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Psychiatrically Relevant Co-Morbidities: Content Areas ...

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    Psychiatrically Relevant Co-Morbidities: Content Areas ... Psychiatrically Relevant Co-Morbidities: Content Areas ... Presentation Transcript

    • Psychiatrically Relevant Co-Morbidities: Content Areas and Assessment Domains Philip D. Harvey, PhD Emory University School of Medicine
    • Top Ten Causes of Disability
      • Ischemic heart Disease**
      • Cerebrovascular disease
      • Major Depression*
      • Lung Cancer**
      • Traffic Accidents**
      • Alcohol abuse*
      • Arthritis
      • Dementia*
      • COPD**
      • Self-inflicted injuries*
      Note. * Clearly neuropsychiatric; ** Likely neuropsychiatric Note. Skin Diseases are attributed to have an average DALYS (disability-adjusted life years) value of 0.1 compared to 25.4 for neuropsychiatric disorders. Is there some overlap here?
    • Domains of Psychiatric Impairment
      • Symptomatic
        • Depression
          • Including hopelessness and suicidality
        • Anxiety
        • Frustration tolerance and explosiveness
      • Quality of Life
        • Subjective Impression
        • Illness Burden
      • Functional Disability
    • Assessment of Psychiatric Symptoms
      • Self report scales
        • Abbreviated
          • BDI
          • STAI
        • Comprehensive
          • MMPI
      • Clinician Ratings
        • MADRS
        • HDRS/HARS
    • Limitations of Assessment Domains
      • Transparent scales cannot prevent or detect response bias
      • Clinician ratings require expertise
      • Comprehensive inventories are long and require literacy
    • Quality of Life Assessment
      • Global Impressions of Life Satisfaction
        • QLES-Q
      • Illness Burden
        • QWB
    • Limitations with Assessment Domains
      • Again, no protection against bias
      • QWB is referenced against other illnesses
        • People with some psychiatric conditions underestimate their burden
    • Dimensions of Functional Impairment
        • Occupational
        • Social
        • Self-Care
        • Independent Living
    • How do you assess functional disability?
      • Self-report
      • Informant report
      • Direct observation
      • Objective information
      • Performance-based tests
    • Limitations of Assessment Domains
      • Objective information
        • Availability; Relevance;
      • Informant report
        • Availability; situation specificity
      • Self-report
        • Bias; Cognitive limitations
      • Observation
        • Situation-specificity; low target frequency
      • Performance-based
        • Practicality; content validity; difficulty
    • Depression as a source of bias
      • Current levels of depression have been reported across neuropsychiatric conditions to influence self-reports
      • These include self-evaluations and subjective reports of anticipated later outcomes
    • Sadder, but wiser
      • College students with elevated BDI scores give self-reports of their attractiveness that are consistent with observer ratings; lower scores overestimate their attractiveness
      • MS patients with depression provide accurate reports of their cognitive disabilities; nondepressed patients overestimate
    • Normal optimistic bias
      • David Dunning reports that 75% of college professors report that they are academically “above average” compared to college professor peers
      • 80% think that they are better looking
      • Feedback that deflates their self opinion leads to increases in convergence between observer ratings and self-report
    • What are the determinants of real-world disability ?
      • The prediction of real-world disability is a considerable challenge
      • Quality of life can be predicted similarly
      • Many factors may contribute small increments of prediction
      • Precise modeling may be the key to answering the question
    • Attn/WM Neg Sx Pos Sx Depression Functional Capacity Work Outcome .14 R 2 =0.20 Social Competence Processing Speed Executive Functioning Verbal Memory .17 -.11 .47 .26 .10 .25 -.17 -.29 .47 .40 .16 .36 Note. N=227; Bowie et al., 2008
    • What are the potential causal models for dermatological conditions?
      • Does itching/acne lead to depression which leads to disability which leads to QoL reduction?
      • Does itching/acne lead to disability which leads to depression which leads to QoL reduction?
      • Does itching/acne leading to disability, depression, and QoL reduction, which are simply correlated?
      • All of these models suggest different points of intervention
    • Social Competence
      • Communication skills
      • Interaction skills
      • Examine verbal, nonverbal, and social cognitive abilities
      • Example Measures
        • Maryland assessment of Social competence (MASC)
        • Social Skills Performance Assessment (SSPA)
    • Everyday living skills
      • Cooking; shopping; planning
      • Child care
      • Emergency procedures
      • Financial Management
      • Example instruments
        • Direct Assessment of Functional Status (DAFS)
        • UCSD Performance-based skills assessment (UPSA)
        • Everyday functioning battery (EFB)
    • Vocational Skills
      • Actual job-related performance
      • Job seeking and job maintenance
      • Example Instruments
        • COMPASS system
          • Provides detailed feedback about employability
    • Medication management
      • The ability to acquire medications
      • Ability to plan and complete medication self-administration
      • Example Tests
        • Medication Management Ability Test (MMAT)
    • Future Directions
      • Deployment of performance-based measures of functioning and collection of multi-channel outcomes
      • Direct assessment of functional potential
        • Use as a treatment outcome
      • Develop sophisticated models of influence
      • Test patterns of causal influence through treatment-outcomes designs