Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
146 Cards in this Set
- Front
- Back
|
Bipolar 1
|
*impairs functioning!
*more likely when psychotic features show up *one or more manic or mixed episodes; often, but not always, there is also a history of major depressive episodes. The periods of mania in bipolar I disorder are associated with significant impairment in social or occupational functioning, or a need for hospitalization to prevent harm to self or others, or psychotic features. |
|
|
Generalized Anxiety Disorder
|
more or less constant anxiety symptoms and worries. Not episodic.
*involves multiple anxiety symptoms and excessive anxiety and worry about a number of events or activities; the anxiety and worry are relatively constant for at least six months and the person finds them difficult to control. |
|
|
Panic Disorder
|
characterized by panic attacks (episodes of intense anxiety)
|
|
|
Agoraphobia
|
Anxiety about being in situations or places from which escape might be difficult or embarrassing or where help might not be available if a panic attack or panic-like symptoms develop)
*DSM diagnoses involving agoraphobia are called “panic disorder with agoraphobia” and “agoraphobia without history of panic disorder.” *Not called just "Agoraphobia". Always associated with a panic disorder |
|
|
Bipolar 2 Disorder
|
Involves at least one major depressive episode and at least one hypomanic episode.
*If person is hospitalized or psychotic, they do not have BP2 |
|
|
Hypomanic symptoms - how to differentiate from Manic
|
Symptoms during these Hypomanic periods reflect a clear change in mood and functioning, but are not severe enough to markedly impair functioning or require hospitalization and there are no psychotic symptoms.
|
|
|
Major Depressive Disorder symptoms
|
a depressed mood, plus at least five other characteristics symptoms (e.g., eating disturbance, sleep disturbance, lethargy, loss of concentration, ruminating about shortcomings, wanting to “disappear,” which suggests suicidality), are required to diagnose a MD episode.
|
|
|
Acronym to remember MDD symptoms
SIG E CAPS |
Sleeplessness-Isolation-Guilt
Energy is decreased Concentration (lack of)-Appetite (increased or decreased)- Psycho-motor agitation/retardation- Suicidal |
|
|
Cyclothymic disorder
|
Involves multiple hypomanic episodes and multiple periods of depressed mood that occur, in an adult, over a period of two or more years;
*the depressed mood is not severe enough to meet the criteria for a major depressive episode (doesnt have all the symptoms and does not completely impair functioning). |
|
|
Psychoeducation
|
*used in intial/early intervention
*involves teaching clients about the nature of a disorder, including its etiology, progression, consequences, prognosis, treatment, and alternatives. *Providing this information could serve to reassure, provide hope that things can change *may also increase her motivation for treatment if it is low. |
|
|
Anorexia Nervosa
|
*associated with extremely thin build (abnormal)
*typically begins in mid to late adolescence, its onset can be in adulthood. *may have distorted body image *associated with not eating, lots of exercise *there is a "binge eating/purging type" of AN *People with anorexia usually lack insight into, or have considerable denial of, the problem and may be unreliable historians |
|
|
Bulimia Nervosa
|
*Patients with bulimia are able to maintain their body weight at or above a minimally normal level, both before the disorder’s onset and during the course of the disorder.
*can look normal *associated with binging/purging *bulimia is among the common co-occurring Axis I disorders in people with Borderline Personality disorder (BPD) |
|
|
Dysthymic Disorder
|
*marked by chronic, less severe depressive symptoms that have been present for at least two years in an adult;
*difficult to distinguish the person’s mood disturbance from her usual functioning. |
|
|
Dementia
|
*people with dementia are usually unaware of or deny their cognitive impairments – i.e., if pt does have early symptoms of dementia, he probably wouldn’t report them himself.
*has impaired memory and cognition *important to distinguish from MDD |
|
|
Life-cycle transitions
|
in DSM as "problems related to the social environment” that may be recorded on Axis IV.
*e.g. retirement |
|
|
Axis IV
|
The problems recorded on Axis IV play a role in the initiation or exacerbation of a mental disorder, develop as a consequence of the client’s mental disorder, or are problems that should be considered in the overall management plan.
You may record on Axis IV as many problems as you judge to be relevant, assuming they have been present sometime during the year preceding the evaluation. The problem is also recorded on Axis I as a V Code when it is a primary focus of clinical attention. *life cycle transitions, occupational problems, go on this axis |
|
|
V Code defined
|
A V Code may be recorded when the client has no mental disorder, and the V Code problem is the focus of diagnosis or treatment; when the client has a mental disorder, but it is unrelated to the V Code problem; or when the client’s mental disorder and V Code problem are related, but the problem is severe enough to require independent clinical attention.
|
|
|
V Codes in DSM
(relational problems, problems related to abuse/neglect) |
Relational Problems (4)
V Code Partner Relational Problem V Code Relational Problem related to a Mental Disorder or General Medical Condition V Code Parent-Child Relational Problem V Code Sibling Relational Problem Probs related to Abuse/Neglect (18) V Code physical abuse of a child V Code sexual abuse of a child V Code neglect of a child V Code physical abuse of an adult V Code sexual abuse of an adult V Code noncompliance with treatment V Code Malingering V Code Adult antisocial behavior V Code Child or Adolescent antisocial behavior V Code Borderline intellectual disorder V Code Age related Cognitive Decline V Code Identity Problem V Code Phase of Life Problem V Code Bereavement V Code Academic Problem V Code Occupational Problem V Code religious or Spiritual Problem V Code Acculturation Problem |
|
|
V Code Phase of Life
|
consideration whenever a client is having difficulty adapting to a developmental transition, such as retirement.
*goes on Axis 1 |
|
|
V Code Identity problem
|
This condition involves uncertainty about numerous issues relating to personal identity (e.g., life goals, career, values, sexual orientation, friendship patterns).
*not applicable if those issues are result of a mental disorder such as adjustment disorder |
|
|
Refer to a support group?
|
Keep in mind that if client is in crisis, then he is not a good candidate for non-crisis-oriented group intervention and it is most likely not the right initial intervention.
|
|
|
Dual relationship
|
A dual or multiple relationship occurs when a social worker assumes two or more roles at the same time or sequentially with a client (or former client).
|
|
|
Borderline Personality Disorder
|
symptoms consistent with borderline personality disorder are (e.g., the recent suicide attempt and its trigger, her “intense” relationships, unstable goals/sense of self, uncontrolled anger, impulsivity, and boredom). You should find out whether these symptoms reflect a pervasive pattern that has been present since at least early adulthood.
*borderline personality disorder and major depression often co-occur *paranoid ideation may occur during periods of extreme stress. *group therapy is a good tx *AA is not that good of a tx |
|
|
Paranoid Personality Disorder
|
involves pervasive distrust and suspiciousness (the belief that other people’s motives are always malevolent)
|
|
|
Body dysmorphic disorder
|
preoccupation with a defect in physical appearance; the defect is either imagined, or, if a slight anomaly is present, the person’s concern is markedly excessive. This diagnosis is not made if the preoccupation is better accounted for by another mental disorder.
|
|
|
Cognitive Behavioral Therapies (CBT)
|
cognitive and cognitive-behavioral therapies have been developed for individuals with BPD (for example, dialectical behavior therapy); and these therapies are also effective for treating depression.
|
|
|
Fees (Ethics)
|
NASW’s Code of Ethics states that when setting fees, social workers should ensure that the fees are fair, reasonable, and commensurate with the services performed, and give consideration to the client’s ability to pay. This is always an ethical duty; in addition, it is specifically relevant in this case because the client is unemployed.
|
|
|
Panic Attacks
|
*associated with panic disorder
*discrete periods of intense apprehension, fear, or terror *not constant |
|
|
Primary Sleep Disorders
|
not diagnosed if the sleep disturbance is related to another mental disorder, a general medical condition, or substance use.
e.g. primary insomnia |
|
|
What is link between anxiety disorder and controlled substances?
|
a person with an anxiety disorder may use alcohol and/or other drugs to manage (self-medicate) his symptoms of anxiety.
|
|
|
Adjustment disorder with anxiety, chronic
|
symptoms begin within three months of the onset of a stressor that is ongoing (e.g. starting a business one year ago and now running the business), adjustment disorder with anxiety, chronic, is a possibility. This disorder is marked by symptoms such as nervousness, jitteriness, and worry.
|
|
|
Hypomanic
|
Someone with hypomania would display, among other symptoms, inflated self-esteem; a decreased need for sleep (Stan has trouble falling asleep — he doesn’t report a decreased need for sleep); distractibility, or attention that is too easily drawn to unimportant external stimuli; pressure to keep talking; an increase in goal-directed activities; and/or excessive involvement in pleasurable activities that have a high potential for negative consequences.
|
|
|
Malingering
|
occurs someone is intentionally producing or feigning his symptoms in order to obtain an external reward.
*it is a factitious disorder |
|
|
Factitious Disorder
|
the patient intentionally produces or simulates physical or psychological symptoms out of an intrapsychic need to adopt the sick role. Indicators suggesting a factitious disorder include symptoms that appear to serve a psychological need; a dramatic presentation of symptoms but an inconsistent, fabricated, and/or vague medical history; psychological, medical, and laboratory test results that are inconsistent with symptoms the patient reports, and a history of multiple hospitalizations and/or medical procedures. The conclusion that a client has intentionally produced a symptom is made through direct evidence and by ruling out other possible causes of the symptom.
|
|
|
Anxiety and substance abuse
|
The possibility of a substance-related disorder should be explored whenever a client presents with anxiety symptoms
|
|
|
Normalizing
|
involves placing a client’s situation or problem in a new context by defining it as expectable or predictable, rather than pathological.
|
|
|
Treatment of GAD
(Generalized Anxiety Disorder) |
*CBT!!!
*referral to a support group (after symptoms have diminished/ NOT INITIAL INTERVENTION) * relaxation methods are useful for physical symptoms *cognitive techniques are useful for psychological symptoms *Self-monitoring *Supportive Therapy (w/ mild GAD) *Severe GAD requires ST plus CBT |
|
|
vocational guidance
|
an intervention used to help clients find suitable employment (e.g., identify qualifications and opportunities, locate job training, learn how to apply for a job)
|
|
|
Self-Monitoring
|
Train the client to detect the initial onset of an anxiety response and to identify the various response systems (physiological responses, thoughts, images, emotions, overt behavior).
Once the client learns to recognize initial internal anxiety cues, he can then apply effective coping responses as soon as he begins to experience an anxiety response. *A CBT intervention |
|
|
Is setting a low fee for a client an ethical responsibility?
|
You may charge a low fee if the client needs you to (for example, because he lacks health insurance), but you are not ethically obligated to do so simply because he is self employed
|
|
|
Contacting family members if a client is suicidal (Ethics/Client welfare)
|
This is an option when a client is suicidal and is allowed by the ethics code under certain conditions, but it is not a requirement.
You may, or may not, be allowed to break the client's confidentiality if he is suicidal. The Code of Ethics says, “Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person.” |
|
|
Consider a client's ability to pay when setting your fee
|
This is always an ethical duty
|
|
|
Terminate tx if client is unable to participate in meaningful way
|
NASW’s Code of Ethics says that social workers should terminate services to clients when the services no longer serve the clients’ needs or interests.
If u ultimately determined that a client can't benefit from your services, you’d want to consider whether his needs might be served better by some other form of treatment; you wouldn’t simply terminate services to a very anxious client without offering relevant referrals. A client “not complying” with recommended treatments does not fit this criteria, unless you have exhausted all means of encouraging her compliance and she is still not improving. |
|
|
Barriers to tx of anxiety
|
*Excessive, chronic anxiety (can prevent functioning)
*Low sense of self-efficacy (anxiety tends cause feelings of powerlessness; many have a history of difficulty coping successfully with stressors. *Low insight/psychological-mindedness (doesn't understand their problem) *The need to overcontrol is common among people with excessive anxiety. *lack of motivation for change (more related to Sub. Abuse) |
|
|
Suicide attempts w/ MDD and Dysthymic Disorder
|
Because their depression is less severe, people with dysthymic disorder may have the energy and resourcefulness to make a suicide attempt when particularly down. Severely depressed people, on the other hand, may be too incapacitated to attempt suicide.
|
|
|
Social Phobia
|
social discomfort and fear of scrutiny or evaluation by others
*another diagnostic consideration in cases of social phobia is avoidant personality disorder because there is considerable overlap between these two disorders. However, to have APD, the avoidance and social phobia should have been longstanding and present at least since early adulthood. |
|
|
Legal duty with Suicide risk
(Legal) |
evaluating the potential that he poses a danger to himself due to his depression and then initiating appropriate protective measures (such as protective involuntary hospitalization) is an important legal duty in this case.
|
|
|
Getting signed releases before consulting with other professionals
(Legal) |
Barring an emergency or other legal exception, the law requires a social worker to have a client’s written permission before disclosing confidential material to other individuals, agencies, or authorities.
|
|
|
Provide info/consult about your fee before initiating treatment
(Legal) |
This is a legal obligation that must be followed with all clients
|
|
|
Reporting spousal abuse
|
Even if you discovered that a client abuses his wife during their fights (or vice versa), you have no reporting mandate in cases of spouse abuse, unless the victim is a minor or elder/dependent adult.
*note...if there is spousal abuse, couples therapy is not recommended |
|
|
Couples therapy
|
recommended if the marital relationship appears to need clinical attention.
if there is spousal abuse, not recommended that they go to couples therapy. |
|
|
AA referral
|
If you know that you need to evaluate for a substance use disorder because a client self-medicates his anxiety before attending social events, but you don’t have nearly enough information to conclude that he is an alcoholic who needs to attend AA (or, if he does abuse alcohol, that he would be a good candidate for AA).
|
|
|
Depression and CBT
|
Individuals with depression, whether acute or chronic, usually benefit from cognitive therapy (e.g., cognitive-restructuring techniques)
|
|
|
V Code Bereavement
|
recorded when a person is having a normal, or expectable, reaction to the death of a loved one.
*culture should be taken into account because bereavement differs across cultures. |
|
|
Respite Care
|
provide temporary care assistance for children, which would serve to relieve some of the stress a parent/caregive is under right now, while he is in crisis. They might need a break.
|
|
|
Intermittent explosive disorder
|
This impulse control disorder is marked by episodes involving a loss of control over aggressive impulses, resulting in assaultive behavior or vandalism.
*can be diagnosed only after all other disorders associated with aggressive impulses/behaviors have been ruled out, including substance intoxication and substance withdrawal. |
|
|
V Code Physical Abuse of Adult
|
If a husband abuses alcohol, there is a very good chance the spousal abuse will require independent clinical attention in this case. (NOTE: If the focus of clinical attention is on the wife as the victim of spousal abuse, the actual code that would be entered would not begin with a “V” but would be 995.81. The 900 series applies to all the V Codes for abuse or neglect of an adult or a child when the focus of clinical attention is on the victim. On the exam, however, choosing the “V Code” will usually be correct – assuming that the exhibit supports it.)
|
|
|
Battered Women Syndrome and PTSD
|
According to Walker (1994), abused women may develop “battered woman syndrome,” which includes a group of abuse-related arousal, anxiety, and avoidance symptoms (including withdrawal) similar to those caused by other traumatic events. The features of battered woman syndrome meet the diagnostic criteria for PTSD.
|
|
|
Dependent Personality DIsorder
|
The essential feature of DPD is a pervasive and excessive need to be taken care of that leads to clinging and submissive behavior and fears of separation. Though individuals with this disorder may be willing to tolerate abuse in order to maintain a relationship, diagnosis of any personality disorder requires the presence of a stable and longstanding pattern of symptoms.
|
|
|
Spousal Abuse/Establish safety from further abuse
(Ethical Obligation) |
Whenever you learn that an adult client is a victim of spousal abuse, you have an ethical obligation to do what you can to help the abused client develop ways of better protecting herself from additional violence. Safety and education should be emphasized first, using crisis intervention techniques; e.g., you should identify the current level of danger in the relationship, help the client develop an “escape plan,” explain the cycle of violence, and provide detailed information about resources (how to contact a local shelter, 24-hour hotlines, and legal alternatives such as police protection and restraining orders).
|
|
|
Normalize symptoms of depression and anxiety
|
It can be appropriate to use this as an intervention as some symptoms of depression and anxiety are expectable.
However, if symptoms are severe, normalizing them would be inappropriate and possibly unsafe. |
|
|
Establish who your client will be/Spousal abuse
|
Partners in an abusive relationship should generally be treated separately. This is especially true in the first stages of treatment before the woman has had a chance to begin her own recovery and/or when the abuser denies the abuse and/or when the abuse incidents are highly unpredictable
|
|
|
A highly directive approach
(actively direct activities) |
used in crisis intervention when the client is too immobile to cope with the crisis (e.g., extremely anxious, severely depressed, out of touch with reality, currently a danger to self or others
*Experts generally recommend that a therapist be active and directive with an Hispanic or Black client. |
|
|
Depressive Disorder NOS
|
Client as a few symptoms associated with depression – e.g. inactivity and difficultly sleeping well.
If her symptoms do not meet the criteria for a specific depressive mood disorder, this diagnosis might apply. |
|
|
Hypochondriasis
|
the patient is preoccupied with a fear of developing a serious disease or with a belief that they have a serious disease; the preoccupation or belief is predicated on an unrealistic and unfounded interpretation of existing physical symptoms and continues despite reassurance from physicians. Some people with hypochondriasis have panic attacks triggered by hypochondriacal symptoms
|
|
|
Somatization disorder
|
This disorder involves a preoccupation with many somatic complaints that have lasted for several years but for which no physical cause (i.e., medical condition, substance effects) has been found (or, if there is a physical cause, the complaints are extreme, given the cause).
|
|
|
Medical conditions that can cause panic attacks
|
A variety of medical conditions (some of them quite serious) can cause panic attacks, including hyperthyroidism, seizure disorders, and cardiac conditions.
|
|
|
Thought Disorder
|
client does not recognize that thoughts are unreasonable
|
|
|
Panic disorders and reluctance to take meds
|
Individuals with panic disorder have a tendency to anticipate catastrophic outcomes from even mild physical symptoms, including medication side effects. You should work closely and cooperatively with the prescribing physician to make sure client uses her medication properly.
|
|
|
Confidentiality (Ethical)
|
A client's family member may believe he/she is entitled to obtain information about his family member's treatment since they may have referred them to therapy or asked them to go. Neither this, nor their attendance at the first session or the fact that he may be paying for the client's treatment gives him any right to obtain confidential information about the client's treatment.
|
|
|
Treatment for panic attacks and agoraphobia
|
involves a very specific technique – in vivo exposure with response prevention (flooding). If you are not qualified to use flooding, then, ethically, you would have to refer Jasmine to a therapist who is.
|
|
|
Factitious Disorders and link to Personality Disorders.
|
Factitious disorders are often accompanied by a personality disorder, especially one involving instability, acting out, and self-destructive behavior, dependence, and manipulation. The DSM indicates that a co-existing borderline personality disorder is especially common. Histrionic PD can also be linked.
|
|
|
Conversion Disorder
|
This disorder requires at least one symptom or deficit affecting voluntary sensory or motor function (e.g., paralysis, blindness, hallucinations)
In conversion disorder, the symptom suggests a physical cause but cannot be fully explained by a medical condition, substance effects, or another mental disorder; in addition, the symptom is not produced voluntarily or controlled by the patient. |
|
|
Factitious Disorder and motivation for tx
|
Most people with factitious disorder are unmotivated to address their disorder. In fact, they are likely to deny their disorder (e.g., to conceal the origin of their symptoms) and to strenuously resist mental health treatments. When do they appear in psychotherapy, it is usually as the result of pressure from someone else or after their deception has been discovered.
*a key ingredient of successful treatments of factitious disorder is a collaborative relationship between the therapist and a physician. |
|
|
Factitious disorder client barriers to tx
|
1) Premature Termination:
Clients with factitious disorder may stay in treatment if the therapist pays attention to their feigned complaints and meets some of their dependency needs; most, however, leave treatment when they are confronted with their deceptions or otherwise realize that they have been found out. 2)Feelings of countertransferance: lients with factitious disorder can be difficult to work with. You may, for instance, develop feelings of anger or frustration in dealing with Erin’s deceptions, manipulations, and/or refusal to comply with treatment; you also may have difficulty dealing with her dependency needs. 3) Refuse to comply w/ prescribed tx: They tend to be demanding and to insist on attention, while at the same time refusing to comply with prescribed treatments. 4)Denial of the problem: When confronted with their deception, people with factitious disorder usually deny the problem (and may become hostile). They also generally resist the development of a positive therapeutic relationship. |
|
|
Indicators for hospitalization
|
suicidality; decompensation, noncompliance, or resistance; and/or acute psychosis, a coexisting substance-related disorder, or both. Hospitalization could also be indicated if you found that a client needed to be separated from environmental stressors that are maintaining his illness.
|
|
|
Mental status
|
perceptual distortions, disturbances in thought content, mood and affect, etc.
You need to understand a client’s current symptoms (especially symptoms of psychosis) in order to determine whether he needs to be hospitalized at this time. |
|
|
Brief Psychotic Disorder
|
involves the sudden onset of at least one positive psychotic symptom and a duration of at least one day but less that one month.
|
|
|
Positive Psychotic Symptom
|
The psychotic symptoms are not "positive" in the everyday sense of something being good or useful. Positive in this context is used with the medical meaning: a factor is present that is not normally expected, or a normal type of behavior is experienced in its most extreme form. Positive symptoms of psychosis include hallucinations, delusions, strange bodily movements or lack of movements (catatonic behavior), peculiar speech and bizarre or primitive behavior.
|
|
|
Schizoaffective Disorder
|
a continuous period of disturbance during which, at some point, the patient has had a mood episode, along with active phase symptoms of schizophrenia. And during an illness episode, the patient has had hallucinations or delusions without any mood symptoms for at least two consecutive weeks; however, symptoms that meet the criteria for a mood episode must be present for a substantial portion of the total duration of the active and residual periods of the illness.
|
|
|
Schizophrenia
|
*requires continuous signs of the disturbance for at least six months, including at least one month of active phase symptoms.
*auditory hallucinations and impaired functioning are indicative of schizophrenia. *people with schizophrenia often have mood symptoms (though they are brief relative to the full duration of their illness, do not occur during an active phase, and do not meet the criteria for a mood episode) *can’t diagnose schizophrenia if psychotic symptoms are substance-induced |
|
|
Major Depressive Disorder, Severe with psychotic features
|
when psychotic symptoms occur only during episodes of major depression (and psychotic symptoms are not substance-induced).
|
|
|
Schizophreniform disorder
|
The essential features of schizophreniform disorder are identical to those of schizophrenia except that the total duration (including prodromal, active, and residual phases) is more than one month and less than six months; in addition, the disorder may or may not include impaired social or occupational functioning.
|
|
|
Delusional Disorder
|
is characterized by non-bizarre, systematized (organized) delusions for at least one month. A non-bizarre delusion is one involving a situation that could theoretically happen, such as a patient believing he is being followed or poisoned by someone (by contrast, a belief that one is being controlled by aliens would be considered a bizarre delusion).
|
|
|
Polysubstance dependence
|
includes the use of at least three groups of substances
|
|
|
Interventions in Schizophrenia
|
Psychosocial interventions, such as skills training, are used during the stable phase of schizophrenia. Prior to that, pt would need to stablize on meds.
|
|
|
Reporting Elder Abuse
|
File a report if you observe elder physical abuse or gain knowledge of an incident that reasonably appears to be elder physical abuse
This specific legal mandate does not apply because if the alleged victim is under age 65 |
|
|
Informed consent and psychotic episodes
|
A client in the midst of a psychotic episode, when there is strong evidence of hallucinations and/or delusions, would not be considered competent to provide informed consent. Your obligations when a client lacks the capacity (either temporarily or permanently) to provide informed consent are to protect the client’s interests by seeking permission from an appropriate third party whom you believe will act in a manner consistent with the client’s wishes and interests, and to inform the client, commensurate with his level of understanding, about the purposes of consent, the purposes of treatment, etc.
|
|
|
Duty to warn/protect
|
Tarasoff decision says, “When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim.” And C.C. 43.92 says, “... where the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims ... the duty [to warn] shall be discharged by the psychotherapist making reasonable efforts to communicate the threat to the victim or victims and to a law enforcement agency.”
|
|
|
Learning Disorders
|
Reading Disorder (dyslexia), mathematics disorder, and disorder of written expression.
Diagnostic Criteria: standardized test achievement is low in those areas. Interferes w/ academic achievement, daily activities |
|
|
Pervasive Developmental Disorders
|
e.g. Autism
characterized by severe impairments in multiple areas of development. |
|
|
Attention Deficit/Hyperactivity Disorder
|
disturbance of at least 6 mos. Person displays at least 6 areas of inattention, and/or at least 6 symptoms of hyperactivity-impulsivity, or combined type (6 or more of both inattention & impulsivity-hyperactivity)
*there should be some impairment for these symptoms in at least 2 settings (i.e. home and school) *symptoms present before age 7 |
|
|
Diagnostic recording of ADD
|
Predominantly inattentive type, predominantly hyperactive-impulsive type, combined type
|
|
|
Conduct Disorder
|
a persistent pattern of conduct that violates the basic rights of others and major age appropriate norms or rules. Signs of the disorder include aggression to people and animals; destruction of property; deceitfulness or theft, and serious violations of rules.
*person has displayed 3 signs in the previous 12 months with at least one sign present in the past 6 months. * may be assigned to individuals 18 or older if they do not meet criteria for antisocial personality disorder *do not make this diagnosis unless the conduct disturbance is persistent and serious |
|
|
Oppositional Defiant Disorder
|
a recurrent pattern of negativistic, defiant, and hostile bxs toward authority figures persisting for at least 6 months. Signs include losing temper, arguing with adults, actively challenging the rules of adults, deliberately annoying people, blaming others for his own misbehavior, being angry or resentful, etc.
|
|
|
Enuresis
|
Child repeatedly voids urine (involuntarily or intentionally) during the day or night into the bed or clothes. If accompanied by distress or impairment in functioning then time criterion does not need to be met
*child's chronological and mental age is at least 4 years |
|
|
Encopresis
|
Child repeatedly passes feces into inappropriate places (involuntarily or intentionally)
At least one event per month for at least 3 months child's age must be at least 4 years |
|
|
Separation Anxiety Disorder
|
Developmentally inappropriate and excessive anxiety concerning separation from home or attachment figures
disturbance last for at least 4 weeks |
|
|
Substance Dependence
|
A cluster of cognitive, behavioral and physiological symptoms indicating that a person continues to use a substance despite having significant substance related problems.
Can be diagnosed for any substance except caffiene |
|
|
Substance Abuse
|
A maladaptive pattern of substance use. The pattern is manifested by recurrent and significant adverse consequences related to repeated use.
Criteria for dependence are not met. 12 month period associated with all classes of substances identified by the DSM IV except nicotine, caffeine, and polysubstance |
|
|
Schizophrenia
|
characteristic psychotic symptoms are present for at least 1 month during active phase and continuous signs of the disturbance are present for at least 6 months.
|
|
|
Schizophrenic Active Phase
|
symptoms may include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as alogia, avolition, or flat affect
|
|
|
Alogia
|
restricted fluency/productivity of thought and speech
|
|
|
Avolition
|
Limited initiation of goal directed behavior
|
|
|
Prodromal and residual symptoms of schizophrenia
|
active phase symptoms that exist with less intensity. e.g. magical thinking rather than full-blown delusions unusual perceptual experiences rather than full-blown hallucinations
|
|
|
Consent to treat with shared custody (Legal)
|
When there is shared custody, you must obtain a copy of the custody order to determine who may consent to a child’s treatment.
This is what must be done in order to establish who may consent to treat a minor. |
|
|
Explaining to family your mandate to report suspected child abuse. (ethical)
|
This is an ethical responsibility, not a legal obligation. It is a legal obligation to file a suspected child abuse report when you have reasonable suspicion to do so. You need not tell your client you are going to file a report if you determine it is in his/her best interest or for your own safety not to tell.
|
|
|
Fees (Legal)
|
The fee "must" be disclosed prior to the provision of therapy.
|
|
|
When a client is referred to you, do you have to see them alone?
|
you could see the client individually or with his family, but there is no law requiring that you must see a referred party alone.
|
|
|
Intervening to deal with a DV crisis
|
1) Determine whether it is safe to have the sbuser in therapy with the victim. Dealing with emotionally-charged issues in therapy can be dangerous in an abusive situation, and an abuser may leave the session feeling hurt, betrayed, and attacked, all of which could turn into anger and abuse.
2) Educate the couple about the cycle of violence. If it were safe to see them both in therapy, educating about Lenore Walker's "cycle of violence" would be a good intervention to help them both recognize the dynamics of the abusive behavior and help them to respond appropriately to short-circuit violence. 3) Provide information regarding legal aid if she is amenable to this. In intervening to keep her safe, such a referral would give her appropriate information about filing assault charges or obtaining a restraining order. This answer respects the client’s possible ambivalence common to people involved in domestic violence dynamics. 4) Help the wife to develop an emergency escape plan. This is a vital ingredient in treating domestic violence, since your first concern needs to be the safety of the person being abused. An escape plan, including phone numbers of shelters and other emergency numbers and a packed bag including credit cards, cash, extra car keys, clothing, diapers and clothes for a baby, etc. is an important part of insuring your client's safety. |
|
|
In Domestic Violence, separating the husband and wife in therapy
|
This is a good technique in assessing domestic violence but not in intervening and managing. It is advisable not to include batterers in the unit of treatment until he or she has tools to manage anger and impulsivity.
|
|
|
No Violence Contract (Intervention)
|
If it is determined that it is safe to work with the DV couple without jeopardizing the victim's safety, then it would be an important intervention to create concrete boundaries and clear guidelines. A no-violence contract in which the husband promises not to act out his anger on the wife and to instead call you, call a crisis hotline, take a time-out, do deep breathing or some other relaxation technique, etc. would be part of this limit-setting.
|
|
|
Anger management classes for DV (intervention)
|
This is an appropriate intervention in working with domestic violence at some point in the treatment. However as a crisis response, it is questionable because a referral to such a group, or even the husband's attendance at two or three sessions, does not mean he has his anger under control.
|
|
|
Teaching communication skills for DV clients (Intervention)
|
Although this would be a good early and/or middle stage intervention once the crisis has been stabilized, abusers actively engaged in domestic violence are often too volatile for this kind of work, which could have the effect of escalating violence. This would not be a good crisis intervention.
|
|
|
If questions on the exam say "manage"...
|
do not pick choices that indicate that you are "assessing" For example, the "determining what constitutes as reasonable suspicion of abuse" indicates that it is an assessment intervention
|
|
|
Filing a child abuse report with family present (Legal)
|
When possible, filing the report with the family present, or having a family member file the report can have a powerful impact on trust in the therapeutic relationship and can have an empowering impact on the client.
there is no law requiring you to inform your clients that you are going to file a report. Clinically it may be best to do so, but if you determine that it is not, or that to do so would place you in jeopardy, then you would not inform the client. |
|
|
Inform the family what they can expect from Child Protective Services once the report has been filed.
|
This is not required, but would be another aspect of competently clinically managing your mandate to file a suspected child abuse report. By giving your clients information, you can reduce their anxiety and help them prepare for what they are facing
|
|
|
Early/Beginning Stage Treatment Goals for DV couples/families
|
*Form a therapeutic alliance
*Increase communication between couple (w/DV) *interrupt abusive family dynamic (aimed at stopping violence and creating safety in the family) *Facilitate adjustment to a blended family. *Strengthen the marital relationship. *improve parenting skills |
|
|
Initial Treatment Goals
|
Examples:
*Stabilizing the crisis and protecting the safety of the client and family |
|
|
Middle Stage Interventions
|
*wit DV, teach anger mgmt techniques
*with Dv, couple support group can be used in middle/later phases of tx, not initial * promoting insight in client *coaching the client to change... |
|
|
Middle Stage Treatment Goals
|
These goals involves a deeper level of change than initial goals
ie. *help improve client's self esteem *cognitive restructuring |
|
|
Maintain as much confidentiality as is possible in filing a child abuse report.
|
This is an important concept to keep in mind when filing a child abuse report. The laws of confidentiality require that you disclose nothing beyond that which is required in discharging your legal mandate.
|
|
|
Document the child abuse report in your records.
|
Therapists are legally required to keep records consistent with sound clinical judgment, and to do so in this case represents sound legal and clinical management of this issue.
|
|
|
Ethics (client relationships)
|
Therapists are ethically required to advise clients that they will not be making decisions for them about their relationships.
Therapists are ethically responsible for telling clients of the risks and benefits of therapy such as couple's counseling possibily leading to the end of a marriage. |
|
|
helping a client explore who could pay for her therapetuic tx (UNETHICAL)
|
However Ramona decides to pay for her fee is her business, but it would be unethical and exploitive to begin exploring with a client who s/he could ask to help pay for treatment.
|
|
|
Techniques to address client's expectations about therapy
|
1) Set boundaries regarding confidentiality and money.
Boundary setting is another way of communicating to a client what s/he can expect in therapy. 1) Collaborate with client on her therapy goals.This is one way imparting information about what client can and cannot reasonably expect from therapy. It would help her to understand how you work, what some of her responsibilities might be, and clear expectations of what you will be working towards. 3) Have client read and sign your informed consent statement. This would be one way of addressing expectations and promoting an understanding of the therapeutic process. That’s what obtaining informed consent is all about. 4) Explain to client her responsibilities as a client. This would also be an important part of the process of clarifying with client her expectations and promoting an understanding of the client’s role in therapy. |
|
|
Primary Insomnia
|
the diagnostic criteria for Primary Insomnia specify at least one month of trouble falling asleep or staying asleep
|
|
|
Bulimia Nervosa and moderately obese people
|
Bulimia Nervosa occurs, although is not common, in moderately obese people. According to DSM-IV-TR, the binging and other behaviors descriptive of Bulimia Nervosa need to have occurred for at least 3 months. In addition, Bulimia Nervosa is often co-morbid with Major Depressive Disorder and it would not be an unheard of response to a loss of control that a client would have experienced in a blackout and rape. And if not all of the diagnostic criteria are met for Bulimia Nervosa, Eating Disorder NOS would make sense as a provisional diagnosis.
|
|
|
Case notes and documentation
|
Although various agencies and therapists have differing policies about what should or should not go into case notes, the best legal position is to document all pertinent information. In any case, if a client is an adult and a psychotherapy client, she has the right to confidentiality and holds privilege, so her parents would not be entitled to see the notes.
|
|
|
Privilege
|
Clients hold their own privilege, whether adults or minors. Children may waive their own privilege in custody cases if the courts find them of sufficient age and maturity, or courts may appoint counsel or a guardian at litem to decide whether to waive privilege. As therapists, we always assert the privilege and let their adult clients or the courts sort out the rest.
|
|
|
Conditions allowing treatment of a minor without parental consent
|
1) if client is 12 or older
2) has been the victim of a rape or trauma and may present a danger of harm to herself without treatment. 3) You would need to determine that there is a good reason to treat her without the involvement or knowledge of her parents. |
|
|
Educational Problems as a risk factor/psychosocial stressor
|
Includes illiteracy, academic problems, discord with teachers or classmates, inadequate school environment.
|
|
|
Psychosocial Stressors
|
Educational Problems
Legal Problems (i.e. client is a victim of a crime) Housing Problems Physical abuse of the child |
|
|
Housing Problems as a risk factor/psychosocial stressor
|
Includes homelessness, inadequate housing, living in an unsafe neighborhood, or discord with neighbors or landlord.
|
|
|
Obtaining Informed Consent
|
1) Explain to the client the nature of the kind of therapy you do, what she might expect, and how long it might last. Ethically, you want your client to be an informed consumer of the service that you offer.
2) Inform client of your availability by phone between sessions. Informing clients of the extent of your availability for emergencies and other contact between sessions is an important aspect of informed consent. 3) Disclose your fee prior to providing therapy. This is both a legal and ethical component of informed consent. 4) Inform client about limits of confidentiality regarding child abuse reporting. This is also an appropriate issue in the ethical responsibility to obtain informed consent, and a therapist could choose to include this information. |
|
|
Validating a client's ambivalence as an intervention
|
Validating a client's ambivalence is a good idea in working with women who are ambivalent about leaving abusive relationships. If a client is no longer in the relationship and has expressed no ambivalence about her fear of her ex-husband, it is not recommended.
|
|
|
Initial Therapeutic Interventions
|
*Offer an accepting, nonjudgmental stance to build a therapeutic alliance. Building a therapeutic alliance is crucial in the initial stage and a nonjudgmental attitude is especially critical since client can be feeling vulnerable
*Clarify Client''s strengths and resources by asking how she has coped with past challenges. *Provide room for client to vent her feelings. It is also important in the initial stage to provide a safe place for clients to express their feelings openly so that they can feel supported and contained. *Teach client self-soothing skills to help client cope with her current stress. *Safety is the top priority for initial interventions and so setting up safety plans is a critical intervention. |
|
|
V Code: Physical Abuse of Adult
|
When there is domestic violence, this V Code is given to the perpetrator of abuse.
|
|
|
If you receive a subpoena for your client's records, how would you proceed?
|
1) Inform client of the subpoena.
This is the necessary first step, since your clients will ultimately direct you as to how to proceed. 2) Have the client contact their attorney. You would want your clients to make an informed decision based on sound legal advice. 3) Assert or waive privilege, depending on your client’s wishes. This is always the bottom line with a subpoena. The client holds privilege and has the right to assert or waive it. 4) Do not allow any records to leave the office without an authorization or a court order. This is another basic fact when dealing with client records. |
|
|
How does a therapist go about asserting or waiving privilege?
|
When a therapist asserts or waives privilege, it is by informing the court (usually through the client’s attorney) after the client has determined that that is what they want to happen.
|
|
|
Late stage goals of therapy
|
Examples:
*Reinforce client's new adaptive behavior and schedule booster sessions (behavioral but not cognitive). *Cognitive rehearsal |
|
|
Cognitive Therapy Goals
|
Early Stage:
*Establish a collaborative therapeutic relationship with client by developing a therapeutic contract *Establish a problem list *Socialize client to the Cognitive model by explaining the relationship between thoughts, feelings and behavior. Middle Stage: *Reduce symptomatic behaviors by using positive reinforcement techniques (can be early stage also) *Addressing cognitions/thoughts *Cognitive restructuring *Address problems Late Stage: *Cognitive rehearsal *Reinforce their new adaptive skills and schedule booster sessions |
|
|
Seeing a client individually after they have transitioned to family therapy.
|
There is no ethical prohibition against occasional individual sessions with clients in couples or family treatment, and it’s not hard to imagine that there may come a time where there is a clinical need to schedule separate sessions (perhaps to assess safety).
|
|
|
Informed Consent, can it be oral?
|
Although it is legally and ethically wisest to obtain written informed consent, there is no legal requirement that informed consent be in writing. However you obtain informed consent, good clinical management of this legal issue should include documentation that informed consent was obtained.
|
|
|
Record keeping of case files after termination
|
The best legal advice is that records be kept for 10 years following a client’s termination. The reason for this is that the statute of limitations for a client to file sexual misconduct by a therapist is 10 years.
|
|
|
Storage of confidential records
|
There is a legal obligation to keep records confidential, and keeping them in a locked file cabinet or under password protection on a computer is consistent with a professional standard of care.
|
