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NCMHCE Review Part 3
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~ Categories of information
~ Presenting issue
~ Mental Status Exam
~ Emotional
~ Behavioral
~ Physical
~ Personality
~ Coping Skills
~ Family of Origin
~ Culture
~ Social Supports and interpersonal relationships
~ Environment live and work
~ Developmental stage
~ Activities of daily living and ability for independence
~ Motivation
~ Categories of Information
~ Emotional Signs and symptoms
~ Degree of emotional control
~ Ability to feel and express a range of emotions
~ Emotional appropriateness
~ Emotional issues which may be a focus of clinical attention
~ Anger
~ Anxiety
~ Depression
~ Grief
~ Guilt
~ Categories of information
~ Psychiatric signs
~ Looking for diagnostic criteria for disorders
~ Affective, behavioral/physical, cognitive, social indicators of mood disorders
~ Changes in thinking behavior associated with cognitive impairments
~ Signs of a substance use disorder
~ Discussing with client
~ Exacerbating factors and triggers
~ Mitigating factors and effective interventions
~ Categories of information
~ Medical and Physical Symptoms and Issues
~ Consider the possibility that symptoms are caused by a medical condition and refer for an evaluation
~ Evaluate current medications and consider medication side effects
~ Is the client intoxicated or in withdrawal from a substance
~ Vegetative symptoms: Persistent problems with appetite, weight control, sleep, energy, sexual desire and function
~ Categories of information
~ Medical and Physical Symptoms and Issues
~ Somatoform Disorders: Physical symptoms with no detectable physiological cause
~ Includes pain disorder and body dysmorphic disorder
~ When tests and physical exams do not support the patient’s symptoms consider malingering of factitious disorders
~ Categories of information
~ Personality Traits
~ Patterns of behavior, thinking and perception that are pervasive can indicate a personality style such as aggressive, addictive, Type A or co-dependent or a personality disorder such as antisocial, histrionic, or borderline
~ Ego functioning
~ Self regulation/impulse control/frustration tolerance
~ Defense mechanisms
~ Healthy use limits dysphoric emotions without significantly disrupting a persons life

~ Categories of information
~ Coping skills
~ Coping abilities, resources and deficits
~ Current coping strategies that are and are not effective
~ Ways the client has responded to similar problems in the past (adaptive and maladaptive)
~ Specific individual characteristics that impact coping ability such as developmental level, cognitive functioning, locus of control and sense of self-efficacy
~ Family of Origin
~ Cultural background
~ Socioeconomic background

~ Categories of information
~ Interpersonal Relationships and Social Supports
~ Type, quality and effectiveness of current relationships
~ If isolated, evaluate for voluntary withdrawal, poor social skills, alienation, shyness/social anxiety, substance misuse or compulsive behaviors, low self-esteem, PTSD
~ Capacity for healthy interpersonal relationships (boundaries)

~ Categories of information
~ Social Roles and Role Functioning
~ Each role holds a set of role expectations
~ What roles does the person fulfill (child, parent, spouse, employee, friend…)
~ Is there role ambiguity or role conflict (parent/friend; parent/employee)
~ Has there been a loss of an important role (empty nest, divorce)
~ Is the client overwhelmed or ambivalent about the responsibilities associated with a role (parenting, employee, spouse)
~ Are client’s normal dependency/affiliation needs being met in an appropriate way (boundaries)
~ Is the client being victimized/manipulating or victimizing/manipulating someone else
~ Categories of information
~ The Environment
~ Living and working environment (safety, security, stressors)
~ Maslow+: Shelter, food, economic resources, education, job opportunities, legal resources, transportation, religious and community groups (assistance, affiliation and support), sources of social support and affiliation (a farm in rural area vs. an urban environment)
~ Developmental Stage
~ Child development issues
~ Current developmental tasks and issues
~ Categories of information
~ Activities of Daily Living / Personal Independence (safety, effectiveness and ability to complete independently)
~ Self-care skills
~ Health care (exercise, sleep, nutrition/cooking, medications)
~ Environmental skills (cleaning, laundry)
~ Financial Skills
~ Child care/parenting skills(if needed)
~ Transportation

~ Categories of information
~ Client’s motivation level
~ What are the clients goals and expectations
~ Help set SMART goals
~ How does the client view his/her role (active, or passive)

~ Sources of Information
~ Client self-report
~ Provides the current, salient factors for the client
~ May not include underlying issues
~ May not be complete if client is not comfortable
~ Observations of verbal and nonverbal behavior
~ Observations of interactions with therapist, others
~ Do observations match client reports?
~ Has there been a physical workup to rule out medical causes of symptoms?

~ Sources of Information
~ Collateral sources
~ Medical referral/report
~ Prior treatment history
~ Relatives
~ Caretakers
~ Case workers
~ Employers

~ A comprehensive assessment should provide the factual evidence supporting your diagnosis
~ The symptoms identified in the assessment will form the basis for the treatment plan
~ Assessments should always involve collaboration with other professionals when permitted to rule out biological or other social/environmental causes (i.e. domestic violence, trauma, detox)
~ No one person’s account will be truly unbiased.
Test Taking Tip
~ In the initial question you are trying to uncover more clues to help you verify your hypothesis about the client’s diagnosis
~ Do not get distracted by questions which would reveal interesting information but not relevant to the case.
~ If you suspect the client has PTSD, gathering information about substance use will not provide you any additional information about that particular diagnosis. It may be a comorbid diagnosis, but the scenario is focused on the PRIMARY diagnosis.