Psychiatrically Relevant Co-Morbidities: Content Areas and Assessment Domains

1. Psychiatrically Relevant Co-Morbidities:Content Areas and Assessment Domains Philip D. Harvey, PhD Emory University School of Medicine

2. Top Ten Causes of Disability Ischemic heart Disease** Cerebrovascular disease Major Depression* Lung Cancer** Traffic Accidents** Alcohol abuse* Arthritis Dementia* COPD** Self-inflicted injuries*

3. Domains of Psychiatric Impairment Symptomatic Depression Including hopelessness and suicidality Anxiety Frustration tolerance and explosiveness Quality of Life Subjective Impression Illness Burden Functional Disability

4. Assessment of Psychiatric Symptoms Self report scales Abbreviated BDI STAI Comprehensive MMPI Clinician Ratings MADRS HDRS/HARS

5. Limitations of Assessment Domains Transparent scales cannot prevent or detect response bias Clinician ratings require expertise Comprehensive inventories are long and require literacy

6. Quality of Life Assessment Global Impressions of Life Satisfaction QLES-Q Illness Burden QWB

7. Limitations with Assessment Domains Again, no protection against bias QWB is referenced against other illnesses People with some psychiatric conditions underestimate their burden

8. Dimensions of Functional Impairment Occupational Social Self-Care Independent Living

9. How do you assess functional disability? Self-report Informant report Direct observation Objective information Performance-based tests

10. Limitations of Assessment Domains Objective information Availability; Relevance; Informant report Availability; situation specificity Self-report Bias; Cognitive limitations Observation Situation-specificity; low target frequency Performance-based Practicality; content validity; difficulty

11. Depression as a source of bias Current levels of depression have been reported across neuropsychiatric conditions to influence self-reports These include self-evaluations and subjective reports of anticipated later outcomes

12. Sadder, but wiser College students with elevated BDI scores give self-reports of their attractiveness that are consistent with observer ratings; lower scores overestimate their attractiveness MS patients with depression provide accurate reports of their cognitive disabilities; nondepressed patients overestimate

13. Normal optimistic bias David Dunning reports that 75% of college professors report that they are academically “above average” compared to college professor peers 80% think that they are better looking Feedback that deflates their self opinion leads to increases in convergence between observer ratings and self-report

14. What are the determinants of real-world disability ? The prediction of real-world disability is a considerable challenge Quality of life can be predicted similarly Many factors may contribute small increments of prediction Precise modeling may be the key to answering the question

16. What are the potential causal models for dermatological conditions? Does itching/acne lead to depression which leads to disability which leads to QoL reduction? Does itching/acne lead to disability which leads to depression which leads to QoL reduction? Does itching/acne leading to disability, depression, and QoL reduction, which are simply correlated? All of these models suggest different points of intervention

17. Social Competence Communication skills Interaction skills Examine verbal, nonverbal, and social cognitive abilities Example Measures Maryland assessment of Social competence (MASC) Social Skills Performance Assessment (SSPA)

18. Everyday living skills Cooking; shopping; planning Child care Emergency procedures Financial Management Example instruments Direct Assessment of Functional Status (DAFS) UCSD Performance-based skills assessment (UPSA) Everyday functioning battery (EFB)

19. Vocational Skills Actual job-related performance Job seeking and job maintenance Example Instruments COMPASS system Provides detailed feedback about employability

20. Medication management The ability to acquire medications Ability to plan and complete medication self-administration Example Tests Medication Management Ability Test (MMAT)

21. Future Directions Deployment of performance-based measures of functioning and collection of multi-channel outcomes Direct assessment of functional potential Use as a treatment outcome Develop sophisticated models of influence Test patterns of causal influence through treatment-outcomes designs