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102 Cards in this Set

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Assessment Goal: Mental Retardation
GOAL:
1. Assess behavioral and affective symptoms
2. Evaluate Academic Skills (Educational Tests)

Standardized IQ Tests + Meas of Adapt Functioning
e.g.,
1. Vineland Adaptive Behavior Scales II
2. Adapt Behav Scale
3. Interviews: Semi-structured
4. Behavior Checklist
Treatment / Interventions & Goal: MR
What are the possible modifications to treatment?
GOAL: Optimize Indep Function'g

Possible Modifications
a. match tx to indvl's developmental lvl
b. comprehensive interdisciplinary approach
c. involve the family
d. directive strategies in order to maintain focus of therapeutic interactions on relevant issues
e. adapt an approach that recognizes the indvl's capacity for growth toward indep function'g (if possible)
Treatments: Mental Retardation
1. Education and Train'g
2. Behavioral Interventions
3. Psychotherapy
4. Family Interventions
* Parent Education
* Parent/Family Counseling
* Support Groups
* Community-based resources
5. Treatments for Adults
* Day Treatment Program
* Behavioral Interventions
* Caregiver Training/Support
Mental Retardation & Behavioral Interventions: On what are the behavioral interventions based?
Based on:
The results from the Functional Assessment (antecedents & consequences maintain'g the undesirable behaviors)
Assessment & Requirement: Learning Dis
Consideration of performance on IQ + Achievement Tests addresses areas of concern
1. Memory
2. attention
3. Academic Achievement
4. Social Skills
Via:
* Neuropsychological Assess
* Psychoeducational Assess
* Social-Emotional Assess
Treatments: Learning Dis
1. Instructional Interventions
2. Behavioral Interventions
3. Family Interventions
The Treatment Approach: Learning Dis
Multidisciplinary Approach
(Incorporates various professionals)
e.g.,
* Psychologist
* Speech Pathologist
* Occupational Therapist
* School Personnel
Treatment:What are the Goals for Instructional Interventions of Learn'g Dis
GOALS:
1. To remediate underlying processing deficits
2. To improve cognitive skills
3. Teach skills that can help compensate for learn'g problems & related difficulties
What type of training applies to
1. Phonological awareness train'g
2. Cognitive Strategy train'g
3. Direct Instruction
Instructional train'g
What are the goals of Phonological and Cognitive Strategy Train'g as well as, Direct Instruction?
1. To remediate underlying processing deficits
2. To improve cognitive skills
3. Teach skills that can help compensate for learn'g problems & related difficulties
Treatment of Behavioral Interventions for Learning Dis:
What are the Goals/Purpose?
To alleviate co-existing behavioral problems
To increase on-task behavior
Treatment Type: Behavioral Intervention for Learning Dis
Behavioral Modification
* Behavioral Contract'g
-- home/school
Treatment: Family Interventions' usefulness
1. To modify parental expectations of a child/adolescent
2. To modify parental responses to the child/adolescent
E.g.,
Parents develop tech's to structure activities in order to enable the child/adolescent to succeed more often
At what grade level would an indvl acquire with a standardized IQ of 41?
Moderate Retardation 30-45 to 50-55 = 2nd grade level
What grade level would an indvl with an IQ of 50-55 to 70 acquire?
Mild Retardation up to a 6th grade reading level.
What type of skills or assistance would an indvl with 20-25 IQ need?
If it's less than 20-25, the indvl has profound Mental Retardation

If the IQ is 20-25 to 35-40, the indvl has Severe Mental Retardation and may benefit from instruction in pre-academic skills
Assessment & Requirement: Autistic Disorder
Monitoring requires a Multidisciplinary approach:
* Psychologist
* Pediatrician
* Neurologist
* Speech-language pathologist
* Psychiatrist
* Physical Therapist
* School Personnel

Assessment:
* IQ Test
* Psycho-educational Tests
* Measure of Adaptive Skills

Diagnostic Instruments:
* Parent Interview for Autism
* Autism Diagnostic Interview-Revised
* Childhood Autism Rating Scale
* BRIGANCE Screens
Treatment: Autistic Disorder
1. Educational & Vocational Interventions
** Cognitive
** Language
** Social
** Functional Skills
2. Behavioral Interventions
3.Sensory Integration Therapy
4. Psychotherapy
5. Parent/Family Interventions
6. Pharmacotherapy
What does TEACCH stand for?
T = Treatment &
E = Education of
A = Autistic & related
C = Communication
H = Handicapped
C = Children
Does the TEACHH approach focus on groups, families, classroom or individuals?
The TEACCH is an:
* Individualized approach
* focuses on adapting materials and the environment to the characteristics of the child
What does the TEACCH approach target
1. Communication
2. Social Skills
3. Coping Skills
Treatment: Autistic Dis: Vocational Train'g
For Adolescents and Adults:
1. Vocational Training
2. Placement via Sheltered Workshops
3. Supported Employment
Treatment for Autistic Dis:
Goal of Behavioral Interventions
Goal:
1. Reduce Undesirable behav's
2. Improve Social skills
3. Improve Communication skills
3. Improve Daily Living skills
Treatment for Autistic Dis:
What are 3 specific Behavioral Interventions/Techniques?
1. Shaping
2. Discrimination Training
3. Applied Behavioral Analysis
Treatment for Autistic Dis: Why is Applied Behavioral Analysis used?
Used for reducing undesirable behav's
* self-injurious behaviors
* ritualistic behaviors
* disruptive behaviors
Treatment for Autistic Dis:
With what does the Applied Behavioral Analysis begin?
Often, with a Functional Assessment to identify that which is maintaining the behav.
* Antecedents
* Consequences
Treatment for Autistic Dis:
What type of therapy is Sensory Integration?
What is the general view about this type of therapy?
A type of Occupational Therapy
* Considered controversial by some in the community
* Limited empirical research
Treatment for Autistic Dis - Psychotherapy:
What are considered viable?
What is considered the least viable
Most Viable for older or high-function'g indvls
1. Highly Structured
2. Directive

Least Viable:
1. Psycho-dynamic
2. Insight-oriented
Treatment for Autistic Dis:Psychotherapy
For Older and Higher Function'g Indvl's,what symptoms can be addressed?
1. Depression
2. OCD
3. Social Skills impairments
Treatment for Autistic Dis: Parent/Family Interventions?
1. Parent Train'g
2. Parent/Sibling Support Grps
3. Family Therapy
4. Referral to Community Services
5. Referral to Advocacy Grps
Treatment for Autistic Dis: Pharmacotherapy
When is it NOT an effective tx?
When is it effectively used?
NOT Effective Used:
- Core Symptoms of Autism

Useful for:
- Depression
- Anxiety
- Other sources of impairment
- Other sources of distress
Treatment for Autistic Dis: Parent/Family Interventions
1. Parent Train'g
2. Parent/Sibling Support Grps
3. Family Therapy
4. Referral to Community Services
5. Referral to Advocacy Grps
Treatment for Autistic Dis: Pharmacotherapy
When is it NOT an effective tx?
When is it effectively used?
NOT Effective Used:
- Core Symptoms of Autism

Useful for:
- Depression
- Anxiety
- Other sources of impairment
- Other sources of distress
Assessment & Requirement: ADHD:
Purpose?
Assessment Tool:
1. ADHD questionnaires & Rating Scales
* ADHD Rating Scale-IV
* Conner's Rating Scale-Revised
* Child Behavior Checklist (CBCL)
* Psychosocial Tests
* Psycheducational Tests

Purpose:
1. Helps to Confirm the Dx
2. Quantifies the indvl's behavioral crc's
3. Tests used to...
* Evaluate Cognitive Abilities
* Evaluate Emotional Adjustment
* Evaluate Social Skills
* Evaluate Academic Achievement
Treatments: ADHD
1. Pharmacotherapy
2. Behavioral Interventions
3. Neurofeedback
4. Parent Education/Train'g
Treatment of ADHD: Pharmacotherapy
Beneficial affects?
Most effects?
Effectiveness Rate?
Side Effects?

Most Effective When?
Ritalin / Methylphenidate (CNS Stim)
* Core symp to ADHD
* When combined with behavioral interventions
* Side Effects are...
--- Dysphoria
--- Decreased Appetite
--- Insomnia
--- Increased Heart Rate
--- Increased Blood Pressure
--- Growth Suppression
Ritalin Side Effect of Dysphoria :
Specifics
1. Sadness
2. Anxiety
3. Irritability
4. Euphoria
Ritalin:
What can a drug-holiday further confirm?
It can confirm that the Rx is still needed
Treatment of ADHD: Behavioral Intervention
Benefits?
1. Improve Academic Performance
2. Improve Social functioning
3. To Reduce Behavioral probl
Treatments of ADHD: Behavioral Interv:
Strategies?
1. Contingency Management
2. Time-out
3. Self-Control Tech
--- Response Cost
--- Self-Instruction
--- Self-Evaluation
--- Self-Reinforcement
Treatment of ADHD: Neurofeedback's effects are most similar to what type of Rx?
Treats the Core symptoms
The effects are most similar to
Ritalin / CNS Stim (70-80% of the cases)
Neurofeedback is aka?
EEG Biofeedback
Treatment of ADHD:
To what degree (%) is Biofeedback effective?
70-80% indvls show benefits similar to those of a CNS Stim
Treatments of ADHD:
Parent Education / Train'g
When is treatment most effective?
When parents
1. Are active participants
2. Provide consistency
3. Provide structured env
4. Consistent with rules
5. Predictable routines
Treatment of ADHD:
Parent Education/Train'g
In what order should the treatment occur?
1. Education about
-- causes of ADHD
-- effects of ADHD on the indvl
2. Encourage parents to
-- develop Realistic expectations of their child
-- connect with Support Grps
-- connect with Community Resources
Treatments: Conduct Dis
1. Family Interv
2. COSST: Cog Problem-Solving Skills Train'g
3. Multisystemic Therapy
4. Pharmocotherapy
5. Out-of-Home Placement
Treatment of Conduct Dis:
Pharmacotherapy
Rx is generally NOT recommended as a means of managing beh of those w/CD
Exceptions:
1. Rx for a ltd time for escalat'g /high risk of danger behaviors
2. Indvl is motivated to change but prior tx's have not worked
3. Co-exist'g Disorders
--- ADHD
--- Major Depr Dis
--- Other co-existing mental dis
Treatments: Tourette's Dis
1. Pharmocotherapy
2. Behavioral Interventions
Treatment: Tourette's Dis
Pharmocotherapy
- Types of Rx
- Effectiveness
- Disadvantage / Side Effects
Type: DA-2 Antagonist Antipsychotic (Haloperidol, Pimozide /Orap

Co-existing ADHD symptoms
Clonidine (Agonist) for Hypertension
Desipramine (TCA) for Depression

Effectiveness: ~80% of cases

Side Effects:
May incr tics
Treatments: Enuresis
1. Night Alarm
2. Pharmocotherapy (Desmopressin)
Treatment: Enuresis
1. Night Alarm's Effectiveness
2. Relapse Rate
3. Increasing Effectiveness
1. Up to 80% of cases
2. 33% relapse w/n 6 months
3. Night Alarm + Behavioral Tech
--- i.e., rehearsal
--- i.e., overcorrection
Treatment: Pharmocotherapy's
1. Effectiveness
2. Relapse Rate
1. Reduction vs Suppression
--- Up to 85% of cases (reductions)
--- 30% (suppresses)
2. >50% relapse w/n 3 months
Treatment: Delirium
1. Assessments
2. Treatments
3. Rx as a Treatment?
1. Assessment Tools:
--- Folstein Mini-Mental State Exam
--- Delirium Rating Scale
--- Confusion Assessment Method

2. Treatment
--- 1st, treat the underlying cause
--- 2nd, manipulate the environment
--- 3rd, when approp, Haloperidol (antipsychotic)
Treatment of Delirium
What is the purpose of the Rx?
Contraindications and Why?
May help to reduce
- agitation
- hallucinations
- delusions

Except for Alcohol Withdrawal Delirium AVOID sedatives as they can mask the symptoms
Treatments: Dementia
1. Assessments
2. Treatments / Rx
1. Assessment Tools:
--- Dementia Rating Scale
--- Alzheimer's Disease Assessment Scale

2. Treatments:
--- Psychosocial Interventions
--- Environmental Manipulation
--- Pharmacotherapy:
------> for agitation (Antipsychotic)
------> for depression (SSRI or Antidepressant)
------> for cognitive impairments (a Cholinesterase Inhibitor
--- Family/caregiver Interventions
Treatment of Dementia:
Why are Assessments ongoing?
Because
1. Dementia is a progressive disorder
2. Dementia often co-exists with other conditions
Substance Abuse & Dependence:
How can the severity of a disorder be clarified; in order to lead to approp treatment?
Screening Tests -> Questionnaires -> Diagnostic Interveiws
Screening Tests:
1. CAGE
2. Drug Abuse Screen'g Test
3. Alcohol Use Disorders Identif Test
Assessments:
1. Substance Dep Severity Scale
2. Addiction Severity Index
3. Maudsley Addiction Profile
Substance Abuse & Dependence:
before treatment requires...
1. Determine a Readiness for Change
2. Indicate the approp LOC
Substance Abuse & Dependence:
What Model is incorporated when determining a Readiness for Change?
Prochaska & DiClemente's Transtheoretical Model:
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
Substance Abuse & Dependence"
What are the various LOC's?
1. Outpatient Care
2. Intensive Outpatient Care
3. Non-hospital Residential Care
4. Intensive Inpatient Care
Substance Abuse & Dependence"
Treatment:
Is treatment a stand-alone model?
Treatment does NOT incorporate a stand-alone model.
1. Multimodal
2. Multidisciplinary
Substance Abuse & Dependence"
Treatment:
Is treatment generally short-term?
Treatment is a long-term process that generally involves ~ 3 stages
1. Acute Intervention
--- ER treatment
--- Detox
2. Rehab
--- Evaluation/Assessment
--- Primary Care (brief & intensive)
--- Extended Care
--- Stabilization
3. Maintenance
--- Aftercare
--- Relapse Prevention
--- Domiciliary Care (when nec'y)
Substance Abuse & Depend:
Treatment:Before treatment of the substance abuse begins, what should 1st be ruled-out or in?
Coexisting Mental Disorders
Try to Determine:
1. Is the coexisting mental dis due to that disorder?
2. Is the coexisting mental dis due to recent substance abuse
Substance Abuse & Depend:Treatment:
How might one determine if a patient has an indep coexisting mental disorder?
If the coexisting disorder persists AFTER abstinence.
Substance Abuse & Depend Treatment:
When developing a treatment plan, how should one proceed if it is determined that a pt has a coexisting mental disorder?
It depends on the severity of the coexisting mental disorder
.
1.For a severe coexisting mental disorder,
--- a. treat the mental disorder
--- b. stabilize the pt
--- c. then begin treatment for the substance

2. For a Non-severe coexisting mental disorder
--- Use a sequential approach
--- a. begin treatment for sub depend
--- b. then, treat for the coexisting mental disorder

3. If the coexisting are NOT serious but the symptoms are barriers for treatment of the substance dependence
--- Treat simultaneously
Substance Abuse & Depend Treatment:
"Parallel" Treatment is aka...?
"Simultaneous" Treatment
Substance Abuse & Depen Treatment:
What are the differences b/w
Parallel, Sequential, and Simultaneous Treatments?
Parallel = Simultaneous Treatment:
Treatment of both Substance and other Mental Disorder; by which the coexisting disorder is a barrier for treatment of the Substance dis.

Sequential Treatment:
Treatment priority is focused When the coexisting mental disorder is Non-severe;
1st the treatment focuses on the Substance Depend and 2ndarily, on the Coexisting mental dis
Substance Abuse & Depend Treatments:
What are the Psychosocial Interv's?
1. CBT
2. Behavioral
3. Motivational Interview'g
4. Relapse Prevention
5. Self-Help Grps
6. Grp Therapy
7. Family Therapy
8. Pharmacotherapy
Substance Abuse & Depend Treatments:
Pharmacotherapy is used when?
Use to treat
1. Intoxication
2. Overdoes
3. Withdrawal Syndromes
4. In Conjunction w/Psychosocial Interventions
5. Promotion of Abstinence
--- Disulfiram (Antabuse)
--- Naltrexone (ReVia)
-----> susceptible to abuse
-----> may enhance the high
-----> may be dangerous in overdose
Schizophrenia:
What has to occur prior to treatment?
1. Assessment
2. Clinical Phase
--- Acute
--- Stabilization
--- Stable
3. Determining the LOC
4. Then...Treatment
Treatment of Schizophrenia:
Before & during treatment, what occurs during the Clinical Phase?
1. Acute Phase focuses on...
--- establish'g a baseline
2. Stabilization Phase
--- monitor symptoms and function'g
3. Stable Phase
--- aligned goals of treatment
--- target symptoms,
--- target level of function'g
--- determine level of insight
--- determine early signs of relapse
--- determine Rx side-effects
Treatment of Schizophrenia can include...
1, Pharmacotherapy
--- Traditional / 1st Gen Rx's
-----> a Phenothiazines (Thorazine,Chlorpromazine, Fluphenazine)
-----> a Thioxanthene (Thiothixene/Navane)
-----> a Butyrophenone (Haloperidol/Haldol)
--- Atypical / 2nd Gen Antipsychotics
-----> a Dibenzodiazepine (Clozapine, Quetiapine/Seraquel)
-----> a Benzisoxazole (Resperidone)
-----> a Thienobenzodiazapine (Olanzapine/ Zyprexa)

Psychosocial Interventions
--- CBT
--- Skills Train'g
--- Family Interventions
--- Assertive Community Treatment (ACT)
--- Supported Empployment
Treatment of Schizophrenia:
What factors should be considered for hospitalization?
1. Risk of suicide or aggressive bx
2. Decompensation, Noncompliant, Resistant, No Improvement in Outpt Care
3. Acute psychosis or Co-existing substance-related dis
4. Requires symptom stabilization (medication is being changed or reestablished)
Interventions: Name the possible diagnosis for these interventions.
1. Parent Management Training
2. Cognitive Problem-Solving Skills Training
3. Assertive Community Treatment (ACT)
4. Multisystemic Therapy
1. Child w/Mild Conduct Dis
2. Eating Disorders
3. Schizophrenia
4. Moderate to Severe Conduct Dis
Interventions: Name the possible diagnosis for these interventions.
1. Sensory Integration Therapy
2. Self-Instructional Train'g
3. Habit Reversal Train'g & Rx
4. Exposure-based CBT
1. Autism Disorder / ADHD
2. Impulsivity / Hyperactivity
3. Repetitive hx: Tics, Stuttering, Nail-biting
4. Anxiety
Interventions: Children with Anxiety can incorporate what steps.
Multi-modal Approach
1. Psychoeducation
2. Family Therapy
3. CBT / Cognitive Modification
4. Exposure (in-vivo or covert)
5. Participant Modeling
6. Contingency Management
Treatment for Specific Client Populations:
Victims of Intimate Partner Abuse
What are 3 validated Screening Questions?
1. Have you been hit, kicked, punched or otherwise hurt by someone within the past year?
2. If so, whom?
3. Do you feel safe in your current relationship?
4. Is there a partner from a previous relationship who is making you feel unsafe now?
Ataque de Nervios:
Describe gen'l symptoms
Anxiety
Dissociate
Mood
Somatoform Dis
Generally in Outpatient Therapy, the disorder identified as the "Reason for Visit" is considered...
- The Principle Diagnosis
- Condition that is the Main Focus of Tx
Commonality of Disorders Among Males & Females
1. BPD
2. Major Dep Dis
3. OCD
4. Substance-Related Dis
1. Females (75%) > Males
2. Females > Males
3. Males = Females
4. Males > Females
OCD prevalence (female:male)
What is the avg age on onset timeline (relatively)
Males > Females
Earlier onset for males
What contributes to the prevalence of OCD being higher for males?
The age of onset is earlier for males than for females
How is the ratio of Major Depression among genders different in Adolescence vs Adulthood?
Adolescence Males = Females
Adults Females(2x's) > Males
What is the purpose of using "What If" questions in therapy?
- It's a Cog-B tech for DE-Catastrophizing
- To develop strategies for coping effectively with outcomes
- Helps t/client examine possible outcomes of the feared event
Cluster A:
1. Criteria/Crc's / Symptoms (min #)
2. Timeline
3. Best Treatment
4. Comorbidities
Odd / Eccentric

Paranoid PD
1. 4 min
2. 1 yr if before age 18

Schizoid PD
1. 4 min
2. 1yr if before age 18

Schizotypal PD
- 5 symptoms min
- 1 yr if before age 18
Cluster B:
1. Criteria/Crc's / Symptoms (min #)
2. Timeline
3. Best Treatment
4. Comorbidities
Dramatic, Emotional, Erratic,

Antisocial PD
1. 3 symptoms since age 15
2. 18 and older

Borderline PD
- 5 min symptoms (2 self-destructive)
- Dialectical Behavior Therapy

Histrionic PD
- 5 symptoms min

Narcissistic PD
- 5 symptoms min
Cluster C
1. Criteria/Crc's / Symptoms (min #)
2. Timeline
3. Best Treatment
4. Comorbidities
Anxious / Fearful
Avoidant PD
- 4 symptoms min

Dependent PD
- 5 symptoms min

OCPD
- 4 symptoms min
What are, @ least 4, co-diagnosis of Panic Dis with Agoraphobia (PDA)?
1. Major Depressive Dis
2. Generalized Anxiety Dis
3. Social Phobia
4. Specific Phobia
Panic Dis with or w/o Agoraphobia: Treatments?
1. In-vivo exposure + response prevention (flooding)
* Cognitive Treatment
* Relaxation
* Breathing Retraining
* Pharmacotherapy
Agoraphobia Best Treatment
In-vivo exposure + response prevention (flooding)
Specific Phobia: Does it produce panic or anxiety?
Can produce Panic or Anxiety
Panic Disorder: What types of symptoms must be produced (Emotional or Physical)?
At least 4 Physical Symptoms
* Heart Palpitations / Accelerated HR
* Sweating
* Chest Pain
* Nausea
* Dizziness
* Derealization
* Paresthesia
Specific Phobia: For ppl < 18, what is a minimum requirement?
Duration of symptoms must be for @ least 6 months
PTSD: What are the 3 Types?
PTSD, Acute (< 3 months)
PTSD, Chronic (3 or > months)
PTSD, Delayed Onset (6 or > months after the stressor)
What is the difference b/w Acute Stress Dis and PTSD, Acute Duration?
Acute Stress Disorder (2 days to 4 weeks)

PTSD, Acute Duration (< 3 mo)
What is the difference b/w Acute Stress Dis and Adjustment Dis?
Acute Stress Disorder (2 days to 4 weeks)

Adjustment Dis (must occur w/n 3 mo of the stressor + should not last more than 6 mo after the stressor has ended)
Adjustment Dis (Timeline)
1. Symptoms MUST occur w/n 3 months of the stressor

2. MUST end w/n 6 months after the stressor/consequences have stopped
Generalized Anxiety Dis: What is the minimum # of symptoms for Children v Adults.
Children - Requires Anxiety/Worry +1 symptom

Adults - Requires Anxiety/Worry + 3 symptoms
Generalized Anxiety Dis Symptoms Duration
@ least 6 months
What might be the diagnosis when the duration criteria for Delusional Disorder is not met?
Brief Psychotic Disorder
(2 days - 1 mo)
Delusional Disorder: Minimum Duration?
@ least 1 month
Minimum # of Symptoms & Duration:

1. Undifferentiated Somatoform Disorder

2. Somatoform Dis, NOS
@ least 1 Symptom lasts for 6 mo or >
@ least 2 Symptoms last for < 6 mo