PSYCHO SOCIAL ASSESSMENT

INTRODUCTION

• Psychosocial assessment is actually a thorough and comprehensive evaluation of an individual patient’s physical, mental, and emotional health, along with his ability to function within a community and his perception of himself.
• It is a tool to learn facts about a person, as well as determine his present and future behavior. It is a very important part of every health care program that helps to set up a plan of management and action for the medical team.
• The nature of psychosocial assessment varies, depending upon the patient’s health condition. Generally a quick and basic psychosocial assessment are conducted in health care institutions during Routine check-ups or on clients who get treatment for a mental health problem.
• Psychosocial assessment is conducted in an unplanned or unorganized setting, such as a slum, as opposed to a hospital, depending upon the situation.

DEFINITION

Psychosocial assessment is an evaluation of an individual's mental health and social well-being. It involves a holistic understanding of the person in their social and cultural context & it assesses the self-perception and the individual's ability to function in the community.

COMPONENTS OF PSYCHOSOCIAL ASSESSMENT

• Identification Data: This includes the patient's name, gender, birth date or age, marital status, race, ethnicity, and languages Known.
• Presenting Illness: The history of the present illness include the problem's location, duration, severity, timing, context, modifying factors, and associated signs or symptoms.
• Present & past Medical/Surgical History: The medical or surgical history includes listing of all present & Past medical & surgical History listing with their dates.
• Medication History: 
  • All current and past medications should be listed, including the dose and frequency. For medications currently taken, a listing of who prescribed them and why they are prescribed should be documented.
  • For past prescribed medications, a listing of why they were started and why they were stopped should be documented.
• Habitual History:
  • The substances currently used should be documented, including the method of use (oral, inhalation, injection, intranasal), the amount, the frequency, and the time.
  • Any substances used in the past should be documented.
  • Common abuse substances include alcohol, heroin, opiates, marijuana, cocaine, crack, methamphetamines, inhalants, stimulants, hallucinogens, caffeine, and nicotine
• Developmental History: 
  • This will provide insight into the origins of behavior, help diagnose and manage some conditions.
  • Any psychological trauma experienced as a child may lead to problems in adulthood.
  • Determine how the patient functioned in their childhood concerning school, friends, personality, and hobbies.
  • Determining the patient's sexual orientation will help the nurse provide better plan care for the patient.
• Violence Risk Assessment: 
  • Violence risk includes an assessment of suicidal ideation, homicidal risk, and abuse.
  • History of previous suicide attempt, family history, feelings of hopelessness, drug and alcohol abuse, history of depression or bipolar disorder, feeling isolated, physical illness, history of aggressiveness or impulsivity, unwillingness to seek help etc.
• Cultural Assessment: 
  • The cultural assessment should list any critical issues regarding the patient's ethnic and cultural background.
  • A good cultural assessment will help the nurse understand the patient's beliefs, values, and practices. These factors can be respected and considered when providing care.
• Spiritual Assessment:
  • The spiritual assessment should note the patient's religious background. Also, the degree of involvement within the religious community and any spiritual practices.
  • It helps the nurse determine if the patient has unresolved spiritual needs or concerns. Unresolved spiritual issues will inhibit recovery. When spiritual concerns are identified, appropriate referrals may help assure holistic wellness.
• Financial Assessment: 
  • Financial assessment should describe the patient's financial situation.
  • Patients in a lower socioeconomic class are at higher risk for many mental health conditions.
  • patients who have limited financial resources may need help with money and may benefit from a social worker's consultation.
• Skills Assessment: 
  • Determining coping skills is an important part of the psychosocial assessment.
  • If the nurse understands the patient's current coping techniques, they will provide better care by fostering adaptive coping skills.
  • Determining the patient's abilities and interests helps get an idea about the patient.
  • Assess the client’s Hobbies, talents & Interests

PSYCHOLOGICAL ASSESSMENT

• Psychological Assessment is method that uses a combination of techniques to study about the person’s Behavior, personality & capabilities.
• The findings are used to develop a report of person’s abilities & behavior which is used as a basis to make recommendations for the Individual’s Treatment.

MOOD

• The term mood refers to a person’s emotional state. Mood is central to psychological health, and disturbances in mood are related to subsequent psychological maladjustment
• Moods such as elation, joyfulness, and excitement, when experienced within normal ranges, enhance a person’s life and are associated with well-being.
• Moods such as anger, hostility, depression, and mania are negative emotions. When these moods are experienced outside of the normal range or when a person no longer has control over these moods, psychological disturbances appear in behavior

METHODS OF ASSESSING MOOD

• Mood is an element in the overall assessment process & is a routine part of both a psychiatric and a mental status examination.
• These can be structured clinical interviews or “naturalistic” interviews.
• In structured clinical Interview, the Interviewer asks a predetermined set of questions. No additional questions are permitted. The client’s responses are scored according to diagnostic criteria.
• In naturalistic or unstructured interviews, the interviewer talks with the client about a variety of topics in a natural setting & ascertains the level of mood

SCALES TO MEASURE THE MOOD

There are many published self-report inventories that assess mood.

The following are the more popular broad-band and narrow-band instruments that assess moods that have particular relevance to client functioning and behavior (i.e., anxiety, depression, mania).

• Broad Band Survey: 
  • It is a 300-item self-report survey designed for use with individuals 16 years of age and older who have at least an eighth-grade education.
  • It takes from 30 to 60 minutes to complete and can be scored via local software, mail-in scoring, or optical scan scoring.
• Narrow Band Survey: 
  • It is a rating scale with 21 Questions where the respondents rate their responses on a 4 point scale
  • It is possible for faking the responses as the respondents can mark as change in the mood when there is no actual mood changes.

BROAD BAND MEASURES OF ANXIETY

• Minnesota Multiphasic Personality Inventory-2:
  •  This scale consists of 23 items that assess physiological symptoms of anxiety (e.g., shortness of breath, sleep disturbances, and heart palpitations) and cognitive signs of anxiety (e.g., edginess, tension, and a fear that you are losing your mind).
• Millon Clinical Multiaxial Inventory:
  • It contains a 14-item scale that correlates positively with items dealing with general distress and is useful in diagnosing patients with an anxiety disorder.
  • Item content deals with nervous tension, intrusive thoughts (particularly over upsetting or traumatic events), sweating, compulsive behaviors, excessive worry, and fears of being alone.
• Personality Assessment Interview: 
  • This scale measures the cognitive, affective, and physiological aspects of anxiety. PAI items deal with subjective feelings of apprehension, ruminative worries, and physical signs of tension and stress.
• Personality Factors Interview : 
  • Personality Factors contains two factor scales, Apprehension and Tension that measure anxiety. Elevations on the Apprehension scale describe a person who complains about excessive worries, apprehension, guilt, and insecurities.
  • Elevations on the Tension scale describe someone who is tense, driven, and frustrated and feels overwrought.
• Symptom Checklist-90:
  • It consists of a list of items that describe mood states (e.g., nervous, apprehensive). Respondents are instructed to check all of the items that describe them. The test takes about 12 to 15 minutes to complete.
  • The items assesses typical symptoms of anxiety, such as feelings of dread and terror, apprehension, tension, trembling, and general nervousness and panic.

NARROW BAND MEASURES OF ANXIETY

• The Beck Anxiety scale:
  • It has 21 obvious items that are rated by the respondent on a 4-point scale.
  • For example, the scale asks such questions as whether the respondent feels like a failure, cries a lot, or feels like killing him-or herself.
  •  Consequently, the scale is more susceptible to faking than are the scales mentioned above.
  •  Administration time is approximately 5 to 10 minutes.

BROAD BAND MEASURES OF DEPRESSION

• The Depressive Adjective Checklist: 
  • It was developed to measure transient moods, feelings, and emotions related to depression.
  • It requires an eighth-grade reading level and has been translated into many foreign languages.
  • There are several available lists to choose from with each list taking from 2 to 3 minutes to complete.
• Rorschach inkblot test
  • The Rorschach inkblot test can be scored to yield scores that pertain to the affect of depression.
  • This measures the degree to which the client tends to become impulsive and drawn into emotional situations.
  • Extensive training is required to reliably score and interpret the Rorschach.

NARROW BAND MEASURES OF DEPRESSION

•  Beck Depression Inventory
  • It  is a 21-item scale designed to assess clinical depression.
  • Respondents rate each item using a 4-point scale.
  • Since all of the items are obvious, the scale is prone to a faked-bad response set. That means that it is easy for respondents to fake responses to appear depressed when, in fact, they are not depressed, and vice versa.
•   Hamilton Depression Scale
  • It contains primarily items dealing with more vegetative symptoms of depression (i.e., sleep, appetite, and energy). The instrument can be used to screen for the more severe forms of depression.

MEASURES OF MANIA

• Hypomania Scale: 
  • It contains 46 items with four major content areas: amorality, psychomotor acceleration, imperturbability, and ego inflation.
  • The major theme underlying these items is impulsivity.
• Millon clinical Mania Scale: 
  • It contains a 13-item Bipolar: Mania scale. Item content pertains to over-activity, elation and inflatedness, flight of ideas, variable moods, over-talkative, and impulsivity.
  • Clinically elevated scores suggest a patient with labile emotions and frequent mood swings
• Personality Assessment Inventory Mania Scale:
  • It contains (24 items) that assesses both mania and hypomania (i.e., an abnormality of mood resembling mania but of lesser intensity).
  • Content addresses elevated mood, irritability, impatience, expansiveness, grandiosity, and exaggerated activity.

PSYCHOLOGICAL ASSESSMENT-INTELLIGENCE

•  Intelligence is the term used in ordinary discourse to refer to cognitive ability.
•  Intelligence is a very general mental capability that, among other things, involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience.
• It is not merely book learning, a narrow academic skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for comprehending our surroundings—“conceptualizing", "making sense" of things, or "figuring out" to do the activities.

METHODS OF ASSESSING INTELLIGENCE

• Stanford–Binet Intelligence Scales: 
  • It is a cognitive ability and intelligence test that is used to diagnose developmental or intellectual deficiencies in young children.
  • The test measures five weighted factors and consists of both verbal and nonverbal subtests.
  • The five factors being tested are knowledge, quantitative reasoning, visual-spatial processing, working memory, and fluid reasoning.
• Raven's Progressive Matrices: 
  • It is a nonverbal test typically used to measure general human intelligence and abstract reasoning and is regarded as a non-verbal estimate of fluid intelligence.
  • It is one of the most common tests administered to both groups and individuals ranging from 5-year-olds to the elderly.
  • It comprises 60 multiple choice questions, listed in order of increasing difficulty.
  • This format is designed to measure the test taker's reasoning ability, & the General Intelligence
• Wechsler Adult Intelligence Scale (WAIS):
  • It is an IQ test designed to measure intelligence and cognitive ability in adults and older adolescents
  • It consists of both Verbal IQ tests & Non-verbal Performance Scale

PSYCHOLOGICAL ASSESSMENT-EMOTIONS

• Emotions motivate behavior and have a significant impact on health and psychological well-being.
•  According to the World Health Organization (2006), “Normally, emotions such as anxiety, anger, pain or joy interact to motivate a person to a goal-directed action.
•  However, when certain emotions predominate and persist beyond their usefulness in motivating people for their goal-directed behavior, they become morbid or pathological.”
•  It is therefore essential to evaluate and monitor emotional states in diagnosis and treatment just as physicians in medical examinations routinely measure pulse rate, blood pressure, and temperature, the vital signs that provide essential information about physical health.

METHODS TO ASSESS EMOTIONS

• STATE-TRAIT ANGER EXPRESSION INVENTORY (STAXI):
  • The maladaptive effects of anger are traditionally emphasized as a major contributor to the etiology of the psychoneuroses and depression.
  • Anger and hostility also contribute to the pathogenesis of hypertension.
• State-Trait Anger Scale (STAS): 
  • It was constructed to assess the intensity of anger as an emotional state at a particular time, and to measure individual differences in anger proneness as a personality trait
  • State anger (S-Anger) was defined as a psychobiological state or condition, consisting of angry feelings that may vary in intensity, from mild irritation or annoyance to fury and rage, with associated activation of the autonomic nervous system.
  • Trait anger (T-Anger) was defined in terms of individual differences in the frequency that S-Anger was experienced over time.
• Anger Expression (AX) Scale: 
  • It was constructed to assess this dimension, guided by working definitions of anger-in and anger-out
  • Anger-in was defined in terms of how often an individual experiences, but holds in (suppresses), angry feelings.
  • Anger-out was defined as the frequency that an individual expresses angry feelings in verbal or physically aggressive behavior.

NORMAL & ABNORMAL BEHAVIOR

• Normal Behavior: Any behavior that pertains to accepted societal patterns
• Abnormal Behavior: Behavior that is against social Norms

NORMAL EMOTIONS/ BEHAVIOR

• Emotions (feelings) are a normal and important part of our lives.
• Some emotions are positive (Normal).
• Think of happiness, joy, interest, curiosity, excitement, gratitude, love, and contentment.
• These positive emotions feels one good.

ABNORMAL EMOTIONS/ BEHAVIORS

• Negative (abnormal) emotions — like sadness, anger, loneliness, jealousy, self-criticism, fear, or rejection — can be difficult, even painful at times.
• when we feel a negative emotion too often, too strongly we dwell on it too long.
• Negative emotions are impossible to avoid, most of them feel it from from time to time. They may be difficult, but we can learn to handle them.

STEPS TO DEAL WITH ABNORMAL BEHAVIORS

IDENTIFYING THE EMOTIONS

• Be Aware of Feelings: 
  • When there is abnormal emotions, such as anger, try to name what is the feeling.
  • For example:
  • That person makes me mad!
  • I get so jealous seeing a particular person
  • Feeling afraid of bullies.
• Do not Hide Feelings:
  • But don't suppress the feelings entirely.
  • Simply telling out or broadcasting the feeling is a lot better than pretending not to have it — or exploding without thinking.
• Recognize the type of Feelings: 
  • Figure out what happened or made to have such kind of feeling
  • For eg. Not able to complete a project or having a fight with some one.
• Do not Blame: 
  • Recognize & explain emotions but don’t blame someone or something for the way such emotions are felt.
  • Feelings are there for a reason — to help you make sense of what's going on.
• Accept all emotions as Natural: 
  • Don't be hard in judging the way the emotions are felt.
  • It's normal to feel them. Acknowledge the ways that help to move on

TAKE ACTION

• Find ways to express Emotions: 
  • Gently confront the emotions to someone else
  • Talk over about the feeling with a friend Or work off the feeling by going by doing some distraction or Diversional therapy.
• Change the Mood: 
  • At a certain point, try to shift from a negative mood into a positive one.
  • Otherwise thinking gets stuck on how bad things are, and that can drag down into abnormal behaviors
  • Try doing things that make happy, even if the situation is unhappy.
• Build Positive Emotions: 
  • Positive feelings create a sense of happiness and well being. Make it a habit to notice and focus on what's good in life — even the little things, like the thinking of some praising words or tastes of food etc. can.
  • Noticing the good things even when the emotions are bad can help to shift the emotional balance from negative to positive.
• Seek Support:
  • Talk about the feelings with a parent, trusted adult, or a friend. They can help you explore the emotions and give a fresh way of thinking about things.
  • And nothing is better than the support of person who understands and care for your feelings.
• Exercise: 
  • Physical activity helps the brain produce natural chemicals that promote a positive mood.
  • Exercise also can release stress buildup and helps to come out of the Negative Feelings.

GET HELP WITH DIFFICULT EMOTIONS

• When the emotions are so tough & if it’s impossible to come out of the Negative feelings of sadness, worry, anger or jealousy for more than a couple of weeks, then Extra help is needed to prevent oneself from hurting them or others
• So, talk to a counsellor or Psychologist as they are trained to teach people how to break out of negative emotions. They can sort out ways to come out of the difficult Emotions.