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Front 1

Etiology

Back 1

The cause of something; presumed or theorized cause.

Front 2

Epidemiology

Back 2

The prevalence of a disorder

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Comorbid

Back 3

Coexisting condition

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Premorbid

Back 4

Preexisting condition

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Ce'ad Mile Fa'ilte

Back 5

translation- 100,000 welcomes

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Spontaneous Remission

Back 6

When a disorder spontaneously disappears, even without treatment. (Occurs with all disorders)

Front 7

Creative Strategies

Back 7

important to the field of mental illness. When therapists alter their strategies for a specific individual.

Front 8

Brain/Mind

Back 8

The mind is the result of the Brain's functioning.

Front 9

Importance of definitions of disorders throughout history

Back 9

Throughout history the way in which a disorder is defined determines how those with the disorder are treated.

Front 10

History of Mental Disorders: North Africa/Eastern Mediterranean Countries

Back 10

Def: Mentally Ill are possessed by evil spirits stuck inside of them.
Treatment: Trephination (2cm hole drilled in head

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History of Mental Disorders: Ancient Greece

Back 11

Def: Mentally ill are under the influence of angry Gods
Treatment: Shunned

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History of Mental Disorders: 1484 Pope/1520Martin Luther

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Pope/Martin Def: Strange people are possessed by devil
Treatment: admit possession, repent.
-Torture if they didn't repent
-To save their soul they were killed
-Resulted in witch burnings

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History of Mental Disorders:
Age of Enlightenment (post middle ages)

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Def: Not a result of possession or witch-craft
Treatment: Institutionalization
-Deplorable conditions

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History of Mental Disorders:
Colonial times (USA)

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Treatment: Hanged, imprisoned, tortured as satan's agents

Front 15

History of Mental Disorders: Moral Treatment of Mental Disorders

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Assumption: A person's devious behavior caused them to become possessed. "Disorder is a result of moral weakness"
-"insane" was introduced at this time
-"these people are normal, but need a moral environment to recover
-80% recovery rates
-Milieu Therapy- reinforce good and decent behavior by changing the environment

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History of Mental Disorders:
The reform Movement
(*Benjamin Rush)

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Treatment: Conditions were bad/treatment was not
-Treated mentally ill with more dignity and respect
-Dorthea Dix: Worked worldwide to reform insane asylums
-*Benjamin Rush- (1745-1813) the father of American Psychiatry encouraged more humane treatment; as the first one to suggest that addiction was a public mental health issue

Front 17

History of Mental Disorders:
Emerging Medical Beliefs

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Def: "Insane suffer from brain lesions or an oversupply of blood or yellow bile"
Treatment: Bleed, purge, and give ice cold water dips to the patient.
-Alternative to moral treatment

Front 18

History of Mental Disorders:
1850- Scientific Psychiatry

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Def: Mentally ill have an organic brain issue
Treatment:
-Focus is to separate the specific disturbances
a) classify them
b) deal with social problems (ex:moral treatment)
-The medical model began to take shape

Front 19

History of Mental Disorders:
Scientific Psychology

Back 19

Def: There is nothing organically wrong with their brain, focus on observable data
Treatment: Experimental Psychology and testing significance of various treatments

Front 20

History of Mental Disorders:
USA- Late 19th Century

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Def: foreigners are inferior and lack moral fiber
-During this time there was a large flux of immigrants
-mental health hospitals were overloaded with foreigners and mentally ill
-The system became overloaded and DR's lost hope and many concluded "they have brain defects and there is nothing we can do.

Front 21

History of Mental Disorders:
Politics and Mental Health Care

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Def:
-Liberals believe environmental issues such as poverty cause mental illness and should be dealt with by gov't.
-Conservatives believe the problem is the individual, and it is their and the communities responsibility to resolve it

Front 22

History of Mental Disorders:
Social Darwinism (1936)

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Theory: The survival of the fittest.
-The mentally ill are inferior and should be sterilized
-1936 (25 states adopted sterilization laws)

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History of Mental Disorders:
The Settlement movement

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Child labor laws were passed and gov't sought ways to help the unfortunate
-WWI saw a conservative swing

Front 24

History of Mental Disorders:
The great depression

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No funding to institutions
-Economic reform followed but not social reform

Front 25

History of Mental Disorders:
WWII

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There was a strong push after the war to improve mental institutions
-1948: National Institute of Mental Health was founded and funded
-1950: Psychotropic medications resulted in less lobotomies and physical restraints

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History of Mental Disorders:
1960 JFK

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-Rise of liberal thinking
-1960 Joint Commission Reported that mental illness was driven by poverty and poor education
-"war on poverty"
-The AMA and hospitals feared JFK may cause socialized medicine
-Focused on prevention and reintegration for mentally ill

Front 27

History of Mental Disorders:
1963 Community Mental Health Act (problems/advantages included)

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The foundation of the system we have today
-provided funding for community mental health centers to provide:
1) Inpatient Service
2) Outpatient Service
3) Partial Hospitalization
4) 24 Hour Emergency Care
5) Consultations, education, and prevention
Problems with the Act:
-Clinics wanted to be in areas where there is less mental illness
-Focus is on clinical services and not on prevention
-Catchment areas are too large
-The centers could not handle all of the responsibility
Advantages of Act:
-Decrease in institution admissions
-Introduction of halfway homes and group homes

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History of Mental Disorders:
1975 bill

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Congress required services for children, aged, alcohol & drug patients. They also required follow up treatment for hospitalized patients

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History of Mental Disorders:
1980 Community Mental Health Centers

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-centers had a major influence on mental health services
-800 centers existed
-financial constraints rendered many centers ineffective

Front 30

History of Mental Disorders:
1980- present

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-Reemergence of conservative policies resulted in deinstitutionalization.
-Mental Illness is as much a problem for the judicial system as it is for clinicians
-33% of homeless are mentally ill
- High comorbid rates of substance abuse disorders
-Corrections spend too much time dealing with mentally ill versus the mental health department

Front 31

Primum non Nocere

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Hippocrates- "Above all do no harm"

Front 32

Prevalence of Mental Disorders:
Male and female

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(In order of prevalence)
Male:
-Alcohol and drug dependencies
-Anxiety disorders
- Dysthymia and other mood disorders; including major depressive disorders
-Antisocial personality disorder
Female
-Anxiety Disorders
-Major Depressive and other mood disorders
-Alcohol and drug dependencies
-Obsessive-compulsive disorder (anxiety disorder)

Front 33

Role of the Counselor:
Developmental model and Remediation Model

Back 33

Developmental model
-Mechanistic view: behavioral
-Organismic view: humanistic
-Contextual view: cognitive behavioral
Remediation Model:
-Medical view
*Both models coexist today

Front 34

Role of the Counselor:
How has health care today influenced our profession?

Back 34

1. Economics must be considered as part of the treatment plan
2. Raises philosophical questions: Should we treat everyone or just the treatable?
3. Brief therapies are becoming more popular- 85% of all therapy is CBT
4. Research focuses on what works and doesn't work
5. For reimbursement a diagnosis must be made
6. "Health insurance will not cover 'improving self-esteem'"

Front 35

Role of the Counselor:
Traditional Model

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Therapist did what he desired. This no longer exists because you are told what to do.

Front 36

Role of the Counselor:
Managed Care Model

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Developed in the early 1990's
-Therapist delivers care that they were told to do by someone else who manages the care

Front 37

Role of the Counselor:
Managed Care model: Gatekeepers

Back 37

Health insurance workers who authorize who gets treatment and how much

Front 38

Role of the Counselor:
Managed Care Model:
Preauthorization Process

Back 38

Counselor takes a biopsychosocial history in first session and gets a diagnosis which is then sent out to get authorization for further sessions

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Trends in the field today:

Back 39

1. Prevention:
-Psycho education
-Life management/coaching
-Preventing needless self-disturbances
-Self help programs
2. Counseling and Psychotherapy are two terms used interchangeably without distinction
3. CBT will dominate
4. Brief therapy will grow (8 sessions)
5. Treatment only for those who can be "cured"
6. More computer assessments
7. Spirituality will be more prominent (partially because of the success of A.A.)
8. Improved research in molecular biology and genetics
9. Specialty services will increase
10. No more "one man" therapists
11. Motivational enhancement therapy- The MET approach is founded on the
assumptions that counselees have the capacity and
responsibility for change and that it is the counselor’s
task to create conditions that enhance clients’ motivation
for and commitment to change.

Front 40

PNL reports

Back 40

Profit and loss reports- determine the quality and efficiency a counselor possesses

Front 41

What are a counselor's 3 choices for reimbursement?

Back 41

1. Take the cash- no insurance
2. Make change- adapt to insurance parameters on managed care
3. "sell shoes"- get another job

Front 42

What is the general philosophy and responsibility of a Clinical Director?

Back 42

1. Provide quality of service
2. Hire clinicians who have:
-excellent communication skills
-an understanding of modern health care
-excellent communication skills

Front 43

Understanding Modern Health care:
Covered benefit vs Preauthorization?
Referral procedure?
P&L's?

Back 43

Covered Benefit:
-What insurance companies say you have available to you
Preauthorization
-Does not mean that the client can get all that is covered in proposed treatment plan
-determines what can be covered
Referral- highly controlled and documented (not just suggested)
P&L's- Profit and loss reports
-insurance companies have these reports for each counselor for each diagnosis to determine which client is referred to who

Front 44

As a counselor, what are some warning signs that you may be in an ethical dilemma?

Back 44

"I have a secret"
"I avoid supervision or a certain case"
-It is important to be diligent regarding boundaries

Front 45

Biopsychosocial History:
Identifying data

Back 45

1. Client's physician (for insurance)
2. Source Referral (thanks for sending business)
3. Presenting Problem (What brings you to treatment now? judge, wife, parents, self, addiction etc . . .
4. Name of client on every page
5. Release of info (must be to a specific person)
6. SS# (no longer required)
7. Have you been in therapy before?

Front 46

Biopsychosocial History:
Substance Abuse Evaluation

Back 46

1. Average/max amount used- (get exact amount- 12oz or 40oz?)
2. Level of drug problem is based on consequences rather than amount
3. Cocaine measured in dollars not amount
4. Pattern and frequency of use
5. Prior substance abuse treatment? (when, where, how long, what kind of care, and results?)
6. Previous attempts to stop and reason for relapse? (include reasons in treatment plan to avoid from happening again)
7. Longest period of abstinence?
8. Meds?
9. Living conditions?

Front 47

Biopsychosocial History:
Psychological/Emotional History

Back 47

1. Reported symptoms of primary presenting problem (ask specific questions about a disorder from DSM if suspect a specific disorder present)
***No matter what the condition it must be clinically significant in order to be reimbursed- There must be a psychological, social, or occupational impairment
2. History of current symptoms
3. Prior Psychological Treatment (where, when, who, meds involved?)
4. Suicidal Ideation
-**The word "CURRENT" is an important protective word. If there is a risk you write "there is a current danger to self" and report it and also there should be a psychiatric evaluation within 24 hours or you are personally liable.
- If they have attempted before but are not at risk write "There is no current danger to self"

Front 48

Biopsychosocial History:
Childhood /Developmental History and Family of Origin

Back 48

Describe relationships to others in terms of how they connect to the presenting problem.
1. Description of father/mother- (What kind of relationship? Quality? Job?)
2. Siblings (Birth order and type of relationship)

Front 49

Biopsychosocial History:
Social History

Back 49

1. Education- (highest level/focus of study)
2. Vocational Training (job training- if no education they feel better being able to report this piece)
3. Military? (problems, rank, branch, when?)
4. Quality of relationship
5. Description of Children
6. Employment History

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Biopsychosocial History:
Social Assessment

Back 50

1. Religious beliefs (values)
2. Basic Needs (nutrition, personal hygiene, sleep)
3. Financial Status (spending habits "broke and own an Escalade")
4. Legal involvement (criminal record)
5. Key findings from physical health assessment (if not seen a physician lately may add to treatment plan)
6. Recreation/leisure activities
7. Peer groups
8. Social skills

Front 51

Biopsychosocial History:
Mental Status Evaluation*

Back 51

1.General Behavior/Gait
"Ataxic"- inability to coordinate voluntary muscular movements; symptomatic of some nervous disorders
2. Stream of thought/progression
"Loose"- difficulty staying on track and jumping from one subject to another
"Blocking"- as they speak they completely lose their train of thought.
"Confabulation"- often used to cover up their "blocking" they change the conversation in a dramatic way or make things up (could be related to early dementia, amnesia, or Korsocoff's syndrome)
3. Mental Trend/Content of thought/perception
"Depersonalization"- outside yourself
"hypochondria"- morbid condition about health and often death
4. Mental trend, Content of thought/cognition content
"Obsessions"- refer to thoughts
"compulsive rituals"- refer to behaviors
"religiosity"- religious in an extreme way
"ideas of reference"- delusional references to them from Bible, TV, books, etc
"nihilistic delusions"- delusions of nothingness
"suicidal ideation"
5. Orientation and Sensorium/Memory
decided on test about ability to count, calculate, concentrate, and comprehend

Front 52

Biopsychosocial History:
Integrated Summary

Back 52

*Completed after client has gone home*
1. Document medical, psychological, social, and spiritual issues as they pertain to the illness
2. Makes the points of the case without the details (do not bring up anything new- only information from the biopsychosocial history

Front 53

Biopsychosocial History:
DSM-IV Diagnostic Classification

Back 53

1. Axis I- mental disorder (besides mental retardation and personality disorder)
2. Axis II- records every mental retardation and personality disorders
3. Axis III- Medical Conditions
4. Axis IV- Psychosocial and Environmental problems
5. Axis V- current and past year Global Assessment of Functioning (GAF score)

Front 54

Biopsychosocial History:
The History- What questions should you ask yourself to make sure you made the right diagnosis?

Back 54

1. Is the data that supports the diagnosis reliable? What is the diagnosis based on? Any reason the client lied?
2. Has any data been overlooked?
3. Enough data to make a diagnosis?
4. Other possible diagnosis that have not been considered?
5. Test your own diagnosis by trying to disprove it

Front 55

Medical History Form

Back 55

1. Sign it to determine that you reviewed it
2. If person refuses to seek necessary medical treatment, counselor has the right to not treat them
3. DO NOT ignore something because of liability reasons! make the correct referral.
4. If you suspect an individual has suicidal ideations and refuses to go to a psychiatrist, you MUST hospitalize against their will. Either call police, ambulance, family member, or taxi (which signs a paper saying they will transport to hospital)

Front 56

Treatment Planning in the 60's, 70's, 80's, and 90's

Back 56

1. 60's
-hardly existed, there were no objectives, lacked detail/direction, only "followed client"
2. 70's
- JCAHO standards were established
- Accreditation- (must meet JCAHO standards)
- Focus on quality of care and thoroughness
3. 80's- Managed Care was established
- Accountability to insurance companies
4. 90's treatment planning now guides the treatment process

Front 57

Why is there such an emphasis on treatment planning?

Back 57

1. Client Benefit
-Direction is clear
-Outcomes are in the focus
-Expectations are on specific result
2. Therapist Benefit
- Therapist is forced to think analytically about each case
- Documentation of objectives helps protect therapist from litigation charges
- Needs of the client are primary, so that therapist cannot easily project their issues on the client

Front 58

Explain the elements of the treatment plan: Problems, Goals, and Objectives.

Back 58

1. Problems
-Problems must be described in the manner of a solution
-Ex: problem=depression/ solution="dissolve' depression
-Point out exactly what needs improvement
-must have already been identified in the assessment before writing it in the problem section
-Ex: Mary is suffering from grief of her mother's death. (The problem is "Mary's grief" not "her mother died"
2. Goals:
-The goal is always the opposite of the problem
-Must be realistic
-Provides guidelines for the direction of the case
-Focus on broad problems such as "depression"; do not focus on "excessive sleep"
-Do not describe how to achieve the goal (save that for the objectives)
3. Objectives:
-List steps that will lead to the goal (detox, AA, remove alcohol from home)
-Measurable with time frames ("by 8th session")
-Only one variable at a time (not: go to AA AND speak at AA)
-Describe actions and services
-Be specific (not AA BUT AA and Clarkston Community Church)
-Should be clearly stated, timelined, within the control of the client (if they dont have a drivers licence do not make them attend a place they cant drive to/ be sure to include and set up a means of transportation)