol or drugs, or Registered psychologists who form a reasonable belief that another practitioner has engaged in notifiable conduct must make a report to AHPRA as soon as is practicable. Under the National Law (Section 140), ‘notifiable conduct’ is defined as when a practitioner has:
- engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
- placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or
- placed the public at risk of harm because the practitioner has practiced the profession in a way that constitutes a significant departure from accepted professional standards.
Although there are no prescribed penalties for psychologists who fail to make a mandatory notification, they may be subject to health, conduct, or performance action.
Reporting other psychologists
Mandatory notification by practitioners about other registered health practitioners:
Under the NRAS, there is an obligation on any registered health practitioner or employer who forms a reasonable belief that another practitioner has engaged in notifiable conduct, to make a report to AHPRA. ‘Notifiable conduct’ is defined as when a practitioner has: practiced whilst intoxicated by alcohol or drugs; engaged in sexual misconduct in connection with the practice of the profession; placed the public at risk of substantial harm during practice because of an impairment or practiced outside accepted professional standards thereby placing the public at risk.
Who is your client, based on the age of the client?
0 – 8 Always the guardian
8 – 14 Need to discuss what will be shared with the parent and what won’t be, however, it is still the parent who is considered the client.
14+ Mature minor. Need to make a clear decision of mature minors below 16 but it is determined at 16+ that they are definitely a mature minor as long as they have no cognitive deficits.
What are the registration standards of the Psychology Board of Australia?
- Continuing professional development
- Criminal history
- English language skills
- General
- Professional indemnity insurance
- Provisional
- Recency of practice
- Area of practice endorsements standards
CPD requirements for registered psychologists
For each annual cycle, all psychologists holding general registration must:
- Develop a learning plan to identify learning needs and goals
- Complete 30 hours of CPD activities, which includes at least 10 hours of peer consultation
- For any area of practice endorsement that is held, specific CPD activities relevant to the area of practice must be completed (16 hours for one endorsement; 15 hours each for two endorsements; 10 hours each for three endorsements; 7.5 hours each for four endorsements; and 6 hours for five endorsements)
- Keep a log of all completed CPD activities
- Maintain a journal ‘reflecting’ on all completed CPD activities (this must be kept for 5yrs in case of audit)
All of these requirements must be met for the annual cycle in order to be deemed fully compliant with the Psychology Board standard for ongoing general registration.
Why are sexual relations between a psychologist and a client unethical?
Sexual relations between therapist and client are unethical as there is an importance of psychologists to:
- understand that if the psychologist/client professional relationship becomes sexualized, it is likely to be detrimental to the client
- be aware that sexual activity with clients is not a legitimate part of a psychological service and does not constitute an appropriate intervention or any other service by a psychologist
- recognize the possible existence of intense emotions between themselves and clients
- ensure they manage the professional relationship ethically and appropriately
- understand that they are responsible for recognizing and maintaining appropriate professional boundaries with their clients
- be aware that clients and former clients may be vulnerable to exploitation in the context of a therapeutic, teaching, consulting or supervisory relationship
- ensure that they maintain relationships of trust with their clients
Sexual relationships between clients are not to occur for a period of 2-yrs following service. One does not see a client with whom they have had a sexual relationship.
What are ways Peer Consulting & CPD might guide practice?
Peer consultation: means supervision and consultation in individual or group format, for the purposes of professional development and support in the practice of psychology and includes a critically reflective focus on the practitioner’s own practice.
- proactive, planned, and responsive way to address limitations and challenges in practice
- developing, updating, and enhancing knowledge through continuing education (maintaining competence)
- professional self-management including self-reflection, self-assessment, and self-care (maintaining psychological and physical wellbeing)
- understanding the limits of one’s own competence, training, and skills, and applying appropriate responses to manage these limitations including consultation and referral
- reflecting on and attending to the influence of a practitioner’s personal motivation, biases, and values - including the impact of these on others
- maintaining proper professional boundaries and attending to transference and counter-transference issues appropriately
- developing cultural responsiveness when working with diverse groups, including Aboriginal and Torres Strait Islander peoples, and,
- monitoring the effectiveness of a psychologist’s practice, and engaging in continuous improvements to practice.
Voluntary vs Involuntary Admission
A voluntary patient is a person who:
- has chosen to be admitted to a mental health facility
- is under guardianship and has been admitted at the request of, or with the consent of their guardian
- has been admitted involuntarily and has been reclassified by agreement between the person and an authorized medical officer or reclassified by the Mental Health Review Tribunal.
Discharge by the patient themselves or by an authorized medical officer.
An involuntary patient is a person who:
Is to be taken to and detained in a declared mental health facility on the certificate of a medical practitioner or accredited person where:
- the practitioner or accredited person has personally examined or observed the person immediately or shortly before completing the certificate, and
- the practitioner or accredited person has formed the opinion that the person is either a ‘mentally ill’ or a ‘mentally disordered’ person and
- the practitioner or accredited person is satisfied that involuntary admission and detention is necessary (and that there is no other less restrictive care reasonably available that is safe and effective), and
- the practitioner or accredited person is not the designated carer, principal care provider, or a near relative of the person
- the practitioner or accredited person must declare any pecuniary interest either direct or indirect held by themselves, a near relative, partner, or assistant in any private mental health facility.
Exclusion Criteria
A person is therefore not to be defined as ‘mentally ill’ or ‘mentally disordered’ merely because of any one or more of the following:
- the person expresses or refuses or fails to express or has expressed or refused or failed to express a particular political opinion or belief
- the person / a particular religious opinion or belief
- the person / a particular philosophy
- the person / a particular sexual preference or orientation
- the person / a particular political activity
- the person / a particular religious activity
- the person / a particular sexual activity or sexual promiscuity
- the person engages in or has engaged in immoral conduct
- the person engages in or has engaged in illegal conduct
- the person has an intellectual disability or developmental disability
- the person takes or has taken alcohol or any other drug
- the person engages in or has engaged in anti-social behaviour
- the person has a particular economic or social status or is a member of a particular cultural or racial group.
Mental Health Review Tribunal
If the Tribunal decides that the consumer is a “mentally ill” person it may:
- make an involuntary patient order directing that the consumer be detained for a period of up to three months.
- discharge the consumer on a community treatment order of not more than 12 months.
- make a community treatment order, but defer the consumer’s discharge for up to 14 days if this is in the consumer’s best interests.
- discharge the consumer into the care of their designated carer or principal care provider.
Each panel comprises:
LAWYER. PSYCHOLOGIST. CARER.
- a barrister or solicitor (who chairs the panel)
- a psychiatrist
- a suitably qualified person (a consumer, carer, or person with other extensive experience in mental health).
Functions:
- reviews of involuntary patients
- reviews of voluntary patients appeal against refusal to discharge (unless the appeal precedes a mental health inquiry in which case it will be heard by the legal member)
- applications for community treatment orders
- applications for electroconvulsive therapy (ECT), surgical operations, and special medical treatment.
High & Low Prevalence Disorders
The 2007 National Survey focused on high prevalence disorders:
- Anxiety Disorders
- Mood Disorders
- Substance Use Disorder
But there are a number of other low prevalence Mental Disorders, that can be more serious and are prevalent in public sector mental health:
- Psychotic Disorders (such as Schizophrenia)
- Severe Depression and Bi-polar Disorders
- Personality Disorders
(Other Disorders include)
- Dissociative
- Somatoform
- Impulse Control
- Adjustment
- Substance-related
- First seen in Childhood
- Substance Use Disorders
Ethical decision-making model
1. Recognise that there is an ethical issue present
Learn to recognize potential ethical problems:
Check if there are any personal ‘clues’ that may alert you, such as: changing your usual professional practices; providing more self-disclosure than usual; avoiding certain topics; ruminating after a session with a client; or feeling uncomfortable or regretful.
Ask yourself: “Would I be comfortable if my colleagues knew about this situation?”
Reflect on whether there is anything adversely influencing your capacity to assess the situation objectively, such as personal needs, values or biases that may be distorting your perception.
Consider discussing the issue with a colleague or supervisor to assess your initial response.
Determine whether the problem is an ethical one that is your responsibility.
Articulate the problem as succinctly as you can and then consider the following questions:
Are there any legal obligations that apply in this situation that are contributing to or may even override the ethical issues (e.g., a mandatory reporting obligation, a client’s right of access to his/her health record)?
Is the problem based on information from factual material?
Has the information come from a reliable source?
Is the problem your responsibility or someone else’s, or perhaps a shared responsibility?
2. Clarify the ethical issues
Identify the ethical principles involved.
Identify which of the three General Principles of the APS Code of Ethics is relevant to the issue: Respect for the rights and dignity of all people and peoples; Propriety; I_ntegrity._
Drill down to identify the ethical standards that are relevant and consult the Ethical Guidelines where necessary to assist with this task. Identify any competing ethical principles, e.g., the right to autonomy versus the right to confidentiality. Identify any aspects of the situation that are exerting pressure on you to act quickly, and think about how to claim more time to make the best possible decision.
Evaluate the rights, responsibilities, and vulnerabilities of all affected parties.
Identify who else is involved, implicated, or affected by this issue (including institutions or the general public where relevant). t).
Consider the rights and responsibilities of each of the people involved (e.g., the right to confidentiality, privacy, autonomy).
Consider how this issue will affect the welfare of each of the people involved, keeping in mind your responsibility to ensure your client’s welfare takes precedence.
Don’t forget to consider your own rights, responsibilities, and welfare in this situation.
Try to identify any gaps in your thinking and knowledge by talking with a colleague or supervisor.
3. Generate and examine available courses of action
Pause to consider all factors that might influence the decision you will make, including your level of competence.
Reflect on any social or cultural factors that should be taken into consideration.
Consider the timelines and include the decision to wait and gather more information, where appropriate and possible. Identify possible alternative courses of action and examine the positive and negative consequences of each.
Consult a trusted colleague, supervisor, and/or your professional organization.
4. Choose and implement the most preferred option
Decide on your most preferred course of action and implement it.
Ensure that you document the issue and how you decided on the course of action, including any consultation with colleagues and reference to ethics resources, which may be required at a later date in the event of a complaint or legal action.
5. Reflect on and review the process
Reflect on your own role in the situation and ask yourself:
*Could I have prevented the issue from developing?
Am I satisfied with the way I managed the situation and the processes I engaged in?
Could I have done anything differently at any stage?
Is there anything I can do differently in the future to prevent such a situation (i.e., integrate my learning into my ongoing professional life)?*
Effect Sizes
Effect size – way to quantify the difference between two groups; a difference in means between two groups.
It tells you how well an intervention works, as opposed to just statistical significance (which just tells you whether something works or not).
- .06 - .07 – medium effect size
- .80 + - good effect size.
When the blurb indicates two types of therapy, and you cant decide which you would choose (due to similar effect sizes), you would look at the client’s preferences.
Single Subject Design
What is the most common single-subject design?
- ABA design
- Baseline > intervention > baseline (hard to do with psychological interventions)
- Main issue – we aim for psych interventions to have an effect even when we have ceased intervening
- Validity and reliability for this is not as high for these studies
- E.g., with meds, you can measure the effect of the medicine on blood sugar, and then take the medicine away and measure the baseline again (to assess whether the results are due to the medicine). With psychological interventions, you can’t remove a psychological intervention
What are the 4 areas that Interpersonal Therapy (IPT) focuses on?
- Grief and loss
- Interpersonal disputes
- Role transitions
- Interpersonal sensitivities
Biggest evidence base with depression (newer research shows it can also be helpful for substance abuse, eating disorders, etc.)
Not recommended for: very complex presentations: psychosis, PD’s, acute suicide risk, chronic substance use.
You decide from the beginning which area you will focus on(e.g., grief and loss, disputes, etc.).
Re-Breathing
When a client hyperventilates when anxious, they can be taught to “re-breathe” or engage in general breathing retraining.
This may include:
- cupping hands over mouth and breathing into hands
- breathing into a paper bag
What is the referral question you’re trying to answer?
Firstly, who is issuing the referral? A GP? Psychiatrist? Self-referral?
Secondly, what does the referral seek to ascertain?
Does it indicate the need for a psychological assessment?
- clinical assessment
- cognitive assessment
- personality assessment
- work capacity assessment
- workers comp assessment
- victims of crime assistance tribunal (VOCAT)
- transport accident commission (TAC)
Does it indicate the need for a forensic assessment?
- risk of violence assessment
- forensic psychological assessment
Does it indicate the need for an educational assessment?
- full scale cognitive (IQ) assessment
- education/achievement assessment
Treatment Plans
General plan for anxiety and depression.
Every treatment plan:
- Starts with assessment and diagnosis
- Socialisation to treatment (Psychoeducation)
- Specific interventions (cognitive and behavioural)
Need to know the order of intervention (don’t jump straight into intervention because there can be other things before that).
— In terms of anxiety, you may set behavioural goals before moving into cognitive techniques.
- With depression, behavioural intervention is typically first (behavioural activation, pleasurable activities)
Treatment Report for Court
What to include in a treatment report for court?
Many psychologists make big mistakes here.
In a treatment report, only include:
- Reasons for writing report (e.g., who asked you to)
- The date they presented for the first time and who referred
- How many sessions you have had
- Presenting issues
- Any test results and assessment
- Findings (i.e., problems and possible diagnosis)
- Treatment that has been recommended
- The progress that has been made (if any)
- Any information about the continuation of treatment/further referrals
You cannot include an opinion!
Questions about Communication
With communication – if they ask you about choosing the content of what you need to present – look at the target audience first before deciding.
The other thing to know is that in a report, as a treating psych, you would never include an opinion or a prognosis about what might happen (e.g., if they would re-offend) – you would only include how many times you’ve seen client, what the diagnosis is, whether they are attending – keep it factual, no opinions.
Only expert witnesses will give opinions. So for any court reports as treating psych, you need to keep it short and focused.
What client features should be taken into consideration when planning an assessment?
- Age
- Cultural background
- English proficiency
- Presenting problem
- Physical/developmental restrictions
- Reason for referral
- Available time
- Intended outcome - or what the client hopes to achieve from psychological intervention
Assessment – test selection, interpretation, application, norms, and administration.
Assessment – test selection, interpretation, application, norms, and administration.
- Understanding of issues in test selection, use, interpretation, acceptability, and appropriateness, including:
- the application and limitations of tests and their psychometric and normative basis, including test reliability, validity, utility, and standardization
- the ability to identify and choose appropriate assessment instruments
- cultural responsiveness in testing diverse groups
- the ability to score tests and interpret results, and
- understanding the limitations of computerized interpretive reports.
Knowledge and understanding of the application of forms of assessment including:
- interview techniques (structured and unstructured)
- systematic behavioural observation
- psychometric assessments
- self-monitoring (including diaries), and
- goalsetting based on needs analysis.
Candidates will be asked detailed questions to demonstrate competence in the administration, scoring, and interpretation of six selected tests:
- WAIS (Wechsler Adult Intelligence Scale)
- WISC (Wechsler Intelligence Scale for Children)
- PAI (Personality Assessment Inventory)
- DASS (Depression, Anxiety and Stress Scale)
- K10 (Kessler Psychological Distress Scale), and
- SDQ (Strengths and Difficulties Questionnaire).
Knowledge and application of interview assessments
- a systematic history-taking approach
- the Mental Status Examination
- risk assessment of suicide, self-harm, and harm to others (acute and chronic)
- diagnostic classification systems (including current versions of DSM and ICD)
- setting and monitoring goals measures (including goal attainment scaling)
Overall you need to understand these Statistics
Overall you need to understand Statistics –
Classical test theory (CTT) is a body of related psychometric theory that predicts outcomes of psychological testing such as the difficulty of items or the ability of test-takers.
It is a theory of testing based on the idea that a person’s observed or obtained score on a test is the sum of a true score (error-free score) and an error score. Generally speaking, the aim of classical test theory is to understand and improve the reliability of psychological tests.
Classical test theory assumes that each person has a true score, T, that would be obtained if there were no errors in measurement. A person’s true score is defined as the expected number-correct score over an infinite number of independent administrations of the test. Unfortunately, test users never observe a person’s true score, only an observed score, X. It is assumed that observed score = true score plus some error:
Item response theory (ITT) is a paradigm for the design, analysis, and scoring of tests, questionnaires, and similar instruments measuring abilities, attitudes, or other variables. It is a theory of testing based on the relationship between individuals’ performances on a test item and the test takers’ levels of performance on an overall measure of the ability that item was designed to measure.
Item response Theory does not assume that each item is equally difficult. item response theory treats the difficulty of each item as information to be incorporated in scaling items.
Descriptive
Mean, median, and mode – They are three types of averages. The mean is the average you are sued to. Add all numbers and divide by the quantity of numbers to find the mean. The median is the middle number. Write all values in numerical order and then find the middle number. For odd numbers +1 then divide 2. Mode is the most frequently occurring number.
Range- the distance between the lowest and highest score.
Bell curve – Is a normal distribution. The mean median and mode are all equal. Exactly half the data is below the mean and half above the mean. The majority of the data is closer to the mean and the least amount of data is furthest from the mean.
SD- In statistics, the standard deviation is a measure of the amount of variation or dispersion of a set of values. A low standard deviation indicates that the values tend to be close to the mean of the set, while a high standard deviation indicates that the values are spread out over a wider range.
Scaling
Standardize Score- The standard score is the signed fractional number of standard deviations by which the value of an observation or data point is above the mean value of what is being observed or measured.
Percentile- Percentile is a measure indicating the value below which a given percentage of observations in a group of observations falls. For example, the 20th percentile is the value below which 20% of the observations may be found.
Tells where one stands in relation to everyone else as opposed to the mean. Allows for fair evaluation of data sets that have different means and SD’s.
Percentiles are not evenly spaced/standardized.
Percentile rank- The percentile rank of a score is the percentage of scores in its frequency distribution that are equal to or lower than it. For example, a test score that is greater than 75% of the scores of people taking the test is said to be at the 75th percentile, where 75 is the percentile rank.
Percentile ranks help in clarifying the interpretation of scores on standardized tests. In the case of test theory, the interpretation of the percentile rank of a raw score is as the percentage of examinees in the norm group. Also, these examinees scored below or at the score of interest.
Percentile rank clarifies the interpretation on standardized tests. They are evenly spaced.
Stanine – Standard Nine which is a method for scaling test scores on a 9 point scale with a SD of 2 and a mean of 5.
Other
Ipsative and normative scores- Generally used in personality/organizational psych testing.
Normative assessment compares quantifiable personality characteristics on each scale and provides a final score which is then compared to patterns of normality e.g other test takers representing the population. Generally, likert scales are used for normative tests.
Ipsative tests are also known as forced choice. Test takers are forced to choose between equally desirable choices. Hence scores indicate individual characteristics within however cannot be compared between individuals.
Confidence interval - A confidence interval is a type of interval estimate, computed from the statistics of the observed data, that might contain the true value of an unknown population parameter.
Alpha level - The alpha level is the probability of rejecting the null hypothesis when the null hypothesis is true. It’s the probability of making a wrong decision.
Reliability - The extent to which the results can be reproduced when the research is repeated under the same conditions.
Validity - The extent to which the results really measure what they are supposed to measure.
What is the strength of findings derived from meta-analyses or Systematic history-taking approach
They provide a valid benchmark for comparing the efficacy of interventions.
What is a systematic review or meta-analysis?
A systematic review answers a defined research question by collecting and summarising all empirical evidence that fits pre-specified eligibility criteria.
A meta-analysis is the use of statistical methods to summarise the results of these studies.
Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:
- clearly stated objectives with pre-defined eligibility criteria for studies
- explicit, reproducible methodology
- a systematic search that attempts to identify all studies
- assessment of the validity of the findings of the included studies (e.g. risk of bias)
- systematic presentation, and synthesis, of the characteristics and findings of the included studies
It is essential that each review is approached rigorously and with careful attention to detail. Plan carefully, and document everything. The consensus reporting guidelines for different study designs proposed by EQUATOR (http://www.equator-network.org/) are a useful starting point. PRISMA provides guidance on what you should include when reporting a systematic review.
Step 1: Why do a systematic review?
Step 2: Who will be involved?
Step 3: Formulate the problem. Has it been done before? Registering your review.
Step 4: Perform your search.
Step 5: Data extraction.
Step 6: Critical appraisal of studies (quality assessment).
Step 7 Data synthesis.
Step 8: Presenting results (writing the report).
Step 9: Archiving and updating.
Why do a systematic review?
The massive expansion of research output, both in peer-reviewed publications, and unpublished, e.g. in conference presentations or symposia, mean it is difficult to establish what work has been done in your area already and to ensure that clinical practice keeps up to date with the best research evidence. See this presentation by Susan Shenkin for an Introduction to Systematic Reviews.
A systematic review is often required as part of undergraduate or postgraduate theses, grant proposals, and establishing research agendas. It will be most useful where:
- there is a substantive research question
- several empirical studies have been published
- there is uncertainty about the results
Systematic reviews can be of interventions (i.e. randomized controlled trials) or observations (i.e. case-control or cohort studies). The type of study to be included will depend on your research question. Although sociology and psychology have been performing systematic reviews of observational studies for decades, many of the recent resources have been developed within a medical framework using randomized controlled trials (RCTs) to assess whether a treatment is effective or not. In psychology and related disciplines, observational studies are more common (as RCTs may not be feasible or ethical, e.g. it would not be possible to randomize children to poor or enriched social environments to assess the impact on cognition), and systematic reviews have a very important role to play.
Assessment Interview (9 Steps to the interview CBT approach):
Assessment Interview (9 Steps to the interview CBT approach):
- Explaining the purpose
- Discussing concerns
- Identifying importance
- Understand – behaviours
- Explore these concerns and antecedents
- Identify consequences
- Explore previous approaches
- Explore coping skills
- Explore clients perception
What do you need to know regarding assessments?
Assessment: Most questions will relate to interpretation. You will need to know:
- The order of interpretation
- How scores dictate what, and how, you will interpret
- Mean and standard scores for subscales and FSIQ
- Mean = 100; SD = 15
What it means to have scores that are 2 SD’s above/below the mean (e.g., scores above 2 SD’s [130] are signs of giftedness, and scores below [70] indicate intellectual delay)
Main tests
Screening / Diagnostic / Screener / Info gathering tool
There are 6 Main Assessments that you are supposed to know:
- WAIS (Wechsler Adult Intelligence Scale)
- WISC (Wechsler Intelligence Scale for Children) - know block design well
- PAI (Personality Assessment Inventory)
- DASS (Depression, Anxiety and Stress Scale)
- K10 (Kessler Psychological Distress Scale)
- SDQ (Strengths and Difficulties Questionnaire) - behaviour & emotional screener
SDQ, DASS, and K10 are screeners and not assessments. You cannot diagnose anything on those tests
Primary Index Scales, Sub-tests
Information to know:
- its use (1)
- the age ranges (2)
- target population, (3)
- whether it’s a screener, a diagnostic, or a measure, or an information-gathering tool (4)
- Whether or not it has Australian norms (5)
- whether or not it’s culturally appropriate (6)
WAIS-IV (Wechsler Adult Intelligence Scale)
The measure of intelligence and cognitive ability, including cognitive delay, learning difficulties, giftedness, examination of cognitive strengths and weaknesses or challenges in cognitive functioning.
- The administration manual contains guidelines for the assessment of some examinees with special needs, such as people who are hard of hearing.
- It includes 13 special group studies providing tables of scores for people with intellectual disability, traumatic brain injury, dementia, and autism spectrum disorders.
WAIS is the Wechsler Adult Intelligence Scale,
Its Use: it’s cognitive
its age range: 16 to 90 years, 11 months, and 30 days (16 - 90:11:30)
Screener, diagnostic, repeated measure, or data-gathering tool: It is a diagnostic,
Does it have Australian norms or not: it does not have Australian norms,
Is it culturally appropriate: and it is not culturally appropriate.
Reliability: is good
Validity: is satisfactory
Time: ~60-70 mins (for core)
- 4 domains (VCI, PRI, PSI, WM) = FSIQ
- VCI – Verbal Comprehension Index
- PRI - Perceptual Reasoning Index
- PSI - Processing Speed Index
- WMI - Working Memory Index
- FSIQ – Full-Scale IQ
- FSIQ is calculated using VCI, PRI, WMI, and PSI
- GAI = VCI & PRI
- CPI = VMI & PSI
- 10 core subtests, 5 supplementary (15 subtests in total)
- Five Supplemental subtests are available to replace core subtests or provide optional additional cognitive functioning information
Individually administered intelligence test, designed for use for clients
- Age: 16-90yr 11m.
Used for:
- investigation of cognitive delay
- learning difficulties
- giftedness
- cognitive strengths & weaknesses
- changes in cognitive functioning
Comprises of 15 subtests, with 10 core subtests.
Subtest raw scores are converted to scaled scores, which are combined to give index scores.
WAIS4 used standard scores (M=100, SD=15) for:
- verbal reasoning
- perceptual reasoning
- working memory
- processing speed index scores
- full-scale IQ score
Raw subtests scores are converted to scaled scores (M=10, SD=3) for 15 subtests.
IQ: Range from:
- < 70: Extremely Low / Intellectual Deficient
- 70-80: Borderline
- 80-90: Low Average
- 90-110: Average
- 110-120: High Average
- 120-130: Superior
- > 130: Extremely Superior
Administration takes approximately 60-70min. Australian norms are not available.
WISC (Wechsler Intelligence Scale for Children)
- Measure intelligence and cognitive ability of children
- Used in education, welfare, mental health, hospitals, community health, and private practice
WISC is the Wechsler Intelligence Scale for children,
Its Use: It’s a cognitive,
Its age range: it’s for 6 to 16, and eleven months, (6:0–16:11)
- So, there’s a crossover between WISC and WAIS,
Screener, diagnostic, repeated measure, or data-gathering tool: It is diagnostic.
Does it have Australian norms or not: It does have the Australian norms,
Is it culturally appropriate: and it’s not culturally appropriate,
Reliability: is good
Validity: is satisfactory
Time: ~65 mins (for core)
- 5 domains (VCI, VSI, FRI, WMI, PSI) = FSIQ
- VCI, VSI, FRI = GAI
- VSI: measures visual details (organization, integration, part-whole relationships)
- FRI: conceptual thinking, inductive reasoning – ability to learn new things
- 10 core subtests, 6 supplementary (16 tasks in total)
WISC (Wechsler Intelligence Scale for Children)
FSIQ (Full-Scale IQ):
VCI (Verbal Comprehension Index)
- Vocabulary, Similarities, Comprehension, (Information) (Word Processing)
PRI (Perceptual Reasoning Index)
- Block Design, Matrix Reasoning, Picture Concepts (Picture Completion)
WMI (Working Memory Index)
- Digit Span, Letter-Number Sequencing, (Arithmetic)
PSI (Processing Speed Index)
- Coding, Symbol Search, (Cancellation)
10 primary subtests (16 subtests in total) are used to calculate full-scale IQ, which represents a child’s overall cognitive ability,
Five primary index scales:
- verbal comprehension,
- visual-spatial,
- fluid reasoning,
- working memory &
- processing speed.
Information, Comprehension, Visual Puzzles, Picture Concepts, Arithmetic, Picture Span, Letter Number Sequencing, Symbol Search, Cancellation
Supplementary tests:
Similarities, Vocabulary, Block Design, Matrix Reasoning, Figure Weights, Digit Span, Coding
Can you diagnose intellectual disability from the WISC?
No. A diagnosis of intellectual disability requires an additional assessment of adaptive behaviour.
Block Design
The only questions about administration relate to block design.
You will not get questions about how to discontinue, etc. Q’s about block design will be basic.
Look at the manual for block design. For example:
• You need to know what happens when someone gets 1 of the first two trails wrong, etc.
Answer: if they get a 1 (not a 2), you need to reverse anyway.
• What happens if someone produces a correct design 2 seconds after the time period has passed? Answer: Score it as an incorrect response and make a note that they did it correctly. Anything passed the time limit is an invalid response.
Testing someone using a WISC even though they fit the age range for a WAIS, based on the grounds of suspected intellectual ability? Answer: No! Because then there are no norms. The only way to determine an intellectual disability is based on age-matched norms
INTERPRETING WISC/WAIS
The WISC is a specialized test for children - Used for people aged 6 to 16y 11m.
You should use the WAIS if you are administering it to someone aged between 16-90.
WISC and WAIS
- WISC and WAIS are very similar in construction, procedure, and scoring.
- They have Australian norms
- When they get 5 wrongs it’s out
- Crystallized IQ is from verbal reasoning - More dependent on learning and background
- Fluid IQ is more dependent on prior learning and prior knowledge. Tested via perceptual reasoning.
- WISC can be done at 6,6 - 16,11, the age for WAIS is done from 16 – 89, based on this you can choose either test. So, number 3 and 4 is out
- Kids who fall into the 16-year-old age - If they are struggling academically, you would use the WISC but if you think they are gifted use the WAIS.
- However, you cannot use WISC on a 17-year-old.
- The same thing is the argument for WPSSI or WISC. A 6-year-old can be done for WPPSI or WISC. WPPSI is done from the ages (2:5 – 7:3)
- and the unitary rules have changed for the WISC, but they have not changed for the WAIS.
Can you diagnose intellectual disability from the WISC?
No. A diagnosis of intellectual disability requires an additional assessment of Adaptive Behaviour.
PAI (Personality Assessment Inventory)
- PAI is a multi-scale self-report test of personality
- It is designed to provide information which is relevant to clinical diagnosis, treatment planning and screening for psychopathology
- A 4th grade reading is required
- Has 344 questions/items
- There are 3 different PAI’s
- there’s the PAI
- then the PAI-CS, which is the correctional settings,
- and the PAI-A, which is the adolescent version.
- can administer it even individually or in a group,
PAI - Personality Assessment Inventory
It’s Use: It is a clinically diagnostic for the DSM-5
its age range: It is for 18 + plus
Screener, diagnostic, repeated measure or data gathering tool: It’s a screener and a clinically diagnostic for the DSM-5
Does it have Australian norms or not: no Australian norms but it is used extensively in Australia
Is it culturally appropriate: and culturally appropriate
Time: ~up to 40 mins
The PAI has 22 non-overlapping scales of four varieties:
1) validity scales - 4 items
2) clinical scales, - 11 items
3) treatment consideration scales, - 5 items
4) interpersonal scales. - 2 items
4 Validity Scale
- Inconsistency (ICN): assesses consistency of the respondent’s answers throughout the inventory.
- infrequency (INF): assesses careless or random responding.
- Negative Impression (NIM): assess presentation of negative experiences.
- and Positive Impression (PIM) Scales: assess presentation of exaggerated presentation of very favourable impression respectively.
- There are also supplemental validity indicators for malingering, defensiveness and under-reporting of substance abuse.
11 Clinical scales:
- provide diagnostic features of those within the neurotic spectrum, those within the psychotic spectrum, and those with behaviour disorder/impulse control problems
1. Somatic Complaints (SOM): Focuses on preoccupation with health matters and somatic complaints associated with somatization or conversion disorders.
- [conversion (sensory/motor), physical functioning, preoccupation with health status]
2. Anxiety (ANX): Focuses on phenomenology and observable signs of anxiety, with an emphasis on assessment across different response modalities.
- [degree of tension and negative affect, involvement of anxiety: cog (ruminative worry), affective (tension, difficulty relaxing), physiological (somatic symptoms)]
- So, the next scale that breaks down is anxiety and
we have anxiety C which is cognitive
Anxiety A, which is an effective,
and then anxiety P which is physiological
- and cognitive, affective, and physiological are kind of like three main areas that we look for in psychological distress and mood disorders and so forth.
- Anxiety-related disorders also has the:
ARD-O, O is for obsessive-compulsive
ARD-P, P is for phobias.
ARD-T, T is for traumatic stress.
3. Anxiety-Related Disorders (ARD): Focuses on symptoms and behaviors related to specific anxiety disorders—particularly phobias, traumatic stress, and obsessive-compulsive symptoms.
- [extent of behavioural expression of anxiety: OCD, phobias/fears, traumatic stress]
4. Depression (DEP): Focuses on symptoms and phenomenology of depressive disorders.
- [unhappiness, distress, suicidal ideation, indication of MDD: affective (feelings of sadness), cog (thoughts of worthlessness), physiological (loss of enjoyment in activity/energy/sleep/appetite/weight]
- for depression, we have:
DPC which is cognitive
DPA which is effective
DPP which is the physiological
5. Mania (MAN): Focuses on affective, cognitive, and behavioral symptoms of mania and hypomania.
- [disruptions in mood, cognition, behaviour: activity (accelerated thought processes, over-involvement), grandiosity (inflated self-esteem, superior/unique skills), irritability (strained relationships b/c others can’t keep up with them]
- mania so we’re talking about:
MAN-A, A is activity level,
MAN-G which is grandiosity.
MAN-I, which is irritability,
- so, as you can see the irritability, grandiosity, inactivity level of all components of the DSM criteria for manic states.
6. Paranoia (PAR): Focuses on symptoms of paranoid disorders and on more enduring characteristics of the paranoid personality.
- [interpersonal mistrust and hostility: hypervigilance (suspicious), persecution (been treated inequitably, other people undermining them), resentment (bitter, cynical)]
- paranoia and it breaks down to:
PAR-H, H being hyper vigilance
PAR-P, P which is the persecution
PAR-A, which is the resentment,
- so, hyper vigilance, persecution and resentment, are the three major criteria for paranoia in the DSM-5.
7. Schizophrenia (SCZ): Focuses on symptoms relevant to the broad spectrum of schizophrenic disorders.
- (psychotic (delusional beliefs, unusual perceptions, magical thinking), social detachment, thought (confusion, [])
- we have schizophrenia, SCZ and it breaks down to
SCZ-P p which is psychotic experiences
SCZ-S, s which is social detachment,
SCZ-T which is thought disorder,
- again, the three major components of the DSM criteria.
8. Borderline Features (BOR): Focuses on attributes indicative of a borderline level of personality functioning, including unstable and fluctuating interpersonal relations, impulsivity, affective lability and instability, and uncontrolled anger.
- (affective instability (emotional responsiveness), identity problems (uncertain about life goals), negative relationships (misunderstood by others, intense relationships), self-harm (impulsivity potential for–ve consequences)
- we have borderline now this is the one that breaks down to four and it’s the only one that breaks down to four
BOR-A, which is affect instability.
BOR-I, I which is identity problems,
BOR-N, in which is negative relationships
BOR-S, s which is self-harm.
- and of course, again four of the major areas from the DSM five.
9. Antisocial Features (ANT): Focuses on the history of illegal acts and authority problems, egocentrism, lack of empathy and loyalty, instability, and excitement-seeking. antisocial behaviours
- (illegal), egocentricity (lack of empathy/remorse), stimulus-seeking (craving for excitement, low tolerance for boredom)
- we have antisocial features ANT
- , which is antisocial behaviors
ANT-E which is egocentricity
- which is stimulus seeking again three major criteria from the DSM.
10. Alcohol Problems (ALC): Focuses on problematic consequences of alcohol use and features of alcohol dependence.
11. Drug Problems (DRG): Focuses on problematic consequences of drug use (both prescription and illicit) and features of drug dependence.
- Some clinical scales comprise three or four smaller facet scales. For example, the MAN scale is made up of Activity level, Grandiosity and Irritability.
5 Treatment scales:
1. Aggression (AGG) measures the respondent’s different kinds of aggressive behaviour’s toward others.
- [(aggressive attitude (poor control, hostility, think they should utilize aggression), verbal aggression (assertiveness to abusiveness, readiness to express anger), physical aggression (fights, violence)]
- we go into aggression:
ARG-A, which is attitude
ARG-V which is verbal
ARG-P which is physical
- and of course, if we’ve got a client that’s scoring highly on that,
- what we want to know is, is there some physical level involved here,
- what are we looking at what type of aggression?
- so that we know how to manage how to put strategies in place.
2. Suicidal ideation (SUI) measures a respondent’s frequency and severity of suicidal thoughts and plans.
- [(thoughts of suicide, behaviours, disguise suicidal ideation)]
3. Non-support (NON) measures how socially isolated a respondent feels, and how little support the respondent reports having.
- [level of stress (family, finances, employment, major changes)]
4. Stress (STR) measures the controllable and uncontrollable hassles and stressors reported by the respondent.
5. Treatment rejection (RXR) measures certain attributes of the respondent that are known to be related to psychological treatment adherence, including motivation, willingness to accept responsibility, and openness to change and new ideas.
- [(attitudes towards Tx)]
- (risk for Tx, non-compliance and early termination – acknowledge need for change? Resist efforts to change?):
- potential complications in Tx like harm of self/others,
- environmental circumstances,
- motivation for tv
2 interpersonal scales
1. Dominance (DOM) measures the degree to which a respondent acts dominant, assertive, and in control in social situations.
2. Warmth (WRM) measures the degree to which a respondent acts kind, empathic, and engaging in social situations.
(how people interact with others):
- relationships and interactions such as warm
- WRM: empathetic, engaging
- vs
- cold rejection: withdrawn, mistrustful style; dominating (DOM)/controlling vs submissive
- 2 pathology scales:
- Borderline features scale,
- antisocial features
- Inconsistency scale:
- pair responses that are similar (it should result in similar item scores for the paired items)
- The other one is Suicide Potential Index (SPI),
- It has a raw score between zero and 20, which then converts to a to a T score and you basically evaluate that by the distance from the mean.
- so, the further above the mean it is, the more likely they are to commit suicide, meaning that I have a lot of a known risk factors, and the further below the mean they are, the less likely they are and the more you’re looking at them, you know that those rooms are depression, so depressed that they can’t get off the couch to do anything.
- The other one we have is violence potential index (VPI),
- and it’s used to indicate obviously the potential for someone being violent, it is the same as the SPI score between zero and 20, which is then converted to a T score.
- The higher the T score above the main, the more likely they are to be violent, the lower the T score the lower that mean the less likely they are to be violent, the more passive, that they are.
- and it’s used to indicate obviously the potential for someone being violent, it is the same as the SPI score between zero and 20, which is then converted to a T score.
Personality Assessment Inventory (PAI) is a multi-scale, self-report test for adults 18 and over.
Provides information for clinical diagnosis, treatment planning, screening for psychopathology.
4th-grade reading level required.
PAI has 344 items which form 22 non-overlapping scales. Respondents answer on a 4-point Likert scale (false - true).
Scales:
Validity:
- inconsistency (consistency)
- infrequency (careless or random)
- negative impression (exaggerated negative)
- positive impression (exaggerated positive)
Clinical:
- Somatic Complaints
- Anxiety
- Anxiety-related
- Depressive
- Manic
- Schizophrenic
- Paranoid & Personality Dis
- Borderline
- Illegal/Authority
- Alcohol & Drug
Treatment:
- Aggression
- Suicidal Ideation
- Recent Stressors
- Nonsupport
- Treatment Rejection
Interpersonal:
- Dominance
- Warmth
PAI
PERSONALITY ASSESSMENT INVENTORY (PAI)
The PAI is a comprehensive personality assessment of psychopathology.
Assesses for personality disorders, mood, anxiety, somatic concerns, drugs, alcohol.
For vocational counselling, you would use 16PF or NEO (5 factors of personality).
PAI is used often for forensics, court reports. PAI has 4 types of scales. Validity, clinical, treatment considerations, and interpersonal scales.
The board focuses on general interpretation and not on specific scales. We may need to know cut-offs for clinical scales (but not for validity scales).
Scored in T scores – mean of 50, SD of 10. E.g., normal/average is 41-59. Reading level is Grade 4. Has 344 questions. 18yrs+ (there is an adolescent one which we do not need to know)
Interpersonal scales - dominance and warmth.
Clinical scales - somatic, anxiety and related disorders, depression, mania, BPD, anti-social PD, alcohol, drugs, paranoia, schizophrenia.
Scores with 60-69 (1 SD) is considered mild/transient.
Any scores 70+ (2 SD) is in clinical range. Need to know clinical scales most comprehensively.
Validity scales – inconsistency, positive impression management (faking good), negative impression management (faking bad), infrequency (e.g., the degree to which some people respond to bizarre questions is true). High scores in validity scales indicate you need to be careful in interpreting the profile.
In MMPI there is a LIE scale (validity scale) – the principle is the same as with the PAI validity scales – if they tell you the T score is 50 or below, you know they are not lying/malingering. If they ask you about any validity scale and the score is below 50, you can be sure that is OK. MMPI is longer than PAI, very similar to the PAI.
Treatment consideration scales – factors that may impact on treatment or other risk factors – aggression, suicide, non-support (social isolation), stress, treatment rejection (how much they want to have the treatment and how motivated they are to change and respond to treatment).
In treatment, 70+ t scores are also used to indicate clinical ranges.
If 18 or more items have not been responded to, they need to review and complete if possible.
Uninterpretable if 18 or more questions (5%) have not been answered. If more than 20% of a specific scale question has not been answered you need to interpret with caution.
In terms of community and clinical norms – in the community – the average is 50, 1SD is 60,
Need to know what is the clinical skyline – which is 2SD above the clinical population (80). When would you compare your scores to the clinical skyline? If your client scored above 70 in any of the clinical or treatment scales, you would then compare your client to the clinical population.
Clinical skyline – is 2 SD above the mean for clinical population. Above 70 is the clinical range. To decide whether a score is clinical or not, you need to look at community norms and whether the score is 2 SDs or more above the mean (which is 50).
Community norms and clinical norms are the important ones to know.
The validity Scale needs to be above 60 for this to be invalid. Clinical Scales and Treatment Scales need to be above 70 for a problem to exist. The clinical skyline is a comparison to the community. Above 70 is still a problem but above the skyline is a serious problem.
How should results to the PAI be presented?
Scores on the PAI are presented as T scores, with a mean of 50T, and an SD of 10T.
T scores can be referenced against general and clinical populations.
PAI includes 4 kinds of scales:
- Validity - respondents’ approach to test, incl. faking good or bad, exaggerating, defensiveness.
- Clinical - Psychiatric diagnostic categories.
- Treatment - Relate to the treatment of clinical disorders.
- Interpersonal - Personality functioning.
What does the DASS measure?
Its Use: its uses for mood,
Its age range: essentially age ranges 14 + Plus,
Screener, diagnostic, repeated measure, or data-gathering tool: it’s a screener and a repeated measure,
Does it have Australian norms or not: It does have Australian norms,
Is it culturally appropriate: not culturally appropriate,
- Used with adults
- Used with care when used with younger people
- 3 domains: Depression, anxiety, stress
- Full DASS is 42 items of 3 domains
- A shortened version is 21 items (takes half the time)
- Depression:
- dysphoria,
- homelessness,
- devaluation of life,
- self-depreciation,
- lack of involvement,
- anhedonia (don’t find anything enjoyable),
- inertia (remain unchanged)
- Anxiety:
- autonomic arousal,
- muscular effects,
- situational anxiety,
- subjective experience of anxiety
- Stress:
- difficulty being able to wind down,
- nervous arousal,
- easily upset/agitated,
- irritable/over-reactive, impatient = measures responses to a stressor
IMP:
- The anxiety scale on DASS correlates with panicky symptoms, phobias, other anxiety disorders.
- Stress scale correlates more to G.A.D.
- Depression scale correlates with Mood disorders
- Generally done above 16 years
Measures levels of severity of depression, anxiety, and stress.
Not a diagnostic measure and will not replace a clinical interview.
Gives client and clinician important feedback and monitor progress.
• Two forms
- Long: 14 items for each of the three scales
- Short: 7 items for each of the three scales
• Instructions:
How much each statement applied to you over the past week – I.e., state measure.
Norms
• Manual Scoring (sum all items within the scale)
- Depression: 3, 5, 10, 13, 16, 17, 21
- Anxiety: 2, 4, 7, 9, 15, 19, 20
- Stress: 1, 6, 8, 11, 12, 14, 18
• N.B: Scores on the DASS-21 will need to be multiplied by 2 to calculate the final score (range is 0-42))
Domains of depression:
- Dysphoria, Hopelessness, Devaluation of Life, Self-Deprecation, Lack of Involvement Anhedonia and Inertia
Domains of anxiety:
- Autonomic arousal, muscular effects, situational anxiety, subjective experience of anxiety.
Domains of stress:
- Difficulty in winding down, nervous arousal, easily upset/agitated, irritable/overreactive, impatience.
DASS 21:
Meaning Depression Anxiety Stress
Normal 0-9 0-7 0-14
Mild 10-13 8-9 15-18
Moderate 14-20 10-14 19-25
Severe 21-27 15-19 26-33
Extremely severe 28+ 20+ 34+
What is the K10?
It’s a global measure of nonspecific psychological distress
It’s Use: Its use is for psychological distress, which has its own conceptual definition.
its age range: It’s from 13 + plus,
Screener, diagnostic, repeated measure, or data-gathering tool: it’s a screener and a repeated measure,
Australian norms or not: It does have Australian norms,
culturally appropriate: it’s not culturally appropriate,
- It has 10 items
- it’s a nonspecific psychological distress scale that is indicating need for further assistance,
- 10 - items about emotional states - identifies levels of distress
- Psychometric assessments – not a diagnostic tool
- psychological distress (those experiencing a wide range of mental health disorders have high scores of non-specified distress)
- Usually when GP’s want referrals to psychologists in a mental health plan
- Queried K-10 stability over time
- it’s a Likert scale: all the time, most of the time, some of the time, a little of the time, none of the time
- Score: one to five you sum the scores to get a total K-10 score,
- the lowest possible score is 10, because even if you say it doesn’t relate to you that’s scores one, so, 10 and the highest is 50.
- The relationship between psychological the K-10 score and psychological distress is linear.
- So, the lower the score the less distress, the higher the score, the more distress.
K-10
Is not a diagnostic tool. It is a screener
It cannot tell you specific mental disorders. E.g., depression
Moderate levels is significant
Below 20 is fine
20 - 24 is a mild mental disorder
25 - 29 is a moderate mental disorder
30 and up is severe
The interpretation so the score categories
- 10 to 15 is low remember 10 means that events have none of the time, all of them, so that within itself is a little bit strange that you score 10 when nothing relates to you, so they didn’t have the first month,
- or zero it actually starts of one.
- 16 to 21 is moderate
- 22 to 29 is high
- The total score of 10-50
1 = none of the time
2 = a little of the time
3 = some of the time
4 = most of the time
5 = all of the time
30 to 50 is very high.
Kessler Psychological Distress Scale
- Screening instrument
– Predictive of anxiety and affective disorders
- Used extensively in population surveys.
K-10 Norms
Category Score/Band
Normal: Under 20
Likely to have a mild mental disorder: 20-24
Likely to have a moderate mental disorder: 25-29
Likely to have a severe mental disorder: 30+
- 13% of the adult population will score 20 and over
- About 1 in 4 patients seen in primary care will score 20 and over
- Manual scoring: Simply sum the response to all 10 items
- Scores range from 10-50
Strengths & Difficulties Questionnaire (SDQ)
SDQ
SDQ (Strengths and Difficulties Questionnaire)
It’s Use: It’s a behavioural tool
its age range: It’s from 2 + plus,
Screener, diagnostic, repeated measure or data-gathering tool: it’s a screener,
Australian norms or not: It does have Australian norms,
culturally appropriate: it’s not culturally appropriate,
- This can be done for younger and older kids
- Emotional problem scale; conduct problem scale; hyperactivity scale and peer problem scale – looks at problems
- Prosocial scale - looks at strengths
- Emotional problem scale and peer problem - make up internalizing problems
- Conduct and hyperactivity - make up externalizing scales
- Total difficulty scale = is the sum of all problem scores
- Don’t have to know the scoring
- Need to know usually when people report on the scoring they report in percentiles and the way you score it is adding up raw scores
- If a child scores on the 90% for total problem scores this means they have more problems than 90% of the child population.
- http://www.sdqinfo.com/
- You can do a 1 sided or 2 sided - the reverse of the page is an impact statement. Impact statement looks at how much the problems the child has impact their home life, friendship, classroom learning, and leisure activities.
- You get a score from 0 - 10 on this. with 10 being severe.
- There are different versions of the SDQ’s
- There’s the parent report measures, there’s teacher report measures and then there’s the youth self-report measures
- Assessment of emotional and behavioural problems in children and adolescents
- used as an initial assessment
- internalizing behaviours (emotional, peers), externalizing (conduct, hyperactivity), prosocial behaviours
SDQ is a behavioral screening questionnaire of strengths and difficulties
It’s Use: it’s a brief screening questionnaire assessing emotional and behavioural problems in children and adolescents,
its age range: the age range goes from 2 + plus (
- for parents and teachers 4 to 17-year-olds)
- (modified version for parents and preschool teachers of 2 to 4-year-olds)
- and (self-report version for completion by young aged 11 to 17-year-olds)
Screener, diagnostic, repeated measure or data-gathering tool: it’s a screener.
Australian norms or not: It does have Australian norms,
culturally appropriate: and it’s not culturally appropriate,
- There are several versions depending on the needs of the user
- Components include a 25-item questionnaire
- there are three components, depending on which version that you’re using
- the first component is psychological attributes and there’s 25 of them,
- it asks about is five different categories asks about:
- conduct problems
- hyperactivity
- emotional problems,
- peer problems
- prosocial behaviour
- Each subscale consists of five items.
- SDQ can be used for clinical assessment
- It can be used as a pre and post measure, and it can also be used as screening as well,
1) 25-item SDQ
2) impact supplement (parent/teacher/self; does the respondent think they have a problem? Assess the level of impact on themselves and to others/friends/home life/leisure activities)
3) follow-up questions: has the intervention reduced the problem or made problem more bearable?
* 25-item, 5 subscales: emotional problems (happy/sad), peer problems (has friends or solitude), conduct problems (temper tantrums, fights), hyperactivity (restless, overactive), prosocial (helpful, considerate of others)
There’s the parent report measures, there’s teacher report measures and then there’s the youth self-report measures
- Some of them have, children are four to 10 children 11 to 17 or youth 11 to 17 etc.
- So, there’s different age groups but they all work off the same principles.
Each version includes between one and three of the following components:
A) 25 items on psychological attributes.
All versions of the SDQ ask about 25 attributes, some positive and others negative. These 25 items are divided between 5 scales:
1) emotional symptoms (5 items)
}
1) to 4) added together to
generate a total
difficulties score
(based on 20 items)
2) conduct problems (5 items)
3) hyperactivity/inattention (5 items)
4) peer relationship problems (5 items)
5) prosocial behaviour (5 items)
* The same 25 items are included in questionnaires for completion by the parents or teachers of 4-16 year old’s (Goodman, 1997).
* A slightly modified informant-rated version for the parents or nursery teachers of 3 (and 4) year old’s. 22 items are identical, the item on reflectiveness is softened, and 2 items on antisocial behaviour are replaced by items on oppositionality.
* Questionnaires for self-completion by adolescents ask about the same 25 traits, though the wording is slightly different (Goodman et al, 1998). This self-report version is suitable for young people aged around 11-16, depending on their level of understanding and literacy.
- In low-risk or general population samples, it may be better to use an alternative three-subscale division of the SDQ into ‘internalising problems’ (emotional + peer symptoms, 10 items), ‘externalizing problems’ (conduct + hyperactivity symptoms, 10 items) and the prosocial scale (5 items) (Goodman et al, 2010).
B) An impact supplement
Several two-sided versions of the SDQ are available with the 25 items on strengths and difficulties on the front of the page and an impact supplement on the back. These extended versions of the SDQ ask whether the respondent thinks the young person has a problem, and if so, enquire further about chronicity, distress, social impairment, and burden to others. This provides useful additional information for clinicians and researchers with an interest in psychiatric caseness and the determinants of service use (Goodman, 1999).
C) Follow-up questions
The follow-up versions of the SDQ include not only the 25 basic items and the impact question, but also two additional follow-up questions for use after an intervention. Has the intervention reduced problems? Has the intervention helped in other ways, e.g. making the problems more bearable? To increase the chance of detecting change, the follow-up versions of the SDQ ask about ‘the last month’, as opposed to ‘the last six months or this school year’, which is the reference period for the standard versions. Follow-up versions also omit the question about the chronicity of problems.
SDQ Overview
- The Strengths and Difficulties Questionnaire (SDQ) is a brief emotional and behavioural screening questionnaire for children and young people. The tool can capture the perspective of children and young people, their parents, and teachers.
- There are currently three versions of the SDQ: a short form, a longer form with an impact supplement (which assesses the impact of difficulties on the child’s life), and a follow-up form.
- The 25 items in the SDQ comprise 5 scales of 5 items each.
- The scales include:
1) Emotional symptoms subscale
2) Conduct problems subscale
3) Hyperactivity/inattention subscale
4) Peer relationships problem subscale
5) Prosocial behaviour subscale
* The SDQ can be used for various purposes, including clinical assessment, evaluation of outcomes, research and screening.
Property
Definition
SDQ
Internal consistency
The degree to which similar items within a scale correlate with each other.
Research on the reliability of the SDQ has produced mixed results. Some articles say the SDQ exhibits strong internal consistency (Yao et al., 2009), some say the SDQ shows satisfactory internal consistency (Goodman, 2001) and others say there are concerns regarding the reliability of the subscales, with most subscales showing low internal consistency. It has been suggested that the SDQ total difficulties score should just be used for screening purposes (Mieloo et al., 2012).
Test-retest reliability
The degree to which the same respondents have the same score after a period of time when trait shouldn’t have changed.
SDQ showed moderate test-retest reliability (Yao et al., 2009).
Concurrent validity
Correlation of the measure with others measuring same concept.
SDQ shows good concurrent validity (Muris, Meesters & van den Berg, 2003).
Discriminant validity
Lack of correlation with opposite concepts.
SDQ showed good discriminant validity (Lundh, Wangby-Lundh & Bjarehed, 2008).
Populations
- The SDQ can be completed by children and young people aged 11-17 years old, and a separate version can be completed by those aged 18 and over. The parent and teacher SDQ can be completed by the parent or teacher of CYP aged between 2 and 17 years old.
- Clinical experience indicates that the SDQ may be appropriate to use with CYP with mild learning difficulties, but not with more severe learning difficulties (Law & Wolpert, 2014).
Administration
- The questionnaire takes between five and ten minutes to complete. All versions of the questionnaire can be given to the appropriate respondent to complete themselves. The questionnaire can be completed on paper or online and can all be found on the Youth In Mind website.
- Alternatively, in order to ensure that each item is understood by the respondent, or to gain additional information about each response, the questionnaires can be administered directly by the clinician who can ask follow-up questions.
Scoring
- Assisted Scoring: If CYP, parents or teachers fill out the SDQ online, the Youth in Mind website produces a technical and readable report with a description of the scores for a small cost.
- Manual Scoring: Paper versions of the SDQ can be scored by following the instructions found on the SDQ website.
Interpretation
- Assisted: After entering paper versions of the SDQ on the SDQ website, a report designed for professionals will then be generated.
- If CYP, parents or teachers fill out the SDQ online, the Youth in Mind website produces instant feedback reports including a technical report designed for professionals as well as a readable report with a description of the scores, the level of concern, an overall impression as well as suggestions about what to do if the child or young person, their parent/teacher still has concerns.
- Manual: Instructions for scoring the SDQ manually can be found on the SDQ scoring website and instructions for interpreting the SDQ when scored by hand can be found here. Instructions in other languages are also available here.
Translation
- The SDQ is one of the most widely and internationally used measure of child mental health and has been translated into more than 80 languages. The English and translated versions are available here. Information on normative SDQ data from the United Kingdom, Australia, Denmark, Finland, Italy, Germany, Japan, Spain, Sweden and the United States can be found here.
A widely used, brief-screening questionnaire with 25 core questions, assessing emotional and behavioral problems in children and adolescents, between 4-17yrs.
Scores contribute to five subscales:
- conduct problems
- hyperactivity
- emotional problems
- peer problems
- prosocial behavior
The second component is the impact supplement which asks respondents whether they think the young person has a problem and the perceived impact of the problem.
How would you use the results of an SDQ in further assessment planning?
These results help identify young people who should be referred for further assessment and or/intervention, as well as evaluating treatment outcomes.
Which of the SDQs Subscales might not be good for indigenous children?
Peer Problem Subscale
Additional Assessments - Candidates must demonstrate familiarity with the use and purpose of the following tests:
Assessment - Candidates must demonstrate familiarity with the use and purpose of the following tests:
Intelligence Scales
- WPPSI (Wechsler Preschool and Primary Scale of Intelligence)
- Stanford-Binet (Stanford-Binet Intelligence Scales) - SB-5
- WASI Wechsler Abbreviated Scale of Intelligence
- Woodcock-Johnson Test of Cognitive Abilities
- Raven’s Standard Progressive Matrices
Adaptive & Educational Assessments
- WIAT (Wechsler Individual Achievement Test)
- ABAS (Adaptive Behaviour Assessment System)
Memory
- WMS (Wechsler Memory Scale)
- WRAML (Wide Range Assessment of Memory and Learning)
Vocational
- SDS (Self Directed Search)
- Strong (Strong Interest Inventory)
Personality
- 16PF (Sixteen Personality Factor Questionnaire)
- NEO (NEO Personality Inventory)
Clinical & Mental Health Tests
- BDI (Beck Depression Inventory)
- GAF (Global Assessment of Functioning)
- STAI (State-Trait Anxiety Inventory)
- WHO-DAS (World Health Organisation Disability Assessment Scale)
- WHO-QOL (World Health Organisation Quality of Life Scale)
- ORS (Outcome Rating Scale)
- MMPI (Minnesota Multiphasic Personality Inventory)
- PHQ-9 (Patient Health Questionnaire 9 Item)
- CBCL (Achenbach Child Behaviour Checklist and Teacher/Youth reports - ASEBA)
- Structured Clinical Interview for DSM (SCID)
Primary Index Scales, Sub-tests
Information to know:
- its use (1)
- the age ranges (2)
- target population, (3)
- whether it’s a screener, a diagnostic, or a measure, or an information-gathering tool (4)
- Whether or not it has Australian norms (5)
- whether or not it’s culturally appropriate (6)
Wechsler Preschool & Primary Scale of Intelligence 4th Ed (WPPSI-IV)
(Intelligence)
Individually administered instrument for assessing pre-school and early primary school children (aged 2yr 6m, to 7y 7m). Is used to assess children referred for cognitive delays, intellectual disabilities, intellectual giftedness, and informing educational intervention and placement decisions.
WPPSI is an Intelligence Scales
- Measure intelligence and cognitive ability
- Time: ~60 mins for all primary subtests
WPPSI assesses the intelligence of preschool and early primary school-aged children, the current version is the WPPSI-4
Its use: A measure of Cognitive Development
The age: 2 years 6 months to 7 years 7 months (2:6-7:7)
Screener, diagnostic, repeated measure or data-gathering tool: It’s a diagnostic
Does it have Australian norms: It has Australian Norm
Is it culturally appropriate: It’s not culturally appropriate, (although it is not a match for Aboriginal status, because Australian indigenous various from continent to continent but does match the NZ indigenous community), however, these are the assessments that we use with our indigenous population, so, we interpret with caution,
- It’s - gender age-appropriate but has not been done for the indigenous population or caveat is a must
Reliability: Excellent
Validity: Good
Ages: 2:6 – 3:11
Full Scale: 3 domains (VCI, VSP, WMI)
Ages: 4:7 – 7:12
Full Scale: 5 Domains (VCI, VSI, FRI, WMI, PSI)
Consist of:
- 15 subtests - 10 core subtests, 5 supplementary (15 tasks in total)
- Subtest batteries differ for younger (2:6-3:11) and older (4:0-7:7) children.
- Verbal Comprehension Index (Information; Similarities; Vocabulary; Comprehension)
- Visual-Spatial index (Block Design; Object Assembly)
- Fluid Reasoning Index (Matrix Reasoning; Picture Concepts)
- Processing Speed Index (Bug Search; Cancellation; Animal Coding)
- WPPSI is used in the assessment of children referred for cognitive delays, intellectual disabilities, and intellectual giftedness, and for informing educational intervention and placement decisions.
Stanford Binet Intelligence Scales (SB5)
(Intelligence)
Can be used for people between 2 and 85+ years in a range of contexts, including clinical and neuropsychological assessment, early childhood assessment, psychoeducational evaluations for placements, compensation evaluations, career assessment, selection, forensics ad research. Takes 45-60min to administer.
SB5 identifies individuals of low intellectual functioning as well as those with gifted intellectual functioning. SB5 measures individual performance on complex tasks of memory, judgment, and comprehension.
SB5 measures five factors of genitive ability:
- Fluid Reasoning
- Knowledge
- Quantitative Reasoning
- Visual-Spatial Processing
- Working memory
Each factor includes a verbal and non-verbal counterpart.
SB5 is an Intelligence Scales
- Measures low intellectual functioning and gifted
- Time: ~45-60 mins
- ~15-20 min after the full-scale batter ABIQ can be administered
Current version is SB-5
Its use: identifies individuals of low intellectual functioning as well as those of gifted intellectual functioning. It measures individual’s performance on complex tasks of memory, judgment, and comprehension.
The age: It has a range of 2-year-olds - 85-year-old (2:0 – 85:0)
Screener, diagnostic, repeated measure or data-gathering tool: It’s a diagnostic
- It’s normed with VIQ - Vocal Intelligence Quotient NVIQ (Nonverbal IQ)
- FSIQ – Full-Scale IQ
Does it have Australian norms: It is not an Australian Norm but a US norm
Is it culturally appropriate: It’s not culturally appropriate
Reliability: Very high
Validity: has good concurrent and criterion validity
- It’s not widely used in private settings
- If we need to use another after the Weschler we go to* C-Tony -2 (comprehensive Test of Nonverbal Intelligence) it is asked by Centrelink etc.
- It identifies both positive and negative cognitive processes
5 domains:
- Fluid Reasoning,
- Knowledge,
- Quantitative Reasoning,
- Visual-Spatial Processing,
- Working Memory
- For each of the five-factor indexes, there are verbal and nonverbal counterparts (e.g., nonverbal fluid reasoning and verbal fluid reasoning).
- The nonverbal subtests require minimal linguistic skills and rely mostly on nonverbal responses (e.g., pointing and/or moving pieces).
- The verbal subtests require competency with words and printed material (e.g., reading and/or speaking).
- The 10 subtests comprise the Full-Scale IQ (FSIQ).
- The five verbal subtests combine to form the Verbal IQ (VIQ), and the Nonverbal IQ (NVIQ) combines the five nonverbal subtests.
- An Abbreviated Battery IQ (ABIQ) can be used when time is limited.
- The ABIQ provides a global estimate of overall cognitive functioning level and can be used as a screening tool.
- The SB-5 can be used in a variety of contexts for different purposes, including clinical and neuropsychological assessment, early childhood assessment, psychoeducational evaluations for special education placements, compensation evaluations, career assessment, selection, forensics, and research.
IQ Range
IQ Classification
<130
Giftedness
120-129
Extremely High
110-119
High average
90-109
Average
80-89
Low average
70-79
Borderline impaired or delayed
>69
Mildly impaired or intellectual delayed
Used in the US from 1908
• Binet’s work with Lewis Terman at Stanford was crucial
– Translated and expanded the test
– Developed norms
• First test to
– Provide detailed instructions on administration and scoring
– Use the concept of IQ
– Provide alternate items
• Application: Ages 2-89+
• Norms: Deviation IQ
– Normed on nearly 5,000 people with complex sampling used
– Matches norms to 2000 U.S. Census
– Age norms
• Tries to balance language-based and non-language skills
• Around an hour to administer
• Individually administered
• Requires training to
administer
• Testing begins with an item from a routing test (object series or vocabulary)
– Optimises difficulty of items to participant
– Improves rapport
– Reduces time required to administer the test
• Facilitates adaptive testing: Testing at a level appropriate for the test taker. Don’t want items that are too hard or too easy. Why?
– More efficient
– Helps with rapport
– Means that test taker is not asked too many items, causing fatigue
• Structure: Ten subtests
– As well as full-scale IQ, you can calculate a Quantitative IQ, Knowledge IQ, and others
Wechsler Abbreviated Scale of Intelligence (WASI)
(Intelligence)
A brief measure of cognitive ability, suitable for ages 6-91yrs.
Takes approx 45min to administer.
It is used in clinical, educational & research settings to estimate IQ when a comprehensive test is unnecessary or to determine if a full test is warranted or as a re-test measure.
Not intended for diagnosis or education support.
WASI is an Intelligence Scales
- A Measure of Intelligence and Cognitive Abilities
- Conducted when a comprehensive test is unnecessary; to determine if a full test is warranted; as a re-test measure
- Time: ~ FSIQ4 (30 mins) Four-Subtest form, 30 minutes,
- ~ FSIQ2 (15 mins) Two-subtest form, 15 minutes
Latest is WASI-II
Its use: in clinical, educational, and research settings to estimate IQ when a comprehensive test is unnecessary, to determine if a full test is warranted or as a re-test measure.
The age: 6-90 years old
Target population: WASI delivers an estimation of a student’s general intellectual ability by measuring the verbal, nonverbal, and general cognition of individuals from 6 to 89 years of age.
Screener, diagnostic, repeated measure or data gathering tool: It’s a diagnostic
Does it have Australian norms: It does have Australian norms for WASI- 4 but not for WASI-2
Is it culturally appropriate: It’s not culturally appropriate
Reliability: Good with adults and children
Validity: demonstrating adequate concurrent validity
- All subtests form the FSIQ-4, and Vocabulary and Matrix Reasoning combined form the FSIQ-2.
- While WASI-II has unique test items and norms, its subtests can substitute corresponding WAIS-IV and WISC-IV subtests if full assessment is required.
Block Design, Matrix Reasoning = FSIQ4
Vocab, Matrix Reasoning = FSIQ2
- VCI (Vocabulary, Similarities, Information, Comprehension) = VIQ
- PRI (Digit Symbol Coding, Symbol Search) = PIQ
- FSIQ
- the short form is used in incidents where it’s not appropriate to use the full WAIS
- the person that may have an impairment that could be a physical impairment that prevents them from being able to sit through the longer test
- we would use it on the indigenous population because there has been the ability to sustain attention and for the rested sub-tests applicability.*
- You get an FSIQ, and it’s an estimate of general cognitive ability.
- The VCI is going to give you crystallized abilities
- and the PRI is going to give you fluid ability,
- so, VCI - Crystallized intelligence and PRI = Fluid intelligence.
- So, from the form theory of intelligence,
- there is a two sub-tests form, which is vocabulary and matrix reasoning.
- obviously, the short form is used in incidents where it’s not appropriate to use the full WAIS
“Superior” Performance: 130 and beyond. Individuals who score in this range are considered to be in the superior or “gifted” range.
“Very High” Performance: 120-129. Individuals who score in this range as classified as performing at a high level.
“Bright Normal” Performance: 110-119.
“Average”: 90-109
“Low Average”: 80-89
“Borderline Mental Functioning”: 70-79
Woodcock-Johnson III Tests of Cognitive Abilities (WJ - III COG)
Suitable for ages 2-90 yrs.
Based on Cattell-Horn-Carroll’s theory of cognitive abilities.
Comprised of 10 tests and 10 extended tests.
Has Australian norms.
WJ is an Intelligence Scales
- The Woodcock-Johnson Tests of Cognitive Abilities is an intelligence test series (often referred to as IQ test). … The comprehensive series of exams is designed to measure general intellectual ability, as well as academic achievement, scholastic aptitude, cognitive abilities and oral language.
- The WJ IV comprehensive system offers the ease of use and flexibility examiners need to accurately evaluate learning problems and improve instructional outcomes for children and adults in a way that no other assessment can.
- Manual provides suggestions for assessing clients with hearing and visual impairments
The latest is: WJ-IV (Fourth Edition)
Its use: It’s a measure of both cognitive abilities and achievement among children and adults.
The age: 2 years to 90 plus year-olds (2:0 – 90:0)
Target population: children and adults
Screener/diagnostic/repeated measure/info gathering tool: It’s a diagnostic
Does it have Australian norms: there are Australian norms for the standard batteries, but not for the extended battery as yet,
Is it culturally appropriate: not appropriate
Time: ~ 40 mins (extended version is ~2 hours)
- 10 subtests and additional 10 extended subtests
- Measures: word knowledge, meaningful memory, visual-spatial ability, synthesis sounds, inductive and fluid reasoning, visual perceptual speed, short-term auditory memory, auditory analysis, short term auditory memory span, delayed recall
- Not very popularly used
The WJ IV consists of three independent and co-normed batteries, which may be used separately or in any combination, emphasising the identification of individual strengths and weaknesses by providing comparisons both within each battery and across batteries:
- WJ IV Tests of Cognitive Abilities
- WJ IV Tests of Achievement
- WJ IV Tests of Oral Language – NEW!
Features
- Patterns of strengths and weaknesses identified through an easy-to-use test and cluster comparison procedure.
- Australian norms (Standard Batteries)
- Updated and expanded interpretive model.
- New domain-specific scholastic aptitude clusters that allow for efficient and valid predictions of academic achievement.
- WJ IV Australian Adaptation Scoring Software (PC only) allows examiners to easily enter raw scores, assessment data, and test session observations for any test in the WJ IV suite of assessments on their computer to quality and easily generate reports.
Benefits
- New! WJ IV Tests of Oral Language battery which supplements the Cognitive and Achievement batteries to provide measures of oral language, phonetic coding, and speed of lexical access for a more comprehensive evaluation of cognitive abilities or achievement.
- Patterns of strengths and weaknesses are a readily obtainable component of any evaluation.
- Yields a new Gf-Gc Composite for comparison to measures of cognitive processing, oral language and achievement.
- Increased diagnostic sensitivity.
- Utilizes the most diagnostically useful system for current and future assessment needs.
- Provides the most efficient use of testing time.
- Offers greater administration flexibility and interpretive clarity.
- Supports multidisciplinary evaluation with three distinct, independent batteries.
- Pinpoints cognitive and language correlates of learning problems, allowing professionals to more accurately target interventions.
Score Range
Percentile Rank
Range Classification
131 and above
98 to 99.9
Very Superior
121 to 130
92 to 97
Superior
111 to 120
76 to 91
High Average
90 to 110
25 to 75
Average
80 to 89
9 to 24
Low Average
70 to 79
3 to 8
Low
69 and below
0.1 to 2
Very Low
RAVEN -
RPM
Raven’s Standard Progressive Matrices
RPM is an Intelligence Scales
Time: 20-45 min
Type: Individual or group
Its use: A nonverbal group test typically used in educational settings
The age: 6 to 80 years
Target population: ethnically diverse population
Screener/diagnostic/repeated measure/info gathering tool: diagnostic
Does it have Australian norms: has Australian norms
Is it culturally appropriate: culturally appropriate
Raven’s Progressive Matrices is a leading global non-verbal measure of mental ability, helping to identify individuals with advanced observation and clear-thinking skills who can handle the complexity and ambiguity of the modern workplace.
The SPM was designed to assess non-verbal reasoning in the general population and is used widely in clinical, educational, occupational, and research settings.
The SPM score indicates a candidate’s potential for success in professional, management and high-level technical positions that require:
- Clear thinking
- Problem identification
- Holistic situation assessment
- Monitoring of tentative solutions for consistency with all available information
- It is usually a 60-item test used in measuring abstract reasoning and regarded as a non-verbal estimate of fluid intelligence.
- It is the most common and popular test administered to groups ranging from 5-year-olds to the elderly.
- It is made of 60 multiple choice questions, listed in order of difficulty.
- This format is designed to measure the test taker’s reasoning ability, the eductive (“meaning making”) component of Spearman’s g (g is often referred to as general intelligence.
- All of the questions on the Raven’s progressives consist of visual geometric design with a missing piece. The test taker is given six to eight choices to pick from and fill in the missing piece.
- Raven thought that the tests commonly in use at that time were cumbersome to administer and the results difficult to interpret.
- Accordingly, he set about developing simple measures of the two main components of Spearman’s g: the ability to think clearly and make sense of complexity (known as eductive ability) and the ability to store and reproduce information (known as reproductive ability).
- Raven’s tests of both were developed with the aid of what later became known as item response theory.
- Many patterns are presented in the form of a 6×6, 4×4, 3×3, or 2×2 matrix, giving the test its name.
- The tests were originally developed by John C. Raven in 1936.
- In each test item, the subject is asked to identify the missing element that completes a pattern.
Another test that might be considered to be culture-fair or culturally reduced is the Raven’s Progressive Matrices (Raven, 1941, 1981; Raven, Court, & Raven, 1983, 1985).
Versions
The matrices are posed in three different forms for participants of different ability:
- Standard Progressive Matrices: The booklet comprises five sets (A to E) of 12 items each (e.g., A1 through A12), with items within a set becoming increasingly difficult, requiring ever greater cognitive capacity to encode and analyse information.
- Coloured Progressive Matrices: Designed for younger children, the elderly, and people with moderate or severe learning difficulties, this test contains sets A and B from the standard matrices, with a further set of 12 items inserted between the two, as set Ab. Most items are presented on a coloured background to make the test visually stimulating for participants. However, the very last few items in set B are presented as black on white; in this way, if a subject exceeds the tester’s expectations, transition to sets C, D, and E of the standard matrices is eased.
- Advanced Progressive Matrices: The advanced form of the matrices contains 48 items, presented as one set of 12 (set I), and another of 36 (set II). Items are again presented in black ink on a white background and become increasingly difficult as progress is made through each set. These items are appropriate for adults and adolescents of above-average intelligence.
- The test was introduced in 1938 and has gone through many revisions, because it is nonverbal, and in most situations requires little more than having the examinee point to the correct item, it is often used in situations where examiners want a measure of ability that is not biased by educational background or by cultural or linguistic deficiencies.
- All of the test items are composed of geometric figures that require the test taker to select among a series of designs the one that most accurately represents or resembles the one shown in the stimulus material.
- The test items are presented in graded levels of difficulty and there are test booklets for different age levels. Validity measures involving the correlation of the Raven Matrices with the Stanford-Binet and the Wechsler Scales range from .54 to .86.
- The authors indicate that “the scales can be described as ‘tests of observation and clear thinking,…By themselves they are not tests of ‘general intelligence’…They should be used in conjunction with a vocabulary test”.
- Despite this caution, the Progressive Matrices have been viewed as measures of intelligence and have been widely used in many countries to test military groups because they are considered to be independent of prior learning.
Scoring:
90-100 Well above average (90th percentile and above)
0-10 well below average (10th percentile and below)
10-30 below average (11th to 30th percentile)
30-70 average (31st – 70th percentile)
70-90 Above average (71st – 90th percentile)
Raven’s Standard Progressive Matrices
Raven’s Progressive Matrices (often referred to simply as Raven’s Matrices) or RPM is a nonverbal test typically used to measure general human intelligence and abstract reasoning and is regarded as a non-verbal estimate of fluid intelligence.
It is one of the most common tests administered to both groups and individuals ranging from 5-year-olds to the elderly.
It comprises 60 multiple choice questions, listed in order of increasing difficulty. This format is designed to measure the test taker’s reasoning ability, the eductive (“meaning-making”) component of Spearman’s g (g is often referred to as general intelligence).
Wechsler Individual Achievement Test (WIAT-II)
Designed to assess achievement in individuals ages 4-85.
Academic achievement is assessed either in a broad range of skills or in particular areas of interest.
Comprised of 9 subtests that make up 4 composites:
- Reading
- Maths
- Written Language
- Oral Language
May be used in school settings to assist in dx of specific learning disability, academic strengths, eligibility for educational services & intervention designs.
The WIAT is often used in schools or clinic settings to assist with the diagnosis of a specific learning disability, identification of students’ academic strengths and weaknesses, eligibility for educational services, and/or intervention designs.
The WIAT is not used to measure academic giftedness in adults or older adolescents. It is important to remember that most assessments, including the WIAT scores, should be considered alongside qualitative behaviour observations and skills analysis of the examiner. This may be included in the question by mentioning “what would the next best step for the psychologist be” …if there is an option
WIAT is an Adaptive & Educational Assessments
Time: ~45-120 mins
WIAT – Wechsler Individual Achievement Test, latest version 3
Its use: Academic achievement (Educational) in a broad range of skills/specific area of interest and giftedness in adults or older adolescent.
The age: It goes from 4 years to 50 years, 11 months (4:00 – 50:11)
Target population: is really important when we’re considering that we’re using in an educational setting and is used in clinical settings too
Screener/diagnostic/repeated measure/info gathering tool: It is a diagnostic
Does it have Australian norms: Yes, it has Australian norms
Is it culturally appropriate: it’s not culturally appropriate
- There is no normative data specific to the indigenous population, however, we do use it, and we interpret with caution
Reliability: subtests and composites indicates adequate stability across time, ages and grades.
Validity: has moderate to high correlations with other achievement test scores which are consistent across various individual and group administered tests.
4 domains:
- Reading,
- mathematics,
- written language,
- oral language
For standard scores, each number given shows the level at which the child is performing:
- Very superior scores are scores over 130.
- Superior scores range from 120-129.
- High Average scores range from 110-119.
- Average scores range from 90-109.
- Low scores range from 80-89.
- Borderline scores range from 70-79.
- Extremely Low scores are scores under 69.
Adaptive Behaviour Assessment System (ABAS-3)
Used to evaluate adaptive behavior skills which are important to everyday functioning.
Useful in identifying strengths and weaknesses.
Can be useful in establishing a baseline to compare the effectiveness of interventions.
Suitable for any age.
ABAS is an Adaptive & Educational Assessments
ABAS – Adaptive Behaviour Assessment System, the latest version is 3
Its use: used to evaluate adaptive behaviour skills which are important to everyday functioning. It’s giving us a picture of adaptive skills across the lifespan
The age: from birth all the way through to 89 years (0-85)
Target population:
Screener/diagnostic/repeated measure/info gathering tool: a measure of ability and a repeated measure
Does it have Australian norms: there are Australian norms
Is it culturally appropriate: not necessarily
Time: ~15-20 mins
3 domains: Conceptual, Social, Practical = General Adaptive Composite
- Conceptual: Communication (speech, listening), functional academics (basic reading, writing), self-direction (independence)
- Social: Leisure (recreational), social
- Practical: Community use (shopping), home/school living (cleaning), health & safety (protection), self-care (groom), motor (fine & motor), work (for adults and youth)
Adaptive behavior assessment system is really important in our diagnostics for intellectual impairment
- and it’s actually a DSM-criteria that intellectual functioning and adaptive skills are paired together when doing a diagnosis.
ABAS and adaptive functioning there are other forms of adaptive functioning assessments but an ABAS in particular is really useful for the assessment of
- people with developmental delays,
- autism spectrum disorder,
- intellectual disability,
- learning disabilities,
- neuropsychological disorders,
- and sensory or physical impairments,
because these are all of the things that if you’re going to restrict us from being able to successfully function in our environment,
- so adaptive skills are really important in understanding how an impairment impacts a person.
- so, in the beginning when we’re talking about measures,
- and when we’re talking about, genotype, phenotype, state, trade, etc.
- This is obviously on the side of a dynamic factor that can change over time,
-
IQ is something that is considered a static factor.
- So, in the early years, it’s still developing, etc.
- Whereas adaptive behaviors are dynamic.
- well, it’s a measure of ability and it can be a repeated measure because this is looking at dynamic factors or phenotypes, that can change over time.
- So, they’re the two that are in our category for adaptive and educational assessments.
Conversations with clients about medication
- How antidepressant medications work
- Why complying with the regimen is critical
- How long it takes to reach therapeutic windows (when enough medication is in the bloodstream to be effective)
- Potential side effects that might arise
- Which side effects to be concerned about and which to endure
- How to talk with the prescribing doctor about symptoms
Wechsler Memory Scale (WMS-IV)
(Memory)
Comprehensive & current battery assessing a range of memory abilities in adults aged 16 - 90.
The adult battery comprises seven subtests:
- Logical Memory
- Verbal Paired Associated
- Visual Reproduction
and four new tests
- Brief Cognitive Status Exam
- Designs
- Spatial Addition
- Symbol Span
WMS is a Memory Scale
- Measures memory abilities and deficits
WMS Measures memory abilities and deficits and Current version VMS-4
Its use: assesses visual memory is used to assess dementia and assess brain dysfunction
The age: 16-90:11 months
Target population:
Screener/diagnostic/repeated measure/info gathering tool: Its diagnostic and we can assess memory impairment
Does it have Australian norms: It does have Au norms
Is it culturally appropriate: Not culturally appropriate for it doesn’t have a version for the aboriginal population but widely used
Time: ~45-60 min
- It’s the most difficult to learn within the Weschler scales
- You can combine the scores WMS and WAIS are used for Neurological
- 5 domains: Auditory memory, visual memory, visual working memory, immediate memory, delayed memory
- 7 subtests: Logical memory, verbal paired associated, visual reproduction, general cognitive screener, design memory, spatial addition, symbol span
Optional: brief cognitive status exam (for those suspected memory deficits or those with neurodevelopmental disorders (learning difficulties, dementia)
- Usually want you to choose to do a WMS when people are having problems with because the WAIS does not measure visual memory.
and their scoring, in working off the bell curve,
- so, it makes a little bit easier to learn to deliver.
Wide Range Assessment of Memory & Learning (WRAML2)
(Memory)
Assesses memory ability in a range of contexts, including:
- memory deficits among people with brain injury
- dementia
- developmental disabilities
Assesses range of memory from childhood to older adulthood (5-90yr).
It had a Screening Memory Index that enables a brief but reliable assessment of memory.
WRAML is a Memory Test
- WRAML is measuring memory abilities and deficits
WRAML’s latest version is 2
Its use: is a standardized test of memory and learning battery, so not as depth as the WMS
The age: It’s from 5 to 90 years old (5:0-90:0) (with the WMS starts at 16, whereas a WRAML starts at 5)
Target population: was based on developments in cognitive, developmental, and neuropsychology. It is designed to assess memory ability in a range of contexts including assessments of memory deficits among people with brain injury, dementia, and learning and other developmental disability.
Screener/diagnostic/repeated measure/info gathering tool: It’s a diagnostic, even though it’s broad still diagnostic
Does it have Australian norms: doesn’t have Australian norms
Is it culturally appropriate: not culturally appropriate
- Time: ~28 min
- Its strength lies in the ability to assess a range of aspects of memory from childhood through to older adulthood (5–90 years).
- The WRAML2 consists of six core subtests that contribute to three core indexes: Verbal Memory, Visual Memory, and Attention-Concentration.
- These combine to provide a General Memory Index.
- Optional subtests enable the assessment of working memory, delayed recall, and recognition memory.
- A Screening Memory Index can also be administered to establish whether a more in-depth assessment is indicated.
- The WRAML2 is designed to be used in a range of clinical settings including schools, rehabilitation services, vocational counselling, hospitals, and private practice as well as in the research.
- 3 domains: Verbal memory, visual memory, attention-concentration = General Memory Index
- 6 subtests
- so, we have the three indexes verbal, visual and attention, and concentration.
Self-Directed Search (SDS)
(Vocational)
Self-assessment career inventory designed to assist ppl 15yr + to identify career interests and match them to suitable occupations or career fields.
Classified into six different categories:
- Realistic
- Investigative
- Artistic
- Social
- Enterprising
- Conventional
More congruent an individual’s personality is with the characteristics of the occupation, the greater the individual’s vocational satisfaction.
SDS is a Vocational Assessment
- Vocational psychometric tests: Career inventory
- identify their career interests and match them with suitable occupations
- the more congruent with the characteristics of occupation, the more satisfaction
The latest version is 5
Its use: to identify their career interests and match them to suitable occupations or career fields based on the theory that people and occupations can be classified into six different categories: RIASEC - Rational, Investigative, Artistic, Social, Enterprising, Conventional,
The age: 11 years to 70 years
Target population: Assesses career interests, it matches aspirations - vocational
Screener/diagnostic/repeated measure/info gathering tool: it’s really just a measuring tool,
Does it have Australian norms: it does have Australian norms
Is it culturally appropriate: it’s not necessarily culturally appropriate
Time: 25-35 minutes
Reliability: demonstrates sound reliability with Cronbach’s alpha coefficients for the activities, competencies and occupations scales.
Validity: demonstrates acceptable concurrent and predictive validity.
- based on the theory that people and occupations can be classified into six different categories, including
- Realistic (R),
- Investigative (I),
- Artistic (A),
- Social (S),
- Enterprising (E),
- Conventional (C).
- RIASEC - Rational, Investigative, Artistic, Social, Enterprising, Conventional,
- The more congruent an individual’s personality is with the characteristics of the occupation, the greater the individual’s vocational satisfaction.
- The SDS consists of five sections:
- Occupational
- Daydreams (respondents can list up to five occupations),
- Activities (66 items rated Like/Dislike),
- Competencies (66 items rated Yes/No),
- Occupations (84 items rated Yes/No),
- and Self-Estimates of abilities and skills (12 items rated on a scale from 1 = Low to 7 = High).
Strong Interest Inventory (SII)
(Vocational)
Suitable for 16+
Used to aid career decision-making by helping people understand their interests across a broad range of categories and to match them with compatible occupational, educational, and leisure pursuits.
Also used for employee engagement, leadership & executive coaching & employee reintegration.
Strong Interest in a Vocational Test
- Vocational psychometric tests: Career assessment instrument
- Aids career decision-making
Its use: its similar to SDS
The age: is 16 Plus
Target population: Assesses career interests, it matches aspirations – vocational, it
Screener/diagnostic/repeated measure/info gathering tool: we don’t consider it diagnostic or screening or any of those, it’s not aimed at coming up with a diagnosis etc., gathering tool
Does it have Australian norms: don’t really have norms
Is it culturally appropriate: it’s not necessarily culturally appropriate
Time: 35-40 minutes
- The SII is often used to aid career decision making by assisting individuals to gain an in depth understanding of their interests across a broad range of categories and to match them with compatible occupational, educational, and leisure pursuits.
- Apart from career exploration and development, the SII is also used for employee engagement, leadership and executive coaching, and employment reintegration.
The 2012 updated version of the SII consists of five scales:
- General Occupational Themes (GOTs) based on Holland’s six personality types of Realistic (R), Investigative (I), Artistic (A), Social (S), Enterprising (E), and Conventional (C)
- 30 Basic Interest Scales (BIS), which measure specific areas such as art, science, athletics, social sciences, sales, and office management
- 260 Occupational Scales (OSS), which are based on occupations in the United States
- 5 Personal Style Scales (PSS) including Work Style, Learning Environment, Leadership Style, Risk Taking, and Team Orientation
- 3 Administrative Indices used to identify test errors or unusual profiles.
Sixteen Personality Factor Questionnaire (16PF)
(Personality)
Standardized, self-report that assesses a broad range of personality factors.
Appropriate for 16+ years.
16PF is a Personality Assessment
- Personality psychometric tests that helps with vocational and occupational preferences and suitability
- Can be good for knowing personality, good to know coping styles, help inform psychiatric diagnosis
Latest version 5th edition
Its use: is a standardized self-report measure that assesses a broad range of personality factors. It is generally used to assist with identifying vocational and occupational preferences and suitability.
The age: 16+
Target population: Adults - is used in occupations - or organisations use it if you have the desirable personality that Provides a measure of personality that fits in with providing us with a measurement of anxiety, adjustment, emotional stability and behavioral problems
Screener/diagnostic/repeated measure/info gathering tool: It’s not diagnostic in line with DSM-5.
Does it have Australian norms: It doesn’tt have Australian norms however it is constructed to worldwide personality type
Is it culturally appropriate: no it’s not culturally appropriate
Reliability: It has adequate reliability (internal consistency and test retest)
Validity: Convergent and discriminant.
So, the true false on this makes it an ipsative test
- So, Ipsative test makes it a forced choice I’ve been talking about last week, - the false choices kind of like in making them go from one extreme to the other.*
- There’s no middle ground like on a Likert scale.
16 PF looks at 16 primary personality scales and 5 global personality scales, they are all bipolar scales. The five primary global scales it’s talking about relate to
- The Big Five Personality Theory that we have,
- OCEAN, which most of you would have learnt about it at university,
it can have some diagnostic meaningfulness, but essentially, it assists us with looking at
- psychiatric disorders,
- Or with therapy planning
- Or with prognosis
- but then also can be used in a career in occupational setting as well and that’s what makes the 16 PF popular, because of its ability across settings.
The 16PF-5 comprises 185 multiple-choice items, resulting in scores on 16 scales of primary personality factors:
- Warmth,
- Reasoning,
- Emotional Stability,
- Dominance,
- Liveliness,
- Rule-Consciousness,
- Social Boldness,
- Sensitivity,
- Vigilance,
- Abstractedness,
- Privateness,
- Apprehension,
- Openness to Change,
- Self-Reliance,
- Perfectionism,
- and Tension.
The measure also assesses
- social desirably expressed through an Impression Management Index,
- and generates scores (through combining related primary scales)
- for five global personality factors (i.e., Extraversion, Anxiety, Tough-Mindedness, Independence, and Self-Control).
NEO Personality Inventory (NEO PI-R)
(Personality)
Based on the 5-factor model of personality, assessing:
- Neuroticism,
- Extraversion,
- Openness,
- Agreeableness &
- Conscientiousness.
NEO-PI is a Personality Battery
- Personality psychometric tests
Latest is the revised version (NEO PI-R)
Its use: Provides a detailed assessment of normal personality, NEO stands for neuroticism, extraversion and openness,
The age: 12+ revised version 17 years to 89 years
Target population: personality inventory
Screener/diagnostic/repeated measure/info gathering tool: Not diagnostic
Does it have Australian norms: there are no Australian norms
Is it culturally appropriate: not culturally appropriate
Reliability: has adequate reliability (internal consistency and test-retest)
Validity: convergent and discriminant validity
Time: ~ 30-40 minutes
- NEO stands for neuroticism, extraversion and openness which is the three of the five for the Big Five Personality Factors and the other two are agreeableness and conscientiousness – so it’s basically a Five Factor Model
- In addition, the NEO PI-R also reports on six subcategories of each Big Five personality trait (called facets)
The NEO PI, NEO PI-R (or Revised NEO PI), and NEO PI-3, respectively
The inventories have both longer and shorter versions with the full NEO PI-R
- consisting of 240 items and providing detailed facet scores,
- whereas the shorter NEO-FFI (NEO Five-Factor Inventory) has only 60 items (12 per domain).
- The test was originally developed for use with adult men and women without overt psychopathology.
- It has also been found to be valid for use with children.
In the most recent publication, there are two forms for the NEO, self-report (form S) and observer-report (form R) versions
The NEO PI-R is self-administered and is available in two parallel versions. Each version contains 240 items and three validity items and requires a 6th-grade reading level.
- Form S, designed for self-reports, is appropriate for use with adults, including individuals of college age.
- Form R, designed for observer reports, is written in the third person for peer, spouse, or expert ratings. It can be used as an alternative measure or as a supplement to self-reports from adult clients.
- Each item is rated on a 5-point scale.
the big five personality factors OCEAN,
- Neuroticism (mood/emotional instability, highly stress/anxious),
- extraversion,
- conscientiousness (goal-directed behaviours, executive functioning),
- openness to experience,
- agreeable (altruism, prosocial behaviours)
PAI, 16-PF, NEO, & MMPI
Special Note:
- So, that’s the only thing you need to really be careful of in the exam is not choosing the PAI** when you should be choosing **16 PF or NEO and vice versa as well.
- So, the PAI you just really need to remember that that is a very clinical instrument based on the major sections in the DSM five
- and is not used in any type of vocations setting, whereas 16 PF** and **NEO are based on the personality theory used in vocational settings.
- The difference between that NEO** has Agreeableness **16 PF doesn’t
- Also remember that the MMPI does provide valuable insight on a range of different areas, not just In terms of clinic diagnostic measures, it has 500 questions and is most widely used within the personality tests.
Difference between
Higher-level dimensions 5 global scales 5 domains
Lower-level dimensions or traits 16 primary factors 30 facet scales
Bottom-up Top-down
Beck Depression Inventory (BDI-II)
(Depression)
A self-report measure of the severity of depression. 21 items.
BDI is a Clinical & Mental Health Tests
- clinical and mental health tests
- this self-report measures severity of depression
The latest version is 2
Its use: self-report measure of the severity of depression
The age: 13 yrs. and older
Target population:
Screener/diagnostic/repeated measure/info gathering tool: diagnostic and repeated measure
Does it have Australian norms: doesn’t have Australian norms but is widely used in Australia
Is it culturally appropriate: not culturally appropriate
Reliability: noted as sound
Validity: it’s designed to validate DSM-IV
Time: 5-10 minutes
- It very much is like A DASS or like a K-10
- Has 21 items
- Respondents select one of four statements for each item that best represents how they have been feeling over the preceding fortnight
Global Assessment of Functioning (GAF)
Measures a person’s overall psychosocial functioning -
- psychological symptom severity
- social functioning
- occupational impairment
- current functioning due to mental health
- self-care
- danger to self/others
GAF is a Clinical & Mental Health Test
- Clinical and mental health tests
- psychosocial functioning
- not supported by DSM-V b/c GAF follows the multi-axial structure and has been designed for DSM-IV
- WHODAS is more recommended
Its use: GAF measures a person’s overall psychosocial functioning and
The age: Adults and school-aged children, however, Children’s Global Assessment Scale is also available
Target population: Adults and school-aged children to gather information
Screener/diagnostic/repeated measure/info gathering tool: a gathering tool
Does it have Australian norms: no Australian norms
Is it culturally appropriate: not culturally appropriate
-
3 domains:
- Psychological symptom severity, s=
- Social functioning,
- Occupational impairment
- APA recommends standardized scales and risk assessment instead of one single score rating covering 3 domains
- Has normative samples
The GAF measures a person’s overall psychosocial functioning and forms Axis V of the DSM-IV-TR.
The GAF summarizes, in a single score, three function domains: psychological symptom severity, social functioning, and occupational impairment.
- Current functioning due to mental health is rated, with self-care and danger to self/others also informing scoring. The GAF is not included in the DSM-5, which also no longer uses a multiaxial structure.
- Instead, the WHODAS 2.0 is recommended and provided in Section III; APA recommends the use of standardized scales and risk assessments rather than a single-score rating for the domains covered by the GAF.
So, in DSM-4 we used to have axes one for clinical disorders, axes to two for personality disorders and intellectual impairment, axes three was social.
So, anything in the social, educational, occupational, you know, like recently divorced or recently lost a job or etc.
- The next one was a general medical condition.
So, if the person has cancer or diabetes, or something that could impact as well, and then the last scale was the GAF, but we don’t actually do that anymore.
GAF score of 1-100
With higher score indicates healthier functioning.
it can be 98, it can be 2, it could be 7.
So, within each of those anchor points, there’s descriptives as to how you define where the person sits in that anchor point.
State-Trait Anxiety Inventory (STAI)
(Anxiety)
One of the most commonly used measures of anxiety in adults.
Provides measures of Trait Anxiety and State Anxiety.
STAI is a Clinical & Mental Health Tests
State Trait Anxiety: how you are predisposed to respond to stressors across life situations; individual differences, how you generally feel
- State anxiety: fluctuating anxiety based on immediate, threatening stimuli/temporary conditions
State Trait Anxiety Inventor
- differentiates between state anxiety and trait anxiety.
- State Anxiety - something temporary. Looks at anxiety in a particular situation. This is panic attacks
- Anxiety trait - is anxiety all the time in a person. This is constant anxiety and may be avoidant personality.
- It can also distinguish between depression and anxiety.
- It is very often used when people present with somatic symptoms
Its use: it measures two types of anxiety, State and Trait there is also a STAI for children (STAIC) with the same number of items
The age: It is used with Adults 18+ but there is a children’s version 9–12
Target population:
Screener/diagnostic/repeated measure/info gathering tool: it’s diagnostic and a repeated measure on STATE ONLY
Does it have Australian norms: there’s no Australian norms,
Is it culturally appropriate: not culturally appropriate
Reliability: Internal consistency is high for the anxiety component
Validity: convergent and discriminant validity
Time: ∼10 minutes to complete
- 40 items in total: 20 items for trait, 20 items for state
- STAI FORM Y-1: State Anxiety (how you feel right in this moment)
- STAI FORM Y-2: Trait Anxiety (how you generally feel)
Phenotype (dynamic) genotype (static)
static (not changeable), dynamic (changeable), etc.
So, state and trait:
- state - refers to the phenotype - the dynamic side of the equation,
- and the state is basically how you’re responding to what’s happening around you at that particular time.
- whereas trait - refers to the genotype - like your inherent side of the equation is your inherent traits, that is going to show through regardless of what’s happening around you.
It’s almost like two separate question is there’s a state one, and there’s a trait one, and you come up with two scores, and then there’s a formula that combines those two scores to gives you an overall score.
So, there’s a Form X and there is a Form Y
consists of 40 questions on a self-report basis
original STAI‐X, the STAI was revised in 1983 (STAI‐Y) and has been used extensively in a number of chronic medical conditions including rheumatic conditions such as rheumatoid arthritis, systemic lupus erythematosus, fibromyalgia, and other musculoskeletal conditions.
Different other versions exist:
- State-Trait Anxiety Inventory for Children (STAIC)
- Test Anxiety Inventory (TAI)
- State-Trait Anger Expression Inventory-2 (STAXI-2)
STAI for children (STAIC) with the same number of items
STAI FORM
Y-1 scoring 1-4:
1 = not at all; 1
2 = somewhat;
3 = moderately so;
4 = very much so
STAI FORM
Y-2 scoring 1-4:
1 = almost never;
2 = sometimes;
3 = often;
4 = almost always
four-point Likert scale.
1) not at all, 2) somewhat, 3) moderately so, and 4) very much so
Using a cut score of 8 overall provided sensitivities and specificities at ∼80% and reaching 90% in a community cohort for the HADS‐A for detecting anxiety disorders.
In primary care populations, cut scores of ≥9 for the HADS‐A yielded moderate sensitivity (0.66) and high specificity (0.93)
WHO-DAS
World Health Organization - Disability Assessment Scale
Clinical & Mental Health Tests
World Health Organisation Disability Assessment Schedule 2.0
- Assessment for health and disability
- mental, neurological, and addictive disorders
Current version 2.0 (previous one was II roman numeral)
Its use: it’s basically a generic assessment instrument, for health and disability.
The age: 18+
Target population: for health and disability
Screener/diagnostic/repeated measure/info gathering tool: not diagnostic a measure of function
Does it have Australian norms: It doesn’t have Australian norms
Is it culturally appropriate: has cultural norms, WHO is cross cultural
Time: ~5-20 minutes
- 12 item OR 36 items
- WHO - Internationally recognised organization.
- Cognitive (understand and communication), mobility (moving/getting around), self-care (hygiene), getting along (interacting with other people), life activities (leisure, work, school), participation (community)
- Scores are summed to get 0-100 disability
WHO-DAS is an instrument that basically covers 6 domains of functioning. the functioning domains that it covers are
- cognition,
- mobility,
- self-care,
- getting along (which is kind of like your social skills interacting with other people)
- life activities (like your domestic responsibilities, leisure work, etc.)
- and participation (joining in community activities)
- they are going to change across time but cognition and mobility, not necessarily, or mobility may or may not change, but cognition you know their understanding and communicating abilities are not likely to change.
WHO-DAS are both available online.
- There are recently added to the curriculum. They are screeners.
- WHODAS is the impact on mental health issues in people’s day-to-day functioning.
- NDIS is accepting the WHODAS as it is a measure of disability caused by health or mental health issues..
- 2 versions one for the client and one for the parents or friends. Can be used for kids as well.
- If the question includes disability due to mental health issues - the answer could be WHODAS
- Look at: American Psychiatric Online Assessment Measures, look under disability for WHODAS
WHO-QOL
World Health Organization- Quality of Life scale
Clinical & Mental Health Tests
Its use: WHOQOL measures of quality of life, is based on an individual’s perception, so it’s self-report
The age: 18 plus
Target population: it’s a measure of quality but perceived quality
Screener/diagnostic/repeated measure/info gathering tool: it’s a screener
Does it have Australian norms: It has Australian norms
Is it culturally appropriate: It is culturally appropriate
- it’s a measure of quality but perceived quality, that’s really important
-
so, a person’s perception can be impacted by a number of different variables obviously,
- their own mental health at that point in time.
- depression
- it can be impacted by personality disorders etc.
- and I guess the important factor there we need to realize is that the person’s perception is real to them
Outcome Rating Scale (ORS)
Brief measure of client functioning, for use in clinical, counseling and community settings.
Was developed as regular monitoring of client progress has significant positive effect on client outcomes from treatment.
High scores may indicate that the client is experiencing sustained improvement in their overall well-being over the course of therapy.
Note that this measure does not assess therapeutic relationship or psychological intervention.
ORS is a Clinical & Mental Health Tests
- measures client functioning (wellbeing) and therapy outcomes (regularly monitor whether there are treatment outcomes/effects)
- Scale to see whether the client is happy with the therapeutic process.
- It is about client outcomes. It is about whether the client is seeing benefit in his life outside therapy.
Its use: a brief measure of client functioning, developed for use in clinical counselling and community settings
The age: 13 +
Target population: The ORS is a simple, four-item session-by-session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention.
Screener/diagnostic/repeated measure/info gathering tool: just a measure
Does it have Australian norms: doesn’t have norms
Is it culturally appropriate: not appropriate
Reliability and Reliability: ORS demonstrated adequate validity and moderate reliability for participants from both clinical and nonclinical samples when compared with extensive measures
Time: ~ 1 min
- The ORS is a simple, four-item session-by-session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention.
- The ORS and CORS they do have psychometric properties,
- but the YCORS doesn’t but it’s a useful way of engaging children.
- CORS was developed for children aged 6 to 12
Four dimensions of client functioning that are widely considered to be valid indicators of successful outcome.
- Personal or symptom distress (measuring individual well-being).
- Interpersonal well-being (measuring how well the client is getting along in intimate relationships)
- Social role (measuring satisfaction with work/school and relationships outside of the home).
- Overall well-being.
- The ORS translates these four dimensions of functioning into four visual analogue scales which are l0cm lines, with instructions to place a mark on each line with low estimate to the left and high to the right.
- The ORS is designed to be accessible to a child with a 13-year-old’s reading level, making it feasible for adolescents and adults.
- The CORS was developed for children age 6–12. It has the same format as the ORS but with more child friendly language and smiley and frowny faces to facilitate the child’s understanding when completing the scales (Duncan et al., 2003).
- For children 5 or under there is also the Young Child Outcome Rating Scale (YCORS), which has no psychometric properties, but can be a useful way of engaging young children regarding their assessment of how they are doing.
- The development of the ORS came in response to a growing area of research demonstrating that regular monitoring of client progress had significant positive effects on clients’ outcomes from treatment.
- Its design was also in response to a need for a briefer, cost-efficient, and less complex tool to assess client functioning than what was available to practitioners at the time.
- The ORS was designed to measure clients’ functioning irrespective of any particular type of treatment model being applied by the practitioner and is in alignment with evidence-based practice to include eliciting feedback on clients’ progress in treatment.
- ORS (13+ years)
- CORS (6-12 years)
- YCORS ( <5 years)
The ORS (ages 13 and over)
- *The cut-off scores are:**
- Cut off for 13–17-year-olds = 28
- Cut off for 18 and over = 25
- *The CORS** (ages 12 and under) cut-off scores are:
- Child Self Reporting = 32
- Carer Reporting on Child = 28
The ORS/CORS cut off scores between the clinical population and the non-clinical population are different depending on the age of the client:
- 13-17-year-olds (self-reporting & carer reporting on teen) = 28
- 18 and over = 25 The CORS (ages 12 and under) cut off scores are:
- Child Self Reporting = 32
- Carer Reporting on Child = 28
It is important to explain these cut-off scores to young people and carers.
the YCORS is just a page form of phases which is full of faces and expressions
- Quantify by using a ruler
Minnesota Multiphasic Personality Inventory (MMPI-2)
(Personality)
Most widely used, clinical assessments in personality assessment, which also assesses dimensions of psychopathology.
MMPI is a Clinical & Mental Health Tests – Personality Assessment
- Another Personality assessment is the MMPI.
- It also has validity scales, T scores but it is just longer, it has 500 questions
Current version is: 2
Its use: MMPI is used quite a lot in Queensland for emergency services, screening of personnel
The age: 18+
Target population: is a standardized psychometric test of adult personality and psychopathology. Psychologists and other mental health professional use various versions of MMPI to help develop treatment plans, assist with differential diagnosis help answer legal questions (forensic psychology) screen job candidates during the personal selection process
Screener/diagnostic/repeated measure/info gathering tool: It is a diagnostic
Does it have Australian norms: don’t have Australian norms, norms of US only
Is it culturally appropriate: definitely not culturally appropriate.
- MMPI does provide valuable insight on a range of different areas, not just In terms of clinic diagnostic measures
- 567 items of True/False responses of abnormal behaviour and personality
clinical scales:
- 1 Hypochondriasis (Hs)
- 2 Depression (D)
- 3 Hysteria (Hy)
- 4 Psychopathic Deviate (Pd)
- 5 Masculinity-‐Femininity (Mf)
- 6 Paranoia (Pa)
- 7 Psychasthenia (Pt) - (phobia, obsessions, compulsions), schizophrenia, hypos mania, social introversion)
- 8 Schizophrenia (Sc)
- 9 Hypomania (Ma)
- 0 Social Introversion (Si)
What are code types:
Code-‐type groups are more homogeneous
- Greater likelihood that descriptors will fit individual with the code type
- More focused descriptors
Highest clinical scales in a profile
- High-‐point codes/One-‐point code types; highest clinical scale in profile
- Two-‐point code types; two highest clinical scales in profile
- Three-‐point code types; three highest clinical scales in profile
Guidelines for Interpreting Code Types
Excluding scales
- Do not include scales 5 and 0 in determining code types. These scales are different in nature from the other eight clinical scales.
- Most previous code‐type research has not included them.
Order of scales
- Except when interpretive materials specifically indicate otherwise, order of scales in two-and three‐point code types is not important (e.g., 13 code and 31 code have same interpretation).
Guidelines for Interpreting Code Types
Definition
- Interpret only defined code types - at least 5 T-score points between lowest scale in code type and next highest clinical scale in profile (excluding 5 and 0).
- For profiles that do not have defined code types, interpretation should focus on individual scales.
Elevation
- When scales in defined code types are elevated (T > 65), include both symptoms and personality descriptors in interpretation.
- When scales in defined code types are not elevated (T < 65), include personality descriptors but not symptoms in interpretation.
it is definite ipsative and its forced choice. So, it’s true or false, there is no in-between
and quite often you get quite a lot of false positives or false negatives because they’re being forced to one direction or the other
Patient Health Questionnaire 9-item (PHQ-9)
(Depression)
9-item depression module of full Primary Care Evaluation of Mental Disorders PHQ.
The full PHQ is a screener & diagnostic tool for mental health disorders such as depression, anxiety, alcohol, somatoform, and eating disorders.
PHQ-9 is a Clinical & Mental Health Tests
- PHQ-9: screens, measures, monitor severity of depression
- Item 9 on PHQ-9 screens for suicide ideation (risk assessment)
- FULL PHQ measures: depression, anxiety, alcohol, somatoform, eating disorders
- It is a self-report
This is the current version
Its use: used to measure change in quality of life over the course of treatment
The age: ≥15 years
Target population: homogeneous populations (same kind)
Screener/diagnostic/repeated measure/info gathering tool: it is used as a screener but as a diagnostic and for monitoring as well, so it’s a multipurpose screening, diagnosing, monitoring and measuring the severity of depression
Does it have Australian norms: no Australian norms
Is it culturally appropriate: not culturally appropriate
Time: ~5:10 min
-
PHQ-9 actually has nine items.
- But based on the DSM and depression only
- it really is a depression assessment
- But not used anywhere near as much as DASS or as BDI
- It actually relates to DSM four, however, as we know the constructs of depression in DSM four and DSM five did not change a great deal.
- Shorter than other depression rating scales
- Can be administered in person by a clinician, by telephone, or self-administered
- Facilitates diagnosis of major depression
- Provides assessment of symptom severity
- Is well validated and documented in a variety of populations
- Can be used in adolescents as young as 12 years of age
- PHQ-9 has 9-items,
- item 10 is the impact scale (how difficult have these problems made it for you to do work/home life/get along with other people):
- Not difficult at all; somewhat difficult; very difficult; extremely difficult.
Scoring (from the non-adapted PHQ-9): <5 = minimal; 5–9 = mild; 10–14 = moderate; 15–19 = moderately severe; 20–27 = severe.
- Over the last 2 weeks
- 0-3: 0= not at all; 1 = several days, 2 = more than half the days, 3 = nearly every day
Child Behaviour Checklist (CBCL), Achenbach System of Empirically Based Assessment
A group of assessment tools that include parent, self and teacher reports of adaptive and maladaptive functioning in children and adolescents aged 6-18.
CBCL is a Clinical & Mental Health Tests
- assessment of emotional and behavioural functioning in children (completed by parent form, OR teachers, OR youth self-report)
- CBCL is PART OF Achenbach System of Empirically Based Assessment (ASEBA)
- ASEBA collection of questionnaires to measure adaptive and maladaptive behaviors of child/adolescent
This is the current version - It belongs to a large family of ASEBA
Its use: it’s widely used questionnaire to assess behavioral and emotional problems
The age: 1-5; 6-18; Teacher, Parent & Self-report forms for youth (CBCL 1-5 CBCL – youth)
Target population:
Screener/diagnostic/repeated measure/info gathering tool: It is often used as a screener however does not include Autism ABAS does
Does it have Australian norms: it doesn’t have norms available
Is it culturally appropriate: but obviously compared with constructs that is consistently various cultures,
- Time ~10-15 min by parents and 6-18-year-old.
- 18m – 5-year-old; 6-19-year-old
- There are 113 questions
- Have self-, parent, teacher reports
- It belongs to a large family of ASEBA
- It is often used as a diagnostic screener, however, the important thing here is that or it does not include autism spectrum disorders.
- ABAS does include autism but CBCL does not include autism.
- So, that’s a really important distinction.
- CBCL child behavior checklist, emotional behavioral problems - minus ASD
- you can compare what the behavior and emotions across the different settings
- and it’s not unusual for us to get vastly different reports from the teacher to what we do from a home setting
- if there’s anything in the vignette about ASD CBCL is not your answer.
- If there’s anything in the vignette to ASD ABAS is your answer
- is basically what this one comes down to, in a very rudimentary (immature, undeveloped) way.
Assessment:
a) Internalizing behaviours (anxious/depression, withdraw/depression, somatic complains)
b) Externalizing Behaviours (aggressive, rule-breaking)
c) Social, Thought and Attention problems
d) competency and adaptive functioning are assessed.
0-2: absent = 0, occurs sometimes = 1, occurs often = 2
SCID
Structured Clinical Interview for DSM
SCID is a Clinical & Mental Health Tests
Current version SKID CV & SKID PD
Its use: Semi structured to making a diagnostic tree of DSM-5, it’s also a differential diagnosis for diagnosis, and it’s used in clinical intake procedures or in comprehensive forensic diagnostic evaluation
The age: 18 and over
Target population: To improve interviewing skills of students in the mental health professions, including psychiatry, psychology, social work, and psychiatric nursing, Through repeated administrations of the SCID, students will become familiar with the DSM-5 criteria and at the same time will incorporate useful questions into their own interviewing repertoire.
Screener/diagnostic/repeated measure/info gathering tool: it’s a diagnosis
Does it have Australian norms: it has Australian norms
Is it culturally appropriate: Culturally appropriate YES and NO for it does not have Aboriginal data
- It’s a semi structured interview guide for making the major DSM-5 diagnosis. You need to be familiar with DSM-5 in order to deliver it,
- So, we have a couple of versions we have
- SCID-CV, which is the Clinical Version.
- SCID-PD, which is the Personality Disorder version.
- So, there’s two PD ones
- one as a screener because as you know it personality disorders there’s a general diagnostic-criteria, for personality disorders that must be met before you then go into specific criteria for a specific personality disorder in one of the clusters of the personality disorders
- So, the screener will tell you whether or not you need to move on to the full SCID-PD
- If they don’t meet that general criteria which is short and sharp, then don’t continue on if they do meet then you continue on, but you still may not in any of the criterion which is said then you will come up with a mixed
- most likely a mix personality disorder
Audit
(Alcohol Screen)
The AUDIT (Alcohol Use Disorders Identification Test)
The AUDIT (Alcohol Use Disorders Identification Test)
Its use: It’s a screening for detecting risky and harmful drinking patterns
The age: 18 and over
Target population: Adults and Adolescents
Screener/diagnostic/repeated measure/info gathering tool: it’s a screener
Does it have Australian norms: it has Australian norms
Is it culturally appropriate: Culturally appropriate YES
- (AUDIT) is a 10-item screening tool developed by the World Health Organization (WHO)
- to assess alcohol consumption, drinking behaviours, and alcohol-related problems.
- to assess whether your drinking is putting you at risk of alcohol-related harm
- questions about your alcohol use during the past 12 months.
0 – Recommended- provide positive reinforcement and offer relevant literature (may be helpful to others)
1 – 7 Low Risk
8 – 12 Risky
13+ High Risk
Mini MSE (MMSE)
MINI MSE (MMSE) allows you to screen for neurocognitive disorders for dementia (not diagnostic).
Don’t get this confused with MSE.The MSE is not to be confused with the Mini-Mental State Examination (MMSE), which is a brief neuropsychological screening test for cognitive impairment and suspected dementia. However, the MMSE can be used for more detailed testing in the cognitive section of this MSE
The MMSE can be used to assess several mental abilities, including:
- short and long-term memory
- attention span
- concentration
- language and communication skills
- ability to plan
- ability to understand instructions
Scores on MMSE – look at this and do it yourself.
If the score is below 25, the result is usually considered to be abnormal (indicating possible cognitive impairment).
Impairment may be classified as follows:
- mild — MMSE score of between 21 and 24
- moderate — MMSE score of between 10 and 20
- severe — MMSE score of less than 10
- The maximum score for the MMSE is 30.
- So 27 is very likely not diagnosed with dementia.
- A score of 25 or higher is classed as normal.
What does the Mental Status Examination assess?
Is the psychiatric equivalent of the physical medical exam. Involves psychologist observing and talking with a client seeking a dx. Systematic behavioural observation of the client
Psychologists use MSE to assess suitability for formal psychological testing or to guide case management in clients with the possibility of severe psychological impairment.
• Level of consciousness / awareness(person / time / place)
normal; clouded, inattentive, distracted;
delirious; stuporous; coma
- Appearance and Behavior (dress, grooming, non-verbal)
- Speech / motor activity (slow; halting, tics, restlessness)
- Thought and perception (coherent, tangential, delusional, hallucinations)
• Mood(how the person generally feels) and affect (immediate expression of emotion);
affect: appropriate/innappropriate, broad, restricted, labile, flat
- Attitudes and insight
- Intellectual functioning (may be assessed with tests, but vocab, memory….)
The mental status exam is the psychologist observing and talking with the client seeking a diagnosis.
- MSE you need to remember the major components.
Acronym - ABC Stamp Licker
- Appearance,
- Behaviour,
- Cooperation
- Speech
- Thought - form and content
- Affect - moment to moment variation in emotion
- Mood - the subjective emotional tone throughout the interview
- Perception - in all sensory modalities
- Level of consciousness
- Insight & Judgment
- Cognitive functioning & Sensorium
- Orientation
- Memory
- Attention & Concentration Reading & Writing
- Knowledge base
- Endings - suicidal and/or homicidal ideation
-
Reliability of the information
*
Kaufman Adolescent & Adult Intelligence Test (KAIT)
(Intelligence)
Measures intelligence & problem-solving skills, for ages 11-85+.
Strengths include:
- a good indication of overall intelligence, less influenced by culture, opportunity, or education
- both visual and auditory formats are used to measure intelligence across different contexts
KAIT computes Composite IQ & separate IQ for Crystallized and Fluid Scales.
What kinds of tests are useful for assessing vocational strengths?
Self Directed Search (SDS)
Strong Interest Inventory (SII)
Setting and monitoring goals measures (including goal attainment scaling)
Setting and monitoring goals measures (including goal attainment scaling)
- The Five Principles of Successful Goal Setting
- Commitment – attachment to the goal
- Clarity – Specify the goal
- Challenge – degree of goal’s difficulty
- Complexity – degree of goals demands
- Complexity – degree of goals demands
Feedback – the presence of progress reporting
APS recognized treatments for Posttraumatic Stress Disorder
According to the updated 2018 version of Evidence-Based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review (4th edition) Posttraumatic Stress Disorder (309.81 (F43.10)) interventions include:
- Trauma-focused Cognitive Behavioural,
- Hypnotherapy,
- Eye Movement Desensitisation and Reprocessing (EMDR),
- Dialectical Behavioural Therapy,
- emotion-focused therapy,
- metacognitive therapy,
- mindfulness-based stressed reduction.
It does not include Solution-focused brief therapy (SFBT) as an evidence-based treatment for PTSD.
This document is a systematic review undertaken to update the APS document Evidence-Based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review (3rd edition). This review was first conducted in 2003 in the context of the Australian government’s Better Outcomes in Mental Health Care initiative.
It was updated in 2006 and again in 2010 with consideration of the introduction of primary healthcare services through the Access to Allied Psychological Services (ATAPS) and Better Outcomes to Mental Health Care initiative.
What are the main features of a risk assessment of suicide, self-harm & harm to others?
Previous attempts (where nature of ideation, outcome & reaction are considered)
Present thinking (has the method been chosen? Is such a method available?
Frequency, intensity & duration of thoughts, and reasons for harm.
Protective Factors (social support & religious beliefs)
other risk factors
Which of the following is an example of how to obtain informed consent?
Psychologists fully inform clients regarding the psychological services they intend to provide, unless an explicit exception has been agreed upon in advance, or it is not reasonably possible to obtain informed consent.
Diagnostic classification systems (including current versions of DSM and ICD)
- Diagnostic classification systems (including current versions of DSM and ICD)
- You need to know:
- The diagnostic features
- The functional consequences
- The key criteria
- You need to know the following disorders:
- From Anxiety Disorders, you need to know
- GAD,
- Panic Disorder,
- Separation Disorder,
- Social Anxiety Disorder
- From Trauma and Stress, you need to know
- PTSD
- Adjustment Disorder
- From Personality Disorder you need to know
- Antisocial
- Borderline
- From the Obsessive compulsive and related Disorder, you need to know
- Obsessive Compulsive Disorder (OCD)
- From Somatic symptom and related Disorder, you need to know
- Somatic Symptom Disorder,
- From Neurodevelopmental Disorders you need to know
- Autism spectrum
- ADHD,
- From Schizophrenia Spectrum and Other Related Disorder, you need to know
- Schizophrenia.
- From Disruptive Disorders you need to know
- Oppositional Defiance Disorder (ODD)
- Conduct Disorder
- From Bipolar and related Disorder, you need to know
- Bipolar 1
- Bipolar 2
- Depressive Disorder you need to know
- Major Depressive Disorder
- From Feeding and Eating Disorders you need to know
- Pica,
- Rumination Disorder,
- Avoidant Restrictive Food Intake Disorder,
- Anorexia,
- Bulimia,
- Binge eating
- Other Specified Feeding or Eating Disorder
- Neurocognitive Disorder you need to know
- Delirium,
- Mild NCD (NCD is Neuro Cognitive Disorder),
- Major NCD,
- From Anxiety Disorders, you need to know
but then there’s specifiers:
- Alzheimer’s Disease,
- Frontotemporal Lobe,
- Lewy bodies,
- Vascular,
- TBI,
- Substance induced,
- HIV infection,
- Parkinson’s,
- Huntington
- Unspecified
- From the Substance Related and Addictive Disorders you need to know
- Alcohol
- Cannabis
- Hallucinogen
- Opioids
- Sedative
- Hypnotic
- Stimulant related
- Caffeine – does not have USE criteria
- Inhalants – does not have a WITHDRAWAL
- Tobacco – does not have an INTOXOCATION
- Other unknown substance induced disorders
- Other unspecified disorders
Look for:
- Use
- intoxication
- Withdrawal
- Other
- Unspecified
Then with each one:
- Intensity
- Duration
- Frequency
Anxiety Disorders
- Separation Anxiety Disorder
- Selective Mutism
- Generalised anxiety disorder
- Panic disorder
- Agoraphobia
- Specific phobia
- Social Anxiety Disorder (social phobia)
- Substance /Medication-Induced Anxiety Disorder
- Anxiety due to another medical condition
- Other specified AD
- Unspecified AD
- Panic specifier
“Anxiety is a negative mood state characterized by bodily symptoms of physical tension, and apprehension about the future”
Generalized Anxiety Disorder
Symptoms must be present for at least 6-months.
Excessive exaggerated anxiety and worry about everyday life events with no obvious reasons for worry.
– Worry about everything
– Prepared for the worst
– Worry feels out of control
Generalized Anxiety Disorder (GAD):
Statistics from DSM-5 (2013)
• One of the most common anxiety disorders
• US 2.9% general adult samples (12 months prevalence)
• 9.0% (lifetime prevalence)
• 12 month prevalence ranges 0.4% - 3.6% internationally
• High comorbidity with depression
• Female : Male = 2 : 1
• Median age of onset is 30 years, but most report feeling “anxious & tense all my life, as long as I can remember”
• Chronic course
Causes of GAD
• Much less physiological reactivity (HR, BP, GSR) in response to stressors than other anxiety disorders (Roemer & Orsillo, 2013)
– Except muscle tension
• Very much a ‘cognitive’ disorder
– Sensitive to threat/danger and worry about threat/danger
– Avoid images associated with the threat (cognitive avoidance) so don’t process information completely
• Cognitive mediators: intolerance of uncertainty
• Metacognition:
– “if I am alert to the threat I will be ready” (+ve)
– “I can’t control my worry, my worries control me” (-ve)
• Avoidance, reassurance-seeking, and distraction -> never dispel beliefs
Psychological Treatments
• CBT:
• Exposure to worry process
• Identify and challenge underlying beliefs
• Confronting anxiety-provoking images
• Coping strategies
• Similar benefits to pharmacotherapy (ST) and better long-term results
Panic Disorder
A panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can’t breathe. You may even feel like you’re dying or going crazy
Panic Disorder (DSM-IV, with agoraphobia (PDA) and without agoraphobia (PD))
DSM-5, just PD
– Unexpected panic attacks
– Anxiety, worry, or fear of another attack
- – Persists for 1 month or more
– Fear or avoidance of situations/events
– Interoceptive avoidance
- – avoid internal physical sensations that might resemble onset of a panic attack
– With / without agoraphobia
Panic Disorder Statistics from DSM-5 (2013)
• 2%-3% (12 months) • 4.7% (lifetime)
• Female: male = 2:1
• Acute onset, ages 20-24
• Associated with drug and alcohol use (hangovers, fatigue, smoking increase likelihood of panic)
• Prevalence decreases with age
Nocturnal Panic
– 60% with panic disorder experience nocturnal attacks
- – non-REM sleep (not nightmares)
- – Delta wave
– Caused by deep relaxation, sensations of “letting go”?
– Children: sleep terrors
– Isolated sleep paralysis
- – “the witch is riding you” (transition between sleeping & waking)
Agoraphobia Statistics from DSM-5 (2013)
- ~2%(12 months); >=65 -> 0.4%
- Female: male = 2:1
- Mean age of onset ~ 17 years (variable)
- DSM-5 reports agoraphobia has the strongest / most specific heritability of the anxiety disorders (61%)
- Social/gender roles? ~75% of those with agoraphobia are female
Treatment
– Psychological
- – Exposure-based-> reality testing
- – Relaxation – Breathing
– Panic Control Treatment
- – Exposure to interoceptive cues
- – Cognitive therapy
- – Relaxation/breathing
– High degree of efficacy
Separation Anxiety Disorder
Separation anxiety is a normal stage of development for infants and toddlers. Young children often experience a period of separation anxiety, but most children outgrow separation anxiety by about 3 years of age.
In some children, separation anxiety is a sign of a more serious condition known as separation anxiety disorder, starting as early as preschool age.
If your child’s separation anxiety seems intense or prolonged — especially if it interferes with school or other daily activities or includes panic attacks or other problems — he or she may have separation anxiety disorder. Most frequently this relates to the child’s anxiety about his or her parents, but it could relate to another close caregiver.
Less often, a separation anxiety disorder can also occur in teenagers and adults, causing significant problems leaving home or going to work. But treatment can help.
Symptoms
Separation anxiety disorder is diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning. Symptoms may include:
- Recurrent and excessive distress about anticipating or being away from home or loved ones
- Constant, excessive worry about losing a parent or other loved one to an illness or a disaster
- Constant worry that something bad will happen, such as being lost or kidnapped, causing separation from parents or other loved ones
- Refusing to be away from home because of fear of separation
- Not wanting to be home alone and without a parent or other loved one in the house
- Reluctance or refusing to sleep away from home without a parent or other loved one nearby
- Repeated nightmares about separation
- Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated
A separation anxiety disorder may be associated with panic disorder and panic attacks ― repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.
Social Anxiety Disorder
Feelings of awkwardness, concern, tension, and discomfort when confronted with strangers or casual acquaintances.
Characteristics:
Marked and persistent fear of one or more social or performance situations in which the person is exposed to possible scrutiny by others.
The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.
The individual often fears that they will be judged negatively by others.
Social Phobia: DSM-5 Statistics
- US: ~7% (12 months); Europe: ~2.3% (12 months)
- • Female : Male ~ 1.5:1.0
- • Onset = adolescence: (75% onset 8-15 years)
Causes
Inherited vulnerability
Temperament, genetics, arousal system
Environmental causes
Relationships, observational learning, negative childhood
experiences
Traumatic causes
Bullying, traumatic social experience
Pharmacotherapy for SAD
Performance only
- Beta-blockers that block NE at the receptor eg. propanolol / inderal -> Antihypertensive meds
- Reduce physical anxiety signs (eg sweating, tremor, increased heart rate) but not emotional
- Side effects -> low blood pressure, depression
General SAD
- more often ‘seen’ than performance only -> more problems, higher comorbidity
- SSRIs: sertraline / zoloft, paroxetine / paxil (placebo controlled studies)
- SNRI: Venlafaxine / effexor
- BZD: alprazalam / xanax, clonazepam / klonopin (side-effects as before)
Treatment:
- CBT
- Video feedback
- Exposure
- Behavioural experiments
- Role-play
- Group settings
- Highly effective
Post-Traumatic Stress Disorder (PTSD)
Exposure to a traumatic event coupled with intrusive recollections, avoidant behaviours, changes to thoughts & mood, and increased reactivity that last more than 1-month after the event or its consequences.
- The traumatic event itself
- Intrusive symptoms
- Behavioural avoidance
- Negative changes in thoughts or mood
- Evidence of reactivity
Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related external reminders
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criterion F: duration (required)
- Symptoms last for more than 1 month.
Criterion G: functional significance (required)
- Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion (required)
- Symptoms are not due to medication, substance use, or other illness.
What are the core features of PTSD?
• Classified under Trauma and Stressor-Related Disorders in DSM-5
- Clinical description
- Trauma exposure
- Extreme fear, helplessness, or horror
- Continued re-experiencing (e.g., memories, nightmares, flashbacks)
- Avoidance
- Emotional numbing
- Reckless or self-destructive behavior
- Interpersonal problems
- Dysfunction
- For 1 month
Posttraumatic Stress Disorder (PTSD):
Statistics
• 6.8% (lifetime); 3.5% (year)
• Prevalence varies
– Type of trauma
– Proximity
• Sexual assault: 32% met PTSD criteria at some point
• Accidents: 15-20%
• Combat: 18.7% for Vietnam veterans, correlation with amount of combat exposure
Treatment
Some of the most effective treatments for PTSD include:
• CBT
• Exposure
• Imaginal exposure
• Cognitive challenging of negative thoughts and appraisals
• Increase positive coping skills
• Increase social support
• Highly effective
• Cognitive Processing Therapy
• Eye movement desensitization and reprocessing therapy (EMDR)
• Aims to reduce the distress associated with a traumatic event
• Client thinks about the emotionally distressing events while focusing on external stimulus
• EDMR appears to weaken the impact of negative emotion
Adjustment Disorder
•
Antisocial personality disorder
Must be at least 18yrs at time of dx. History prior to 15yrs must support Conduct Disorder.
Noncompliance with social norms
-“Social Predators”
- Violate rights of others
- Irresponsible
- Impulsive
- Deceitful
- Lack conscience, empathy, remorse
- High rates of substance abuse (60%)
- Many movies feature antisocial PD
Antisocial -> ‘moral insanity; ‘sociopathy’; ‘psychopathy’
ASPD captures many of the deviant or abnormal behaviors associated with psychopathy but does not capture many of the psychopathic personality traits
classified as interpersonal traits or affective traits
E.g. the Hare Psychopathy Checklist-Revised (PCL-R)
Hare criteria (PCL-R) for psychopathy include:
Glibness/superficial charm
Grandiose sense of self-worth
Proneness to boredom/need for stimulation
Pathological lying
Conning/manipulative
Lack of remorse
Theory of mind
Psychopathy based on personality traits rather than observable behaviour (DSM)
Overlap with criminality:
Original PCL-R normative data: male prison inmates
Overlap with ASPD, criminality (esp violent crime)
Intelligence separates criminal and non-criminal ASPD
Successful psychopaths?
Causes
- Early histories of behavioral problems
- DSM-5 Conduct disorder -> essentially a behavioural description (see p. 455 B&D, 2015)
Families history of:
- Inconsistent parental discipline
- Variable support
- Criminality
- Violence
DSM-5: general pop ~= 3.3% (US data)
ASPD & criminality? Family, twin, adoptee studies
Environmental triggers (Crowe, 1974)
- Cross fostering analysis: rates of arrests, convictions and ASPD in adopted bio offspring of felons > in adopted offspring of non-felons
- But adopted bio offspring of felons who committed crimes -> longer time in institutions (orphanages) than (a) non-criminal offspring of felons (b) offspring of non-felons -> Gene-environment interaction
- Arousal hypotheses
- Underarousal – risk-taking behaviours to increase stimulation
- Fearlessness – opposite of attent bias – don’t respond to danger cues
Treatment
- Unlikely to seek help
- Mental health stigma
- High recidivism
- Early intervention
- Parent training concerning discipline
- Prevention
- Rewards for pro-social behaviors
- Skills training
- Improve social competence
Borderline Personality Disorder
Highly stigmatized diagnosis (laypeople and health professionals
- Used to be associated with psychoanalytic view of trauma
- BORDERLINE- associated with psychotic behaviour, clients can be hard to characterize
- Most prevalent PD in clinical populations
- Often misdiagnosed as bipolar (emotions reactive and volatile rather than cyclical)
- Also misdiagnosed as schizophrenia - brief psychotic breaks (2-4 hours)
Characteristics
- Low/unstable sense of self
- Heavily dependent on other people’s evaluation
- May have a very poor self-image
- Sense of emptiness
- Labile, intense moods – often intense anger
- Intense fear of abandonment (real or perceived)
- Volatile and unstable relationships
- Suicide attempts, self-harm behaviours, impulsivity and risk-taking
- Often low insight into own emotional reactions and behaviours
Comorbitiy
- DSM-5: general pop ~= 1.6%-5.9%
- Common in males but less frequent in clinical samples
- Males often end up in forensic settings or using substances
- Males - impulsivity, Females - emotionality
- High comorbidity with other disorders:
- Depression – 20% (completed suicide – 6%)
- Bipolar – 40%
- Substance abuse – 67%
- Eating disorders - 25% of those with bulimia nervosa
Borderline PD: Treatment
- Very likely to seek treatment
- Antidepressant medications often prescribed are not effective for BPD
- Need stability and predictability- don’t like uncertainty
- Marsha Linehan: For women with BPD, CBT has 3 major problems:
- Focus on change invalidating (withdrawal, anger) -> high drop out
- Clients unintentionally reinforced therapists for ineffective treatment (interpersonal warmth/engagement -> change the topic of the session) while punishing effective therapy (therapists would “back off” when client’s emotional)
- Too many problems! (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework, dep, anxiety)
OCD
Obsessions:
Intrusive and mostly nonsensical thoughts, images, urges, or irrational beliefs that the individual tries to resist or eliminate.
• Common obsessions :
– repeated thoughts about contamination (e.g., becoming contaminated by shaking hands)
– repeated doubts (e.g., wondering whether one has performed some act such as having hurt someone in a traffic accident or having left a door unlocked)
– a need to have things in a particular order (e.g., intense distress when objects are disordered or asymmetrical)
– aggressive or horrific impulses (e.g., to hurt one’s child or to shout obscenity in church)
Compulsions:
Behaviours (or mental rituals) designed to suppress or neutralize the thoughts and provide relief
• The individual with obsessions usually attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action (a compulsion)
• E.g.,
– “I’m getting contaminated by germs” -> washing
– “Did I turn the stove off?” -> checking stove
– “I might commit blasphemy” -> hail Mary’s
Somatic Symptom Disorder
Somatic symptom disorder (SSD) occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life - typically more than 6months.
A person with SSD is not faking his or her symptoms. The pain and other problems are real. They may be caused by a medical problem. Often, no physical cause can be found. But it’s the extreme reaction and behaviors about the symptoms that are the main problem.
- Statistics (including in DSM-5) based on DSM-IV Somatization Disorder.
DSM-5:
- Prevalence “not known” (DSM-5, p.312)
- Prevalence likely to increase with less restrictive criteria in DSM-5
- General adult population “maybe around 5%-7%” (DSM-5, p. 312)
- Likely to be higher rates in females than males
- Older adults:
- Likely to be underdiagnosed
- DSM-5 recommends focusing on Criterion B
- Comorbid depression common
Somatic Symptom Disorder
- Associated with:
- Personality trait of negative affectivity/neuroticism
- Recent life stressor
- More common in:
- Females
- Lower SES
- Fewer years of education
- Higher unemployment
- Run in families and associated with Antisocial PD (ASPD mainly males) -> biological basis disinhibition/impulsiveness?
Expression (ASPD or SSD -> depend on gender roles)
Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, and restricted/repetitive behaviors.
The effects of ASD and the severity of symptoms are different in each person.
ASD is usually first diagnosed in childhood with many of the most-obvious signs presenting around 2-3 years old, but some children with autism develop normally until toddlerhood when they stop acquiring or lose previously gained skills.
According to the CDC, one in 59 children is estimated to have autism. Autism spectrum disorder is also three to four times more common in boys than in girls, and many girls with ASD exhibit less obvious signs compared to boys.
Autism is a lifelong condition. However, many children diagnosed with ASD go on to live independent, productive, and fulfilling lives. The information here focuses primarily on children and adolescents.
Characteristics of autism spectrum disorder fall into two categories:
Social interaction and communication problems: including difficulties in normal back-and-forth conversation, reduced sharing of interests or emotions, challenges in understanding or responding to social cues such as eye contact and facial expressions, deficits in developing/maintaining/understanding relationships (trouble making friends), and others.
Restricted and repetitive patterns of behaviors, interests or activities:
hand-flapping and toe-walking, playing with toys in an uncommon way (such as lining up cars or flipping objects), speaking in a unique way (such as using odd patterns or pitches in speaking or “scripting” from favorite shows), having the significant need for a predictable routine or structure, exhibiting intense interests in activities that are uncommon for a similarly aged child, experiencing the sensory aspects of the world in an unusual or extreme way (such as indifference to pain/temperature, excessive smelling/touching of objects, fascination with lights and movement, being overwhelmed with loud noises, etc), and others.
ADHD Disorder
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.
Must persist for at least 6months. Ppl under 17 must have 6 or more symptoms, over 17rs must have 5 or more.
There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:
- Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
- Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
- Combined Presentation: Symptoms of the above two types are equally present in the person.
Schizophrenia
Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include:
- hallucination: hearing, seeing or feeling things that are not there;
- delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary;
- abnormal behaviour: disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt;
- disorganised speech: incoherent or irrelevant speech; and/or
- disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language.
Oppositional Defiant Disorder
Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.
Angry and irritable mood:
- Often and easily loses temper
- Is frequently touchy and easily annoyed by others
- Is often angry and resentful
Argumentative and defiant behavior:
- Often argues with adults or people in authority
- Often actively defies or refuses to comply with adults’ requests or rules
- Often deliberately annoys or upsets people
- Often blames others for his or her mistakes or misbehavior
Vindictiveness:
- Is often spiteful or vindictive
- Has shown spiteful or vindictive behavior at least twice in the past six months
ODD can vary in severity:
- Mild. Symptoms occur only in one setting, such as only at home, school, work, or with peers.
- Moderate. Some symptoms occur in at least two settings.
- Severe. Some symptoms occur in three or more settings.
Conduct Disorder
Conduct disorder is a severe condition characterized by hostile and sometimes physically violent behavior and a disregard for others.
At least three symptoms must be present in the past 12 months, with at least one in the last 6 months.
Children with CD exhibit cruelty, from early pushing, hitting and biting to, later, more than normal teasing and bullying, hurting animals, picking fights, theft, vandalism, and arson.
Since childhood and adolescent conduct disorder often develops into the adult antisocial personality disorder, it should be addressed with treatment as early as possible.
Bipolar Disorder
Bipolar 1:
Presence of at least a single manic episode.
Recurrent.
Symptom-free for 2 months.
Bipolar 2:
Presence of at least a single hypomanic episode & past major depressive episode.
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Onset 15-18 years onset usually more acute than in MDD.
Typically chronic course.
Bipolar I vs II
Good to know the difference between hypomanic (Bipolar II) versus manic(Bipolar I)
Remember, depressive episodes in Bipolar are equally severe in both I and II, but the manic episodes are less severe in B II than B I. People are high but ability to function in everyday life is not as severely affected in Bipolar II. E.g., sleep might be lessened, rapid speech, not eating much (or over-eating lots), seem high, but don’t seem psychotic, etc., but they are still able to go to work (hypomanic, B II).
With full mania, they can’t go to work, they are severely impaired. Hypomania is harder to diagnose because it is a bit more on the borderline. You cannot diagnose B II until they have had a depressive episode because that’s when you know that is not just their personality type. With Bipolar I – you can diagnose with only a manic episode because it is so much more extreme. Depressive episodes for people with Bipolar are a lot more severe – and the depressive episodes of people with Bipolar II are especially
severe.
So Bipolar I is at least one manic episode, and Bipolar II is at least one depressive episode to get the diagnosis. The only context/diagnosis in which you can have a (full) manic episode is with Bipolar I.
Major Depression
Major Depressive Disorder:
Key criterion: No evidence of mania or hypomania episodes.
DSM-IV: single episode / recurrent with symptoms present for 2-week period
Single episode rare: ~85% single episode -> second episode
DSM-IV MDD, recurrent
More than 2 episodes separated by more than 2 months when not depressed.
4 Episodes (lifetime) = median
DSM-5 does not distinguish between single & recurrent, notes “A diagnosis based on a single episode is possible, although the disorder is a recurrent one in the majority of cases” (p. 155)
Feeding & Eating Disorders
• Severe disturbances in eating behaviour.
Anorexia Nervosa
– refusal to maintain minimal body weight (BMI < 17.5 [DSM-IV]; changed to significantly low in DSM 5)
Pica
– eating nonfood items at an inappropriate developmental level
Bulimia Nervosa
– repeated binges followed by compensatory behaviours
Eating Disorder Not Otherwise Specified
– don’t meet criteria for AN or BN
• DSM-5
– added Binge Eating Disorder
• Obesity: not in the DSM 5, in ICD classified as a general medical condition
Neurocognitive Disorders
The neurocognitive disorder is a general term that describes decreased mental function due to a medical disease other than a psychiatric illness. It is often used synonymously (but incorrectly) with dementia.
Causes
Listed below are conditions associated with neurocognitive disorder.
BRAIN INJURY CAUSED BY TRAUMA
- Bleeding into the brain (intracerebral hemorrhage)
- Bleeding into the space around the brain (subarachnoid hemorrhage)
- Blood clot inside the skull causing pressure on the brain (subdural or epidural hematoma)
- Concussion
BREATHING CONDITIONS
- Low oxygen in the body (hypoxia)
- High carbon dioxide level in the body (hypercapnia)
CARDIOVASCULAR DISORDERS
- Dementia due to many strokes (multi-infarct dementia)
- Heart infections (endocarditis, myocarditis)
- Stroke
- Transient ischemic attack (TIA)
DEGENERATIVE DISORDERS
- Alzheimer disease (also called senile dementia, Alzheimer type)
- Creutzfeldt-Jakob disease
- Diffuse Lewy body disease
- Huntington disease
- Multiple sclerosis
- Normal-pressure hydrocephalus
- Parkinson disease
- Pick disease
DEMENTIA DUE TO METABOLIC CAUSES
- Kidney disease
- Liver disease
- Thyroid disease (hyperthyroidism or hypothyroidism)
- Vitamin deficiency (B1, B12, or folate)
DRUG AND ALCOHOL-RELATED CONDITIONS
- Alcohol withdrawal state
- Intoxication from drug or alcohol use
- Wernicke-Korsakoff syndrome (a long-term effect of deficiency of thiamine (vitamin B1))
- Withdrawal from drugs (such as sedative-hypnotics and corticosteroids)
INFECTIONS
- Any sudden onset (acute) or long-term (chronic) infection
- Blood poisoning (septicemia)
- Brain infection (encephalitis)
- Meningitis (infection of the lining of the brain and spinal cord)
- Prion infections, such as mad cow disease
- Late-stage syphilis
Complications of cancer and cancer treatment with chemotherapy can also lead to neurocognitive disorder.
Other conditions that may mimic organic brain syndrome include:
- Depression
- Neurosis
- Psychosis
Dementia
Is not a DSM5 diagnostic criteria.
Is a major neurocognitive disorder.
Substantial cognitive decline and demonstrated by concern from the individual or a clinician.
Performance on objective assessment shows decline from previous (usually 2SDs from norm).
Interferes with independence and functioning.
Medication 💊
The mood will improve within 1-3 weeks, sleep is usually the first to improve.
It is important to provide psychoeducation that may not have been provided by his psychiatrist.
You may start by explaining to the client that his mood will likely improve within 1-3 weeks, and provide reassurance that sleep is usually the first to improve.
You would never encourage the client to cease medication immediately. You may refer the client to the GP for review of medication if you felt after a reasonable period of time the medication was not helpful.
