Studied by 26 people
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
