DSM Study Guide CORRECT

5 symptoms of psychosis

Delusions; hallucinations; disorganized behavior; disorganized thought or speech; negative symptoms

SIGECAPS (Major Depressive Episode)

Sleep disturbance, loss of Interest, feelings of Guilt or worthlessness, low Energy, poor Concentration, Appetite changes, Psychomotor changes, Suicidality (plus depressed mood)

Affect

Observable expression of a subjectively experienced emotional state

Blunted affect

Significant reduction in intensity of emotional expression

Flat affect

Near absence of emotional expression

Inappropriate affect

Emotional expression inconsistent with speech or thought content

Labile affect

Rapid and abrupt shifts in emotional expression

Restricted (constricted) affect

Mild reduction in range and intensity of emotional expression

Anhedonia

Lack of pleasure or interest in normally enjoyable activities

Avolition

Inability to initiate and sustain goal-directed behavior

Compulsions

Repetitive behaviors or mental acts performed in response to obsessions or rigid rules

Conversion symptom

Loss or alteration of voluntary motor or sensory function not explained medically and not intentional

Mood

Pervasive and sustained emotional state that colors perception of the world

Dysphoric mood

Unpleasant mood such as sadness, anxiety, or irritability

Elevated mood

Exaggerated sense of well-being, euphoria, or elation

Description of elevated mood

Feeling high, ecstatic, on top of the world, or in the clouds

Euthymic mood

Normal mood range without depression or elevation

Expansive mood

Unrestrained emotional expression with inflated self-importance

Irritable mood

Easily annoyed and provoked to anger

Disorientation

Confusion about time, place, or person

Hallucination

Perception-like experience without external sensory stimulus

Types of hallucinations

Auditory (voices or sounds) and visual (formed or unformed images)

Flight of ideas

Rapid, pressured speech with abrupt topic changes based on associations

Pressured speech

Accelerated and excessive speech that is difficult or impossible to interrupt

Delusion

Fixed false belief held despite clear contradictory evidence

Bizarre delusion

Delusion involving something physically impossible

Delusional jealousy

Belief that one’s partner is unfaithful

Erotomanic delusion

Belief that another person of higher status is in love with the individual

Grandiose delusion

Belief of inflated worth, power, identity, or special relationship

Delusion of reference

Belief that external events have special personal significance

Persecutory delusion

Belief that one is being harmed, harassed, or conspired against

Thought broadcasting

Belief that one’s thoughts are being broadcast to others

Thought insertion

Belief that thoughts are placed into one’s mind by an external force

Illusion

Misperception of a real external stimulus

Magical thinking

Belief that thoughts or actions cause outcomes that defy cause-and-effect laws

Obsession

Intrusive, unwanted thoughts, urges, or images causing anxiety or distress

Psychomotor agitation

Excessive, nonproductive motor activity driven by inner tension

Psychomotor retardation

Visible slowing of movement and speech

Prodrome

Early warning sign or symptom of a disorder

Depersonalization

Feeling detached from one’s self, body, or mental processes

Derealization

Feeling detached from surroundings, which seem unreal or dreamlike

Dissociation

Splitting off mental contents from conscious awareness

Flashback

Dissociative reexperiencing of a traumatic event as if occurring now

Hypervigilance

Increased sensory sensitivity and exaggerated threat detection

Startle response

Reflexive reaction to sudden unexpected stimuli

Parasomnias

Sleep disorders involving abnormal behaviors during sleep

Mood-congruent psychotic features

Psychotic content consistent with depressed or manic mood themes

Mood-incongruent psychotic features

Psychotic content not consistent with mood themes

Rapid cycling

Bipolar disorder with four or more mood episodes in 12 months

Circumstantiality

Overly detailed speech that eventually reaches the point

Loose associations

Minimal logical connection between thoughts

Tangential speech

Off-topic speech that never returns to the original point

Perseveration

Involuntary repetition of words, ideas, or movements

TIPPM + ASC + PS

Thoughts, Intent, Previous attempts, Plans, Means; Agitation, Self-control; Protective factors and Safety planning

IS PATH WARM

Ideation, Substance use, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood change

PALS

Proximity of help, Availability of method, Lethality of method, Specificity of plan

Sommers-Flanagan Safety planning

• Warning sign recognition

• Internal coping strategies

• Social contacts for distraction 

• Family and friends for help through crisis

• Contacting crisis professionals

• Reducing lethal means

Some options the therapist might use,

• Increase frequency of sessions and provide more consistent support (phone, in-person)

• Build a larger treatment team: possible referrals to psychiatry, support groups

• Include helpful friends or family

• Collaboratively strategize coping skills and activities

• Work on cognitions

• Work on self-soothing and affect regulation skills

• Provide emergency contacts

• Obtain commitment (to follow through)

 Supervision and consultation

• Counselors should not work in isolation. As trainees, you should always let your supervisor know if you have a suicidal client and discuss your approach. You have the option to consult while the client is in the room. Here is the sample “script” I suggested: “Thank you so much for letting me know what is going on—I really appreciate you sharing it. As you know, we work as a team here. I’m going to consult with my supervisor so that I may sure we are giving you the best care possible.” Note that the counselor does not ask permission here. We want as egalitarian a relationship as possible but if you need to consult, I think it’s more straight-forward to just say it. 

 “Documentation should show that the counselor…

• Conducted a thorough suicide risk assessment 

• Obtained adequate historical information

• Obtained/requested records regarding previous tx

• Asked directly about suicidal thoughts and impulses

• Discussed limits of confidentiality

• Implemented suicidal interventions

• Developed a collaborative safety plan

• Gave safety resources (e.g., telephone numbers)

• Discussed restriction of access to firearms or other lethal methods

“The following situations  (in addition to suicidality & homicidality, and possibly others) warrant immediate consultation

• Suspicion of child, elder, or dependent abuse

• Current or recent intimate partner violence 

• Current or recent sexual assault

• Mania

• Psychosis

• Anorexia, bulimia

• Gravely disabled

• Delirium

• Intoxication

General Guide to Violence Assessment

1. 1. Ask direct and indirect questions about violent behavior history. Be especially alert to physical aggression and cruelty. If the threatened behavior is similar to a past violent behavior, risk is higher.

2. 2. Because potentially violent individuals aren't always honest about their violence history, you may need to interview collateral informants (assuming you have a release of information signed or have an ethical-legal responsibility to protect someone from harm).

3. 3. Listen for details to help identify potential victims. If the details aren't forthcoming, you may need to ask about those details. Identification of a specific victim increases violence risk (and provides you with information about whom to warn).

4. 4. Listen for specifics about the plan and use curious and indirect questioning to further assess the specificity of the client's violence plan. More specific plans are associated with increased violence risk.

5. 5. If clients don't tell you about access to weapons or means for committing a planned violent act, you should ask. Access to lethal means increases violence risk.

6. 6. Historical information is doubly important. Generally speaking, the sooner violent behavior patterns began, the more likely they are to continue. Clients raised in chaotic and violent environments (including gang involvement) are at higher risk for violence.

7. Diagnostic information may be helpful. In the DSM, the best violence predictors include items from list A of the DSM-5's antisocial personality diagnostic criteria (American Psychiatric Asso-ciation, 2013, p. 659)

8. Evaluate violence-related cognitions. If clients have low expectations of being caught or of experiencing consequences, or view the consequences, even death, as a positive outcome, risk is higher.

9. Consider substance use. Positive attitudes toward substance use or substance use when carrying weapons conters greater risk.

10. Notice your intuition. Intuition isn't a great predictor of anything, but if risk factors are present and you have images of a particular client committing a violent act, consult your colleagues or supervisors, err on the conservative side, and begin warning potential victims.

Know the basics of what goes into a SOAP note：

subjective- what client says, objective- what we observe about the client, assessment- diagnosis, analysis, plan- how you’ll move forward