Folk. Presentation Psych Ax.01

8/8/2019 Folk. Presentation Psych Ax.01

1/16

PSYCHOSOCIAL ASSESSMENTPSYCHOSOCIAL ASSESSMENT

JOHN STONE ( PSYCHOSOCIAL OCCUPATIONAL THERAPIST)JOHN STONE ( PSYCHOSOCIAL OCCUPATIONAL THERAPIST)

[email protected] (2010)


2/16

ClassificationClassification

To identify groups of clients who share similar clinical features to enableTo identify groups of clients who share similar clinical features to enableintervention planning, prediction of likely outcome, research and effectiveintervention planning, prediction of likely outcome, research and effectivecommunication between clinicians. Most physical conditions can be based oncommunication between clinicians. Most physical conditions can be based onaietiology and be confirmed by medical screening . In Psychiatry we have toaietiology and be confirmed by medical screening . In Psychiatry we have tomostly rely on symptoms alone.mostly rely on symptoms alone.



3/16

Organic Alzheimer's

Dementia VascularDementia due to: HIV

Head injuryPDHuntingtonsPicks

CJDDelirium: Confused?

Mood disorders (Depression) ReactiveSevere

AgitatedMild

ManiaBi-Polar Hypo/Hyper

Schizophrenia type ParapheniaSchiziodPsychosis



4/16

Personality DisordersPersonality Disorders ParanoidParanoid

AntiAnti--socialsocial

ImpulsiveImpulsive Intellectual DisabilitiesIntellectual Disabilities

Obsessive/NeurosisObsessive/Neurosis SocialSocial

PhobicPhobic

O.C.D.O.C.D.

Severe Stress ReactionSevere Stress Reaction

Generalized AnxietyGeneralized Anxiety

Reaction to Stress ExperiencesReaction to Stress Experiences AcuteAcuteP.T.S.D.P.T.S.D.

Functional Somatic SyndromesFunctional Somatic Syndromes Adjustment,Functional, M.E., Gulf War,Adjustment, Functional, M.E., Gulf War,building sickness, Postbuilding sickness, Post--viral, IBS,viral, IBS,Fibromyalgia, etc.Fibromyalgia, etc.



5/16

Psychiatric InterviewingPsychiatric Interviewing

Therapeutic use of selfTherapeutic use of self

Listening SkillsListening Skills

Time, pace and sequenceTime, pace and sequence

EnvironmentEnvironment

Supervision & trainingSupervision & training

Mental Health competenciesMental Health [email protected] (2010)


6/16

What Information ?What Information ?

HistoryHistory FamilyFamily father/motherfather/mother /siblings/siblings illness,illness, personality,personality, occupation,occupation, qualityquality ofof relationshiprelationship.. Any Any psychpsych familyfamily illnessillness oror

neuroneuro illnessillness..

PersonalPersonal-- birthbirth probs,probs, development,development, childhood,childhood, education,education, health,health, qualityquality ofof relationshipsrelationships seizures,seizures, nervousnervous problems,problems,

behavioralbehavioral issues,issues, OccupationsOccupations andand satisfactionsatisfaction withwith jobs,jobs, menstrualmenstrual historyhistory.. MaritalMarital historyhistory qualityquality ofof relationships,relationships, healthhealth andandworkwork ofof spouse,spouse, SexualSexual historyhistory abuse,abuse, ChildrenChildren anyany lossloss of,of, mentalmental andand physicalphysical healthhealth ofof childrenchildren.. PresentPresent socialsocial situationsituation housing,housing, whowho livingliving with,with, financialfinancial problemsproblems..

ForensicForensic

PhysicalPhysical

Personality,Personality, Spirituality,Spirituality, beliefsbeliefs andand cultureculture

DailyDaily [email protected] (2010)


7/16

PresentationPresentation

RisksRisks

BehaviorBehavior

SpeechSpeech

MoodMood

DepersonalizationDepersonalization

Obsessions/fearsObsessions/fears

Delusional ideasDelusional ideas

Hallucinations/illusionsHallucinations/illusions

OrientationOrientation

Attention/concentration/memoryAttention/concentration/memory

Insight/view of the world/locus of controlInsight/view of the world/locus of [email protected] (2010)


8/16

Formal AssessmentFormal Assessment

CognitiveCognitive

Mood StatesMood States

Behavior / suicide / risksBehavior / suicide / risks

Schizophrenia/PsychosisSchizophrenia/Psychosis

OT Formal AssessmentOT Formal Assessment

Talking TherapiesTalking [email protected] (2010)


9/16

Stress

VulnerabilityLow High

High

ILLNESS

WELLNESS

Zubin& Spring (1977)

Model of Stress Vulnerability

14.10.2010 [email protected] (2010)


10/16

Dementia AssessmentDementia Assessment

Signs indicating a need for evaluation?Signs indicating a need for evaluation?

CognitiveCognitive memory, attention, perception,memory, attention, perception,disorientation outside of existing pathologydisorientation outside of existing pathology

Personality ChangesPersonality Changes mood, agitation, elationmood, agitation, elation

Problem Behavior'sProblem Behavior's wandering, sleepwandering, sleep

Changes in DailyFunctioningChanges in DailyFunctioning --PADL, DADL, IADLPADL, DADL, IADL

Need =Need = Comprehensive Psychiatric interview, laboratory tests,Comprehensive Psychiatric interview, laboratory tests,e.g. urine, bloods, B.P., Chest xe.g. urine, bloods, B.P., Chest x--ray, history, CT scanray, history, CT scan

presentation analysis and evaluation through use of psychometricpresentation analysis and evaluation through use of psychometricassessment and of daily functioning.assessment and of daily functioning.



11/16

Psychometric Assessment andPsychometric Assessment and

MMSEMMSEMMSEMMSE

Possible poor results for under educated, depressed, notPossible poor results for under educated, depressed, notdesigned to account for ageing, not sensitive to early ordesigned to account for ageing, not sensitive to early ormild impairment, not a diagnostic tool and open tomild impairment, not a diagnostic tool and open todistorted results with the presence of other conditions.distorted results with the presence of other conditions.Does not measure the impact of cognitive deficits onDoes not measure the impact of cognitive deficits ondaily living, community engagement and taskdaily living, community engagement and taskperformance. The AMPS (an assessment of ADL) hasperformance. The AMPS (an assessment of ADL) hasbeen shown to be more favorable and to other testsbeen shown to be more favorable and to other testssuch as the CAMCOG in identifying subjects withsuch as the CAMCOG in identifying subjects with

Dementia.Dementia. [email protected] (2010)


12/16

Occupational TherapyOccupational Therapy

AssessmentAssessment Psychometric assessments should be only a part of analysis.Psychometric assessments should be only a part of analysis.

OT provides unique and essential evidence with training in bothOT provides unique and essential evidence with training in bothphysical and psychosocial aspects of performance and disability.physical and psychosocial aspects of performance and disability.

An assessment of ADL is more useful than cognitive as itAn assessment of ADL is more useful than cognitive as itincorporates many performance components including culturallyincorporates many performance components including culturally

relevant functional ability to lead lives and maintain identitiesrelevant functional ability to lead lives and maintain identities.. OT provides strategies to maintain function, assists in helpingOT provides strategies to maintain function, assists in helping

carers to cope better, and facilitates the personhood by allowingcarers to cope better, and facilitates the personhood by allowingindividuals to maintain their occupational and personal identitiesindividuals to maintain their occupational and personal identitiesin the face of illness.in the face of illness.



13/16

OT & The New Culture ofOT & The New Culture of

Dementia Care Assessment

Dementia Care Assessment

Knowing the personKnowing the person habits, routines &habits, routines &

preferencespreferences

Acknowledging personality traits and lifeAcknowledging personality traits and lifeexperiencesexperiences

Facilitating strengths and abilities that theFacilitating strengths and abilities that the

person can DOperson can DO not focusing on the inevitablenot focusing on the inevitablelosses ofFunction.losses ofFunction.

Promoting engagement in longPromoting engagement in long--life activates andlife activates and

interests using RETAINED abilities.interests using RETAINED [email protected] (2010)


14/16

OT & NEW CULTUREOT & NEW CULTURE

We identify:We identify: Mechanisms of enhancing their controlMechanisms of enhancing their control

Behaviors as signs of discomfort not problemsBehaviors as signs of discomfort not problems

Losses of function and personhood, and support them in a prosthetic mannerLosses of function and personhood, and support them in a prosthetic manner Obstacles to well being in environmentsObstacles to well being in environments

Coping strategies for carersCoping strategies for carers education, selfeducation, self--support, and problem solvingsupport, and problem solving

Compensation for loss of ability to think and planCompensation for loss of ability to think and plan

Harmful stress and over stimulationHarmful stress and over stimulation

Inadequacies of care regimes/environmentsInadequacies of care regimes/environments

Effective communication strategiesEffective communication strategies

Methods of validating clients experiences rather than attempting to forceMethods of validating clients experiences rather than attempting to forcereality orientation to the presentreality orientation to the present



15/16


16/16

Can I go home now ?Can I go home now ?


Folk. Presentation Psych Ax.01

Documents

Transcript of Folk. Presentation Psych Ax.01