NCMHCE Exam Review Podcast
Assessment Part 2
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Objectives
~ Define assessment
~ Review acronyms to help you remember what to look for when assessing for a problem.
What is Assessment
~ Assessment is the process of gathering, analyzing and integrating information into a comprehensive picture that describes
~ The nature, frequency, intensity and duration of the client’s problems
~ The roles the client, significant others and the environment/community play in the current issues
~ The functioning of the client and significant others
~ Client motivation to address presenting issues
~ Resources needed to resolve problems and effectively participate in treatment.
Presenting Issue
~ Represents the problems that are foremost in the client’s mind
~ Denial of any problems may also provide information into client insight, judgement and motivation
Evaluating the presenting issue
~ When did it begin?
~ What makes it worse? Better?
~ How often does it occur and to what intensity?
~ If the client is reporting multiple symptoms, assess the above for each and identify which symptom presented first.
~ What are the antecedents of (triggers/precipitants) the problem?
~ How do you feel when the problem occurs? What are you thinking?
~ Describe what happens right after the problem (reinforcers), habitual responses.
Stressors
~ What stressors are occurring and what is their frequency, intensity and duration?
~ How does the client deal with the stressors?
~ Are the stressors impacting the course of the presenting problem?
Emotional Range
~ Emotional control (dysregulation or flattening) can impact the client’s health, relationships and functioning at work or school.
~ People who avoid dealing with emotions may develop depression, anger or anxiety
~ People who experience dysregulation may also develop depression, anger or anxiety
~ Trauma-induced changes in emotional range may also impact the client’s ability to function
~ Remember that affect is the current, transient state. Always assess affect.
Mood Disorders
~ When the client presents with mood symptoms, inquire about
~ Previous episodes of the same symptoms
~ How he or she has dealt with them before
~ If there was a previous episode, was there full remission?
Depression
~ What to look for
~ Anhedonia
~ Dysphoria
~ Sleep changes
~ Appetite changes
~ Changes in psychomotor behavior
~ Reduction in libido
~ Reduced energy
~ Nonverbals indicating any of the above
~ Highly self-critical
~ Cognitive distortions
~ Hopelessness/pessimism
~ Irritability
~ Guilt/shame
~ Difficulty concentrating
~ Withdrawal from relationships
Depression Mnemonic A SAD FACES
~ A = Appetite (Weight Change)
~ S = Sleep (Insomnia / Hypersomnia)
~ A = Anhedonia
~ D = Dysphoria
~ F = Fatigue
~ A = Agitation / Retardation
~ C = Concentration Diminished
~ E = Esteem (Low) / Guilt
~ S = Suicide / Thoughts of Death
Mania
~ What to look for
~ Elevated mood
~ Grandiosity
~ Irritability/aggression
~ Pressured speech
~ Flight of ideas
~ Restlessness
~ Hypersexuality
~ Impulsivity
~ Limited insight
~ Poor concentration
~ Impatience
~ Gregariousness
~ Provocativeness
Mania Mnemonic DIG FAST
~ Distractibility
~ Indiscretion
~ Grandiosity
~ Flight of ideas
~ Activity increase
~ Sleep deficit
~ Talkativeness
Anxiety
~ What to look for
~ Irritability/edginess
~ Uneasiness/worry
~ Panic
~ Hypervigilance
~ Psychomotor agitation/Nervous habits
~ Nonverbals indicative of worry
~ Ruminating
~ Persistent worrying about a variety of things
~ Difficulty concentrating
~ Withdrawal from relationships
~ Highly critical of self
~ Sleep problems
~ Clinginess/dependency
Anxiety Mnemonic: Worry WARTS
~ Worry
~ Worn out
~ Absentminded
~ Restless
~ Touchy
~ Sleepless
PTSD
~ What to look for:
~ Exposure to a traumatic event
~ Re-Experiencing (Dreams, memories, flashbacks)
~ Avoidance of reminders
~ Negative thoughts or feelings that began or worsened after the trauma and/or difficulty experiencing positive emotions
~ Trauma related arousal and reactivity
PTSD
~ Disinterest in usual activities
~ Re-experience
~ Event preceding symptoms
~ Avoidance
~ Month or more of symptoms
~ Sympathetic arousal
Substance Abuse – SAD CLIPS
~ Signs of intoxication or withdrawal
~ Slowed reflexes
~ Aroma of drugs
~ Difficulty concentrating
~ Confusion
~ Lowered inhibitions
~ Impaired Coordination
~ Pupils
~ Slurred speech
Physical Symptoms – CLASSED
~ Is the client under a doctors care? If so why?
~ If there are obvious long-standing physical/developmental issues, how have they impacted the client?
~ Convulsions or seizures
~ Libido
~ Appetite
~ Sleep
~ Sex hormones
~ Energy
~ Dizziness or fainting
~ Describe childhood health
Medical Referral- EAT LOADS
~ Eating Disorder
~ AIDS/HIV
~ Tuburculosis
~ Long standing depression
~ Ongoing physical complaint (chest pain, dizziness, abdominal pain, chronic cough, fatigue)
~ Abrupt personality or behavioral change
~ Delirium/Dementia
~ Substance abuse
Test Taking Tip
~ Everything in the NCMHCE has one clear diagnosis and assumes a mutual respect between client and counselors. Thus, the test is measuring for ideal questions and treatments, even if those might not be appropriate or applicable in some real-world situations.
~ In reading the initial scenario, focus on the symptoms and all components of the question.
~ Does the question indicate the client is grieving and withdrawn? Then you would look for remedies that target that area such as support groups
~ Consider whether the information that is being requested is actually beneficial and whether it will narrow down the diagnosis. Asking too many questions will lower your score
~ Gather support FOR your diagnosis NOT to rule out other things.