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157 Cards in this Set
- Front
- Back
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DSM 5 changes Neurodevelopmental Disorders * Intellectual Disability (3) |
* need for cognitive AND adaptive functioning assessment * severity determined by adaptive functioning * no more mental retardation term |
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Pain Disorder Goals (5)
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* teach copings skills
* increase non somatic focused activities * decrease somatic focus and sick role * decrease somatic symptoms * maximize psychosocial functioning |
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DSM 5 changes Neurodevelopmental Disorders * Communication Disorders (4) |
* Language Disorder * Speech Sound Disorder * Childhood-Onset Fluency Disorder (Stuttering) * Social (pragmatic) communication disorder |
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DSM 5 changes Neurodevelopmental Disorders * Autism Spectrum Disorder (3) |
* 4 previous disorder are now 1 single condition * with different levels of symptom severity * 2 core domains 1) deficits in social commun. and social interaction 2) restricted repetitive behaviors, interests and activities (if no RRBI's are present, diagnosis is social communication disorder). |
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DSM 5 changes Neurodevelopmental Disorders * ADD/ADHD |
* same 18 symptoms divided in 2 symptom domains (inattention and hyperactivity/impulsivity) * at least 6 symptoms in one domain needed added (+) several symptoms in each setting (+) several inattentive or hyperactive-impulsive symptoms were present before age 12 * subtypes replaced with specifiers * comorbid diagnosis with autism not allowed
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DSM 5 changes Neurodevelopmental Disorders *Specific Learning Disorder |
* specify if - impairment in reading - imp. in written expression - impairment in mathematics - not otherwise specified * can use more than one specifier |
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DSM 5 changes Neurodevelopmental Disorders * Motor Disorders |
+ Developmental coordination disorder + Stereotypic movement disorder + Tourette's disorder + Persistent (chronic) motor or vocal tic disorder + provisional tic disorder + other specified + unspecified |
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DSM 5 changes Schizophrenia Spectrum and Other Psychotic Disorders * Schizophrenia (part 1) |
* 2 changes - elimination of the social attribution of bizarre delusions and 2 or more voices conversing (Scheniderian first rank auditory hallucinations) - 2 criterion A symptoms are required - must have at least 1: delusions, hallucinations and disorganized speech |
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DSM 5 changes Schizophrenia Spectrum and Other Psychotic Disorders * Schizophrenia (part 2) |
Subtypes: * DSM IV subtypes were eliminated * dimensional approach to rating severity for the core symptoms is included |
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DSM 5 changes Schizophrenia Spectrum and Other Psychotic Disorders * Schizoaffective Disorder |
* requirement that a major mood episode be present for a majority of the disorder's total duration after Criterion A has been met.
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DSM 5 changes Schizophrenia Spectrum and Other Psychotic Disorders * Delusional Disorder |
* no longer requires that delusions are non-bizarre * no longer separate from shared delusional disorder
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DSM 5 Schizophrenia Spectrum and Other Psychotic Disorders Catatonia |
* in all contexts, require 3 catatonic symptoms from a total of 12 characteristics * may be specifier for depressive, bipolar, and psychotic disorders * as a separate diagnosis in the context of another medical condition or other specified diagnosis. |
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DSM 5 Bipolar and Related Disorders * Bipolar Disorders |
* includes an emphasis in activity and energy as well as mood * specifier "with mixed features" added |
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DSM 5 Bipolar and Related Disorders * Other Specified Bipolar and Related Disorder |
* either all symptoms but hasn't met duration or * too few symptoms of hypomania are present but duration is sufficient. |
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DSM 5 Bipolar and Related Disorder * Anxious Distress Specifier |
* intended to identify patients with anxiety symptoms that are not part of the bipolar criteria |
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DSM 5 changes Depressive Disorders * Disruptive Mood Dysregulation Disorder |
* included for children up to age 18 who present persistent irritability and frequent episodes of extreme behavior dyscontrol |
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DSM 5 changes Depressive Disorders * Premenstrual Dysphoric Disorder |
* moved from DSM-IV appendix to the main body of book |
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DSM 5 changes Depressive Disorders * Persistent Depressive Disorder |
* previously dysthymia |
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DSM 5 changes Depressive Disorders * Major Depressive Disorder |
* added specifier "with mixed features" (3 manic symptoms, but insufficient to meet manic episode criteria)
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DSM 5 changes Depressive Disorders * Bereavement |
* in Conditions for Further Study * exclusion is omitted in DSM-5 |
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DSM 5 changes Depressive Disorders * Specifiers for Depressive Disorders |
* with anxious distress specifier has been added * guidance on assessment of suicidal thinking, plans and risk factors in given |
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DSM 5 changes Anxiety Disorders
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* chapter no longer includes obsessive-compulsive disorder (which is now in the obsessive-compulsive and related disorders) * no longer includes posttraumatic stress disorder and acute stress disorder (which is included with the trauma and stressor related disorders) |
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DSM 5 changes Anxiety Disorders * Agoraphobia, Specific Phobia, and Social Anxiety Disorder |
* deletion of the requirement that individuals over age 18 recognize that their anxiety is excessive or unreasonable. * the anxiety must be out of proportion to the actual danger or threat * 6 month duration is now extended to all ages |
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DSM 5 changes Anxiety Disorders * Panic Attack |
* the different types of panic attacks are now replaced with terms "unexpected and expected" * panic attacks function as a marker and prognostic factor for severity across an array of disorders (can be listed as a specifier to all DSM 5 disorders) |
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DSM 5 changes Anxiety Disorders * Panic Disorder and Agoraphobia |
* Panic Disorder and Agoraphobia are unlinked in DSM 5 (2 separate diagnosis with different criteria) * for agoraphobia, fears from 2 or more agoraphobia situations is now required
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DSM 5 changes Anxiety Disorders * Specific Phobia |
* there is no longer a requirement that individuals over age 18 years must recognize that their fear and anxiety are excessive or unreasonable, and the duration requirement (typically lasting for 6 months or more) now applies to all ages. * different types of phobias are now specifiers |
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DSM 5 changes Anxiety Disorders * Social Anxiety Disorder (Social Phobia) |
* deletion of the requirement that fear or anxiety is excessive or unreasonable * duration criterion of "typically lasting for 6 months or more" is now required for all ages * the "generalized" specifier has been deleted and replaced with a "performance only" specifier |
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DSM 5 changes Anxiety Disorders * Separation Anxiety Disorder |
* no longer in childhood, now in Anxiety Disorders * wording has been modified to represent separation anxiety in adulthood * attachment figures may include the children of adults * age of onset does not need to be before 18 * typically lasting for 6 months or more |
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DSM 5 changes Anxiety Disorders * Selective Mutism |
* now in the Anxiety Disorders chapter |
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DSM 5 changes Obsessive-Compulsive and Related Disorders * Body Dysmorphic Disorder |
* "with muscle dysmorphia" has been added
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DSM 5 changes Obsessive-Compulsive and Related Disorders * Hoarding Disorder |
* new diagnosis * persistent difficulty discarding or parting with possessions and distress associated with discarding them |
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DSM 5 changes Obsessive-Compulsive and Related Disorders * Trichotillomania (Hair Pulling Disorder) |
* under OCD disorders |
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DSM 5 changes Obsessive-Compulsive and Related Disorders * Excoriation (Skin-Picking) Disorder |
* newly added |
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DSM 5 changes Trauma and Stressor Related Disorders * Acute Stress Disorder |
* requires being explicit as to whether qualified traumatic events were experienced directly, witnessed, or experienced indirectly. * "person's response involved intense fear, helplessness or horror" has been eliminated * need 9 or 14 symptoms in the categories: intrusion, negative mood, dissociation, avoidance and arousal |
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DSM 5 changes Trauma and Stressor Related Disorders * Adjustment Disorders |
* array of stress response syndromes that occurs after exposure to a distressing (traumatic or nontraumatic) event. * subtypes marked by depressed mood, anxious symptoms, or disturbances in conduct have been retained. |
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DSM 5 changes Trauma and Stressor Related Disorders * Posttraumatic Stress Disorder - part 1 |
* more explicit 'how the subject experienced the traumatic event' * "subjective reaction" has been eliminated * separate criteria added for children 6 and younger |
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DSM 5 changes Trauma and Stressor Related Disorders * Posttraumatic Stress Disorder - part 2 |
4 symptom clusters: * Intrusion symtoms * Persistent avoidance * Negative alterations in cognitions and mood * Alterations in arousal and reactivity |
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DSM 5 changes Trauma and Stressor Related Disorders * Reactive Attachment Disorder |
* result of social neglect or other situations that limit a young child's opportunity to form selective attachments.
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DSM 5 changes * Dissociative Disorders |
* derealizations is included in the name and symptoms structure of what was called depersonalization disorder and is now called depersonalization/derealization disorders * dissociate fugue is now a specifiers of dissociative amnesia / not a diagnosis * criteria for dissociative identity disorder have been changed to indicate that symptoms of disruptions of identity may be reported as well as observed |
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DSM 5 changes Dissociative Disorders * Dissociative Identity Disorder |
* criterion A has been expanded to include certain possession-form phenomena and functional neurological symptoms * transitions in identify may be observable by others or self-reported * may have recurrent gaps in recall for everyday events, not just for traumatic experiences |
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DSM 5 changes Somatic Symptoms and Related Disorders |
* reduced the number of these disorders and subcategories to avoid problematic overlap * Somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder have been removed. |
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DSM 5 changes Somatic Symptom and Related Disorders * Somatic Symptoms Disorder |
* based on a long and complex symptom count of medically unexplained symptoms. * individuals previously diagnosed with somatization disorder will usually meet criteria for SSD but only if they have the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms. |
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DSM 5 changes Somatic Symptom and Related Disorders * Hypochondriasis and Illness Anxiety Disorder |
* Hypochondriasis eliminated/ pejorative term * Illness Anxiety disorder - high health anxiety without somatic symptoms (unless their health anxiety was better explained by a primary anxiety disorder) |
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DSM 5 changes Somatic Symptom and Related Disorders * Psychological Factors Affecting Other Medical Conditions and Factitious Disorder * Conversion Disorder |
* new * somatic symptoms are predominant * for conversion disorder, criteria was modified to emphasize the essential importance of the neurological examination |
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DSM 5 changes Feeding and Eating Disorders * Pica and Rumination Disorder |
* now diagnoses can be made for any age |
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DSM 5 changes Feeding and Eating Disorders * Avoidant/Restrictive Food Intake Disorder |
* used to be feeding disorder of infancy
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DSM 5 changes Feeding and Eating Disorders * Anorexia Nervosa |
* amenorrhea has been eliminated * includes not only overtly expressed fear of weight gain but also persistent behavior that interferes with weight gain |
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DSM 5 changes Feeding and Eating Disorders * Bulimia Nervosa |
* reduction in the required minimum average frequency of binge eating and inappropriate compensatory behavior frequency from twice to once weekly. |
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DSM 5 changes Feeding and Eating Disorders Binge-Eating Disorder |
* frequency of binge eating required has changed from at least twice a week for 6 months to at least once a week for 3 months. |
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DSM 5 changes Feeding and Eating Disorders Elimination Disorders |
* no longer exclusive for children |
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DSM 5 changes Sleep-Wake Disorders |
* sleep disorder related to another mental disorder or a general medical condition have been removed * greater specification of coexisting condition is provided for each disorder * the diagnosis of primary insomnia has been renamed insomnia disorder to avoid the differentiation of primary and secondary * narcolepsy distinguished from other forms of hypersomnolence |
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DSM 5 changes Sleep-Wake Disorders * Breathing-Related Sleep Disorders |
* divided into 3 relatively distinct disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation |
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DSM 5 changes Sleep-Wake Disorders * Circadian Rhythm Sleep-Wake Disorders |
* expanded to include advanced sleep phase syndrome, irregular sleep-wake type, and non-24-hour sleep-wake type * jet lag type was removed |
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DSM 5 changes Sleep-Wake Disorders * Rapid Eye Movement Sleep Behavior and Restless Legs Syndrome |
* rapid eye movement sleep behavior and restless leg syndrome were made independent disorders |
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DSM 5 changes Sexual Dysfunctions |
* gender specific sexual dysfunctions have been added * for females, sexual desire and arousal disorders have been combined into one disorder: female sexual interest/arousal disorder * most disorders now require a minimum duration of approx. 6 months and more precise severity criteria. |
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DSM 5 changes Sexual Disorders * Genito-Pelvic Pain/Penetration Disorder |
* new * merger of vaginismus and dyspareunia * sexual aversion disorder has been removed |
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DSM 5 changes Sexual Disorders *Subtypes |
* lifelong versus acquired * generalized versus situational |
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DSM 5 changes Gender Dysphoria |
* new diagnostic class * emphasizes "gender incongruence" * it is considered a multi category concept rather than a dichotomy * separate criteria sets are provided for children, adolescents and adults * "the other sex" was replaced by "some alternative gender" SUBTYPES and SPECIFIERS: "post transition" |
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DSM 5 changes Disruptive, Impulse-Control and Conduct Disorders * Oppositional Defiant Disorder |
* 4 refinements: 1) symptoms are now groups into 3: angry/irritable mood, argumentative/defiant, vindictiveness. 2) the exclusion criterion for conduct disorder has been removed 3) provide guidance on the frequency needed for a behavior to be considered symptomatic 4) a severity rating has been added to the criteria |
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DSM 5 changes Disruptive, Impulse-Control and Conduct Disorders * Conduct Disorder |
* a descriptive features specifier has been added for individuals who meet full criteria for the disorder but also present with limited prosocial emotions (callous or unemotional interpersonal style across multiple settings and relationships) |
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DSM 5 changes Disruptive, Impulse-Control and Conduct Disorders * Intermittent Explosive Disorder |
* besides physical aggression, now verbal aggression and nondestructive/noninjurious physical aggression also meet criteria. * more specific criteria defining frequency needed to meet criteria * specifies if the aggressive outburst are impusilve and/or anger based in nature, and use cause marked distress, impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences. * minimum of 6 years old to diagnose |
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DSM 5 changes Substance-Related and Addictive Disorders Criteria and Terminology - part 1 |
* not more abuse vs. dependence * criteria is provided for intoxication, withdrawal, substance-medication induced disorders and unspecified substance-induced disorders. * substance use is identical with substance dependence symptoms combine into a single list with 2 exceptions
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DSM 5 changes Substance-Related and Addictive Disorders * Gambling Disorder |
* new * treated as similar to drugs of abuse |
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DSM 5 changes Substance-Related and Addictive Disorders * Criteria and Terminology - part 2 |
* recurrent legal problems has been deleted * craving or strong desire or urge to use added * Cannabis withdrawal is new * Caffeine withdrawal is new * severity is based on the number of endorsed criteria (2-3, mild, 4-5, moderate, 6+ severe) * early remission (at least 3 months, < than 12) * sustained remission (at least 12 months) * +specifiers "in a controlled environment" and "on maintenance therapy" |
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DSM 5 changes Neurocognitive Disorders * Major and Mild Neurocognitive Disorder |
* dementia and amnestic dis. now Major NCD * an updated listing of neurocognitive domains is also provided and necessary for establishing the presence of NCD, distinguish is mild/major * etiological subtypes: due to Alzheimers, due to HIV, TBI, etc. |
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DSM 5 changes Paraphilic Disorders * Specifiers |
* + "in remission" and "in controlled environment" * there is difference between paraphilia and paraphilic disorders, the latter causes distress * need to meet criteria A and B to be diagnosed * pedophilia has become pedophilic disorder |
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Crisis Situations (10) |
* Suicidality * Violent/Assaultive homicidal behavior/rape * Child abuse * Elder/dep adult abuse * intimate partner abuse * Grave disabilily * Acute medical illness * Drug/alcohol intoxication / withdrawal * Acute psychosis * anorexia/bulimia |
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Crisis |
1) requires immediate attention 2) establish therapeutic alliance 3) assess risk factors (pt, ideation, intent, demo, use collateral, record review) 4) use additional resources 5) include family if appropriate 6) assess need for hospitalization 7) intervene to reduce immediate risk factors 8) short term tx - directive and crisis focused |
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Crisis |
* Safety emergencies are exceptions to confidentiality, therapist may breach confidentiality to tier notify a patient's family of the suicidality or to hospitalize the pt. * Ideally it can be done with pt. consent * Limit breach to only the necessary information |
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Violence and Assaultive Behavior Statistics |
* homicide, rape, sexual assault, robbery and assault * 60% of perpetrators are under 30 * more male * teens have the highest rate of being victims of violent crimes (9 x as likely between 12-24) * american indians higher rates of victimization * males victimized equally by stranger/non stranger * females more victimized by nonstranger
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Risk Factors for Violence |
1) Antisocial Personality Disorder 2) demographics (male, under 30, non white, poor, low IQ) * history of criminal past, substance abuse 3) mental status (impulsivity, poor judgment) 4) means (53% with a gun) 5) lack of social support, hostile relationships 6) protective factors: compliant with tx, family support, school/work involvement, coping skills, religion, fear of punishment |
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Child Abuse |
* physical abuse * sexual abuse * neglect * willful cruelty or unjustifiable punishment * unlawful corporal punishment or injury |
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Assessing Child Abuse |
1) interview and observation 2) interview collaterals 3) refer for medical evaluation / psych testing 4) not ask leading questions (open ended) to kids 5) note inconsistencies in reports 6) ensure child's immediate safety |
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Reporting Child Abuse |
* California requires that therapist who has a REASONABLE SUSPICION of abuse, or knows that abuse is occurring, make a child abuse report to DCS or local law enforcement immediately or asap by phone and then send a written report within 36 hrs. * not responsible to confirm if abuse occurred * typically notify parent that report is being made unless puts child at risk |
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Elder/Dependent Adult Abuse |
* physical abuse * neglect * abandonment * isolation * financial abuse |
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Assessing elder / Dependent abuse |
* interview and observe * include collaterals * initially avoid asking the adult directly "did your daughter....?", instead "how did you get hurt?" * refer for medical examination |
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Reporting elder/ dependent abuse |
* the therapist who has a REASONABLE SUSPICION of elder or dependent adult abuse, or knows that abuse is occurring, must by law make an abuse report to APS or local law enforcement by phone immediately or asap, and follow up with a written report within 2 working days. |
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Grave Disability |
* unable to provide adequate food, clothing or shelter |
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Assessment procedures |
* know the assessment procedures (interviewing, mental status exam, psych testing) * know the procedures to collect collateral information * know limitations of assessment procedure * able to present assessment finding and make recommendations * know DSM 5 * understand legal and ethical responsibilities |
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Clinical Interview |
1) history of presenting problem 2) personal hx 3) family background 4) current functioning
* with children: 1) add hx from parents 2) family evaluation |
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Mental Status Exam |
* functioning at the present moment 1) orientation and sensorium 2) appearance and behavior 3) mood and affect 4) attention, concentration and memory 5) intellectual functioning 6) insight and judgment 7) thought content, process and perceptions |
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Basic Issues in Psychological Testing |
* purpose of the instrument * type of test (objective vs. subjective) * method of assessment (direct or indirect) * interpretation of scores * norm referenced vs. criterion-refrerenced * scoring and cutoffs significance * standardization sample * reliability and validity |
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Common Tests |
* Personality (MMPI-2, MCMI-III) * Intelligence (WAIS-IV, WISC-IV, Stanford Binet, Raven's Progressive Matrices). * Achievement (WRAT3, WIAT) * Neuropsychological status (WMS) * Symptoms (SCL-90) * Functioning (Depression, BDI, anxiety, BAI) |
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MMPI-2 (Validity scales) |
* 13 scales (3 validity and 10 clinical) L - (lie) - naive attempt to fake good F - (inFrequency) - unconventional thinking and behavior, dissatisfaction, possible fake bad K - (defensiveness) - high score unwillingness to disclose, too low, excessive openness, poor insight |
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MMPI |
* 547 true or false questions * mean 50 * standard deviation 10 * scores over 65 are significant |
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MMPI-2 Clinical Scales |
1. Hypocondriasis 2. Depression 3. Hysteria 4. Psychopathic Deviate 5. Masculinity-femininity 6. Paranoia 7. Psychasthenia 8. Schizophrenia 9. Hypomania 10. Social Introversion |
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MCMI |
* normed for clinical populations * shouldn't be used with patients who are experiencing minor adjustments or severe pathology. * 175 T of F questions * 75 indicates a trait * 85 indicates a disorder |
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WAIS-IV (ages 16 - 90-11months) |
* 10 core subtests * 5 supplemental tests * Verbal Comprehension (similarities, vocabulary, information. Suppl: comprehension) * Perceptual Reasoning (block design, matrix reasoning, visual puzzles. Supl: figure weights) * Working Memory (digit span, arithmetic. Supl: letter-number sequencing) * Processing Speed (symbol search and coding. Supl: cancellation) |
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WISC-IV (ages 6 to 16-11months) |
* Verbal Comprehension Index * Perceptual Reasoning Index * Working Memory Index * Working Memory Index * Processing Speed Index |
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Achievement Tests |
* learning disorders are assessed with achievement tests * most common WRAT3 (wide range achievement) and WIAT (Wechsler Ind. Achievement test). |
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Assessment Feedback |
* always give feedback unless circumstances preclude * feedback should be relevant * evaluator should be open to * client's feedback and impression about the test results should be solicited * include diagnosis * highlights strengths and weaknesses, consistencies and inconsistencies * recommendations and referrals, clinical concerns |
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Cultural Competence |
* ability to provide appropriate and effective services to minority group members, taking into consideration their languages, histories, traditions, values. * be aware of their own cultural values as well as the culture of their patients. * cultural values and beliefs affect the expression of psychological distress as well as help-seeking behavior |
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Treatment |
* 1/4 of patients drop out after first session * 70% drop out before the 10th session * clinicians must use well-established tx or probably efficacious (empirically supported) |
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ADHD interventions |
* Self-instruction therapy * Parent training and contingency contracting (time out, response cost, positive reinforcement) * help the parents develop a daily routine for child * help parents positively manage the home environment * teach effective study and test-taking strategies * individual therapy to increase self-esteem * encourage extra curricular activities * improve social skills |
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Oppositional Defiant Disorder and Conduct Disorder interventions |
* parent training for children with ODD * multimodal intervention strategy for conduct disorder * behavior modification and family therapy * role play and model * develop alternative behaviors * teach parenting skills including limit setting * behavior contracting * relaxation training * social skills and assertiveness training |
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Elimination Disorders interventions |
* behavior modification for enuresis (encopresis) * teach parents to diminish ridicule reactions * establish reward system for continence * provide bladder training * decrease fluid intake * medical evaluation |
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Substance Abuse Interventions |
* Alcohol - Community reinforcement approach, cue exposure tx, marital therapy, social skills t * Cocaine - behavior therapy, CB relapse preven. * Opiate - brief dynamic therapy, cognitive thera * Benzos - CBT |
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Psychotic Disorders interventions |
* family intervention * social skills training * supported employment * relapse prevention * family therapy * medication management (50% attempt suicide, 10% succeed) |
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Major Depression Interventions |
* behavior therapy * cognitive therapy * interpersonal therapy * brief dynamic therapy * self-control therapy * social problem solving therapy * cognitive therapy for geriatric patients * reminiscence therapy for geriatric patients * relapse prevention * assertiveness training |
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Bipolar Disorder Interventions |
* behavioral interventions to improve impulse control * role playing, behavior rehearsal, role reversal * interventions to treat depression * medication management |
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Anxiety Disorders interventions (adults) |
* CBT (cognitive th, worry expose, relaxation training, worry behavior preventions, time management and problem solving) * applied relaxation * thought stopping or aversion therapy * biofeedback/relaxation training * self-monitoring of anxiety symptoms and triggers * medication management |
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Anxiety Disorders Interventions (children) |
* CBT for anxious children * family anxiety management training * medication management * minimizing overprotectiveness from parent |
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Obsessive-Compulsive Disorder Interventions |
* exposure and response preventions * cognitive therapy * relapse prevention * thought stopping * aversion therapy * relaxation skills (progressive muscle relax., breathing, autogenics, self-hypnosis, guided imagery * medication management |
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Panic/Agoraphobia/Specific Phobia/Social Anxiety Interventions |
Panic Disorder - CBT, applied relaxation Agoraphobia - exposure, couples communicating training adjunctive to exposure Specific Phobia - exposure, guided mastery. Systematic desensitization Social Phobia - exposure, CBT, systematic des. |
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Posttraumatic Stress Disorder Interventions |
* stress inoculations training * exposure tx * eye mov. desensitization and retrain (EMDR) * cognitive processing therapy (sexual assault) * systematic desensitization * relaxation skills * self-monitoring of anxiety and triggers * cognitive restructuring * anger management * couple or family therapy * group therapy * medication management |
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Pain Disorder Interventions |
* Stress inoculaiton training for coping with stressor * behavioral therapy * multi-component cogntivie behavior therapy * CBT adjunctive to physical therapy for pain * CBT * EMG biofeedback * thermal biofeedback (migraines) * educate mind - body connection * relaxation skills |
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Sexual Disorders Interventions |
* sex therapy * sensate focus * establish a pleasant, relaxing environment and time for sexual contact * discuss health promotion strategies (alcohol, exercise, cigarettes) |
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Eating Disorder Interventions |
* CBT * interpersonal therapy for bulimia * hypnosis * coping skills * self-monitoring * behavioral contingencies to reward behavior * medical evaluation |
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Sleep Disorder Interventions |
* sleep hygiene * relaxation techniques * self-hypnosis * restructuring cognitions * medication management |
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Impulse Control Disorders Interventions |
* self-monitoring for impulse behaviors * relapse prevention * create a plan to deal with triggers * individual psychotherapy * coping skills training * behavioral contingencies * flooding with response prevention * medication management |
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Personality Disorders Goals (cluster A, odd, eccentric) |
Paranoid Personality Disorder - decrease distrust and suspiciousness, improve reality testing Schizoid - increase awareness and experience of various emotions, exhibit interest in social relationships Schizotypal - increase comfort in social relationships, diminish magical thinking, display fewer oddities in appearance and behavior |
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Personality Disorder Goals (cluster B, dramatic, emotional, erratic) |
Antisocial - decrease antisocial behavior, increase respect for rights of others, improve ability to foresee consequences/long term plans Borderline - achieve stability in self-image and image of others, decrease lability and impulsive behaviors Histrionic - achieve modulated expression of emotion, decrease attention-seeking behavior Narcissistic - decrease need for admiration, less grandiose self image, develop empathy |
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Personality Disorder Goals (cluster C, anxious, fearful) |
Avoidant - decrease social discomfort, decrease sensitivity to criticism and rejections, improve self-esteem Dependent - increase self-reliance and independence, improve self-esteem Obsessive-Compulsive - increase tolerance for imperfections and disorder, decrease preoccupation with orderliness and control |
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Personality Disorder Interventions |
* dialectical behavioral therapy * skills focused therapy * anger management * assertiveness training * interpersonal therapy * cognitive therapy |
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Other Interventions |
Marital Discord - behavioral marital therapy, emotionally focused couples therapy, insight oriented marital therapy Sex offenders - behavior modification for sex offenders |
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Cognitive Therapies - part 1 |
Beck - become aware of cognitions (automatic thoughts), test reality, correct distorted thinking, collaborative empiricism, schema focused work
Meichenbaum's Stress Inoculation - bolster pt.'s repertoire of coping responses to milder stressors. 3 phase intervetions: education, preparation and acquisition. |
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Cognitive Therapies - part 2 |
Meichenbaum's Self-Instruction therapy - combines modeling and graduated practice with elements of rational emotive therapy. Used with ADHD. 5 step: therapist modeling, therapist verbalization, patient verbalization, patent silently walks through, independent performance
Cognitive Processing Therapy - PTSD from sexual assault. 12 structured sessions. Education, restructuring (ellis ABC model), "exposure" to trauma, label feelings, identifies and resolves cognitive schemas. |
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Cognitive Therapies - part 3 |
Motivational Interviewing - non confrontational, considers ambivalence, empathic understanding, develop discrepancy between goal and behavior
Relapse Prevention - enhance the maintenance stage of change, integrates behavioral skills training, cognitive interventions, lifestyle changes. Identify risky situations, ways of coping, learning from negative consequences. |
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Behavioral Therapy |
* based on specific and observable behaviors * contingencies * alone or in combination with cognitive therapy * helpful with patients who lack adaptive behavior |
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Behavioral Therapy - part 1 |
Self-monitoring - close observation and tracking of behavior
Graded Task assignment - think of tasks that need to be done, break them down into smaller steps, arrange them in a hierarchy to perform
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Behavioral Therapy - part 2 |
Distraction - engage in diversionary activities such as physical activities, play, work, visual imagery
Contingency Contracting Management - operant conditioning, identify behaviors, target them. |
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Linehan's Dialectical Behavioral Therapy |
* key dialectic is "acceptance" and "change" * focuses on present behavior and the current factors that are controlling it * asks patients to work in therapy for about 1 year |
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Exposure with Response Prevention (flooding) |
* tx of many anxiety disorders * exposing the pt. to the feared object or situation while preventing pt from responding in the typical maladaptive way, * exposure is typically at maximum intensity for a prolonged period.
Interoceptive - induce "panic attack" with aerobic exercise, spinning in a chair, hyperventilating and tolerate for at least 30 seconds. |
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Systematic Desensitization |
* predominantly for anxiety disorder * training individual to relax deeply with progressive relaxation * list situations that arouse anxiety * gradually exposes pt to feared situation in imagination or in vivo from least to most anxiety provoking. |
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Skills training - part 1 |
Progressive and Passive Muscle Relaxation - tensing and releasing tension of various muscle groups. Passive just release w/o tension
Autogenics - series of structured exercises that tend to induce somewhat of a hypnotic trance. |
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Skills Training - part 2 |
Biofeedback - instruments to detect and amplify physiological processes (hear rate, muscle tension, skin temperature) used in conjunction with other relaxation techniques |
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Interpersonal Psychotherapy |
* short term, typically 12-16 sessions * its are taught to evaluate their interactions with others and how this contributes to symptoms * active, emphasis on current issues and social functioning. Intrapsychic phenomena are not addressed. |
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Assessing Treatment Outcome |
* Functional Assessment - through clinical interview and symptom checklist (work and school functioning, interpersonal functioning, etc)
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Monitoring Outcome |
Needs assessment - looks at specific needs of a particular population or group, ex. reduce hospitalizations of psychotic pts.
Formative evaluation - assesses the effectiveness of a program as it is being implemented. Patient satisfaction questionnaires, is it meeting goal?
Summative evaluation- conducted after the program has been implemented in order to assess its overall effectiveness objectively |
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Pay attention when an answer appears right but involves "assess for danger to self and others"...
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sometimes there is no suicide content in the question, so we would be only assessing for danger to others, not necessarily to self.
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DSM 5
Intellectual Disability (Mild, Moderate, Severe, Profound) Highlights: |
* onset during developmental period
* BOTH intellectual and adaptive functioning deficits * intellectual functions deficits CONFIRMED by BOTH clinical assessment and individualized, standardized intelligence testing. * deficits in adaptive functioning that result in failure to meet developmental and so cultural standards for persona independence and social responsibility. (daily life, communication, social participations, independent living, across multiple environments) |
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DSM 5
Autism Spectrum Disorder ( WITH OR WITHOUT: * accompanying intellectual impairment * accompanying language impairment Highlights: |
A. Persistent deficits in social communication and social interaction across multiple contexts
B. Restricted, repetitive patterns of behavior, interests, or activities by at least 2 of following: stereotyped or repetitive movements, or use of objects, sameness.inflexible routines, highly restricted interests, hyper or hypo reactivity in sensory aspects of environment (temperature, textures). |
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DSM 5
Attention-Deficit/Hyperactive Disorder * combined presentation * predominantly inattentive presentation * predominantly hyperactive/impulsive presentation (mild, moderate and severe) |
A persistent pattern of inattention and/or hyperactivity that interferes with functioning or development characterized by (1) and/or (2):
1. Inattention (6 or more of 9 sx have persisted for at least 6 months) 2. Hyperactivity and impulsivity (6 or more of 9 sx for at least 6 months) * several sx present prior to age 12 * several sx present in 2 or more settings |
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DSM 5
Specific Learning Disorder * w/ impairment in reading * written expression * mathematics (mild, moderate, and severe) |
A. Difficulties learning and using academic skills as indicated by the presence of at least 1 of the 6 sx, persisted for at least 6 mo.
B. Affected academic skills * not better accounted for by intellectual disabilities, visual or auditory acuity, mental or neurological disorders, etc. * criteria met based on a clinical synthesis of individual's hx (develop., medical, family, educational), school reports and pscyhoeducational assessment. |
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Tic Disorders
* Tourette's Disorder * Motor or Vocal Disorder - w motor tics only - w vocal tics only |
Tourette's Disorder
A. BOTH multiple motor and one or more vocal tics have been present, not necessarily concurrently. B. wax and wane, but more than 1 yr; B. onset before 18 yo. Persistent (Chronic) Motor or Vocal Tic Disorder A. Single or multiple motor OR vocal tics; B. was and wane, but more than 1 yr., C. before 18 yo; (criteria not met for Tourette's) |
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Delusional Disorder
Erotomanic Type, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified) Specify if: with bizarre content |
A. the presence of ONE (or more) delusions with a duration of 1 month or longer
B. crit A for schizophrenia has NEVER been met C. apart from the impact of the delusion, functioning is not markedly impaired (bizarre/odd) D. if manic or dep. episodes have occurred, they have been brief relative to delusional period |
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Differential Diagnosis |
can be distinguished from them by the absence of the other characteristic symptoms of the active phase of schizophrenia.
(hallucinations, disorganized speech, what else?) |
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Brief Psychotic Disorder
* w/ marked stressor * without marked stressor * with postpartum onset w/ catatonia |
A. Presence of one (or more) of the following symptoms. At least one of these must be present:
1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly disorganized or catatonic behavior * at least 1 day but less than 1 month |
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Schizophreniform Disorder
* w/ good prognostic features * w/o good prognostic features * w/ catatonia |
A. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be 1, 2 or 3:1. Delusions2. Hallucinations3. Disorganized speech4. Grossly disorganized or catatonic behaviors
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Schizophrenia
* First episode, currently in acute episode * First episode, in partial remission (or full remission) * Multiple episodes, currently in acute episode (partial and full remission) * unspecified * w/ catatonia |
A. 2 or more of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be 1, 2 or 3:
1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative Symptoms (diminished emotional expression or avolition) B. causes impairment C. continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms. |
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Differential Diagnosis
Schizophreniform vs. Schizophrenia vs. Brief Psychotic Disorder |
TIME FRAME:
Psychotic Disorder: at least 1 day but less than 1 month Schizophreniform: present for a significant portion of time during a 1 month period Schizophrenia: continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms: |
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Schizoaffective Disorder
* Bipolar Type * Depressive Type * With Catatonia |
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia
B. Delusions of hallucination for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of illness. C. Symptoms that meet criteria for a major mood disorder are present for the majority of the total duration of the active and residual portions of the illness |
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Differential Diagnosis
Schizoaffective vs. Schizophrenia |
Criterion C of Schizoaffective disorder is designed to separate it from schizophrenia (Symptoms that meet criteria for a major mood disorder are present for the majority of the total duration of the active and residual portions of the illness) and criterion B is designed to distinguish it from a depressive or bipolar disorder w/ psychotic features (presence of prominent delusions and/or hallucinations for at least 2 weeks in the absence of a major mood episode).
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Major Depressive Disorder
* w/ anxious distress * w/ mixed features * w/ melancholic features * w/ atypical features * w/ mood-congruente psychotic features * w/ mood-incongruent psychotic features * w/ catatonia * w/ postpartum onset * w/ seasonal pattern |
A. 5 of 9:
a. depressed mood, b. diminished interest/pleasure, c. weight loss/gain, d. insomnia/hypersom, d. psychomotor agitation/retard., e. fatigue, f. feelings of worthlessness, f. < concentration, g. recurrent thoughts of death. |
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Differential Diagnosis
Major Depressive Disorder vs. Persistent Depressive Disorder (Dysthymia) |
* if there is a depressed mood plus 2 or more x meeting criteria for a persistent depressive episode for 2 years or more, then diagnosis of PDD is made.
* if pt's sx currently meet full criteria for a major depressive episode, then the specifier of "w/ intermittent major depressive episodes" can be used. |
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Panic Disorder
(an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes) |
A. 4 of 13 possible sx.
B At least 1 of the attacks has been followed by 1 month (or more) of one or both of the following: 1. persistent concert or worry about additional panic attacks 2. a significant maladaptive change in behavior related to the attacks. |
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Agoraphobia
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A. marked fear or anxiety about 2 (or more) of the following SITUATIONS (public transportation, open spaces, enclosed spaces, lines or crowds, being outside of the home alone).
B. Pt fears or avoids the situation C. Situations almost always provoke fear/anxiety D. Situations actively avoided E. Out of proportion ** PERSISTENT, TYPICALLY LASTING 6 MO + ** |
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Somatic Symptoms Disorder |
A. one or more somatic sx that are distressing or result in significant disruption of daily life B. Excessive thought, feelings or behaviors related to the somatic symptoms or associated health concerns 1. Disproportionate and persistent thoughts about seriousness of one's sx 2. Persistent high level of anxiety about health 3. Excessive time+ energy devote these concerns |
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Differential Diagnosis
Fictitious Disorder vs. Malingering vs. Somatic Sx Disorder |
* malingering is differentiated from factitious disorder by the INTENTIONAL reporting of sx for personal gain (money, time off work).
* the diagnosis of FD requires the absence of obvious rewards. * in SSD, there may be excessive attention and tx seeking for perceived medical concerns, but here is no evidence that the individual is providing false information or being deceptive. |
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Differential Diagnosis
Anorexia vs. Bulimia vs. Binge-Eating Disorder |
Anorexia - significant low weight. May binge eat but not necessarily. Can be restricting or binge-eating/purging type.
Bulimia - episodes of binge eating. Recurrent compensatory behavior. Binge-Eating Disorder - bing eat but not engage in regular compensatory behaviors. Less designed to influence body weight than bulimia. |
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Gender Dysphoria
* with a disorder of sex development * posttransition |
A. A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least 6 of the following (children), 2 (adol/adu)1. strong desire to be the other gender2. cross dressing 3. preference fro cross gender roles play4. pref for toys stereotypically other gendered5. playmates6. rejection typical toys7. strong dislike one's sexual anatomy8. desire for the primary or secondary sex characteristics that match one's experienced gender
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Differential Diagnosis
Oppositional Defiant Disorder vs. Conduct Disorder |
ODD - angry/irritable, argumentative/defiant/ vindictiveness. Typically less severe than CD and do not include aggression toward people or animals, destruction of property or pattern of theft or deceit. More sx emotional dysregulation.
Conduct - violation basic rights of others, society 's rules. aggression to people and animals, destruction property, theft, serious rule violations. Specifiers: w/ limited prosocial emotions, lack of remorse or guilt, callous-lack of empathy, unconcerned about performance, shallow or deficient affect. |
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Neurocognitive Disorders
(Major and Mild) * acquired rather than developmental MAJOR: the cognitive deficits interfere w/ independence in every day activities MILD: deficits do not interfered w/ everyday activities but greater effort, compensatory strategies, or accommodation is required |
A. Evidence of significant COGNITIVE DECLINE from a previous level of performance in 1 OR MORE cognitive domains (complex attention, executive function, learning and memory, language, perceptual0motor, or social cognition) based on:
1. Concern of the individual or KNOWLEDGEABLE INFORMANT. 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing, in its absence, another quantified clinical assessment. |
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Differential Diagnosis
PTSD vs. Acute Stress Disorder |
Acute Stress Disorder is distinguished from PTSD because the sx pattern in acute stress disorder is restricted to a duration of 3 days to 1 month following exposure to the traumatic event.
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Alcohol Use Disorder
* mild * moderate * severe |
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 (of 11) of the following, occurring within a 12-month period:
(larger amounts, desire cut down, time spent, craving, failure to fulfill obligations, interpersonal problems, reduced occup. recreational activities, hazardous use, physical problems, tolerance, withdraw). |
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V62.4 (Z60.3)
Acculturation Difficulty |
This category should be used when difficulty in adjusting to a new culture (following migration) is the focus of CLINICAL ATTENTION or HAS AN IMPACT OF THE individual's treatment or prognosis.
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V62.82 (Z63.4) Uncomplicated Bereavement
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this category can be used then the focus of clinical attention is a normal reaction to the death of a loved one. Some people present with sx characteristics of a major depressive episode. The bereaved individual typically regards the depress mood as "normal". Duration varies. The depressed mood in MDE is more persistent and not tied to specific thoughts or preoccupation. Thoughts of the deceases.
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