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PSYCHOSOCIAL ASSESSMENTPSYCHOSOCIAL ASSESSMENT
JOHN STONE ( PSYCHOSOCIAL OCCUPATIONAL THERAPIST)JOHN STONE ( PSYCHOSOCIAL OCCUPATIONAL THERAPIST)
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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.
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Organic Alzheimer's
Dementia VascularDementia due to: HIV
Head injuryPDHuntingtonsPicks
CJDDelirium: Confused?
Mood disorders (Depression) ReactiveSevere
AgitatedMild
ManiaBi-Polar Hypo/Hyper
Schizophrenia type ParapheniaSchiziodPsychosis
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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.
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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)
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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)
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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)
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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)
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Stress
VulnerabilityLow High
High
ILLNESS
WELLNESS
Zubin& Spring (1977)
Model of Stress Vulnerability
14.10.2010 [email protected] (2010)
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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.
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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)
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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.
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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)
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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
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Can I go home now ?Can I go home now ?
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