Mental Health
Made Simple ?
Simple Factoids
From Doc Ty
Why?
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1993 Those with Severe Mental Illness
discharged to the street by government
60-85% have mental health issues
Misunderstood, stigmatized, ignored
Interesting Fact:
The Human Brain can rewire
past damaged areas
Diagnosis Wheel
(Gathering the Story)
Medical History
Socio-Cultural
History
InformantsPersonal
Individual
InformantsProfessional
Family History
Psychological
Testing
Laboratory
Tests/results
Diagnosis Flow
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Syndromes are ID
Wide Range of diagnosis
are created
One is chosen to move
forward on
Comorbid diagnoses and
arrange in order of
importance
Check up with a formulation
Reevaluate as new data
emerges
Diagnosis
Wheel
Diagnosis
Flow
Inciting
Incident
Adjust
DSM-IV-TR
DSM-IV-TR
ICD-9-CM
General
and Mental Health
Codes
Diagnosis
CrossReferenced
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The Diagnostic Statistical Manual Fourth Edition, Text Revision
produced by the American Psychiatric Association
DSM-V due 2013
1 of 2 International Benchmarks for Diagnosis
Assessments FYI
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Clinicians use codified assessment tools
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Behavioural
Weschler Intelligence Scales
Weschler Memory Scales
Minnesota Multiphasic Personality Inventory (MMPI)
Millon Clinical Multiaxial Inventory
California Psychological Inventory
Rorschach
Thematic Apperception Test
Neuropsychological Impairment
Behavioural
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Focuses on preceding events/resulting
consequences as an understanding factor.
Typical includes: measures of behaviour
(overt/covert); antecedents
(internal/external); conditions surrounding
behaviour; and consequences
Validity: Challenging because of a moving
matrix dependent on clinician or team, need
definitions to truly understand results.
Weschler Intelligence Scales
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Provides 3 IQ: Full scale; Verbal; Performance
Main thrust: Accuracy in predicting future behaviour,
long-term predictions however fall short.
Bias towards logical thought patterns; middle to
upper-class Caucasian demographics.
Norms may not be applicable to other cultures; lower
socio-economic stratas; Enormity of calculations
lends to higher end false results due to clinician
error.
Weschler Memory Scales
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Core component of any thought cognitive
assessment.
Diagnosis of: depression, anxiety,
schizophrenia, head injuries, stroke, learning
disabilities, and neurotoxic exposure
stipulate memory complaints.
Administration time is upwards to 42 mins.
MMPI
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Standardized questionnaire
Provides wide range of self-description scores
Quantitative Measure of emotional adjustments and attitude towards test
taking.
Areas: General health, occupational interests, preoccupations, morale, phobias,
and educational problems.
Moderate levels of stability and internal consistency, high overlap with the
different scales,
Bias: Gender, Age, Socio-economics, demographics, race, place of residence,
intelligence and education are all variables that if not properly taken into
account can skewer results or produce false results.
Used to screen individuals for high stress or sensitive jobs (i.e. air traffic
controller)
Primarily Axis I
Millon Clinical Multiaxial Inventory
(MCMI)
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Self-report assessment much like MMPI (personality, emotional
adjustment and attitude towards test taking), is one of few that focuses
on personality disorders.
Current one is 175 items, separated into 28 scales in these categories:
Modifying Indices, Clinical Personality Patterns, Severe Personality
Pathology, Clinical Syndromes, and severe syndromes.
Driving Theory: Millon believed in polarity (active-passive, self-other,
and pleasure-pain) by ranking these can see if the person is typical or
non-typical on the personality spectrum.
Individual’s age, gender and ethnicity should be taken into account,
and separate scoring norms have been developed to mitigate false
results.
Primarily Axis II
California Psychology Inventory (CPI)
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Primarily for young adults with society avg. reading level of Gr. 4
Focused on “Folk Concepts” (culturally relevant), translated into 40
languages.
Focuses on typical population and interpersonal behaviours.
Assess enduring interpersonal personality characteristics in a typical
population.
20 Scales under general domains:
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Observable, interpersonal style, & orientation (i.e. Sociability, social
presence)
Internal normative orientation & values (i.e. responsibility, self-control)
Aspects of Cognitive intellectual functioning (i.e.achievement via
conformance, intellectual efficiency)
Measures of role and personal style (i.e flexibility, psychologicalMindedness)
Rorschach
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10 inkblots given systematically, individual’s
responses tracked to uncover the structure of the
personality.
3 General Categories: location (area of inkblot they
focused on); determinants (specific properties of blot
used in responses); content of response.
Excellent at bypassing an individual’s cognitive
inhibitions.
Challenges: Subjective nature, results need to be
checked/re-checked,
Thematic Apperception Test (TAT)
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Method of revealing dominant drives, emotions, sentiments,
complexes and conflicts of personality.
20 pictures in which individual is asked to make up a story:
what is happening, thoughts/feelings of characters, events that
led up to picture, outcome of event.
2 sessions, given sequence of cards, upwards 2 hrs to
administer,
Qualitative not quantitative analysis
Up to Clinician Intuitive Clinical Judgment does not allow for
universal standards, those who like say works well, those who
detract says does not work.
Best results when apart of a battery of tests
Requires for best results a specialized/trained administrator
Neuropsychological Impairment
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A battery of tests
Individual presents outside of test parameters can
create a false negative (or positive)
Types:
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Visuocontructive Abilities
Mental Activity
Memory and Learning
Verbal Functions and Academic Skills
Motor Performance
Executive Functions
Emotional Status
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P.518 (Table 12.1)
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Axis I
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Clinical Disorders
Diagnosis pre-18 yrs
Schizophrenia and
other psychotic
disorders
Factitious Disorders
Delirium, dementia,
Amnestic and other
Cognitive Disorders
Mood Disorders
Dissociative
Disorders
Mental disorders due to a
General Medical
Condition
Anxiety Disorders
Sexual & Gender
Identity Disorders
Substance related
disorders
Somatoform
Disorders
Eating Disorders
Sleep Disorders
Impulse-Control
Disorders Not
Elsewhere
Classified
Adjustment
Disorders
•Other Conditions that May be a Focus of Clinical Attention
Axis II
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Personality Disorders
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
ObsessiveCompulsive
Not Otherwise
Specified
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Mental Retardation
Axis III
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General Medical Conditions (ICD-9-CM coded)-medical conditions that may
cause Mental Disorders.
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Infectious/Parasitic (001-139)
Neoplasm (140-239)
Endocrine, nutritional, & Metabolic, Immunity (240-279)
blood & blood forming organs (320-389)
Circulatory system (390-459)
Respiratory (460-519)
Digestive Systems (520-579)
Genitourinary System (580-629)
Complications in pregnancy, childbirth, and the pueperium (630-676)
Skin and subcutaneous tissue (680-709)
Musculoskeletal System and connective tissue (710-739)
Congenital Anomalies (740-759)
Certain conditions originating in Perinatal Period (760-779)
Symptoms, Signs, and Ill defined Conditions (780-799)
Injury and Poisoning (800-999)
Axis IV
Psychosocial/ Environmental Problems
-Used to report factors that may affect diagnosis for Axis I/II
Problems with:
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Primary Support Group (Family. e.g.: death, health issues; abuse)
Related to Social Environment (e.g.: racism, retirement, death of friend)
Educational (e.g.: school environment, literacy)
Occupational (e.g.: un/underemployed; stressful work schedule)
Housing (e.g.: homelessness; safety)
Economic (e.g.: insufficient governmental supports; insufficient Income)
Access to health services (e.g.: inadequate, transportation, insurance)
Legal (e.g.: judicial involvement – perpetrator or victim)
Other (e.g.: disasters; war; famine; hostility; discord with professional supports; lack of governmental supports).
Axis V
Global Assessment of Functioning
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Can they Function in Society?
The G.A.F. scale is a rating scale of 0 to 100 that is used over the time span an individual is receiving
treatment to determine functionality.
Functioning impeded by physical or environmental limitations is not assessed.
These are averaged for the Axis V total and in brackets it is stated when score was e.g. (current), (at
discharge) (highest level past year).
Example of DSM-IV Multiaxial
Evaluation form
Example 1: (p.35 DSM-IV-TR)
Axis I: 296.23 Major Depressive Disorder, Single episode, Severe without Psychotic Features
305.00 Alcohol Abuse
Axis II: 301.6
Dependent Personality Disorder
Frequent use of denial
Axis III: None
Axis IV: Threat of Job Loss
Axis V: GAF = 35 (current)
Psychopharmacology
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Work with a Pharmacist and consistent
Pharmacy.
Questions
 Any
questions?
 Any Comments?