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228 Cards in this Set
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Sigmund Freud is most known for
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Psychoanalytic Theory of Personality
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Seeks to relieve the person of neurosis; uses free association and dream analysis to uncover repressed conflicts that are re-lived on an emotional and intellectual level; long term, multiple times a week. Continues until a mature understanding is achieved and integrated into personality.
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Important Dimensions of Freud's Theory
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1. Levels of Consciousness
2. Structure of Personality 3. Psychosexual Stages of Child Development |
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Levels of Consciousness Include
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Conscious
Preconscious Unconscious |
Conscious: mental activities of which we are fully aware
Preconscious: feelings, thoughts, and ideas which we are not currently aware but can bring awareness to relatively easily Unconscious: feelings, thoughts, memories, and desires of which we are unaware |
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What methods did Freud use to bring the unconscious conflicts to the awareness of patients?
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Free Association
Dream Analysis (experimented with hypnosis) |
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According to Freud, what is included in the Structure of Personality?
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1. Instincts:
life instinct (eros) death instinct (thanatos) 2. Personality: Id Ego Superego |
1. Instincts: inborn factors that give force and direction to psychological activity
a. life instinct: constructive, loving, and altruistic acts b. death instinct: destructive, hateful, and agressive acts 2. Personality: Id- only part present at birth; operates on pleasure principle; seeks immediate gratification; no regard for anything or anyone else; cathexis occurs when the id invests libidinal energy into an image of an object that has the capacity to fill a need ego- gives power to go beyond being able to keep an image of need gratifying object in the mind to actually getting needs met; operates on reality principle; seeks to gain gratification in acceptable manner; defenses designed to keep anxiety level manageable by keeping anxiety-producing impulses out of the conscious; defenses can be adaptive; maintain stability of personality by keeping from overwhelm by anxiety and stress Superego- arises out of the ego; develop beliefs about what is good and bad; takes over position of parents (observes, judges, rewards and punishes) |
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What are the two aspects of the Superego that were identified by Freud?
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1. The Conscience
2. The Ego Ideal |
1. Conscience: contains "should nots", things for which one has been punished
2. Ego Ideal: contains "the shoulds", positive moral teachings. Rewards include feelings of self righteousness and pride. Punishments include feelings of guilt and shame. How the ego negotiates between needs of id and morals of superego, and realities of world determines individual behavior. |
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Name the Psychosexual Stages of Development and the ages in which they occur?
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Stage 1: Oral (birth-1year)
Stage 2: Anal (2-3) Stage 3: Phallic (3-6) Stage 4: Latency Period (6-11) Stage 5: Genital (12-adulthood) |
Oral Stage (birth-1) : breast or substitute is object of cathexis; need to take in nourishment and to breathe; sucking when not eating reveals need for satisfaction; results in erotic pleasure; way of investigating world; initial ability to tell what is me and what is not me
Anal (2-3): teaching the child control over bowel and urinary function; erotic pleasure is anus and sphincter muscles Phallic (3-6): sources of erotic pleasure are penis, clitoris and vulva; pleasure from self stimulation with a love object; Oedipus Complex and Electra Complex; resolution when child represses feelings for opposite sex parent and begins to identify with same sex parent Latency (6-11): sexual feelings continue to be repressed; stop masturbating out of fear of castration and loss of parental love; defensive rejection of sex; "Infantile Amnesia" for sexual urges of earlier stages; focus on work and play with same sex; superego maintains parental standards; failure to negotiate stage may lead to discomfort with opposite sex, avoidance of intimacy, or aggressive, emotionally detached sexual activity Genital (12- adulthood): develop primary and secondary sex traits; normal focus on opposite sex; Intercourse is primary erotic activity; when expression of sexuality is limited to marriage may develop defense of sublimation (sports, art, music, service in place of sexual activity) |
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Alfred Adler developed
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Individual Psychology
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Name Alfred Adler's theories?
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1. Personality Development
2. Methods of Psychoanalysis |
1. Personality Development: begin in state of inadequacy or inferiority; basic drive toward self-actualization or superiority; individual is seen in relation to environment not composed of id, ego, superego; primary indicator of wellness is successful function in groups; birth order impact on personality; self image or "fiction" influences how children interpret and respond to life events
2. Method: therapist task is to help pt identify dysfunctional patterns and develop more positive self image and life goals; therapist assesses pt's drive toward perfection, activity and interest in contributing to good of society; therapy is non-authoritarian, equal pt-therapist interaction; empathy is therapeutic goal, focus is on daily life experience |
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John B. Watson developed
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Behaviorism
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Objective way of analyzing behavior.
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Using Behaviorism what did John Watson condition "Little Albert" to fear and how?
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"Little Albert" was conditioned to fear a white rat and then generalize that fear to a white rabbit using behavioral techniques.
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Watson concluded that the child had no fear of the rat or the rabbit until he was behaviorally conditioned, therefore, parents can shape child's behavior through stimulus-response conditioning.
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What was the conclusion following the "Little Albert" experiment?
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Parents could shape child's behavior through stimulus-response conditioning.
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Through the Behaviorism school of thought, what did Watson emphasize?
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He emphasized observable behavior of individuals rather than their emotional or mental state, which could not be observed.
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Who developed Classical or Response Conditioning?
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Ivan Pavlov
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What terms are associated with Classical Conditioning?
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Unconditioned Stimulus
Unconditioned Response Conditioned Stimulus Conditioned Response |
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Define Unconditioned Stimulus and give an example.
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A stimulus that innately evokes a response in the organism.
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Example, the meat powder that was presented to dogs that resulted in unconditioned or innate response of salivation.
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Define Unconditioned Response and give an example.
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An innate response to a stimulus.
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Example, the salivation of Pavlov's dogs when presented with the unconditioned stimulus of the meat powder.
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Define Conditioned Stimulus and give an example.
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A stimulus that does not innately evoke a response in an organism but the organism learns to respond to because it has been paired with an unconditioned stimulus in the past.
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Example, Pavlov's dogs learned to respond to the ringing of a bell because the bell had been repeatedly paired with the presentation of the meat powder.
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Define Conditioned Response and give an example.
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The organism's learned response to a conditioned stimulus.
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Example, Pavlov's dogs' learned response to the ringing of the bell was salivation.
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What was Jean Piaget interested in and what theory did he develop from this interest?
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Piaget pioneered Cognitive Development Theory. He was interested in children's changing cognitive abilities via the qualitative interviews with children.
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What were the two ways that Piaget said children learn?
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1. Assimilation
2. Accomodation |
Assimilation is a way of learning where a person incorporates aspects of the environment into an existing thought structure.
Accomodation is another way of learning which refers to modifying current thought structure to incorporate a new, perceived feature of the environment. |
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List Piaget's Stage Model which represents the development of children's cognitive abilities.
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Stage 1: Sensorimotor (birth-2)
Substage 1: Impulsive and Reflexive action Substage 2: Primary Circular Action Substage 3: Practicing Secondary Circular or Repetitive Actions for their Consequences Substage 4: Coordinating Secondary Schemes Substage 5: Tertiary Circular Actions/Continuation of Experimentation with more variable Substage 6: Invention through Mental Combinations Stage 2: Preoperational (2-7) thoughts are egocentric Stage 3: Concrete Options7-11 able to reason about concrete aspects of environment and understands conservation Stage 4: Formal Operations 11-adulthood, if achieved at all; able to reason about things in abstract |
Sensorimotor: This stage has 6 substages which are precursor to intelligence.
1. Impulsive and Reflexive Actions are actions taken for their own sake. 2. Primary Circulare Action is repetitive actions that are combined over time (looking at and touching a stuffed animal). 3. Practicing Secondary Circular or Repetitive Actions for their Consequences (pushing a bowl repeatedly off the high chair to be picked up by parent). 4. Coordinating Secondary Schemes and applying to new situations: child experiments with goal-directed behavior (taking lid off a box to get toy inside) 5. Tertiary Circular Actions/Continuation of Experimentation with More Variability: child shows increased flexibility and creativity in previously acquired behaviors and skills (dropping toys and other objects to observe effect). 6. Invention through Mental Combinations: child increasingly performs experiments internally and object permanence is fully developed; now understands that object does not stop existing when out of sight. |
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Leo Vigotsky was known for his work with what population?
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He worked with children using the Child Development Theory.
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Vignotsky believed that children learn best in what type of environment?
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A supportive environment where they can identify what needs to be done, rather than someone telling them.
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Application of his theories are seen in classrooms where there is social interaction, group conversation, and oral and written expression.
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Kurt Lewin was known for his work in?
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Social Psychology, Organizational Management, and Applied Psychology
Addressed prejudice through sensitivity training Nature and Nurture shape individuals Force Field Analysis Leadership Climates: Authoritarian, Democratic, Laissez-faire |
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What did Anna Freud identify?
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Defense Mechanisms
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Name the ego defense mechanisms
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Compensation, Conversion, Denial, Displacement, Identification, Isolation of Affect, Intellectualization, Projection, Rationalization, Reaction Formation, Regression, Repression, Sublimation, Substitution and Undoing
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Define Compensation
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the seeking of success in one area of life as a substitute for success in another area of life that has been limited because of personal or environmental barriers.
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Define Conversion
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the transformation of anxiety into a physical dysfunction, such as paralysis or blindness, which does not have a physiological basis.
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Define Denial
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a refusal to acknowledge an aspect of reality, including one's experience, because to do so would result in overwhelming anxiety.
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Define Displacement
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shifting of negative feelings one has about a person or situation onto a different person or situation
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Define Identification
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anxiety is handled through identifying with the person or thing producing the anxiety
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ex. identifying with a kidnapper
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Define Isolation of Affect
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painful feelings are separated from the incident that triggered them initially
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ex. a rape victim telling story without emotion
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Define Intellectualization
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reasoning is used to block difficult feelings; involves removing one's emotions from a stressful event
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Define Projection
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negative characteristics are denied and instead seen as being characteristics of someone else
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Define Rationalization
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person substitutes a more socially acceptable, logical reason for an action rather than identifying the real motivation
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Define Reaction Formation
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adopting a behavior that is the antithesis of the instinctual urge
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ex. acting as if one has sympathies for oppressed group when actually has prejudice against group
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Define Regression
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reverting to more primitive modes of coping associated with earlier and safer developmental periods
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Define Repression
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unconscious pushing of anxiety-producing thoughts and issues out of conscious and into the unconscious
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Sigmund Freud is accurately credited with identifying this defense mechanism, although Anna also addressed this in her work
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Define Sublimation
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intolerable drives or desires are diverted into activities that are acceptable
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Define Sublimation
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a mechanism by which intolerable drives or desires are diverted into activities that are acceptable
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Define Undoing
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a mechanism by which an individual engages in repetitious ritual in an attempt to reverse an unacceptable action previously taken
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Acting Out
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exhibiting observable behavior rather than by merely feeling or reflecting
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directly related to stress and emotional conflict/ often used by children and adolescents
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Affiliation
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shared emotional conflict or stress for the purpose of eliciting support or help
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Could be positive such as church or exercise groups or negative such as gang activity.
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Aim Inhibition
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individual places a limit on their instinctual demands and accepts a modified fulfillment of goals or desires
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A person who wants to go to med school, but becomes a pharmacist instead.
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Altruism
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person deals with their emotional conflict or stress by selflessly dedicating their life to meeting others' needs
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The person receives vicarious gratification.
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Anticipation
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person deals with anxiety by "practicing" their emotional reaction to a future event and considering responses or solutions that they may utilize
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Autistic Fantasy (or Fantasy)
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Daydreaming excessively as a substitute for real action.
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Avoidance
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refusal to participate in activities or encounter situations or objects that represent unconscious, aggressive or sexual impulses and the possible punishment for those impulses
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Dynamic Theorists consider avoidance a major defense used by people with phobias.
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Deflection
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a group member who redirects attention away from themselves and onto another group member
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Devaluation
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Attributing negative qualities about themselves to others
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Often used by bullies.
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Dissociation
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compartmentalizing or separating of activities or thoughts from the main portion of one's consciousness
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individuals who lead "two" lives(often addicts)
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Fixation
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interruption of normal personality development at a stage short of mature independence
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Help-Rejecting Complaining
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an individual deals with their emotional conflict or stress by asking for help and then rejecting the help that is given
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Requests are often disguised hostility which are then expressed by refusing the requested suggestions or advice.
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Humor
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deals with their own emotional conflict or stress by pointing out amusing aspects of the stress
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Idealization
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over-estimating the desirable qualities and under estimating the limitations of something that is important to the person
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Identification
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both the unconscious and the conscious modeling of another person's behavior or style
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Incorporation
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a child, through the process of observation, assimilates into their ego and superego the values, attitudes, and preferences of parenting
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one of the earliest mechanisms used in the development process
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Introjection
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unconsciously incorporating ideas, attributes, or mental images into one's own personality
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Isolation
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person is able to split off emotional components from a thought or experience
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commonly used in OCD
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Omnipotence
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dealing with his or her own emotional stress by feeling or acting in a superior manner
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Passive Aggression
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expresses aggression toward another person in an indirect and unassertive manner, which, in turn, gives the agitator the opportunity to avoid the emotional stress related to dealing with person's reaction
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Projection Identification
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falsely attributes to another person one's own unacceptable impulses, thoughts or feelings; person consciously recognizes attributes that are projected and considers them justifiable reactions to the person on whom they are projecting; the projector feels at one with the other person
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a very primitive form of relating; for the receiver it is far more disturbing and more difficult to deal with than projection
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Resistance
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prevents the bringing of repressed feelings or information to conscious awareness, sparing the anxiety that would come from those memories or insights
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Restitution
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relieving stress or guilt by doing something to make up for what one considers a behavior error committed against another individual
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Self-Assertion
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a healthy way of dealing with emotional conflict or stress by expressing feelings and thoughts directly and in a non-coercive or non-manipulative matter
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Somatization
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experiencing physical symptoms of sympathetic and parasympathetic systems as the result of emotional conflict or stress
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Splitting
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relating to significant others, person may "split" the significant other into 2 parts, good and bad, in an effort to cope with painful feelings associated with that person
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Suppression
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conscious and intentional exclusion of data from consciousness
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refusing to think about something that is temporarily interfering with current functioning
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Symbolization
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a way of turning emotional conflicts into symbols, which can be viewed as displacements of deeper desires
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ex. interpreting a specific dream as a symbol of a deeper feeling or desire
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What school of psychology was Abraham Maslow associated with and what concept did he develop?
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He was associated with the Humanistic school of psychology, and developed Maslow's hierarchy of needs
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Others associated with Humanistic psychology are Carl Rogers, Fritz Perls and Eric Berne. Maslow also borrowed ideas from mentors Harry Harlow, Alfred Adler, Ruth Benedict and Max Wertheimer.
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What did Maslow see as the hierarchy of human needs?
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Physiological Needs
Safety Needs Belonging and Love Needs Esteem Needs Self-Actualization |
Physiological:
oxygen,water, food, sleep, sex Safety: protection, security, structure, predictability Belonging and Love: affection, identification with a group, friendship, intimacy Esteem: respect, recognition, appreciation Self-actualization: developing full potential |
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According to Maslow, how does positive self-esteem occur?
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Positive self-esteem occurs when an individuals' social experiences result in recognition, feelings of adequacy, and acceptance.
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Basic needs must be met before higher needs. Maslow believed that only 1-2% of population reached self-actualization.
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Who was Rene Spitz associated with and what was he interested in studying?
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Rene Spitz was part of the psychoanalytic movement in America. He was interested in ego development of the child and relationship between mother and child.
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What did Rene Spitz observe in hospital settings and orphanages?
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He observed emotional deficiencies that had a significant effect on the children's psycho-emotional development. He called this "hospitalism" or "Anaclitic depression".
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Name three significant principles in the psychological development in children that Rene Spitz identified.
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The Smiling Response
Stranger Anxiety Semantic Communication |
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What was the focus of Erik Erikson's Ego Psychology?
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He focused on adult development and the ability of individuals to solve problems and effectively negotiate society.
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Built on Freudian Theory; thought that Freud neglected characteristics and development of healthy personalities
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How did Erikson describe the healthy personality?
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"actively masters the environment, show a certain unity of personality, and is able to perceive the world and self correctly
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He believed (unlike Freud) that development occurs over the lifespan; later experiences could alter, but not entirely change what had been achieved in prior stages either in a positive or negative direction.
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How many psychosocial stages did Erikson identify and what did they correspond to?
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He identified 5 childhood stages and 3 stages of adulthood. The childhood stages correspond to Freud's psychosexual stages.
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Name Erikson's 8 Psychosocial Stages and the ages in which they occur.
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Stage 1: Trust vs. Mistrust (birth-1)
Stage 2: Autonomy vs Shame & Doubt (2-3) Stage 3: Initiative vs Guilt (3-5) Stage 4: Industry vs Inferiority (6-11) Stage 5: Indentity vs Identity Diffusion or (Role or Identity Confusion) (12-18) Stage 6: Intimacy vs Isolation (early adulthood 19-mid 30s) Stage 7: Generativity vs Stagnation/Self Absorption (middle age: mid 30's to 50's) Stage 8: Integrity vs Despair (old age: 60's and beyond) |
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Describe Trust vs Mistrust.
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Stage 1: quality of infants relationship with mother; determines the level of trust the individual develops in himself and in others (ages birth-1 year)
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Describe Autonomy vs Shame and Doubt.
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Stage 2: (2-3 years of age); sense of power over independence as they gain control over elimination system; parents need to provide balance; punitive or rigid parenting may result in compulsivity and stinginess with time and resources in adulthood;
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Describe Initiative vs Guilt
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Stage 3: (ages 3-5 years)
growing ability with language, locomotion, and managing environment; initiative is acheived through empathic parenting otherwise sense of guilt develops |
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Describe Industry vs Inferiority
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Stage 4: (ages 6-11) need to engage in worthwhile activities that are seen through to completion; adult assistance and positive reinforcement important
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Describe Identity vs Identity Diffusion
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Stage 5: (12-18 years)
identity confusion can occur at any age; synthesis of earlier life experience, growing sense of purpose; neg outcome may be adult acting like adolescent due to stunted emotional growth |
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Describe Intimacy vs Isolation.
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Stage 6: (ages 19-mid 30's)
able to develop healthy relationships and take appropriate emotional risks with opposite sex; or become self absorbed and isolated (avoid intimacy). |
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Describe Generativity vs Stagnation/ Self Absorption
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Stage 7: (ages mid 30's- 50's)
desire to have children and prepare the next generation to take over |
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Describe Integrity vs Despair
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Stage 8:
(old age 60's and beyond) sense that life has been worthwhile and lived in harmony with values, sense of having been true to self, not fear death; or despair that there is not time to create different life, continue to fear death |
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How did Erikson build on Freud's theory?
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He added characteristics of healthy personalities.
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According to Margaret Mahler (Separation-Individuation Process), what is the definition of Object Relations?
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Object Relations is the process by which an infant struggles, over the first few years, to differentiate between self and non-self (other).
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List the stages in Mahler's stage based developmental theory.
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Stage One: Normal Autism
(ages birth-1 month) Stage 2: Symbiosis (1-4 months) Stage 3: Separation-Individuation (4-8 months thru 36 months) Substages: 1. Differentiation from Mother/Hatching (4-8 months) 2. Practicing (8-15 months) 3. Rapprochement (15-24 months) 4. Achievement of Individuality (24-36 months thru 4 years) |
Abandoned Stage 1 after further research.
Failure to navigate Rapprochement may lead to Narcissistic or Borderline Personality Disorder. |
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According to B.F. Skinner, what is Operant Conditioning?
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Operant Conditioning is behavior that has been reinforced will be repeated. Deals with the modification of voluntary behavior through consequences.
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differs from Pavlov who worked with conditioning of behavior so that it occurs under new antecedent behavior.
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What are the four types of Operant Conditioning?
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Positive Reinforcement
Negative Reinforcement Punishment Extinction |
Positive and Negative Reinforcement Strengthen Behavior.
Punishment and Extinction Weaken Behavior. Antecedent(stimuli)---------------- Response(behavior)---------------- Consequence |
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Name Lawrence Kohlberg's 3 general levels of
Moral Development. |
level 1: Preconventional Morality (individual perspective)
Level 2: Conventional Morality (individual conforms to expectations of society) Level 3: Post Conventional Morality (identification of moral principles) |
Most people never reach
level 3. |
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Define John Bowlby's concept of Attachment Theory.
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The nature of our attachments with our caregivers is the blueprint for future relationships.
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What is Separation Anxiety?
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Part of Attachment Theory, occurs between 6 and 8 months of age, separation anxiety is when a baby is distressed when separated from the primary caregiver.
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According to Attachment Theory, what is Stranger Anxiety?
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Stranger Anxiety happens around 8 months old. The baby is distressed by seeing a stranger's face as opposed to the face of a familiar person, such as the mother.
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Describe the phases a child goes through with a prolonged separation from the primary cargiver.
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1. Protest Phase- anger
2. Despair/Depression- usually crying 3. Detachment-through repression (healthy adaptation) 4. Anaclitic Depression-type of depression seen in children who initially have a supportive and caring mother but then are removed from her care. |
Anaclitic Depression seen in children who have been hospitalized or in orphanages.
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Define the characteristics of attachment as described by Bowlbey.
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1. Proximity Maintenance: the desire to be near people to whom we are attached
2. Safe Haven: returning to the attachment figure for comfort and safety when feeling afraid or threatened. 3. Secure Base: point of security (usually the mom) from which the child can explore surroundings without fear of abandonment. 4. Separation Distress: anxiety that occurs in the absence of attachment figure. |
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Who was the Person In The Environment System (PIE) developed for and why?
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Developed by James Karl and Karen Wandrei. PIE was developed specifically for Social Workers to give an assessment system to examine the social functioning of adult clients.
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PIE creates uniform statements about_____.
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Uniform statements are created about social, environmental, mental and physical health problems, and current strengths.
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Bio-psycho-social Assessment
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How does PIE delineate problems?
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It delineates problems in terms of duration, severity, and the client's ability to cope or problem solve, and current strengths.
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Strengths based system
Not diagnostic/cause and effect . |
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What are the four factors needed to provide a total picture of client's issues according to PIE?
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Factor I:
Social functioning: problems, type, severity, duration, coping ability Factor II: Environmental Problems: severity, duration Factor III: Mental Health Problems: Axis I and/or II diagnoses and conditions listed in the most recent addition of the DSM-IV Factor IV: Physical Health Problems: correlates with Axis III in the DSM-IV-TR |
All factors are needed to provide a total picture of client's issues.
REFERENCE Page 38 in study guide for example |
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Who developed PIE?
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James Karl and Karen Wandrei developed PIE in the 1990s.
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Childhood physical development includes
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growth and motor development
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Physical and mental disabilities impact continued development and functioning.
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Childhood cognitive and intellectual development includes
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learning, remembering, using symbols, and problem solving
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Childhood language development includes
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competence of using correct sounds (phonology)
encoding messages (semantics) understanding the way words are combined (syntax) using language in different contexts (pragmatics) |
Some childhood psychopathology is first noticed during language development such as autism.
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What are the general social and emotional development patterns?
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Newborns do not express fear
around 8-12 months begin to show fear of perceived threats Beginning in preschool through adulthood the capacity for empathy and understanding social rules is developed. |
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What can self-image in children be based on?
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Self-image can be based on genetic factors, parental training, modeling of others, social and cultural experiences, and other environmental factors.
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Describe sexual development.
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Inquisitiveness is natural; parents who normalize and explain have children who grow up with healthier attitudes toward sex; parents who over react may cause children to be confused and secretive; parents should educate themselves if same sex attraction is an issue
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List the milestones of average human development.
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Birth-2
Responds to faces and bright objects 2 months Appearance of social smile; follows moving objects w/ eyes 4 months Recognizes familiar objects; coos; enjoys people more 6 months Teething begins; turns over 7 months Picks things up 8 months Sits alone; strangter anxiety 9 months Crawls 10 months Pays attention; plays 11 months Stands with support 12 months Leafs through books looking at pictures 10-12 months Walks with support; shows a greater variety of emotion 15 months Walks alone; can name some familiar things 18 months runs 2 years Can speak in short sentences 6 years Well-developed speech; well-developed ability to use imagination |
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Roughly what ages does adolescent development take place?
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12-18 years are the ages of typical adolescent development
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What is Positive Youth Development?
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The efforts of communities, schools, government agencies, and adults to create supportive communities for young people, and to encourage youth to contribute in a positive way to the larger community.
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What is the typical sequence of sexual maturation in adolescence?
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Bodies change and begin to go through puberty as early as age 10; sexual feels happen as the body changes; interest in opposite or same sex occurs; the desire to date or be social becomes more important.
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This may be influenced by physical size, intellect, disability, and/or genetics.
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What risks do adolescents who struggle with gender identity, are gay or lesbian or who question their sexual identity face?
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The teens are at high risk for depression, emotional problems and suicide.
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What does adult social development consist of?
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Adults' focus on dating, career choice, mating, producing children, and forming a new home and family life.
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Describe the experiential learning model that David Kolb designed.
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Doing: active experimentation
Watching: reflective observation Feeling: concrete experience Thinking: abstract conceptualization |
Adults' learn and grow emotionally, cognitively, and spiritually. Usually through, formal or self-instruction, guidance and mentoring, trial and error, and sometimes therapy.
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Children from what type of family structure are at the most risk for being physically abused?
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Economically disadvantaged, young, single parents are the most likely to abuse their children.
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Describe the profile of a typical sexual perpetrator
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male, is familiar to the child, and has been abused himself as a child
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What are some signs of sexual abuse?
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trouble walking or sitting; sexually inappropriate behavior; avoidance of a specific person w/o apparent reason; running away; reluctant to change in front of others; sexually transmitted disease; pregnant before age 14
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List and describe the four phases of the cycle of abuse as it relates to Domestic Violence
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Phase I: Tension Building
breakdown in communication; after the victim becomes fearful and experiences the need to calm the abuser down Phase II: Incident the verbal, emotional and/or physical abuse that occurs; involves feelings of deep anger, blaming, and sometimes threats and intimidation Phase III: Reconciliation abuser apologizes, gives excuses, blames the victim and denies the abuse or says that it was not as bad as the victim reports Phase IV: Calm incident is forgiven and in one's mind no abuse is taking place; sometimes called "the honeymoon phase" |
Many stay in abusive relationship b/c of emotional or financial dependence; guilt about breaking up the family; believe violence is part of relationships; isolation from outside support system; commitment to partner; embarrassment; hope; fear of increased violence
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Define addiction.
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Addiction is the "physical or psychological craving for a drug".
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Often involved in domestic abuse
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What is the current research focus on addiction?
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neurobiology and brain reasearch which identifies the pleasure center of the brain as reinforcing the addiction.
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In order to make an accurate assessment and recommend the best course of treatment what should Social Workers consider?
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SW should consider:
Needs History Personal Resources Motivation Level Support System |
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What are the classes of substances identified in the DSM-IV-TR?
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Alcohol
Inhalants Amphetamines Opioids Cannabis Phencyclidine (PCP) Cocaine Sedatives/hypnotics/anxiolytic Hallucinogens |
Nicotine is listed in DSM
Caffeine is not listed even though it is known to be addictive. |
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Define Substance Dependence.
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Substance Dependence causes physiological signs and symptoms of tolerance and withdrawal.
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What is tolerance?
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gradually increasing the amount of substance to produce the desired effect previously attained
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Define Substance Abuse.
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Abuse is a maladaptive pattern of substance use that leads to clinically significant impairment or distress within a 12 month period. No symptoms of tolerance or withdrawal.
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Who constitutes the largest segment of the poor?
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Children
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1/5th of all children live in poverty
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What are the poor more at risk for than the rest of the population?
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malnourishment which leads to disease; unable to obtain healthcare; hazardous living environments; less likely to complete High School resulting in inability to obtain secure employment which provides adequate income
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Cycle of Poverty
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Who is more likely to live in poverty?
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Single women with children are more likely to live in poverty.
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Also more likely to by physically abusive to their children under age 14.
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What is the 10th leading cause of death in the US?
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suicide
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11 attempts for every 1 that succeeds
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What are some characteristics associated with suicidal behavior?
|
1. mental disorder, particularly mood disorder or Schizophrenia
2. substance abuse 3. certain psychological traits such as apathy, indifference to tx, low social involvement, hopelessness, poor pain tolerance, and poor health 4. inadequate social support 5. unemployment or retirement 6. stressful life events 7. being male 8. previous attempt 9. being gay, lesbian or transgender 10. family history 11. family violence, including physical or sexual 12. access to firearms 13. incarceration |
Prevention is most likely to succeed if early intervention for s/s of depression, etc followed by tx and education.
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What percentage of the elderly suffer from depression and what are they commonly misdiagnosed with?
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55% suffer from depression; most likely to be misdiagnosed with alzheimer's or dementia
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What are Elizabeth Kubler-Ross's stages of dying?
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Stage 1: Denial
disbelief shock that gradually remits Stage 2: Anger Rage and resentment toward others or G-d Difficulty relating to dying person Stage 3: Bargaining Try to strike a deal with fate, G-d or others Stage 4: Depression Deep sadness as dying person becomes more weak and uncomfortable Fear of Death may occur Sense of tremendous loss Stage 5: Acceptance Void of feeling Dying person's struggle against death ends |
this is foundation for grief process; does not happen in order
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What does the NASW state in regards to Cultural Competence and Social Diversity?
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1. Social Workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.
2. Social workers should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups. 3. Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sexual orientation, age, marital status, political beliefs, religion, and mental or physical disability. |
In all cases, social workers should use the social work skills of empathy, caring,and strengths-based assessment and treatment.
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Describe the Ethnographic Approach.
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Culture is viewed as fluid, evolving, heterogeneous,and conflictual rather thatn as static, fixed, cohesive, and unified. Derived from the field of anthropology.
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The client becomes the cultural guide for the social worker.
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What is the goal of using the Ethnographic Approach?
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The goal is for the sw to understand the client's experiences as he or she has felt, lived, and known the experience. To understand the client's frame of reference.
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What are the 3 broad categories related to Culturally Competent Social Work?
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1. Attitude of Social Worker
2. Knowledge 3. Skills of the Social Worker |
should be applied to any client when working on the micro, meso, or macro level
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Describe the important aspects of the Attitude of the Social Worker.
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1. Self Awareness
2. Consider the client as individual first and then as member of group 3. understand the difference within and across all groups and recognize the strengths of each group and each individual in group 4. therapeutic relationship can be viewed as a two-way learning for sw and client 5. attempt to understand client's distressing experience, as well as the impact of oppression and discrimination in the client's daily life 6. seek to understand beliefs and behaviors of the client's culture that are in conflict that are in conflict with the laws of the culture in which the client presently resides 7. respect the client's privacy and confidentiality and make every effort to ensure truly informed consent 8. sw cannot refuse to work with a client solely because of the client's race, ethnicity, sexual orientation, or disability. if a sw has a valur difference with the client but chooses to work with them anyway the sw must respect the client's choices |
Must be able to apply basic principles of sw practice to all persons, including recognizing and building upon their strengths.
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What knowledge base are sw's expected to have?
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1. should continually read books and professional journals, attend workshops and use consultation in an attempt to understand many issues of cultural diverse clt's
2. attend activities of divers populations 3. ask client for information and clarification about beliefs, values, and behaviors that the sw does not understand 4.make an effort to learn as much as possible about the client's native language and use an interpreter if necessary |
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Discuss the importance of SW Skills
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1. engage the client as partner in therapeutic process
2. let the client know that he or she has clinical expertise and some knowledge about client's culture, but that client is expert on culture 3. use culturally sensitive language when explaining in the first sentence that the client will be cultural guide 4. focus on developing therapeutic relationship by using basic principles of social work practice 5. sometimes beneficial to match client with sw of similar background, but not always possible. in such cases discuss openly with client any past negative experiences that are leading to transference 6. therapy styles may need to be modified when working with diverse clients 7. make sure client agrees with tx and tx does not conflict with client's belief system 8. first interview sw should offer suggestions that may be immediately helpful 9.utilize client's cultural resources when tx planning 10.be attuned to variations in non-verbal behavior and not misinterpret for pathology |
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What is Ethnographic Interviewing?
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This allows the sw to depart for the traditional technique of listening for the underlying "feelings" associated with the client's words to listening for the underlying "cultural meaning". Restate and incorporate terms and phrases used by client rather than rephrasing and reframing the terms and phrases. Do not assume that you understand every word spoken and ask the client to clarify terms or statments as they relate to client's culture.
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This way the client prioritizes needs and concerns rather than the social worker doing it for them.
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What is a cultural assessment tool?
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Elaine Congress developed a Culturagram which is a family assessment tool that is intended to individualize culturally diverse families.
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Name the 10 areas which are examined when using a Culturagram.
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Reasons for relocation
Legal status Time in community Language spoken in home and in community Health beliefs Crisis events Holidays and special events Contact with cultural and religious institutions Values about education and work Values about family including structure, power, myths and rules |
see page 54 in study guide for questions in a cultural evaluation
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What information does a cultural evaluation provide for the social worker?
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It gives information about the client's cultural beliefs, values, behaviors, and support system.
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see p. 54 in study guide for list of questions
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Theorists like Leon Chestang assert that everyone is part of what two systems?
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The Nurturing System and the Sustaining System
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Describe the Nurturing System.
|
The Nurturing System consists of the individual's family, intimate friends, and the immediate community.
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The nurturing system is one in which a person is viewed and treated as a unique individual who is loved for who he is by his family, friends and neighborhood acquaintances in his immediate environment.
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Describe the Sustaining System.
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The Sustaining System consists of institutions of the larger society.
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The sustaining system is one in which that same individual receives his education, is employed, and is involved int the economic and political world.
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What is the "dual perspective" concept that Chestang describes?
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Dual perspective is where an individual must constantly shift between the safe culture of loved ones and the dominant culture of the larger society, evaluating what kind of behavior is expected in each.
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It is important for the social worker to recognize the daily challenges that clients face while living in the Nurturing and Sustaining Systems.
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What might cultural norms influence?
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Cultural norms may influence how the client understands his own issues and may affect how they view and utilize social services.
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Describe the different forms of adaptation that Bicultural Identity can take.
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Traditional Adaptation:
exhibit strong ethnic identity Marginal Adaptation: often results in cultural conflict Assimilation: learn to value norms of Sustaining System and devalue norms of their ethnic group Bicultural Adaptation: individuals INTEGRATE the norms, values, and beliefs of their ethnic group and of larger society |
see pages 56-58 in study guide for details on ethnic groups
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What stages are in the coming out process?
|
1. Identity Confusion
2. Recognition of gay or lesbian identity 3. Exploration and experimentation relative to gay or lesbian identity 4. Disclosure of identity to others 5. Acceptance of gay or lesbian identity 6. withdrawal from the heterosexual world 7. Pride in identity 8. Increased disclosure to others 9. Re-involvement in heterosexual world 10. Broadening focus beyond gay or lesbian sexual orientation |
Important note: the client may be in a different place of acceptance than the process of family members; loved ones may need time to adjust; therapy should be related to the stage of coming out if that is what the presenting issue is; tx should focus on problem solving, social skills, and assertiveness
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What is Transgender?
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Can be heterosexual, bisexual, homosexual, or non-sexual; believes that his or her physical body does not represent his or her true sex; current tx is to view transgender individual's in terms of social and political ramifications rather than as dysfunctional; sw's should address related family issues
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Sexual orientation is completely different from gender identity. Gender identity refers to the individual's sense of self as a man or a woman. Cross dresser's usually do not have gender identity issues they just like to dress in clothing of the opposite sex.
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List and define terminology used to identify non-heterosexual sexuality, sexuality, sexual anatomy, or gender identity.
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Gay/Lesbian:
attracted to the same sex Bisexual: attraction to both men and women Pansexual: attraction that is based upon the individual, not the sex Transgender: refers to gender identity as male or female Transsexual: Desire to live and be accepted as a member of the opposite sex; generally with a desire to change one's body through surgery or hormone therapy Intersex: ambiguous sexual anatomy, also referred to as hermaphrodite Genderqueer and Intergender: catch-all terms for gender identities other than man and woman |
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How has the Feminist Theory contributed to the field of Women's Issues?
|
helping to clarify the nature of inequality between gender
further promoting women's rights, issues and interest examining the history of feminism in areas such as reproductive rights, sexual objectification, language, literature, films, art, interpretation of history, treatment of women, social status, oppression and other related areas |
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What are some ways in which spirituality can be viewed?
|
an orientation in life
a source of inspiration universal connectedness, expressed in energy, cause and effect, and mystical theories a spiritual path in the search for meaning in life, which can include organized religion or other forms of spirituality |
sw's need to be respectful of the diversity of client's belief system and if appropriate utilize those beliefs in treatment
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What types of problems are the elderly faced with?
|
series of losses: retirement, independence, ability to perform daily activities, loss of friends and relatives to death, loss of importance, and impending loss of own life
Unfinished business: depression is common and higher risk of suicide (integrity vs. despair) |
may experience side effects from medication; may not get the attention they need or may feel guilty because someone else has to care for them
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What is included in the multi-modal approach that social workers need to take when working with the elderly?
|
addressing physical, psychological, and social needs; tx includes case management, coordination of services, referral services and mental health services; individual therapy includes helping the person to grieve their losses, setting realistic expectations, preserving as much autonomy as possible, and finding meaning in life; therapy should have a structured/gentle approach with therapist taking an active role
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sw's offer support, validation,a nd explore options for services; work with family members and caregivers; crisis intervention and referral for adult protective services may be necessary
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How does Macionis define a disability?
|
A disability is a physical or mental condition that limits everyday activities.
|
about 49.7 million Americans of all ages have a disability; about two-thirds of those have a severe disability
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|
Name the four disease stages that individuals with HIV face.
|
1. Acute infection
2. Asymptomatic 3. Symptomatic or Chronic 4. AIDS (Acquired Immune Deficiency Syndrome) |
Once diagnosed there is a long period of emotional and psychological adjustment with the individual experiencing denial, anger, depression, and hopelessness.
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During the period after being diagnosed with HIV, individuals generally go through a long phase of emotional and psychological adjustment. What psychiatric diagnosis are they most at risk for during this phase?
|
Adjustment Disorder
Anxiety Depression |
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|
What losses may be faced by HIV and AIDS clients?
|
loss of support from their social group; loss of phsysical functioning; loss of financial security; possible loss of jobs; loss of self-esteem; loss of life goals; and possible impending loss of their own lives
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What should mental health tx focus on when working with HIV and AIDS clients?
|
focus should be on helping the client deal with the here and now and learning new ways of coping and problem solving
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SW's need to help HIV and AIDS clients engage in lifestyle changes
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|
What are some tx strategies which may be beneficial to HIV and AIDS clients?
|
CBT
Support Groups Psychotherapy Groups Crisis Intervention as needed (especially in final stage) |
increased risk of suicide with this population
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|
Name some factors to consider when working with military veterans returning home from deployment.
|
"military culture" and "warrior mentality": soldiers view themselves as part of a brotherhood of support
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returning veterans find themselves lost when trying to reintegrate into society. Women returning home have resulted in issues not previously seen.
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|
What types of injuries and psychological issues are returning veterans dealing with today?
|
more head and limb injuries
Increase in: PTSD; TBI (traumatic brain injury); sexual trauma, for both men and women |
due to better body armor their are less casualties, but more trauma to head and limbs; families are requiring services as well and children are experiencing secondary PTSD and other issues
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|
Describe some other issues faced due to re-integration.
|
sleep issues; anxiety; numbness; hyper-vigilance; substance abuse; desire to return to active duty; marital difficulties are common
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What social work strategies are helpful with veterans?
|
Acknowledge that you do not understand what the veteran has experienced
Be patient Be cognizant of coping mechanisms used by the veteran Encourage the veteran to tell his or her story Avoid insensitively worded questions such as "Did you kill anyone?", "Did you see anyone killed?", and "Did you see any dead bodies?" Provide information and help obtaining government and community resources for the veteran and family |
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|
List some therapeutic interventions that have been effective with veterans.
|
CBT
Solution Focused Brief Therapy Acceptance and Commitment Therapy (ACT) Narrative Therapy Family and Couples Therapy EMDR |
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What is the NASW Standard for Cultural Competence in Social Work Practice?
|
requires social workers to "be knowledgeable about and skillful in the use of services available in the community and broader society and be able to make appropriate referrals for their divers clients"...and to "be aware of the effect of social policies and programs on diverse client populations, advocating for and with clients whenever appropriate.
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NASW code of ethics was amended in 2008 to prohibit discrimination of clients based on "immigration status".
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|
Name the NASW policies regarding immigrants that support specific goals related to undocumented individuals and their families.
|
To guarantee that the human service and education needs of all children are met regardless of their or their parents' legal status
To ensure access to emergency health and mental healthcare for all immigrants To ensure appropriate immigration-related services to undocumented minors in foster care, and, if they are eligible, adjustment of their status before they leave foster care To provide for efforts to remove penalties on the children of undocumented immigrants based on their parents' actions To protect all immigrants from family violence, including the undocumented, with provisions to protect women from gender-specific forms of violence. To oppose mandatory reporting of immigration status by health, mental health, social service, education, policy, and other public service providers. |
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Who has rights to benefits and services in the US as defined by federal law?
|
All RESIDENTS of the US regardless of immigration status.
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If SW have a case where they must disclose client information, the NASW code of ethics creates an expectation that these clients be fully informed in their own language, prior to the release of information.
|
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Describe what the NASW code of ethics identifies as Social Justice.
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Social Justice is one of the major ethical issues identified by NASW, stating, "Social workers pursue social change; particularly with and on behalf of vulnerable and oppressed individuals and groups of people. Social workers' social change efforts are focused primarily on the issues of poverty, unemployment, discrimination, a nd other forms of social injustice. Social workers strive to ensure access to needed information, services and resources; equality of opportunity and meaningful participation in decision making for all people."
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these activities seek to promote sensitivity to and knowledge about oppression and cultural and ethnic diversity
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|
What are Social Workers' ethical responsibilities to broader society as defined by the NASW?
|
1. Promote the general welfare of society. Advocate for living conditions conducive to the fulfillment of basic human needs and should promote social, economic, political, and cultural values, and institutions that are compatible with the realization of social justice.
2. Facilitate informed public participation in shaping social policies and institutions. 3. Provide appropriate professional services in public emergencies to the greatest extent possible. 4. Engage in social and political action that seeks to ensure that all people have equal access to the resources, employment services, and opportunities they require to meet their basic human needs and to develop fully. 5. Act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups. 6. Promote conditions that encourage rewpect for cultural and social diversity with the US and globally. Promote policies and practices that demonstrate respect for difference, support the expansion of cultural knowledge and resources, advocate for programs and institutions that demonstrate cultural competence, and promote policies that safeguard the rights of and confirm equity and social justice for all people. 7. Social workers should act to prevent and eliminate domination of, exploitation of and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability |
Be aware of the impact of the political arena on practice and advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice.
Organizations, agencies, institutions and businesses that exhibit and promote cultural competence will integrate diversity into their policies, procedures, hiring practices, and training. Social workers and members of diverse populations must participate in political office, administrative positions, program planning, policy-making, and serving on boards of directors in order to achieve social and economic justice. |
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What does Assessment refer to?
|
Assessment is the process of arriving at tentative conclusions about the nature of client's situation, including problems and resources. This is the basis for treatment planning. Should be an ongoing process.
|
Mary Richmond was one fo the first to concentrate on assessment and diagnosis.
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|
What aspects of the client's internal and external experience should the assessment focus on?
|
Internal:
Biophysical functioning Use and abuse of substances Cognitive and preceptual functioning Emotional functioning Mental disorders Behavioral functioning Motivation Degree of acculturation Language fluency Problem Solving Skills External: Health and safety factors Social Support Systems Environmental needs of adults and children Cultural norms Educational support and needs Precipitating events that brought the client to seek social work services |
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What are the areas that the client's self report should focus on?
|
Problem area: identified from client's point of view; be careful if psychiatrically unstable
Strengths: need to be identified; may need direction from sw to identify own strengths Support System: resiliency may be determined by having at least one significant individual in client's life Attitude: positive (hope that things will get better) or negative (defeatist or persecutory) Level of Motivation Use of Resources: personal and environmental (ex. problem solving skills, faith or spirituality, cultural values, cognitive abilities, and dependence on his or her support system Danger to Self or Others: if yes then take immediate action |
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|
What should observation based data include?
|
Appearance: note any condition relevant to understanding client (ex. body weight, physical disabilities, health, facial affect, grooming, etc)
Health concerns: observe in addition to reading medical record; look for self care, cognitive ability, emotional functioning, and social skills; also look for possible substance use/abuse Life Skills: indicative of functioning (strength or limitation); depending on age note mobility, money management, cleanliness, personal hygiene, communication skills, organizational skills, social skills, problem-solving skills, self care, and work skills |
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|
When to refer for additional evaluation.
|
After subjective and objective assessment, the sw may decide to refer for additional evaluation such as formal psychological testing, psych eval, vocational testing, or med eval
|
may need to refer to another professional or agency. explain why to client and facilitate process. follow up with individual to whom the client was referred and use that info to complete assessment,
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|
Assessment of Problem Areas and Strengths
|
Biopsychosocial Model: how the body's functioning may contribute to current problem
Psychological: emotions, thinking processes and behaviors Social: role of environment, culture, socioeconomic status, poverty, and spirituality in the clt's health NEXT: identify current level of functioning, strengths and weaknesses, mental health status, needs |
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Medical Model
|
focuses on pathology or what is "wrong" with client
|
social workers explore strengths, resiliency and positive life function in addition to problem area
|
|
Strengths Perspective
|
strengths are essential in healing process; incorporating them will aid in empowering clt to reach desired goals
|
what is wrong with the clt often reinforces the powerlessness of the clt in current situation
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Strengths Perspective of Assessment
|
Empowers clt to solve own problems
Examines possible alternatives Teaches competencies Creates more equity between the client and social worker builds self confidence helps clts to see that problems are influenced by multiple factors, are interactive, and are ever changing |
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Social History
|
focus on strengths of client as well as problem areas; should include info from multiple sources
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|
|
Identify presenting problem
|
Why clt was referred to agency or setting; reason from viewpoint of agency, clt and family
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Referral Problem
|
the primary reason for seeking help; the problem that needs to be address FIRST
|
may be differing opinions about primary problem; all perspectives should be stated in social history
|
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Gathering Data via interviewing and observation
|
begins in intake
topics include: problem areas, strengths, support system, attitude of clt, clt motivaation, clt's resources, danger to self and others, appearance, health and life skills |
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Records
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both current and past; need to have clt release to obtain info from outside sources
|
Compliance with HIPPA
|
|
Assessment Instruments
|
any tests or asssessments that have been given to the clt are necessary pieces of info for the formulation of a diagnosis and treatment plan
|
90% of errors are dx
|
|
Suicide Risk
|
requires timely assessment; "no harm" contract for ideation without plan; admit to hospital if ideation with plan
|
involuntary commital requires emergency services and significant others
|
|
Specific Domains of Mental Status Exams
|
Appearance: age, height, weight, grooming
Attitude: cooperative, uncooperative, hostile, guarded, suspicious Behavior: observation of level of activity, abnormal movements, eye contact, gait Mood: described by clt in own words; internal emotional state Affect: the emotion conveyed by the clt's nonverbal behavior; evaluated by appropriateness, intensity, range, reactivity and mobility (subject to CULTURAL INFLUENCES) Speech: production rather than content; include ability to name objects, produce specific words in a set time and repeat short sentences Thought Process: quantity, rate and form (coherent or logical); can't be directly observed only inferred from clt's speech; flight of ideaas, poverty of speech, perseveration; a formal thought disorder may be exhibited by thought blocking; loosening of associations, tangential thinking, derailment, circumstantial Thought content: delusions, obsessions, phobias, over valued ideas, and preoccupation; abnormalities measured by open ended conversational type questions; delusions (paranoid, grandiose, erotomanic, jealousy, reference); thought withdrawal, Insertion, broadcasting Perception: sensory experience; main distortion is hallucination (auditory, visual, tactile, gustatory, olfactory); distortion of sense of time, depersonalization, derealization Cognition: level of alertness, orientation, attention, memory, language and executive function Insight: the individual's understaqnding of his or her problems and tx options; on a continuum Judgement: ability to make sound, reasoned and responsible decisions |
Abnormal movements or tremors may include: tics, catatonia, repetitive purposeless movements, odd mannerisms, restlessness, psychomotor agitation, or retardation
Mood states: neutral, euthymic (normal), depressed or dysphoric, euphoric, angry, anxious, indifferent (apathetic), anhedonic (inability to experience pleasure) Types of Affect: full range, restricted, blunted, flat, labile, congruent, incongruent, exaggerated, or dramatic |
|
Documentation
|
SOAP notes:
subjective observation objective data assessment plan BIRP notes: Behavior of clt Intervention of sw on behalf of that documented behavior Response to intervention Plan |
|
|
DSM Classification:
|
Axis I: Clinical Disorders
Other conditions that might be the focus of tx (V codes) Axis II: Personality Disorders (V codes) Mental Retardation Borderline Intellectual Functioning (V code) Axis III: General Medical Condition or current medical conditions that have potential relevance to the understanding and management of the disorders on Axis I or II Axis IV: Psychosocial and Environmental Problems Axis V: GAF sw's judgement of overall functioning |
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Specifiers
|
Mild
Moderate Severe In Partial Remission In Full Remission Prior History |
|
|
Mental Retardation
|
Mild IQ 50-70
Moderate IQ 35-55 Severe IQ 20-40 Profound IQ less than 25 |
Teachable
Trainable Total Care Institutionalization |
|
Learning Disorders
|
Reading Disorder
Math Disorder Disorder of Written Expression |
significantly impair person's ability to perform activities of dailing living or in academic area
|
|
Motor Skills Disorder
|
Developmental Coordination Disorder: only motor skills disorder in the DSM
|
not the result of medical condition or PDD
|
|
Communication Disorders
|
Expressive Language
Receptive Language Mixed Receptive-Expressive Phonological Stuttering |
|
|
PDD
|
serious impairment in social interaction skills, communications skills, or stereotypical behavior or interest; frequently involve mental retardation
|
Rhett's disorder: primarily girls; after post birth normal development; decrease in head grown, loss of mother skills, social engagement and language development
Autistic Disorder: significant impairment in communication, social interaction, restricted range of interest (respirdone to tx irritability; no single tx) Childhood Disintegrative Disorder: significant loss of skills after seemingly normal development for the first 2 yrs of life (no medication unless for depression or to decrease anxious behavior; behavior therapy programs; rewards to reinforce desirable behavior) Asperger's: impairment in social interaction that is both severe and sustained; nonfunctional repetitive/stereotypical behavior, interest, activity in the absense of significant delay in language, cognition or self help skills; has adaptive behavior that does not include social involvement and interest in environment (psych meds for specific behaviors; hyperactive, inattention and impulsive may use psychostimulents, clonidine, trycyclics, or Strattera/ for irritibility and aggression may use mood stabilizer, beta blockers, clonidine, naltrexone, or neuroleptics/ tricyclics or SSRIs for compulsions, obsessions, ritualistic behavior/ for anxiety try SSRIs or tricyclics; behavior mod, educational intervention, individual psychotherapy to help learn social skills, detect social cues, deal with emotions around dx |
|
ADD/ADHD/ and Disruptive Behavior Disorders
|
ADD/ADHD
combined type predominantly inattentive type predominantly Hyperactive-Impulsive type (tx focus on meds such as stimulents or Strattera, tricyclics effective in some adults; therapies include individual psychotherapy, behavior mod, social skills; psychotherapy and meds preferred for adults Conduct Disorder: Before 10 yrs called Childhood-Onset type/ onset at 10 or later called Adolescent-Onset (more common in males; females tend to runaway more) pattern of violating the rules and norms of society and the rights of others in a variety of settings (may have aggression with animals or people, destruction, dishonesty, truancy, stealing, runaway); meds used only if Axis I disorder present; tx is difficut due to nature of behavior CBT and support for family most effective, tx rarely brief Oppositional Defiant Disorder: present for at least 6 months; negative, hostile, defiant; dx when does not meet criteria for Conduct Disorder (or Antisocial if over 18); behavior not due to mood disorder; more common in males before puberty/ females after puberty; meds not currently recommended; Behavior Mod through parent training, parent training may be more effective than family therapy |
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|
Feeding and Eating Disorders
|
Pica: persistent eating of at least 1 nonfood item for a at least 1 month; no standard tx, Behavior Mod
Rumination Disorder: repetitive regurgitation and rechewind of food over at least 1 month; onset preced by period of normal functioning; tx based on cause of behavior/ Behavior Mod may extinguish behavior Feeding Disorder of Infancy or Early Childhood: failure to eat a sufficient quantity of food with failure to gain or maintain weight; must occur over at least 1 month period; not the result of medical or mental disorder or inabillity to access food |
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|
Tic Disorders
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Tourette's: multiple motor tics and minimum of one vocal tic over the cours of the disorder; must occur multiple times per day almost every day or intermittently for more than 12 months; no more than 3 consecutive months that are considered "tic free"
Chronic Motor or Vocal Tic Disorder: single or multiple motor tics or vocal tics over more than 1-yr period and occur repeatedly in a day, on most days, or occur intermittently with a max of 3 tic free consecutive months Transient Tic Disorder: single or multiple motor and/or vocal tics occuring repetitively over a day's time, on most days, for a minimum of 4 weeks and a max of 12 consecutive months; not previously met other criteria |
no specific meds; antipsychotic meds and anti-hypertensive med to decrease tics
Habit Reversal Training (HRT) to increase tic awareness and develop competing response; based on presencce of premonitory urge (or sensation) just before tic/ replace with alternate response |
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Elimination Disorders
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Encopresis: at least 4 yrs old; one event each month over at least 3 months and not directly related to substance or medical condition; may be voluntary or involuntary; tx to prevent constipation and encourage good bowel habits; therapy may be needed to reduce shame, guilt or loss of self esteem
Enuresis: at least 5 yrs old occuring at least 2x a week for over at least 3 consecutive months or must result in significant distress or impairment; may be voluntary or involuntary; tx focus on behavior; meds may be desmopressin acetate (DDAVP); most important reason to treat is minimize embarrassment and anxiety and frustration of child and parent/ help child feel not alone by talking with someone/ Behavioral Approach |
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Separation Anxiety
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evident for a minimum of 4 weeks and onset before age 18; developmentally normal in infants and toddlers to approx 3-5 yrs; r/o panic disorder with agoraphobia first; meds include Prozac (fluoxetine)/only SSRI approved by FDA for those younger than 18 yrs, used when functional impairment is moderate to severe; CBT/ focus on skill building, recognizing anxious feelings re physical reaction, thoughts in anxious situations, plan how to cope adaptively; younger children use play therapy; children's success praised highly by therapist and parent
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Selective Mutism
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persistent failure to speak in certain situations with a demonstrated ability to talk as evidenced by doing so in other situations; lasts minimum of 1 month and cannot be during first month of school; slightly more common in females; some cases treat with meds such as Prozac/more successful in younger children/reduces sx in about 3/4 of children; Behavior Mod techniques using positive reward for speech and withheld when silent, stimulus fading involves finding motivating "stimulus" for child to speak in mute situations/a trusted parent is often good "stimulus"/ particularly effective when paired with positive reinforcement techniques
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Reactive Attachment Disorder of Early Childhood
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disturbance in ability to relate in most social situations; onset before age 5
Two Types: Inhibited type- failure to initiate and respond to social interaction in a manner consistent with the individeual's developemental level Disinhibited Type- indiscriminate sociability (lack of boundaries) Meds not indicated unless other Axis I disorder; no standard tx |
Typically evidence of abuse, neglect and frequenjt changes of caregivers; dx fairly uncommon
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Stereotypic Movement Disorders
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repetitive, nonfunctional motor behavior, such as body rocking, head banging and biting oneself; disrupts individual's life and has potential to cause physical injury; not result of compulsion, tic or PDD; must continue for minimum of 4 weeks; Prozac, Zoloft and Luvox (SSRIs) or Anafranil (tricyclic) may help; goal of tx is to ensure safety, as well as improve ability to function, surroundings modified as necessary, aim to reduce stress that may trigger movements, relaxation techniques to help resist urges
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Delirium, Dementia, Amnestic and Other Cognitive Disorders
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significant decline in cognition caused by either the direct effects of a sustance or toxin, or a medical condition, or both; substance or medical condition is provided as part of dx
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Delirium
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disturbance in the level of consciousness; onset over a brief time; often clears when condition relents
1. Due to General Medical Condition 2. Substance Induced Delirium 3. Due to Multiple Etiology 4. Delirium NOS (Indeterminate Etiology |
Tx is finding etiology and treating underlying cause
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Dementia
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impairment in a number of cognitive abilities, including memory and often becomes progressively worse over time
1. Dementia of Alzheimer's Type 2. Vascular Dementia 3. Dementia Due to Other General Medical Conditions 4. Substance-Induced Persisting Dementia 5. Dementia Due to Multiple Etiologies 6. Dementia NOS (Indeterminate Etiology) |
cannot be cured; med may improve mental function, mood and behavior; meds include Aricept, Reminyl, Exelon and Namenda/ Antidepressants for depression/Anxiety, agitation, and hallucinations may be treated with antipsychotics; goal of tx is to keep person safe/make adjustments to home, use calendars for memory, maintain good nutrition and sleep; nursing home may be necessary
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Amnestic Disorder
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impairment in memory solely
1. Due to General Medical Condition 2. Substance-Induced Persisting Amnestic Disorder 3. Amnestic Disorder NOS (indeterminate etiology) |
no tx proven; many recover slowly over time; sometimes recover past memories; generally recover from transient global amnesia w/o tx
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Cognitive Disorders NOS
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do not meet criteria for for specified disorders, but impair cognitive function
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Mental Disorders Due to General Medical Condition
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involve sx that appear to have resulted directly from physiological changes associated with medical condition
3 Criteria: a. good evidence that problem is directly related to medical condition b. does not meet criteria for other mental disorder that can cause observed sx c. sx occurred in absence of delirium; meds are specified to underlying etiology of given mental disorder |
Catatonic Disorder
Personality Change Mental Disorder NOS Delirium Dementia Amnestic Disorder Psychotic Disorder Mood Disorder Anxiety Disorder Sexual Dysfunction Sleep Disorder (all followed by phrase: Due to General Medical Condition) |
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Separation Anxiety
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evident for a minimum of 4 weeks and onset before age 18; developmentally normal in infants and toddlers to approx 3-5 yrs; r/o panic disorder with agoraphobia first; meds include Prozac (fluoxetine)/only SSRI approved by FDA for those younger than 18 yrs, used when functional impairment is moderate to severe; CBT/ focus on skill building, recognizing anxious feelings re physical reaction, thoughts in anxious situations, plan how to cope adaptively; younger children use play therapy; children's success praised highly by therapist and parent
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Selective Mutism
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persistent failure to speak in certain situations with a demonstrated ability to talk as evidenced by doing so in other situations; lasts minimum of 1 month and cannot be during first month of school; slightly more common in females; some cases treat with meds such as Prozac/more successful in younger children/reduces sx in about 3/4 of children; Behavior Mod techniques using positive reward for speech and withheld when silent, stimulus fading involves finding motivating "stimulus" for child to speak in mute situations/a trusted parent is often good "stimulus"/ particularly effective when paired with positive reinforcement techniques
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Reactive Attachment Disorder of Early Childhood
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disturbance in ability to relate in most social situations; onset before age 5
Two Types: Inhibited type- failure to initiate and respond to social interaction in a manner consistent with the individeual's developemental level Disinhibited Type- indiscriminate sociability (lack of boundaries) Meds not indicated unless other Axis I disorder; no standard tx |
Typically evidence of abuse, neglect and frequenjt changes of caregivers; dx fairly uncommon
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Stereotypic Movement Disorders
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repetitive, nonfunctional motor behavior, such as body rocking, head banging and biting oneself; disrupts individual's life and has potential to cause physical injury; not result of compulsion, tic or PDD; must continue for minimum of 4 weeks; Prozac, Zoloft and Luvox (SSRIs) or Anafranil (tricyclic) may help; goal of tx is to ensure safety, as well as improve ability to function, surroundings modified as necessary, aim to reduce stress that may trigger movements, relaxation techniques to help resist urges
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Delirium, Dementia, Amnestic and Other Cognitive Disorders
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significant decline in cognition caused by either the direct effects of a sustance or toxin, or a medical condition, or both; substance or medical condition is provided as part of dx
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Schizophrenia
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Positive Symptoms: hallucination (a perception w/o an accompanying external reality)delusions, disorganized speech, inappropriate affect, disorganized behavior
negative symptoms: flat or blunted affect; avolition, alogia, decrease in the amount of speech or poverty of content of speech, anhedonia |
avolition: loss of willpower or decisiveness
alogia: speech disturbance involving poverty of speech (speech that contains little or no meaningful information) anhedonia: loss of ability to experience pleasure |
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3 Phases of Schizophrenia
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1. Prodromal: decline in role functioning and precedes active phase (full blown criteria not yet met)
2. Active Phase: full-blown sx (ex. delusions, hallucinations, severly disorganized speech) 3. Residual Phase: follows active phase; psychotic sx have improved but impairment continues |
continuous signs of disorder for minimum 6 months to receive dx; mood disorder during active phase have to be relatively brief/ otherwise Pchizoaffective Disorder or Mood Disorder with Psychotic Features should by r/o; active phase lasts at least 1 month unless tx has decreased sx
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Subtypes of Schizophrenia
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1. Paranoid Type: prominent delusions; typically of persecutory or grandiose type or audityory; other sx not prominent
2. Disorganized Type: disorganized speech ad behavior as well as flat or inappropriate affect 3. Catatonic Type: minimum of 2 of the following a. motor immobility: catalepsy or stupor b. excessive purposeless movement (unrelated to external stimuli) c. negativism or mutism d. peculiar voluntary movement e. echolalia or echopraxia 4. Undifferentiated Type: does not meet other criteria 5. Residual Type: minimum of one full blown episode; continues to have impairment but in the absence of prominent psychotic sx |
catalepsy- rigid maintenance of posture over extended period of time
stupor- unresponsive, immobile, mutism negativism- resistance to instruction, rigid posturing or resistance to being moved |
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Med Management and Tx for Schizophrenia
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meds: combo of antipsychotic, antidepressant, and anti-anxiety depending on type of sx
Treatment: wrap around services including social skills, education, independent living assistance, case management, and med compliance; group therapy helpful when reality based, solution focused, task centered; family therapy decreases relapse rates; community and support groups helpful |
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Schizophreniform Disorder
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Differs from Schizophrenia in 2 ways: may not experience impairment in social or occupational functioning; sx of disorder are minimum 1 month and less than 6 months; continues beyond 6 months change to Schizophrenia
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meds and tx similar to Schizophrenia
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Schizoaffective Disorder
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major depressive, manic or mixed episode in combo with sx of Schizophrenia; delusions or hallucinations during 2 week period when prominent mood sx not present; mood sx need to be prominent part
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tx antipsychotics and individual therapy; problem solving approach
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Delusional Disorder
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minimum one non-bizarre delusion and evident for minimum 1 month; may be accompanied by tactile or olfactory hallucinations if related to delusion; psychosocial function apart from delusion is normal; concurrent mood episode brief
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Subtypes:
Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified meds are only marginally effective; some antipsychotics help delusions temporarily; Individual therapy most helpful/ client therapist relationship most important |
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Brief Psychotic Disorder
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Schizophrenic sx; evident at least 1 day, no more than 1 month; specify with marked stressors or w/o marked stressors
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with postpartum onset-sx appear 4 weeks postpartum
if specific stressor, remove stressor, brief hospitalization and/or antipsychotics may be necessary |
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Shared Psychotic Disorder
(Folie a Deux) |
delusion in and individual closely involved with another individual who has prominent delusion
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Benzos can help alleviate intense sx after removal from primary person; therapy focus on individual
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