Assessment; Intervention Planning; Diagnosis; Treatment Planning. Flashcards Preview

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1
Q

What is Assessment?

The Assessment Process.

A
  • It is a critical element in the treatment of a CT.
  • Refers to the process of arriving at tentative conclusions about the nature of the CT’s situation, including problems and resources.
  • It provides the basis for treatment planning.
  • It should be an ongoing process.
2
Q

What should Assessment focus on?

The Assessment Process.

A
  • Internal: Biophysical functioning-?; Use and abuse of alcohol and drugs; Cognitive and perceptional functioning; Emotional functioning; Mental disorders; Behavioral functioning; Motivation; Degree of acculturation; Language fluency; Problem solving skills.
  • External: Health and safety factors; Social support systems; Environmental needs of adults and children; Cultural norms; Educational support and needs; Precipitating events that brought the CT to seek SW services.
3
Q

What is Intake (interview)?

The Assessment Process.

A
  • The assessment process generally begins with the intake interview, where pertinent info is gathered.
  • The intake interview more extensive social history is written, which leads to a statement of CT strengths and problem areas or to a diagnosis and then a treatment plan.
4
Q

CT Interviewing and Observation, what is Gathering data via interviewing?

The Assessment Process.

A
  • Problem areas- should be identified from the CT’s point-of-view. The most pertinent info is often obtained when the CT is most upset. Personal and environmental problem areas, including economic factors, that are having an effect on the CT’s psychosocial functioning should be explored and identified.
  • Strengths- of the CT and CT’s support system need to be identified. Identifying CT strengths can provide encouragement and lead to CT believing he/she is the driving force in dealing with current problems. The CT’s coping mechanisms, both adaptive and maladaptive, should be assessed and can shed light on their effect on the CT’s presenting problems.
  • Support system- is one of the most important aspects of the treatment process and needs to be throughly explored. That one support system increases the CT’s ability of resiliency. Support system includes family members, friends, religious affiliations, caretakers, pets, helping professionals, etc.
  • The Attitude- of the CT needs to be assessed. A positive attitude about current situation and has the ability to see things as being able to get better, he/she will have a greater chance of dealing with the problem. A negative, defeatist, or persecutory attitude about his/her situation is generally not good. There are many treatment strategies and methods that focus on changing CTs attitudes.
  • CT Motivation should be explored because a CT can have devious reasons for seeking therapy, such as wanting secondary gains. E.g. satisfying someone else’s request for the CT to obtain help or avoiding negative legal consequences. SW can ask the CT directly about his/her level of motivation or can assess the level of motivation based on the CT’s answers to questions that are asked.
  • *Motivational interviewing- is a CT- centered method for addressing the CT’s ambivalence ( simultaneous and contradictory attitudes or feelings (such as attraction and repulsion) toward an object, person, or action) and eliciting the CT’s own motivation to change rather than imposing the change. According to Miller and Rollnick (1991), motivational interviewing is not a set of counseling techniques, but a way of being with the CT while assessing the CT’s motivation to change. It is useful in substance dependence, problematic gambling, dual diagnosis, brief intervention, mental disorders, parenting and in the court system.
  • The CT’s Relationships are an essential component of the data gathering process. Interpersonal relationships frequently plays a key role in seeking treatment. The patterns of behavior that may be contributing to the presenting problem can be identified. Relationships in the CT’s work environment may contribute to the CT’s problems, so gathering information about the CT’s employment history is valuable.
  • Use of Resources- both personal and environmental is important to the CT’s situation. SW should determine if the CT has used community resources in the past and his/her attitude toward seeking and accepting help. An assessment should be made for the CT’s personal resources, such as problem solving skills, faith or spirituality, cultural values, cognitive abilities, and dependance on his/her support system. An assessment should be made to the CT’s willingness to access personal and community resources in the future.
  • Danger to Self or Others- should be explored in the initial interview. If the SW senses any indication that the CT is planning to harm him/herself or another person, SW should take immediate action.
5
Q

CT Interviewing and Observation, what is Gathering data via observation?

The Assessment Process.

A
  • SW should observe the CT over time and in multiple situations.
  • Observation-based data gathering includes:
    Appearance- of the CT, SW should note any condition relevant to understanding the CT, such as body weight, physical disabilities, apparent healthiness, facial affect, grooming, etc.
    Health- Obtained through medical records. The impact of life stressors on the CT can often be seen in the physical and emotional health of the CT. Self-care, cognitive abilities, emotional functioning, and social skills can be observed. Drug use may also be considered a possibility when certain physical, behavioral, and cognitive elements are observed.
    Life skills- are indicative of the CT functioning and may be deemed as strengths or limitations in the CT’s situation. Depending on the age and ability of the CT, factors to observe may include mobility, money management, cleanliness, personal hygiene, communication skills, organizational skills, social skills, problem- solving, self-care and work skills.
6
Q

What is Referral for additional evaluations?

The Assessment Process.

A
  • It may be necessary to obtain additional information through formal psychological testing, psychiatric evaluation, vocational testing, or medical evaluations. SW may need to refer CT to another mental health professional, medical doctor or agency. SW should tell the CT why this referral is needed and facilitate the referral process. The SW should then follow up with the individual with whom the CT was referred and use the information to complete the intake process.
7
Q

What is Assessment of Problems Areas and Strengths?

Assessment Methods

A
  • Biopsychosocial model of assessment considers three elements of the CE’s situation: (1) the biological component or how the body’s functioning may be contributing to the CT’s current problems; (2) the psychological component, or the emotions, the thinking process and behaviors of the CT; (3) the social component, or the role fo the environment, culture, socioeconomic status, poverty, and spirituality in the individuals’s health.
  • After gathering all these information, SW then identifies the CT’s current level of functioning, strengths and weaknesses, mental health status (including previous problems areas), and the CT’s needs.
  • The traditional Medical Model of assessment focuses on the CT’s pathology or what is “wrong” with the CT. In the process of gathering data and formulating a diagnosis, SW have traditionally identified problems areas, but sometimes w/o enough consideration of the CT’s strengths, resiliency, and positive life factors.
  • The Strengths Perspective of assessment is based on the notion that CT strengths are essential ingredients in the healing process and that incorporating the strengths of the CT will aid in empowering the CT to reach the desired goal.
  • Strength Perspective benefits are: empowers the CTs to solve their own problems; examines possible alternatives; teaches competencies; creates more equity between the CT and SW; builds self- confidence; helps CTs to see that problems are influenced by multiple factors, are interactive, and are ever-changing.
8
Q

What does Social History include?

Assessment Methods

A
  • Gathering data via interviewing and observation- is importation when writing the social history. The topic include problem areas, CT strengths, support system, attitude of the CT, CT motivation, CT’s use of resources, danger to self and others, appearance, health and life skills.
  • Identification of presenting problem- information gathered initially should focus on why the CT (sometimes called the “identified patient”) was referred to the agency or setting. SW should find out the reason for the referral from the viewpoint of the agency, CT and the family but there will be one problem that will be considered the referral problem, which is the primary reason for seeking help.
  • Family History- gathering family history can provide SW with valuable information about the CT’s past and can identify potential predicators of the CT’s future prognosis. Information can be gather by asking open-ended questions (e.g. “tell me about your family”) or direct questions (e.g. “Were you abused as a child?”). A CT’s response gives him/her a chance to identify what may be most important to them about their family, rather than the SW deciding what is most important. SW’s should always be attuned to cultural factors as they ask questions and interpret CT responses. SW should look for patterns of behaviors in families (e.g. poor decision- making, abuse, etc.) as possible predicators of how the CT may function. The position that the CT holds in the family constellation and his/her relationship w/ family members may also be important information needed to complete the social history. Medial and mental health history of CT and family should be assessed in relationship to their impact on CT’s current problems.
  • Sexual History- is vital information to the treatment plan. The taking of sexual history may depend on the CT’s age and reason for treatment. SW’s should prepare CT that these types of questions will be asked. These question should not be asked until well into the assessment process. Questions can be open-ended or specific. It is vital to take a sexual history due to sexual offense, or if a history of sexual abuse or sexual perpetration. Sex offenders may be reluctant or unwilling to admit to sexual behavior and may become angry when confronted. When working with a child, the SW may want to engage the child in a play situation or having the child draw pictures and describe what he/she has drawn. SW can also ask parents about their child’s sexual knowledge, including whether the parent suspects that the child has been molested.
  • Records pertinent to the CT and his/her situation, both current and past, are vital social history as they provide information that may not be readily attainable through the interview process. Relevant records to be obtained with CT permission, include school, medical, abuse and neglect, substance abuse treatment (psychiatric and medical) and criminal records. All records requests and evaluation should be in compliance with HIPPA regulations.
  • Assessment instruments are necessary pieces of information for the formulation of a diagnosis and treatment plan for the CT. In general, SW are not trained nor licensed to administer or interpret psychological tests and are only allowed to use evaluation tools for which they are qualified to administer and interpret. With CT’s permission, SW can gather school test results, vocational testing, achievement tests, psychiatric evaluations, and psychological tests.
  • Collateral contacts/ information- refers to data that is gathered from individuals who know or have had contact with the CT. They provide valuable information and often differing points of view with regard to the CT and his/her situation. Strengths of the CT and support system may also be identified when making collateral contacts. SW’s may interview relatives, neighbors, caregivers, school personnel, and co-workers. SW should inform CT that these contacts will be made and use caution and sensitivity in dealing with the CT’s feelings about these contacts.
  • Suicide Risk- requires a timely assessment. It is important to take necessary steps to prevent harm. A “no harm” contract is sometimes created for those who are having suicidal ideation, but some research suggests that this is ineffective. If a CT have a specific plan, it is important to have the CT admitted to the hospital. If the CT refuses to voluntary admit him/herself it may be necessary to contact EMS and a family member or friend to assist with the process. Drastic changes in mood may also indicate a problem in a CT who has a history of suicide or is coming out of a major depression. A person who has formulated a plan to commit suicide may also display calmness and happiness and could have all of his affairs in order.
  • Risk Factors for suicide may include: Previous suicide attempt; Family history of suicide; Mental disorders; Alcohol and substance use; Serious physical illness; History of abuse or trauma; Impulsiveness; aggressive tendencies; Feelings of hopeless; Significant losses; Isolation; no support system; Lack of mental health care; Easy access to weapons, drugs or other means.
  • Protective Factors may include: No access to guns, lethal drugs, weapons; Strong support system; Religious and cultural beliefs about suicide; Problem- solving skills; Mental health care, including treatment for substance disorders.
    Suicide chart- pg. 115- 116
  • Violence Risk- or risk of harm to others is another category that requires a timely assessment. Risk cannot be entirely eliminated, is dynamic and depends on the circumstances. Some risk factors include: History of violence or harm to others; “Social restlessness” (e.g. frequent relocation, job changes, few relationships); Individuals with mental disorders (unreliable predicators of risk); Emotions related to violence: irritability, anger, hostility, suspiciousness, fear; Substance abuse; Poor compliance with treatment; discontinuing medications; Feeling persecuted or feeling that mind or body is being controlled by external forces; Evidence of recent severe stress or loss; Access to Victims.
9
Q

The Indicator of Traumatic Stress and Violence entails?

Assessment Methods

A
  • When assessing trauma, SWs can be attuned to the indicators of trauma by observing the behavior that occurs in the assessment interviews. The SW can ask the CT about physical complaints, sleep disturbances, and coping methods. Trauma can occur with one-time, multiple, or long- lasting repetitive events that effect each person differently. Some individuals develop PTSD while others exhibit brief symptoms or resilient responses. It is important for clinicians to remember that traumatic stress reactions are normal reactions to abnormal experiences/ circumstances. Immediate reactions to trauma vary in severity. Reaction include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and blunted affect (is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect). More severe reactions may include continuous distress w/o periods of feeling calm or rest, severe dissociation and derealization symptoms, and intense intrusive thoughts. Delayed reaction may include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety about flashbacks, depression, avoiding emotions, avoiding activities associated with the trauma.
  • Trauma Impacts individuals in multiple areas of functioning: Emotional- reactions are significantly influenced by the individual’s sociocultural history. The individual may associate with strong feelings from the post trauma and the may feel emotionally out of control. Another common response is emotional numbness. (Numbing is a biological process in which emotions are detached from the thoughts, behaviors and memories).
    - Emotional dysregulation: Generally there are two emotional extremes in reaction to traumatic stress. There is a feeling of being overwhelmed (too much) or little emotion (too little). Some trauma survivors may have difficulty regulating the expression of anger, anxiety, sadness, and shame (especially with trauma experienced at a young age.) In older individuals and those who functioned well prior to the trauma, the emotional dysregulation is generally short-lived and an immediate reaction. It is common that self-medication is used as a coping skill to regain emotional control.
    - Physical: Common physical complaints include somatic symptoms, sleep disturbances, gastrointestinal, cardiovascular, neurological, respiratory and urological concerns (urinary tract infections, kidney stones, bladder control problems, and prostate problems). CTs are likely not aware of the connection b/w their emotions and physical symptoms. Focus on physical symptoms may help the person avoid emotion.
    • Hyperarousal and sleep disturbances: Hyperarousal is a biological mechanism to keep a person prepared for some event and is characterized by sleep disturbances, muscle tension, and a lower threshold for startle responses. These symptoms can persists for years after a trauma and can interfere with the ability to appropriately assess and respond to specific input from the environment (e.g. loud noises or sudden movements) which can lead to overreaction.
    • Cognitive: Traumatic experiences can alter the way in which a person thinks and processes information. Trauma frequently alters core life assumptions- thoughts about self, the world, and regarding the future. E.g. of Cognitive changes: Cognitive errors such as misinterpreting a situation as dangerous because it resembles the previous trauma; Excessive or inappropriate guilt; assuming responsibility for the traumatic event or possessing survivor’s guilt; Idealization: inaccurate rationalizations, idealization or justification of a perpetrator’s behavior leading to traumatic bonding; Trauma- induced hallucinations or delusions which are congruent with the content of the trauma; Intrusive thoughts or memories: experiencing w/o warning, thoughts and memories associated with the trauma that triggers strong emotions and behavioral reactions.
      - Behavioral: Individuals may use avoidance to reduce tension and stress; may indulge in self-medication; may exhibit compulsive behaviors (e.g. overeating), impulsiveness (e.g. high risk behaviors), self-injurious behaviors, and aggressiveness. A traumatized individual may subconsciously reenact aspects of the trauma (e.g. a child crashing a toy plane into a toy building after 911). Reenactment helps the individual to master the trauma.
10
Q

What does Standardized Testing include?

Assessment Methods

A
  • Unlicensed SWs are not allowed to administer tests such as: Psychiatric evaluations; Intelligence (IQ) test; Learning disabilities test; Communication disorder tests; Adult and children’s ADHD test; Personality test such as the MMPI.
  • Depending on the SW’s level of training and scope of practice, SW may with some specific training, administer test such as depression inventories, behavioral checklists, personality inventories, alcohol use inventories, etc.
  • Mental Status Examination- is part of a psychiatric clinical assessment to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. This exam can be used in outpatient and inpatient settings. It consists of informal inquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition. The domains examined are appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgement.
11
Q

What does Standardized Testing and Specific domains include?

Assessment Methods

A
  • Appearance- physical appearance includes a CT’s age, height, weight, and overall grooming.
  • Attitude- refers to the CT’s interaction with the mental health professional. CT’s attitude may be described as cooperative, uncooperative, hostile, guarded, or suspicions.
  • Behavior- includes general observation about the CT’s level of activity, specific abnormal movements, eye contact, and gait. E.g. of abnormal movements or tremor includes tics, Catatonia (detach from reality or oblivious to environmental stimuli), repetitive purposeless movements (head banging, rocking), odd mannerisms, restlessness, psychomotor agitation, or retardation.
  • Mood and Affect- Mood is described by the CT in his/her own words; it is an internal emotional state. Types of mood states include neutral, euthymic (normal mood), depressed or dysphoric, euphoric, angry, anxious, indifferent (apathetic), or anhedonic (inability to experience pleasure). Affect is the emotion conveyed by the CT’s nonverbal behavior. The affect is evaluated by appropriateness, intensity, range, reactivity, and mobility. Types of affect include full range, restricted, blunted, flat, labile (tendency toward emotional flexibility freedom of a movement and abrupt changes in mood and effect.), congruent (in agreement or harmony.), incongruent, exaggerated, or dramatic. Affect is subject to cultural influences.
  • Speech- is assessed by listening to the CT. The focus is on the production of speech rather than the content of speech (which is related to thought). E.g.s of speech include loudness, rhythm, pitch, articulation, quantity, rate, and spontaneity. It also includes the CT’s ability to name objects, produce specific words in a set time, and repeat short sentences. Abnormalities of speech may include stuttering, mutism, echolalia (repetition of another person’s words), palilalia (repetition of the individual’s own words), and neologisms (made-up words that have specific meaning to the individual).
  • Thought process- refers to the quantity, rate, and form (logical or coherent) of thought. It cannot be directly observed, only inferred from the CT’s speech. Rate can be described as “flight of ideas” (i.e. thought are rapid and pressured.) Poverty of thought is a term used to described a reduction in the quantity of thought. Perseveration (the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus.) is noted if the CT keeps returning to the same limited set of ideas.
    A formal thought disorder may be exhibited by thought blocking (where the CT’s thoughts seem to be interrupted w/o apparent causes; frequently mid-sentence), loose associations (thoughts appear unconnected unbeknownst to the speaker), tangential thinking (replying in an oblique or irrelevant way), derailment, and circumstantial (where the CT includes a great deal of irrelevant details and makes frequent diversions.)
  • Thought Content- identifies a CT’s delusions, phobias, obsessions, over-valued ideas, and pre-occupation. Abnormalities are measured through open-ended, conversational types of questions w/ the CT. Delusions (false ideas or beliefs that are not held by the CT’s educational, cultural and social background) are abnormalities of thought content. The content of delusions can be paranoid, grandiose (when the individual is convinced that he/she has a special talent or understanding of some phenomenon or that he/she has accomplished something of great importance), erotomanic (when the individual believes that another person, frequently of higher status, is in love with him/her), jealous, or delusions of reference (a common or action that is interpreted to have special meaning to the CT.)
    Thought withdrawal is a belief that one’s thoughts are being withdrawn from one’s mind.
    Thought insertion is belief that others are putting thoughts into one’s mind.
    Thought broadcasting is a belief that one’s thoughts are broadcasted or heard by others.
  • Perception- is a sensory (sensation or physical senses) experience. The main perceptual distortion is a hallucination (i.e. sensory perception in the absence of any external stimulus.) These occur in any of the five senses. The most common type of hallucination is auditory- person hears voices or sounds that others cannot hear. Visual hallucinations involves seeing things others cannot see. Tactile hallucinations involve touch. Olfactory hallucination involve smell. Gustatory hallucinations involve taste and are generally unpleasant. Distortion of sense of time (e.g. deja vu); depersonalization distortion of sense of self; and derealization (distortion of sense of reality.)
  • Cognition- assesses the CT’s level of alertness, orientation, attention, memory, language, and executive functions.
    Alertness is assess by the individual’s level of consciousness (awareness of and responsiveness to the environment). The level of consciousness can be alert, drowsy, clouded, or stupor.
    Attention and concentration is assessed by serial sevens (subtracting 7 from 100, 7 from 93, etc.) and digit span (ability to repeat numbers in a specific sequence.)
    Memory is assessed on three levels: immediate recall (repeating words), short-term (recalling three items after a small time delay), and long-term (recollection of historical or geographical facts.)
    Language is assessed through the ability to name objects, repeat phrases, and observing spontaneous speech.
    Executive function can be assessed by asking about similarities, (e.g. “what do a ball an apple have in common?”) and proverbs (e.g. Ask the meaning of the proverb, “People in glass house should not throw stones”.)
  • Insight- refers to the individual’s understanding to his/her problems and treatment options. Insight is a continuum (e.g. good, poor, no insight).
  • Judgment- refers to the individual’s ability to make sound, reasoned and responsible decisions. A typical question might be, “If you were in a movie theatre and smelled smoke what would you do?” or “What would you do if you won the lottery?”
12
Q

What does Medical Terminology include?

Assessment Methods

A
  • Alert and Oriented, aka oriented X3 is used to describe a CT that is aware and oriented to person, place and time.
  • Complete Blood Count or CBC, aka Full Blood count is a very common test used to determine the chemistry in a person’s blood.
  • Congestive Heart Failure is a condition in which the heart is unable to pump enough blood to the rest of the body. Common symptoms include lethargy (lack of energy and enthusiasm), extreme tiredness, swelling and fluid retention.
  • Chronic Obstruction Lung Disease (COPD) is a chronic condition of the lungs in which chronic bronchitis and emphysema are the most common complaints.
    • “SOAP notes- is a commonly used format for SW and behavioral health professionals to use in documenting progress in a CT’s record. SOAP- “Subjective”- observation, “Objective”- data, “assessment”, and “plan”.
  • “BIRP notes” is another format used for documenting CT progress. BIRP- “behavior” of CT, “intervention” of the SW on behalf of the documented behavior, “response” to the intervention, and “plan”.
13
Q

What does Medical Terminology include?

Assessment Methods

A
Commonly used acronyms include:
    bid- 2x a day
    tid- 3x a day
    qid- 4x a day
    @hs- at hr of sleep (bedtime)
    prn- as needed
    stat- immediately
    f/u- follow up
    hx- history
    sx- symptoms
    dx- diagnosis
    nka- no known allergies
    dc- discontinue or discharge
    lmp- last menstrual period
    rx- prescription
    r/o- rule out
    uri- upper respiratory infection
    uti- urinary tract infection
    wnl- w/in normal limits
    mri- Magnetic Resonance Imagining.
14
Q

DSM Classification System consists of?

A
  • 22 diagnostic categories (including Z Codes or Other Conditions That May Be A Focus of Clinical Attention). The disorders are organized by similarity in symptoms or etiology (underlying problem or disorder) and from a life span approach. E.g. disorders that first manifest in children are addressed first, such as Neurodevelopment Disorders. Then adolescence, early adulthood, and later adulthood such as Neurocognitive disorders. If there are diagnoses that manifest differently as the individual ages, DSM- 5 specifies the signs or symptoms that are present (e.g. Attention Deficit/ Hyperactivity Disorder). For disorders that do not meet the full criteria, the clinician uses “Other Specified (disorder)” or “Unspecified (disorder)”. If the disorder is associated with substance use or a medical condition, the terms “Substance/ Medication Induced (disorder)”, or “(disorder) Due to Another Medical Condition” are used.
  • The DSM- 5 no longer uses the multi-axial formulation found in the DSM-IV-TR. Axes I, II and III are combined, making the formulation more consistent with ICD-9 and ICD- 10 Codes (International Classifications of Diseases.) Axes IV and V were also eliminated. Psychosocial stressors are accounted for by the expanded section in “Conditions that May be the Focus of Clinical Attention” (Z Codes).
  • Specifiers- When diagnosing, the clinician may be requested to add “specifiers”. There are several types of specifiers: duration (e.g. first episode, multiple episodes, continuous), type specifiers (e.g. Delusional Disorder, jealous type), and severity specifiers (e.g. mild, moderate, severe; 1- 4). Severity specifiers are defined w/in diagnostic categories.
15
Q

Examples of a Diagnostic Formulation includes?

DSM Classification System

A

F60.3 Borderline Personality Disorder
F34.1 Persistent Depressive Disorder, early onset, w/ anxious distress, moderate
Z62.811 Personal history (past history) of sexual abuse in childhood.
- Diagnostic codes written in parentheses denote code that are consistent with ICD Codes.
- Either diagnostic code is considered to be equivalent.
- Individuals are viewed from a bio-psychosocial perspective in which psychosocial stressors, medical conditions, strengths, daily functioning, and mental disorders all interact. SW may want to include any medical diagnosis of a chronic nature (e.g. diabetes, congestive heart failure) that impacts the individual’s ability to function. It is important to indicate where you obtained this information, such as CT report, prior medical records or family report.
- A co-occurring disorder is defined as a combination of disorders that an individual may experience (e.g. Borderline Personality Disorder and Post- Traumatic Stress Disorder; Major Depressive Disorder and Alcohol Use Disorder). Co-occurring disorder replaces the term dual diagnosis.
- Individuals with mental health disorders are more likely to experience a substance use disorder. The co-occurring disorder can be difficult to diagnose because of the complexity of symptoms. The disorder may vary in severity. Individuals with co-occurring disorders often experience chronic medical issues, social and emotional problems rather than if the individuals was diagnosed with either a mental health disorder or a substance use disorder. The are vulnerable to both relapse of substance use and psychiatric decompensation.

16
Q

Symptoms of Neurologic and Organic disorders is?

DSM Classification System

A
  • Organic disorder is a disease process due to a medical or physical condition that affects mental function. It may be temporary or long- term. Most organic disorders fall into the categories of delirium, dementia and amnestic. The specific disorder can be acute (e.g. delirium) or chronic (e.g. dementia). Other examples include: traumatic brain injury, hypoxia (is a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.), cardiac arrhythmias (also known as Arrhythmia, cardiac arrhythmia or heart arrhythmia, is a group of conditions in which the heartbeat is irregular, too fast, or too slow… Some types of arrhythmias have no symptoms. Symptoms when present may include palpitations or feeling a pause between heartbeats.), and degenerative disorders (e.g. Multiple Sclerosis, Parkinson’s Disease, Huntington’s Chorea, infections).
  • A functional neurological disorder occurs when the brain’s structure is not damaged but it does not function correctly. Symptoms does not fall into specific diagnoses. The cause of a functional neurological disorder is unknown. Frequently symptoms are attributed to psychological factors such as emotional conflicts or stress.
  • Common symptoms of functional neurological disorder include tremors, headaches/migraines, difficulty with memory, changes in personality, pain, sleep disturbance, inability to move arms or legs properly. Symptoms vary in intensity and may be constant or intermittent. The individual is not able to intentionally produce or control the symptoms.
17
Q

What does Neurodevelopment Disorders include?

DSM-5

A
- Intellectual Disabilities
       Intellectual Disability (Intellectual Development Disorder)- replaces the term "mental retardation". Intellectual Disability is characterized by both intellectual and adaptive functioning deficits that begin during the developmental period. It occur in reasoning, problem solving, planning, abstract thinking, judgement, academics and an inability to learn from experience. Intellectual functioning deficits are manifested by clinical observation and standard intelligence testing. 
Adaptive functioning deficits are manifested in failure to meet developmental and sociocultural standards of personal independence and social responsibility.  There are limitations in activities of daily living, communication, independent living, and social interactions across multiple situations (e.g. home, school). 
The level of severity is defined by adaptive functioning rather than IQ. Severity indicates what level of support is required in academic, social and practical domains. DSM- 5 notes that IQ measures are less valid in the lower end of the IQ range. 
- Global Developmental Delay- is reserved for children under the age of 5 when clinical severity cannot be reliably assessed through standardized testing. The child fails to meet expected developmental milestones in serval areas of intellectual functioning. R/A after a period of time is required. 
There is no specific meds for Intellectual Disability Disorder or Global Development Delay. If there are specific symptoms, such as tics, meds may be prescribed for those symptoms. Treatment modalities focus on multidisciplinary interventions depending on the type of deficits the individual is experiencing. The goal is for the individual to function at his/her full potential. Use of social skills training is considered beneficial.
18
Q

What is Communication Disorders?

Neurodevelopment Disorders - DSM-5

A
  • These disorders are identified in the DSM- 5 under four diagnoses. The communication difficulty must negatively impact academic or occupational achievement and/or interpersonal communication. Communication disorder tend to be common in males.
    (1) Language Disorder is a failure to acquire and use spoken language, written language or sign language due to deficits in comprehension or production. Language difficulties are below those expected for a child of the same age. Associated defects significantly interfere with socialization, academic achievement or occupational performance and effective communication.
    There are no meds currently prescribed.
    Treatment focuses on the child working with a speech and language therapist.

(2) Speech Sound Disorder- is a new disorder that is defined as a persistent difficulty with speech sound production that interferes with the intelligibility of the individual’s speech. This disorder interferes with social interaction, academic achievement or occupational performance. Most intelligible speech occurs by the age of 3. Children with Speech Sound Disorder continue to use immature speech patterns past the age when other children can produce words clearly.
No meds for the treatment.
Most children respond well to treatment by a speech and language therapist and speech difficulties improve over time.

(3) Childhood- Onset Fluency Disorder (Stuttering) is diagnosed when a child fails to use age and dialect appropriate speech sounds. The average age of onset is by age 6, but the range can be between 2-7 years of age. The disorder causes significant anxiety related to speaking or limitations in effective communication. Stress and anxiety can exacerbate the disorder. The disorder interferes with the individuals’s achievement in academics, occupation, and interpersonal communication. The individual may avoid situations due to fear that stem from humiliation and embarrassment.
The symptoms consist of: sound distortions, substitutions or omissions; articulation problems; words produced with excessive physical tension; and monosyllabic word repetitions.

(4) Social (Pragmatic) Communication Disorder is a new order. The individual diagnosed with this disorder has persistent difficulties in the social use of verbal and nonverbal communication. The diagnosis is appropriate after the 4 or 5 when the child has adequate speech and language abilities. There is no evidence of restricted/ repetitive patterns of behavior, interests or activities as would be seen in Autism Spectrum Disorder. There is functional impairment in effective communication, social relationships, academic achievement or occupational performance. 
There are specific deficits in the following areas: communication for social purposes; impaired ability to change communication to match context or the needs of the listener (e.g. setting, speaking with an adult vs. a child); following rules of conversation (e.g. taking turns, rephrasing what has been heard); and understanding inferences, nonliteral or ambiguous meanings of language. 
Since Social (Pragmatic) Communication Disorder is new, there has not been specific research related to effective meds or treatment. However, since many of the communication issues are similar to Autism Spectrum Disorder, similar medications and treatment have been suggested including social skills training, speech and language therapy.
19
Q

What is Autism Spectrum Disorders?

Neurodevelopment Disorders - DSM-5

A
  • This is a new disorder under the DSM- 5. It consolidates the following DSM- IV disorders: Autistic Disorder, Asperger’s Disorder, Rett’s Disorder, Childhood Disintegrative Disorder and Pervasive Development Disorder NOS.
    Symptoms of the disorder are represented in terms of severity in social communication/ interaction and restrictive behaviors/ interests/ activities. Symptoms include: reduced sharing of emotion and a failure of normal back and forth conversation; stereotyped or repetitive motor movements or speech; insistence on sameness; no flexibility in routines, ritualized patterns to sensory input. Severity is assessed separately for social communication and restricted, repetitive patterns of behavior.
    ** If symptoms are related only to social communication, then the clinician should look at the criteria for social (Pragmatic) Communication Disorder.
    Meds are generally used to treat specific behavioral issues (e.g. aggression, self-injurious behaviors, and self-harm behaviors). Risperidone and Abilify are prescribed to treat these behaviors. Other medications have been prescribed for specific symptoms (e.g. anxiety, depression, obsessive- compulsive behavior, hyperactivity).
    There are no single treatment for autism and requires an interdisciplinary team approach. Treatment is tailored to the individuals child’s needs. The main goals of treatment are to lessen associated deficits and family distress and to increase quality of life and functional independence. Many of the treatments utilized are related to Applied Behavioral Analysis (e.g. Intensive Behavioral intervention, Pivotal training-(PRT)- is a method of systematically applying the scientific principles of applied behavior analysis (ABA) to teach learners with autism spectrum disorders (ASD) functional social-communicative and adaptive behaviors within a naturalistic teaching format.). Speech therapy, physical therapy, and occupational therapy can address specific deficits in those areas.
20
Q

What is Attention- Deficit/ Hyperactivity Disorder (ADHD)?

Neurodevelopment Disorders - DSM-5

A
  • A clear pattern of inattention and/or hyperactivity not accounted for by an individual’s developmental stage. ADHD is more common in boys. Some symptoms are evident before age 12 and impairment must be significant and evident in at least two different settings. In preschool children, hyperactivity is the main manifestation. In school age children, inattention is more prominent. In adolescent, hyperactivity is less common and may be more related to fidgetiness, inner restlessness or impatience. In adulthood, impulsivity may remain problematic even when hyperactivity has diminished. In children, there must be at least six symptoms in either or both inattention and hyperactivity- impulsivity. In adolescents and adults ( over age 17), the individual must present with five symptoms.
  • Three different types of ADHD:
    Attention- Deficit/ Hyperactivity Disorder, Combined Type
    Attention- Deficit/ Hyperactivity Disorder, Predominantly Inattentive Type
    Attention- Deficit/ Hyperactivity Disorder, Predominantly Hyperactive- Impulsive Type

Treatment has typically focused on meds (e.g. psychostimulants such as Ritalin, Dexedrine, or Adderall.) These psychostimulants are often helpful in curbing hyperactivity and impulsivity, attention, and learning. Strattera is a non-stimulant that is prescribed for adults or children who do not tolerate psychostimulants. Tricyclic antidepressants are also effective in adults.
There are varies therapies utilized for individuals with ADHD. Psychotherapy allows the child to talk about upsetting thoughts and feelings, identify self-defeating behaviors, and learn alternative ways to handle these emotions and behaviors. Behavior therapy focuses on ways to deal with immediate issues and create behavior change (e.g. organizing schoolwork). Social skills training assists individuals with ADHD in maintaining good social relationships and understanding social cues. Psychotherapy and medication are the preferred treatment in adults.

21
Q

What is Specific Learning Disorder?

Neurodevelopment Disorders - DSM-5

A
  • The inability to learn or use academic skills as quickly or as accurately as other children of the same developmental age. The specific learning difficulties occur during school- age yrs and may not manifest until the demands of the school exceed the individual’s abilities. This disorder significantly impairs the person’s ability to perform activities of daily living or in academic areas. This disorder tend to be more common in males.

Specify type:

  • with impairment in reading
  • with impairment in written expression
  • with impairment in mathematics

Specify severity: Mild, Moderate, or Severe.

There are no meds to treat Specific Learning Disorder.

Treatment is provided by an Education Learning specialist. It focuses on strengthening skills the child currently has, developing new learning strategies and use of multimodal teaching (e.g. using different senses) to take advantage of the child’s strength.

22
Q

What does Motor Disorder entails?

Neurodevelopment Disorders - DSM-5

A
  • Developmental Coordination Disorder- is characterized by marked impairment in developmental acquisition and execution of skills requiring motor coordination. It involves the following symptoms: significant developmental delays, substantial impairment in motor coordination and achieving normal motor milestones. These impairments significantly interfere with academic achievement or daily activities. None of the impairments are the results of a general medical condition.
    There are no meds that are prescribed unless there is a significant tremor that interferes with motor function; in that circumstances beta-blockers may be prescribed.
    There are no specific treatment designed for individuals with developmental Coordination Disorder. However, physical and/or occupational therapy are considered to be helpful.

Stereotypic Movement Disorder- is characterized by repetitive, motor behaviors that have no apparent useful purpose (e.g. body rocking, head banging). Head banging is more common in males, whereas self-biting is more common in females. The behavior (s) must be present for a minimum of 4 weeks. The behavior (s) are not the result or a compulsion or tic. The behavior (s) have the potential to cause physical injury requiring medical intervention. The disorder causes clinically significant impairment in daily activities.
In same cases, antidepressants such as Prozac, Zolof, and Luvox (selective serotonin reuptake inhibitors, or SSRIs) or Anafranil (a tricyclic antidepressant) may be helpful in treating Stereotypic Movement Disorder.
The goals of treatment are to ensure the child’s safety, as well as to improve the child’s ability to function. The child’s surroundings may need to be modified to reduce risk of injury.

Tic Disorder are defined in the DSM-5 (2013) as “… a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalizations. Although tics can include almost any muscle group or vocalization, certain tic symptoms, such as eye blinking, or throat clearing are common across patient populations. Tics are generally experienced as involuntary, but can be voluntarily suppressed for varying length of time.
Copropraxja- involves obscene gestures and words.
Palilalia- involves a repetition of one’s own sounds and words.
Echolalia- involves the repetition of the last sound or word of another individual.
Typical onset is between 4 and 6 yrs of age. Peak severity occurs between ages 10 and 12 with a decline during adolescence. Tics wax and wane in severity. They are not the direct result of a medical condition or a substance.
Tics Disorders are:
Tourette’s Disorder involves both motor tics and vocal tics over the course of the disorder. Onset is before age 18. Tics wax and wane in frequency, but have persisted for more than 12 months.
Persistent (Chronic) Motor or Vocal Tic Disorder involves either motor tics or vocal tics, but not both, over a 1-yr time period. Tics wax and wane in frequency. Onset is before age 18.
Provisional Tic Disorder is characterized by single or multiple motor and/or vocal tics that have been present for less than a year. Onset is before age 18. The individual must not have previously met the criteria for Tourette’s Disorder or Persistent (Chronic) Motor or Vocal Tic Disorder.
There are no specific meds for any of the Tic Disorders. Antipsychotic meds and anti-hypertensive agents are used to decrease tics when the tics cause significant distress or impairment.
Comprehensive Behavioral Intervention for Tics (CBIT) includes habit reversal training (HRT) education and life style changes. Habit reversal is intended to involve replacing a tic with a competing response (i.e. a more comfortable or acceptable movement or sound) when an individual feels a (pre)mon(i)(tory) urge building. Education teaches individuals to become more aware of tics and life style changes to reduce the occurrence of tics.

23
Q

Schizophrenia Spectrum and Other Psychotic Disorders entails?
Neurodevelopment Disorders - DSM-5

A

The hallmark of Schizophrenia Spectrum and Other Related Psychotic Disorder is a significant distortion in the individual’s perception of reality. Individuals with this disorder show impairment in the capacity to reason, and behave rationally or spontaneously. Also impairment in the individual’s capacity to respond spontaneously with appropriate affect and motivation. These disorder occur in the absence of impairment of memory or consciousness.

Terminology-
Hallucination- are sensory distortions concerning the five senses that other do not observe. The most common type of hallucination is auditory (hearing sounds or voices). The next most frequently occurring are visual hallucinations such as seeing shadows or imaginary people. There may also be tactile (hallucinations of touch), olfactory (hallucination of smell), and gustatory (hallucination of smell)

Delusion: A delusion is a false belief that is not held by others of the individual’s culture. The individual cannot be dissuaded that the belief is untrue even when presented with evidence to the contrary. 

Disorganized Speech: is characterized by non-logical ideas. Examples of disorganized speech are: tangential speech, in which the individual moves from one topic to another with little association to the previous topic (“going off on a tangent”); Loose associations, in which there is no logical progression from one thought to another; or word salad in which no rules or grammar are used, and the words are jumbled. 

Negative Symptoms: are symptoms that include restricted, blunted emotional expression or flat affect. There is a lack of motivation that characterizes negative symptoms as if something has been taken away from the individual. 

Schizophrenia- a psychosis not apparently the result of organic mental disorder or mood disorder that has lasted more than six months in which the active phase has begun before the subject is 45yrs.
Typical features- thought disturbance- misinterpretation of reality, misperception, loose association, delusion or hallucination.
Mood Changes- inappropriate affect, blunted emotion, inability to empathize and ambivalence.
Communication Problem- incoherence or poverty of speech content; Behavior patterns that may be bizarre, regressive or withdrawn.

Psychotropic drugs, Psychotherapy and help with social functioning enable most ppl to live fairly comfortable and somewhat independent.

24
Q

What is Delusional Disorder?
Schizophrenia Spectrum and Other Psychotic Disorders
Neurodevelopment Disorders - DSM-5

A

This disorder is characterized by a minimum of one non-bizarre delusion and must be evident for a minimum of 1 month. It can be accompanied by tactile or olfactory hallucinations if related to the delusion. An individuals psychosocial functioning, apart from the delusions, is normal. Any concurrent mood episodes are brief relative to the duration of the delusions.

Types of Delusions Disorders:
Erotomanic Type- is diagnosed when the individual believes that another person, frequently of higher status, is in love with him or her.

Grandiose Type- is diagnosed when the individual is convinced that he/she has a special talent or understanding of some phenomenon or that he she has accomplished something of great importance.

Jealous Type: is diagnosed when the individual believes that his or her spouse or lover has been unfaithful based on faulty inferences.

Persecutory Type: is diagnosed when the individual believes that someone is conspiring, trying to poison, following him or her, etc.

Somatic Type: is diagnosed when the individual is convinced that one or more of his or her body openings emits noxious odor, that insects are crawling under the skin, that a parasite has invaded his/her body, or that one or more body parts are not functioning.

Mixed Type: is diagnosed when a specific delusional theme does not predominate.

Unspecified Type: is diagnosed when the SW is uncertain about the central delusional theme or when the delusion does not fall under any of the categories above.

Medications: are only marginally effective. Some antipsychotic medication may relieve delusional beliefs but only temporarily.

Individual therapy is usually the most effective modality for individuals suffering from Delusional Disorder. The most important factor is the quality of the CT-SW relationship where trust is the key issue. Early in the relationship is it important that the SW does not challenge the CT’s delusional beliefs and instead concentrate on realistic and concrete problems and goals within the individual’s life. Once a supportive relationship has been established the SW can begin reinforcing positive gains and behaviors the individual makes in his/her life, and then gradually and gently challenge the delusional beliefs.

25
Q

What is Brief Psychotic Disorder?
Schizophrenia Spectrum and Other Psychotic Disorders
Neurodevelopment Disorders - DSM-5

A

This disorder is characterized by Schizophrenic symptoms that have been evident at least 1 day and no more that 1-month. A SW should specify With Marked Stressor (s) if symptoms seem to be caused by stressful event; Without Postpartum Onset if symptoms appear within 4- weeks postpartum; specify with Catatonia (detached from reality and oblivious to environmental stimuli) if he individual meets the criteria for Catatonia.
If symptoms are only minimally impairing the individuals functioning and if a specific stressor has been identified, removing the stressor should provide sufficient treatment. Brief hospitalization may be necessary for evolution and safety. Antipsychotic mediations may be necessary. After the acute episode is resolved, individual, family, and group therapy may be considered to cope with stressors, resolve conflict, and improve self-esteem and self-confidence.

26
Q

What is Schizophreniform Disorder?
Schizophrenia Spectrum and Other Psychotic Disorders
Neurodevelopment Disorders - DSM-5

A

This disorder is different from Schizophrenia in two ways. One, the individual may or may not experience impairment in social or occupational functioning. Two, the individual should have symptoms of the disorder a minimum of 1-month and less than 6 months. If the disorder continues beyond 6 months, the diagnosis should be changed to Schizophrenia.
Medication and treatment are similar to those listed for Schizophrenia. Schizophrenia is a psychotic disorder characterized by a combination of specific positive and negative symptoms.
Positive Symptoms- includes hallucinations, delusions, disorganized speech, inappropriate affect, and disorganized behavior (absence of goal- orientation often manifested in failure to perform activities of daily living).
Negative Symptoms- include a flat or blunted affect (the absence or a severe restriction of observable emotion), avolition (a loss of willpower and decisiveness), alogia (a speech disturbance in Schizophrenia involving poverty of speech), decrease in the amount of speech or poverty of content of speech (speech that contains little or no meaningful information), and anhedonia (a loss of ability to experience pleasure).

There are three phases of Schizophrenia:
Prodromal Phase- is characterized by a decline in role functioning and precedes the active phase.
Active Phase- is distinguished by full-blown symptoms of Schizophrenia (e.g. delusions, hallucinations, severely disorganized speech, etc.)
Residual Phase- follows the active phase, in which the psychotic symptoms have improved but impairment continues.

There must be continuous signs of disorder of a minimum of 6 months to be diagnosed with Schizophrenia. Any mood episodes that may have occurred during the active phase of the disorder must have been relatively brief; otherwise, a diagnosis of Schizoaffective Disorder or Mood Disorder with Psychotic Features should be considered. The active phase must have lasted at least 1 month unless treatment led to a decreased in symptoms.

Medication management often requires a combination of antipsychotic, antidepressant, and anti-anxiety medications depending on the types of symptoms the individual experiences. Antipsychotic meds help to normalize biochemical imbalances that cause Schizophrenia. The biggest obstacle for individuals with Schizophrenia is medication compliance.
Treatment requires “wrap around services”. Such services include social skills training, education about the disorder, independent living assistance, case management, and medication compliance. Although psychotherapy is not a treatment of choice, is can be beneficial in providing encouragement, reassurance and reality testing. Group therapy is beneficial when it focuses on real-life plans, problems, social and work roles, relationships, medication compliance, and practical recreational or work activity. Family therapy can significantly decrease relapse rates and provide support for both the individual with Schizophrenia and family members. Self-help and community support groups (e.g. National Alliance for the Mentally Ill) are also beneficial.

27
Q

What is Schizoaffective Disorder?
Schizophrenia Spectrum and Other Psychotic Disorders
Neurodevelopment Disorders - DSM-5

A
  • This disorder has major depressive ( Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems), or Manic ( is an emotional state characterized by a period of at least one week where an elevated, expansive, or unusually irritable mood exists), episode in combination with symptoms of Schizophrenia. The mood symptoms are prominent feature of the disorder. There must have been a period of two or more weeks in the absence of mood symptoms during the lifetime of the illness.
    Specify: Bipolar type or Depressive type with Catatonia (if applicable)
    Antipsychotic medications are the treatment of choice for individuals diagnosed with Schizoaffective Disorder.
    Individual therapy is the most common format for treatment. Supportive, CT- centered, non-directive psychotherapy is the modality often used. A problem- solving approach can also be very beneficial in helping the individual learn how to deal with issues more functionally and improve daily coping skills. With episodes of severe psychosis, inpatient hospitalization may be necessary.
28
Q

What does Bipolar and Related Disorder entail?

Neurodevelopment Disorders - DSM-5

A
  • Bipolar- also known as manic depression, affects mood and energy levels. Symptoms of bipolar include manic states of ecstatic nature, and depressive states of severe hopelessness. Extreme irritability, restlessness, and irregular sleep patterns are all signs of bipolar.
  • Manic Episode is characterized by mood that is abnormally elevated, expansive, or irritable that persists for a minimum of a week. In addition, the individual has at least three of the following symptoms (four if mood is irritable):
    • grandiosity or self-esteem that is inflated
    • decreased need for sleep
    • pressured speech
    • racing thoughts
    • easily distracted
    • psychomotor agitation or persistently increased goal- oriented behavior
    • excessive involvement in activities that are likely to result in negative consequences.
      The symptoms cannot be the direct result of a substance or medical condition and must cause marked impairment in functioning.
  • Hypomanic Episodes involves symptoms associated with a Manic Episode, but are less extreme. The symptoms must be present for 4 days and have been present most of the day, nearly every day. Even though the symptoms are accompanied by a change in functioning, the episode does not cause significant impairment in functioning. The symptoms are not the direct result of a substance or a medical condition.
  • Major Depressive Episode is characterized by at least two weeks of depressed mood, or a loss of pleasure in most activities. Children and adolescents may present with irritability instead of sadness. The individual must have at least five of the symptoms listed below with a marked change in functioning. The symptoms should not be a direct result of a substance or a medical condition. The individual should not be experiencing normal bereavement.
    Characteristics of Major Depressive Episode:
  • change in appetite or a significant loss of weight
  • sleep disturbance, either insomnia or hypersomnia
  • restlessness, agitation or motor sluggishness
  • fatigue
  • feelings of worthlessness; guilt- laden
  • difficulty thinking, concentrating and making decisions
  • recurrent thoughts of death
29
Q

What does Bipolar and Related Disorder entail?

Neurodevelopment Disorders - DSM-5

A
  • Bipolar I Disorder- involves a minimum of one Manic episode and Major Depressive Episode (although mania- an intense preoccupation with some kind of idea or activity. A state of agitation accelerated thinking, hyperactivity, & excessive elation seen in some major affective disorder-Affective disorders are a set of psychiatric disorders, also called mood disorders. The main types of affective disorders are depression, bipolar disorder, and anxiety disorder may be the first manifestation of the disorder).
  • Bipolar II Disorder- involves a minimum of one Hypomanic episode and Major Depressive Episode (s).

Medications are an integral part of treatment for Bipolar Disorder (either I or II). Mood stabilizers (Lithium, Tegretol, Depakote) have been the first line of treatment in the past and are still used. Atypical antipsychotics (Geodon, Risperdal, Zyprexa, Abilify, Seroquel) are more frequently prescribed because they can provide greater symptom relief but have greater side effects and are more expensive. Antidepressants may be added during a depressive episode.
Both typical and atypical antipsychotics are dopamine antagonists, which means that they impede chemical messengers in the brain known as dopamine.

In conjunction with medication management, therapy is considered beneficial. The key components for treatment of Bipolar Disorders are:
- strong education about the disorder
- looking for and planning for signs of relapse
- illness acceptance
- regular sleep and activity patterns
- direct involvement with family
Some successful treatment have been Cognitive- Behavioral Therapy, Interpersonal Therapy with Social Rhythm Therapy, and Family- Focused Therapy.

Cyclothymic Disorder (cy-clo-thy-mic)- is characterized by mood shits between hypomanic and depressive symptoms that do not meet criteria for either episode. The hypomanic and depressive symptoms have been present for at least half the time. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must persist for a minimum of two years in adults, or on year in children and adolescents.

Generally speaking, meds is not the first line of treatment. Lithium carbonate can be tried to manage mood swings that are similar to those found in Bipolar Disorder.
There is no clear treatment of choice. Individual psychotherapy techniques may vary. Some clinicians have found a psychoeducational approach to be helpful. Since Cyclothymic disorder is a chronic condition, helping individuals to better predict their mood swings and increase their level of coping skills become vital.

30
Q

What is Depressive Disorders?

Neurodevelopment Disorders - DSM-5

A
- Disruptive Mood Dysregulation Disorder- characterized by chronic, severe persistent irritability. The child has severe temper outbursts that are grossly out of proportion in intensity or duration for the situation and are not consistent with the child's developmental level. The outbursts occur regularly and when absent, the child's mood is persistently irritable and angry. Symptoms must be present for at least 12 months and manifest in at least two settings (e.g. home, school). The diagnosis cannot be made before age 6 or after age 18. The onset is typically before age 10.
Disruptive Mood Dysregulation Disorder is a relatively new disorder, treatment and meds options are still under investigation. If the CT demonstrates depression and anxiety then SSRI meds-re a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder and anxiety disorders; by increasing levels of serotonin in the brain; and stimulants would likely be considered first. If the disorder is more related to bipolar disorder, then mood stabilizers or atypical antipsychotic agents might be the treatment of choice. 
Cognitive Behavior Therapy (CBT) and Behavior Therapy are considered to be the essential components of psychosocial intervention with individuals with this disorder. 
  • Major Depressive Disorder- involves a minimum of one Major Depressive Episode, and causes clinically significant distress or impairment.

Specify: single episode or recurrent episode.

Antidepressants are commonly prescribed for depression. There are several types of antidepressants: tricyclics, selective serotonin reuptake inhibitors (SSRI’s), MAO inhibitors (psychotic drug- reduces metabolism of monoamine oxidase) and atypical antidepressants (Trazodone, Wellbutrin), Electroconvulsive Therapy (ECT)- small electric current sent thru the brain triggering brief seizure; is a treatment of last resort for severe and chronic depressive symptoms.
Cognitive- Behavioral therapy is the most popular and typically the most effective in the treatment of depression. Emphasis is placed on discussing thoughts and behavior associated with depression. While emotions are a focus of treatment some of the time, dealing with problematic thinking and behaviors will more likely lead to a change in an individual’s emotional state.
Interpersonal therapy is another therapy utilized in the treatment of depression. The foci of this approach are the individual’s social relationships, more effective communication, appropriate expression of emotions and appropriate assertiveness in social and occupational situations.
Other approaches can also be used (e.g. Behavioral Therapy or Rational Emotive Therapy). Whatever the approach used, the emphasis is on the individual taking a proactive approach to treatment.

31
Q

What is Depressive Disorders?

Neurodevelopment Disorders - DSM-5

A
  • Persistent Depressive Disorder (Dysthymia- dys-thy-mi-a- persistent mild depression; defined as a low mood occurring for at least two years, along with at least two other symptoms of depression) is characterized by depressive symptoms that do not meet the criteria for a Major Depressive Episode. Symptoms have been present a minimum of tow years in adults and one year in children and adolescents in combination with other depressive symptoms. It is common for the individual to develop Major Depressive Episodes; however, once the episode clears the individual returns to the chronic state of dysthymia. The individual has two or more of the following:
  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration
  • feelings of hopelessness
    Antidepressant meds is helpful in keeping the person’s energy level up and preventing depressed mood. SSRI’s are the most commonly prescribed meds.
    The best treatment is a combination of psychotherapy and antidepressant meds. Cognitive therapy emphasizes change in faulty or distorted thinking and realistic, attainable goals in the individual’s life that assist the person in returning to a normal level of functioning. Interpersonal therapy focuses on an individual’s relationship with others and how to improve and strengthen existing relationships while also finding new ones. Solution- focused therapy looks at specific problems that persist in the individual’s life and how to best bring about change in the person’s behavior to solve these difficulties. Social skills training focuses on teaching new skills so that the individual can become more effective in social and work relationships.
  • Premenstrual Dysphoric-a state of unease or generalized dissatisfaction with life Disorder- is characterized by symptoms that occur during a majority of the woman’s menstrual cycle. The symptoms begin in the final week before the onset of menses-the time of menstruation and begin to improve within the few days after the onset of menses and become minimal or absent in the week post-menses. One or more of the first three symptoms and up to five additional symptoms must be present:
  • significant affective lability (Emotional lability refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur)
  • significant irritability or anger or increased interpersonal conflict
  • marked anxiety, tension, and/or feeling of being keyed up or on edge
  • decreased interest in usual activity
  • subjective difficulty in concentration
  • lethargy, easily fatigued, or lack of energy
  • significant change in appetite; overeating or specific food cravings
  • hypersomnia or insomnia
  • sense of being overwhelmed our out of control
  • physical symptoms ( breast tenderness/ swelling, joint/ muscle pain, sensation of bloating or weight gain)

The symptoms cause clinically significant impairment and distress.

Serotonin Reuptake Inhibitors (SSRI’s) and Xanax (a benzodiazepinc) have been reported to be effective in treating Premenstrual Dysphoric Disorder although no treatment has been conclusively shown to be effective in well- controlled studies.
Cognitive Behavior therapy (CBT), light therapy, exercise, relaxation strategies and nutrition therapy are appropriate interventions although untested.

32
Q

What does Anxiety Disorder entail?

Neurodevelopment Disorders - DSM-5

A
  • a chronic or recurring state of tension, worry, fear, and uneasiness arising from unknown or unrecognized perception of danger or conflict.

Separation Anxiety Disorder
- It is distinguished by developmentally inappropriate excessive anxiety around separation from significant others (parents or spouse). Features include clinically significant (e.g. severe distress or impairment of function) symptoms of anxiety; unrealistic worries about the safety of loved ones; reluctance to fall asleep without being near the primary attachment figure; excessive distress, such as tantrums, when separation is imminent; nightmares with separation- related themes; and homesickness, such as a desire to return home or make contact with the significant other. Physical and somatic symptoms, such as dizziness, light headaches, headaches, nausea, stomachache, cramps, vomiting, muscle aches, or palpitations, may be present and problematic. In children and adolescents the symptoms must be present for at least 4 weeks and in adults 6 months. Symptoms cause significant impairment and distress.
- The medication fluoxetine (Prozac), the only selective serotonin reuptake inhibitor (SSRI) approved by the FDA in those younger than 18, is typically prescribed. This medication should be used when functional impairment is moderate to severe.
- The therapy focus on teaching children several major skills: recognizing anxious feelings regarding separation and identifying their physical reactions to anxiety; identifying their thoughts in anxiety provoking separation situations; and developing a plan to cope adaptively with the situation. In younger children who have difficulty expressing thoughts and feelings play therapy is beneficial.
Behavioral strategies such as modeling, role-playing, relaxation training, and reinforced practice are used. Children are taught to implement their coping skills while gradually facing anxiety producing situations. Children’s successes are praised highly by the SW and parents.

  • Selective Mutism
    This disorder is identified by a persistent failure to speak in certain situations with a demonstrated ability to talk as evidenced by doing so in other situations. It lasts a minimum of 1 month and cannot be evident only in the fist month of school. This diagnosis is not given if it is apparent that the person’s failure to speak is rooted in a lack of familiarity of or comfort with the language.
  • Occasionally, it is treatable with medication- Fluoxetine (Prozac), a SSRI. Treatment with medication is more successful in younger kids. Fluoxetine has been found to reduce the symptoms in about three-fourths of children.
  • A number of different approaches have been used in an attempt to treat Selective Mutism. Behavior modification techniques may be used in which positive rewards for speech are given and then withheld when the individual is silent. Punishment is not recommended. Stimulus fading involves finding a motivating “stimulus” for the child to speak in a mute situation, which is typically a place that is intimidating and therefore speech is more difficult. A trusting parent is often a good “stimulus” to use. Stimulus fading has been found to be particularly effective when used in conjunction with positive reinforcement techniques.
  • Specific Phobia
    Is diagnosed when a specific object or situation causes excessive or unreasonable anxiety; avoidance behavior is often evident. Types of phobias include animal, natural environment, such as storms, blood-injection- injury, and “other types” that do not fall under one of the previous categories. The concerns are fear about harm from the object, concerns about embarrassment, or fear of consequences related to exposure.
  • Medications are not generally prescribed. Individuals who experience anticipatory anxiety may benefit from benzodiazepines (e.g. individuals who are afraid of flying might be able to control their fear with medication). Individuals whose phobia interferes with daily functioning may benefit from an SSRI (e.g. Paxil)
  • Desensitization, in which the individual is exposed to graded doses of a phobic object or situation, is an effect technique and that the individual can practice outside of the therapy session. Emotive imagery helps to decrease the anxiety when the individual faces real life situation. (Emotive imagery- behavior and cognitive therapy, the CT imagines emotion arosuing scenes while relaxing and being comfortable and protected). Relaxation techniques are sued to manage anxiety symptoms.
33
Q

What does Anxiety Disorder entail?

Neurodevelopment Disorders - DSM-5

A
  • Social Anxiety Disorder (Social Phobia)
    Is characterized by fear of embarrassing oneself in social situations or feeling foolish. Avoidance behavior is often evident and the condition is not due to a medical situation or substance. This disorder typically lasts for more than 6 months.
    Imipramine (Tofranil among others, is a tricyclic antidepressant-are a class of medications that are used primarily as antidepressants) has been effective in blocking some Panic Attacks. MAO (are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A (MAO-A) and monoamine oxidase B (MAO-B)) inhibitors have also been helpful for some individuals. Some benzodiazepines ( Librium, valium) are effective in a phobic situation if they are taken in sufficient doses to produce relaxation.
    Psychotherapy and behavioral treatments (systematic desensitization with increasingly anxiety- producing objects or situations and in vivo exposure) are common interventions that are preferred prior to initiating medication on a long- term basis.
    Systematic desensitization, also known as graduated exposure therapy, is a type of behavior therapy developed by South African psychiatrist, Joseph Wolpe. That gradually alleviate the fear and anxiety associated with an object or event. Using relaxation exercise and imagery relaxation technique the CT is exposed to stimuli from a gradation of anxiety provoking situation.
    In- Vivo exposure- the subject gradually approaches a feared stimulus while in a relaxed mood.
  • Panic Attack Specifier
    A panic attack is characterized by a circumscribed period of intense fear or discomfort that the peaks within 10 minutes. At least four of the following symptoms are present: Palpitations, sweating, trembling & shaking, shortness of breath or sense of smothering, sense that one is chocking, discomfort or pain in chest area, nausea or abdominal discomfort, dizziness, lightheadedness, feeling faint, numbness or tingling sensations, chills or hot flashes, derealization (sense of unreality), depersonalization (sense of being detached from self), fearfulness that one is going to lose control or go crazy, fear of dying.
  • Panic disorder
    is characterized by a pattern of recurrent panic attacks accompanied by persistent worry of behavioral change. Anxiety symptoms and functional impairment are independent of the actual panic attack. Panic attacks are uncued/ spontaneous. At lease one of the attacks has been followed by 1 month (or more) of one (or more) of the following: persistent concern about having additional attacks; worry about the implementations of the attack or its consequences (e.g. losing control, having a heart attack, “going crazy”); a significant change in behavior related to the attacks.
    The panic attacks are not due to the direct physiological effects a drug or a medical condition. The panic attacks are not better accounted for by another mental disorder.
34
Q

What does Anxiety Disorder entail?

Neurodevelopment Disorders - DSM-5

A
  • Agoraphobia- is characterized by fear and anxiety in two or more of the following five situations: using public transportation, being in open spaces, being in closed places, standing in a line or being in a crowd, being outside of the home alone. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available.
  • Many individuals can be treated for Panic Disorder or Agoraphobia without the aid of meds. If meds is needed, benzodiazepines and SSRI antidepressants are the medication of choice.
  • Individual psychotherapy is preferred. Education around the “fight or flight” response and the associated physiological sensation as well as developing more effective coping strategies are the primary foci of treatment. Relaxation and imagery techniques have proven to be effective. A cognitive or rational- emotive approach for irrational thoughts during a Panic Attack is helpful as is a behavioral approach emphasizing graduated exposure to panic- inducing situations.
  • “Fight or Flight”- hyperarousal- acute stress response- physiological reaction that occur in response to a perceived harmful event, attack or threat to survival.
  • Generalized Anxiety Disorder (GAD)
    This disorder involves excessive anxiety and worry about a number of things that persists for a minimum of 6 months. The behavior is not due to a medical condition or substance.
  • Meds should be prescribed if the anxiety symptoms are serious and interfering with normal daily functioning. The most commonly prescribed anti-anxiety meds are benzodiazepines (Ativan, Xanax, Valium, Librium and Klonipin). Antidepressants and Buspirone are alternatives to benzodiazepines.
  • Individual therapy is the recommended treatment approach as individuals with the disorder are uncomfortable discussing their anxiety in front of others. Therapies for individuals with Generalized Anxiety Disorder need to focus on the the low-level, ever present anxiety. Relaxation exercises are a good initial strategy. Reducing stress and increasing overall coping skills are beneficial.
35
Q

What is Obsessive- Compulsive Disorder (OCD)?

Obsessive- Compulsive & Related Disorder - DSM-5

A
  • is characterized by anxiety- producing obsessions (persistent thoughts, urges, or images) or compulsions (behaviors the individual feels compelled to do repeatedly according to rigid rules). The obsessions or compulsions are time- consuming or causing clinically significant distress or impairment in social, occupational or other important areas of functioning.
  • Certain psychiatric meds can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are prescribed first. Antidepressants have been helpful in individuals with OCD- help increase levels of serotonin. Antidepressants that have been specifically approved by the DFA to treat OCD include: Clomipramine (Anafranil), Fluvoaxmine (Luvox), Fluoxetine (Prozac), Paroxetine (Paxil), Sertaline (Zoloft).
  • Cognitive- Behavioral Therapy (CBT) has shown to be the most effective form of therapy for OCD in both children and adults. It involves retraining thought patterns and routines so the compulsive behaviors are no longer necessary. One CBT approach in particular is called exposure and response prevention, which involves gradually exposing the individual to a feared object or obsession and teaching the individual appropriate coping skills to manage anxiety.
  • Body Dysmorphic Disorder- is characterized by a preoccupation with a slight or perceived physical defect judged by the individual to negatively affect his or her appearance.
  • SSRI have been the primary meds used.
  • CBT or behavior modification therapies are highly recommended in addition to meds. Body dysmorphic disorder is considered a chronic condition and requires maintenance therapy and regulation of SSRIs.
  • Hoarding Disorder- is characterized by a persistent difficulty discarding or parting with possessions. The accumulation of possessions interferes with living areas of the home. The hoarding creates clinically significant distress and impairment.
  • SSRI are used to treat. With mixed results.
  • Hoarding is difficult to treat. The goal is to get rid of a significant amount of possessions to make living space livable and provide the individual with skills to maintain a positive balance between possessions and livable space. The most effective treatment is CBT that includes training in decision-making and categorizing; exposure and habituation to discarding; and cognitive restructuring.
36
Q

What does Obsessive- Compulsive Disorder (OCD) cover?

Obsessive- Compulsive & Related Disorder - DSM-5

A
  • Trichotrillomania (tri-kuh-ti-luh-mei-nee-uh)- (hair pulling disorder)- involves compulsive hair pulling that leads to significant hair loss. There is increased tension before hair pulling and pleasure or relief when pulling the hair out. The individual makes repeated attempts to decrease or stop the hair pulling. This behavior is not the result of a medical condition or another mental condition. This condition is more common in women and the average age of onset is 13 years of age.
  • Meds treatment includes joint approach between mental health prescribers and dermatologists (topical steroids, anxiolytic with histamine properties, antidepressants and antipsychotics). (histamine produces many varied effects within the body, including the contraction of smooth muscle tissues of the lungs, uterus, and stomach; the dilation of blood vessels, which increases permeability and lowers blood pressure; the stimulation of gastric acid secretion in the stomach)
  • Insight- oriented psychotherapy, behavioral treatment and hypnotherapy are effective treatments.
  • Excoriation (Skin- Picking) Disorder- is characterized by the recurrent, compulsive picking of skin, leading to skin lesions. There have been repeated attempts to decrease or stop skin picking. This disorder causes clinically significant distress or impairment. The most common sites are hands, fingers, torso, arms, and legs. There may be multiple sites and sue of multiple instruments (fingernails, knives, tweezers, pins). Picking may result in significant tissue damage or localized infections.
  • There is little data on effective treatment. There is some support that SSRI’s have been helpful. Naltrexone (an opioid antagonist) reduces the urge to skin pick. Lamictal has shown some efficacy.
  • Brief Cognitive Therapy and habit reversal have been used to treat the disorder.
37
Q

What does Trauma and Stressor Related Disorder covers- DSM-5?

A
  • Reactive Attachment Disorder- is characterized as a disruption in a child’s normal attachment behavior. It is a result of grossly negligent parenting and maltreatment. The child exhibits a pattern of inhibited, emotionally withdrawn behavior toward adult caregivers. There is minimal social and emotionally responsiveness to others, episodes of unexplained irritability, sadness or fearfulness with adult caregivers. The onset must be before age 5. Developmentally the child should be at least 9 mnths old.
  • Disinhibited Social Engagement Disorder- This disorder is characterized as a disruption in a child’s normal attachment behavior. It is a result of grossly negligent parenting and maltreatment. The child engages in an inappropriate pattern of behavior where he/she actively approaches and interacts with unfamiliar adults, violating cultural boundaries. The child does not check by with adult caregiver after venturing away and exhibits a willingness to go off with an unfamiliar adult with minimal or no hesitation. The child has a developmental age of at least 9 months.

Medications are not indicated for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder unless there are other disorders such as depression, anxiety, or Attention Deficit Hyperactivity Disorder.

Treatment often includes individual psychological counseling, education of parents and caregivers about the disorder, parenting skills (Attachment and Biobehavioral Catch-up), family therapy, special education services, and residential or inpatient treatment for children with more serious issues or who put themselves or others at risk of harm.

  • Post-traumatic Stress Disorder (PTSD)- is defined as exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways; directly experiencing a traumatic event, witnessing the event that occurred to others, learning that the traumatic event occurred to a close family or friend experiencing repeated or extreme exposure to aversive details of the traumatic events. The symptoms have occurred for over a 1-month period. The individual has increased and avoids internal and external stimuli that are reminiscent of the trauma. There are specific criteria for children 6 years and younger.
38
Q

What does Trauma and Stressor Related Disorder covers- DSM-5?

A
  • Acute Stress Disorder (ASD)- consists of PTSD like symptoms that immediately follow exposure to a traumatic event and that last b/w 3 days to 1 month after the trauma exposure.

In both ASD and PTSD, there are not specific pharmacological interventions that prevent the development of either disorder after trauma exposure. For individuals who are currently experiencing symptoms, SSRIs and other antidepressants have provided relief in PTSD symptoms of re-experiencing, avoidance, numbing, and hyperarousal.

After trauma, CBT may speed recovery to prevent PTSD when therapy begins 2 to 3 weeks after trauma exposure. Early supportive interventions, psycho-education (relying on personal strengths, using existing support networks), and CM appear to be helpful in ASD. EMDR (Eye Movement Desensitization and Reprocessing) is also effective. Single session techniques or psychological debriefings are not recommended as they many increase symptoms.

  • Adjustment Disorder- is characterized by the development of emotional or behavioral symptoms, w/in 3 months of a stressor or stressors, which results in distress and/or impaired functioning.
    The following Adjustments Disorders are identified in DSM-5:
    Adjustment Disorder with Depressed Mood.
    Adjustment Disorder with Anxiety
    Adjustment Disorder with Mixed Anxiety and Depressed Mood
    Adjustment disorder with Disturbance of Conduct (violation of others’ right or of important societal norms and rules)
    Adjustment Disorder with Mixed Disturbance of Emotions and Conduct
    Adjustment Disorder Unspecified.

Meds are not usually used for Adjustment Disorder unless it is complicated by another disorder. Psychotherapy is the treatment of choice for any Adjustment Disorder because the disorder is precipitated by a specific event. Therapy is short- term, rarely going beyond 6 mnths. The form of psychotherapy may vary, but should occur within a supportive, non-judgmental atmosphere that promotes individual growth. Solution-focused approaches are preferred. The goal of therapy is to provide the individual with new coping skills, more effective ways of dealing with stress, and an enhanced understanding of personal issues.

39
Q

What is Dissociative Disorders- DSM- 5?

A
  • These disorders are characterized by a disruption in one or more of the following: consciousness, memory, identity, or perception. The disruption can be sudden or gradual, transient (short time; impermanent) or chronic. The symptoms are frequently caused by trauma. The disruption is not the result of a medical condition or a substance.
  • Dissociative Identity Disorder- is characterized by the presence of two distinct identities that alternately take control of the individual’s behavior accompanied by extensive forgetting of personal information. This disorder is the result of a traumatic experience(s) in which dissociation is a defense mechanism. The symptoms are not the result of a medical condition or a substance.

Antidepressant meds are effective in managing depression, mood stabilization, and PTSD type symptoms. Some antipsychotic meds have been effective in managing overwhelming anxiety and intrusive PTSD symptoms. Some antipsychotic medications have been effective in managing overwhelming anxiety and intrusive PTSD symptoms.

Psychotherapy is typically used for Dissociative identity disorder. The types of treatment vary and can be controversial (e.g hypnosis). The goal when possible, is to move the individual toward better integrated functioning through safety stabilization and symptom reduction; working in depth and directly with trauma memories; and integration and rehabilitation.

  • Dissociative Amnesia- is characterized by an inability to remember important information of a personal nature (typically associated with a traumatic or stressful event.) on one ore more occasions. Symptoms cause clinically significant impairment and distress. When there is purposeful travel or bewildered wandering that is associated with amnesia or other important personal information, then specify “with dissociative fugue ( fyoog- a state or period of loss of awareness of one’s identity, often coupled with flight from one’s usual environment, associated with certain forms of hysteria and epilepsy.)

There are no specific meds that treat Dissociative Amnesia. Individuals frequently have comorbid (two chronic diseases or conditions) disorders of mood and anxiety and can be treated with meds associated with those symptoms.

Many cases resolve spontaneously when the individual is removed from the stressful situation. The treatment of choice is Cognitive therapy with augmentation (refers to the combination of) by hypnosis or drug-facilitated interview. Although hypnosis is helpful, it is not necessary for recovery of historical material or for dealing with that material that has been recovered. Group psychotherapy has been shown to be helpful.

  • Depersonalization/ Derealization Disorder- is characterized by episodes of depersonalization (i.e. send of being detached from one’s body or mental processes) and/or derealization (feelings of unreality or being detached from the environment) while reality testing remains intact.

SSRIs have been shown some effectiveness in treating Depersonalization/ Derealization Disorder.

Psychotherapy is not effective in treating this disorder. The most viable treatment options have been stress management strategies, distraction techniques, reduction of sensory stimulation, relaxation training and physical exercise in some patients.

40
Q

What does Somatic Symptoms and Related Disorder entail- DSM- 5?

A

These are clusters of disorders characterized by multiple, recurring physical complaints that lead to the individual seeking medical treatment or evaluation. The result of evaluation and treatment is reinforcement of the individual’s fearful belief in some non- existent medical illness. At some point health care providers realize there are strong emotional underpinnings and refer individuals for mental health evaluation.

  • Somatic Symptom Disorder- is characterized by six or more months of a general preoccupation with fears of having a serious disease that has not been detected based on the individual’s misinterpretation of bodily symptoms (previously known as hypochondriasis). The conviction persists despite negative physical and laboratory findings. It causes clinically significant distress and impairment.

Specify if: with predominant pain

Antidepressant or anti-anxiety meds alleviate some of the somatic symptoms of there are anxiety or depressive symptoms present.

The goal of treatment is to help individuals to learn to control their symptoms thru stress reduction and coping strategies for chronic illness. Other types of psychotherapy (Insight- oriented, Behavior therapy, Cognitive therapy and hypnosis) may be useful. Having a supportive relationship with a sympathetic healthcare provider is the most important part of treatment.
Insight- oriented psychotherapy- with a focus on helping CTs to understand their own inner workings and motivations.
Behavior therapy- seeks to identify and help change potentially self destructive or unhealthy behavior.

  • Illness Anxiety Disorder- is characterized by a preoccupation with being sick or with developing a disease. There are few or no somatic symptoms present, but the individual is primarily concerned with that idea that he or she is ill. The diagnosis can be used for individuals who do have a medical illness but whose anxiety is out of proportion to the diagnosis and who assume the worst possible outcome. The anxiety is incapacitating and causes emotional distress or impairs thee individual’s ability to function. Some individuals may visit physicians ( care- seeking type) while others may not (care-avoidant type).

Anti-anxiety meds maybe helpful in alleviating the anxiety associated with the individual’s fear about illness. The meds typically cannot provide lasting relief.

  • Conversion Disorder (Functional Neurological Symptoms Disorder) is characterized by loss of functioning in voluntary motor and sensory functions deemed not to be fully the result of a medical condition, a substance or a phenomenon sanctioned by a culture. The loss of functioning is initiated or exacerbated by a stressful event and is not caused exclusively by pain or sexual dysfunction. The disorder is more common in women than in men. The longer the duration of the individual’s symptoms and the more regressed the individual is, the more difficult the treatment.

Meds have not proven reliable. Individuals with Conversion Disorder may improve when stress, anxiety or another underlying problem is treated. Anti- anxiety meds such as benzodiazepines ( Valium, Xanax, Ativan, Klonipin) or a beta blocker (Corgard, Atenolol) may be helpful. If there are depression symptoms, antidepressants may be helpful.
Beta blocker- any of a class of drugs that prevent the stimulation of the adrenergic receptors responsible for increased cardiac action. Beta blockers are used to control heart rhythm, treat angina, and reduce high blood pressure.
Adrenergic-relating to or denoting nerve cells in which epinephrine (adrenaline), norepinephrine (noradrenaline), or a similar substance acts as a neurotransmitter.

Insight- oriented psychotherapy or Behavior Therapy may help treat the symptoms of Conversion Disorder and prevent form recurring. Hypnosis may help the individual identify and resolve psychological issues. To prevent complications of Conversion Disorder, physical therapy may be helpful.

  • Factitious Disorder- is characterized by the repeated feigning, inducing, or aggravating physical and psychological symptoms motivated by a desire to receive medical care and be involved in the medical system, in the absence of financial or other external incentives. Sometimes referred to as Munchausen Syndrome, individuals embellish their personal history, chronically fabricate symptoms to gain hospital admission and move from hospital to hospital. The onset is typically 20s or 30s. The disorder occurs more often in women than men.

Factitious Disorder Imposed on Another (or Factitious Disorder by Proxy) is most commonly perpetrated by mothers on their infants or young children.

Individuals with Factitious Disorder elude therapy by abruptly leaving the hospital or failing to keep follow-up appnntmnts. Treatment focuses on management rather than on cure. The goals are:
1. reduce the risk of serious illness or death
2. address underlying emotional needs or underlying psychiatric diagnosis
3. be mindful of legal and ethical issues.
Appoint a PCP as a gatekeeper for all medical and psychiatric treatment.

In case of Factitious Disorder Imposed on Another, the main goal is to ensure the safety and protection of any real or potential victims.

41
Q

What is Feeding and Eating Disorders-DSM- 5?

A

Involves abnormal behaviors related to the consumption of food, which leads to significant physical health and psychosocial functioning impairment.

  • Pica- this disorder is typified by the age-inappropriate, persistent eating of at least one nonfood item (e.g. dirt, hair, insects, and paints) for at least 1- month period. The individual does not display an evident aversion to food. Pica may occur with another mental disorder and must be severe enough to require clinical assistance.

There is no standard treatment for individuals with Pica. The most effective approaches involve behavior modification, education, and family guidance. Every effort should be made to ameliorate any significant psychosocial stressors or toxic substances (e.g. lead).
Ameliorate- make something bad or unsatisfying better.

  • Rumination Disorder- is characterized by repetitive instances of regurgitation, re-swallowing or spitting out food. The onset must have been preceded by a period of normal functioning and the behavior should not be the result of a medical condition. The symptoms have persisted for at least 1 month. In infants, the behavior may be the result of inadequate emotional interaction and the infants have learned to self-soothe through rumination.

There is no standard meds that is used for treating Rumination Disorder. Treatment is based on the cause of the behavior (mother- child relationship deficits). Behavior modification techniques (habit- reversal) may help the individual to extinguish the behavior.

  • Avoidant/ Restrictive Food Intake Disorder- is characterized by a lack of interest in food, or avoidance based on the sensory features of the food or perceived consequences of eating. It is a persistent failure to meet nutritional or energy needs as evidenced by one or more of the following: significant weight loss or achieved expected weight; nutritional deficiency; dependence on nutritional supplements; or marked interference with psychosocial functioning. The individual may outright refuse food, be selective in what food will be consumed, eating too little, avoid food, or delayed self-feeding.

Meds is not a standard treatment. Treatment is based at optimizing the interaction between the caregiver and child during feedings and identifying any factors that can be changed to promote increased food intake (e.g. decreasing distractions during food times, giving praise to positive food behaviors).

42
Q

What is Feeding and Eating Disorders-DSM- 5?

A
  • Anorexia Nervosa- is characterized by either explicit refusal to maintain an appropriate body weight or failure to gain the amount of weight appropriate to a given growth period (85% of appropriate body weight or less). It also involves a distorted image of one’s body (weight or shape), intense fear of becoming fat, negative self- evaluation based on this image, or refusal to acknowledge that the low body weight is a problem that has significant medical consequences.

Subtypes of Anorexia Nervosa- (a) Restricting Type, in which the current episode does not involve binge eating or purging on a regular basis; and (b) Binge- Eating/ Purging Type, in which the current episode involves binge- eating or purging.

Specific meds have not been effective in improving the core symptoms of Anorexia Nervosa. Antidepressant meds (such as Amitriptyline, a tricyclic antidepressant) may be helpful. Chlorpromazine (Thorazine) may be beneficial for individuals experiencing severe obsessions and increased anxiety and agitation. Careful monitoring is indicated especially if the individual is vomiting, which can interfere with the effectiveness of the meds.

Cognitive Behavioral Therapy has been found effective for inducing weight gain. Individuals are taught cognitive restructuring to identify automatic thoughts and challenge their core beliefs. Group therapy is often the chosen treatment because it provides support for the individual, as well as confrontation on issues more easily than in individual therapy. Family therapy focuses on family relationship issues. Inpatient treatment may be indicated if the individual’s weight and refusal to eat is endangering the physical health of the person.

  • Bulimia Nervosa- is characterized by eating of large amount of food in a brief period of time (i.e. bingeing) and a subsequent feeling of having lost control of eating during a binge episode. The individual engages in recurrent efforts to compensate (self-induced vomiting, laxative abuse, diuretics, and strenuous exercise) for bingeing to avoid weight gain. The bingeing and purging occurs an average of 1 (mild) to 14 or more times (extreme) a week over a 3- month period. The individual may binge to soothe emotional distress, as breakthrough eating when hunger becomes an issue while trying to restrict eating to maintain thinness, or an inability to sustain semi- starvation. Body image has an excessive impact on self- evaluation. Symptoms have been present for at least 3 months.

Antidepressants such as tricyclic antidepressants: (Imipramine, Desipramine; or Phenelzine), Nardil (MAO inhibitor), and SSRIs can be helpful in treating an individual with Bulimia Nervosa. Phenyton (Dilantin) and Carbamazepine (Tegretol) may help reduce the frequency of bingeing behavior. Monitoring is particularly important if the individual is vomiting or using large amounts of laxatives, which may impact the meds effectiveness.

Cognitive Behavioral Therapy is considered the benchmark for the treatment of Bulimia Nervosa. Group therapy is the chosen treatment because of its powerful effects and cost- savings. In group therapy, the individual is able to receive support but also confronted on issues more easily than in individual therapy. Family therapy focuses on the individual’s compliance with treatment recommendations.

  • Binge- Eating Disorder is characterized by recurrent binge eating over a short period. Binges consist of eating more rapidly than normal to the point of being uncomfortably full, eating large amounts of food even when not hungry, eating alone, and feeling guilty or upset about the episode. The behavior must occur at least once a week for 3 months. There is no compensatory behavior utilized after the binge. The behavior occurs in private and includes food with dense caloric content. Individuals feel they cannot control their eating.

SSRIs and tricyclic antidepressants have helped improve mood and binge eating episodes. Cognitive Behavior Therapy is the most effective treatment. Self-help groups, (e.g. Overeaters Anonymous and Weight Watchers) have proven helpful.

43
Q

What does Elimination Disorders entail- DSM- 5?

A
  • Enuresis- is characterized by pattern of urinating in bed or clothing by an individual who is at least 5 yrs of age. Urination must occur at least 2x a week over at least 3 consecutive months or must result in significant distress or impairment. Urination may be voluntary or involuntary. There are three subtypes: nocturnal only (during the nighttime); diurnal only (during the waking hrs); and nocturnal and diurnal (waking hrs and nighttime).

Management requires a focus on the behavioral aspect of Enuresis to break problematic habits, rather than relying on meds. When meds s indicated, Desmorpressin acetate (DDAVP) is currently the preferred medication.

A behavioral approach is commonly implemented (e.g. reinforcement charts or restricting fluids prior to bedtime). Alarm therapy is another approach that alerts the child to respond when voiding beings so the child will get out of bed and go to the bathroom.

  • Encopresis is characterized by a pattern of expelling feces voluntarily or involuntarily into places deemed inappropriate (e.g. clothing, floor) by an individual who is at least 4 yrs old. There must be a minimum of 1 of these events each month over at least 3 mnths and it must not be directly related to the effects of a substance or a medical condition. It is more common in males.

Specify if: with constipation and overflow incontinence; without constipation and overflow incontinence.

Medication treatment includes daily laxatives if constipation is on issue. Otherwise, meds is not indicated. CBT can be used to help the child cope with shame, guilt, or loss of self-esteem associated with Encopresis. The treatment goal is to prevent constipation and encourage good bowel habits. Treatment also includes educating the child and family about Encopresis, discussing how family tension can be reduced, and establishing a non-punitive atmosphere.

44
Q

What does Sleep- Wake Disorders entails- DSM- 5?

A

Lack of control of sleep.

  • Insomnia Disorder is characterized by dissatisfaction in the quantity and quality of sleep through difficulty falling asleep or staying asleep, or non-restorative sleep that persists for at least 3x per week for 3 months despite adequate opportunity for sleep. It results in marked distress or impairment in functioning, and is not due to Narcolepsy, Breathing- Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomia.
    Circadian rhythm sleep disorders are caused by desynchronization between internal sleep-wake rhythms and the light-darkness cycle.
    Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep.

Meds include use of benzodiazepines, Lunesta, Sonata and other hypnotics. It is recommended that these meds be prescribed for short-term, not long-term use. Meds are targeted to the specific time that the person has difficulty with sleep. Over- the- counter meds (e.g. Melatonin) are believed to alleviate sleeplessness but these meds are not as rigorously tested.

Treatment includes: CBT to address disruptive thoughts about sleep; behavioral techniques that address improving sleep hygiene patterns; relaxation techniques and biofeedback.
Biofeedback is the process of gaining greater awareness of many physiological functions of one’s own body, primarily using electronic or other instruments, with a goal of being able to manipulate the body’s systems at will.

  • Hypersomnolence Disorder is characterized by excessive sleepiness that persists for a minimum of 3x per week for at least 3 mnths. The person experiences either recurrent sleep or lapses into sleep w/in the same day. Also characteristic of this disorder are prolonged main sleep episodes of more than 9 hrs per day that is non-restorative, and the person has difficulty being fully awake after abrupt awakening. It results in significant distress or impairment in functioning and is not a byproduct of insomnia or another sleep disorder.

Symptoms can be managed with either wake-promoting meds (e.g. Provigil) or traditional psychostimulants.

Behavioral therapy and sleep hygiene techniques are the preferred treatment.

  • Narcolepsy is characterized by sudden, recurrent periods of irrepressible (not able to control or contain) need to sleep, lapses into sleep or naps that occur 3x per week for a minimum of 3 mnths. The individual experiences extreme drowsiness every 3-4 hrs, sleep paralysis, loss of muscle tone (cataplexy-is a sudden and uncontrollable muscle weakness or paralysis that comes on during the day and is often triggered by a strong emotion, such as excitement or laughter.) and sleep attacks. There exists the occurrence of components of REM (Rapid Eye Movement) sleep as the individual moves from sleep to wakefulness.

Meds include psychostimulants that induce wakefulness, including Modafinil (provigil), Methylphenidate (Ritalin). Sodium oxybate (Xyrem) controls cateplexy, improves nighttime sleepiness.

Lifestyle modifications are helpful in managing symptoms of Narcolepsy, which include:
Sticking to a schedule; sleeping and waking up at the same time each day
Taking short naps at regular intervals during the day
Avoiding nicotine and alcohol
Engaging in moderate regular exercise at least 4-5 hrs before bedtime.

45
Q

What does Sleep- Wake Disorders entails- DSM- 5?

A
  • Breathing- Related Sleep Disorders share respiratory control instability as a common risk factor but have different physiological and anatomical causes. All of these disorders are diagnosed with polysomnography (sleep study).
  • Obstruction Sleep Apnea Hypopnea- abnormally slow or shallow breathing (hy-po-pne-a) is the most common type of breathing related sleep disorder. It is characterized by a total absence in breathing (apnea) or decrease in airflow (hypopnea). When the brain registers impaired breathing it briefly arouses the individual from sleep. Snoring is a central feature of this breathing related sleep disorder.

Treatment options include: weight loss, surgical intervention, positive airway pressure (CPAP, BPAP) and oral appliances. Drug therapy has proven to be less successful.

  • Central Sleep Apnea occurs when the breathing completely stops and starts during sleep. The brain fails to send proper signals to muscles that regulate breathing.
  • Sleep- related Hypoventilation is characterized by elevated carbon dioxide levels that decreases respirations. There are frequent episodes of shallow breathing that last 10 or more seconds.
  • Circadian Rhythm Sleep- Wake Disorders are characterized by a persistent or recurrent patter of sleep caused by incongruity between the sleep-wake requirements imposed by the person’s environment and actual sleep- wake patterns. It leads to excessive sleepiness, insomnia or both. Disorder types include:
    Delayed Sleep Phase Type- (a pattern of late onset of sleep and late awakening that persists in spite of efforts to change the pattern)
    Advance Sleep Phase Type- an inability to remain awake or asleep until the desired or conventionally acceptable later sleep or wake time.
    Unspecified Type

Treatment for Circadian Rhythm Sleep Disorder consists of several options. Chronotherapy is used to reset the biological clock that involves progressively delayed sleep over the period of a week until the synchronize with the desired sleep-wake schedule. Photo or Light Therapy involves exposure to bright light to alter the endogenous biology rhythm.
Endogenous substances and processes are those that originate from within a system such as an organism, tissue, or cell. The term is chiefly used in biology but also in other fields. Endogenous substances and processes contrast with exogenous ones, such as drugs, which originate from outside of the organism.

46
Q

What does Sleep- Wake Disorders entails- DSM- 5?

A
  • Parasomnias are are sleep disorders that involve abnormal behavior, experiential or physiological events, sleep, specific stages or sleep- wake transitions. These include:
    Non- Rapid Eye Movement Sleep Arousal Disorders are non REM sleep arousal disorders that represent variation of both wakefulness and non REM sleep. It results in a combination or complex motor behavior without conscious awareness. There are recurrent episodes of incomplete awaking from sleep, accompanied by either sleepwalking or sleep terrors. The individual does not remember any dream imagery and amnesia for the episode is present.

Nightmare Disorder is characterized by recurrent dreams that are threatening, frightening, or cause dysphoria. The individual is fully oriented when awakened and can usually remember the dream.
Dysphoria a state of unease or generalized dissatisfaction with life.
In Patients with post-traumatic related nightmares, nefazodone (an antipsychotic) and Minispress provide some therapeutic benefit.
Treatment using behavioral techniques, universal sleep hygiene, lucid dream therapy, and cognitive therapy have proven to be helpful.

Rapid Eye Movement Sleep Behavior Disorder is characterized by repeated episodes or arousal during sleep associated with vocalization and/or complex motor behaviors during REM sleep. The behaviors reflect action-filled or violent dreams and can result in significant injury to the individual or bed partner. Upon awakening the individual is fully alert and can usually recall the dream counter.

Restless Legs Syndrome is a sensorimotor, neurological sleep disorder characterized by a desire to move the legs (or arms) associated with uncomfortable sensations (e.g. creeping, crawling, tingling, burning, or itching). The frequent movements are in response to the uncomfortable sensations. The symptoms must occur at least 3x per week over a period of 3 months. It reduces sleep time and sleep disturbance. The syndrome is more common in women than men.

Meds includes: Mirapex, Requip, benzodiazepines, Gabapentin, and opiates.

47
Q

Which of the following Sleep- wake Disorders is not considered a Parasomnia in the DSM- 5?

A
  • Narcolepsy

Sleep- wake Disorder- Parasomnia is Nightmare Disorders, Sleep Terrors, and sleepwalking.

48
Q

What is Sexual Dysfunctions-DSM- 5?

A
  • This disorder involves either a disturbance in the sexual response cycle or pain/ discomfort associated with sexual intercourse. Sexual disorders are generally treated by assessing the physical problems that may be contributing to the sexual dysfunction. Medical treatment is instituted once the cause is determined. Meds may include hormones and specific meds that address the specific dysfunction. Behavioral Therapy can help the person address feelings of anxiety, fear or guilty that may have an impact on sexual function. Education about sex and sexual behaviors and responses may help the individual overcome feelings associated with the dysfunction.
49
Q

What does Sexual Dysfunctions entail-DSM- 5?

A
  • Delayed Ejaculation- is characterized by marked delay in ejaculation or marked infrequency or difficulty in maintaining an erection until completion of sexual activity or a marked decrease in erectile rigidity. This disorder can interfere with fertility and produce low self-esteem. It results in significant distress (extreme anxiety, sorrow, or pain) or interpersonal conflict.
  • Female Orgasmic Disorder is characterized by marked infrequency of orgasms and reduced intensity of orgasmic sensations. There is significant distress or interpersonal conflict.
  • Female Sexual Interest/ Arousal Disorder is characterized by a lack of, or significantly reduced, sexual interest/ arousal in sexual activity. Some experience dysfunction across the entire range of sexual response/ pleasure (decrease or absence of erotic feelings, thoughts, fantasies; decreased impulse to initiate sex; decrease or absent receptivity to partner overtures; or inability to respond to partner stimulation).
50
Q

What does Sexual Dysfunctions entail-DSM- 5?

A
  • Genito- Pelvic Pain/ Penetration Disorder is characterized by pain or discomfort, muscular tightening, or fear or anxiety about pain when having sexual intercourse.
  • Male Hypoactive Sexual Desire Disorder is characterized by diminished desire for sexual activity and few if any sexual thoughts or fantasies.

Premature ( Early) Ejaculation refers to ejaculation that persistently occurs within 1 minute following vaginal penetration and before the individual wishes for it to occur. Such occurrence results in significant distress or interpersonal conflict. This is the most common form of sexual dysfunction in novel sexual situations or in men who had a substantial interval since last orgasm.

51
Q

What is Gender Dysphoria-DSM- 5?

A
  • This diagnosis refers to the emotional distress based on a mismatch between one’s assigned gender and how the individual perceives his or her true gender. There are different behaviors that express this distress based on the individual’s age.
  • Gender Dysphoria in Children- this disorder is characterized by a strong desire to be the other gender or an insistence that one is the other gender (different from one’s assigned gender). In boys there is a strong preference for cross- dressing in female attire. In girls there is a strong preference for wearing typical masculine clothing and resistance to wearing typical feminine clothing. In play, children exhibit cross- gender roles and preferences for toys and games that are cross gender. The symptoms need to be present for a period of 6 mnts and cause clinically significant distress and impairment.
  • Gender Dysphoria in Adolescents and Adults this disorder is a marked incongruence (not the same, not compatible or out of place) between one’s experience/ expressed gender and assigned gender. There is a strong desire to be rid of one’s primary and/ or secondary sex characteristics, to be the other gender and to be treated as the other gender. The individual has a strong conviction that he/ she has typical feelings and reactions of the other gender. The symptoms need to be present for at least 6 mnts and cause clinically significant distress or impairment.

Pharmacotherapy (e.g. antidepressants, anxiolytics- pertaining to substances or procedures for reducing anxiety. Anti-anxiety drugs, and antipsychotics) may be necessary for individual with comorbid (existing simultaneously with and usually independently of another medical condition) psychiatric disorders.

Individual treatment focuses on understanding and dealing with gender issues. Group, marital, and family therapy can provide a helpful and supportive environment. As adults, hormone therapy and transgender surgery may be the interventions of choice.

52
Q

What does Disruptive, Impulsive- Control and Conduct Disorders entail- DSM- 5?

A
  • Oppositional Defiant Disorder is represented by an angry/ irritable mood, argumentative/ defiant behaviors, and vindictiveness that is not typical for the child’s developmental level. In children younger that age 5, the behaviors must be present on most days for at least 6 months. In children older than 5 it must occur at least once once per week for at least 6 months.
    There is little research on the effectiveness of meds for the treatment. Meds is not currently recommended.
    The central focus of therapy is usually behavior modification through parent training and family therapy that gradually shapes the child’s behavior. The goal of intervention is to reinforce more prosocial behaviors and diminish undesired behaviors at the same time. Parent support groups are also helpful.
  • Intermittent Explosive Disorder is characterized by aggressive outbursts that are rapid onset and short duration. The aggressiveness is clearly out of proportion to the precipitating factors. The episodes involve verbal assaults, destructive/ nondestructive property assault, injurious/ non- injurious physical assault. Verbal episodes occur at least 2x per week for a period of 3 mnths. Damage to property or physical assault must occur at least 3x during a 12 mnth period. This disorder may appear as early as 6yrs or equivalent developmental level. The average age of onset ranges from 13 to 21 yrs.
    Anticonvulsants (also commonly known as anti-epileptic drugs or as anti-seizure drugs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures) have been used in treating explosive CTs but with mixed results. Mood stabilizers have also been helpful. SSRI’s have been useful in reducing impulsivity and aggression.
    Group therapy and family therapy is useful if the CT is an adolescent or young adult. The goal of therapy is for the CT to verbalize thoughts of feelings that precede an explosive outburst.
53
Q

What does Disruptive, Impulsive- Control and Conduct Disorders entail- DSM- 5?

A
  • Conduct Disorder involves a pattern of repetitive and persistent behaviors in which the basic rights of others are violated. The behaviors can be aggressive, causing or threatening harm to others or animals, or nonaggressive behavior resulting in property damage, deceitfulness or theft or serious violation of rules. There is evidence of 3 or more behaviors present in the past 12 mnths and the pattern of behavior is repetitive and persistent.
  • If the onset is before age 10 it is called Childhood- Onset Type; onset at age 10 or later is called Adolescent- Onset Type. This disorder is more common in males. Specify with limited prosocial emotions (e.g. lack of remorse or guilt, callous- lack of empathy, unconcern about performance, shallow or deficient affect). Approximately 40% of children diagnosed with Conduct Disorder manifest Antisocial Personality Disorder later in life.
    Antisocial Personality Disorder (ASPD or APD) is a personality disorder characterized by a long-term pattern of disregard for, or violation of, the rights of others. A low moral sense or conscience is often apparent, as well as a history of crime, legal problems, or impulsive and aggressive behavior.
    Antipsychotic meds has been effective; SSRIs have been used to target impulsivity, irritability and mood lability. Meds is only indicated if the child/ adolescent has another disorder (e.g. Attention Deficit Hyperactivity Disorder, depression, etc.). Synonyms- Psychopathic personality, psychopath, sociopath.
    Treatment can be provided in a variety of different settings depending on the severity of the behaviors. The treatment is challenging because of the child’s or adolescent’s uncooperative attitude, fear, and distrust of adults. Behavior therapy and psychotherapy is usually necessary to help the child or adolescent appropriately express and control anger. Parents often need expert assistance in devising and carrying out special management and educational programs in the home and at school. Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. The earlier the treatment is offered, the better the chance for improvement.
  • Pyromania- this disorder is the deliberate setting of fires on more than one occasion. The individual experiences pleasure or relief while setting the fires, or in the aftermath of the fire setting. Behavior involves a fascination with ore attraction to fire. The individual spends significant time planning, setting, and watching fires. The person fails to resist an impulse to set fires.
    Individuals may be indifferent to the consequences of the fire and its effect on life and property. Indifferent- having no particular interest or sympathy; unconcerned.
    There is no single treatment that has proven effective in the treatment of Pyromania.
  • Kleptomania this disorder is a repeated failure to resist the impulse to steal items w/o reason. The theft is not a way of expressing anger or getting vengeance and is not related to a delusion or a hallucination. There is increased tension just before the theft and a sense of pleasure or relief in the satisfaction of the impulse. Most of individuals with this disorder are women.
    SSRI’s have been effective in treating Kleptomania in some CTs. Selective Serotonin Reuptake Inhibitor. SSRI antidepressants are a type of antidepressant that work by increasing levels of serotonin within the brain. Serotonin is a neurotransmitter that is often referred to as the “feel good hormone”.
    Behavior therapy including systematic desensitization and aversive conditioning has been reported as being helpful.
    Systematic desensitization- also known as graduated exposure therapy, treats phobias in which the patient is exposed to progressively more anxiety-provoking stimuli and taught relaxation techniques.
    Aversive conditioning- is the use of something unpleasant, or a punishment, to stop an unwanted behavior. If a dog is learning to walk on a leash alongside his owner, an undesired behavior would be when the dog pulls on the leash.
54
Q

What does Substance- Related and Addictive Disorder entails-DSM- 5?

A
  • These disorders are brought on by the ingestion of an illegal drug or a medication, or by exposure to a toxin, (e.g. specific rat poisons, specific pesticides, nerve gases, carbon monoxide). The criteria includes “craving” as a symptom; whereas, legal involvement was deleted from the criteria previously listed in DSM-IV-TR.
  • Substance- Related Disorders include reversible, substance- specific mental disorders caused by substance
    intoxication and those caused by substance withdrawal. Common behavioral and psychological changes associated with intoxication include belligerence, heightened emotions, impairment in cognitive abilities, and social and occupational functioning. Withdrawal is typically associated with substance dependence and involves a craving for more of the substance as a means of alleviating the symptoms. Substance Intoxication can occur with any of the classes of substances except for tobacco. Substance withdrawal occurs with alcohol, amphetamines, cocaine, nicotine, opioids, and sedatives, hypnotics, and anxiolytics. (An anxiolytic (also antipanic or antianxiety agent) is a medication, or other intervention, that inhibits anxiety. This effect is in contrast to anxiogenic agents, which increase anxiety.)
    These disorders involve substance use that is problematic and there is a repetition or pattern of behavior that causes clinically significant distress or impairment. This is evidenced by 2 of the following occurring within a 12-month period:
    tolerance
    withdrawal
    more use than intended
    craving for the substance
    unsuccessful efforts to cut down
    spending excessive time in acquisition of the substance
    cessation of activities because of substance use
    continue to use despite negative effects
    failure to fulfill major role obligations
  • Substance Disorders by Classification:
    Alcohol (central nervous system depressant)
    Caffeine (central nervous stimulant)
    Cannabis (perception distorting)
    Hallucinogens (including PCP) (perception distorting)
    Inhalants (perception distorting)
    Opioids (narcotics)
    Sedatives, hypnotics, or anxiolytics (central nervous system depressant)
    Stimulants ( including Cocaine) (central nervous stimulant)
    Tobacco (nicotine)
    Other
    (The central nervous system consists of the brain and spinal cord)
55
Q

What does Substance- Related and Addictive Disorder entails-DSM- 5?

A
  • Non- Substance- Related Disorders
    Gambling Disorder is included in the Substance- Related and Addictive Disorders because like substance use, gambling activates the reward centers of the brain. Gambling behavior becomes problematic when the individual engages in persistent and maladaptive gambling behavior that is excessive.

Once gambling behavior reaches a pathological pattern, the individual will borrow, lie, and jeopardize important relationships. In a sense, gambling becomes both the cause of the problem and the solution of the problem. Gambling disorder is slightly more common in males than females.

The individual engages in persistent and recurrent gambling behavior for at least a 12- month period that causes clinically significant impairment or distress with at least 4 of the following:
Gambling with increasing amounts of money to attain the desired excitement
Restlessness or irritability when attempting to cut down or stop gambling
Repeated unsuccessful efforts to control, cut back or stop gambling
Preoccupation with gambling
Often gambling when feeling distressed
After losing money, often returning another day to “get even”
Lying to conceal the extent of involvement in gambling
Jeopardizing or losing a significant relationship, job, educational or career opportunity
Reliance upon others to provide money to relieve desperate financial situations

Effective meds include SSRIs and Bupropion, mood stabilizers (lithium and anti-seizure meds), and naltrexone.

There is no single treatment appropriate for everyone with this diagnosis. Effective treatment attends to the multiple needs of the individual. Treatment plans must be assessed and modified continually to meet changing needs. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. Scientifically based approaches to addiction treatment include a comprehensive set of treatment components:
Cognitive- behavioral interventions
Community reinforcement
Motivational enhancement therapy
12-step facilitation
Contingency management
Pharmacological therapies
Systems treatment
56
Q

What is Neurocognitive Disorders- DSM- 5?

A
  • There are abnormalities of the following mental processes. The conditions may be temporary or permanent. Abnormalities may include the following:
    Memory deficits
    Language disturbance
    Perceptual disturbance
    Impairment in planning and organizing activities
    Failure to recognize or identify objects
  • Delirium is characterized by a significant decline in cognition caused by either the direct effects or a substance or toxin, or a medical condition, or both; the substance or medical condition is provided as part of the diagnosis.
  • Delirium is a disturbance in the level of consciousness with concomitant* changes in cognition. The onset is over a brief time period and often clears when the condition relents with particular impairment in attention. The disorders are defined in terms of the following etiology:
    1. Delirium Due to a General Medical Condition
    2. Substance- Induced Delirium
    3. Delirium Due to Multiple Etiologies
    4. Delirium NOS (Indeterminate Etiology)
    ( con-com-i-tant- naturally accompanying or associated.)

Treatment for Delirium involves ascertaining the etiology of the delirium and treating the underlying cause.

57
Q

What is Neurocognitive Disorders- DSM- 5?

A

Major and Mild Neurocognitive Disorders are described as progressive impairments in cognitive functioning that do not affect the level of consciousness. It results in increased impairment in social and occupational functioning over time. The individual’s memory is compromised with an inability to learn new information and recall previously learned information. The individual shows disturbance in executive functioning (planning, organizing, sequencing, and abstracting). There may be associated symptoms with disturbance in mood, behavior, judgment and personality.

Mild Neurocognitive Disorder is defined as a modest cognitive decline from a previous level of performance in one or more cognitive areas (i.e. complex attention, executive function, learning and memory, language, perceptual- motor, or social cognition). It is distinguished from normal age related changes. The cognitive deficits do not interfere with capability for independence in everyday activities; although, the individual may need to exert greater effort or develop compensatory strategies.

Major Neurocognitive Disorder (A.K.A dementia) is defined as progressive impairment in one or more cognitive areas with at least two areas being impaired. There is substantial impairment to the degree that it interferes with independence in everyday activities that require assistance with complex activities of daily living.

In both types of neurocognitive disorders, the possible or probable (likely to be the case or to happen) etiology of the disorder is required. It may be due to Alzheimers’s disease, Frontotemporal Lobar Degeneration, Lewy Body Disease, Vascular Disease, Traumatic Brain Injury, Substance/ Medication Use, HIV Infection, Prion Disease, Parkinson’s Disease, Huntington’s disease, Another Medical Condition, Multiple Etiologies or Unspecified.
*Frontotemporal lobar degeneration (FTLD) is a pathological process that occurs in frontotemporal dementia. It is characterized by atrophy in the frontal lobe and temporal lobe of the brain, with sparing of the parietal and occipital lobes. (The word ‘frontotemporal’ refers to the lobes of the brain that are damaged in this type of dementia. The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem-solving, planning and the control of emotions. An area of usually the left frontal lobe also controls speech; temporal lobe is the region where sound is processed and, not surprisingly, it is also a region where auditory language and speech comprehension systems are located. The auditory cortex is located on the upper banks of the temporal lobe and within the Sylvian fissure; Sylvian fissure, also known as the lateral sulcus, separates the frontal and parietal lobes superiorly from the temporal lobe inferiorly. The insular cortex is located immediately deep to the Sylvian fissure.)
4 lobes of the brain- frontal, parietal, temporal & occipital.
*Lewy body dementia (LBD) is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood.
*Vascular disease is any abnormal condition of the blood vessels (arteries and veins). The body uses blood vessels to circulate blood through itself. Problems along this vast network can cause severe disability and death. Vascular diseases outside the heart can “present” themselves anywhere.
*A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally. Prion diseases can affect both humans and animals and are sometimes spread to humans by infected meat products. The most common form of prion disease that affects humans is Creutzfeldt-Jakob disease (CJD).
*Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
*Huntington’s disease (HD) is a fatal genetic disorder that causes the progressive breakdown of nerve cells in the brain. It deteriorates a person’s physical and mental abilities usually during their prime working years and has no cure.

58
Q

Neurocognitive Disorders & Treatment- DSM- 5?

A
  • The first step in treatment is to determine the ethology of the symptoms. Neurocognitive Disorders cannot be cured, but meds may improve mental function, mood and behavior. In mild and moderate memory impairment, meds such as Aricept, Reminyl, Exelon, and Namenda are helpful. Antidepressants assist with depressive symptoms. Anxiety, agitation, and hallucinations may be treated with antipsychotic meds.

A goal of treatment is to keep the individual with a neurocognitive disorder safe. Supportive and educational psychotherapy regarding the nature and course of the illness can be beneficial. Caregivers and family members can make adjustments to the home that can the person life easier and safer. Calendars and lists can aid memory. For ex, a caregiver could place sticky notes or signs with pictures on them around the house to help the person remember where objects are stored and to guide the person to the bathroom or kitchen. Maintaining good nutrition and managing sleep problems are also important. As the disorder progresses, nursing home placement may be necessary.

59
Q

Personality Disorders entails- DSM- 5?

A
  • It is an “enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” Persons may express themselves in violence; they can often go undetected.
  • Paranoid Personality Disorder is characterized by a general distrust/ suspiciousness of others and is more common in males. The individual must exhibit a minimum of four of the following:
  • Believing that others are exploiting or harming him/her in the absence of convincing evidence
  • Consistently and w/o justification questioning the loyalty and trustworthiness of others
  • Avoiding confiding in others because of unjustified beliefs that they will use the information against him/her
  • Perceiving benign remarks or events as demeaning and threatening
  • Bearing grudges
  • Interpreting innocuous remarks as personal attacks
  • Having unwarranted doubts about spouse or partners’s fidelity.

Meds are usually contraindicated for Paranoid Personality Disorder because meds can arouse unnecessary suspicion that usually results in noncompliance and premature treatment termination. If the individual suffers from severe anxiety or agitation, an anti-anxiety meds may be helpful for a brief period.

Individuals with Paranoid Personality Disorder rarely present for therapy. When an individual does, a client- centered supportive approach is the most effective. Rapport building will be more difficult because of the nature of the disorder. The SW’s loyalty and trust may come into question. Challenging the CT’s beliefs may lead to the individual leaving therapy permanently. The primary focus of treatment is:

  • The individual’s here-and-now feelings of mistrust towards the SW
  • Consistency of his or her mistrust of the SW with his/her typical “suspicion” thought patterns
  • Discounting of disconfirming data
  • Accuracy of his/her observations contrasting with the rigidity of his/her paranoid interpretation.

Client-centered therapy places significant focus on the client. According to Rogers’s view of client-centered therapy, the client-centered therapist refrains from asking questions, making diagnoses, providing reassurance, or assigning blame during his or her interactions with the client.
Non-Directive Therapy is a psychotherapeutic approach in which the psychotherapist refrains from giving advice or interpretation as the client is helped to identify conflicts and to clarify and understand feelings and values.

60
Q

Personality Disorders entails- DSM- 5?

A
  • Schizoid Personality Disorder which is characterized by restricted range of emotions and a pattern of detachment from others. Common symptoms are:
  • Lack of interest in close relationships
  • Preference for solitary activities
  • Minimal interest in sexual activity
  • Minimal or no pleasure in activities
  • The absence of friends or confidants with the possible exception of close kin
  • Indifference to praise or criticism
  • Emotional detachment, coldness or flat affect

Meds are not indicated for individuals with Schizoid Personality Disorder unless there is another disorder. If the individual experiences depression, antidepressants have shown little improvement unless there is suicidal ideation present or the depression is severe.

Individuals are not likely to seek treatment unless there is significant stress or pressure. As soon as the individual’s stress lessens, treatment is terminated. Rapport is difficult to establish since these individuals prefer social distance. Stability and support are keys to effective treatment. The focus of treatment is :

  • Anything that creates affect in the here-and-now
  • Reflections on detachment (viewing all relationships as messy and undesirable)
  • Prevalence of silence
  • Minimal expressions of empathy
  • The “in-session” experience
  • Schizotypal Personality Disorder is characterized by a pattern of deficits in interpersonal skills (social skills) and a decreased capacity for close relationships. Cognitive and perceptual distortions and eccentric behavior are also evident. Common Symptoms include the following:
  • Ideas of reference (the belief that casual events have a special meaning to the individual)
  • Odd beliefs or magical thinking that impacts behavior
  • Unusual perceptual experiences
  • Oddities in thought and speech
  • Suspiciousness or paranoid beliefs
  • Affect that is either inappropriate or constricted
  • Odd or eccentric behavior or appearance
  • Absence of friends and confidants with possible exception of close relatives
  • Social anxiety frequently associated with paranoid fears

During times of extreme stress an individual with Schizotypal Personality Disorder may develop psychotic symptoms. Antipsychotic meds may be used for acute transient* psychotic symptoms. In the absence of psychosis, meds is not indicated.
*transient- lasting only for a short time; impermanent.

Schizotypal Personality Disorder is best treated with some form of psychotherapy. Individuals with this disorder usually distort reality more so than Schizoid Personality Disorder. Goals in treatment should focus on illogical thinking and odd emotional reactions, the reaction of others to their strange behavior and confrontation of tangential* or superstitious thinking. Group therapy may be appropriate once the person is less mistrustful and suspicious of others.
* tangential-diverging from a previous course or line; erratic.

61
Q

Personality Disorders entails- DSM- 5?

A
  • Antisocial Personality Disorder is characterized by a pattern of disregard for or violation of others’ rights evident since at least age 15 and the individual is at least 18yrs of age. If the individual’s behavior is consistent with this diagnosis, but he/she is younger than 18, the diagnosis of Conduct Disorder should be used. This disorder is more common in males. Common symptoms include the following:
  • Frequent violations of the law
  • Deceitfulness for personal gain or pleasure
  • Impulsive behavior or lack of planning
  • Irritability or aggressiveness
  • Disregard for own safety or safety of others
  • Consistent irresponsibility
  • Absence of remorse

Meds is not indicated for Antisocial Personality Disorder. Meds may be helpful for other concurrent* disorders.
* concurrent- existing, happening, or done at the same time.

Individuals with Antisocial Personality Disorder rarely seek treatment on their own unless mandated by court or significant other. Threats are never an appropriate motivating factor for any type of treatment, especially with this disorder. Effective therapy is limited. Emotions are the key aspect for treatment. Reinforcing appropriate behaviors and feelings may be helpful. The focus of treatment is:

  • Denial of consequences
  • Impulsivity and lack of thinking through actions
  • Duplicity and lying
  • Practical consequences of behavior
  • Suggestions of behavior that will improve consequences
  • Blaming of others
  • Need for self-control
  • Borderline Personality Disorder is characterized by instability in relationships, self-image and affect, as well as impulsive behavior. It is more common in females. Common symptoms include the following:
  • Frantic efforts to avoid abandonment
  • Unstable and intense relationships
  • Disturbance in identity
  • Impulsive behavior that has the potential for self-harm
  • Repeated suicidal threats, gestures, behavior or, alternatively, self- mutilation
  • Unstable affect caused by reactivity of mood
  • Persistent feelings of emptiness
  • Chronic anger that the individual has difficulty controlling
  • Brief episodes of paranoid ideation or severe dissociative symptoms in response to stress

Antipsychotic meds may be helpful during brief reactive psychotic symptoms. Antidepressants and anti-anxiety meds may be appropriate for anxiety and depressive symptoms.
A commonly used therapeutic treatment approach for individuals with Borderline Personality Disorder is Dialectical* Behavior Therapy. Behaviors for focus in treatment include:
* Dichotomous thinking (the tendency to think in terms of polar opposites—that is, in terms of the best and worst—without accepting the possibilities that lie between these two extremes).
* Impulse control
* Behavioral excess
* Lack of self-regulation
* Self- damaging behaviors
* Dialectical- relating to the logical discussion of ideas and opinions.

62
Q

Personality Disorders entails- DSM- 5?

A
  • Histrionic Personality Disorder is characterized by high emotionality and attention- seeking behavior. It is more common in females. Common symptoms include:
  • Discomfort when he/she is not the focus of attention
  • Inappropriate seductiveness or provocative behavior
  • Rapid shifts in emotion and emotional shallowness
  • Use of physical appearance to attract others’ attention
  • Speech that is impressionistic and devoid of detail
  • Dramatic behavior and expression of emotion
  • Suggestibility
  • Perception that relationships are closer than they are in reality

Meds are not indicated unless there is another disorder. If meds is prescribed, care should be taken because of the potential for using meds for self-destructive or other harmful behaviors.

Individuals with Histrionic Personality Disorder present for treatment only when stress or some other situational factor has overwhelmed their ability to function and cope effectively. Under these circumstances, these individuals may seek treatment more quickly and exaggerate their symptoms and inability to function. Individuals are emotionally needy and are often reluctant to terminate therapy. Behaviors for focus in treatment include:

  • Impulsive reactions
  • Provocativeness
  • Seductiveness
  • Need for attention
  • Catastrophic thinking
  • Narcissistic Personality Disorder is characterized by grandiosity, a need to be admired by others, and absence of empathy. It is more common in males. Common symptoms are:
  • An exaggerated sense of importance
  • Fantasies of unlimited success, power, brilliance, etc.
  • Perception of being special and belief that he/she can only be understood by specific, high- status individuals
  • Sense of entitlement
  • Using others to achieve personal goals
  • Envy of others or perception that others envy him/her
  • Arrogance and haughtiness (the appearance or quality of being arrogantly superior and disdainful).

Meds are not indicated for Narcissistic Personality Disorder unless there is another disorder.

Individuals with this disorder try to sustain an image of perfection and personal invincibility and attempt to project that impression to others. Grandiosity and devaluing others should be interpreted as defensive strategies. In therapy manipulative behaviors that demean and devalue others, lack of empathy and self- centeredness relate to the primary goals of treatment.

63
Q

Personality Disorders entails- DSM- 5?

A
  • Avoidant Personality Disorder is characterized by social inhibition, low self-esteem and excessive sensitivity to criticism. Other common symptoms include:
  • Avoidance of interpersonal relationships because of oversensitivity to rejection, disapproval, or criticism.
  • Guardedness in intimate relationships out of fear or being shamed or ridiculed.
  • Perception of inferiority to others
  • Avoidance of new activities or taking risks because of fear of embarrassment.

Meds should be prescribed for other specific orders; anti-anxiety and antidepressants maybe helpful. Anxiety complaints are frequently associated with social situations or disconnected feelings and prescribing meds should be done so with caution as the symptoms are characteristic of the disorder.

Individual therapy is the preferred modality, but group therapy can be effective if the person agrees to attend enough sessions. Self-esteem issues will be raised during treatment; negative self-valuation is a lifelong pervasive thought that necessitates a solid therapeutic relationship. Target issues include fear, anger, passive- aggression, shame, catastrophic thinking style.

  • Dependent Personality Disorder is characterized by an extreme need to be taken care of which leads to submissive behavior and clinginess as well as fear of separation. It is more common in females. Common symptoms include:
  • An excessive need for advice and reassurance when faced with decisions
  • The need for others to take responsibility for much of his/ her life
  • Tendency to express agreement with others even when in disagreement because of the fear of losing approval and support.
  • Trouble taking on projects, especially independently because of low self-confidence
  • Often volunteering for unpleasant tasks in hopes of gaining the nurturance and support of others
  • Discomfort with being alone because of fear of not being able to care for oneself
  • Seeking to fill the gap created by a lost close relationship by urgently seeking a replacement relationship
  • Preoccupation with situations that require independent care for self.

Meds should only be prescribed for other disorders and with caution. * Individuals with Dependent Personality Disorder frequently present with physicians with multiple physical complaints and anxiety. Sedative drug abuse and overdose are common in individuals with Dependent Personality Disorder

The most effective treatment focuses on solutions and specific life problems the individual is presently experiencing. Termination issues will be of extreme importance because of dependency issues. The focus of treatment is addressing:

  • Ambivalence (the state of having mixed feelings or contradictory ideas about something or someone).
  • Catastrophic thinking
  • Lack of initiation
  • Passive control of others
  • Placing too much emphasis on others’ opinion.
  • Obsessive- Compulsive Personality Disorder is characterized by perfectionism, preoccupation with orderliness and considerable effort to control self and others, resulting in reduced flexibility, openness and efficiency. This is more common in male. Common symptoms include:
  • Preoccupation with rules, details, list, etc.
  • Perfectionism that makes completion of tasks difficult or impossible
  • Excessive devotion to work at the expense of other activities/ relationships
  • Rigidity around morality, ethics, values
  • Inability to let go of worthless or worn-out items
  • Miserliness (Mi-ser-li-ness excessive desire to save money; extreme meanness.)
  • Rigidity and stubbornness

Meds are not indicated unless the individual is also suffering from another disorder.

Individuals with Obsessive- Compulsive Personality Disorder will seek treatment when life has become overwhelming to their existing coping skills. Short-term therapy is most likely to be beneficial with the person’s current support system and when coping skills are not functioning. Individuals are often not in touch with their feelings as much as their thoughts. The main focus of treatment is to target:

  • Affect, guilt, anger, fear of retribution
  • Rigidity
  • Self- protectiveness

Other Specific Personality and Unspecified Personality Disorder is diagnosed when dysfunction in personality functioning is evident and when the symptoms do not meet the criteria for a specific personality disorder.

64
Q

What are Paraphilic Disorders- DSM- 5?

A

These disorders cause intense sexually- oriented urges, fantasies, or behaviors associated with objects and situations not typically associated with sexual arousal.

  • Exhibitionistic Disorder is characterized by intense and recurring urges, fantasies, or behaviors that are sexually arousing (minimum of 6 mnths) around exposing one’s genitals to people the individual does not know. The urges and fantasies must result in significant distress to the individual or, alternatively, the individual must have engaged in the behavior.
  • Fetishistic Disorder involves intense and recurring urges, fantasies, or behaviors (minimum of 6 mnts) that are sexually arousing and are focused on inanimate objects. This behavior cannot be restricted to female clothing used with cross-dressing or to vibrators and similar devices and must result in marked distress or in significant impairment in functioning.
  • Frotteuristic Disorder consists of intense and recurring urges, fantasies, or behaviors (minimum of 6 mnts) that are sexually arousing and focused on touching or rubbing against a person who has not given consent.
    (Frot-teu-ris-tic)
  • Pedophilic Disorder consists of intense and recurring urges, fantasies, or behaviors (minimum of 6 mnths) that are sexually arousing, in an individual who is age 16 or older and is focused on sexual involvement with children who are at least 5 yrs younger; the person has to either have acted on the urges or the urges and fantasies have resulted in significant distress in the person or interpersonal conflict.
65
Q

What are Paraphilic Disorders- DSM- 5?

A
  • Sexual Masochism this disorder involves intense and recurring urges, fantasies, or behaviors (minimum of 6 mnths) of being humiliated, physically hurt, or made to suffer in a manner and leads to sexual arousal. The behavior results in marked distress in the person or impairment in functioning.
    (ma· suh· ki· zm)
  • Sexual Sadism is characterized by intense and recurring urges, fantasies, or behaviors (minimum of 6 mnths) focused on real acts against another person that result in psychological or physical suffering for that other person and sexual arousal for the perpetrator.
  • Transvestic Disorder involves intense and recurring urges, fantasies or behaviors (minimum of 6 mnths) around cross- dressing by a heterosexual male that results in sexual arousal and either marked distress or impairment in functioning
  • Voyeuristic Disorder includes intense and recurring urges, fantasies, or behaviors (minimum of 6 mnths) focused on secretly observing an individual who is disrobing, naked, or involved in sexual activity that results in sexual arousal and either marked distress for the observer or interpersonal conflict.

SSRIs- Selective serotonin reuptake inhibitors have shown promise in treating individuals with paraphilic disorders, as well as depression and other mood disorders. It has been found that a decreased level of serotonin in the brain results in an increased sex drive. Different types of hormones have been useful in treating sexual offenders for many years.

Treatment options vary and must take into account the specific needs of each individual case. Options include individual psychotherapy, group therapy, marital therapy and family therapy. Cognitive- Behavioral Therapy may be used with the following steps:

  • Aversive conditioning (to avoid)
  • Confrontation of cognitive distortions
  • Victim empathy
  • Assertiveness training (social skills, time management, structure)
  • Relapse prevention
  • Surveillance systems (e.g. family)
  • Lifelong maintenance

Group therapy is useful in helping individuals overcome the denial that is frequently associated with Paraphilic Disorders and as a form of relapse prevention.

66
Q

What does Medication- Induced Movement Disorders and Other Adverse Effects of Medication entail-DSM- 5?

A
  • Is important because these disorders relate to the management of medications. The term ‘induced’ doe not necessarily mean causal. Instead, there is a relationship between the medication and subsequent symptoms.
  • Neuroleptic- Induced Parkinsonism (e.g. tremor, muscular rigidity, Kinesis- movement; motion)
  • Neuroleptic Malignant Syndrome (e.g. severe muscle rigidity, temperature)
  • Neuroleptic- Induced Acute Dystonia (e.g. unusual positioning or spasms)
  • Neuroleptic- Induced Acute Akathisia (e.g. restlessness, pacing)
67
Q

What does Medication- Induced Movement Disorders and Other Adverse Effects of Medication entail-DSM- 5?

A
  • Tardive Dyskinesia presents with involuntary choreiform- jerky, involuntary movements as with chorea; athetoid- a condition involving slow, involuntary worm- like movements of the fingers, toes, hands and feet; or rhythmic movements of tongue, jaw or extremities.
    (Choreiform movement (countable and uncountable, plural choreiform movements) repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated; often seen in Huntington’s disease.)
    (Chorea-a neurological disorder characterized by jerky involuntary movements affecting especially the shoulders, hips, and face.)
  • Tardive Dystonia or Tardive Akathisia involves movement problems that occur late in the course of treatment and persists for months or years even when neuroleptic meds have been reduced or discontinued.
    (Neuroleptic/ Antipsychotics- a drug that depresses nerve functions; a major tranquilizer.)
  • Medication- Induced Postural Tremor (e.g. fine tremor accompanying efforts to maintain a posture)
  • Antidepressant Discontinuation Syndrome involves abrupt cessation or marked dose reduction of an antidepressant that causes nausea, hyper- responsivity to noises or lights.
  • Other Adverse Effect of Medication may include issues such as severe hypotension, cardiac arrhythmias.
    (Hypotension is the medical term for low blood pressure (less than 90/60).)
68
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Relational Problems are characterized by relationships that have significant impact on the health of the individuals w/in given relationships (intimate adult partner parent/ caregiver- child)
  • Parent- Child Relational Problem focuses on primary caregivers and the quality of the parent- child relationship (e.g. lack of parental control, inadequate supervision, parental overprotection, threats of physical violence, avoidance of problems, hostility).
  • Sibling Relational Problems focuses on patterns of interaction among siblings that creates significant impairment in individuals or family functioning.
  • Upbringing Away from Parents focuses on issues regarding a child being raised away from parents (e.g. foster care, kinship care, under state custody)
  • Child Affected by Parental Relationship Distress focuses on the negative effects of parental discord on the child in the family.
69
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Relationship Distress with Spouse or Intimate Partner relates to the quality of the intimate relationship or when the quality of that relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder (e.g. conflict resolution difficulty, ange with the other partner).
  • Disruption of Family by Separation or Divorce
  • High Expressed Emotion Level w/in Family occurs when there is hostility, emotional over-involvement or criticism directed toward a family member who is an identified CT in the family environment. It affects the individual’s course, prognosis or treatment of a mental or medical disorder.
  • Uncomplicated Bereavement is a normal reaction to the death of a loved one. The individual seeks professional assistance to deal with associated symptoms.
70
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Problems Related to Abuse or Neglect- these problems are indicated when the focus of treatment is severe mistreatment of another person. The clinician codes as confirmed or suspected.
  • Child Physical Abuse is the non-accidental physical injury to a child (e.g. minor bruises to severe fractures or death) The injury is considered abuse regardless of whether or not the caregiver intended to hurt the child.
  • Child Sexual Abuse encompasses any sexual act involving a child that is intended to provide sexual gratification to a parent, caregiver, or other individual responsible for the child.
  • Child Neglect occurs when a parent or caregiver deprives the child of basic age- appropriate needs that results in physical or psychological harm to the child (e.g. abandonment, inadequate supervision, failure to provide necessary education, medical care).
  • Child Psychological Abuse is defined as non-accidental verbal or symbolic acts by a parent or caregiver that result in significant psychological harm to the child (humiliation, threatening to abandon the child).
71
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Spouse or Partner Violence, Physical are non- accidental acts of physical force that result in physical harm (e.g. shoving, slapping, hair pulling, pinching, using a weapon)
  • Spouse or Partner Violence, Sexual occurs when one partner forces or coerces sexual acts. The coercion can be physical or psychological or the victim is unable to consent.
  • Spouse or Partner Neglect is an egregious act or omission by one partner that deprives a dependent partner of basic needs and results in physical or psychological harm. (Egregious-outstandingly bad; shocking)
  • Spouse or Partner Abuse, Psychological encompasses non- accidental verbal or symbolic acts by one partner that results in significant harm to the other partner (humiliation, interrogating, restricting access, stalking, isolating the individual from family, friends, or social supports).
  • Adult Abuse by Nonspouse or Nonpartner abuse occurs by another adult who is not an intimate partner.
72
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Educational and Occupational Problems
  • Academic or Educational Problem is impacting the individual’s diagnosis, treatment or prognosis (e.g. illiteracy, lack of access to schooling, academic performance, discord with teachers).
  • Problem Related to Current Military Deployment Status indicates that the individual’s deployment status is the focus of clinical attention or impacts an individual’s diagnosis, treatment or prognosis.
  • Other Problem Related to Employment (unemployment, recent change of job, job dissatisfaction, sexual harassment, problems related to a supervisor).
73
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Housing and Economic Problems
  • Homelessness is used when there is a lack of a regular dwelling or living quarters (e.g. homeless shelter, warming shelter, domestic violence shelter, public space, building not intended for residential use, cave).
  • Inadequate Housing is a lack of adequate housing that includes lack of heat, electricity, infestation by insects or rodents, inadequate plumbing, overcrowding.
  • Discord with Neighbor, Lodger, or Landlord is the focus of clinical attention or impacts the individual’s treatment or prognosis.
  • Problem Related to Living in a Residential Institution is related to a problem(s) living in a residential institution or has an impact on the individual’s treatment or prognosis.
  • Lack of Adequate Food or Safe Drinking Water
  • Extreme Poverty
  • Low Income
  • Insufficient Social Insurance or Welfare Support is used for individuals who meet eligibility criteria for social or welfare support but are not receiving it or lack access to needed insurance or support programs (e.g. insufficient documentation)
  • Unspecified Housing or Economic Problem.
74
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Problems related to Crime or Interaction with the Legal System
  • Victim of a Crime
  • Conviction in Civil or Criminal Proceedings Without Imprisonment
  • Imprisonment or Other Incarceration
  • Problems Related to Release from Prison
  • Problems Related to Other Legal Circumstances
  • Other Health Service Encounters for Counseling and Medical Advice
  • Sex Counseling is used when an individual seeks counseling for sex education, sexual behavior, sexual orientation, sexual attitudes, sexual enjoyment or others’s sexual behavior
  • Other Counseling or Consultation is counseling that is sought for a problem that is not specified anywhere else in this section.
  • Problems Related to Other Psychosocial, Personal, and Environmental Circumstances
  • Religious or Spiritual Problem related to distressing experiences that involve questioning or loss of one’s faith, conversion to a new faith, questioning spiritual values.
  • Problems Related to Unwanted Pregnancy
  • Problems Related to Multiparity (1 : the production of two or more young at a birth. 2 : the condition of having borne a number of children.)
  • Discord with Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker
  • Victim of Terrorism or Torture
  • Exposure to Disaster, War, or Other Hostilities
75
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Other Circumstance of Personal History
  • Other Personal History of Psychological Trauma
  • Personal History of Self- Harm
  • Personal History of Military Deployment
  • Other Personal Risk Factors

Problem Related to Lifestyle is noted when the individual’s lifestyle directly affects the course, prognosis, or treatment of a mental or other medical disorder (e.g. lack of physical exercise or inappropriate diet). List both the mental or medical disorder and the lifestyle problem.

  • Adult Antisocial Behavior is coded when the focus of treatment is adult antisocial behavior not associated with a mental disorder.
  • Child or Adolescent Antisocial Behavior is coded when the focus of treatment is antisocial in a child or adolescent not associated with a mental disorder.
76
Q

What Are Other Conditions That May Be The Focus of Clinical Attention- DSM- 5?

A
  • Problems Related to Access to Medical and Other Healthcare
  • Unavailability or Inaccessibility of Healthcare Facilities
  • Unavailability or Inaccessibility of Other Helping Agencies
  • Non- adherence to Medical Treatment is coded when the CT does not comply with either mental health treatment or treatment for a general medical condition. The noncompliance may result from discomfort associated with treatment, cost of treatment, religious or cultural beliefs, maladaptive personality traits or coping strategies, or a mental disorder.
  • Overweight or Obesity
  • Malingering is behavior which produces or exaggerates psychological or physical symptoms to avoid something unpleasant (e.g. work) or to obtain something desirable (e.g. to get drugs or Workmen’s Compensation). It is based on external incentives. Malingering may be adaptive in certain circumstances.
  • Wandering Associated with a Mental Disorder relates t individuals with a mental disorder whose desire to walk about leads to significant clinical management or safety concerns (e.g. Major Neurocognitive Disorder). It includes individuals who wish to escape an unwanted housing situation or those who walk or pace as a result of a medication induced restlessness. List the disorder first then the Z code of wandering associated with that specific disorder.
    Neurocognitive Disorder-is a general term that describes decreased mental function due to a medical disease other than a psychiatric illness. It is often used synonymously (but incorrectly) with dementia.
  • Borderline Intellectual Functioning requires careful assessment of intellectual and adaptive functions and their discrepancies.
77
Q

What does Psychopharmacology entail- DSM- 5?

A

Brand name meds are titled with a capital letter and the generic bands are in lowercase.

Anti-Anxiety or Anxiolytic medications

  • Librium (chloridiazepoxide)
  • Xanax (alpraxolam)
  • Valium (diazepam)
  • Ativan (lorazepam)
  • Klonipin (clonazepam)
  • Restoril (temazepam)
  • Dalmane (flurazepam)
  • Tranxene (clorazepate)
  • Serax (oxazepam)

Common side effects of benzodiazepines include fatigue, dizziness, confusion, drowsiness, impaired motor coordination, headache, memory impairment, irritability, and restlessness.
benzodiazepines- are a type of medication known as tranquilizers.

  • Buspar (buspirone) does not have a sedative effect and is not addictive. It is an effective treatment for Generalized Anxiety Disorder and when anxiety and depressive symptoms occur together. Since it takes at least two weeks to achieve full effectiveness, it should not be uses in crisis intervention or with panic disorder. It should not be taken with Haldol (an antipsychotic), MAO inhibitors (a category of antidepressants), or Antabuse (used in treatment of alcohol dependence).

Common side effects include nausea, headache, and dizziness.

  • Beta Blockers (e.g. Lopressor and Inderal) reduce the physiological symptoms of anxiety (e.g. racing heart) which makes them particularly effective with anticipatory anxiety.
    Anticipatory anxiety is where a person experiences increased levels of anxiety by thinking about an event or situation in the future. Rather than being a specific disorder in its own right, anticipatory anxiety is a symptom commonly found in a number of anxiety related conditions, such as generalised anxiety.
    Beta blockers are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack after a first heart attack.

Common side effects include sedation, hypotension (low BP), and decreased heart rate.

Antihistamines (e.g. Benadryl and Vistaril) are used less frequently in the treatment of anxiety. They are rapidly absorbed and have a sedative effect.

78
Q

What does Psychopharmacology entail- DSM- 5?

A
  • Antidepressants
  • Tricyclic Antidepressants (this class of med inhibits the reuptake of norepinephrine and serotonin)
    Reuptake: The reabsorption of a secreted substance by the cell that originally produced and secreted it. The process of reuptake, for example, affects serotonin. Serotonin is a neurotransmitter (a chemical messenger). It is produced by nerve cells in the brain and is used by nerves to communicate with one another.
    Norepinephrine, also called noradrenaline, substance that is released predominantly from the ends of sympathetic nerve fibres and that acts to increase the force of skeletal muscle contraction and the rate and force of contraction of the heart. It can treat low blood pressure and heart failure.
  • Elavil (amitriptyline)
  • Sinequan (doxepin)
  • Pamelor (nortriptyline)
  • Anafranil (clomipramine)
  • Vivatyl (protiptyline)
  • Tofranil (imipramine)
  • Norpramin (desipramine)
  • Surmontil (trimipramine)
  • Aventyl (amoxapine)

Common side effects include sedation, anticholinergic effects (e.g. dry mouth, constipation, urinary hesitancy, blurred vision, sexual dysfunction).
anticholinergic agent is a substance that blocks the action of the neurotransmitter acetylcholine at synapses in the central and the peripheral nervous system.
acetylcholine- a compound which occur throughout the nervous system which function as a neurotransmitter.
neurotransmitter a chemical substance that is released at the end of a nerve fiber by the arrival of a nerve impulse and, by diffusing across the synapse or junction, causes the transfer of the impulse to another nerve fiber, a muscle fiber, or some other structure.

Tetracyclic Antidepressants (this class of medication affects serotonin and norepinephrine)

  • Ludiomil (maprotiline)
  • Remeron (mirtazapine)

Common side effects include drowsiness, gastrointestinal upset, nightmares, tiredness, sunlight skin sensitivity.

  • MAO Inhibitors
  • Nardil (phenelzine)
  • Parnate (tranylcypromine)
  • Marplan (isocarboxazid)
  • Emsam (selegiline)

Common side effects include dry mouth, dizziness, insomnia, weakness, hypotension, sexual dysfunction, weight gain.

When taking MAO Inhibitors, it is necessary to avoid food that have a high content of the amino acid tyramine (e.g. cheese, chocolate, yogurt) because MAO inhibitors combined with tyramine may result in extreme hypertension or death.

  • Selective Serotonin Reuptake Inhibitors (SSRI’s)
  • Prozac (fluoxetine)
  • Paxil (paroxetine)
  • Zoloft (sertaline)
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Luvox (fluvoxamine)
  • Pexera (paraexetine- mesylate)
  • Sarafem (fluoxetine- hydrochloride): prescribed for Premenstrual Dysphoric Disorder

Common side effects include headache, nausea, anxiety, constipation, dry mouth, sexual dysfunction, sedation.

Atypical Antidepressants (SSNRI's)
Atypical not representative of a type, group, or class.
  • Effexor (venlafaxine)
  • Wellbutrin (bupropion)
  • Desyrel (trazodone)
  • Cymbalta (duloxetine)
  • Serzone (nefazodone)
  • Asendin (amoxapine)
  • Pristiq (desvenlafaxine)

Common side effects are similar to SSRI’s-headache, nausea, anxiety, constipation, dry mouth, sexual dysfunction, sedation.

79
Q

What does Psychopharmacology entail- DSM- 5?

A
  • Antipsychotics (also called major tranquilizers or neuroleptics)
  • Thorazine (chlorpromazine)
  • Mellaril (thioridazine)
  • Stelazine (trifluoperazine)
  • Haldol (haloperidol)
  • Prolixin (fluphenazine)
  • Navane (thiothizene)
  • Trilafon (perphanazine)
  • Orap (pimozide) Used for Tourette’s Disorder

(“Phenothiazines” is the largest of the five main classes of neuroleptic antipsychotic drugs.)
Phenothiazine: One of a group of tranquilizing drugs with antipsychotic actions thought to act by blocking dopaminergic transmission (messages sent using the substance dopamine) within the brain.

  • Atypical Antipsychotics
  • Clozaril (clozapine)
  • Risperdal (risperidone)
  • Zyprexa (olanzapine)
  • Abilify (aripiprazole)
  • Seroquel (quetiapine)
  • Fanapt, Fanapta (iloperidone)
  • Loxitane (loxapine)
  • Invega (paliperidone)
  • Latuda (lurasidone HCL)

Common side effects:
Dystonias (severely disordered tissue tone characterized by mini-seizures and facial, tongue, neck, and back spasms)
Anticholinergic effects (e.g. weight gain, sexual dysfunction, blurred vision, confusion, and constipation)
Akathisia (restlessness accompanied by anxiety or agitation)
Parkinsonian symptoms (e.g. hand and finger tremors, mask-like facial expression, physical rigidity, slowed speech).
Less common but severe side effects:
Tardive Dyskinesia (involuntary movements of face, torso, or limbs)
Neuromalignant syndrome (NMS- characterized by catatonic stupor, fever, and unstable vital signs)

Drugs used to address side effects of antipsychotics

  • Cogentin (benztropine)
  • Benadryl (diphenhydramine)
  • Artane (trihexyphenidyl)
80
Q

What does Psychopharmacology entail- DSM- 5?

A
  • Mood Stabilizers
  • Eskalith, Lithobid (lithium, lithium citrate)
    Common side effects include weight gain, fatigue, nausea and vomiting, increase in thirst and urination, confusion, diarrhea, muscle weakness and hand tremors. A Patient’s blood levels must be monitored.
  • Depakote (divalproex sodium) (an anticonvulsant)
    Common side effects include sedation, dizziness, hair loss and weight gain. A Patient’s blood levels must be monitored.
  • Lamictal (lamotrigine- an anticonvulsant)
    Common side effects include headache, dizziness, insomnia, skin disorders that can be life threatening.
  • Neurontin (gabapentin)
    Common side effects include migraines, pain, dizziness, drowsiness, peripheral edema.
  • Topamax (topiramate- an anticonvulsant)
    Common side effects include constipation, decreased sweating, dizziness, drowsiness, decreased appetite, nausea, nervousness, difficulty sleeping, and weight loss.

*Tegretol (carbamazepine) (an anticonvulsant)
* Tripletal (oxcarbazepine) (an anticonvulsant)
Common side effects include clumsiness or unsteadiness, dizziness, drowsiness, lightheadedness; nausea or vomiting.

  • Zyprexa (olanzepine)
    Common side effects include constipation, dizziness, drowsiness, dry mouth, headache, runny nose, vision problems, weakness, weight gain.
  • Geodon (ziprasidone)
    Common side effects include drowsiness, dizziness, restlessness, uncontrollable muscle movements (e.g. shaking of hands), constipation, diarrhea, nausea, vomiting, rash or hives, runny nose; sneezing, cough.
  • Symbyax (combination of zyprexa and prozac) used to treat the depressive episode of Bipolar disorder as well as Schizophrenia and Schizoaffective Disorder.
    Common side effects include weight gain, sleepiness, diarrhea, dry mouth, increased appetite, weakness, swelling of hands and feet, tremors, sore throat, difficulty concentrating.
81
Q

What does Psychopharmacology entail- DSM- 5?

A

Psychostimulants typically used to treat ADHD and can also be used for Narcolepsy and obesity. They have a high abuse potential. In most individuals they create wakefulness, improved mood, and an increase in alertness. In individuals with ADHD these drugs have a paradoxical response including improved concentration and increased ability to exercise self-control.

  • Ritalin, Daytrana, Metadate, Methylin (methylphenidate)
  • Dexedrine, Dextrostat (dextroamphetamine)
  • Adderall (amphetamine & dextroamphetamine)
  • Concerta (methylphenidate)
  • Vyvanse (lisdexafetamine dimesylate)
  • Dexozyn (methamphetamine)
  • Focalin (dexmethylphenidate)
    Commonside effects include insomnia, loss of appetite, anxiety, gastrointestinal pain, and cardiac arrhythmia.
  • Strattera (atomoxetine- non- stimulant; a norepinephrine reuptake inhibitor to treat ADHD)
    Common side effects include nausea, fatigue (in children and adolescents) and difficulty sleeping (in adults).
  • Catapress (clonidine)
  • Tenex (guanfacine)
  • Intiniv (guanfacine)
    These meds are prescribed for tics, impulsivity, and aggressive behaviors.
    Common side effects include marked increased or decreased heart rate, shortness of breath, rapid weight gain and swelling, confusion and hallucinations, fever, pale skin, decreased urination, dizziness, dry mouth, blurred vision, headache, joint pain, nausea, vomiting or loss of appetite, insomnia, frequent nighttime urination, skin rash, decreased sex drive or impotence.
82
Q

What is treatment Planning- DSM- 5?

A

Treatment Plan- in developing a plan for a client, it must be individualized for each client. The treatment plan that CT and SW develop is from the information gathered during the social history and is specialized to respond to the needs of this particular CT. The plan should include CT’s family and support system and should contain short-term and long-term measurable goals and objectives. The should clarify the CT’s responsibility in carrying out the goals, as well as the SW’s responsibilities. The plan should be continually evaluated and altered if necessary.

When making an assessment of problem areas and level of care, the SW refers to the CT’s intake interview and social history to determine problem areas and CT strengths. The SW summarizes all of the information that has been gathered and determines, with the CT, the focus of treatment. The SW and CT write an individual plan, which includes a list of problems, in order of importance.

83
Q

What is treatment Planning- DSM- 5?

A
  • Selection of Treatment Approaches
    Treatment planning is usually based on a number of factors including, but not limited to, the following:

Type of agency- e.g. community agency, mental health, child and family services, inpatient, outpatient, secure facility, public school, private practice, etc. If a CT seeks services in an agency that cannot provide the help he/she needs, treatment planning may require a referral to a different type of agency.

Nature of CT’s problem (s)- treatment approaches should be based on the type of problems that the CT is experiencing (e.g. emotional problems, relationship difficulties, addictions, incarceration, medical problems, etc.) at the time that the CT is in need of services.

Philosophy of agency- most agencies or treatment settings have a particular treatment focus, which may be a requirement of that type of agency or the philosophy of the private practitioner. As an example, a Youth Corrections group home may utilize Reality Therapy as a preference for working with behavior disordered youth. Division of Child and Family Services agencies may have a particular program, which is used with children in foster care who are transitioning into independent living.
Reality therapy is a therapeutic approach that focuses on problem-solving and making better choices in order to achieve specific goals. Developed by Dr. William Glasser, reality therapy is focused on the here and now rather than the past. Is an approach to psychotherapy and counseling.

84
Q

What is treatment Planning- DSM- 5?

A

Individual CT’s needs- despite an agency’s or private practitioner’s philosophy of treatment, each CT is an individual with his/her own needs, and the treatment plan and service provided should match those needs. The CT’s developmental level, cognitive ability, level of literacy, employability, culture, life stage, and support system are all factors that should be considered when developing a treatment plan.

SW’s knowledge and skill level- SW should only provide that treatment in which they are trained and skilled. If SWs are experts in a certain type of treatment (e.g. cognitive behavioral therapy, family therapy, psychodynamic therapy, solution- focused therapy, etc. ) they may choose to use that type of treatment approach it it fits with the needs of the CT. Because SW service can be provided in a variety of settings with a variety of CT types, it is wise for SW to have knowledge and skills pertaining to the many types of treatment approaches.

Legal, ethical or insurance restrictions or considerations- if a CT is incarcerated, in the custody of the government, or on probation, there may be legal restrictions as to the type of treatment that is to be provided. Ethical considerations may include value conflicts between CT and SW, biomedical issues, or other ethical dilemmas. In this ear of managed care, the CT’s insurance may dictate or restrict the type of treatment that the CT may receive.
Value conflicts occur when someone make choices that are guided by their values, and someone else thinks they made a wrong choice. Your feelings that they made a wrong choice is a clear sign that you have different values and would have made a different choice.

Level of care needed- the treatment plan, decided upon by the SW and CT, should specify the level of care that the CT needs (e.g. outpatient, hospitalization, home healthcare, hospice, incarceration, etc.). The treatment plan should also specify if the care is to be short term or long term.

85
Q

What is Practice Evaluation and The Utilization of Research-DSM- 5?

A

Two reasons why SWs engage in research:
1. Is to evaluate their own practice, consisting of the interventions and programs they utilize. SW have a responsibility to provide high quality care to their CTs. This necessitates that they evaluate work with CTs. Funders are increasingly requiring demonstration that their intervention are achieving the intended goals.

  1. SW engage in research is to add to the body of knowledge in the field. Knowledge gained from research provides the basis for making micro, meso and macro-level practice decisions. Treatment decisions based on clinical and research findings is called “evidence based practice.”

Micro level, which is often classified as the most common type of practice, involves working directly with an individual or a family.
Meso/ mezzo-level indicates a population size that falls between the micro- and macro-levels, such as a neighborhoods, small groups and institutions. However, meso-level may also refer to analyses that are specifically designed to reveal connections between micro- and macro-levels.
Macro-level work at the community and systems-level,

86
Q

What does Practice Evaluation and The Utilization of Research entail-DSM- 5?

A
  • Types of Research
    • Action Research- is designed to find solutions or to develop new approaches to solving problems typically in an agency or other practice setting.
    • Case (Field) Study- involves an in-depth study of a single unit or case.
    • Correlational Research- is research that seeks to identify the extent to which changes in on variable are associated with changes in another variable or variables using correlation coefficients. (Correlation coefficient is a statistical measure of the strength of the relationship between the relative movements of two variables. The values range between -1.0 and 1.0. A calculated number greater than 1.0 or less than -1.0 means that there was an error in the correlation measurement.)
    • Descriptive (Survey) Research- is designed to provide a description of an area of concern or interest and may lead to the formulation of research questions that can be addressed in future studies.
    • Evaluative Research attempts to determine the extent to which an intervention or program has been successful in achieving its goals and objectives and/or is cost effective.
87
Q

What does Practice Evaluation and The Utilization of Research entail-DSM- 5?

A
  • Experimental Research involves the exposure of one or more experimental groups to one or more treatment interventions and the comparison of results to those obtained from one or more control groups in an effort to identify possible cause-and-effect relationships. Experimental research is a type of explanatory research design.
    • Explanatory (Causal Comparative) Research involves searching through data in an attempt to identify possible causal factors of observed consequences.
    • Exploratory (Formulative) Research is designed to provide preliminary data on issues and provides a basis for later, more in-depth research.
    • Historical Research attempts to develop an accurate reconstruction of the past. A historic perspective is used to interpret and organize data obtained in the course of research.
    • Pretest/ Post- test involves testing study participants before the introduction of the intervention and again following the intervention.
88
Q

What does Practice Evaluation and The Utilization of Research entail-DSM- 5?

A
  • Qualitative Research is from a non- statistical perspective, designed to understand the phenomenon under investigation from the perspective of the respondent (A respondent is a person who is called upon to issue a response to a communication made by another. The term is used in legal contexts, in survey methodology, and in psychological conditioning.)

Examples of Qualitative Research:
Ethnography is research that seeks to understand individuals in their own social or cultural context. This type of research involves a blending of two perspectives- an emic perspective, or the perspective of an individual who is part of the group being studied, and an etic perspective, or the perspective of an outsider to the group being studied. The researcher is a participant- observer in this research.
Oral Histories involves the interviewing of study participants who can relate firsthand experiences of the phenomena under study (e.g. interviewing survivors of Nazi concentration camps.)

  • Quantitative Research is research that can be summarized using numbers and statistics.
  • Quasi- Experimental Research is one in which the researcher attempts to approximate the conditions of experimental research in a setting in which he/she is unable to control and/or manipulate all relevant variables.
  • Single Subject Research is a type of evaluation measurement done on a single case to determine the effectiveness of intervention(s).AB Design consists of a baseline (A) and an intervention (B) phase.ABAB Design involves the initial baseline (A) and intervention phases, (B) followed by withdrawal of the intervention for a time (second baseline phase), then reintroduction of the same intervention.
    (A-B-A-B Design- An experimental design, often involving a single subject, wherein a baseline period (A) is followed by a treatment (B). To confirm that the treatment resulted in a change in behavior, the treatment is then withdrawn (A) and reinstated (B) (Butcher, Mineka & Hooley, 2004).)ABAC Design involves a baseline phase (A), the introduction of an intervention (B); then the withdrawal of the intervention (a second baseline), and the introduction of a different intervention (C).Multiple Baselines involves collecting baseline data on a minimum of three target behaviors:
    1. applying an intervention to a single target behavior
    2. applying an intervention to a different target behavior after change has been effected in the first target behavior
    3. applying an intervention to a different target behavior after change has been effected in the second target behavior.
    This design seeks to test causality (the relationship between cause and effect.) by demonstrating that a given target behavior only undergoes change when an intervention is introduced.
89
Q

What are Statistical Terms- DSM- 5?

A
  • Bell Shaped (or Normal) Curve- involves a symmetrical distribution consisting of a higher point in the middle of the distribution and equal tails on either side. Approximately 68% of the scores in the distribution lie within one standard deviation of the mean. Much in nature is distributed in this manner.
    (Standard deviation is a number used to tell how measurements for a group are spread out from the average (mean), or expected value. A low standard deviation means that most of the numbers are close to the average. A high standard deviation means that the numbers are more spread out.)
  • Skewed Distribution occurs when the distribution of some variable (e.g. income) is asymmetrical (i.e. more scores are congregated in one tail of the distribution than in the other tail).
  • Statistic is a number computer from data used to describe samples and to test hypotheses.
90
Q

What are Statistical Terms- DSM- 5?

A
  • Descriptive Statistics are statistics that simply summarize a set of observations.
    • Correlation Coefficient (r) is a statistic that reflects the degree to which two variables are associated or co-vary (ranges from +1 to -1).
    • A positive sign in front of the number indicates a positive correlation. A change in one variable is associated with a change in the other variable in the same direction.
    • A negative sign in front of the number indicates a negative correlation. A change in one variable is associated with a change in the other variable in the opposite direction; as one variable increases the other decreases. A.K.A- Perfect inverse correlation.
    • The closer the r value to 1.00 (negative or positive), the stronger the correlation.
    • The positive or negative in front of the number does not impact the strength of the correlation.
    • A correlation of .90 is considered a strong correlation.
    • A correlation of less than .50 is considered a weak correlation.
    • Mode is the number that occurs most often in a series of numbers (e.g. “5” is the mode of the following series of numbers: 1, 1, 3, 5, 5, 5, 7, 7, 9). A series of numbers may have more than one mode (e.g. in the number series 1, 1, 1, 3, 3, 5, 5, 5, 7, 8, 9, 9, 9, the numbers “1”, “5”, and “9” all appear 3x, thus this series has three modes.)
    • Median (middle) is a number that has the same number of scores above and below it (or on either) when arranged in descending or ascending order. For example, “5” is the median in the following series of numbers. (Put numbers in order First)
      2 3 5 (Median Score) 9 10
    When there is an even amount of numbers in a series, the median is the average of the two middle numbers; in the following example, “4” is the median score:
    1 3 5 7 (3+5= 8/2= 4)
    • Mean is the arithmetic average (sum of the scores divided by the number of scores). In the example above, the mean score is “4” (1+3+5+7= 16/4= 4).
    • Range is the difference between the highest and the lowest scores in a distribution. Example: In {4, 6, 9, 3, 7} the lowest value is 3, and the highest is 9. So the range is 9 − 3 = 6.
    • Standard Deviation measures the spread of a set of data around the mean of the data. In a normal distribution, approximately 68% of scores fall within plus or minus one standard deviation of the mean, and 95% fall within plus or minus two standard deviations of the mean. Standard Deviations is the most common measure of statistical dispersion. (For example, the mean of the following two is the same: 15, 15, 15, 14, 16 and 2, 7, 14, 22, 30. However, the second is clearly more spread out. If a set has a low standard deviation, the values are not spread out too much.)
    • Variance is the standard deviation squared.
91
Q

What are Statistical Terms- DSM- 5?

A
  • Statistical Significance is the probability that a difference in scores (e.g. the mean score of a control group as opposed to the mean score of an experimental group) could have resulted from sampling error alone.
  • ANOVA is a statistical test designed to identify whether there are real differences in the mean scores of more than two groups.
92
Q

What are the General Research Terminology-DSM- 5?

A
  • Halo Effect can occur when evaluating someone too positively or too negatively because of the presence of one or a few characteristics.
  • Hawthorne Effect is the term used to describe subjects who behave differently than they normally do because they are aware they are being observed for research purposes.
  • Levels or Scales of Measurement refers to the precision with which a variable is measured and dependent on the nature of the variable and on the method of measurement.
    • Nominal refers to a level of measurement involving categories that are distinguished only by name, such as male and female.
    • Ordinal refers to a level of measurement that reflects each person’s position or rank with respect to a characteristic; absolute differences between levels cannot be ascertained (e.g. 1= Very Satisfied; 2= Satisfied; 3= Dissatisfied)
    • Interval is a level of measurement that involves rankings. The intervals between adjacent rankings are equal (e.g. the Fahrenheit temperature scale).
    • Ration refers to an interval scale with a true zero point (e.g. age, height, and weight).
93
Q

What are the General Research Terminology-DSM- 5?

A
  • Placebo Effect refers to changes in a dependent variable that result from a subject’s belief that he/she is being treated (e.g. patients of a pain clinic may report a decrease in pain after being given a placebo or a “dummy” treatment).
  • Null Hypothesis is a statement predicting that there will be no relationship between two or more variables. For example, “There will be no relationship between age at marriage and marital stability.
  • Research Hypothesis is a statement that predicts a relationship between two or more variables (e.g. “Age at marriage will be positively related to marital stability”).
  • Reliability (in measurement theory) is the consistency in the measurement of a variable; in the other words, the extent to which repeated administrations of an instrument with the same sample would yield the same results.
94
Q

What are the General Research Terminology-DSM- 5?

A
  • Sample is a subset of a population or a universe of individuals or objects selected to represent the population from which they are drawn as the focus of a study.
  • Representative Sample is the term used to refer to the extent to which a sample is important in ways similar to the population from which it was drawn (e.g. racial/ ethnic composition; age distribution; income distribution). The more similar the sample is to the population, the more confidence the researcher can have that a study of the entire population would yield the same results.
  • Sampling Bias is a systematic distortion of a sample, whether intentional or unintentional. Sampling bias effects the extent to which a sample is representative of the population from which it was drawn.
  • Sampling Error refers to the normal differences that exist between a population and a sample. [Normally a sample is unlikely to be perfectly representative of the population from which it was drawn.]
  • Random Sampling (or Randomization) is a method for assigning subjects to an experimental and a control group where every individual has an equal chance of being assigned to either unit.
95
Q

What are the General Research Terminology-DSM- 5?

A
  • Validity (in measurement theory) is the extent to which an instrumental being used measures what it intends to measure.
    • External Validity (in research design) refers to the amount of confidence we can have that the findings of a study are applicable to larger population from which the study sample was drawn.
    • Internal Validity (in research design) refers to the amount of confidence we can have that variations in a dependent variable can be explained by the variations in the independent variable. There are many factors that pose a threat to internal validity.
  • Independent Variable (I.V.) is the item that is thought to influence or cause a behavior or outcome. In mental health research, “I” is frequently the intervention.
  • Dependent Variable (D.V.) is the outcome or behavior thought to be caused or influenced by the Independent Variable (e.g. Diana Baumrind conducted research on the impact of different parenting styles on child behavior; in her studies, Parenting Style is the Independent Variable and Child Behavior is the Dependent Variable).
  • Intervening and Extraneous Variables are factors other than the Independent Variable that may exert influence on the outcome.
  • Self- Anchored Rating Scales are scales created by the CT and SW to measure progress in achieving treatment objectives.