How Psychological Assessments Can Help You With Those Puzzling Patients

1. How Psychological Assessments Can Help You With Those Puzzling Patients Add Your Name Here

2. What Percent of Primary Care Visits Are Driven By Psychological Factors? Cummings & VandenBos, 1981

3. Of The 10 Most Common Physical Complaints In Primary Care, What Percent Were Explained Organically ? Kroenke & Mangelsdorff, 1989

4. Primary care MDs treat more patients with psychological conditions than do mental health professionals

5. In The Fast Pace of Primary Care, Many Mental Health Patients Fall Through the Cracks • Patients with psychological problems are difficult to treat in the primary care system • As a result, psychiatric disorders are overlooked by primary care physicians between 33% and 79% of the time (Higgins, 1994).

6. You Order Tests All Of The Time X-rays, MRIs, Blood Tests,EKGs, etc.

7. Ironically, what you see so often— Stress and Psych Problems — is the one thing you cannot order a test for. Until now.

8. True or False? • Since pain and depression are subjective states, they cannot be measured scientifically. • False

9. Psychometrics is the scientific method used to assess subjective states, such as pain, depression or anxiety.

10. How Good Are Psychometric Tests? • A review based on 125 meta-analyses and 800 studies concluded good psychometric tests are comparable to good medical tests in their ability to diagnose and predict outcome (Meyer, et al, 2001) • Psychological factors are more reliable predictors of back pain than imaging and diagnostic disc injection (Carragee et al, 2004)

11. What is the Value of using Psychological Tests • How much more difficult would you life be if you didn’t have tests like x-rays or blood tests? • In the same way, psychometric tests can help you assess subjective experiences, and identify psychosocial complications

12. New psychological tests, like the BHI™ 2 and BBHI™ 2, have been developed specifically use with medical patients… and can help to answer many of your questions.

13. 10 = Bad Pain 9 8 7 6 5 4 3 2 1 0 = No Pain Is This Patient’s Level Of Pain High? Rate Your Pain • Is this pain higher than the average patient? • Is it higher than the average healthy person? • What is the patient’s pain percentile rank? • A BHI 2 could answer these questions

14. Only The BHI 2 Assesses All Of These Variables What Psych Conditions Bring Patients into Primary Care? Anxiety 20% Miscellaneous includes substance abuse & personality disorders Misc 15% Depression 20% Job Stress 10% Family Problems 10% Chronic Pain/ Somatization 25% Tulkin and Gordon, 1998

15. The BHI 2 was designed to help psychologists and physicians collaborate • It can help to answer a physician’s questions • It points out to the psychologist what info is needed from the physician

16. The Health PsychologyArrow of Causality:Which Comes First? Severe Physical Symptoms Extreme Anxiety Only the BHI 2 and BBHI 2 interpret both possibilities

17. The BHI 2 and BBHI 2 allow you to track changes in pain Normal Delayed

18. The BHI 2 Was Designed to Assess Common Psychological Concerns • Depression • Anxiety • Family Dysfunction • Survivor of Violence • Borderline personality • Etc.

19. They Were Also Designed to Assess Common Medical Concerns. • Pain • Including percentile rank, variability and distribution • Functioning • Somatization • Satisfaction with medical care • Prescription abuse • Muscular Bracing • Tension headaches, myofascial pain, TMJ • Etc.

20. For Those Patients Who Are Especially Puzzling A certain percentage of psychologically-involved patients may be difficult for you to figure out. A referral for a BHI 2 test might shed some light on the matter.

21. Case Hx • 39 Year old female. Somatization? • diffuse physical symptoms • no objective medical findings • resists examination • noncompliant with PT • no response to any treatment

22. On the BHI 2 bidirectional scales, the length of the bar shows how far the score deviates from the mean. Case History 1: Profile

23. Case History 1: Validity Validity Scales These validity scores give no indication of biased responding

24. Case History 1: Physical Sx Scale Physical Symptom Scales Unusually high level of diffuse somatic symptoms, coupled with great difficulties functioning

25. Case History 1: Affective scales Affective Scales Reports of depression are higher than 87% of patients Very low level of anger. Total absence of anger, or difficulty expressing angry feelings? (Somatization often involves denied feelings)

26. Case History 1: Psychosocial Scales Psychosocial Scales The patient reports a history of trauma and abuse. Is that why she hates being examined? The patient views the workplace and medical setting as being supportive.

27. Case History 1: Character Scales Character Scales Symptom Dependency High = using symptoms to meet dependency needs Perseverance High = still showing some determination and optimism

28. Treatment • During examination and procedures, be sensitive to her Hx of trauma • Initiate treatment for depression • Psychotherapy and Rx • Assertiveness training for appropriate expression of anger

29. Treatment • Work to improve support system • Decrease family conflicts if possible • Set up behavioral plan to help her to increase her level of functioning • Encourage occasional medical visits • its an important part of her support system • overall work to decrease medical utilization by addressing underlying psych problems

30. The Results? • A satisfied patient who gets the care she needs… • And for you, the satisfaction of effectively treating a challenging case.