Assessment, Diagnosis, Intervention

Front 1

DSM Basics
Assessment vs. Treatment

Back 1

1- Assessment; only tells you what you have - Not what to do.
2- Does NOT suggest treatment approaches.

Front 2

DSM
Do you share the DSM and diagnosis w/ client?

Back 2

No. You read it then explain it to the client.

Front 3

DSM
relation to International Classification of Diseases (ICD)

Back 3

DSM compatible, but NOT identical to diagnostic codification of the ICD.
There is a relationship between the 2, re: coding classification system

Front 4

ICD

Back 4

International Classification of Diseases: first international system published in 1948

Front 5

Limitations of DSM

Back 5

Focuses on descriptive rather than etiological (underlying cause related) factors. No Treatment
Does take into account research as well as cultural factors.

Front 6

Diagnosis Deferred

Back 6

Information is inadequate to make a formal diagnostic judgment.
No history available
Want next SW to be aware of it.

Front 7

Culturally-Bound Syndromes

Back 7

conditions resemble the symptoms of a mental disorder but is related directly to culture. brain fag, rootwork (hex), ataque de nervios (anxiety); mimics a mental disorder.

Front 8

Research Changes

Back 8

-Literature reviews;
-Data analysis and re-analysis
-Field trials
Latest DSM reflects the importance of research

Front 9

DSM Baisics - Multi-Axial System
5 separate axes

Back 9

Diagnosis always goes on Axis 1 or 2.
Memorize the 2 things that go on Axis 2 and then every else goes on Axis 1.
If you don't know where it goes - put it on Axis 1

Front 10

Axis I
Syndromes & Disorders that are included

Back 10

Clinical Syndromes
Pervasive developmental Disorders
Learning Disorders
Motor Skills Disorders
Communication Disorders

Front 11

Axis I
Clinical Syndromes include

Back 11

Mood disorders, Schizophrenia, dementia, anxiety disorders, substance disorders disruptive behavior disorder.

Front 12

Axis I
V codes

Back 12

Not attributed to a mental disorder but are the focus of treatment:
bereavement, malingering and adolescent antisocial act.

Front 13

Axis I
2 questions to be considered:

Back 13

1- What are the major psychiatric symptoms in relation to the disorder?
2- What is the course and duration of the illness and how does it vary?

Front 14

Axis I
will axes denote the severity of the illness?

Back 14

No. Merely where it is classified and the diagnostic category is placed there for convenience.
A plan is needed for addressing every Axis.

Front 15

Axis II
This includes:

Back 15

Personality Disorders and Mental Retardation
*every personality disorder ends in "personality disorder"

Front 16

Axis II
3 Questions:

Back 16

1- Are there any life-long maladaptive patterns? 2- Do the patterns tend to cause difficulty in intimate, social or work relationships? 3- What developmental issues are currently impairing daily functioning?

Front 17

Axis II
When do diagnoses generally start, if on this axis?

Back 17

childhood or adolescence and persist in a stable form into adulthood. Generally, no periods of remission.

Front 18

Axis III
General Medical Conditions

Back 18

Physical (medical) conditions that may be relevant to the conditions being treated.
HEARING & VISION
When was last physical exam?

Front 19

Axis IV
Psychosocial an Environmental Stressors

Back 19

Actual list of stressors as factors:
education; housing problems; economic; social environment; job; problem w/ access to health care services; primary support problems.

Front 20

Axis IV
Why relevant to SW?

Back 20

take into account the environment.

Front 21

Axis V
Global Assessment of Functioning
(GAF)

Back 21

Scale 0 - 100 (40 - 50 danger to self or others); Higher the # - Higher the level of functioning.
Highest level of functioning over a period of time.

Front 22

Intelligence and the Bell Shaped Curve:
mean
median
mode
Standard Deviation

Back 22

Mean: average
Median: middle score
Mode: frequently occurring
SD: deviant from the mean

Front 23

Gifted vs Talented

Back 23

Gifted - IQ score above 130
Talented: high IQ in 1 area

Front 24

Measure of central tendency
Skewed

Back 24

Always fall in the middle
bell cure isn't in the middle

Front 25

Mental Retardation

Back 25

Sub-average intelligence and deficits in functioning.
Onset before age 18 (later: dementia)
IQ of 70 or below
slightly more common in males

Front 26

Mental Retardation:
Borderline Intellectual Functioning

Back 26

IQ 71-84, code on Axis II

Front 27

Mild Retardation

Back 27

55 - 70 (highway driving)
Educable - 6th grade level
Minimal assistance, some supervision, live in community or in supervised setting.

Front 28

Moderate Retardation

Back 28

35-55 (residential driving)
Trainable - 2nd grade level; can't live by themselves; moderate supervision and can do own personal care. preform unskilled or simi-skilled work; live in community

Front 29

Severe Retardation

Back 29

20 - 35 School Zone
Neither Educable or Trainable
generally institutionalized; little or no communicative speech; possible group home

Front 30

Profound Retardation

Back 30

Below 20
generally total care

Front 31

Pervasive Mental Disorders (Axis I)

Back 31

Involve multiple functions
Behaviors are not considered normal at any age.
Qualitative impairment in: reciprocal interaction, verbal & non verbal skills, imaginative activity, and intellectual skills

Front 32

Examples of Pervasive Mental Disorders (Axis I)

Back 32

Autistic Disorder
Other pervasive developmental disorders: Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder

Front 33

What is the co-morbid disorder most common associated w/ Pervasive mental disorders?

Back 33

Mental retardation

Front 34

Autistic Disorder

Back 34

severe form, onset in infancy or childhood, self-stimulating, self-injuring, poor prognosis, 2/3 mentally retarded, 3 time more common in males, hereditary factor.

Front 35

Autistic Disorder
What is the age of onset requirement in DSM-IV?

Back 35

Age 3

Front 36

Autistic Disorder
Is condition related to parenting style?

Back 36

NO

Front 37

Rett's Disorder

Back 37

Only IN FEMALES; deceleration of head growth; start out normal and a 5 to 24 months problem develop; loss of previously acquired hand skills; loss of social engagement; impaired language

Front 38

Child hood Disintegrative Disorder

Back 38

Normal development for 2 years then a drastic decline, followed by a loss of previously acquired skills, and development of autistic like symptoms

Front 39

Asperger's Disorder

Back 39

autistic like symptoms W/OUT LANGUAGE Impairment, severely impaired social interaction. these children often have normal to above normal intelligence; NO MENTAL RETARDATION

Front 40

One way Autism varies from Asperger's Disorder

Back 40

Autism usually has retardation and language impairment.

Front 41

Learning Disabilities
Overall Definition

Back 41

These disorders have significant difficulty in acquisition of listening, speaking, reading, writing, reasoning, and math. (Normal in every area but 1)

Front 42

Learning Disabilities
Main things one would see.

Back 42

Delay in skill level (2 SD below mean)
Generally noted between ages 8 & 13
More common in boys
Don't always catch up - into adulthood
Involve specific function (not multiple like pervasive)

Front 43

Learning Disabilities
Additional comments

Back 43

Delayed - Outside the norm
Don't outgrow it; will learn to live w/ it; compensate for disability

Front 44

Social Work Treatment for Learning Disabilities

Back 44

Generally behavioral in nature. Again, learn to compensate for disability.

Front 45

ADHD
Attention Deficit Hyperactivity Disorder

Back 45

Onset in Childhood - generally before age 7
Symptoms must persist for at least 6 months
Symptoms required in 2 or more situation (work, home, school)

Front 46

ADHD
1 Criteria set w/ 3 subtypes

Back 46

Predomitately inattentive
Hyperactivity-impulsivity
Combined

Front 47

ADHD - Outgrow? and co-conditions; males/females; etiology; intellegence

Back 47

Do NOT outgrow; can have co-condition (learning disability, conduct or oppositional disorder) More common in males; etiology unknown; No intellectual deficits, just deficites in attention and concentration

Front 48

ADHD
Treatment

Back 48

- Evaluate by a neurologist or physician for a physical
- If meds don't work, consider diagnosis is accurate
- Deal w/ Behaviors

Front 49

ADHD
Dealing w/ Behaviors

Back 49

Parents - identify parenting styles that reinforce neg behavior
Teachers - sit, catchup
Address Self-esteem issues thru counseling

Front 50

ADHD
Impulsive type vs inattentive type

Back 50

Impulsive - often in trouble at school
Inattentive - Poor grades

Front 51

ADHD
Medication

Back 51

Ritalin (methylphehidate) - said to be a paradoxical medication (is a stimulant but it calms children down)
Cylert (permoline) which is not recommended for first line of therapy.

Front 52

Effect of ADHD medication

Back 52

increase tolerance
decrease impulsivity
sustain attention

Front 53

Self Esteem
child
adolescent
adult

Back 53

parent/teacher
friends say about you
feel about yourself

Front 54

Conduct Disorder

Back 54

pattern of behavior that violates rights of others

Front 55

Conduct Disorder
4 Categories

Back 55

Aggression to people/animals
Distruction of property
deceitfulness or theft
Serious violation of rules

Front 56

Conduct Disorder
Females
2 additional criteria

Back 56

Staying out at night
intimidationg others

Front 57

Conduct Disorder
Onset

Back 57

Childhood and adolescent (onset prior to age 10 poor prognosis) By age 18/20 - changed to anti social behavior

Front 58

Conduct Disorder
More common in males or females?

Back 58

Males

Front 59

Conduct Disorder
Treatment

Back 59

Behavioral: identificaiton of BC's (behaviors and consequenses, family treatment required to reinforce BC's

Front 60

Oppositional Defiant Disorder

Back 60

Similiar to conduct Disorder, but not as severe. Does NOT repeadtedly violate the rights of others. Rule out medical conditions (hearing impairment)

Front 61

Oppositional Defiant Disorder
Treatment

Back 61

Same as Conduct Disorder but not as intense
Behavioral/BC's/Family

Front 62

Feeding and EAting Disorders of Infancy or Eary Childhood

Back 62

Pica
Tourette's Disorder
Enuresis
Encopresis

Front 63

Pica

Back 63

repeated eating of non-nutritive substances for 1 month (can't be hungry)
Onset 1-2 (make sure it's not culture)

Front 64

Tourette's Disorder

Back 64

Vocal and motor tics all present AT THE SAME TIME.
Onset: before age 18
symptoms last for atleast 1 yr.

Front 65

Tourette's Disorder
Treatment

Back 65

Medicine

Front 66

Enuresis

Back 66

Elimination Disorder - not due to a physical disorder.
Elimination of urine during day or night
must be age 5 before it can be diagnosed.

Front 67

Encopresis

Back 67

Repeated elimination of feces or soiling
Occurs 1 time a month for 3 months
Must be atleast 4 before diagnosed.

Front 68

Treatment for Elimination Disorders

Back 68

Get physical Exam before making diagnosis.
Kids should be potty trained by 3 and a half. (except foster homes - 4yrs)

Front 69

Separation Anxiety Disorder

Back 69

Excessive anxiety over separation from home or caregiver.
Must last 4 weeks
Begin before age 18 (use early onset before age 6)
Don't confuse w/ Stranger Anxiety or Separation Anxiety

Front 70

Stranger Anxiety

Back 70

normal reactions experiences by an infant when startled or feeling threatened. (8 months)

Front 71

Separation Anxiety

Back 71

feelings of anxiety and fear that result after being separated from a significant other.
(4/5 yrs)

Front 72

Selective Mutism

Back 72

Must last at least 1 month. Must impair functioning. Persistent refusal to talk.
Exclude during first month of school or language problem.

Front 73

Delirium

Back 73

Abrupt onset of symptoms that fluctuate. Clouded Sensorium, Brief duration, can happen in young or old. (you look at them and know something is wrong)

Front 74

3 types of Delirium

Back 74

Delirium Due to a general medical condition.
Substance-Induced Delirium
Delirium due to Multiple Etiologies.

Front 75

Dementia

Back 75

Relatively stable symptoms that do NOT fluctuate. NO clouded sensorium. Long duration. Must have disturbance in occupational and social functioning. characterized by multiple cognitive deficits. Slow & Progressive; look normal

Front 76

To Diagnosis Dementia (3)

Back 76

Combo of techniques:
psychometric and other mental status testing,
measurement of the activities of daily living skills
radiological techniques.

Front 77

Types of Dementia

Back 77

Alzheimer's - nerve cells containing tangles and fibers and clusters of degenerating nerve endings(plaque)
Vascular - small repeated strokes in brain
Other General Medical conditions: HIV
Parkinson's Disease: Tremors, rigidity (Sinemet is meds used) Higher functioning than Alzh.

Front 78

Clinical Diagnosis of Dementia

Back 78

involve memory disturbances, language and perception. decreased problem solving and judgment. increasing loss of control.

Front 79

Assessment and Social Work intervention w/ Dementia

Back 79

Measure of Memory Psychometric
Measure of Judgment ability
Orientation to person, place, time
Affect
Intelligence & Cognition ability
Reality Orientation or validation Therapy

Front 80

Measure Memory Psychomentric

Back 80

Short Portable Mental Status Questionnaire; 7 Digit Progression Scale

Front 81

Judgment Ability

Back 81

Families note problems first. Use Family questionnaire to measure deficits

Front 82

Orientation

Back 82

Person Place and Time; Plus spatial Orientation to measure deficits
Oriented x1, x2, x3
x4: situational orientation (quilt) not connected to the 1,2, or 3

Front 83

Look at Affect

Back 83

depression vs dementia

Front 84

Intelligence and cognition ability

Back 84

confabulation - use the clock test

Front 85

What should you rule out before diagnosis?

Back 85

Dehydration or UTI
Electrolyte imbalance

Front 86

Substance Related Disorders
What if client is under the influence of a substance?

Back 86

Never treat. Must refer to detoxification or reschedule when NOT under the influence.

Front 87

Time requirement for sustained remission?

Back 87

12 months

Front 88

If individual in in recovery and behaviors start to change rapidly or unpredictably - what do you do?

Back 88

Assess for relapse (reinstatement)

Front 89

Substance Use Disorders

Back 89

Abuse
Dependence

Front 90

Abuse

Back 90

less severe, continuted use knowing it is causing harm
does not apply to caffeine and nicotine

Front 91

Dependence

Back 91

needs to take larger amounts w/ unsuccessful attempts to quit.

Front 92

Substance Induced Disorders

Back 92

Intoxication
Withdrawal

Front 93

Intoxication

Back 93

the development of a substance specific reversible syndrome, condition related to recent ingestion of psychoactive substance.

Front 94

Withdrawal

Back 94

maladaptive cognitive and behavioral declines due to reduction of a substance; generally, this category is usually associated w/ dependence. The 2 substances most problematic in withdrawal are alcohol and heroin.

Front 95

Substances are generally associated with:

Back 95

abuse, dependence, intoxication, or withdrawal.

Front 96

11 Classes of substances

Back 96

alcohol, amphetamines, caffeine, hallucinogens, inhalants, nicotine, opioids, phencyclidine (PCP) sedatives, hypnotics, anxiolytics.

Front 97

Which substances would you have withdrawal?

Back 97

alcohol, amphetamines, caffeine, nicotine, opioids, sedatives, hypnotics and anxiolytics.

Front 98

Cannibus, Marijuana

Back 98

Stays in system the longest

Front 99

Schizophrenic Disorders
5 types

Back 99

Disorganized
Catatonic
paranoid
Undifferentiated
Residual

Front 100

Disorganized type

Back 100

marked incoherence, lack of systematized delusions, silly affect

Front 101

Catatonic Type

Back 101

stupor, rigidity, bizarre posturing, waxy flexibility and excessive motor activity

Front 102

Paranoid Type

Back 102

one or more systematized delusions, or auditory hallucinations w/ a similar theme

Front 103

Undifferentiated type

Back 103

"garbage can" bits of other types

Front 104

Residual Type

Back 104

not currently displaying symptoms displayed in the past.

Front 105

Criteria for diagnosis of Schizophrenic disorders

Back 105

Characteristic psychotic symptoms
deterioration in adaptive functioning
6 months duration w/ active phase lasting at least 1 month

Front 106

A's generally associated w/ diagnosis of Schizophrenia

Back 106

Associative Disturbance; Autism; Avolition (lack of goal directed behavior; can't get out of bed) Ambivalence, Alogia (poverty of speech), Affective Disturbances

Front 107

Difference between mood and affect

Back 107

mood - the general feeling (depressed)

affect - how you show it (flat or blunted)

Front 108

Other Selected Psychotic disorders

Back 108

Brief psychotic disorder

Front 109

Brief Psychotic Disorder

Back 109

AKA 3 day schizophrenia, symptoms have existed no longer than a month (at least a few hours) with a sudden onset linked to a psychosocial stressor

Front 110

Schizophreniform

Back 110

time frame for episode is less than 6 months - Provisional

Front 111

Schizoaffective Disorder

Back 111

having a mixture of symptoms suggestive of both and affective (mood) disorder and schizophrenia

Front 112

Schizophrenia

Back 112

1 month active phase
for a period of 6 months

Front 113

Shared Psychotic Disorder
AKA Induced Psychotic Disorder

Back 113

Folie a Deux, 2 people share and create a delusional system

Front 114

Brief Reactive psychosis to Schizphreniform to schizophrenia

Back 114

Brief Reactive psychosis - less than 1 month
Schizphreniform - less than 6 months
schizophrenia - 6 months plus

Front 115

Positive Symptoms (Schizophrenic)

Back 115

hallucinations and/or delusions

Front 116

Hallucinations

Back 116

inaccurate perceptions where inaccurate auditory stimuli is the most common

Front 117

Delusions

Back 117

strong beliefs held against strong contrary evidence

Front 118

Negative Symptoms (Schizophrenic)

Back 118

refers to lack of movement (avolition or speech (alogia)

Front 119

Treatment for Schizophrenic disorders

Back 119

Anti-psychotic meds (most common)
psychodynamic, behavioral and social learning
family therapy
community based treatments (half-way house)

Front 120

Medications Used w/ Psychotic Disorders
Overview
Antipsychotic Drugs
AKA Neuroleptic Drugs

Back 120

Treat severe psychotic disorders
peak concentrations occur between 2-4 hours
Should NOT prescribe 2 anit-psychotic drugs a the same time.
After discharge, wait 3-6 months before consider changing meds.

Front 121

Old or Typical Antipsychotic meds

Back 121

Chlorpromazine

Front 122

General Side Effects w/ Antipsychotic Meds

Back 122

Most common drowsiness or sleepiness

Front 123

Parkinsonian or EPS (Extra-Pyramidial) side effects of Medication

Back 123

Dystonia: Acute contractions of the tongue
Akathisia: Most common form of EPS - inner restlessness (shaking of legs)

Front 124

Anti-Parkinsonian Medications used to decrease EPS side effects

Back 124

Cogentin/benzotrpine
Artane/trihexyphendiyl
Benadryl/diphenhydramina

Front 125

Tardive Dyskinesia

Back 125

permanent neurological condition that can result from using the older anitpsychotic meds (too much)and not taking anything to help control the EPS side effects

Front 126

New or Atypical Anti-psychotic Meds

Back 126

clozapine/clozaril
resperdone/resperdal
Olanzapine/Zyprexa

Front 127

Agranulocytosis

Back 127

Side effect for Clozaril
Can be deadly.
MUST monitor weekly or bi-weekly

Front 128

Mood Disorders
4 types of mood episodes

Back 128

Manic
Hypomanic
major depressive
mixed

Front 129

Manic episode

Back 129

Presenting mood is persistently elevated; must also have at least 3 of the following symptoms: increased psychomotor agitation, flight of ideas, decreased need for sleep, grandiosity, sexual preoccupation, positive symptoms, episodes last approximately 1 week.

Front 130

Hypomanic episode

Back 130

Lasts at least 4 days
similar to manic but not severe enough to interfere w/ functioning, expansive, irritable and elevated mood.

Front 131

Major depressive episode

Back 131

depressed mood lasting approximately 2 weeks, plus five other associated features (changes in sleeping or eating, appetite disturbance, fatigue, reduced concentration, delusions...)

Front 132

Mixed episode

Back 132

alternating moods lasting approximately 1 week, must meet criteria for BOTH manic and depressive

Front 133

Episodes vs Diagnosis

Back 133

A disturbance in mood will disrupt many areas of an individual's functioning, a mood episode is not a diagnosis, the episodes are characteristics of the diagnosis.

Front 134

Bipolar Disorders:
Mixed, manic, and depressed

Back 134

Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar Disorder NOS

Front 135

Bipolar I Disorder

Back 135

one or more manic episodes, usually w/ a history of depressive episodes.
Manic followed by depression (and have psychotic aspects)
BIG ONE
tends to have sexual Issue

Front 136

Bipolar II

Back 136

1 or more depressive with at least one hypomanic episode, no psychosis

Front 137

Cyclothymic Disorder

Back 137

persistent mood disturbance lasting AT LEAST 2 WEEKS, must not be w/out for 2 months, less severity than bipolar
Cycles (Up and Down)

Front 138

Depression Disorders: AKA Unipolar depression

Back 138

presence of 1 or more depressive episodes w/out history of manic or hypomanic

Front 139

Major Depressive Disorder

Back 139

one or more major depressive episodes, episodes must last at least 2 weeks. (only 1 ingredient)

Front 140

Dysthymia

Back 140

2-year history of depressed mood, must not be without for tow months, less severity than major depression, constant for a period of 2 years.
(just down and stay down)

Front 141

Dysthymia in children

Back 141

Different criteria - just a period of 1 year

Front 142

Treatment for Mood disorders

Back 142

w/ mild to moderate depression: Psychotherapy (best)
Medication: antidepressants tricyclics compounds, lithium carbonate for manics, antianxiety for anxiousness, ECT is used to tread depression.

Front 143

Endogenous depression

Back 143

caused by internal events
ECT is often used for this type of depression

Front 144

Exogenous or environmental depression

Back 144

caused by external events
AKA reactive depression

Front 145

Medications for Bipolar Disorders

Back 145

Lithium Salts: used to treat manic episodes of bipolar disorder and should diminish manic symptoms in 5-14 days.

Front 146

If you give a client Lithium, what do you need to monitor and why?

Back 146

Need routine lithium levels and other recommended tests(white blood cells, calcium, kidney & thyroid function). Amount person needs may vary over time. Small range between a therapeutic dose and toxic one.

Front 147

Side Effects of Lithium

Back 147

drowsiness, weakness, nausea and vomiting, fatigue and hand tremor.

Front 148

Other mood stabilizers: Medications
Anti-convulsant category
Work well w/ Schizoaffective disorders or agitated depression of the cyclic nature

Back 148

Depakote (Valproic Acid)
Depakene
Clonzapepam (denzodiazepine)

Front 149

Side Effects of mood stabilizers

Back 149

nausea, indigestion, drowsiness or hair loss. May interact w/ the use of alcohol or depressant medicaitons

Front 150

Medications for Depression

Back 150

Tricyclics: AKA TCA's
Tofranil (Imipramine)
Elavil (Amitriptyline)

Front 151

MAO Inhibitors for Depression

Back 151

Eldepryl (selegiline)
Dietary restrictions - No foods w/ the chemical tyramine (cheese, beef, red wine, chocolate, coffee, bananas)

Front 152

Other Anti-Depressants
SSRI's

Back 152

Selective Serotonin Re-uptake Inhibitors
Prozac/Fluoxetine
Paxil/paroxetine hydrochloride
Zoloft

Front 153

Side Effects

Back 153

sexual disinterest and orgasmic delay

Front 154

Definition of Anxiety (characteristics)

Back 154

an unpleasant state characterized by subjective feelings of worry apprehension, (cognitive) difficulty concentrating, (behavioral) restlessness, irritability, insomnia, (somatic) sweat shortness of breath

Front 155

Definition of Anxiety

Back 155

Considered pathological when the magnitude and/or duration exceed normal limits (taking into account the preceding event)

Front 156

Presentation in Anxiety

Back 156

Anxiety causes somatic symptoms and visa-versa. Often see primary physician, due to tremors, dyspnea, dizzy, sweaty, irritable, restlessness, hyperventilation, pain, heartburn.

Front 157

Differential Diagnosis (treatment)

Back 157

client needs physical exam to rule-out endocrine problems (thyroid, adrenal) cardiac problems, neuro-seizures,drug withdrawal. effects of stimulant drug.

Front 158

Selected Anxiety Disorders

Back 158

Panic Disorder w/or w/out Agoraphobia
Agoraphobia
Social Phobia
Specific phobia
Obsessive-Compulsive Disorder
Generalized Anxiety disorder
Acute Stress Disorder

Front 159

Panic Disorder
W/ or without Agoraphobia

Back 159

attacks involving intense FEAR and apprehension lasting several minutes

Front 160

Agoraphobia w/ History of Panic Disorder

Back 160

fear of being in places where escape may be difficult

Front 161

Social phobia

Back 161

persistent fear of one or more social situations in which person may come in contact with. (avoidant disorder of childhood was placed here)

Front 162

Specific Phobia

Back 162

fear to a object or stimulus not general fear, easiest to treat.

Front 163

Obsessive-Compulsive Disorder

Back 163

recurring obsessions (thoughts) and compulsions (behaviors) severe enough to affect social/occupational functioning. (defense mechanism often exhibited is reaction formation)

Front 164

Post-Traumatic Stress Disorder

Back 164

symptoms must last at least one month, if more than 6 months after event should specify delayed onset, must be outside of rang of usual experience. Often relive situation, but it isn't real.

Front 165

Generalized Anxiety Disorder

Back 165

undue persistent worry for at least 6 months about a least 2 or more life circumstances.

Front 166

Acute Stress Disorder

Back 166

acute reactions to extreme stress. (occurs w/in 4 weeks of the stressor and last from 2 days to 4 weeks) This may help predict the development of PTSD.

Front 167

Anti-Anxiety Medications
Potentially addictive
4 - best used

Back 167

1- to address anxiety in relation to an identified stressor; 2- time limited course, several weeks in duration; 3- better for exodenous factors 4- often a euphoric feeling results

Front 168

General

Back 168

use a high dose at night for difficulty sleeping, diminish anxiety but doesn't cure, watch for history of substance abuse, as they will be more liely to use these drugs for suicide

Front 169

Anti-Anxiety Meds:

Back 169

Benzodiazepines are a central nervous system depressant, so do not mix w/ alcohol or significant depression can result. Consider Buspar if history of drug abuse behavior is suspected
Alprazolam/Xanax - Diazepam/Valium

Front 170

Anxiety Disorder
Counseling

Back 170

Explore stressors and worries.
Treatment: behavioral and cognitive methods
teach person to recognize and prepare for symptoms (relaxation training)
Systematic desensitization and crisis management are often used.

Front 171

Repressed Memory Therapy (RMT)

Back 171

these involve memories from the past generally related to trauma that has been forgotten, these MEMORIES are remembered through therapy which are generally related to past events. If memories aren't real (false memories)

Front 172

Fear vs Anxiety

Back 172

Fear - response to a real threat
Anxiety - response w/out presence of real threat

Front 173

Somatoform Disorders
Unconscious

Back 173

consist of physical symptoms that have no know physiological cause.
Prior to diagnosis a physical exam needs to be completed.

Front 174

Somatization Disorder

Back 174

recurrent and multiple somatic complains (at least 13)
begins in teens.
Onset before age 30

Front 175

Conversion Disorder

Back 175

change or loss in physical functioning is noted to a physical condition.
individual does NOT have voluntary control of symptoms

Front 176

Pain Disorder

Back 176

preoccupation w/ pain w/ no know underlying cause

Front 177

Hypochondriasis

Back 177

unrealistic interpretation of physical symptoms as an abnormal, preoccupation w/ the fear of being seriously ill. The person can acknowledge that there are no grounds for fear.

Front 178

Body Dysmorphic Disorder

Back 178

preoccupation w/ an imagined body flaw

Front 179

Factitious Disorders
Conscious

Back 179

Factitious Disorder w/ Physical symptomes - Munchausen syndrome: person is creating physical symptoms for attention
Factitious Disorder NOS: (by proxy) creating physical symptoms in other for attention

Front 180

Dissociate Disorders

Dissociate Amnesia

Back 180

sudden inability to remember essential personal information, too extreme to be ordinary forgetfulness

Front 181

Dissociative Fugue

Back 181

abrupt unexpected travel away from home or work

Front 182

Dissociative Identity Disorder
was multi personality disorder

Back 182

one person w/ at least 2 distinct personalities.
1 is dominant a a particular time.
5 year history of the problem
(name change)

Front 183

Dipersonalization Disorder

Back 183

one or more episodes of depersonalizaion causing significant distress for the individual, during episodes reality testing remains intact

Front 184

Gender Identity Disorders

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Must have discomfort w/ won sexual identity (ego-dystonic)
1- gender dysphoria; 2- transient stress related cross-dressing; 3- persistent preoccupation w/ castration or penectomy w/out a desire to acquire the sex characteristic of the other sex.

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Gender Identity Disorders
Counseling

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Reparative Therapy: starts w/ the assumption that all people are born heterosexual and the purpose is to cure or convert homosexuals to heterosexuals. This method conflicts w/ social works basic assumptions

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Paraphillias

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strong sexual fantasies and strong urges involving...

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fetishism

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use of non-living objects

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transvestitism

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cross-dressing

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pedophilia

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interest in prepubertal children. To be considered a perpetrator you must be 5 years older than the victim and the perpetrator must be at least 16 years old.

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Exhibitionism

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exposing genitals - person feels guilty but can't stop themselves

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voyeurism

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observing others engaging in sex

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sexual masochism

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sexual excitement through self suffering

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sexual sadism

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sexual excitement through pain infliction

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frotteurism

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touch/rubbing against a non consenting person

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Selected Sexual Dysfunction's
AKA sexual desire disorders

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disturbances in the sexual response cycle, cannot be entirely due to organic factor

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male erectile disorder

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failure to attain/maintain erection

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premature ejaculation

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does so w/ minimal stimulation after insertion into vagina (most common in males)

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dysparenuria

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genital pain in male/female during/after sex

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vaginismus

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recurrent or persistent involuntary spasm of musculature that interferes w/ sex (female)

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Treating Sexual Difficulties

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Often left untreated due to embarrassment. Generally not a singel cause and factors can include: prior sexual failure, inconsistency, performance anxiety, neg attitudes toward sex and use of substances. history of past sexual trauma.

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Sexual Fantasy
Female

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link fantasy that focuses on their partner or romantic exchanges. More likely to envision themselves w/ another woman (25%do)

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Sexual Fantasy
Males

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fantasize about a partner other than a present lover. Most men say they don't envision themselves w/ other men (90% do not)

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Normal Sexual Behavior

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There is no normal and it is what the couple desires

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Psychological Treatment Techniques for Sexual Dysfunctions

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Embarrassing. therapist basic acceptance and permission giving become critical in helping client to express themselves. Listen carefully to what client is saying. Client need accurate information

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Psychological treatment cont.

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behavioral and gognitive treatment are combined to assist clients in developing better adjustment and coping skills. Couple or individual commitment is critical as much of the intervention is completed as homework.

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Psychological treatment cont.
Objectives for clients in treatment include communication increase with:

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1- accepting self and partner, while expressing and sharing feelings
2- listen to partner and do not respond automatically

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Sensate Focus Exercises

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Work of Masters and Johnson, which focuses on progressive exercises begins w/ non-genital touch only. leads to genital touch Goal is to receive pleasure w/out pressure to preform and or achieve orgasm.

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Eating Disorders

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Anorexia Nervosa & Bulimia

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Anorexia Nervosia

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intense fear of gaining weight. Usually Underweight. disturbances in body image, won't eat and over exercises. Resistant to treatment w/ STRONG Denial. onset during late adolescence (12-18) can progress into 30's. 1/2 are bulimics, common co-condition

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Anorexia: treatment

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get client to gain weight. behavioral rewards contingent on eating , strong family/genetic link,
AVOID group therapy w/ other that have SAME condition

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Bulimia Nervosa

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episodes of binge eating, self-induced vomiting w/ laxatives, diuretics or fasting, sense of lack of control during eating binges, chronic concern w/ body weight and shape. NORMAL WEIGHT. 2 binges per week for 3 months

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Bulimia Nervosa
Treatment

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Often group confrontation

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Impulse Control Disorders NOS
pathological Gambling

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chronic failure to resist gambling

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Pyromania

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deliberate personal fire setting associated w/ arousal

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Kleptomania

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Steal w/out need

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Intermittent Explosive Disorder

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loss of control/violent (go crazy, extreme violence)

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Trichotillomania

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impulse to pull own hair w/ hair loss

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Trichotillomania - treatment

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Aversive therapy/conditioning: snapping the rubber band when they pull out hair.

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Sleep Disorders
Insomnia Disorders

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Trouble falling or staying asleep

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Hypersomnia Disorders

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increased sleepiness
Narcolepsy: repeated sleep episodes
and Breathing related sleep disorder, sleep disruption leads to excessive sleepiness

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Circadian Rhythm Sleep Disorder

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mismatched cycle

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Parasomnias

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Abnormal incidents during sleep
1- Nightmare disorder: remembers dreams
2- Sleep Terror Disorder: do NOT remember dreams, sudden awakenings; 3- Sleepwalking Disorder: unresponsive to other who try to wake person

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Adjustment Disorders

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maladaptive reaction to a psychosocial stressor; develops w/in 3 months of stressor. Lasts 6 months or longer. Must impair occupation/social functioning, diagnosis is made based on predominate symptoms.

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Adjustment Disorders
Examples of

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Depressed mood; disturbance of Conduct; Mixed Emotions features;Withdrawal; Anxious mood; mixed disturbances of emotions and conduct; physical complaint; work inhibition.

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Personality Disorders

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AXIS II
begin early in life
interferes but on incapable of social functioning.

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Personality Disorders
Cluster A
Weird
odd/eccentric behavior
socially isolated and withdrawn

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Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

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Schizoid Personality disorder

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very detached w/ a pattern of indifference. lack desire for intimacy.
I just want to be alone
zoided out in a world of their own.

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Schizotypal

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typical of schizophrenia, numerous social and interpersonal problems. Want intimacy just can't "get it together"
Ideas of Reference/Delusions of Reference

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Ideas of Reference

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incorrect interpretation of a causal incident as having a particular or unusual meaning to the person

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Delusions of Reference

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beliefs that are held w/ delusional conviction.

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Personality Disorders
Cluster B
Wild
dramatic/emotional/erratic behavior

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Antisocial
Borderline
Narcissistic
Histrionic

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Antisoical PD

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old psycho/sociopath

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Borderline PD

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instability of self
Be Sure to set CLEAR Boundaries and defuse crisis formulation in treatment. Can us dialectical behavioral therapy

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Narcissistic

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grandiose sense of self-importance, lack of empathy as a main criteria

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Personality Disorders
Cluster C
Worried
anxious or fearful behavior

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Avoidant
Dependent
Obsessive Compulsive PD
Passive Aggressive PD

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Avoidant PD

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pattern of social discomfort

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Dependent Pd

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dependent submissive behavior, most frequent in females

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Obsessive Compulsive PD

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perfectionism an inflexibility, defense mechanism
reaction formation
Monk - can function, but must be in a certain way

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Passive Aggressive PD

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procrastination, was dropped from DSM-IV

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Other conditions that may be the focus of Clinical intervention
V codes

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Academia problems
Childhood or adolescent antisocial behavior
Adult antisocial behavior
borderline intellectual functioning
Bereavement
malingering

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Academic problem

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underachiever

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Childhood or adolescent antisocial behavior

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isolated acts
divorce so kid bring gun to school
Serious violation of rules but not a mental disorder

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Malingering

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voluntary mental and or exaggerated physical symptoms w/ an obvious recognizable goal.

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Bereavement

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major depressive disorder w/ a death of a loved one; should last about 1 yr.

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Acculturation Problem

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exposure to living in a new culture

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Assessment and Intervention w/ AIDS and HIV

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Can test + after 12 weeks of infection
Can be transmitted soon after infection
Normal t-cell count is 400 - 1700
t-cell falls below 200 and person is susceptible to opportunistic infections - AIDS

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AIDS and HIV
babies

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newborns takes approx 15 months to be sure if s/he is infected
Pregnant HIV positive women given HIV medication as precaution for a less chance of baby developing + HIV status.

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Treatment for AIDS

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Always educate

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Assessing Danger to Self

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Document and plan of avoidance of the potential for harm to self or others.
"Do no Harm Agreement"
No-Suicide Agreement"

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Assessing Danger to self
ideation and intent

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Ideation - the idea w/ a vague plan
Intent - with a specific plan

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Treatment of Assessing Danger to self
with: ideation and intent

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When ideation and intent are clear, immediately recommend/seek in-patient hospitalization and document this. Do not do a no-suicide agreement if intent is noted.

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WAIS

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measures intelligence

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Rorschach

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Measures associations through viewing ink blots

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SPMSQ

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measures mental status

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TAT

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measures perception through telling stories about pictures.