Lmsw Prep Psychopathology And Psychopharmacology

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Mental Status Exam

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-Focuses on present symptoms, complaints, and demeanor (not historical data or events).
-As problem behaviors are identified, more in-depth questions follow.
***social workers always report strengths & concerns.

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Typical Areas of Assessment (Mental Status Exam)

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1. Appearance & attitude
2. Behavior and physical movement
3. Speech & Language
4. Feelings, affect, & mood
5. Thought content and processes
6. Intelligence & cognition
7. Perceptions and sensory experiences (looking at things that aren't there).
8. Impulsivity
9. Judgment & insight.

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Examples of mental status exam questions

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*Orientation: What is today's date?
*Hallucinations: Do you see or hear things that others cannot see or hear?
*Delusions: Do you ever think that others are planning to hurt you?
*Mood: How are you feeling today? Do you ever feel down or have thoughts of hurting yourself?
*Memory: I'd like for you to remember 3 words and in a few mins I'll ask you to repeat them back to me-ball, car, and grass.

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DSM-IV

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the official source of diagnostic information for psychiatric disorders. Multiaxial approach.

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Axis I

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Clinical syndromes such as schizophrenia, depression, anxiety, sexual disorders, eating disorders, DID, MDD, OCD, panic, specific phobia, factitious, kelpto, pyro, bipolar, sleep disorders, somatoform, etc.
*has a beginning and assumed end*

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Axis II

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*Developmental disorders include autism and mental retardation
*Personality disorders include antisocial, borderline, histrionic, narcissistic, paranoid, schizoid/schizotypal, OCD personality disorder (different from OCD which is in Axis 1).

**lifelong and show up in childhood or adolescence**

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Axis III

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General medical conditions/physical disorders. Hypertension, thyroid, diabetes etc may interfere with mental functioning.

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Axis IV

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Environmental or Psychosocial stressors:
Loss of a job, death of a loved one, divorce, terrorist attack.

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Axis V

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Global Assessment of Functioning (GAF)
scaled from 1-100
higher the # better functioning
lower the # worse functioning

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Panic Disorder

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(Anxiety neurosis): an anxiety disorder that is characterized by extreme and frequent panic attacks. The attacks include symptoms such as severe feelings of terror, rapid breathing and rapid heart rate. A person suffering from a panic disorder may experience these attacks unexpectedly and for no apparent reason, but they can also be preceded by some sort of triggering event or situation.

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Phobias

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The most common type of anxiety. Abnormal or unusual fears that have no real basis in fact. An unusual fear becomes a ______ when it interferes with everyday activities.

*treatments include: systematic desensitization, flooding*

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Obsessive Compulsive Disorder

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(Axis 1). Obsessions are irrational thoughts that preoccupy clients' waking hours. Compulsions are behavioral or cognitive habits that are characterized by ritualistic behavior or a prescribed set of actions. If client cannot act out their ritual they may become very anxious.

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PTSD

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When people experience truly novel & threatening life event (war, disaster, rape, child abuse etc.) they lack the cognitive ability to objectify the elements of the event. Duration is more than a month.
*treatments include: antipsychotics & zoloft, prolonged exposure in vivo or imagination*

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Acute Stress Disorder

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First response to a trauma or crisis. Is generally short term anxiety response similar to PTSD. Symptoms that persist for longer than a month may be reclassified as PTSD.

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Agoraphobia

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without panic disorder, focuses on the fear of being unable to control your own safety in a public area. Clients may go out in public but only with a trusted & protective partner. Comfort & safety in being at home.

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Generalized Anxiety Disorder

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characterized by the continued worry about 2 or more areas of clients lives. Popular topics of worry may be clients' children, jobs, family security, personal health, etc. These worries interfere with their jobs and personal lives.

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Conversion disorder

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the transfer of a psychological threat into a physical condition. Ex. a woman goes rock climbing and goes blind @ top of summit. When she comes back down she can see again. A psychological issue turns into a physical issue.

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Hypochondria

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the fear of contracting a disease or becoming ill. Clients have recurrent & multiple complaints about illnesses or body dysfunctions that apparently are not due to an physical disorder.

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Dissociative amnesia

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after a stressful life situation, clients are unable to remember common information such as their name, address, etc. No brain damage is involved, & memory loss may be partial or complete.

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Dissociative fugue

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a unique type b/c clients generally lose all their memory and construct new lives in other locations. While recovery is usually complete, clients don't remember what took place during the fugue state.

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Dissociative Identity Disorder

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characterized by the occurrence of 2 or more personalities in the same individual, each of which is sufficiently integrated to have a relatively stable life of its own & can take control of the person's behavior. Most likely related to childhood trauma.

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DSM-IV 3 Major Types of Mood Disorders

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*Bipolar Disorders
*Depressive Disorders
*Mood Disorders due to medical conditions or substance-abuse.

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Major Depressive Disorder

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may appear completely overwhelmed by the sadness & futility of lie. They become passive, may refuse to get out of bed, and sometimes have to be force-fed. Particularly in younger people, there is always the danger of suicide. Can be triggered by traumatic event.

*can be diagnosed after 2 weeks of symptoms

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Dysthymia

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Chronic depression lasting more than 2 years (less severe than MDD).

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Bi-Polar I

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has at least 1 manic phase in the midst of major depressive symptoms. (ex. a man in the middle of a mania episode goes to a funeral and starts laughing uncontrollably, and starts running up and down the aisles=manic). Also...psychotic/delusions/hallucinations.

*onset-teens to early adulthood*
*Diagnosed after 2 weeks of symptoms*

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Bi-Polar 2

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has hypomanic episode, a person has a sustained mood that is elevated (heightened), expansive (grand, superior) or irritable.
(ex. someone seems much happier than normal and only needs 3 hrs of sleep. This is different from their normal habits=hypomania). Hypomanic episodes are less severe & have at least 4 days of mood change but usually not marked or severe impairment.
No psychotic features.

*less severe than Bipolar 1*
*Diagnosed after 2 weeks of symptoms*

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Cyclothymia

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For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms.

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Suicide

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Rate has tripled in 30 yrs for young people in America. White males between 20-24 seem most affected. Young women may threaten or even attempt _______ more than men, men are much more likely to complete the act.

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Schizophrenia

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Affect males & females equally although males develop symptoms earlier. Symptoms include:
*Early stages-loss of concentration and sleep problems, social withdrawal (early assessment is the client's loss of personal hygiene or self-care skills
*Middle stages-change in work performance, deterioration in appearance & social relationships
*Later stages-bizarre behavior, hallucinations, disordered thinking, delusions etc.


**onset-early/young adulthood (18-26)*
*main treatment-antipsychotics (Thorazine & Haldol) also skills training.

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Schizophrenia: Positive symptoms vs. Negative symptoms

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*Positive symptoms-symptoms that show up or are present (delusions, hallucinations)

*Negative symptoms-things that go away (social withdrawal, loss of motivation).

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2 Types of Sexual Disorders

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*Paraphilias-the need for unusual or bizarre imagery or acts in order to achieve sexual excitement (fetishes).

*Sexual dysfunctions-inhibited desire or performance, or with reaching orgasm too rapidly or too slowly. Low sexual desire is the most common form of sexual dysfunction.

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Adjustment Disorders

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People's relatively normal responses to life events (is often given to protect clients from more stigmatizing labels such as depression or anxiety).
*Criteria
1. Problems develop within 3 months of an identified stressor
2. Symptoms reflect more than normal distress and/or impairment in functioning.
3. Problems do not merit another Axis I or II disorder.
4. Symptoms not related to bereavement.
5. Symptoms may not last longer than 6 months

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Types of Personality Disorders (Axis II)

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-Avoidant
-Dependent
-Obsessive-Compulsive
-Borderline
-Histrionic
-Narcissistic
-Schizoid
-Schizoidtypical
**Personality disorders are considered personal attributes (attitudes and behavior) that persist over time and across situations.
*Theme with personality disorders=FEAR

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Mental Retardation-Degrees of Severity

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*Mild-50-55 to 70 IQ
*Moderate-35-40 to 50-55 IQ
*Severe-20-25 to 35-40 IQ
*Profound-Below 20 or 25 IQ
**Borderline intellectual functioning-71-84 IQ
**100 words or less=severe

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Personality Disorder Clusters

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A. Odd or Eccentric (schizotypal, schizoid, paranoid personality)
B. Dramatic, erratic or over-emotional (historionic, narcissistic, antisocial, borderline).
C. Anxious or fearful (avoidant, dependent, obsessive-compulsive

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Avoidant Personality Disorder

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Fear or anxiety about rejection and humiliation. Hesitant, fearful, self-depricating, and hypersensitive to social rejection, fear of performing in public. May appear indifferent to others.
*similarity to symptom disorders: hypochondria, GAD, depression, social phobias.

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Dependent Personality Disorder

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Anxious about separations and abandonment, more common in women. A heightened need to be cared for, avoids making demand for fear of rejection. Sees themselves as modest, considerate, self-depricating. Easily intimidated & avoids anger for fear of alienating others.
*Similarity to symptom disorders: social phobias, agoraphobia, depression.

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Obsessive-compulsive Personality Disorder

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Anxious about uncertainty about the future, 2/3 men. Orderly, stingy, stubborn, & sometimes irritable & vindictive. Proud of their integrity and rationality; contemptuous of people who are impulsive or frivolous. All about rules, procedures, details, morally rigid...
*Similarity to symptom disorders: Not particularly similar to ocd since unwanted obsessive thoughts and behaviors are relatively uncommon.

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Borderline Personality Disorder

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Dramatic or erratic fluctuations in affect, self image, impulsivity. Unstable & fluctuating interpersonal relationships and feelings of self-worth, transient fears, feelings of emptiness, short term paranoia, chronic feelings of emptiness. They avoid real or imagined abandonment, alternate between extremes of idealization & devaluation of others & self...mood fluctuations.
**Similarity to symptom disorders: paranoia, destructive behavior, impulsivity, bipolar disorder.

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Histrionic Personality Disorder

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Excessive emotionality, attention seeking, dramatic, theatrical, expression of emotion. May have inappropriate sexual/provocative behaviors. Uncomfortable when not the center of attention, may believe that relationships are more intimate than they acually are. Rapid shifting and shallow expression of emotions. May be easily influenced.
**Similarity to symptom disorders: May resemble substance abuse behavior, or personality change due to change in medical condition.

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Narcissistic Personality Disorder

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Grandiose, need for admiration, and lack of empathy. Exaggerates achievements or personal importance. Fantasies of great success, power, brilliance, beauty, or ideal love. Only famous or brilliant people can appreciate them. Sense of entitlement, may take advantage of others to enhance self. Envious of others.
**Similarity to symptom disorders: obsessive compulsive features, hypomania, potentially comorbid w/substance abuse.

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Schizoid Personality Disorder

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Marked detachment from social relationships, appear uninterested in close relationships and don't enjoy family relationships, loners. Limited range of emotions & a reduced ability to sense external or physical stimuli, they fail to enjoy pleasurable or romantic events.
**Similarity to symptom disorders: major depression

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Schizotypical Personality Disorder

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Detached from others, limited interested in personal relationships, may be particularly superstitious or preoccupied with paranormal. They have unusual powers of influence or predicting the future. Cognitive or perceptual distortions along with eccentric behavior. Ideas of reference-incorrect explanations or perceptions of casual events. Suspicious, paranoia are common...they don't have delusions of reference-where beliefs are held with delusional conviction.
**Similarity to symptom disorders: schizophrenia

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Antisocial Personality Disorder

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Pervasive disregard for the rights of others..deceit & manipulations are central themes. Easily irritable at the imposition of unfair rules, laws, or requests. Perform acts that are unlawful, violate the rights of others, and disregard the wishes & feelings of others.
**Similarity to symptom disorders: mania during bi-polar, aggressive behavior w/schizophrenia.

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Types of Antidepressants

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1. MAOI's (Monoamine Oxidase Inhibitors)
2. Tricyclic Antidepressants (TCA's)
3. SSRI's (Selective Serotonin Re-uptake Inhibitors)
4. Other drugs
5. Drugs for bi-polar

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Common side effects of MAOI's

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*CNS-Dizziness, headache, drowsiness, sleep disturbance, weakness, fatigue, tremors.
*Autonomic-blurred vision, glaucoma, urinary retntion.
*GI-Dry mouth, constipation
*Other-Edema, weight gain, anorgasmia, ejaculatory disturbances.

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MAOI's (Monoamine Oxidase Inhibitors)

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1. Marplan
2. Nardil
3. Parnate

**don't mix w/cheese, red wine, & chocolate! :(

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Tricyclic (TCA's)

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1. Tofranil
2. Elavil
3. Nopramine
4. Anafranil

**they might kill you if you take too many!

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Common side effects of Tricyclics

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*CNS-confusion, disorientation, delusions, anxiety, nightmares, dizziness, headache, fatigue
*Autonomic: Dry mouth, blurred vision, constipation
*GI-nausea, epigastric distress, vomiting, anorexia, diarrhea.
*Other-lethality of overdoes, alopecia, weight gain/loss.

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SSRI's (Selective Serotonin Re-uptake Inhibitors

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1. Prozac
2. Paxil
3. Zoloft
4. Luvox
5. Celexa
6. Lexapro

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Common side effects of SSRI's

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*CNS-headaches, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, abnormal dreams..**SEXUAL DYSFUNCTION**
*GI-nausea, diarrhea, dry mouth, anorexia, constipation, abdominal pain, vomiting
*Respiratory-upper resp tract infection, flu-like symptoms, cough.

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Other Antidepressants

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1. Wellbutrin
2. Effexor
3. Pritiq
4. Cymbalta

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Drugs for Bi-Polar Disorder

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1. Lithium*
2. Depakote
3. Neurontin

*these are mood stabilizers
*clients will probably have more than 1 RX.

*Side effects: fine hand tremors, muscle weakness, slurred speech, vertigo....

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Antipsychotic Meds: Major Tranquilizers
-Typical

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1. Thorazine
2. Haldol
3. Prolixin
4. Phenergan

*they may trigger movement disorder=tardive dyskinesia

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Common side effects of Major Tranquilizers (Typical)

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Drowsiness, neck spasm, protrusion of the tongue, agitation, jitteriness, insomnia, Pseudoparkinsonism (mask like faces, drooling, shuffling).

***BIG SIDE EFFECT=Tardive dyskinesia-starts with small tongue tremors, facial tics & abnormal jaw movements, can progress into rolling of the tongue, smacking, sucking. Later can develop into spasmodic movements of hands, feet, arms, legs, neck & shoulders (except with the newer atypical antipsychotics).

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Antipsychotic Meds: Major Tranquilizers (Atypical)

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1. Clozaril (bone marrow issues)
2. Risperdal (after 2 yrs-get tardive dyskinesia)
3. Abilify (used a lot for PTSD)
4. Seroquel (may cause cataracts)

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Major side effect of Clozapine

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Agranulocytosis. The clumping of white blood cells.

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Antiparkinson Medications

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1. Artane
2. Congentin
3. Benedryl
4. Symmetrel
5. Parlodel

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Antianxiety Agents (Minor Tranquilizers)

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A. Benzodiazepine
-Valium
-Xanax
-Klonapine
-Ativan
-Buspar
B. Beta Blockers
-Inderol
-Lopressor
C. Azapirones
-Buspar

***THESE ARE HIGHLY ADDICTIVE

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Cerebral Stimulants (Hyperactivity)
**Paradoxical Effect)

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1. Benzedrine
2. Ritalin
3. Adderall

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Drugs for Substance Abuse

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1. Antabus (alcohol antagonist..will make you puke)
2. Trexan