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67 Cards in this Set
- Front
- Back
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What are the four steps involved in constructing a differential diagnosis?
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First: Gather a database of relevant information about the client/patient and their situation, including presenting problem, history of presenting problem, other relevant history, the Mental Status Exam, and any relevant testing.
Second: Identify (rule in) diagnoses that are suggested by information in your database. Third: From the diagnoses you have just identified (ruled in), rule out diagnoses that are contradicted by other information in your database. Fourth: Consider the diagnosis/diagnoses that is/are left, after Step 3, in terms of how well they fit with your database; then make the best diagnosis you can, indicating any level of diagnostic uncertainty and any significant rule-outs. (“Rule-outs,” in this sense, are diagnoses that you don’t believe you can make currently with the information at hand, but which are suggested by your database and for which you and other clinicians need to be on the lookout.) |
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What sort of information goes on each of the 5 axes of the DSM?
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I.
Clinical Disorder Other Conditions That May Be a Focus of Clinical Attention II. Personality Disorders Mental Retardation Prominent maladaptive personality features and defense mechanisms (A ‘V Code,’ V62.89 Borderline Intellectual Functioning, is also coded on Axis II) III. General Medical Conditions (with ICD-9-CM codes) IV. Psychosocial and Environmental Problems V. Global Assessment of Functioning, using the GAF Scale. In addition, the Social and Occupational Functioning Assessment Scale (SOFAS), the Global Assessment of Relational Functioning Scale (GARF), and the Defensive Functioning Scale, may be used. |
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Which of the following statements is true concerning Dorothea Dix?
a. Dorothea was a European who experienced the maltreatment first hand, and immigrated to America to escape the public’s insensitivity toward the mentally ill. b. America rejected Dorothea Dix’s efforts to improve conditions for the mentally ill and her life was threatened several times. c. Dorothea found the treatment of the mentally ill dehumanizing, and set out on a quest to improve their condition by lobbying in different states to get laws passed. d. Thousands of new hospitals for the insane were established in America during the mid to late 1800s yet very few adopted the humanitarian treatment set forth by Dorothea Dix. |
c. Dorothea found the treatment of the mentally ill dehumanizing, and set out on a quest to improve their condition by lobbying in different states to get laws passed.
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In using the DSM, what are three ways that levels of diagnostic uncertainty are indicated?
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1. By writing “(Provisional)” after the diagnosis
2. By indicating the class or subclass of disorder (e.g., Depressive Disorder), followed by “Not Otherwise Specified” or “NOS.” 3. 799.9 Diagnosis or Condition Deferred on Axis I; or Diagnosis Deferred on Axis II 4. By indicating the presence of a mental disorder, with enough evidence to rule out a particular class of disorders: e.g., Unspecified Mental Disorder (nonpsychotic) 5. V Codes on Axis I (for Other Conditions That May Be a Focus of Clinical Attention) |
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To the extent that an assessment method measures what it is supposed to measure and not something else, the assessment method is considered to have ____________.
a. predictive validity b. concurrent validity c. construct validity d. face validity |
c. construct validity
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1. In an epidemiological context, what are “sensitivity,” “specificity,” and “efficiency”?
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I. Sensitivity:
The proportion of individuals who actually have the condition who are correctly identified by the assessment procedure as having the condition ( TP/[TP + FN]) II. Specificity: The proportion of individuals who actually don’t have the condition who are correctly identified by the assessment procedure as not having the condition ( TN/[TN + FP]) III. Efficiency: The proportion of individuals who are correctly identified by the assessment procedure as either having, or not having, the condition ( [TP + TN]/Grand Total) |
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DEFINE:
positive predictive value |
positive predictive value (or, predictive value of abnormal assessment results)
The probability that a positive result from an assessment procedure is accurate: that is, that it’s a True Positive ( TP/[TP + FP] ) |
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Define:
negative predictive value |
negative predictive value (or, predictive value of normal assessment results)
The probability that a negative result from an assessment procedure is accurate: that is, that it’s a True Negative ( TN/[TN + FN] ) |
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How does the base-rate of a disorder in the population of interest affect the sensitivity, specificity, predictive values, and efficiency of an assessment for that disorder?
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The base doesn’t affect sensitivity, specificity, or efficiency at all, since those parameters are only about the assessment procedure itself. When the base rate of a condition in the population increases (holding sensitivity and specificity constant), then the positive predictive value goes up and the negative predictive value goes down. When the base rate of a condition in the population decreases (again, holding sensitivity and specificity constant), then the positive predictive value goes down and the negative predictive value goes up. In general, even using very good assessment procedures, “the problem of base rates” that you may at times hear referred to is that (a) when a
condition has a really low base rate, assessments will yield a lot of false positives, which will lower the predictive value of a positive result, though it will make the value of a negative result very high; and (b) when a condition has a really high base rate, assessments will yield a lot of false negatives, which will lower the predictive value of a negative result, though it will make the value of a positive result very high. |
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Define:
Prevalence |
The proportion of a population that has the condition during part or all of some time frame
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Define:
Point prevalence |
Point prevalence:
The proportion of a population that has the condition at one measurement (e.g., a survey that takes one or two days) |
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Define:
Period prevalence |
Period prevalence:
The proportion of a population that has the condition at any time during a specified period (e.g., one year) |
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Define:
Treated prevalence |
Treated prevalence:
The proportion of a population that is receiving treatment for a condition |
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Define:
Lifetime prevalence |
Lifetime prevalence:
The proportion of a population that has ever had the condition in their lifetimes to date |
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Define:
Incidence |
Incidence:
The rate at which new cases of the condition occur in a population—that is, the proportion of the population who become a new case—within some time period (e.g., six months, one year) |
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Define:
Incidence |
Incidence:
The rate at which new cases of the condition occur in a population—that is, the proportion of the population who become a new case—within some time period (e.g., six months, one year) |
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Define:
Relative risk |
Relative risk:
The incidence of developing the condition when the risk factor is present divided by the incidence of developing the condition when the risk factor is not present (with factor/without factor) |
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Define:
Odds ratio |
Odds ratio:
Analogous to Relative Risk: the odds of developing the condition with the risk factor, divided by the odds of developing the condition without the risk factor |
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Define:
Attributable risk |
Attributable risk:
The proportion of the population (exposed and not exposed) who develop a condition that is associated with a risk factor: the incidence of a condition for those with the risk factor minus the incidence for those without the risk factor (with factor - without factor) |
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In studies of the outcome of treatment(s) for clinical syndromes, does it matter whether outcome is measured in terms of client satisfaction rather than symptom levels or functioning levels? Why or Why Not?
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Yes.
Because they are not equivalent—knowing about satisfaction doesn’t tell you anything about symptoms and functioning, and vice versa. Although satisfaction and treatment success can be related in various ways, it’s fairly common for interventions that don’t really work—in terms of improving clients’ symptoms and functioning levels—to leave clients feeling satisfied. Also, some interventions work very well, but may also leave clients feeling stressed or dissatisfied in some other way. How clients feel about how they’re treated is important but, just because the results of an intervention study show that clients were satisfied doesn’t necessarily mean that they got better in terms of their actual symptoms and functioning level: in fact, they may have gotten worse. |
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In a between-groups study of treatment outcome, would you be concerned if there was significant attrition (drop-out rate) from only one of the groups?
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Yes
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In a between-groups study of treatment outcome, would you be concerned if there was significant attrition (drop-out rate) from all of the groups, if the proportion of drop-outs was the same in all groups?
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Yes
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In a study of treatment outcome that is intended to be a double-blind study and that includes a placebo control group, if participants in the treatment group(s) came to believe they were getting a real treatment rather than the placebo, how might this create a problem in interpreting the study results?
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Because if the participants know they’re getting the real treatment, (a) the positive effects on their morale and optimistic expectations may, in themselves, lead to improvement, and (b) participants may feel a pressure to rate themselves as better off, whether they are or not. Under these circumstances, figuring out whether the treatment itself had anything to do with helping people is usually impossible.
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In the same study, if participants in the placebo control group came to believe they were getting a fake treatment rather than a real treatment, how might this create a problem in interpreting the study results?
***(Reference: In a study of treatment outcome that is intended to be a double-blind study and that includes a placebo control group, if participants in the treatment group(s) came to believe they were getting a real treatment rather than the placebo, how might this create a problem in interpreting the study results?) |
Because, compared to the treatment group, clients’ morale might decrease, they might develop more negative expectations and feel more discouraged, and they might feel some pressure to rate themselves as doing more poorly than they actually were. Also, a subgroup of clients might get angry at getting no treatment and become even more determined to improve, which could further confuse interpretation of the results.
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Define:
statistical significance |
Is the likelihood that differences between
groups happened by chance—rather than because of the difference in treatments— acceptably low? |
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Define:
magnitude of effect |
How large are any differences between groups?
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Define:
clinical significance |
Do any differences between groups translate into changes that matter much to clients?
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Define:
efficacious |
Was the treatment being studied either better than no treatment, or equal to or better than another recognized treatment?
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Define:
effective |
Is the treatment useful in clinical, non-research settings?
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When looking at psychotherapy outcome studies as a whole, what factor appears to have the least to do with clients getting better?
1.) Placebo effects 2.) Relationship between the client and the therapist (specifically, the Working Alliance) 3.) Therapist believes in the type of therapy provided (allegiance) 4.) The specific model of therapy 5.) The specific therapist |
4.) The specific model of therapy
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When looking at psychotherapy outcome studies as a whole, what factor appears to have the
least to do with clients getting better? 1.) Placebo effects 2.) Relationship between the client and the therapist (specifically, the Working Alliance) 3.) Therapist believes in the type of therapy provided (allegiance) 4.) The specific model of therapy 5.) The specific therapist |
4.) The specific model of therapy
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For which cognitive disorder is a “reduced clarity of awareness of the environment” (also referred to as a “disturbance of consciousness,” and occasionally as a “clouded sensorium”) a required criterion?
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Delirium
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If an individual has developed a memory problem and one or more other cognitive problems, all of which are believed to be the direct physiological consequence of a medical condition and/or substance use, should that person be diagnosed with Amnestic Disorder?
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No
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Define:
“pseudodementia” |
Pseudodementia is any “functional” mental disorder (“functional” means that the mental disorder is not due to direct physiological effects of a substance or medical problem) that presents with symptoms (for example, indecisiveness, apathy, concentration difficulties leading to short-term memory problems) that make it look like dementia. The most common culprit in cases of “pseudodementia” is Major Depressive Disorder.
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What cognitive disorder is suggested when a person is having trouble focusing, sustaining, or shifting attention?
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Delirium
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When diagnosing dementia or amnestic disorder, why is it important to know about the person’s premorbid functioning?
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Because, in order to diagnose dementia or amnestic disorder, one has to believe that whatever cognitive deficits are present represent a significant decline from previous levels of functioning
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The three symptom clusters in the criteria set for Autistic Disorder are:
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a. qualitative impairment in social interaction
b. qualitative impairments in communication c. restricted repetitive and stereotyped patterns of behavior, interests, and activities |
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According to Newton, Litrownik, and Landswerk (2000), regarding the relationship of multiple changes of placement and problems measured by the Child Behavior Checklist, “high change children get worse, but “getting worse” is not attributable to volatile placement histories, independent of initial starting position, race/ethnicity, age, or gender.”
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False
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What two symptom clusters do Autistic Disorder and Asperger’s Disorder share?
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a. qualitative impairment in social interaction
b. restricted repetitive and stereotyped patterns of behavior, interests, and activities |
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True or False:
ADHD is overdiagnosed in both boys and girls. |
False
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True or False:
Citing Lewis, Balla, & Shanok, 1979, the text notes: “…in one area of Connecticut over a year …adolescents sent to psychiatric hospitals and those sent to jail were just as likely to have histories of violence and had equal levels of emotional problems. However, the adolescents sent to jail were much more likely to be European American than African American. It appears that disturbed European American adolescents are incarcerated, whereas disturbed African Americans are hospitalized.” |
False
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List four positive symptoms of active phase schizophrenia:
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1.) delusions
2.) hallucinations 3.) disorganized speech (reflecting formal thought disorder) 4.) grossly disorganized or catatonic behavior |
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In the context of schizophrenia, what is a “negative” or Type II symptom?
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The diminution or loss of normal functions; such as range and intensity of emotional expression (affective flattening), fluency and productivity of thought and speech (alogia), and/or initiation of goal-directed behavior (avolition).
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Check one: Were you to have Schizophrenia, might you prefer to be living in a developed _____ or developing country_____?
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Developing
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The touching but misguided memorial to Kurt Schneider and his theory of First Rank Symptoms of Schizophrenia (or, Schneiderian symptoms) can be found where?
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In the Note beneath Criterion A for Schizophrenia.
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What are the four possible aspects of formal thought disorder?
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idiosyncratic word use
goal-directedness continuity of ideas appropriateness of levels of concreteness and abstraction |
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For which of the following treatments for mild to moderate unipolar depression in adults is there some significant research support?
___ cognitive-behavior therapy (CBT) ___ interpersonal therapy ___ behavior therapy ___ exercise ___ marital therapy ___ electroconvulsive therapy ___ antidepressant medication ___ counseling ___ all of the above ___ none of the above |
_x__ cognitive-behavior therapy (CBT)
_x__ interpersonal therapy _x__ behavior therapy _x__ exercise _x__ marital therapy _x__ antidepressant medication _x__ counseling Electroconvulsive Therapy would be a bit of overkill in most cases for mild to moderate depression. |
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True or False:
Unlike Bipolar Disorder, unipolar depression is usually not recurrent once successfully treated, and therefore long-term maintenance therapy for treated unipolar depression is rarely required. |
False
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True or False:
In cases of Bipolar Disorder, psychotherapy and a consistency of routines can each decrease the recurrence of mood episodes. |
True
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A hypomanic episode must last at least 4 days, but a manic episode must last at least 1 week (or any duration if hospitalization is necessary). Aside from this difference in duration, a manic episode differs from a hypomanic episode in that a manic episode is characterized by one or more of what three circumstances?
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1. marked impairment in functioning
2. psychotic features 3. hospitalization is necessary prevent harm to self or others |
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In terms of mood episodes, what distinguishes Bipolar I from Bipolar II?
Thus, all Bipolar I disorders are characterized by _____: either at least one _______ or at least one _______. Bipolar II disorder entails at least one ____ episode and at least one ______ episode, but never a _____ episode nor a _____ episode.) |
For Bipolar I, although other mood episodes may occur, at minimum there must be mania, either in the form of at least one Manic Episode or at least one Mixed Episode. For Bipolar II, there must be at least one Major Depressive Episode and at least one Hypomanic Episode, and no mania—no Manic Episode or Mixed Episode.
Thus, all Bipolar I disorders are characterized by mania: either at least one Manic Episode or at least one Mixed Episode. Bipolar II disorder entails at least one Major Depressive episode and at least one Hypomanic Episode episode, but never a Manic episode nor a Mixed episode. |
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True or False:
Panic Disorder Without Agoraphobia and Panic Disorder With Agoraphobia are different from other anxiety disorders in that the person has panic attacks that are situationally predisposed. |
False
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2. Which, if any, are symptoms of Panic Attack?
Palpitations, pounding heart, or accelerated heart rate Feeling dizzy, unsteady, lightheaded, or faint Sweating Derealization (feelings of unreality) or depersonalization (being detached from oneself) Trembling or shaking Fear of losing control or going crazy Sensations of shortness of breath or smothering Fear of dying Feeling of choking Paresthesias (numbness or tingling sensations) Chest pain or discomfort Chills or hot flushes Nausea or abdominal distress Pelvic discomfort |
2. Which, if any, are symptoms of Panic Attack?
X Palpitations, pounding heart, or accelerated heart rate X Feeling dizzy, unsteady, lightheaded, or faint X Sweating X Derealization (feelings of unreality) or depersonalization (being detached from oneself) X Trembling or shaking X Fear of losing control or going crazy X Sensations of shortness of breath or smothering X Fear of dying X Feeling of choking X Paresthesias (numbness or tingling sensations) X Chest pain or discomfort X Chills or hot flushes X Nausea or abdominal distress Pelvic discomfort |
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True or False:
Blood-injury-injection phobia is best treated with the same exposure paradigm as other phobias. |
False:
(You would need to assess for whether the person has a vaso-vagal response and, if so, add muscle-tensing or other interventions that would keep blood pressure sufficient to prevent fainting. This is because individuals with a blood-injury-injection phobia often have, in addition to anxiety, a vaso-vagal response. According to one source: “Fainting is unique to blood-injury-injection phobia. Up to 70% of these phobics report fainting, and often they have fainted several times. This is known as vasovagal syncope, or 'emotional fainting', and occurs as a reflex-like activity in the parasympathetic nervous system. These activities include bradycardia (low heart rate), hypotension (low blood pressure), cerebral ischaemia [or ischemia]and hypoxia (less blood supply to the brain with less oxygen). These things together cause a brief loss of consciousness. These effects are opposite to what most phobics experience: Heightened response in the sympathetic nervous system, including tachycardia (increased heart rate), hypertension (high blood pressure), along with a range of other symptoms such as excess adrenaline. Fainting occurs in about 5 percent of blood donors who are not otherwise known to be phobic.”) |
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True or False:
Exposure and response prevention (also known as ritual prevention) is the heart of behavioral treatment of OCD. |
True
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True or False:
Social phobia is the least common phobia. |
False
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True or False:
Several studies with good methodology have shown that Critical Incident Stress Debriefing is an effective intervention in reducing the risk of PTSD for ad hoc groups (that is, groups of people who just happen to be in the same situation, as opposed to work teams, such as EMT teams, police teams, or military platoons) who have been exposed to a potentially |
False
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Summarize BRIEFLY the two aspects of Criterion A for PTSD and ASD:
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a. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
b. the person's response to the trauma involved intense fear, helplessness, or horror. (In children, this may be expressed instead by disorganized or agitated behavior.) |
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Yes or No:
Does childhood sexual abuse in which force or threats of force did not occur meet Criterion A for PTSD? |
Yes
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What is the essential characteristic of each of the three symptom clusters for PTSD?
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a. persistent reexperiencing of the traumatic event
b. avoidance of stimuli that might provoke reexperiencing of the traumatic event, and a numbing of general responsiveness c. symptoms of central nervous system hyperarousal |
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The criteria sets for Acute Stress Disorder and PTSD share the same three symptom clusters. What is the essential characteristic of the additional symptom cluster found in the criteria set for Acute Stress Disorder?
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dissociative symptoms
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Dissociative Identity Disorder can be confused with many other disorders. For example, because Dissociative Identity Disorder can produce symptoms that are easily construed as Schneiderian symptoms—e.g., the experience of voices conversing with one another, and/or a voice commenting on the person’s behavior and thinking; the sense that important aspects of one’s behavior and experience are under the control of other entities—it is important to include Dissociative Identity Disorder in the differential diagnosis for _____________________________.
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Schizophrenia (and other disorders with psychotic symptoms)
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In order to diagnose Substance Dependence, must the client be physiologically dependent on the substance?
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No
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When diagnosing comorbid mental disorders in a substance-dependent or substance-abusing person, either while they are still abusing the substance, or during, or just after detox, what are the three patterns of comorbidity (that is, the three possible causal relationships) between (a) the substance dependence or substance abuse diagnosis, and (b) other Axis I or Axis II diagnoses that should be alert for?
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I. Substance use induces the mental disorder(s).
II. Mental disorder(s) predisposes the substance abuse/dependence (.e.g., as in self-medication for an anxiety disorder by abusing alcohol). III. The individual has predispositions, independently, to both substance abuse/dependence and mental disorder(s); the presence of each exacerbates the other. |
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Using the DSM-IV, can an individual have both a Substance Dependence diagnosis and a Substance Abuse Diagnosis for:
the same substance? for different substances within the same class of substance? |
the same substance: NO
for different substances within the same class of substance? NO |
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List one reason why treatment approaches for women with substance dependence/abuse problems may need to be different in some ways than treatment approaches for men.
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The etiology and course of substance dependence/abuse may be different for woman than for men;
woman also are more stigmatized in certain ways than men; women may experience more and different role pressures than many mend do; and women may receive less support from male partners than males do from women partners |
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Can controlled drinking programs work for individuals with mild-to-moderate alcohol problems or dependence?
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Yes
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