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78 Cards in this Set

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What are components of a crisis? (Golan, 1978)
1. Harzardous event - initial shock disrupts equilib and starts series of reactions -> crisis.
2. Vulnerable state - all the emotional, bio, cog beh responses to events -> anxiety.
3.Active Crisis State - Disequilibrium/disorganization - 3 stages a) physical agitation, b) preoccupation with events leading to crisis, c) return to equilibrium - realize cop technqies or seek help.
4. Restoration of equilibrium - success depends on ability to evulate sit and cop strategies
Define situational crisis and its components.
Crisis origin is sudden, random, shocking and often catastrophic that cannot be anticipated or controlled.
1. Event threatens sense of psychological well being - disequilibrium
2. Factors effecting if one will interpret crisis = perception of event & ability to cope / social supports.
3. Sources of stress include - physical illness, untimely death, crime, natural dis, war, divorce, material loss
Define maturational (developmental) cris - transitional states
Crisis origin is embeded i developmental process - so can be anticipated.
What are the developmenatl transition states and the developmental task of each. 6 stages.
1)Childhood - task - socialization - parents, friends, success/failure in school. peer conflict, moving, academic probs.
2)adololescence - IDENTITY - failure in academics or athletics, grdauation, college, breakup wi/bf, pregnant - job search.
3)Young Adulthood - 18-34 - Preoccupied with intimacy, parenthood - career. relat problems, procreating, $ probs, age 30 trans..
4)Middle adult - look at what u have accomp and what u wanted. Physical decline, illness, parenting, moving, regrets about relats, death.
5)Maturity - consolidating experiences & resources -> focus on later life. health problems, retirement, empty nest.
6)Old Age - retirement til death - evaluate past and share wisdom of their life - acheiving satisfaction wi life, lonliness, $, problems with family.
What are four common factors that lead a transition state to activate an emotional crisis?
1) The person cannot prepare for the changes - prep helps.
2) The accomplishment of the tasks assoc with dev stage is hindered b/c per lacks skills or resources.
3) Unanticipated traumatic event - hurts ability to cope.
4) Crisis because the challenge doesn't fit societies expec for devel level.
Positive Crisis Outcomes
Problem solving efforts are successful and person returns to precrisis state. May also grow from crisis exp b/c new prob solving methods reduce emotional discomfort
Negative Crisis Outcomes
a. Person lacks effective means to resolve problem, emotional pain persists - becomes depressed, withdrawn - engages in impulsive behavior - uses drugs - tries to commit suicide - extreme behaviors.
b. Person regains equilibrium thinking that crisis has ended, but has only subsided - transcris states - person in vulnerable to minor prob b/c single stressor may retrigger crisis.
What types of questions should be used in the assessment of a crisis?
1) Open-ended questions about clients feelings
2) Closed-ended questions to quickly elicit details about what is occuring in their life. i.e. thinking of harming yourself?
What does assessment of lethality involve?
1) Listen and look for clues to danger: a) verbal clues - I wanna kill him or myself. Also if MENTION PREVIOUS ATTEMPTS b) nonverbal - prep for death, sleep changes, recent fight, provocation. c) reports from others
2)If signs are present - conduct struc inquiry to collect info to determ and implement appropriate plan to protect client / others a) ask direct questions - goin2 kill urself? when? where? b) use client's words to clarify vague threats c) self-harm also includes destructive behavior - abusing drugs/alcohol
What distress signals are highly associated with crisis?
Difficulty managing feelinsg, Suicidal or homocidal tendencies, drug abuse, inability to use help
Key Questions to explore in assessing crisis origin and development
1. What recent stress events have occured in client's life.
2. What dev stage is client in?
3. Is client in initial or acute stage of crisis?
Assessing Affective Domain in Crisis Intervention
1.Abnomral or impaired affect
2.Anxiety and tension
3.Sense of loss/emptiness
4.hopelessness/helplessness
5.fear,anger,guilt,embaras,shame
Assessing Cognitive Domain in Crisis Intervention
1. Altered Cognitive Processes: memory problems, trouble making decisions.
obessional thoughts about crisis, intrusive thoughts, concentarion problems, dostorted reality due to crisis
2. Pereception of Situation: Feelings are consistent wi perceptions of situation
3. clients subjective interpretation of stres events is determ of crisis res.
Ataque de nervios
an idiom of distress involving uncontrollable shouting, crying, trembling, physical agression following a stressful event - Latinos from Caribean may report it
4 Goals to be addressed in all crisis interventions

+ 2 additional goals in clients wi chronic life history
1.relieving clients symptoms
2.identify factors that led to crisis state.
3.return client to precrisis state
4.Applying remedial measures
5.develop coping strategies 4 future
6.help clieny connect stress wi past experiences
What are 6 Characteristics of suicide assessment?
1.Primary Goal - level of risk they will attempt suicide in nr future.
2.lev of risk varies over time
3.Any level of sui crisis should be treated as emergency
4.Includes data collection, MSE, consultations with md's
5.Ask direct questions about SI
6.Uses direct & indirect techs
What are gender risk factors for suicide?
-4to5 x as many males commit sui as fems.
-Fem attempt sui 3 x males, but succeed less b/c males choose lethal means
What are age factors of suicide?
-Attempts highest = 24-44
-Completed suicide = 65+

-Biggest increase in age 10-19 wi largest inc 10-14.
Race risks for suicide
Highest risk for whites for all ages except teens - Native American are higher. White males highest risk of all.
Marital status risks for suicide
+Higher rates for suicide for divorced, sep, widowed then single.
-lowest rates among married
Living Environments
+highest risk living alone
+higher risk living in city
Psychiatric History as risk for suicide
+50-80% of sui inv have history of sev depression. In these cases sui occurs w/in 3 mos of when symp improve
+ for teens risk inc when comorbid wi CD, sub dep, ADHD
Previous suicide attempt as risk
+60-80% who commit sui have 1 previous attempt, 80% give warning of their intent
subjective distress as risk for suicide
+people who commit sui tend to be exp high levels of sub stress, motivated by desire to esc pain or bad situation
-Risk is low if contem sui to influence others
biological correlates of suicide
Low levels of serotonin and 5 HIAA associated with suicide
What are 6 Characteristics of suicide assessment?
1.Primary Goal - level of risk they will attempt suicide in nr future.
2.lev of risk varies over time
3.Any level of sui crisis should be treated as emergency
4.Includes data collection, MSE, consultations with md's
5.Ask direct questions about SI
6.Uses direct & indirect techs
What are gender risk factors for suicide?
-4to5 x as many males commit sui as fems.
-Fem attempt sui 3 x males, but succeed less b/c males choose lethal means
What are age factors of suicide?
-Attempts highest = 24-44
-Completed suicide = 65+

-Biggest increase in age 10-19 wi largest inc 10-14.
Race risks for suicide
Highest risk for whites for all ages except teens - Native American are higher. White males highest risk of all.
Marital status risks for suicide
+Higher rates for suicide for divorced, sep, widowed then single.
-lowest rates among married
Living Environments
+highest risk living alone
+higher risk living in city
Psychiatric History as risk for suicide
+50-80% of sui inv have history of sev depression. In these cases sui occurs w/in 3 mos of when symp improve
+ for teens risk inc when comorbid wi CD, sub dep, ADHD
Previous suicide attempt as risk
+60-80% who commit sui have 1 previous attempt, 80% give warning of their intent
subjective distress as risk for suicide
+people who commit sui tend to be exp high levels of sub stress, motivated by desire to esc pain or bad situation
-Risk is low if contem sui to influence others
biological correlates of suicide
Low levels of serotonin and 5 HIAA associated with suicide
Suicide risk factors specific to teens and kids
1.Most common is interper loss (break up wi bf) argu wi parents
2.most attemp are impulsive & out of desire to get atten of other, escape pain
3.ealry warning signs = talk of death,talk of reun wi dead per, giving away prized posess
4.exposure to suicide..media..classmate
Suicide risk factors for elderly
+physical/mental ill,ethol, stress,few friends,exlcuded from family matters,losses of growing old,loss of spouse,$,etc.
What is direct assessment of suicide?
1.Inetnt-have they said they want to kill themself..I'm useless
2.Plan-when,where,how. made will recently?
3.Means-can they pull it off?
Means of suicide wi highest risk vers lower risk
+Guns,hanging,drowning,CO2 poisoning,sleep pills,antidepressants,aspririn,car crash,extreme cold
-low-wrist cutting,housegas,nonRX drugs,valium, tranquilizers
MMPI-2 scores suggestive of suicide
T-score of 65+ on scale 2 (Depression,D) = possible suicide...inc risk if also elev on 4 (psychopathic dev, pd), 7 (psychasthenia, Pt), 8 (schiz,Sc) &/or 9 (hypomania, Ma)
MCMI-III scores ind of suicide potential
1.elv score on Depression scale/2B - closely mont sui.
2.elv on both Depressive scale & Bord scale = extr dif cont aff & behav.
3.high score on maj dep scale associate with sense of hopelessness n pess & SI
Steps to be taken if LETHALITY of suicide is assessed to be LOW
1.talk over problem wi client
2.elicit ambivalent feelings about suicide
3.offer emotional support
4.explore alts for meeting clients needs
5.provide referrals for outside help
6.obtain agreement that client should contact if change is situation i.e. increased hopelessness
Steps to be taken if LETHALITY of suicide is assessed to be HIGH
1.Take more directive approach: "I don't want you to harm yourself."
2. Develop No suicide contract
3.If client won'r commit to these, notify support system - get their help in watching client and removing weapons
What are the components of NO -SUCIDE contract?
1.cl promises to not commit sui for spef period of time (2 days)
2.to not stay alone during that period of time
3.remove all lethal means of sui form environment
4.suggest person stays wi friends/family
5.see cl more often and touch base over reg intervals
Steps to be taken if LETHALITY of suicide is assessed to be VERY HIGH
1.Encourage voluntary commitment to psychiatric facility by client using support system
2.If they refuse,arrange involuntary hold by contacting person or agency designated.
3.follow up until client is stablized
4.after crisis is stablized, follow up to repair any dam caused by breach of confidentiality
How do you know if lethality of client's suicide is VERY HIGH?
Client has a lethal plan and previous attempts and is socially isolated or client cannot coopertate with any methods of self-protection due to psychosis, drug use, or lack of support
When is OUTPATIENT MANAGEMENT appropriate option for suicide risk?
1. Suicide risk is low.
2.when high risk client has adequate support system, willing to use outside resources,agrees to no-suicide contract
3.client wi character pathology has history of vague,nonlethal sui threats
Important techniques to use when using outpatient management for suicidal client
1.Consult wi colleagues
2.reassure client that desire to commite sui is a temporary state & consider other options until crisis has passed
3.Establish rapport and connection to life
4.Establish increased sense of hope - what SPECIFICALLy caused this crisis
3.Teach cl to use prob solving technques
4.help client to distance self and the feeling state - but that pain is not always permanent condition
5.increased social contact
6.teach family members warining signs of sui - have them encourage client to stay connected wi others
7.refer to md if extremely anx or unable to sleep
8.24 hr clincial backup
Goals in Assessing Dangerousness to others?
1.idenify cause of current crisis
2.determine prob that cl will cause violent act in future
3.may be wriiten or spoken, direct (kill wife) or indirect (do something crazy)
Factors associated with high risk for violence
1.specific plan 2 hurt someone (have weapon)
2.history of previous acts of violence (has person exp, witness, or perpetrated violence)
3.behavior-signs of tension, agitation, loud speech
4.personality char- poor impulse cont,very agress,labile affect
5.psych dx- drug intox/withdrw,deler,mania,paranoia,impulse control prob
6.demographic-young age (beg. 15-18 to age 30-35) low s.e.s., minority, les educated
7.low IQ, poor school/work his
3 variables to determine how dangerous a client is & how directive you should be
1.Plan-can client say how,when,where she plans to commit violent act
2.previous violence
3.willingness to use outside resources - isolated = more chance to harm others
Clear and Present Danger in danger to others.
1. client names intended victim
2.describes motive
3.specific concrete plan for harming victim
4.intends to carry out plan
MMPI-2 scores indicative of possible dangerousness to others.
a. High score on scale 6 (Paranoia) - psychotic behavior- often seek revenge on others.
b.High- scale 4 (Psychopathic Deviate)=agressive or assualtive
+High on 4 and 9(Hypomania)=antisocial and act on impulsive
+6,4,9 = Dangerous and poor judgment,acting out violently seems justified
MCMI-III scores indicative of possible dnagerousness to others
+High score on Antisocial Scale 6a - vengful,agressive,
+6b - sadistic,no shame guilt
+High on both is VERY Dangerous
+High on Paranoid scale P-controlling,belligerenet way,brood over injustice,revenge
You should express your duty to warn when..
Client has identified a specific person who is at risk for suffering physical harm
Gravely Disabled Adult
Unable to take care of basic needs:food,shelter,clothing. Cannot prepare food,eat,maintain hygene needed to prevent illness,infection,responding appropriately to life-threatening situations
Gravely disabled minor
Inability to use elements of life essential to health,safety,development: food, clothing,shelter - even though it has been provided by others
Indicates functional impairment - gravely disabled
1.disorder interferes wi ability to function during interview
2.poor concentration during assessment tasks
3.general capacity to function
4.difficulty interacting wi interviewer
5.multipple imapired areas of performance in client's daily life
Procedures available for assessing functional impairment
1.MSE- do u hospitalize?
2.BDI-II- 29 or above is high level of incapacity
3.BSI (brief sys inventory) and STAI (state-trait anxiety inventory) scores
4.MMPI elevated scores on 6 (Pa), 8 (sc) 9 (Ma)
5. GAF scores 30-21 = delus,halluc,impairment in judg; 20-11 = danger to self others,minimal hygiene (smear feces),10-0=clear expectation of death due to neglect of above
Evidence Code 1024
Law that states that what a client communicates to you is not privileged if u dtermine that disclosure is necessary to prevent danger to self/others.
-client cannot invoke privelege
Ethics code standard 4.05
-You may discole confidential info about client only as mandated by law or valid purpose
Disclose only what is necessary about client to prevent sucide etc.- tell client that u r going to do this
Tarsoff decision?
Therapist determines patient presents a serious threat of physical violence to another - is obligated to use care to protect intended victim
MMPI-2 scores indicative of possible dangerousness to others.
a. High score on scale 6 (Paranoia) - psychotic behavior- often seek revenge on others.
b.High- scale 4 (Psychopathic Deviate)=agressive or assualtive
+High on 4 and 9(Hypomania)=antisocial and act on impulsive
+6,4,9 = Dangerous and poor judgment,acting out violently seems justified
MCMI-III scores indicative of possible dnagerousness to others
+High score on Antisocial Scale 6a - vengful,agressive,
+6b - sadistic,no shame guilt
+High on both is VERY Dangerous
+High on Paranoid scale P-controlling,belligerenet way,brood over injustice,revenge
You should express your duty to warn when..
Client has identified a specific person who is at risk for suffering physical harm
Gravely Disabled Adult
Unable to take care of basic needs:food,shelter,clothing. Cannot prepare food,eat,maintain hygene needed to prevent illness,infection,responding appropriately to life-threatening situations
Gravely diabled minor
Inability to use elements of life essential to health,safety,develoipment: food, clothing,shelter - even though it has been provided by otehrs
Indicates functional impairment - gravely disabled
1.disorder interferes wi ability to function during interview
2.poor concentration during assessment tasks
3.general capacity to function
4.difficulty interacting wi interviewer
5.multipple imapired areas of performance in client's daily life
Procedures available for assessing fucntional impairment
1.MSE- do u hospitalize?
2.BDI-II- 29 or above is high level of incapacity
3.BSI (brief sys inventory) and STAI (state-trait anxiety inventory) scores
4.MMPI elevated scores on 6 (Pa), 8 (sc) 9 (Ma)
5. GAF scores 30-21 = delus,halluc,impairment in judg; 20-11 = danger to self others,minimal hygiene (smear feces),10-0=clear expectation of death due to neglect of above
Evidence Code 1024
Law that states that what a client communicates to you is not privileged if u determine that disclosure is necessary to prevent danger to self/others.
-client cannot invoke privilege
Ethics code standard 4.05
-You may discole confidential info about client only as mandated by law or valid purpose
Disclose only what is necessary about client to prevent sucide etc.- tell client that u r going to do this
Tarsoff decision?
Therapist determines patient presents a serious threat of physical violence to another - is obligated to use care to protect intended victim
Civil Code 43.92
where patient has communicated to therapist serious threat of physical violence against a reasonably ident victim - duty to warn shall be discharged by therapist to comm threat to victim and law enforcement
welfare code 5150
When person,due to menatl illness,is danger to self,others,or gravely disabled, a peace officer,memebers of county facility,mobile crisis - may go into custody of DMH for 72 hr tx
welfare code 5250
A 14 day certification for intensive tx that after 72 hours patient remains dangerous to self/others/gravely diabled
WIC 5260
a second 14 day hold if a patient continues to present danger to self or others
WIC 5300
After 2nd 14 day hold if client still remains a serious danger, a 180 day hold may be applied
WIC 5350
If a client is gravely diabled a conservator may be appointed by a court hearing.. if a person has family who will say in writing they will care for cl, then they may not be considered gravely diabled