participating in the care of the mentally ill: a
TRANSCRIPT
Sodeinde Olanrewaju, MNACP
PARTICIPATING IN THE CARE OF THE
MENTALLY ILL: A PSYCHOLOGICAL
PERSPECTIVE AND CALL TO ACTION
Introduction
Mental illness, also called mental disorder,
psychiatric disorder or psychological disorder
refers to a mental, social or culturally
unacceptable behaviour that is characterized by
distress, impairment, risk to self or risk to others
CAUSES OF MENTAL ILLNESS
Multifactorial
Interactions between people's genetic makeup (biology), personality (psychology), and sociocultural environment (social world) contribute to illness experience
BIOPSYCHOSOCIAL MODEL(ENGEL, 1977)
• The biological influences are varied, and include
genetics, infections, physical trauma,
nutrition, hormone, and toxins.
• The psychological component proffer psychological
explanations such as lack of self-control, emotional
turmoil, or maladaptive thinking.
• Social and cultural factors are conceptualized as a
particular set of stressful events (being laid off, for
example) that can differentially impact mental health
depending on the individual and his or her social
context.
BIOPSYCHOSOCIAL MODEL (CONT’D)
The biopsychosocial model posits that each of these
factors is not sufficient to create health or mental illness,
but the interaction between them determines the course of
one's illness development.
CARING FOR PEOPLE WITH MENTAL ILLNESS
Because of multifactorial causes, caring for people with mental illness is very challenging and therefore require a multidisciplinary team approach, involving :
Doctors
Nurses
Psychologists
Social workers
Occupational therapists, etc
PSYCHOLOGICAL PERSPECTIVE TO CARE OF
MENTALLY ILL
Assessment
Management
Research
Training
• An objective,
systematic collection,
organization, and
interpretation of
information in a
situation and the
prediction of the
person’s behavior in a
new set of situation
PSYCHOLOGICAL ASSESSMENT
PSYCHOLOGICAL ASSESSMENT (CONT’D.)
Involve a combination of techniques to arrive at
some hypothesis about a person’s behavior,
personality and capabilities
Provide accurate and objective information to
help answering referral question
PSYCHOLOGICAL ASSESSMENT (CONT’D.)
All assessment procedures are more or less formal
ways of finding out:
1. What is wrong with the Client?
2. What is the cause?
3. What can I do to reduce or totally eliminate the
problem?
PSYCHOLOGICAL ASSESSMENT (CONT’D.)
Become imperative because of a need for a
more objective, reliable, and less crude
assessment techniques
Long been recognized by eminent psychiatrists
(Bender,1938; Rorscach,1942)
PSYCHOLOGICAL ASSESSMENT (CONT’D.)
Sources of information
1. Information from client (Clinical Interview)
2. Information from significant others
3. Information from personal records, eg. Case notes, school records, etc.
4. Behavior Observation
5. Administration of psychological tests
CHOICE OF PSYCHOLOGICAL TESTS
Depends on:
Referral questions
Assessment techniques available
Psychologist training & orientation
Practical consideration
(Mental Measurement Yearbook,8th edition)
MAJOR PSYCHOLOGICAL ASSESSMENT
Personality assessment
Intelligence (IQ) assessment
Cognitive assessment
Neuropsychological assessment
PERSONALITY ASSESSMENT
INDICATION
- Predispose to major psychological dx
- Account for unusual features
- Determine treatment response
TYPES
- Projective
- Non-Projective:
PROJECTIVE TECHNIQUES (CRITIQUE)
Most misunderstood and most widely criticized
Strongly criticized to be too long, too complex and too
subjective in its administration, scoring and
interpretation in addition to considerable low validity
(Groth-Marnat, 2007).
The validity and reliability of projective techniques have
been found to be high enough to provide useful
inferences about personality. (Protrowski & Kewller,
1989; Daves, 1994; wood I Nezworski & Stejskal,
1996)
TYPES OF PROJECTIVE TECHNIQUES
Rorschach Ink Blot Test
Thematic Apperception Test
Draw A Person Test
Sentence Completion Test
RORSCHACH INK BLOT TEST
• Rorschach Inkblot Test-a set of 10 inkblots,
seeks to identify people’s inner feelings by
analyzing their interpretations of the inkblots
RORSCHACH INK BLOT TEST (CONT’D)
RORSCHACH INK BLOT TEST (CONT’D)
RORSCHACH INK BLOT TEST (CONT’D)
• This is a projective
developed by Henry Murray
and Christiana Morgan in
the 1930s
• Consist of 31 standard
cards
• The rational behind the
technique is that people
tend to interpret ambiguous
situation in accordance with
their own past experience
and motivations
THEMATIC APPERCEPTION TEST
THEMATIC APPERCEPTION TEST(CONT’D)
THEMATIC APPERCEPTION TEST(CONT’D)
A 22 year old man with clenched fist
Sex: Male- Identified with the male sex
Age: 22years- Wishful thinking and
desire to be older
Ear (large)- idea of reference
Nose minimised- Castration anxiety
Shoulder (large)- insecurity/ desire to
be in control
Waistline- unconscious sexual conflict
Hand (clenched)- Aggressive tendency
Legs (long)- Need for autonomy
SAMPLE OF DAP
SAMPLE OF ISBC
Poor insight: I think this hospital is not for me
Feeling Abandoned and need for love: - A mother… is essential for a baby child - My father… abandoned me - I need… unconditional love
Perceived feeling of deprivation, suffering, and maltreatment: - I wish… I had gone for my secondary school graduation - What pain me… is people suffering - Back home… I was maltreated - I suffered… from my uncle bad treatment
Identity crisis: I have… no identity
Adolescent crises and need for independence: - Happiest time… is being free - Boys… are expected to take charge
Religious preoccupation - The only trouble… is God’s wrath - I am best… when my relationship with God is at its pick
NON-PROJECTIVE TECHNIQUES
• Use of Self-report inventories/ questionnaires:
- EPQ
- SES
- CPI
- MMPI
- MCMI
MMPI-2
Gold standard in personality testing
Most widely researched and most widely used
objective personality inventory
Designed specifically to assesses
- Personality traits and psychopathology
- Also predict treatment outcomes
MMPI-2 (CONT’D)
Validity scales (3)
Clinical Scales (10): Scale 1- 0
Result enables the clinician to make inferences
about client's typical behaviors and way of thinking.
Also determine severity of impairment, outlook of
life, approaches to problem solving, typical mood
states, likely diagnoses, and potential rx problems
MMPI-2: QUALIFICATION OF TEST TAKER
Who can take the MMPI-2?
18yrs and older
Individuals who can read and
write
At least 8th
grade (Junior sec
sch. 2)
MMPI-2: ADMINISTRATION, SCORING &
INTERPRETATION
Administration - Individual - Group
Scoring - VRIN/ TRIN convertion- Template (‘Keys’)
Interpretation
MMPI-2 TEMPLATE
MMPI-2 PROFILE
MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)
MCMI is the second most widely used personality inventory after MMPI
Developed by Theodore Millon, Carrie Millon, Roger Davis & Seth Grossman
To provide information on specific DSM psychopathology
MCMI is intended to be an evolving assessment tool to be refined and updated as needed on the basis of substantive advances theoretical logic, research data, and professional nosology
THEODORE MILLION (1928 – 2013)
COMPOSITION OF MCMI-III
Consist of 175 questions
Modelled on four set of scales
Personality Disorder Scales
Clinical Syndrome Scales
Modifying Indices
Random Response Indicators
ADMINISTRATION AND SCORING
Easy to administer
Conducive testing environment
Give Client question and answer booklet, pencil
and eraser
Require 30– 60 minutes to complete
Scored with a template
MCMI SCORING TEMPLATE
SAMPLE OF MCMI PROFILE
INTELLIGENCE (IQ) ASSESSMENT
Assess intellectual ability
Mostly required during rehabilitation/ deficit in intellectual functioning.
IQ TESTS
Progressive Matrix
Wechsler Intelligence Test Series
Vineland Adaptive Behavior Scale
PROGRESSIVE MATRICES
Developed by Raven(1958)
It is a non-verbal and multiple-choice test of
intellectual capacity and general mental ability.
Test are progressively more difficult
Consist of 5 sets of 12 designs of Matrices from which
a part has been removed
Subject choose the missing part from 6-8 alternatives
Useful for illiterate, foreigners, deaf, subject with
speech difficulties
RAVENS SAMPLE QUESTION
RAVENS SAMPLE QUESTION 2
VINELAND ADAPTIVE BEHAVIOUR SCALE
Communication Domain
Daily living Skills Domain
Socialization Domain
Motor Skills Domain
Maladaptive Behaviour Index
NEUROPSYCHOLOGICAL TESTING
Psychological dx may be due to neurological disturbance as well as life problem -Distinguish between biogenic (Neurological) & psychogenic cases
TESTS
Luria- Nebraska Neuropsychological Battery
Halsted-Reitan Battery
Bender Visual-Motor Gestalt Test
Slosson Drawing Coordination Test
BENDER VISUAL-MOTOR GESTALT TEST
Most widely used screening test for organicity
Paper and pencil test developed by Bender in 1938
Consist of 9 simple familiar geometric design, each printed on
separate card
Each card is presented one after the other during administration
Examinees are expected to reproduce or copy the design on a
piece of paper as accurately as possible
Errors such as location of figures, overlapping difficulties, etc
are indicative of brain damage/neurological impairment
SLOSSON DRAWING COORDINATION TEST
WECHLER INTELLIGENCE SCALES
Wechsler Pre-school and Primary Scale of
Intelligence (WPPSI)
Wechsler Intelligence Scale for Children (WISC)
Wechsler Adult Intelligence Scale (WAIS)
WECHSLER ADULT INTELLIGENCE SCALE (WAIS)
Developed by David Wechsler in 1997
Based on Wechsler’s philosophy of intelligence
as "... the global capacity of the individual to
act purposefully, to think rationally, and to deal
effectively with his environment."
Assess intellectual functioning of adults, aged
16 – 89
David Wechsler, a
leading American
psychologist and
one of the pioneer
researcher in IQ
testing
DAVID WECHSLER(1896-1981)
WAIS
Consist of 14 Subtests, grouped into - Verbal Scales - Performance Scales
Yield 3 traditional composite scores - Verbal IQ (VIQ) - Performance IQ (PIQ) - Full Scale IQ (FSIQ)
4 Index Scores
(based on more refined domain of cognitive functioning) - Verbal Comprehension - Perceptual Organization - Working Memory - Processing Speed
VERBAL
Vocabulary
Similarities
Arithmetic
Digit Span
Information
Comprehension
Letter-Number Sequencing
PERFOFMANCE
• Picture Completion
• Digit Symbol
• Block Design
• Matrix Reasoning
• Picture Arrangement
• Symbol Search
• Object Assembly
WAIS VERBAL AND PERFORMANCE SUBTESTS
PICTURE COMPLETETION
PICTURE COMPLETETION…/2
BLOCK DESIGN
PICTURE ARRANGEMENT
WAIS SCALES ORGANISATION
IQ SCORE
• 130 and above
• 120-129
• 110-119
• 90-109
• 80-89
• 70-79
• 69 and below
IQ SCORE
• Very Superior
• Superior
• High Average
• Average
• Low Average
• Borderline
• Extremely low
QUALITATIVE DISCRIPTION OF SCORES
PSYCHOTHERAPY
Individual
Group
- Open group
- Close group
Insight therapy
Behaviour therapy
GROUP THERAPY SESSION
PSYCHOTHERAPY
Psychoanalysis
Client centred
Cognitive
Cognitive-Behaviour Therapy
- Becks
- Ellis
CALL FOR ACTION
Participating in the care of the mentally ill is very
challenging as associated:
Stigma
Dangerousness (Risk to self and others)
Burden of care
- Emotional and financial stress, etc.
- Burnout
CALL FOR ACTION (CONT’D)
Need to protect ourselves (burnout) and clients
Need for synergy among health workers - Teamwork (everybody wins) - Every part of the body is important
Need capacity building and human capital development
Need for personal development
Effective government policy (Relativity allowance)