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IGDA. 6: Supplementary assessment procedures ^ meaningful to the patient (e.g. family

supports, religious beliefs).

functioning, social context, cultural framework

and quality of life Various types of supplementary assessment
procedures should be considered for use in
IGDA WORKGROUP, WPA evaluating these domains, including
clinician-rated, self-rated and family-rated
scales, checklists, and semi-structured
interview methods.

6.1 (a) to document areas and degrees of

impairment in social and occupational 6.4
Supplementary procedures (Fig. 6.1) can
functioning for the purposes of compre- Choice of a supplementary assessment pro-
be used to obtain a comprehensive
hensive diagnosis, prognosis, care plan- cedure should be based on a consideration
assessment of social, cultural and other
ning and disability compensation; of the purpose intended (e.g. to aid in deter-
contextual factors influencing the occur-
rence, presentation, course or treatment of (b) to describe patients’ social support mining level of treatment needed, to identi-
clinical disorders. They may also be useful systems or networks, personal and fy particular targets of treatment); the
for measuring social and occupational func- environmental resources, and recent breadth or specificity desired (e.g. global
tioning and participation, social support, and remote stressful life events for the assessment of functioning v. specific mea-
family adjustment, life events and quality purposes of diagnosis and treatment; sure of social functioning); the kind of pa-
of life. In these, as in all clinical assess- tient, or setting of evaluation (e.g. adults
(c) to assess the family’s perceptions of the with schizophrenia, married couples, peo-
ments, the cultural framework should be patient’s problems, their impact on the
systematically considered. ple in institutional care); and the resources
patient, and their consequences for
available (e.g. trained interviewer, or cleri-
family functioning;
cal scorer of self-report questionnaire).
6.2 (d) to assess quality of life for a broad
The purposes of these supplementary as- assessment of well-being and to ensure
sessments are: that attention is paid to what is most 6.5
Global assessment instruments provide an
overall rating of clinical state or function-
ing. A trained clinician is usually needed
to make the assessment. The rating is
usually made on a single continuous scale
and can be used to monitor clinical
improvement over time.

Detailed measures of social functioning
should be used to assess clinical state and
health status and to determine level of care
(e.g. in-patient, out-patient or long-term re-
sidential treatment). The most important
areas to assess are interpersonal function-
ing, occupational functioning, self-care
and broader social participation, keeping
in mind that their relative importance
varies across cultures.

Important areas of social context to
be assessed include socio-economic status
(for example through head of house-
hold’s occupation and education), social
supports and stressors, and access to care
(including financial, insurance, geographi-
Fig. 6.1 Supplementary assessment procedures. cal, transportation and cultural barriers).

I G D A . 6 : S U P P L E M E N TA RY A S S E S S M E N T P R

6.8 6.10 social functioning. American Journal of Psychiatry,

Psychiatry, 149,
Scales and instruments to appraise marital The need to broaden the information base
Kabanov, M. M. (1985) Reabilitatsiya Psikhicheski
and family functioning as well as sexual of health status assessment has led to the Bolnykh [ The Rehabilitation of the Mentally Ill]
Ill] (2nd edn).
health are useful in planning couple or development of quality-of-life measures. Leningrad: Medicine.
family therapy. These refer predominantly to the individ- Katschnig, H., Freeman, H. & Sartorius, N. (1999)
ual’s subjective perception of satisfaction Quality of Life in Mental Disorders.
Disorders. Chichester: John Wiley
with and position in life in relation to that & Sons. Also available from the publisher in Italian,
6.9 Japanese and Spanish translations.
individual’s goals, expectations, standards
It is often important, particularly in multi- Weiss, M. G., Raguram, M. & Channabasavanna,
and aspirations.
cultural societies, to assess the cultural S. M. (1995) Cultural dimensions of psychiatric diagnosis.
framework of the experience of illness A comparison of DSM ^ III ^ R and illness explanatory
FURTHER READING models in south India. British Journal of Psychiatry,
Psychiatry, 166,
explanations and help-seeking behaviours. 353^359.
Consideration of the patient’s explanatory
World Health Organization (1999) International
models can be valuable for both valid Goldman, H. H., Skodol, A. E. & Love, T. R. (1992) Classification of Functioning, Disability and Health (ICF).
diagnosis and effective care planning. Revising Axis V for DSM ^ IV: a review of measures of Geneva: WHO.

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