Sodeinde Olanrewaju, MNACP

PARTICIPATING IN THE CARE OF THE

MENTALLY ILL: A PSYCHOLOGICAL

PERSPECTIVE AND CALL TO ACTION

Introduction

Mental illness, also called mental disorder,

psychiatric disorder or psychological disorder

refers to a mental, social or culturally

unacceptable behaviour that is characterized by

distress, impairment, risk to self or risk to others

CAUSES OF MENTAL ILLNESS

Multifactorial

Interactions between people's genetic makeup (biology), personality (psychology), and sociocultural environment (social world) contribute to illness experience

BIOPSYCHOSOCIAL MODEL(ENGEL, 1977)

• The biological influences are varied, and include

genetics, infections, physical trauma,

nutrition, hormone, and toxins.

• The psychological component proffer psychological

explanations such as lack of self-control, emotional

turmoil, or maladaptive thinking.

• Social and cultural factors are conceptualized as a

particular set of stressful events (being laid off, for

example) that can differentially impact mental health

depending on the individual and his or her social

context.

BIOPSYCHOSOCIAL MODEL (CONT’D)

The biopsychosocial model posits that each of these

factors is not sufficient to create health or mental illness,

but the interaction between them determines the course of

one's illness development.

CARING FOR PEOPLE WITH MENTAL ILLNESS

Because of multifactorial causes, caring for people with mental illness is very challenging and therefore require a multidisciplinary team approach, involving :

Doctors

Nurses

Psychologists

Social workers

Occupational therapists, etc

PSYCHOLOGICAL PERSPECTIVE TO CARE OF

MENTALLY ILL

Assessment

Management

Research

Training

• An objective,

systematic collection,

organization, and

interpretation of

information in a

situation and the

prediction of the

person’s behavior in a

new set of situation

PSYCHOLOGICAL ASSESSMENT

PSYCHOLOGICAL ASSESSMENT (CONT’D.)

Involve a combination of techniques to arrive at

some hypothesis about a person’s behavior,

personality and capabilities

Provide accurate and objective information to

help answering referral question

PSYCHOLOGICAL ASSESSMENT (CONT’D.)

All assessment procedures are more or less formal

ways of finding out:

1. What is wrong with the Client?

2. What is the cause?

3. What can I do to reduce or totally eliminate the

problem?

PSYCHOLOGICAL ASSESSMENT (CONT’D.)

Become imperative because of a need for a

more objective, reliable, and less crude

assessment techniques

Long been recognized by eminent psychiatrists

(Bender,1938; Rorscach,1942)

PSYCHOLOGICAL ASSESSMENT (CONT’D.)

Sources of information

1. Information from client (Clinical Interview)

2. Information from significant others

3. Information from personal records, eg. Case notes, school records, etc.

4. Behavior Observation

5. Administration of psychological tests

CHOICE OF PSYCHOLOGICAL TESTS

Depends on:

Referral questions

Assessment techniques available

Psychologist training & orientation

Practical consideration

(Mental Measurement Yearbook,8th edition)

MAJOR PSYCHOLOGICAL ASSESSMENT

Personality assessment

Intelligence (IQ) assessment

Cognitive assessment

Neuropsychological assessment

PERSONALITY ASSESSMENT

INDICATION

- Predispose to major psychological dx

- Account for unusual features

- Determine treatment response

TYPES

- Projective

- Non-Projective:

PROJECTIVE TECHNIQUES (CRITIQUE)

Most misunderstood and most widely criticized

Strongly criticized to be too long, too complex and too

subjective in its administration, scoring and

interpretation in addition to considerable low validity

(Groth-Marnat, 2007).

The validity and reliability of projective techniques have

been found to be high enough to provide useful

inferences about personality. (Protrowski & Kewller,

1989; Daves, 1994; wood I Nezworski & Stejskal,

1996)

TYPES OF PROJECTIVE TECHNIQUES

Rorschach Ink Blot Test

Thematic Apperception Test

Draw A Person Test

Sentence Completion Test

RORSCHACH INK BLOT TEST

• Rorschach Inkblot Test-a set of 10 inkblots,

seeks to identify people’s inner feelings by

analyzing their interpretations of the inkblots

RORSCHACH INK BLOT TEST (CONT’D)

RORSCHACH INK BLOT TEST (CONT’D)

RORSCHACH INK BLOT TEST (CONT’D)

• This is a projective

developed by Henry Murray

and Christiana Morgan in

the 1930s

• Consist of 31 standard

cards

• The rational behind the

technique is that people

tend to interpret ambiguous

situation in accordance with

their own past experience

and motivations

THEMATIC APPERCEPTION TEST

THEMATIC APPERCEPTION TEST(CONT’D)

THEMATIC APPERCEPTION TEST(CONT’D)

A 22 year old man with clenched fist

Sex: Male- Identified with the male sex

Age: 22years- Wishful thinking and

desire to be older

Ear (large)- idea of reference

Nose minimised- Castration anxiety

Shoulder (large)- insecurity/ desire to

be in control

Waistline- unconscious sexual conflict

Hand (clenched)- Aggressive tendency

Legs (long)- Need for autonomy

SAMPLE OF DAP

SAMPLE OF ISBC

Poor insight: I think this hospital is not for me

Feeling Abandoned and need for love: - A mother… is essential for a baby child - My father… abandoned me - I need… unconditional love

Perceived feeling of deprivation, suffering, and maltreatment: - I wish… I had gone for my secondary school graduation - What pain me… is people suffering - Back home… I was maltreated - I suffered… from my uncle bad treatment

Identity crisis: I have… no identity

Adolescent crises and need for independence: - Happiest time… is being free - Boys… are expected to take charge

Religious preoccupation - The only trouble… is God’s wrath - I am best… when my relationship with God is at its pick

NON-PROJECTIVE TECHNIQUES

• Use of Self-report inventories/ questionnaires:

- EPQ

- SES

- CPI

- MMPI

- MCMI

MMPI-2

Gold standard in personality testing

Most widely researched and most widely used

objective personality inventory

Designed specifically to assesses

- Personality traits and psychopathology

- Also predict treatment outcomes

MMPI-2 (CONT’D)

Validity scales (3)

Clinical Scales (10): Scale 1- 0

Result enables the clinician to make inferences

about client's typical behaviors and way of thinking.

Also determine severity of impairment, outlook of

life, approaches to problem solving, typical mood

states, likely diagnoses, and potential rx problems

MMPI-2: QUALIFICATION OF TEST TAKER

Who can take the MMPI-2?

18yrs and older

Individuals who can read and

write

At least 8th

grade (Junior sec

sch. 2)

MMPI-2: ADMINISTRATION, SCORING &

INTERPRETATION

Administration - Individual - Group

Scoring - VRIN/ TRIN convertion- Template (‘Keys’)

Interpretation

MMPI-2 TEMPLATE

MMPI-2 PROFILE

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)

MCMI is the second most widely used personality inventory after MMPI

Developed by Theodore Millon, Carrie Millon, Roger Davis & Seth Grossman

To provide information on specific DSM psychopathology

MCMI is intended to be an evolving assessment tool to be refined and updated as needed on the basis of substantive advances theoretical logic, research data, and professional nosology

THEODORE MILLION (1928 – 2013)

COMPOSITION OF MCMI-III

Consist of 175 questions

Modelled on four set of scales

Personality Disorder Scales

Clinical Syndrome Scales

Modifying Indices

Random Response Indicators

ADMINISTRATION AND SCORING

Easy to administer

Conducive testing environment

Give Client question and answer booklet, pencil

and eraser

Require 30– 60 minutes to complete

Scored with a template

MCMI SCORING TEMPLATE

SAMPLE OF MCMI PROFILE

INTELLIGENCE (IQ) ASSESSMENT

Assess intellectual ability

Mostly required during rehabilitation/ deficit in intellectual functioning.

IQ TESTS

Progressive Matrix

Wechsler Intelligence Test Series

Vineland Adaptive Behavior Scale

PROGRESSIVE MATRICES

Developed by Raven(1958)

It is a non-verbal and multiple-choice test of

intellectual capacity and general mental ability.

Test are progressively more difficult

Consist of 5 sets of 12 designs of Matrices from which

a part has been removed

Subject choose the missing part from 6-8 alternatives

Useful for illiterate, foreigners, deaf, subject with

speech difficulties

RAVENS SAMPLE QUESTION

RAVENS SAMPLE QUESTION 2

VINELAND ADAPTIVE BEHAVIOUR SCALE

Communication Domain

Daily living Skills Domain

Socialization Domain

Motor Skills Domain

Maladaptive Behaviour Index

NEUROPSYCHOLOGICAL TESTING

Psychological dx may be due to neurological disturbance as well as life problem -Distinguish between biogenic (Neurological) & psychogenic cases

TESTS

Luria- Nebraska Neuropsychological Battery

Halsted-Reitan Battery

Bender Visual-Motor Gestalt Test

Slosson Drawing Coordination Test

BENDER VISUAL-MOTOR GESTALT TEST

Most widely used screening test for organicity

Paper and pencil test developed by Bender in 1938

Consist of 9 simple familiar geometric design, each printed on

separate card

Each card is presented one after the other during administration

Examinees are expected to reproduce or copy the design on a

piece of paper as accurately as possible

Errors such as location of figures, overlapping difficulties, etc

are indicative of brain damage/neurological impairment

SLOSSON DRAWING COORDINATION TEST

WECHLER INTELLIGENCE SCALES

Wechsler Pre-school and Primary Scale of

Intelligence (WPPSI)

Wechsler Intelligence Scale for Children (WISC)

Wechsler Adult Intelligence Scale (WAIS)

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Developed by David Wechsler in 1997

Based on Wechsler’s philosophy of intelligence

as "... the global capacity of the individual to

act purposefully, to think rationally, and to deal

effectively with his environment."

Assess intellectual functioning of adults, aged

16 – 89

David Wechsler, a

leading American

psychologist and

one of the pioneer

researcher in IQ

testing

DAVID WECHSLER(1896-1981)

WAIS

Consist of 14 Subtests, grouped into - Verbal Scales - Performance Scales

Yield 3 traditional composite scores - Verbal IQ (VIQ) - Performance IQ (PIQ) - Full Scale IQ (FSIQ)

4 Index Scores

(based on more refined domain of cognitive functioning) - Verbal Comprehension - Perceptual Organization - Working Memory - Processing Speed

VERBAL

Vocabulary

Similarities

Arithmetic

Digit Span

Information

Comprehension

Letter-Number Sequencing

PERFOFMANCE

• Picture Completion

• Digit Symbol

• Block Design

• Matrix Reasoning

• Picture Arrangement

• Symbol Search

• Object Assembly

WAIS VERBAL AND PERFORMANCE SUBTESTS

PICTURE COMPLETETION

PICTURE COMPLETETION…/2

BLOCK DESIGN

PICTURE ARRANGEMENT

WAIS SCALES ORGANISATION

IQ SCORE

• 130 and above

• 120-129

• 110-119

• 90-109

• 80-89

• 70-79

• 69 and below

IQ SCORE

• Very Superior

• Superior

• High Average

• Average

• Low Average

• Borderline

• Extremely low

QUALITATIVE DISCRIPTION OF SCORES

PSYCHOTHERAPY

Individual

Group

- Open group

- Close group

Insight therapy

Behaviour therapy

GROUP THERAPY SESSION

PSYCHOTHERAPY

Psychoanalysis

Client centred

Cognitive

Cognitive-Behaviour Therapy

- Becks

- Ellis

CALL FOR ACTION

Participating in the care of the mentally ill is very

challenging as associated:

Stigma

Dangerousness (Risk to self and others)

Burden of care

- Emotional and financial stress, etc.

- Burnout

CALL FOR ACTION (CONT’D)

Need to protect ourselves (burnout) and clients

Need for synergy among health workers - Teamwork (everybody wins) - Every part of the body is important

Need capacity building and human capital development

Need for personal development

Effective government policy (Relativity allowance)