Assessment, Diagnosis, Intervention Flashcards

Terms Definitions
DSM Basics
Assessment vs. Treatment
1- Assessment; only tells you what you have - Not what to do.
2- Does NOT suggest treatment approaches.
Do you share the DSM and diagnosis w/ client?
No. You read it then explain it to the client.
relation to International Classification of Diseases (ICD)
DSM compatible, but NOT identical to diagnostic codification of the ICD.
There is a relationship between the 2, re: coding classification system
International Classification of Diseases: first international system published in 1948
Limitations of DSM
Focuses on descriptive rather than etiological (underlying cause related) factors. No Treatment
Does take into account research as well as cultural factors.
Diagnosis Deferred
Information is inadequate to make a formal diagnostic judgment.
No history available
Want next SW to be aware of it.
Culturally-Bound Syndromes
conditions resemble the symptoms of a mental disorder but is related directly to culture. brain fag, rootwork (hex), ataque de nervios (anxiety); mimics a mental disorder.
Research Changes
-Literature reviews;
-Data analysis and re-analysis
-Field trials
Latest DSM reflects the importance of research
DSM Baisics - Multi-Axial System
5 separate axes
Diagnosis always goes on Axis 1 or 2.
Memorize the 2 things that go on Axis 2 and then every else goes on Axis 1.
If you don't know where it goes - put it on Axis 1
Axis I
Syndromes & Disorders that are included
Clinical Syndromes
Pervasive developmental Disorders
Learning Disorders
Motor Skills Disorders
Communication Disorders
Axis I
Clinical Syndromes include
Mood disorders, Schizophrenia, dementia, anxiety disorders, substance disorders disruptive behavior disorder.
Axis I
V codes
Not attributed to a mental disorder but are the focus of treatment:
bereavement, malingering and adolescent antisocial act.
Axis I
2 questions to be considered:
1- What are the major psychiatric symptoms in relation to the disorder?
2- What is the course and duration of the illness and how does it vary?
Axis I
will axes denote the severity of the illness?
No. Merely where it is classified and the diagnostic category is placed there for convenience.
A plan is needed for addressing every Axis.
Axis II
This includes:
Personality Disorders and Mental Retardation
*every personality disorder ends in "personality disorder"
Axis II
3 Questions:
1- Are there any life-long maladaptive patterns? 2- Do the patterns tend to cause difficulty in intimate, social or work relationships? 3- What developmental issues are currently impairing daily functioning?
Axis II
When do diagnoses generally start, if on this axis?
childhood or adolescence and persist in a stable form into adulthood. Generally, no periods of remission.
Axis III
General Medical Conditions
Physical (medical) conditions that may be relevant to the conditions being treated.
When was last physical exam?
Axis IV
Psychosocial an Environmental Stressors
Actual list of stressors as factors:
education; housing problems; economic; social environment; job; problem w/ access to health care services; primary support problems.
Axis IV
Why relevant to SW?
take into account the environment.
Axis V
Global Assessment of Functioning
Scale 0 - 100 (40 - 50 danger to self or others); Higher the # - Higher the level of functioning.
Highest level of functioning over a period of time.
Intelligence and the Bell Shaped Curve:
Standard Deviation
Mean: average
Median: middle score
Mode: frequently occurring
SD: deviant from the mean
Gifted vs Talented
Gifted - IQ score above 130
Talented: high IQ in 1 area
Measure of central tendency
Always fall in the middle
bell cure isn't in the middle
Mental Retardation
Sub-average intelligence and deficits in functioning.
Onset before age 18 (later: dementia)
IQ of 70 or below
slightly more common in males
Mental Retardation:
Borderline Intellectual Functioning
IQ 71-84, code on Axis II
Mild Retardation
55 - 70 (highway driving)
Educable - 6th grade level
Minimal assistance, some supervision, live in community or in supervised setting.
Moderate Retardation
35-55 (residential driving)
Trainable - 2nd grade level; can't live by themselves; moderate supervision and can do own personal care. preform unskilled or simi-skilled work; live in community
Severe Retardation
20 - 35 School Zone
Neither Educable or Trainable
generally institutionalized; little or no communicative speech; possible group home
Profound Retardation
Below 20
generally total care
Pervasive Mental Disorders (Axis I)
Involve multiple functions
Behaviors are not considered normal at any age.
Qualitative impairment in: reciprocal interaction, verbal & non verbal skills, imaginative activity, and intellectual skills
Examples of Pervasive Mental Disorders (Axis I)
Autistic Disorder
Other pervasive developmental disorders: Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder
What is the co-morbid disorder most common associated w/ Pervasive mental disorders?
Mental retardation
Autistic Disorder
severe form, onset in infancy or childhood, self-stimulating, self-injuring, poor prognosis, 2/3 mentally retarded, 3 time more common in males, hereditary factor.
Autistic Disorder
What is the age of onset requirement in DSM-IV?
Age 3
Autistic Disorder
Is condition related to parenting style?
Rett's Disorder
Only IN FEMALES; deceleration of head growth; start out normal and a 5 to 24 months problem develop; loss of previously acquired hand skills; loss of social engagement; impaired language
Child hood Disintegrative Disorder
Normal development for 2 years then a drastic decline, followed by a loss of previously acquired skills, and development of autistic like symptoms
Asperger's Disorder
autistic like symptoms W/OUT LANGUAGE Impairment, severely impaired social interaction. these children often have normal to above normal intelligence; NO MENTAL RETARDATION
One way Autism varies from Asperger's Disorder
Autism usually has retardation and language impairment.
Learning Disabilities
Overall Definition
These disorders have significant difficulty in acquisition of listening, speaking, reading, writing, reasoning, and math. (Normal in every area but 1)
Learning Disabilities
Main things one would see.
Delay in skill level (2 SD below mean)
Generally noted between ages 8 & 13
More common in boys
Don't always catch up - into adulthood
Involve specific function (not multiple like pervasive)
Learning Disabilities
Additional comments
Delayed - Outside the norm
Don't outgrow it; will learn to live w/ it; compensate for disability
Social Work Treatment for Learning Disabilities
Generally behavioral in nature. Again, learn to compensate for disability.
Attention Deficit Hyperactivity Disorder
Onset in Childhood - generally before age 7
Symptoms must persist for at least 6 months
Symptoms required in 2 or more situation (work, home, school)
1 Criteria set w/ 3 subtypes
Predomitately inattentive
ADHD - Outgrow? and co-conditions; males/females; etiology; intellegence
Do NOT outgrow; can have co-condition (learning disability, conduct or oppositional disorder) More common in males; etiology unknown; No intellectual deficits, just deficites in attention and concentration
- Evaluate by a neurologist or physician for a physical
- If meds don't work, consider diagnosis is accurate
- Deal w/ Behaviors
Dealing w/ Behaviors
Parents - identify parenting styles that reinforce neg behavior
Teachers - sit, catchup
Address Self-esteem issues thru counseling
Impulsive type vs inattentive type
Impulsive - often in trouble at school
Inattentive - Poor grades
Ritalin (methylphehidate) - said to be a paradoxical medication (is a stimulant but it calms children down)
Cylert (permoline) which is not recommended for first line of therapy.
Effect of ADHD medication
increase tolerance
decrease impulsivity
sustain attention
Self Esteem
friends say about you
feel about yourself
Conduct Disorder
pattern of behavior that violates rights of others
Conduct Disorder
4 Categories
Aggression to people/animals
Distruction of property
deceitfulness or theft
Serious violation of rules
Conduct Disorder
2 additional criteria
Staying out at night
intimidationg others
Conduct Disorder
Childhood and adolescent (onset prior to age 10 poor prognosis) By age 18/20 - changed to anti social behavior
Conduct Disorder
More common in males or females?
Conduct Disorder
Behavioral: identificaiton of BC's (behaviors and consequenses, family treatment required to reinforce BC's
Oppositional Defiant Disorder
Similiar to conduct Disorder, but not as severe. Does NOT repeadtedly violate the rights of others. Rule out medical conditions (hearing impairment)
Oppositional Defiant Disorder
Same as Conduct Disorder but not as intense
Feeding and EAting Disorders of Infancy or Eary Childhood
Tourette's Disorder
repeated eating of non-nutritive substances for 1 month (can't be hungry)
Onset 1-2 (make sure it's not culture)
Tourette's Disorder
Vocal and motor tics all present AT THE SAME TIME.
Onset: before age 18
symptoms last for atleast 1 yr.
Tourette's Disorder
Elimination Disorder - not due to a physical disorder.
Elimination of urine during day or night
must be age 5 before it can be diagnosed.
Repeated elimination of feces or soiling
Occurs 1 time a month for 3 months
Must be atleast 4 before diagnosed.
Treatment for Elimination Disorders
Get physical Exam before making diagnosis.
Kids should be potty trained by 3 and a half. (except foster homes - 4yrs)
Separation Anxiety Disorder
Excessive anxiety over separation from home or caregiver.
Must last 4 weeks
Begin before age 18 (use early onset before age 6)
Don't confuse w/ Stranger Anxiety or Separation Anxiety
Stranger Anxiety
normal reactions experiences by an infant when startled or feeling threatened. (8 months)
Separation Anxiety
feelings of anxiety and fear that result after being separated from a significant other.
(4/5 yrs)
Selective Mutism
Must last at least 1 month. Must impair functioning. Persistent refusal to talk.
Exclude during first month of school or language problem.
Abrupt onset of symptoms that fluctuate. Clouded Sensorium, Brief duration, can happen in young or old. (you look at them and know something is wrong)
3 types of Delirium
Delirium Due to a general medical condition.
Substance-Induced Delirium
Delirium due to Multiple Etiologies.
Relatively stable symptoms that do NOT fluctuate. NO clouded sensorium. Long duration. Must have disturbance in occupational and social functioning. characterized by multiple cognitive deficits. Slow & Progressive; look normal
To Diagnosis Dementia (3)
Combo of techniques:
psychometric and other mental status testing,
measurement of the activities of daily living skills
radiological techniques.
Types of Dementia
Alzheimer's - nerve cells containing tangles and fibers and clusters of degenerating nerve endings(plaque)
Vascular - small repeated strokes in brain
Other General Medical conditions: HIV
Parkinson's Disease: Tremors, rigidity (Sinemet is meds used) Higher functioning than Alzh.
Clinical Diagnosis of Dementia
involve memory disturbances, language and perception. decreased problem solving and judgment. increasing loss of control.
Assessment and Social Work intervention w/ Dementia
Measure of Memory Psychometric
Measure of Judgment ability
Orientation to person, place, time
Intelligence & Cognition ability
Reality Orientation or validation Therapy
Measure Memory Psychomentric
Short Portable Mental Status Questionnaire; 7 Digit Progression Scale
Judgment Ability
Families note problems first. Use Family questionnaire to measure deficits
Person Place and Time; Plus spatial Orientation to measure deficits
Oriented x1, x2, x3
x4: situational orientation (quilt) not connected to the 1,2, or 3
Look at Affect
depression vs dementia
Intelligence and cognition ability
confabulation - use the clock test
What should you rule out before diagnosis?
Dehydration or UTI
Electrolyte imbalance
Substance Related Disorders
What if client is under the influence of a substance?
Never treat. Must refer to detoxification or reschedule when NOT under the influence.
Time requirement for sustained remission?
12 months
If individual in in recovery and behaviors start to change rapidly or unpredictably - what do you do?
Assess for relapse (reinstatement)
Substance Use Disorders
less severe, continuted use knowing it is causing harm
does not apply to caffeine and nicotine
needs to take larger amounts w/ unsuccessful attempts to quit.
Substance Induced Disorders
the development of a substance specific reversible syndrome, condition related to recent ingestion of psychoactive substance.
maladaptive cognitive and behavioral declines due to reduction of a substance; generally, this category is usually associated w/ dependence. The 2 substances most problematic in withdrawal are alcohol and heroin.
Substances are generally associated with:
abuse, dependence, intoxication, or withdrawal.
11 Classes of substances
alcohol, amphetamines, caffeine, hallucinogens, inhalants, nicotine, opioids, phencyclidine (PCP) sedatives, hypnotics, anxiolytics.
Which substances would you have withdrawal?
alcohol, amphetamines, caffeine, nicotine, opioids, sedatives, hypnotics and anxiolytics.
Cannibus, Marijuana
Stays in system the longest
Schizophrenic Disorders
5 types
Disorganized type
marked incoherence, lack of systematized delusions, silly affect
Catatonic Type
stupor, rigidity, bizarre posturing, waxy flexibility and excessive motor activity
Paranoid Type
one or more systematized delusions, or auditory hallucinations w/ a similar theme
Undifferentiated type
"garbage can" bits of other types
Residual Type
not currently displaying symptoms displayed in the past.
Criteria for diagnosis of Schizophrenic disorders
Characteristic psychotic symptoms
deterioration in adaptive functioning
6 months duration w/ active phase lasting at least 1 month
A's generally associated w/ diagnosis of Schizophrenia
Associative Disturbance; Autism; Avolition (lack of goal directed behavior; can't get out of bed) Ambivalence, Alogia (poverty of speech), Affective Disturbances
Difference between mood and affect
mood - the general feeling (depressed)

affect - how you show it (flat or blunted)
Other Selected Psychotic disorders
Brief psychotic disorder
Brief Psychotic Disorder
AKA 3 day schizophrenia, symptoms have existed no longer than a month (at least a few hours) with a sudden onset linked to a psychosocial stressor
time frame for episode is less than 6 months - Provisional
Schizoaffective Disorder
having a mixture of symptoms suggestive of both and affective (mood) disorder and schizophrenia
1 month active phase
for a period of 6 months
Shared Psychotic Disorder
AKA Induced Psychotic Disorder
Folie a Deux, 2 people share and create a delusional system
Brief Reactive psychosis to Schizphreniform to schizophrenia
Brief Reactive psychosis - less than 1 month
Schizphreniform - less than 6 months
schizophrenia - 6 months plus
Positive Symptoms (Schizophrenic)
hallucinations and/or delusions
inaccurate perceptions where inaccurate auditory stimuli is the most common
strong beliefs held against strong contrary evidence
Negative Symptoms (Schizophrenic)
refers to lack of movement (avolition or speech (alogia)
Treatment for Schizophrenic disorders
Anti-psychotic meds (most common)
psychodynamic, behavioral and social learning
family therapy
community based treatments (half-way house)
Medications Used w/ Psychotic Disorders
Antipsychotic Drugs
AKA Neuroleptic Drugs
Treat severe psychotic disorders
peak concentrations occur between 2-4 hours
Should NOT prescribe 2 anit-psychotic drugs a the same time.
After discharge, wait 3-6 months before consider changing meds.
Old or Typical Antipsychotic meds
General Side Effects w/ Antipsychotic Meds
Most common drowsiness or sleepiness
Parkinsonian or EPS (Extra-Pyramidial) side effects of Medication
Dystonia: Acute contractions of the tongue
Akathisia: Most common form of EPS - inner restlessness (shaking of legs)
Anti-Parkinsonian Medications used to decrease EPS side effects
Tardive Dyskinesia
permanent neurological condition that can result from using the older anitpsychotic meds (too much)and not taking anything to help control the EPS side effects
New or Atypical Anti-psychotic Meds
Side effect for Clozaril
Can be deadly.
MUST monitor weekly or bi-weekly
Mood Disorders
4 types of mood episodes
major depressive
Manic episode
Presenting mood is persistently elevated; must also have at least 3 of the following symptoms: increased psychomotor agitation, flight of ideas, decreased need for sleep, grandiosity, sexual preoccupation, positive symptoms, episodes last approximately 1 week.
Hypomanic episode
Lasts at least 4 days
similar to manic but not severe enough to interfere w/ functioning, expansive, irritable and elevated mood.
Major depressive episode
depressed mood lasting approximately 2 weeks, plus five other associated features (changes in sleeping or eating, appetite disturbance, fatigue, reduced concentration, delusions...)
Mixed episode
alternating moods lasting approximately 1 week, must meet criteria for BOTH manic and depressive
Episodes vs Diagnosis
A disturbance in mood will disrupt many areas of an individual's functioning, a mood episode is not a diagnosis, the episodes are characteristics of the diagnosis.
Bipolar Disorders:
Mixed, manic, and depressed
Bipolar I
Bipolar II
Cyclothymic Disorder
Bipolar Disorder NOS
Bipolar I Disorder
one or more manic episodes, usually w/ a history of depressive episodes.
Manic followed by depression (and have psychotic aspects)
tends to have sexual Issue
Bipolar II
1 or more depressive with at least one hypomanic episode, no psychosis
Cyclothymic Disorder
persistent mood disturbance lasting AT LEAST 2 WEEKS, must not be w/out for 2 months, less severity than bipolar
Cycles (Up and Down)
Depression Disorders: AKA Unipolar depression
presence of 1 or more depressive episodes w/out history of manic or hypomanic
Major Depressive Disorder
one or more major depressive episodes, episodes must last at least 2 weeks. (only 1 ingredient)
2-year history of depressed mood, must not be without for tow months, less severity than major depression, constant for a period of 2 years.
(just down and stay down)
Dysthymia in children
Different criteria - just a period of 1 year
Treatment for Mood disorders
w/ mild to moderate depression: Psychotherapy (best)
Medication: antidepressants tricyclics compounds, lithium carbonate for manics, antianxiety for anxiousness, ECT is used to tread depression.
Endogenous depression
caused by internal events
ECT is often used for this type of depression
Exogenous or environmental depression
caused by external events
AKA reactive depression
Medications for Bipolar Disorders
Lithium Salts: used to treat manic episodes of bipolar disorder and should diminish manic symptoms in 5-14 days.
If you give a client Lithium, what do you need to monitor and why?
Need routine lithium levels and other recommended tests(white blood cells, calcium, kidney & thyroid function). Amount person needs may vary over time. Small range between a therapeutic dose and toxic one.
Side Effects of Lithium
drowsiness, weakness, nausea and vomiting, fatigue and hand tremor.
Other mood stabilizers: Medications
Anti-convulsant category
Work well w/ Schizoaffective disorders or agitated depression of the cyclic nature
Depakote (Valproic Acid)
Clonzapepam (denzodiazepine)
Side Effects of mood stabilizers
nausea, indigestion, drowsiness or hair loss. May interact w/ the use of alcohol or depressant medicaitons
Medications for Depression
Tricyclics: AKA TCA's
Tofranil (Imipramine)
Elavil (Amitriptyline)
MAO Inhibitors for Depression
Eldepryl (selegiline)
Dietary restrictions - No foods w/ the chemical tyramine (cheese, beef, red wine, chocolate, coffee, bananas)
Other Anti-Depressants
Selective Serotonin Re-uptake Inhibitors
Paxil/paroxetine hydrochloride
Side Effects
sexual disinterest and orgasmic delay
Definition of Anxiety (characteristics)
an unpleasant state characterized by subjective feelings of worry apprehension, (cognitive) difficulty concentrating, (behavioral) restlessness, irritability, insomnia, (somatic) sweat shortness of breath
Definition of Anxiety
Considered pathological when the magnitude and/or duration exceed normal limits (taking into account the preceding event)
Presentation in Anxiety
Anxiety causes somatic symptoms and visa-versa. Often see primary physician, due to tremors, dyspnea, dizzy, sweaty, irritable, restlessness, hyperventilation, pain, heartburn.
Differential Diagnosis (treatment)
client needs physical exam to rule-out endocrine problems (thyroid, adrenal) cardiac problems, neuro-seizures,drug withdrawal. effects of stimulant drug.
Selected Anxiety Disorders
Panic Disorder w/or w/out Agoraphobia
Social Phobia
Specific phobia
Obsessive-Compulsive Disorder
Generalized Anxiety disorder
Acute Stress Disorder
Panic Disorder
W/ or without Agoraphobia
attacks involving intense FEAR and apprehension lasting several minutes
Agoraphobia w/ History of Panic Disorder
fear of being in places where escape may be difficult
Social phobia
persistent fear of one or more social situations in which person may come in contact with. (avoidant disorder of childhood was placed here)
Specific Phobia
fear to a object or stimulus not general fear, easiest to treat.
Obsessive-Compulsive Disorder
recurring obsessions (thoughts) and compulsions (behaviors) severe enough to affect social/occupational functioning. (defense mechanism often exhibited is reaction formation)
Post-Traumatic Stress Disorder
symptoms must last at least one month, if more than 6 months after event should specify delayed onset, must be outside of rang of usual experience. Often relive situation, but it isn't real.
Generalized Anxiety Disorder
undue persistent worry for at least 6 months about a least 2 or more life circumstances.
Acute Stress Disorder
acute reactions to extreme stress. (occurs w/in 4 weeks of the stressor and last from 2 days to 4 weeks) This may help predict the development of PTSD.
Anti-Anxiety Medications
Potentially addictive
4 - best used
1- to address anxiety in relation to an identified stressor; 2- time limited course, several weeks in duration; 3- better for exodenous factors 4- often a euphoric feeling results
use a high dose at night for difficulty sleeping, diminish anxiety but doesn't cure, watch for history of substance abuse, as they will be more liely to use these drugs for suicide
Anti-Anxiety Meds:
Benzodiazepines are a central nervous system depressant, so do not mix w/ alcohol or significant depression can result. Consider Buspar if history of drug abuse behavior is suspected
Alprazolam/Xanax - Diazepam/Valium
Anxiety Disorder
Explore stressors and worries.
Treatment: behavioral and cognitive methods
teach person to recognize and prepare for symptoms (relaxation training)
Systematic desensitization and crisis management are often used.
Repressed Memory Therapy (RMT)
these involve memories from the past generally related to trauma that has been forgotten, these MEMORIES are remembered through therapy which are generally related to past events. If memories aren't real (false memories)
Fear vs Anxiety
Fear - response to a real threat
Anxiety - response w/out presence of real threat
Somatoform Disorders
consist of physical symptoms that have no know physiological cause.
Prior to diagnosis a physical exam needs to be completed.
Somatization Disorder
recurrent and multiple somatic complains (at least 13)
begins in teens.
Onset before age 30
Conversion Disorder
change or loss in physical functioning is noted to a physical condition.
individual does NOT have voluntary control of symptoms
Pain Disorder
preoccupation w/ pain w/ no know underlying cause
unrealistic interpretation of physical symptoms as an abnormal, preoccupation w/ the fear of being seriously ill. The person can acknowledge that there are no grounds for fear.
Body Dysmorphic Disorder
preoccupation w/ an imagined body flaw
Factitious Disorders
Factitious Disorder w/ Physical symptomes - Munchausen syndrome: person is creating physical symptoms for attention
Factitious Disorder NOS: (by proxy) creating physical symptoms in other for attention
Dissociate Disorders

Dissociate Amnesia
sudden inability to remember essential personal information, too extreme to be ordinary forgetfulness
Dissociative Fugue
abrupt unexpected travel away from home or work
Dissociative Identity Disorder
was multi personality disorder
one person w/ at least 2 distinct personalities.
1 is dominant a a particular time.
5 year history of the problem
(name change)
Dipersonalization Disorder
one or more episodes of depersonalizaion causing significant distress for the individual, during episodes reality testing remains intact
Gender Identity Disorders
Must have discomfort w/ won sexual identity (ego-dystonic)
1- gender dysphoria; 2- transient stress related cross-dressing; 3- persistent preoccupation w/ castration or penectomy w/out a desire to acquire the sex characteristic of the other sex.
Gender Identity Disorders
Reparative Therapy: starts w/ the assumption that all people are born heterosexual and the purpose is to cure or convert homosexuals to heterosexuals. This method conflicts w/ social works basic assumptions
strong sexual fantasies and strong urges involving...
use of non-living objects
interest in prepubertal children. To be considered a perpetrator you must be 5 years older than the victim and the perpetrator must be at least 16 years old.
exposing genitals - person feels guilty but can't stop themselves
observing others engaging in sex
sexual masochism
sexual excitement through self suffering
sexual sadism
sexual excitement through pain infliction
touch/rubbing against a non consenting person
Selected Sexual Dysfunction's
AKA sexual desire disorders
disturbances in the sexual response cycle, cannot be entirely due to organic factor
male erectile disorder
failure to attain/maintain erection
premature ejaculation
does so w/ minimal stimulation after insertion into vagina (most common in males)
genital pain in male/female during/after sex
recurrent or persistent involuntary spasm of musculature that interferes w/ sex (female)
Treating Sexual Difficulties
Often left untreated due to embarrassment. Generally not a singel cause and factors can include: prior sexual failure, inconsistency, performance anxiety, neg attitudes toward sex and use of substances. history of past sexual trauma.
Sexual Fantasy
link fantasy that focuses on their partner or romantic exchanges. More likely to envision themselves w/ another woman (25%do)
Sexual Fantasy
fantasize about a partner other than a present lover. Most men say they don't envision themselves w/ other men (90% do not)
Normal Sexual Behavior
There is no normal and it is what the couple desires
Psychological Treatment Techniques for Sexual Dysfunctions
Embarrassing. therapist basic acceptance and permission giving become critical in helping client to express themselves. Listen carefully to what client is saying. Client need accurate information
Psychological treatment cont.
behavioral and gognitive treatment are combined to assist clients in developing better adjustment and coping skills. Couple or individual commitment is critical as much of the intervention is completed as homework.
Psychological treatment cont.
Objectives for clients in treatment include communication increase with:
1- accepting self and partner, while expressing and sharing feelings
2- listen to partner and do not respond automatically
Sensate Focus Exercises
Work of Masters and Johnson, which focuses on progressive exercises begins w/ non-genital touch only. leads to genital touch Goal is to receive pleasure w/out pressure to preform and or achieve orgasm.
Eating Disorders
Anorexia Nervosa & Bulimia
Anorexia Nervosia
intense fear of gaining weight. Usually Underweight. disturbances in body image, won't eat and over exercises. Resistant to treatment w/ STRONG Denial. onset during late adolescence (12-18) can progress into 30's. 1/2 are bulimics, common co-condition
Anorexia: treatment
get client to gain weight. behavioral rewards contingent on eating , strong family/genetic link,
AVOID group therapy w/ other that have SAME condition
Bulimia Nervosa
episodes of binge eating, self-induced vomiting w/ laxatives, diuretics or fasting, sense of lack of control during eating binges, chronic concern w/ body weight and shape. NORMAL WEIGHT. 2 binges per week for 3 months
Bulimia Nervosa
Often group confrontation
Impulse Control Disorders NOS
pathological Gambling
chronic failure to resist gambling
deliberate personal fire setting associated w/ arousal
Steal w/out need
Intermittent Explosive Disorder
loss of control/violent (go crazy, extreme violence)
impulse to pull own hair w/ hair loss
Trichotillomania - treatment
Aversive therapy/conditioning: snapping the rubber band when they pull out hair.
Sleep Disorders
Insomnia Disorders
Trouble falling or staying asleep
Hypersomnia Disorders
increased sleepiness
Narcolepsy: repeated sleep episodes
and Breathing related sleep disorder, sleep disruption leads to excessive sleepiness
Circadian Rhythm Sleep Disorder
mismatched cycle
Abnormal incidents during sleep
1- Nightmare disorder: remembers dreams
2- Sleep Terror Disorder: do NOT remember dreams, sudden awakenings; 3- Sleepwalking Disorder: unresponsive to other who try to wake person
Adjustment Disorders
maladaptive reaction to a psychosocial stressor; develops w/in 3 months of stressor. Lasts 6 months or longer. Must impair occupation/social functioning, diagnosis is made based on predominate symptoms.
Adjustment Disorders
Examples of
Depressed mood; disturbance of Conduct; Mixed Emotions features;Withdrawal; Anxious mood; mixed disturbances of emotions and conduct; physical complaint; work inhibition.
Personality Disorders
begin early in life
interferes but on incapable of social functioning.
Personality Disorders
Cluster A
odd/eccentric behavior
socially isolated and withdrawn
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Schizoid Personality disorder
very detached w/ a pattern of indifference. lack desire for intimacy.
I just want to be alone
zoided out in a world of their own.
typical of schizophrenia, numerous social and interpersonal problems. Want intimacy just can't "get it together"
Ideas of Reference/Delusions of Reference
Ideas of Reference
incorrect interpretation of a causal incident as having a particular or unusual meaning to the person
Delusions of Reference
beliefs that are held w/ delusional conviction.
Personality Disorders
Cluster B
dramatic/emotional/erratic behavior
Antisoical PD
old psycho/sociopath
Borderline PD
instability of self
Be Sure to set CLEAR Boundaries and defuse crisis formulation in treatment. Can us dialectical behavioral therapy
grandiose sense of self-importance, lack of empathy as a main criteria
Personality Disorders
Cluster C
anxious or fearful behavior
Obsessive Compulsive PD
Passive Aggressive PD
Avoidant PD
pattern of social discomfort
Dependent Pd
dependent submissive behavior, most frequent in females
Obsessive Compulsive PD
perfectionism an inflexibility, defense mechanism
reaction formation
Monk - can function, but must be in a certain way
Passive Aggressive PD
procrastination, was dropped from DSM-IV
Other conditions that may be the focus of Clinical intervention
V codes
Academia problems
Childhood or adolescent antisocial behavior
Adult antisocial behavior
borderline intellectual functioning
Academic problem
Childhood or adolescent antisocial behavior
isolated acts
divorce so kid bring gun to school
Serious violation of rules but not a mental disorder
voluntary mental and or exaggerated physical symptoms w/ an obvious recognizable goal.
major depressive disorder w/ a death of a loved one; should last about 1 yr.
Acculturation Problem
exposure to living in a new culture
Assessment and Intervention w/ AIDS and HIV
Can test + after 12 weeks of infection
Can be transmitted soon after infection
Normal t-cell count is 400 - 1700
t-cell falls below 200 and person is susceptible to opportunistic infections - AIDS
newborns takes approx 15 months to be sure if s/he is infected
Pregnant HIV positive women given HIV medication as precaution for a less chance of baby developing + HIV status.
Treatment for AIDS
Always educate
Assessing Danger to Self
Document and plan of avoidance of the potential for harm to self or others.
"Do no Harm Agreement"
No-Suicide Agreement"
Assessing Danger to self
ideation and intent
Ideation - the idea w/ a vague plan
Intent - with a specific plan
Treatment of Assessing Danger to self
with: ideation and intent
When ideation and intent are clear, immediately recommend/seek in-patient hospitalization and document this. Do not do a no-suicide agreement if intent is noted.
measures intelligence
Measures associations through viewing ink blots
measures mental status
measures perception through telling stories about pictures.
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