Clinical Diagnosis for discussion internal medicine/ psychiatry /addiction Mark degree of importance for each??Provisional.Etiological/ pathology.Disease/syndrome.Symptoms ?? Craving.Psychodynamic mostly CBT.Problems/ ComplicationsD.D.Deferred and follow up of change base line. Needs of the patient.
Core principles: Source ofinformationProper Clinical assessment process is important to generate a solidly supported treatment plan.- Clinical judgment.- Patient’s self-report. ( individualize ttt , ttt goals are mutually determined and targeted at real needs, enhance the pt”s motivation).- Collateral reports : family , as the pt is nt always willing , to know how other perceive the problem, and to note whether the pt had trouble with other intervention.
Goals of a Clinical Needs AssessmentBeside providing the diagnosis for treatment of substance use disorders,Needs assessment process is essential:1)Provide report for multiple service sectors.2)Broad ranges of life areas.3)identify,and response to co-occurring disorders, and environmental or situational risk factors.
Goals of a Clinical Needs .(Assessment (cont4)identify, strengths, Psycho-Social-Spiritual supports, personal resources and interpersonal resources.5)Identify the patient’s involvement with other systems.6)Identify possible barriers to treatment.7)Provide base line for monitoring change in the problems.8)Support evidence based practice.9)Good validity and reliability.10)Adminstered and interpreted with cultural sensitivity.
Hallmarks of a Good Clinical Assessment Informs the treatment plan. Cross-checks for inconsistencies in the patient’s self-reported information. Help facilitate patient recall and give the patient voice.
Using the Assessment for Severity-Based Problem Prioritization Assessing recency, breadth and prevalence of clinical problems. Using scale scores in assessment as measures of problem severity. Treatment and problem history as an indicator of severity.
Global Appraisal of Individual Needs ((GAIN LECTURE ABBASSIA MARCH2013ABBSIA 201 Needs.pdf
Structure of GAIN clinical scale
Addiction Severity Index (severity and baseline follow up) General info Additional tests?? Employment/support status. Alcohol/drug. Legal status. Family history. Family and social relationship. Psychiatric status. Severity profile .
Addiction Severity Index Severity Rating for the Interviewer
Addiction Severity Index Severity Rating for the patient
Problem Severity and Intervention History Grid
CB Approach, case formulation Relevant childhood data. Current life problem. Already investigated. Core beliefs ( unlovable or helpless). Conditional assumptions/beliefs/rules ( +ve or –ve). Compensatory strategies. (compulsive, inappropriate, energy depleting, not balanced, usage of drug.)
CB Approach, case formulation .((cont Vulnerable situations, cues. Internal – external. Automatic thoughts (core- conditional – drug related). Emotion associated with automatic thoughts . Behaviors ( drug seeking, irresponsible activities, abuse others, avoidance. Integration of the above data .
Steps of change
Diagnosis and Classification Comparison of DSM-IV and ICD-10. Future consideration in diagnosis.DSM-5
TREATMENT PLANNING Acute alcohol or drug intoxication or withdrawel potential. Biomedical condition and complications. Emotional, behavioral, cognitive conditions and complications. Readiness to change. Relapse, continued use, and continued problem potential. Recovery environment.