clinical scales Flashcards
how many clinical scales are there? what are their names?
10
1 hypocondriasis; 2 depression; 3 hysteria; 4 psychopathic deviate; 5 masc fem; 6 paranoia; 7 psychastenia; 8 sz; 9 hypomania; 0 socil introversion
what can oyu say about the scales internal consistency?
not great; coeff alpha ranges from like .3-.8’s – for clinical settings you wanna see .9 and for research we’ll deal with .7 or .8
what are the best ones? i.e. the more internally consistent? the worst?
1, 7, 8, 0
5 and 6
how do you explain the poor IC?
Heterogeneity of item content
Lack of a theoretical underlying construct
High scale scores reflect different endorsement patterns
-Harris-Lingoes scales help sort this out
-Further breakdown the clinical scales in to more discrete components.
what are you doing when your interpreting the clincial scales
developing and testin hypotheses
making inferences about “extratest” characteristics
Symptoms
Personality traits
Diagnosis
Response to Treatment
Research shows the clinical scales correlate with these characteristics
regarding the clinical scales what are the cut off and corresponding decriptor?
very high >75 high 66-75 moderate 56-65 modal 41-55 low <41
high scores
65-70, anything above 65 you ought to look at
refer to the textbook!!!!! refer to the literature!!!!!!
low scores
limited research on low scores
not the opposite of high scores
refer to the textbook and literature
organizing the information
SPIT-D Symptoms Personality/Temperament Interpersonal fucntioning Treatment repsonse Demographics
Scale 1
Hs - hypochondriasis
Scale 1 intent
Identify individuals presenting with hypochondriasis
Scale 1 score threshold
T > 60 consider interpreting (unless medical setting)
T > 80 = Extremely High
T > 60 –psychiatric and non-psychiatric pts have distinct personality characteristics
T = 60-typical of individuals with real physical problems
Elderly likely to score higher than normal populations (i.e. > 50)
high 1 sx’s T >60
(T > 60)
Non-specific but excessive body concerns
Chronic weakness, lack of energy, fatigue and sleep problems
Actual physical symptoms will exist and often a stress response
Chronic pain pts usually elevated on 1&3
high 1 sx’s T >80
somatic delusions more likely and bizarre complaints, esp if Scale 8 is elevated
high 1 personality/temp
Selfish, self-centered, narcisstic Pessimistic, defeatist, cynical Complainers Demanding and critical Indirect expression of hostility Unambitious, dull, lack enthusiasm Problems verbalizing needs
high 1 interpersonal functioning
Make others miserable
Demanding and critical of others
Express anger indirectly
high 1 tx and dx considerations
Major incapacitation not evident
Reduced efficiency in functioning over extended period
Lack insight and see themselves as medically ill
Poor candidates for psychotherapy-likely to terminate and reject psychological explanations and interventions
Criticize therapist as they do everyone else
scale 1 common Dx’s - extreme high scorers? and moderately high scorere?
extreme high = conversion do
mod high = somatoform, pain, anx, or dep do’s
whats unique about this scale?
its seen as more homogenous than the other scale – most of items deal wth somatic omcplaints
scale 1 correlated most highly with
sclaes 2 and 3 (e.g. conversion v)
scale 2
D - depression
considered pretty heterogeneous
with classic sx of depression along with physical problems, problems controlling thoughts, anxiety and irritabilty/hostility
scale 2 intent
Assess symptoms of depression
Good index of dissatisfaction with own situation
scale 2 score thresholds
T > 70 indicative of depression
T 60-70 indicative of general uninvolvement and poor attitude
scale two demographic considerations
Age (elderly 5-10 pts higher in norms)
High Scorer Symptoms (T > 70)
Depressed or dysphoric mood Hopelessness around dealing with problems SI common w/ attempts more likely Sxs comprising depressive syndrome Irritable Frequent worry
2 - Personality Characteristics/ Temperament
Insecure
Lack motivation to achieve
Unable to function in a many settings/give up easily
Over-controlled with regards to impulse control
Might wanna look at scale 9 to check out the impulse control hypothesis
2 - Interpersonal Relationships/Behaviors
Often lack involvement in intimate relationships
Maintain distance from people
Feel uncared for and are hurt easily
Acquiesce to avoid confrontation
Conventional, lack creativity in problem-solving
2 - Tx-Dx Implications
Distress level drives to therapy; likely motivated for tx
Depression interferes with active engagement
Moderate relief of symptoms can prompt premature termination
Most common diagnosis = Depression
Scale 3
Scale 3 –Hy Interpretation
High correlation with scale 1. Question focus on endorsement of physical ailments and denial of psychological issues
1 & 3 = conversion V (extrememly careful about this diagnosis)
3 - intent
Intent
Assess hysterical reactions to stress; psychogenic loss or disorder of function
3 - score thershold
T > 80 may be indicative of classic hysteria
T 70-80 common among chronic pain patients
T 60-70 characteristics common to classic hysteria
T = 60 common among medical patients w/o psychological component
Its probably even higher than that
3 - High Scorer Symptoms (T > 80)
Overwhelmed by stress and react by developing physical symptoms
Diffuse physical symptoms inconsistent with a known illness
Mild sadness or anxiety
Lack of energy
Sleep problems
Absence of experience of emotional distress/turmoil
