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  • 1. Psychiatrically Relevant Co-Morbidities: Content Areas and Assessment Domains Philip D. Harvey, PhD Emory University School of Medicine
  • 2. 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?
  • 3. Domains of Psychiatric Impairment
    • Symptomatic
      • Depression
        • Including hopelessness and suicidality
      • Anxiety
      • Frustration tolerance and explosiveness
    • Quality of Life
      • Subjective Impression
      • Illness Burden
    • Functional Disability
  • 4. Assessment of Psychiatric Symptoms
    • Self report scales
      • Abbreviated
        • BDI
        • STAI
      • Comprehensive
        • MMPI
    • Clinician Ratings
      • MADRS
      • HDRS/HARS
  • 5. Limitations of Assessment Domains
    • Transparent scales cannot prevent or detect response bias
    • Clinician ratings require expertise
    • Comprehensive inventories are long and require literacy
  • 6. Quality of Life Assessment
    • Global Impressions of Life Satisfaction
      • QLES-Q
    • Illness Burden
      • QWB
  • 7. Limitations with Assessment Domains
    • Again, no protection against bias
    • QWB is referenced against other illnesses
      • People with some psychiatric conditions underestimate their burden
  • 8. Dimensions of Functional Impairment
      • Occupational
      • Social
      • Self-Care
      • Independent Living
  • 9. How do you assess functional disability?
    • Self-report
    • Informant report
    • Direct observation
    • Objective information
    • Performance-based tests
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. 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)
  • 18. 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)
  • 19. Vocational Skills
    • Actual job-related performance
    • Job seeking and job maintenance
    • Example Instruments
      • COMPASS system
        • Provides detailed feedback about employability
  • 20. Medication management
    • The ability to acquire medications
    • Ability to plan and complete medication self-administration
    • Example Tests
      • Medication Management Ability Test (MMAT)
  • 21. 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