You’re probably seeing a pattern here…mental health is my passion. It’s so fascinating to research and interesting to see how people manage, treat and live with mental illness. So whether you’re interested in the diagnostic process or just mental illness in general, keep reading!
If you want to, ask for consent from the people around you to practice this so you can gauge on normal behaviour, how to react to questions and answers and gain confidence in your practice. You could do these assessments on people without telling them but that’s frowned upon for obvious reasons. I’ve put these in dot point form so it’s easier to chunk together and make sense of it all.
Some quick notes on diagnosis
- Mental illness is diagnosed by observing a persons behaviour, including actions and expressions of thoughts and feelings.
- Behaviour is compared to social and cultural norms.
- As a general guideline: consider whether or not the behaviour, emotional pattern or personality interferes with the individuals normal social, occupational or personal functioning.
- Someone with mental illness can live their life untreated with mental illness if they don’t harm themselves or others either physically or mentally.
Sources of data can be
- Interviews with the patient
- Identification of defence mechanisms
- Interviews with family, friends and employers
- Previous medical records and treatments
- Psychological testing
Conducting patient interviews
- Be sure to ask open ended questions, this way you illicit more of a response from the patient.
- When doing an informal interview, allow for a large chunk of time to be taken up.
- When following a formal interview, try not to get the answers that you want, allow for the patient to give their own proper answers.
Conducting interviews with family, friends and employers
- It is possible that they can cover and lie to try and protect the patient
- The other people in the patients life and the patient themselves will see their symptoms quite differently
- During interview period or knowing that their friends and family will be interviewed, may try and appear ‘normal’ by attempting to hide away from previous behaviour
- The family or patient may dismiss mental illness as a whole in an attempt to ignore the situation
- It’s important to ask employers if there has been any concerns over their mental health or behaviour in the past
Possible defence mechanisms
- Denial: they will deny reality and their own behaviour and actions despite evidence to suggest that they did it
- Projection: they blame other people for how they treat them “they deserved getting bullied”
- Repression: They unconsciously block awareness to their own behaviour
- Rationalisation: They will attempt to explain themselves in a poorly thought out manner
- Displacement: they will place their attitudes for one person or topic, onto another. So if they were envious for example, of a friend who had been hanging out with another friend more than them, they’ll get angry at the other friend as opposed to who the anger should be directed at
- Suppression: they will consciously suppress any awareness they have for their behaviour
- Sublimation: they’ll use socially unacceptable behaviour in a social setting without skipping a beat
- Dissociation: they will attempt to separate themselves from their own behaviour
- Splitting: they have the inability to see both good and bad in other people and themselves cohesively
- Fantasy: they will attempt to compensate for lack of fulfilment and/or attention by creating false scenarios and make it about themselves, start drama on purpose, fake many illnesses etc
Previous treatment and medical records
- Make sure you gain consent before doing this
- Make note of any mental illness or medication related to mental illness (antidepressants)
- Often, antidepressants are linked to antisocial behaviour or abnormal behaviour
- Request any notes from employers if they have monitored patients mental health
- It’s important to see if they also fake illness, so look to see if they have a variety of unrelated symptoms and testing in their records
Developmental and social factors that can effect the patient
- Parents behaviour and relationship
- Place of birth and childhood
- Relationship with friends and siblings: is it healthy or toxic, is it long term or short term, is there a high friendship turnover etc
- Schooling, careers and achievements
- Signification relationship history
- Marital status and children
Mental status examination
These are the things you’ll be looking out for when assessing a patient, you can also practice this with people who give you consent so you have a rough idea on normal behaviour and abnormal behaviour
- Appearance, behaviour and attitude
- Characteristics of speech
- Affect and mood
- Thought content, processes and concentration
- General intellectual level
- Insight and judgement
5 axis diagnosis
- Primary psychiatric diagnosis: so this would be depression, anxiety etc
- Personality disorders: bipolar, BPD, impulsive behaviour etc
- General health: diabetes, illness, disease, obesity etc
- Stresses: relationships, work, housing, financing etc
- Global assessment of functioning: the score for this testing will determine how they function day to day and any concerns
I hope this has been interesting to read and easy to understand! There’s so much more to diagnosing but this is just the basics. There’s a lot of peer reviewed journals and study’s online that can assist in further research and knowledge.