LMSW EXAM - Bootcamp!

3 Areas to identify in each question (PPL)

1. Problem

2. Person

3. Last Sentence (guide to answer question)

Key words

1. Person/Client "hot seat"

2. SAFETY Red Flags - suicide, abuse, life-threatening, unexplained marks, alcohol, recent loss

3. Strong words/adjectives

4. Age

5. Diagnosis

6. Symptoms/Duration

7. Who are you?

8. Where are you in session?

9. Quotations

10. Direct requests/concerns

11. Qualifiers (First/Next/Best)

Distractors

FARM GRITS ROAD - Answers that look appealing at first glance but are often wrong - ELIMINATE! Exam is here and now

How do you answer first/next questions?

90% of exam is SAFETY FIRST.

COE: Ethical responsibilities towards clients

1. Client's best interests are primary

2. Respect/promote right to self-determination if client is mentally alert/stable, NOT unstable/intoxicated/psychotic

3. Informed consent, written agreement by client to undergo treatment, risks/benefits/costs disclosed

4. Avoid conflicts of interest (Things that interfere with SW's impartial judgment/discretion)

5. DO NOT promote individual therapy sessions to ppl who have a relationship w/ each other (except couples, family, group treatment) - Provide family members with appropriate referrals

6. Avoid dual/multiple relationships

7. Avoid bartering (unless common practice in community)

8. Obtain a professional translator FIRST if client does not speak the language of SW

9. Do not disclose client information w/out consent unless req'd by law

10. Provide client with reasonable access to records (First explore/discuss reason for request) Follow laws of state.

11. Ensure CONTINUITY of services

12. NO relations with clients past or present

Mandated reporting

SW's are req'd and responsible for reporting any instances of abuse that is suspected. Abuse includes physical, emotional, sexual, neglect, CHILD AND ELDER ABUSE

Duty to Warn

SW's MUST WARN a threatened victim of any harm that his/her client may cause when there is a REAL INTENT (PLAN)

Subpoena by the court

SW may be req'd by law to disclose confidential information

COE: Ethical responsibilities to colleagues

1. Refer to colleague who may be better trained in an area than SW. SW can take client but must be COMPETENT.

2. When CONSULTING with colleague, disclose least amount of information

3. FIRST speak to a colleague to discourage/prevent/correct unethical behavior

4. AVOID relationships with colleagues (conflict of interest)

Disorders in Infancy, Childhood, Adolescence

Autism, ADHD, Oppositional Defiant Disorder, Conduct Disorder, Enuresis, Separation Anxiety Disorder

Adult Disorders

Delirium, Dementia, Amnestic/Cognitive Disorders, Schizophrenia and other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders

Autistic Disorder

1. Deficits in social interaction and nonverbal COMMUNICATION

2. Lack of peer relationships. eye contact, abnormal body movement,

3. Restricted, repetitive patterns of behavior

4. Inflexibility to routine, Fixed interests

Attention Deficit Hyperactivity Disorder

1. Symptoms at least 6 months

2. Inattentive: Difficulty focusing, staying on task follow-through, listening, easily distracted, loses things, forgetful

3. Hyperactive: Impulsive, fidgeting, running around, talking excessively

4. Several symptoms present prior to age 12

5. Must occur in 2 or more settings

6.. Behaviors can increase/decrease based on settings.

7. TX: Behavior modification

DO NOT CHOOSE FARM GRITS ROAD

1. FOCUS on unresolved issues/past

2. ADVICE - giving/judging

3. RECOMMEND "to a support group"

4. MAKE an appt.

5. GIVE pamphlets/literature

6. RECOMMEND a session

7. INFORM parents/speak to parents (when child/ado)

8. TERMINATE (Exceptions: Moving, client reaches goals/no new crisis, client does not pay)

9. SPEAK to supervisor (except transference/counter)

10. RESPECT self-determination (If mentally UNSTABLE)

11. OFFER contract as a reminder

12. ALLOW the clients to lead the session

13. DO nothing/say nothing

How does the exam want you to have a CLEAR understanding of client's issues?

ASSESS BEFORE ACTION.

RUSAFE

1. RULE out medical

2. UNDER the influence/delusional/hallucinating Do Not Treat

3. SAVE Lives - Safety first (Answers: Duty to warn, report child/elder abuse, 911, mobile crisis, ER)

4. ASSESS before action - (Answers: ASSESS, ASK or DICE - Determine, Identify,Clarify, Explore)

5. FEELINGS - (Answers: ACKNOWLEDGE person's feelings) CONCERNS (AID ASSIST, INFORM client, DISCUSS concerns)

6. EMPOWER - If client is mentally stable/alert (Answers: Respect client's decisions)

HIV Decisions

NOT DUTY TO WARN! 3 options:

1. FIRST urge client to disclose to partner

2. FIRST encourage client to engage in safe sex

3. Research/follow state laws as needed

COE: Ethical responsibilities in practice settings

1. Accurately document services in client's records while keeping best interests in mind

2. Maintain records securely for a period of time consistent with state laws

COE: Ethical responsibilities as professionals

1. MONITOR/EVALUATE policies and implementation of programs

2. ADVOCATE when necessary

HMO Insurance/Short term Care/MANAGED CARE

1. Emphasizes short term, discourages long term treatment

2. Cases assigned to case manager to whom provider must justify necessity for treatment for payment and services.

3. More precise diagnosis = greater likelihood of reimbursement

4. Encourages Cognitive/Behavioral short term TX.

5. Contracts are INFLEXIBLE, abide by rules to receive reimbursement

Oppositional Defiant Disorder

At least 6 months - Angry, irritiable, defiant, talking back to adults, rebellious behavior, attitude, blames others, cursing, lying

- NO SERIOUS VIOLATIONS OF OTHERS RIGHTS

Conduct Disorder

1. Violates other's rights, bullies, shoplifts, truancy, DX up to age 17

2. TX: Family, schools, community, client, parent/child behavior modificationq skills

Enuresis

1. Repeatedly urinating during day/night

2. Up to 5 years old

3. Rule out medical first

Separation Anxiety Disorder

1. Excessive distress when separated from major attachment figures.

2. Clinging, school refusal, sleep refusal

3. School Phobia is a form of separation anxiety.

4. Brought on when leaving home/family members to attend school.

5. At least 1 month of symptoms

Impulse control disorders

Trichotillomania, Intermittent Explosive Disorder, Gambling, Kleptomania, Pyromania,

Delirium

1. Disoriented

2. Short period of time

3. Sometimes due to medical condition/substance use: DEHYDRATION, HEAD TRAUMA

Dementia

1. Slow onset

2. Deterioration of memory/cognition

3. Alzheimer's, HIV, Parkinson's

Amnestic Disorders

Memory impairment w/out cognitive impairment

Korsakoff's Syndrome

Chronic alcoholism causes inability to recall previously learned information

Schizophrenia

1. Hallucinations, delusions, disorganized speech, disordered/catatonic behavior, impaired thinking, negative symptoms (diminished emotional expression or avolition) THOUGHT DISORDER

2. Duration at least 1 month, but more than 6 months

3. TX = Medication and ego-supportive therapy (No INSIGHT therapy!)

Schizophreniform

1. Same symptoms of schizophrenia

2. DURATION is at least 1 month, but less than six months

2. Triggered by turmoil/high stress

3. TX = Mediation and supportive therapy

Delusional Disorder

1. NON-BIZARRE/IRRATIONAL beliefs/delusions

2. Hallucinations absent or not prominent

3. Persecutory/Jealous Types of delusions

4. NO IMPAIRED FUNCTIONING

Brief Psychotic Disorder

1. 1 Symptoms of criterion A Schizophrenia

2. DURATION LESS THAN 1 MONTH

Psychotic symptoms may also occur during which other conditions?

Bipolar 1 Disorder, Major Depression, Substance Induced Mental Disorders, Mental disorders due to a medical condition (ex. Amphetamine induced psychotic disorder with delusional features), Delusional Disorder, Borderline Personality Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder

Differential diagnosis Schizophrenia and Delusional Disorder

1. Delusions occur in both

2. Schizophrenia experience other symptoms (hallucinations, bizarre delusions)

3. DD less functional impairment

schizoaffective disorder

Same symptoms of schizophrenia with a major depressive episode, manic episode, or mixed episode

Disruptive Mood Dysregulation Disorder

a childhood disorder (diagnosed after age 6, before age 18) marked by severe recurrent temper outbursts along, persistent irritable or angry mood, 3 or more times per week period of 12 months

Major Depressive Disorder

1. Symptoms: (most of day, nearly every day for 2 weeks)

-Depressed mood

-Lack of pleasure

-weight loss/gain

-insomnia/hypersomnia,

-psychomotor agitation

-sad/empty/worthlessness

-suicidal ideation

- fatigue

- difficulty concentrating

- excessive guilt

MDD and bereavement differences- excessive guilt, anhedonia, suicidality

Dysthymic Disorder

1. MDD symptoms but LESS SEVERE

2. Chronic

3. Duration more than 2 years (Children 1 year)

4. Symptoms cannot be absent for longer than 2 consecutive months

Bipolar 1 Disorder

1. One or more manic episodes (Elevated, expansive, irritable mood, or excessive mood and increased energy) usually accompanied by a major depressive episode)

2. Symptoms may last at least 1 week to a few months

3. 3 or more manic symptoms

4. Impaired functioning

Manic symptoms

Inflated self-esteem, decreased need for sleep, loud/rapid speech, restlessness, racing thoughts, increased sociability and goal-directed activity, impairment of normal activities/relationships

Bipolar II Disorder

- 1 or more depressive episodes with at least 1 or more hypomanic episode

- NO manic episodes or mixed episodes

Depressive Symptoms

Sadness, loss of interest in usual activities, sleep/appetite disturbance, feelings of worthlessness/guilt, difficulty concentrating, suicidal thoughts/death

Neurovegetative symptoms of depression

changes in appetite of weight, sleep disturbances, fatigue, decrease in sexual desire/function

Rapid Cycling

4 or more manic episodes of illness over 12-month period

Mixed State

Both depression and Mania occur at the same time

Children and Adolescents with Bipolar Disorder

1. Can occur, more likely if parents have illness

2. Children/Ados may experience very fast mood swings b/t depression and mania in one day

3. Children with mania likely to be irritable and prone to tantrums than to be overly happy

4. Bipolar difficult to tell apart from other problems in this age group

Hyperthyroidism can mimic

Mania

Hypothyroidism can mimic

Depression

Mood disorder

Refers to a disturbance of mood and other symptoms that occur together for a minimal duration of time and not due to physical/mental illness

Panic Disorder

1. Brief, recurrent, panic attacks

2. Followed by persistent worry of another panic attack and behavior change

2. TX = Desensitization techniques

social anxiety disorder

intense fear of social situations, leading to avoidance of such

Generalized Anxiety Disorder

1. Excessive worry and physical symptoms (restlessness, fatigue, headache, stomachache)

2. Ex. client reports frequently irritable and unable to focus, tension, insomnia

3. At least six months

4. Worry impedes functioning

Panic attack or depression caused by substance

Substance Induced Anxiety Disorder or Mood Disorder

Panic attack caused by medical illness

Anxiety or Mood disorder caused by General Medical Condition

Somatoform Disorders

Disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of physical disease (emotional connection)

obsessive-compulsive disorder

An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions).

Body Dysmorphic Disorder

1. Excessive preoccupation with one body part

2. Severe, impairment in functioning

3. Cause of decline = obsessing about defect

Conversion Disorder

Involuntary loss of voluntary function, however client does not control or produce them voluntarily

Factitious vs. Malingering

1. Intentionally produced symptoms, differing incentives

2. Malingering fakes symptoms for external gain/goal

3. Factitious produces symptoms due to need to be "sick patient"

Munchausen's Syndrome

Faking an illness/producing symptoms to receive sympathy as patient

Munchausen's By Proxy

Abuse of another (typically a child) in order to seek attention for the abuser

PTSD

1. Exposure and response to life-threatening event

2. Arousal, intrusive, avoidance symptoms (distressing memories, dreams, dissociations,

3. LAST A MONTH AND BEYOND

4. Impairment to functioning/life pursuits

acute stress disorder

PTSD symptoms that appear for a month or less

Reactive Attachment Disorder

1. Disorder caused by lack of attachment to caregiver - NEGLECT

2.

Adjustment disorder

a disorder in which a person's response to a common stressor, is maladaptive and occurs within 3 months of the stressor

Disinhibited Social Engagement Disorder (DSED)

a trauma-related attachment disorder characterized by indiscriminate, superficial attachments and desperation for interpersonal contact

Somatization Disorder

Recurrent/multiple somatic complaints that cannot be explained medically of several years. STRESS.

Substance related Disorder

Drug/Alcohol Intoxication and Withdrawal, Drug/Alcohol Abuse and Dependence

Disorders that are chronic

All personality disorders, Schizophrenia (> 6 months), Dysthymic and Cyclothymic (> 2 years), Generalized Anxiety Disorder (> 6 months), Hypochondrias (> 6 months), Somatization Disorder (several years)

Paraphilias vs. Sexual Sexual Dysfunction

Inappropriate sexual object or practice vs. inhibition of sexual response

Parasomnias vs. Dyssomnia

Abnormal event that occurs during sleep, b/t sleep/waking VS. disturbance in amount/timing of sleep

Personality Disorders

1. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture

2. 2 or more areas (cognition, affectivity, interpersonal functioning, impulse control)

Cluster A personality disorders

odd/eccentric

paranoid, schizoid, schizotypal

Schizoid PD

LONER, introverted, withdrawn, detachment from social relationships, RESTRICTED RANGE OF EMOTIONAL EXPERIENCE AND EXPRESSION, NO DESIRE FOR FOR SOCIAL RELATIONSHIPS

Paranoid PD

Interpreting actions of others as deliberately threatening or demeaning, distrustful and suspicious

Schizotypal

Odd/strange/bizarre behavior/beliefs/mannerisms and interpersonal/social deficits due to fear/paranoia

Magical thinking

ideas that one's thoughts or behaviors have control over specific situations

ideas of reference

The false impression that outside events have special meaning for oneself.

Cluster B personality disorders

dramatic, emotional, erratic

antisocial, borderline, histrionic, narcissistic

antisocial personality disorder

1. Disregard for the rights of others, Impulsive/irresponsible/callous

2. Must be > 18 (symptoms can occur at 15)

Borderline PD

1. Unstable in interpersonal relationships, behavior, mood, and self-image.

2. Abrupt and extreme mood changes

3. Stormy interpersonal relationships

4. Fluctuating self-image

5. self-destructive actions

Narcissistic PD

Exaggerated self-importance, absorbed fantasy for success, seek constant attention/admiration, oversensitive to failure

Histrionic PD

Melodramatic, attention-seeking, excessive emotionality, sexually seductive

Cluster C personality disorders

Anxious, fearful

avoidant, dependent, obsessive compulsive

Avoidant PD

Hypersensitive to rejection, unwilling to be involved, fear of not being liked

Dependent PD

Pattern of dependent and submissive behavior

Obsessive Compulsive PD

preoccupation with perfection, control, and orderliness

Multiple Personality Disorder

Dissociative Identity Disorder

Mental Status Exam

Structured way of observing and describing current state of mind - appearance, attitude, affect, behavior, cognition, insight, judgment, mood, perception, speech, thought process, thought content

Displacement

Place unwanted/unpleasant feelings onto someone less threatening or innocent bystander - ex. angry at boss, take it out on spouse

Dissociation

A person often loses track of time or themselves and their usual thought processes and memories. People who have a history of any kind of childhood abuse often suffer from some form of dissociation

Projection

Taking your emotions and placing it on others - ex. All of my coworkers are greedy, but I am not

Introjection

To incorporate someone else's emotions into one's self, internalized beliefs of others

Idealization

overestimation of an admired aspect or attribute of another

Identification

a person patterns oneself after a significant other

Identification with the aggressor

mastering anxiety by identifying with a powerful aggressor

Isolation of affect

Expressing no emotionality when confronted with difficult events

Projective Identification

BPD Clients, Unconsciously perceiving other's behavior as a reflection of one's own identity

Reaction formation

Turning unwanted or dangerous thoughts, feelings or impulses into their opposites. Ex. Person with a sudden loss shows a happy mood