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Psychiatrically Relevant Co-Morbidities: Content Areas ...

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Transcript of "Psychiatrically Relevant Co-Morbidities: Content Areas ..."

  1. 1. Psychiatrically Relevant Co-Morbidities: Content Areas and Assessment Domains Philip D. Harvey, PhD Emory University School of Medicine
  2. 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. 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. 4. Assessment of Psychiatric Symptoms • Self report scales – Abbreviated • BDI • STAI – Comprehensive • MMPI • Clinician Ratings – MADRS – HDRS/HARS
  5. 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. 6. Quality of Life Assessment • Global Impressions of Life Satisfaction – QLES-Q • Illness Burden – QWB
  7. 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. 8. Dimensions of Functional Impairment Occupational Social Self-Care Independent Living
  9. 9. How do you assess functional disability? • Self-report • Informant report • Direct observation • Objective information • Performance-based tests
  10. 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. 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. 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. 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. 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. 15. Attn/WM Neg Sx Pos Sx Depression Functional Capacity Work Outcome.14 R2 =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. 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. 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. 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. 19. Vocational Skills • Actual job-related performance • Job seeking and job maintenance • Example Instruments – COMPASS system • Provides detailed feedback about employability
  20. 20. Medication management • The ability to acquire medications • Ability to plan and complete medication self-administration • Example Tests – Medication Management Ability Test (MMAT)
  21. 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
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