NCMHC: Intake, Assessment, Diagnosis Flashcards

• developed my Engle
• posits that health and illness result from the interplay between biological, psychological, and social factors

• model oftentimes used by counselors
• expands on the biopsychosocial model developed by Engle
• includes the idea that one must also consider the ways in which individual find meaning in their lives

1. cognitive= difficulty concentrating, poor memory, anxiousness
2. emotional=tearfulness, agitation, irritability, loneliness, depression, unstable moods, detachment
3. physical= weight loss/gain, swelling or aches, GI problems, insomnia, heart palpitations, chest pain, breakouts, fatigue, frequent minor illnesses
4. behaviors= change in appetite, withdrawal from preferred activities, nail biting, pacing, tics, hyperactivity, increased aggression

1. Identification= demographic info
2. Chief complaint=client's version of what the problem is
3. social/environmental issues=evaluates development and physical settings: friends, family, peers, work, housing, financial status
4. history= multi stage process of obtaining family hx, developmental hx, medical hx, substance use, mental health hx
5. MSE= concise, complete eval of client's current mental functioning level regarding cognitive and behavioral aspects

• process in which counselor gathers info to make a diagnosis based on DSM5TR
• can be structured or unstructured, includes hx, development, etc

• the system of knowledge, concepts, rules, and practices that are learned and passed on throughout generations
• dynamic
• oftentimes, one experiences cultures that intersect at once= leads to a unique individual identity
• must be considered by counselors as culture interacts with client experiences

• race=category of identity based on physical traits and biological characteristics
• ethnicity= specifies an individual's community or group (Can be self assigned or attributed by others)

• CFI
• designed to evaluate client perspective in order to to gain a comprehensive understanding of the individual's specific experience
• 16 questions across 4 domains, generally asked in an initial interview
  • cultural definition of the problem
  • cultural perceptions of cause, context, support
  • cultural factors affecting self coping
  • past help seeking
• provides emphasis on the way mental illness is perceived thru cultural lens

prevailing circumstances, symptoms, difficulties that the client believes is a problem requiring therapy

1. counselor's personal characteristics
2. client may adjust responses to questions based on how they perceive the counselor's characteristics
3. counselor's demographics may influence how much clients want to share

1. establish rapport
2. start where the client is
3. exploratory interviewing=delve into the topics that seemed particularly troubling to client as they discuss the presenting problem
4. questioning= use open, closed, clarification questions to get deeper insight into problem
5. observation
6. note taking of subjective and objective data

• normal= those that are common to the majority of the population, as related to emotional functioning, social interactions, mental capacity
• abnormal= maladaptive, dysfunctional, or disruptive bxs. Can be an exaggeration of a normal bx or be the absence of a typical response

1. Deviant Bx=withdrawal from society's concept of appropriate bx
2. Dysfunction= interferes with daily living
3. Distress= does the dysfunction cause distress?
4. Danger= danger to self and/or others
5. Duration= length of symptoms

1. exclusion of Asperger syndrome
2. loss of subtype variations of schizophrenia
3. renaming of gender identity dx to gender dysphoria
4. PTSD criteria include application to combat vets and first responders
5. omission of bereavement exclusion for depressive dx

• about 7% of US population has at least 1 episode of MDD annually
• 3x more frequent in ages 18-29 than other age ranges
• 1.5-3x more likely in women than males
• 64% of cases occur with severe impairment
• length of mdd is a factor in recovery

• premenstrual dysphoric dx
• when pregnant, women with pmdd tend to notice symptoms disappears; after pregnancy these symptoms can be exacerbated
• SI very common
• tends to follow a predictable, cyclical pattern
• higher rate of postpartum depression is expected (but research shows that women with pmdd did not have higher occurrence of it than control groups)

• autism spectrum dx and reactive attachment dx share many symptoms but are different
• children with RAD must experience the component of severe social neglect (while children with ASD are less likely to have a hx like this)
• ASD presents individuals with difficulty in having intentional communication (while RAD still allows children to have social communication levels representative of their intellect)

• disinhibited social engagement dx and ADHD
• a lot of children who have DSED are misdiagnosed as ADHD bc the impulsivity they may present when interacting with stranger
• it is possible for the two to occur concurrently

• oftentimes, dissociative dx form as a result of trauma
• many of the symptoms of dissociation are determined by trauma (e.g. embarrassed or confused by symptoms or even a desire to conceal them from people)
• because of this, dissociative dx are placed right next to the trauma dx section in the dsm
• many trauma dx include dissociative symptoms

• describes the onset of the sexual dysfunction= determines the course of treatment
  1. lifelong subtype= present since first sexual experiences
  2. acquired subtype= developed after a period of normal sexual functioning
  3. generalized subtype= not limited to certain types of stimulation, situations, or partners
  4. situational subtype= present only during certain situations

• neurocognitive refers to issues with cognitive functioning that have been acquired rather than developed as a child
• neurocognitive dx represent impairment in functioning that has increased throughout time and thus the reasoning for the abnormality can be determined

• severity of the impairment to cognitive functioning
• in major neurocognitive dx, there is severe decline in 1+ areas of cognitive functioning (language, or memory, or social cognition)
• in mild neurocognitive dx, the individual can largely still meet responsibilities of daily living (generally able to function on their own)

• A= odd and eccentric
  • paranoid PD, schizoid PD, schizotypal PC
• B= dramatic and erratic
  • antisocial PD, borderline PF, histrionic PD, narcissistic PD
• C= fearful and anxious
  • avoidant PD, dependent PD, obsessive compulsive PD

• mental status exam
• tool used when evaluating a client and is part of the collection of info used to diagnose
• purpose: determine how the client is functioning mentally and emotionally at that specific moment in time, whether its during the initial interview or any session in the therapy process
• mostly done by observation (appearance, attitude, behaviors, and motor functioning)
• good MSE eval should cover things such as emotional state, their thoughts, cognitive functioning, and general impression of the client
• cognitive portion of MSE cannot rely only on observation- must assess for orientation, memory, concentration, intelligence

• AKA dual disorders or dual diagnoses
• more prevalent in client who have substance use dx or presently use substances
• a substance use dx often co-occurs with a mood or anxiety dx
• should be addressed simultaneously-- and thus may required a multidisciplinary team approach

1. mental health symptoms worsening while undergoing treatment
2. persistent substance use problems with treatment

• assessed by examining a number of self-sufficient factors, like the presence of a formally diagnoses developmental disability, physical disability, or mental dx
• includes client's ability to communicate needs, IQ, ability to complete self care tasks, risk of voluntary or involuntary harm to self or others
• Levels of care include
  • outpatient services
  • inpatient services
  • assisted living ina facility

1. onset= when the problem started (may provide info re triggers)
2. progression= determining the frequency of the problem (intermitted, acute or chronic, if there is a pattern, etc)
3. severity= how severe does the client think it is? how is it impacting the client

• persons other than the client who can provide info to the client's level of functioning
• requires an ROI (unless its a forensic interview and there's implied consent)
• can provide a level of objectivity when discussing the client's situation
• can be helpful when a client's info can't be trusted or is skewed for some reason (e.g. substance use severe cognitive impairment, mental illness or disorder)

• allows client to define the problem specifically and determined factors affecting emotional wellbeing
• Antecedents= what was going on before the problem? this could be environmental or could be individuals in the client's life
• Behaviors= problematic interactions/ reactions based on the antecedents.
• Consequences= cognitive (internal) and environmental (external) interactions with the behavior. What happened as a result of the behavior. Certain values or beliefs may be linked to the behavior and attempting to maintain or decrease the behavior

• normal does not equal good and abnormal does not equal bad
• use person centered language to help de-stigmatize
• normal vs abnormal bx is culturally dependent
• use the 4 D's of abnormality to assess for mental health functioning
  • deviance
  • dysfunction
  • distress
  • danger
  • duration is sometimes considered the 5th d

• it is important to use various tools (questionnaires, checklists, rating scales, standardized tests) to make sure client are getting the services they need
• standardized testing= formal process that produces a score can be interpreted using guidelines
  • personality tests= MMPI
    • projective tests include TAT and Rorschach
    • objective tests include 16 personality factors questionnaire and Edwards Personal preference schedule
  • aptitude test= SAT

• test
  • more formal means to quantify info, guide tx, and develop goals
• assessment
  • more informal. Includes surveys, interviews, observations

1. achievement
2. aptitude
3. intelligence
4. occupational
5. personality

• measure knowledge of a specific subject
• primarily used in education
• GED and California Achievement Test are examples that measure learning

• measure the capacity for learning and can be used as part of a job application
• measure abstract or conceptual reasoning, verbal reasoning, and or numerical reasoning

• measure mental capability and potential
• example: Wechsler Adult Intelligences Scale and Wechsler Intelligences Scale for Children

• assesses skills, values, or interests as they relate to vocational and occupational choices
• includes the ONet Interest profiler, the Career Assessment Inventory

• can be objective ( rating-scale based) or projective (self-reporting based) and help counselor and client understand personality traits and underlying beliefs and behaviors

• BDI II
• inventory used to measure presence and severity of symptoms in individuals 13+

• BPS
• inventory designed for children 6+
• examines the perception the child has of each parent of caregiver and is often used in custody cases

• there are 4 total: clinical multiaxial inventory 3, adolescent clinical inventory, adolescent personality inventory, and behavioral health inventory

• MMPI=II
• 567 item inventory
• one of the most widely administered projective personality tests
• used to determine indicators of psychopathology in adults 18+

• inventory widely used to help people 14+ what personality trait influence their perception of the world and decision making process
• preference is ID'd within 4 types:
  • extraverted or introverted
  • sensing or intuitive
  • thinking or feeling
  • judging or perceiving

determined the perception of personal happiness and satisfaction in individual 17 +

• TAT
• projective test
• narrative and visual test that required the individual to create a story and allows the counselor insight into the individual's underlying emotional states, desires, behavioral motives, and needs
• 5+

• visual test that records an individual's perception and description of various inkblots
• used to determine underlying personality or thought disorders 5+

observing the ABCs of a client in real time. The counselor would be observing the client as they interact with the real world or testing environment and noting the ABCs

1. Alertness
   • primary indicator of client's level of consciousness. alert and orient x1, x2, or x3 (person, place, time)
   • can also be described with adjectives like lethargic, apathetic, confused
2. Speech Patterns
   • how articulate (mumbling, cursing, sentence syntax), tone, fluctuations
3. Nonverbal Cues
   • eye contact, facial expression, mannerisms (fidgeting, etc)

• clients are asked to complete an assessment form prior to the first session
• includes identifying info about household, gender, age, brief description of the problem in the client's own words

• diagram that depicts the client's family systems in order to understand significant life events that may indicate familial patterns
• can provide insight into perceived relationships btwn client and fam

• reviews all systems the client is involved with
• client can construct map of social relationships in their life (work, church, organizations, etc
• client then uses different lines to define the relationship btwn self these social systems (solid= strong; dotted= fractured)

• DSM5 created
• adult and child version (adult will complete their own; a parent may complete the child's; an adolescents will complete the child version for themselves)
• first level= self report questions in 13 domains, rated on scale 0-4. A high enough score on this may indicate that the second level of questioning may be needed
• second level= another level of questioning in these domains. helps counselor identify areas of need to help create clinical formulation

• world health org. disability assessment schedule 2
• assessment conducted by clinicians to analyze disability in people 18+
• 2 versions:
  1. simple= client rates difficulty on scale 1-5. summed across all 13 domains and determined the degree of impairment in functioning
  2. complex= uses item0response theory based scoring, which weighs individual items within each domain. This is done with a computer and results in a score 0-100, where 0= no disability and 100=full disability

• cutting
• strangling self
• hitting head on something
• ignoring medical advice
• excessive substance use

middle aged adults present highest suicide risk over other age groups

males are more likely to commit suicide than females

high suicide risk, especially those healthy entrenched in social media groups as a means of support and socialization

• this is to evaluate the counseling process and outcomes
  1. goal attainment scaling= Id problems are reframed as goals to be address. goals are given weights or rating of importance and addressed in that order
  2. target problem scaling= help when the ID problems are hard to quantify. client IDs severity of each target problem and rates the changes in the problems as treatment progresses
  3. task achievement scaling= tasks related to the established goal are given rating when completed to assess progress toward goal
  4. surveys= used to rate and evaluate the client's feelings about services and may measure satisfaction

• first pioneered by Carl Rogers and his person-centered, humanistic approach to counseling, Carkhuff developed a 5 point scale to measure the counselor's levels of empathy, genuineness, concreteness, and respect
  1. therapist is contradictory in statements and nonverbal cues; exhibits defensiveness
  2. therapist is superficially professional but lacks genuineness
  3. therapist does not express defensiveness; there is implied but no overt professionalism
  4. therapist is genuine and nondefensive
  5. therapist is open/ honest, accurately and genuinely reflects ideas and reactions to client