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LCSW > Assessment, Diagnosis, Treatment Planning > Flashcards

Assessment, Diagnosis, Treatment Planning Flashcards

1
Q

Biopsychosocial history

A

-Client Appearance
-Previous Hospitalizations
-Psychiatric hx - suicidal ideation, psychiatric disorders, family psychiatric hx, hx of violence/self harm
-Chief complaint/presenting problem
-Complementary therapies - i.e. acupuncture, meditation
-Occupational/educational background
-Social patterns
-Sexual patterns - orientation, practices issues
-Interests/abilities
-Current/Past substance use
-Physical, sexual, emotional, financial abuse
-Spiritual/cultural assessment
-Mental Status

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2
Q

Mental status

A

General attitude - reaction to being interviewed
Mental activity - logical or loosely associated
Speech profile - normal, childlike, pressured
Emotional state- depressed, agitated, calm
Level of consciousness - alert or stuporous
Orientation - normal or disoriented
Thought processes: pressured thoughts, flight of ideas, thought blocking, disconnected thoughts
Judgement: Good, fair, poor none
Insight: good, fair, poor, none
Memory - intact or presence of deficits
Mood

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3
Q

Casual informational observation

A

-gaining info by watching the client during unstructured activities

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4
Q

Guided observation

A

-checklist/rating scale to evaluate behavior

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5
Q

Clinical level observation

A

-Observation is done in controlled setting fore a lengthy period of time

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6
Q

Standardized test

A

-The questions and potential responses from the tests can be compared with one another - every aspect of the test must be consistent

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7
Q

Behavioral assessment

A

-evaluated in relation to environment
-must include a stimulus, organism, response, and consequences (SORC)

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8
Q

Dynamic assessment

A

-determine whether someone benefits from education
-testing-teaching-retesting
-examinee is provided a problem to solve - assessed on problem-solving
-Then provided education to increase competency until it is solved

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9
Q

Domain-referenced testing

A

Breaks evaluation into specfic domains of abilitity - i.e. reading or math

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10
Q

Elements required for effective coping

A

-habits that sustain good health: balanced died, exercise, etc.
-Satisfaction with life- work families, sense of humor, spiritual belief, etc.
-Support systems
-Healthy response to stressful circumstances- problem-solving as opposed to avoidance, using support systems instead of self-blame, reframing and assessing positives and negatives realistically

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11
Q

Mini Mental Status Exam- whose it for?

A

Clients with evidence of dementia or short-term memory loss should have cognition assessed

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12
Q

Mini Mental Status Exam

A

-client carrys out specified tasks and scale on ability to do so

-Memory: Remembering and later repeating names of three common objects
Attention- counting backward from 100 by increments of 7 or spelling “world” backward
Language- naming objects examiner points to, repeating common phrases
-Orientation - providing date and location of examiner’s office
-Visual-spacial skills - copying picture of interlocking shapes

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13
Q

sexualized behavior

A

-in adolecents and children, points to sexual abuse
-in adults, often indicates that the individual uses the body as an expression of power

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14
Q

Psychosocial stress

A

one percieves a threat as part of social interaction with other individuals

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15
Q

Sympathetic nervous system response

A

Fight or flight

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16
Q

Clients at risk of psychosocial stress

A

-resocialization (after incarceration), role change (job loss), situation change (foster care, rehab)

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17
Q

Benton visual retention test (BVRT)

A

assess visual memory, spatial perception, motor skills to detect brain damage

-subject asked to reproduce the geometric patterns on ten cards from memory

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18
Q

Beery developmental test of visual-motor integration (Beery-VMI-6)

A

-visual-motor skills in children, like BVRT involves reproduction of shapes.

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19
Q

Wisconsin card sorting test (WCST)

A

assesses ability to form abstract concepts and shift cognitive strategies - required to sort a group of cards in order not disclosed to them

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20
Q

Stroop color-word association test (SCWT)

A

measure of cognitive flexibility - tests an individuals ability to suppress a habitual reaction to a stimulus

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21
Q

Halstead-Reitan Neuropsychological Battery

A

Group of tests that are effective at differentiating between people and those with brain damage. Clinician has control over which exams to administer but are likely to assess sensorimotor, perceptual and language functioning.

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22
Q

Luria-Nebraska Neuropsychological Bettery

A

11 subtests assessing areas like rhythm, visual function and writing. - brain damage test

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23
Q

Bender visual-motor gestalt test

A

Responding to cards containing geometric figures where the examinee must recall

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24
Q

Executive functions

A

cognitive features that control and regulate other abilities and behaviors.

-provide the capacity to initiate, stop or change behavior and to solve problems.

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25
Q

Difficulty in executive function

A

-reduced ability to delay aratification
-problems with understanding cause and effect
-poor organization/planning
-overall poor judgement

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26
Q

Assessments to evaluate executive functinoning

A

-Trail making test
-WAIS IV
Clock drawing tests

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27
Q

Antipsychotic drugs

A

used to treat schizophrenia and psychotic symptoms - bother older first generation anti psychotic drugs and newer atypical/second generation antipsychotic drugs

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28
Q

Haldol (haloperidol)

A

Antipsychotic (first gen)

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29
Q

Thorazine (chlorpromazine)

A

Antipsychotic (first gen)

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30
Q

Stelazine (trifluoperazine)

A

Antipsychotic (first gen)

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31
Q

Prolixin (Fluphenazine)

A

Antipsychotic (first gen)

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32
Q

Navane (thiothixene)

A

Antipsychotic (first gen)

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33
Q

Clozaril (clozapine)

A

Antipsychotic (second gen/atypical)
-requires frequent blood testing due to risk of agranulocytosis (blood disorder)

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34
Q

Risperidal (Risperidone)

A

Antipsychotic (second gen/atypical)

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35
Q

Seroquel (Quetiapine)

A

Antipsychotic (second gen/atypical)

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36
Q

Abilify (Aripiprazole)

A

Antipsychotic (second gen/atypical)

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37
Q

Effexor (venlafaxine)

A

Atypical antidepressant

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38
Q

Prozac (Fluoxetine)

A

SSRI

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39
Q

Zoloft (Sertraline)

A

SSRI

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40
Q

Paxil (Paroxetine)

A

SSRI

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41
Q

Lexapro (Escitalopram)

A

SSRI

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41
Q

Luvox (Fluvoxamine)

A

SSRI

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42
Q

Celexa (Citalopram)

A

SSRI

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43
Q

Wellbutrin (bupropion)

A

Atypical antidepressants
-does not cause libido loss and is sometimes prescribed with SSRI to counter sexual side effects

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44
Q

Cymbalta (duloxetine)

A

Cymbalta
-depression linked with somatic complaints

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45
Q

Tofranil (imipramine)

A

Tricyclic antidepressants

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46
Q

Elavil (amitriptyline)

A

Tricyclic antidepressants

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47
Q

Nardil (phenelzine)

A

MAO inhibitors (MAOIs)

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48
Q

Parnate (Tranylcypromine)

A

MAO inhibitors (MAOIs)

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49
Q

Eldepryl (selegiline)

A

MAO inhibitors (MAOIs)

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50
Q

Lithium

A

Mood Stabilizer (Bipolar Disorder)
-Can cause kidney or thyroid problems

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51
Q

Tegretol (carbamazepine)

A

Mood Stabilizer (Bipolar Disorder)
-Can cause liver problems

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52
Q

Depakote (sodium valproate)

A

Mood Stabilizer (Bipolar Disorder)
-Can cause liver problems

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53
Q

Lacmictal (Lamotrigine)

A

Mood Stabilizer (Bipolar Disorder)

54
Q

Tardive dyskinesia (TD)

A

-Causes involuntary movements of the face, tongue, mouth or jaw
-irreversible
-caused by older antipsychotics

55
Q

Parkinsonian Syndrome

A

tremor, shuffling, gait or bradykinesia
-possible side effect of older antipsychotics
-reversable with benzotropine

56
Q

Musicle rigidity

A

another possible side effect of older antipsychotics
can be reversed

57
Q

Atypical/Second-Gen antipsychotics

A

Much less risk of TD, but they are very expensive and can cause weight gain, affect blood sugar, and affect the lipid profile

58
Q

Mood Stabilizers

A

-Used for bipolar disorder
-Can cause weight gain
-Regular blood work necessary to monitor for drug levels and side effects

59
Q

SSRIs

A

-fewer side effects than other antidepressants
-Cannot overdose on SSRIs alone
-Take weeks to be effective
-Loss of libido
-Can lose effectiveness after years of usage
-Rare side effects - agitation, suicidal ideation, or manic symptoms

60
Q

Tricyclic antidepressants

A

can cause dry mouth and overdose can result in complications including cardiac dysrhthmias
-less commonly used today, but still treat depression in some clients

61
Q

MAO inhibitors

A

-less commonly used to treat depression due to required dietary limitation and possible dangerous side effects (hypertension + seratonin syndrome)
-3rd line of treatment for these reasons

62
Q

Benzodiazepines

A

-Treat anxiety
-effective, short-acting, quick relief
-potential for abuse/addiction
-in elderly, long term use can cause psychotic symptoms that can be reversed through discontinuing

63
Q

Ativan (Lorazepam)

A

Benzodiazepine (anxiety)

64
Q

Xanax (alprazolam)

A

Benzodiazepine (anxiety)

65
Q

Klonopin (clonazepam)

A

Benzodiazepine (anxiety)

66
Q

Valium (diazepam)

A

Benzodiazepine (anxiety)

67
Q

Ritalin (methylphenidate)

A

-Short acting
-Amphetemine-like
-ADHD

68
Q

Ritalin LA

A

-long acting
-Amphetemine-like
-ADHD

69
Q

Concerta (Methylphenidate)

A

-long acting
-Amphetemine-like
-ADHD

70
Q

Adderall (dextroampetamine-amphetamine)

A

-Short acting
-Amphetemine-like
-ADHD

71
Q

Adderall XR

A

long acting

72
Q

Amphetamine-like ADHD drugs

A

-relieve symptoms quickly
-potential for abuse
-surpress appetite
-feelings of edginess
-increased heart rate

73
Q

Strattera (atomoxetine)

A

non-amphetamine like drug most common
0less appetite surpressing
-takes 2-4 weeks to be effect
-must be taken every day
-liver problem
-low risk for abuse

74
Q

Neurodevelopmental Disorders

A

-DSM-5 classification
-group of conditions effecting the brain that occur during childhood development
-Cause varying degrees of functional impairments (school, home)
-parents play a role in assessment/treatment
-neuropsychological assessment using standardized assessments is required

75
Q

Intellectual Development Disorder (Intellectual Disability)

A

-neurodevelopmental disorder
-deficits in mental abilities and adaptive functioning
-impairements in judgement, learning, reasoning, problem solving, planning and abstract thinking
-supported by IQ scores two deviations below the mean but should not be standalone criterion
-epilepsy and cerebral palsy may co-occur

76
Q

Global developmental delay

A

-Diagnosis for children under 5 showing symptoms of Intellectual Developmental Disorder (i.e. delays in mildstones) but are too young for full assessment

77
Q

Unspecified Developmental Disorder

A

-older than 5
-cannot be assessed bc of sensory, physical or mental impairment

78
Q

Language disorder

A

-Nuerodevelopmental disorder (Communication Disorder)
-problems with recieving/expressing language
-must be a deficit in child’s social, academic or occupational functioning
-developmental delays with first words/phrases, reduced vocab and issues with comprehension

79
Q

Speech Sound Disorder

A

-Nuerodevelopmental disorder (Communication Disorder)
-difficulties with pronounciation and articulation
-speech-language pathologist can determine
-not uncommon for young children
-if significant or past age 8, intervention/treatment may be warranted

80
Q

Child-hood onset Fluency Disorder (Stuttering)

A

-Nuerodevelopmental disorder (Communication Disorder)
-stuttering
-identified between ages 2-7
-more prevalent in males
-less prevalent in adults
-can be successful with early intervention and a calm home environment
-worsened by stress/performance anxiety

81
Q

Social Communication Disorder

A

-Nuerodevelopmental disorder (Communication Disorder)
-problems taking social cues, matching language to the vibe (ex. talking the same in recess as class), understanding sarcasm and difficulty with social rules (i.e. listening before talking).
-Similar to ASD but ASD occurs in presence of restricted or repetitive behavior patterns

82
Q

Autism Spectrum Disorder

A

-Nuerodevelopmental disorder (Communication Disorder)
-two categories necessary (deficits in social interation/social communication AND restricted repetitive patterns of behavior - ex. routines, ritual, hyperfixation)

-average onset 12 - 24 months

3 levels:
-level 1 - requiring support - early intervention focusing on growth nad interpersonal communications
-level 2- requiring substantial support - applied behavior analysis
-level 3- requiring very substantial support - applied behavior analy

83
Q

Cerebellar abnormalaties and enlarged ventricals

A

Linked to ASD in addition to abnormal levels of norepinephrine (adrenalin), serotonin, and dopamine

84
Q

Genetic etiology of ASD

A

-studies that siblings of children with autism are more likely to have autism themselves

85
Q

ADHD

A

-neurodevelopmental disorder
-Diagnosed if child displays 6+ symptoms of inattention or hyperactivity-impulsivity in more than one setting
-Onset before age 12 and symptoms for more than 6 months

-predominately inattentive = 6+ inattentive symptoms (forgetful, distracted, difficulty focusing attention)
-predominately hyper-active-impulsive type 6+ impulsive symptoms (out of chair, runs or climbs, talks more)
-Combined type is 6+ of both

7% of children, 2.5% of adults
2:1 male-to-female ratio (females more likely predominate inattentive)

-teens more likely to engage in antisocial behavior/substance use

86
Q

Is ADHD genetic?

A

significant evidence suggesting it is, ADHD occurs at a slightly higher rate among biological relatives than general population

87
Q

Specific learning disorder

A

-Neurodevelopmental disorder

-academic difficulty as evidenced by at least one of the following for at least 6 mos (after interventions tried)
-incorrect spelling
-problems with math reasoning
-problems with math calculation
-difficulty reading
-problems understanding what is read
-difficulty using grammar

-lack improvement for at least 6 months in the presence of targeted assistance

88
Q

Treatment for specific learning disorder

A

-treatment considered after psychological testing and evaluation
-Response-to-intervention supports to develop plan to assist child in school
-if they do not progress, IEP or 504

89
Q

Motor Disorders

A

malfunction of the nervous system that cause involuntary and often excessive movements or purposeless behaviors.

90
Q

Treatment for motor disorders

A

Physiotherapy, occupational therapy, and behaviora plan are used for developmental coordination disorder and stereotypica movement disorder.

Habit reversal is a practice for tic disorder.

-Tourettes can be treated with Haloperidoll (haldol) and pimozide (Orap)

91
Q

Developmental coordination disorder

A

-individual’s movements are impaired while engaging in specific motor tasks.

-exhibit clumbsyh behaviors, running into things or dropping objects.

-inaccurate performance of motor skills - using scissors, throwing ball, etc.

92
Q

Stereotypic movement disorder

A

-Repetitive and purposeless motions
-Rocking, head banging, head shaking, waving or hitting oneself.
-Must include specifier if behavior would cause self-harm without intervention

93
Q

Tourette disorder

A

-Tic disorder
-multiple motor/vocal tics
-remain consistent for 1 year

94
Q

Motor or vocal tic disorder

A

requires at least one motor or vocal tic, but not a combination of vocal or motor tics (Tourettes)

95
Q

Provisional Tic disorder

A

-similar to tourette’s, but tics present for less than one year

96
Q

Schizophrenia spectrum and other psychotic disorders

A

group of conditions charecterized by deficits in 1+ of the following 5 domains:

-Delusions
-Hallucinations
-Disorganized thinking (speech)
-Grossly disorganized or abnormal motor behavior (including catatonia)
-Negative symptoms of schizophrenia (i.e. restricted range of emotions, reduced body language, lack of facial expression)

97
Q

Delusions

A

Firmly held beliefs that persist despite contradictory evidence

98
Q

Persecutory

A

-Most common delusion
-Person believes someone or something is out to get them

99
Q

Referential

A

-delusion where individual believes that someon in the public domain is targeting them

100
Q

Bizarre delusions

A

Delusion that something impossible has happened

101
Q

Grandious delusions

A

Person believes they have superior qualities or capabilities

102
Q

Erotomanic delusions

A

Erroneous belief that another person is in love with them

103
Q

Somatic delusions

A

Health related delusions

104
Q

Nihilistic delusions

A

Delusions of non-existing

105
Q

Hallucinations

A

Individuals seeing or hearing things that do not exist
-Auditory hallucinations (hearing voices) is most common

106
Q

Disorganized thinking (speech)

A

manifests as incoherence (word sald), free or loose associations that make little sense, random responses to direct quesitons

107
Q

Grossly disorganized or abnormal motor behavior

A

shabby appearance, inappropriate sexual behavior, unpredictable agitation, decreased motor activityC

108
Q

Catatonia

A

Decreased motor activity

109
Q

Delusional Disorder

A

-presence of at least one delusion for at least 1 month or longer
-Does not meet criteria for schizophrenia
-functioning not significantly impared, behavior (other than delusion) is not bizarre

-Should be specified if delusions are bizarre (something impossible has happened)

110
Q

Brief Psychotic disorder

A

at least one:
-delusions
-hallucinations
-disorganized speech
-catatonic behavior
-more than one day but LESS THAN ONE MONTH!
-cannot be attributed to another psychotive/depressive disorder

111
Q

Schizophreniform Disorder

A

At least two of the following symptoms, one being a core positive symptom:
-Delusions (CP)
-Hallucinations (CP)
-Disorganized speech (CP)
-disorganized or catatonic behavior
-negative symptoms (i.e. diminished expression)
-At least one month but LESS THAN 6 MONTHS DURATION
-Depressive/bipolar, schizoaffective all ruled out

112
Q

Schizophrenia

A

At least two of the following symptoms, one being a core positive symptom:
-Delusions (CP)
-Hallucinations (CP)
-Disorganized speech (CP)
-Severely disorganized or catatonic behavior
-Negative symptoms

-Level of functioning significantly below the level prior to onset
-Continual signs for MORE THAN 6 MONTHS (without successful treatment)
-Depressive, bipolar and schozaffective all ruled out
-if individual has had communication/ASD, client must have hallucinations or delusions

113
Q

Is there a genetic component to schizophrenia?

A

twin and adoption studies suggest this. The rates of first-degree biological relatives are greater than that of general population

114
Q

Structural abnormalities linked to schizophrenia

A

-enlarged ventricals, diminished hippocampus, amygdala and globus pallidus

115
Q

Functional abnormalities linked to schizophrenia

A

-hypofrontality and deminished activity of the prefrontal cortex

116
Q

Dopamine hypothesis

A

believed that schizophrenia was caused by either an excess of the neurotransmitter dopamine or oversensitive dopamine receptors.

this has been somewhat undermined by research and antipsychotics that have been effective although they block dopamine.

117
Q

Onset age of schizophrenia

A

18-25 males
25-35 females

118
Q

factos that improve schizophrenia progrnosis

A

-chronic condition

-improved prognoses:
0good premorbid adjustment
-acute/late onset
-female gender
-presence of precipitating event
-brief duration of active-phase symptoms
-insight into the illness
-family hx of mood disorder
-no fam hx of schizphrenia

119
Q

Treatment of schizophrenia

A

-antipsychotic medication
-psychosocial intervention
-Many individuals prone to relapse without family support - can benefit from fam therapy, social skills training, employment support

120
Q

Schizoaffective disorder

A

-symptoms matching criteria a for schizophrenia (one CP symptom, one other symptom) + major depressive or manic episode.
-Hallucinations or delusions for at least TWO WEEKS that don’t occur during depressive/manic mood episode
-Significant depressive or manic mood symptoms for most of the length of the illness

121
Q

Bipolar I

A

-must meet criteria for at least one manic episode, usually preceded by an episode of major depression
-manic episode cannot be attributed to schizoaffective disorder or another schizophrenia spectrum disorder

122
Q

Criteria for Manic Episode

A

-expansive/irratble mood
-most of the day for at least one week
-increased energy

at least 4 of the following:
-inflated sense of self
-decreased need for sleep
-overly talkative/pressured speech
-racing thoughts
-distractability
-agitation
-excessive engagement in problematic consequences

-cannot be effects to a substance

123
Q

Bipolar II

A

1+ major depressive episode and 1+ hypomanic episode
-no manic episodes

124
Q

hypomanic episode

A

-signifantly elevated/irratible mood
-energy
-most of the day, last at least 4 days

three of the following (or 4 with irritable mood)
-inflated sense of self
-decreased need for sleep
-overly talkative
-racing thoughts
-distractibility
-goal-directed behaviors

-not severe enough to impair function/require hospitalization, but a clear departure from normal mood.

125
Q

Cyclothymic disorder

A

-considerable number of hypomania symptoms without meeting all criteria
-depressive symptoms that do not meet criteria for major depressive disorder for 2 or more years
-not as severe as Bipolar I or II

126
Q

Disruptive mood disregulation disorder

A

-ages 6-18
-recurrent temper outbursts at least 3x per week
-occurs in more than one setting
-verbal outbursts grossly disproportional to the situation

127
Q

Major Depressive Disorder

A

-5+ of the following symptoms during 2 consecutive weeks, they are associated with a change in normal functioning
-either depressed mood or loss of pleasure must be included

-weight loss or gain of more than 5% in one month
-hypersomnia or insomnia (almost daily)
-motor agitation/retardation
-fatugue (daily
-inappropriate guilt/feelings of worthlessness
-poor concentration
-suicidality

128
Q

learned helplessness model (martin Seligman)

A

-belif that one does not have control over negative life effects - cognitive distortions are internal (“it’s my fault”), stable (“it’s never going to change”) or global (“this will always happen to me”

129
Q

self-control model of depression (lynn rehm)

A

-depression is caused by individuals ruminating over negative outcomes, setting high standards for themselves, having low rates of self-reinforcement and high rates of self-punishment)

130
Q

cognitive theory (Aaron beck)

A

-depression is the result of negative/irrational thoughts about oneself, the world and the future (cognitive triad)

131
Q

early remission

A

criteria for substance use met, remission between 3 mos and 1 year

132
Q

sustained remission

A

remission for 1+ year

LCSW (8 decks)

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