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LMSW Exam > Clinical Practice > Flashcards

Clinical Practice Flashcards

1
Q

What does clinical practice seek to do?

A

Alleviate the internalized negative effects of environmental factors such as stress from health, vocational, family, and interpersonal problems

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2
Q

What is the workers role in clinical practice?

A

Helps individuals, couples, and families to modify attitudes, feelings, and coping behaviors that interfere with optimal social functioning

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3
Q

Where is clinical practice done?

A

Agencies or Private Practice Settings

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4
Q

What is assessment for in clinical practice?

A

Focused on the person-in-environment, with the goal of enhancing social functioning

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5
Q

What theoretical approaches are used in clinical practice?

A

Psychosocial

Problem-Solving

Behavior Modification

Cognitive Therapy

Crisis Intervention

Family Therapy

Group Therapy

Narrative Therapy

Ecological or Life Model

Task-Centered

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6
Q

Psychosocial

A

focuses on intrapsychic and interpersonal change; based on psychoanalytic theory, ego psychology, role, and systems theory

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7
Q

Problem-Solving

A

to solve discrete problems, based on psychosocial and functional approaches

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8
Q

Behavior Modification

A

for symptom reduction of problem behaviors and learning alternative positive behaviors

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9
Q

Cognitive Therapy

A

for symptom reduction of negative thoughts, distorted thinking, and dysfunctional beliefs

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10
Q

Crisis Intervention

A

Brief treatment of reactions to crisis situations to reestablish the client’s equilibrium

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11
Q

Family Therapy

A

treats the whole family system and sees the individual symptom bearer as indicative of a problem in the family as a whole

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12
Q

Group Therapy

A

a practice model in which group members can help and be helped by others with similar problems, get validation for their own experiences, and test new social identities and roles

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13
Q

Narrative Therapy

A

Uses the stories that people tell about their lives to reveal how they structure perceptions of their experiences; therapist co-constructs alternative, more affirming stories with the client

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14
Q

Ecological or Life Model

A

Focuses on life transitions, environmental pressures, and the maladaptive fit between individual and family or the larger environment; focuses on the interaction and interdependence of people and environments

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15
Q

Task-Centered

A

Focuses on accomplishing tasks to reinforce self-esteem and reestablish usual capacity for coping

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16
Q

What’re the assumptions and knowledge base used in clinical practice?

A

Individual growth, development, and behavior result from complex interaction of psychological and environmental factors

Theories of personality development

Systems Theory

DSM-5

Sociocultural factors are a significant influence, including ethnicity, immigration status, occupation, race, gender, sexual orientation, and socioeconomic class

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17
Q

What does the Ongoing Clinical Process Include?

A

Problem Assessment

Planning for Change

Determining the Intervention Locus

Evaluating Change

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18
Q

Problem Assessment

A

Identify forces that contribute to or maintain the problem

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19
Q

What is included in Problem Assessment?

A

Stresses that may impair functioning can originate in the individual, the individual’s system, or the system’s environment

DSM-5

Done to evaluate client’s strengths, to appraise the client-system’s strengths and weaknesses, and to identify supports or constraints that may influence change possibilites

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20
Q

What’s included in Planning for Change?

A

Criteria for Intervention Strategies

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21
Q

What is the criteria for Intervention Strategies?

A

Should be consistent with objectives

Should be evidence that strategy is effective

Must be consistent with professional values

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22
Q

What is included in Determining the Intervention Locus?

A

Behavioral: modify actions

Affective: modify feelings

Cognitive: modify thoughts or thought patterns

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23
Q

What is included in evaluating change?

A

Assess progress in achieving treatment goals

Assess effectiveness of treatment interventions

Determine areas still needing work

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24
Q

What’re the stages of clinical practice?

A

Beginning Stage

Middle Stage

Ending Stage

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25
Q

What is included in the beginning stages of clinical practice?

A

Assessment

Establishing a positive therapeutic relationship

Contracting or goal setting

Connecting with resistance clients

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26
Q

What is included during the assessment at the beginning stages of clinical practice?

A

Presenting problem

Match between presenting problem and available services

Understanding of the client’s problems and how that largely depends on data collected in early interviews that is expanded as treatment progresses

Worker’s Role

Other Sources of Data

Clinical Diagnosing

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27
Q

Beginning Stage: Presenting problem

A

What are the client’s concerns and problems?

How does the client describe the problems?

Can the client clearly articulate what is disturbing?

What factors contribute to the client’s problem?

What strengths does the client show in relation to the presenting problem?

Is the client’s affect appropriate and his expectations realistic?

What does the client hope to achieve?

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28
Q

Beginning Stage: Match Between Presenting Problem and Available Services

A

Does the agency or private practice setting offer the appropriate services and have the needed skills to address the client’s presenting problem effectively?

Should the client remain with this worker or agency, or be referred elsewhere?

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29
Q

Beginning Stage: Worker’s Role

A

Ask leading questions

Ask the client to elaborate and describe the situation in detail; the worker also observes the client’s behavior and affect in the treatment situation; worker organizes data to formulate a meaningful, dynamic psychosocial or diganostic assessment

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30
Q

Beginning Stage: Other Sources of Data

A

Interviewing Other Family Members

Home Visits

Collateral Contacts with Teachers

Clergy

Doctors

Social Agencies

Friends

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31
Q

Beginning Stage: Establishing a Positive Therapeutic Relationship

A

Characteristic of the Worker

Needs of the Client

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32
Q

Establishing a Therapeutic Relationship: Characteristics of the Worker

A

Nonpossessive warmth and concern

Genuineness

Appropriate empathy

Nonjudgemental Acceptance

Optimism about the Possibilities for Change

Objectivity Regarding the Client and the Client’s Situation

Professional Knowledge and Competence

Capacity to Communicate with the Client

Self-Awareness

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33
Q

Establishing a Positive Therapeutic Relationship: Needs of the Client

A

Hope and courage to engage in the change process

Motivation to change

Trust in the worker’s interest and skill to help

Be dealt with as an individual rather than a case

Personality type

To express self

To be accepted as a person of worth

Make one’s choices

Change one’s own pace

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34
Q

Contracting or Goal Setting: The Contract in Theory

A

Compatible with various models of social work practice; not limited to an initial working agreement, but part of the total social work process

Helpful in facilitating client’s activity in problem solving, maintaining a focus, and continuing in therapy

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35
Q

Contracting or Goal Setting

A

an explicit agreement between the worker and client regarding target problems, goals, and strategies of social work intervention, and differentiating the roles and tasks of the client and worker

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36
Q

Contracting or Goal Setting: Mutual Agreement

A

Determined in a reciprocal process between client and worker

Must be stablished at the beginning and monitored throughout to avoid hidden agendas

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37
Q

Contracting or Goal Setting: Differentiated Participation

A

Worker is responsible for delineating unique aspects of his/her participation at each phase of the process

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38
Q

Contracting or Goal Setting: Reciprocal Accountability

A

The client and the worker are each accountable to the other for fulfilling upon work toward agreed upon goals

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39
Q

Contracting or Goal Setting: Explicitness

A

Work is specific, clear, and open

No implicit or covert contracts, or discrepant client-worker expectations

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40
Q

Contracting or Goal Setting: Realistic Agreement

A

Within the capacities of client and worker

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41
Q

Contracting or Goal Setting: Flexibility

A

To guard against rigidity, includes provisions for renegotiation by mutual consent

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42
Q

Beginning Stage: Contracting with Resistant Clients

A

The worker recognizes, accepts, and addresses his/her own resistance if present

The worker recognizes and accepts client’s resistance, whether due to negative experiences with professionals, fear of worker’s authority, or fear of change

Client resistance may be expressed passively or through open hostility

The worker clarifies role and purpose

The worker explores client reactions (resistance) and strategizes on how to work with them

Limitations

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43
Q

Contracting with Resistant Clients: Limitations

A

Difficult to contract with involuntary clients who do not acknowledge or recognize problems, or who see the worker as marginal or unhelpful, and with very severely distrubed or mentally retarded clients

Acknowledge openly the difficulty for both worker and client inherent in mandatory treatment and to negotiate a contract within those realities

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44
Q

Middle Stage: Worker Interventions Definition

A

Continue the work of the beginning stage with more emphasis on helping the client resolve problems and make changes in feelings, behavior, or ways of thinking

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45
Q

Middle Stage: Worker Interventions

A

Supporting or Sustaining

Direct Influence

Exploration

Worker encourages the client’s reflections and responds to enhance the client’s insight; focus on current and recent experiences

Encourages the client’s reflection on pattern-dynamics and underlying personality dynamics adversely affecting current adaptation; focus on conscious and preconscious, rather than unconscious material

Confrontation

Clarification

Interpretation

Partilization

Universalization

Ventilation

Catharsis

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46
Q

Worker Interventions: Supporting or Sustaining

A

Reduce the client’s feelings of anxiety, poor self-esteem, and low self confidence, the worker expresses confidence in or esteem for the client, interest in and acceptance of the client, and a desire to help

Expressed through interest, sympathetic listening, acceptance of client, honest reassurance, and encouragement

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47
Q

Worker Interventions: Direct Influence

A

Worker gives advice or suggestions to influence client

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48
Q

Worker Interventions: Exploration

A

Workers continued effort to understand the client’s view of self and his/her situation

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49
Q

Worker Interventions: Confrontation

A

The worker finds ways to challenge the client to think about discrepancies in what s/he says or does, other maladaptive behavior behavior, or about resistance to treatment or to change

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50
Q

Worker Interventions: Clarification

A

Accomplished through questions, and repeating or rephrasing material the client brings up

Requires sensitivity to the client’s defensiveness

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51
Q

Worker Interventions: Interpretation

A

Used with clients who are not emotionally fragile

Worker suggest psychodynamic meaning of the client’s thoughts, feelings and fantasises, especially about the origins or problem behaviors

Aims at enhancing the client’s insight and working through conflictual material by deepening and extending the client’s conscious understanding

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52
Q

What may interpretation involve?

A

Uncovering repressed (unconscious process) or suppressed (conscious process) material

Connecting the present to the past so the client can see present distortions more clearly

Integrating material from various sources so the client gains a more realistic perspective on his/her situation

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53
Q

Worker Interventions: Partialization

A

To facilitate the client feeling less overwhelmed and more empowered to problem solve and break down problems or goals into smaller, more manageable components

Prioritize the components into a hierarchy of importance to the client or those that are more manageable to address first

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54
Q

Worker Interventions: Ventilation

A

The client airs feelings associated with the data presented about oneself and the situation

The release of emotions may help reduce the intensity of the client’s feelings, the feeling that they are unspeakable or that the client must be alone with them

Worker may need to distinguish between times when ventilation is useful to reduce the intensity and when it “feeds the fire”

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55
Q

Worker Interventions: Catharsis

A

Reliving and consciously examining repressed, early life, or traumatic experiences in treatment to achieve abreaction, the release of tension or anxiety that was caused by the conflict and its repression

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56
Q

Middle Stage: Special Considerations in Treatment

A

Resistance

Transference

Countertransference

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57
Q

Special Considerations in Treatment: Resistance

A

In psychodynamic terms, resistance is an unconscious defense against painful or repressed material

It can be expressed through silence, evasiveness, balking at the worker’s suggestions, or a premature desire to end treatment

The worker should recognize and understand resistance as an opportunity to learn more about the client and then work empathically with the client to face resistance and understand when and how to use it effectively

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58
Q

Special Considerations in Treatment: Transference

A

Client’s unconscious attempts to recapitulate with the worker the conflicts attached to a relationship experienced with significant persons in the past

The worker needs to help the client understand dynamics of transference, how it related to past relationships, and how it contributes to present relationship difficulties

The worker must be aware of self, reality of clinical situation and relationship, and of the client’s conflicts that are revealed through transference

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59
Q

Special Considerations in Treatment: Countertransference

A

The therapist’s unconscious distorted perceptions and responses to the client based on emotional conflicts regarding a significant person from the social worker’s past

Worker needs to understand countertransference reactions, be aware of their presence and consequences, and use supervisory help or therapy to understand them and not impose them on the client

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60
Q

Stages of Clinical Practice: Ending Stage

A

Used the termination phase of treatment

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61
Q

Ending Stage: Opportunities of Termination of Treatment

A

Rework old, unfinished issues or work on presenting problems that reemerge at time of termination

Growth opportunity for coping constructively with loss and anger, sadness, success, disappointment, abandonment

Offers a chance to evaluate treatment and the treatment relationship

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62
Q

Ending Stage: Factors Affecting the Client’s Ending

A

Degree of client’s involvement in treatment

Degree of success and satisfaction

Client’s earlier losses

Mastery of early life separation-individuation stage of development

Reason for Ending

Timing

Transfer Plan

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63
Q

Ending Stage: The Client’s Resistance to Ending

A

Clinging to therapy and to the worker to protect self from anxious and angry feelings

Resisting reworking old problems and symptoms if they recur during termination

Introducing new problems to avoid ending

Finding new relationships as an escape from dealing with pain of ending with the worker

Defensive reactions

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64
Q

Ending Stage: The Worker’s Role

A

Plan adequate time for termination

Inform the client if ending prematurely

Be aware of countertransference attitudes and behaviors about ending

Remain sensitive, observant, empathic, and responsive to the client’s response to ending

Encourage the client to deal with experience of ending, and to confront the client on inappropriate, dysfunctional coping with ending

Encourage the client’s belief in ability to take care of self and to direct his/her own life

Present the possibility of future contact at time of difficulty

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65
Q

How much time is required for long term treatment termination?

A

4-8 sessions

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66
Q

Clinical Practice: DSM-5

A

Classification system with periodic revisions

Comprehensive description of the symptoms and manifestations of mental health disorders and associated information

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67
Q

DSM-5: Cultural Assessment

A

Evaluation of the impact of cultural context, cultural belief systems, and cultural differences between client and interviewer in assessing illness behavior

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68
Q

DSM-5: Defensive Functioning Scale

A

An assessment of the client’s defense or coping patterns at the time of the evaluation and the period just preceding it

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69
Q

What is special about the fifth edition of the DSM?

A

underscores how they can continue to manifest at different stages of life and may be impacted by the developmental continuum that influences many disorders

recognizes age-related aspects of disorders by arranging each diagnostic chapter in chronological fashion, with diagnoses most applicable to infancy and childhood listed first, followed by diagnoses more common to adolescence and early adulthood, and ending with those relevant to adulthood and later years

Individual disorders, diagnostic criteria were revised to better serve young people (working with parents, defining a diagnostic home, developing more precise criteria

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70
Q

DSM-5: Parents’ Integral Role

A

Parents provided a particularly valuable perspective on framing of the DSM-5

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71
Q

Why do parent’s play an integral role when diagnosing a child?

A

criteria require that symptoms be observed by them or individuals who interact regularly with the child

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72
Q

What two disorders were added to the DSM-5?

A

Social Communication Disorder

Disruptive Mood Dysregulation Disorder

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73
Q

DSM-5: Social Communication Disorder

A

persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability

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74
Q

DSM-5: Disruptive Mood Dysregulation Disorder

A

characterized by severe and recurrent outbursts that are grossly out of proportion to the situation in intensity or duration

occurs, on average, three or more times each week for a year or more

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75
Q

What disorders had slight changes in the DSM-5?

A

Autism Spectrum Disorder

Attention Deficit Hyperactivity Disorder

Posttraumatic Stress Disorder

Specific Learning Disorder

Eating Disorders

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76
Q

DSM-5: Autism Spectrum Disorder

A

incorporates four disorders from the previous manual : ASD, Aspergers disorder, childhood disintegrative disorder, and the catch-all diagonsis of pervasive developmental disorder not otherwise specified

People diagnosed with one of the separate DSM-IV disorders should still meet the criteria for autism spectrum disorder or a different DSM-5 diagnosis

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77
Q

DSM-5: Attention deficit/hyperactivity disorder (ADHD)

A

prior to age 12, compared to 7 as the age of onset in DSM-IV

No clinical difference between children with earlier versus later symptom onset in terms of their disorder course, severity, outcome, or treatment response

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78
Q

DSM-5: Posttraumatic Stress Disorder (PTSD)

A

new subtype for children younger than 6

new research details what diagnosis looks like in younger children, which will help clinicians tailor treatment to younger children

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79
Q

DSM-5: Specific Learning Disorder

A

No longer limits learning disorders to reading, mathematics and written expression

Dyslexia is included in the descriptive text

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80
Q

DSM-5: Eating Disorders

A

Previously listed among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence are now listed in the Feeding and Eating Disorders chapter

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81
Q

What disorders are included in the Feeding and Eating Disorders chapter in the DSM-5?

A

PICA, rumination and avoidant/restrictive food intake disorder

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82
Q

DSM-5: Characteristics of Childhood Disorders

A

primarily disorders of abnormal development and maturation

common for children to have more than one diagnosis

eating disorders and gender identity disorders were moved from the child section

learning disorders for reading and mathematics, or written expression are determined through the use of individually administered standardized testing

Intellectual Developmental Disorders

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83
Q

Abnormal Development and Maturation

A

the inability to attain certain normal developmental skills

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84
Q

DSM-5: Disorders Usually Diagnosed in Infancy, Childhood, or Adolescence

A

Motor Skill Disorder and Developmental Coordination Disorder

Communication Disorders

Pervasive Developmental Disorders

Attention-Deficit and disruptive behavior disorders

Feeding and Eating Disorders of Infancy or Early Childhood

Tic Disorders

Elimination Disorders

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85
Q

DSM-5: Intellectual Development Disorder

A

Below average intellectual functioning; an IQ (intelligence quotient) of 70 (+/-5) or below for an individually administered IQ test

Concurrent deficits or impairments in adaptive functioning

Degrees of severity range from mild, moderate, severe and profound

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86
Q

DSM-5: Motor Skills Disorder and Developmental coordination Disorder

A

motor coordination is substantially below or markedly delayed for the child’s age and measured intelligence

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87
Q

DSM-5: Communication Disorders

A

Expressive or receptive language disorders

Phonological (articulation) or stuttering disorders

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88
Q

DSM-5: Pervasive Developmental Disorders

A

spectrum of disorders characterized by qualitative impairment in communication skills; and stereotyped behavior, interests, and activities

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89
Q

DSM-5: Criteria for Childhood Disintegrative Disorder

A

at least two years of normal development, followed by deterioration of language skills and social interaction, and onset of stereotyped behaviors and interests

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90
Q

DSM-5: Criteria for Aspergers Disorder

A

social impairment and restricted behaviors and interests, but with normal language and cognitive development

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91
Q

DSM-5: Criteria for ADHD

A

Inattentive and/or hyperactive, impulse types

symptoms persist for at least six months and include difficulty staying focused, being easily distracted, fidgeting, acting “driven”

symptoms are not motivated by anger or the wish to displease or spite others

treatment by medication and/or behavior modification

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92
Q

DSM-5: Criteria for Conduct Disorder

A

persistent pattern of behavior in which others’ rights and property are violated, and significant age-appropriate rules or societal norms are ignored

aggression and destruction of property are common

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93
Q

DSM-5: Criteria for Oppositional Defiance Disorder

A

pattern of negative, hostile, and defiant behavior with less serious violations of the basic rights of others that characterize conduct disorders

behavior is motivated by interpersonal reactivity or resentful power struggle with adults

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94
Q

DSM-5: Criteria for PICA

A

persistent eating of nonnutritive substances such as paint, hair, sand, cloth, pebbles, etc., without aversion to food

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95
Q

DSM-5: Criteria for Rumination Disorder

A

Regurgitation and rechewing of food

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96
Q

DSM-5: Criteria for Tic Disorders

A

Characterized by rapid, recurrent, stereotyped motor movements or vocalizations

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97
Q

DSM-5: Criteria for Tourette’s Disorder

A

multiple motor tics and one or more vocal tics

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98
Q

DSM-5: Criteria for Chronic Motor or Vocal Tic Disorder

A

either motor or vocal tics

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99
Q

DSM-5: Transient Tic Disorder

A

like Tourette’s but less severe, and symptoms and within 12 months

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100
Q

DSM-5: Elimination Disorders

A

Encopresis

Enuresis

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101
Q

DSM-5: Criteria of Encopresis

A

repeated passage of feces in inappropriate places

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102
Q

DSM-5: Criteria of Enuresis

A

repeated voiding of urine during day or night in bedding or clothes after continence would be expected

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103
Q

DSM-5: Other Disorders of Infancy, Childhood and Adolescence

A

Separation Anxiety Disorder

Reactive Attachment Disorder

Selective Mutism

Stereotype/Movement Disorder

104
Q

DSM-5: Criteria of Separation Anxiety Disorder

A

Excessive distress when separated from major attachment figure(s)

sleep refusal unless near that person

105
Q

DSM-5: Criteria for Reactive Attachment Disorder

A

a lack of attachment or indiscriminate, superficial attachments

106
Q

DSM-5: Criteria for Selective Mutism

A

not speaking in specific social situations though having the ability to communicate

107
Q

DSM-5: Criteria for Stereotype/Movement Disorder

A

repetitive, driven motor behavior, (e.g., hand waving, picking, head banging, rocking)

108
Q

DSM-5: Delirium, Amnestic, and Other Cognitive Disorders

A

Delirium, dementia, amnestic disorder

109
Q

DSM-5: Criteria for Delirium

A

Disturbance in consciousness or cognition that develops over a short period of time and is due to a medical condition or substance induced

110
Q

DSM-5: Criteria for Dementia

A

memory impairment, multiple cognitive deficits

includes Alzeheimer’s (gradual onset with progressive deterioration), vascular dementia, dementia due to HPV, Parkinson’s or other medical conditions

111
Q

DSM-5: Criteria for Amnestic Disorder

A

memory impairment without other cognitive impairments

may be substance induced

112
Q

DSM-5: Mental Disorders Due to a General Medical Condition

A

Delirium, dementia or amnestic disorder

Psychosis

Mood Disorder

Sexual Dysfunction

Sleep Disorder

Personality Change due to medical condition

113
Q

DSM-5: Substance Related Disorders

A

may be caused by abusing a drug, by side effects of a medication, or by toxin exposure

114
Q

DSM-5: Substance Dependence Criteria

A

maladaptive pattern of drug use with increased tolerance, withdrawal symptoms, compulsive use, or behavior problems

115
Q

DSM-5: Substance Abuse Criteria

A

social role, legal, or medical problems due to drug use

116
Q

DSM-5: Substance Intoxication or Withdrawal

A

Behavioral, psychological, and physiological symptoms due to effects of the substance

will vary depending on type of substance

117
Q

DSM-5: What symptoms can come with substance dependence?

A

Induced Delirium

Dementia

Psychosis

Mood Disorders

Anxiety Disorder

Sexual or Sleep Dysfunction

118
Q

Should treatment of substance abuse come first or treatment of symptoms?

A

treatment of substance abuse

119
Q

What treatment options are there for those going through substance abuse issues?

A

Outpatient or Inpatient

Residential or Day Care

Group

Individual

Family Counseling

Methadone Maintenance (for opiates)

Detoxification

Self-Help Groups

Combination of Therapies and Medication

120
Q

DSM-5: Schizophrenic and Other Psychotic Disorders

A

characterized by psychotic symptoms during an active phase, deterioration from a previous level of functioning, and extended duration of symptoms

onset is often in adolescence or young adulthood

medical conditions or substances causing psychosis should be evaluated and diagnosed seperately

121
Q

What psychotic symptoms can be present during an active phase?

A

Delusions

Hallucinations

Disorganized Speech

Thought disorder

122
Q

Examples of thought disorder?

A

loose associations or poverty of content

123
Q

Examples of negative symptoms for psychotic disorders?

A

flat affect

alogia

avolition

124
Q

DSM-5: Duration for Psychotic Symptoms

A

continuous illness for at least six months with at least one month of an active phase of psychotic symptoms

125
Q

DSM-5: Schizophrenia Criteria

A

may be catatonic, disorganized type, paranoid type, undifferentiated type, or residual type

126
Q

Schizophrenia: Catatonic Type

A

stupor, negativism, rigidity, mutism

127
Q

Schizophrenia: Disorganized Type

A

incoherence, flat, or grossly inappropriate affect

128
Q

Schizophrenia: Paranoid Type

A

delusions or frequent auditory hallucinations often persecutory or grandiose

129
Q

Schizophrenia: Undifferentiated Type

A

prominent hallucinations, incoherence, or grossly disorganized behavior

130
Q

Schizophrenia: Residual Type

A

absence of prominent psychotic features

131
Q

DSM-5: Schizophrenia Treatment

A

medication and ego supportive therapy aimed at containing psychotic symptoms and maintaining the person’s highest level of functioning

132
Q

DSM-5: Schizophreniform Disorder Criteria

A

illness of less than six months duration

a greater likelihood of an acute onset preceded by turmoil/high stress

a range of prognoses and characterized by the absence of blunted or flat affect

133
Q

DSM-5: Schizoaffective Disorder

A

psychotic symptoms of schizophrenia concurrent with the presence of either a major depressive episode, a manic episode, or a mixed episode

134
Q

DSM-5: Delusional Disorders Criteria

A

characterized by the presence of a persistent delusion

hallucinations are either absent or not prominent

may be persecutory type, jealous type, somatic type, or grandiose type

135
Q

Delusional Disorders: Persecutory Type

A

delusion that one is being malevolently treated

136
Q

Delusional Disorders: Jealous Type

A

that one’s sexual partner is unfaithful

137
Q

Delusional Disorder: Erotomaniac Type

A

that someone is in love with delusional person

138
Q

Delusional Disorders: Somatic Type

A

that one has some physical defect or disease

139
Q

Delusional Disorders: Grandiose Type

A

that one has a great but unrecognized talent, has made a great discovery, or is a prominent person or close to a prominent person

140
Q

DSM-5: Brief Psychotic Disorder Criteria

A

usually sudden onset and duration of less than one month

141
Q

DSM-5: Shared Psychotic Disorder

A

a delusion is held with another person in a close relationship

142
Q

What’re the types of treatment of schizophrenic and other psychotic disorder?

A

Psychopharmacology

Individual Psychotherapy

Family Therapy

Group Therapy

Milieu Therapy

Social Network Intervention/Case Management

Self-Help Groups

143
Q

Treatment of Psychotic Disorders: Psychopharmacology

A

anti-psychotic medication with consistent administration and monitoring for response and side effects

144
Q

Treatment of Psychotic Disorders: Individual Psychotherapy

A

supportive in nature, little anxiety inducement, contain psychotic symptoms, and focus on realistic goals to maintain highest level of functioning

the goal is to facilitate coping and self-acceptance

145
Q

Treatment of Psychotic Disorders: Family Therapy

A

provide education and support to family members

146
Q

Treatment of Psychotic Disorders: Group Therapy

A

practical, supportive

helps develop social skills to begin or sustain relationships

147
Q

Treatment of Psychotic Disorders: Milieu Therapy

A

often hospital/institutional treatment involving a therapeutic combination of staff, program, social structure, respite, and expectations of reasonable behavior

148
Q

Treatment of Psychotic Disorders: Social Network Intervention/Case Management

A

help with housing, income, social contacts, educational and vocational opportunities, medical care, or other resources

149
Q

Treatment of Psychotic Disorders: Self-Help Groups

A

for support and education to the client and family members

149
Q

Differential Diagnosis: Dementia and Other Medical Conditions

A

dementia, medical conditions, and substance disorders may also cause psychotic symptoms

illnesses that may have less severe or transient psychotic features include major depressive disorder, BPD, or personality disorder such as schizotypal personality disorder

149
Q

Differential Diagnosis: Psychotic Disorder and Paranoid Personality Disorder

A

there may be a paranoid ideation or pathological jealousy, but there are no delusions or hallucinations

150
Q

Treatment of Psychotic Disorders: Course

A

varies from chronic to remission within a few months

151
Q

DSM-5: Mood Disorders Criteria

A

characterized by persistent abnormal mood, either depressed or euphoric

symptoms may be somatic, affective, cognitive, and/or behavioral

impact is psychological distress and impaired role functioning

culture may affect presentation

152
Q

DSM-5: Mood Disorders

A

Major Depressive Disorder

Persistent Depressive Disorder

Bipolar I Disorder

Bipolar II Disorder

Cyclothymic Disorder

153
Q

DSM-5: Major Depressive Disorder Criteria

A

vegetative or classic symptoms

significant weight loss or gain

insomnia

sleeping too much

motor agitation or low energy

feeling sad, empty, or worthless

difficulty concentrating or making decisions

general loss of pleasure and interest

recurrent thoughts of death or suicide

154
Q

DSM-5: Persistent Depressive Disorder

A

similar symptoms to major depressive disorder, but less severe and more chronic

last at least two years

155
Q

DSM-5: Bipolar I Disorder

A

formerly called manic-depression

one or more manic episodes characterized by persistent abnormally elevated or irritable mood

pressured speech

grandiosity

sleeplessness

excessive pleasurable, high-risk activity

156
Q

DSM-5: Bipolar II Disorder

A

major depressive episodes with at least one hypomanic episode (manic symptoms at a less severe intensity)

157
Q

DSM-4: Cyclothymic Disorder

A

chronic, fluctuating mood with many hypomanic and many depressive symptoms, but not as severe as either bipolar I or bipolar II

158
Q

DSM-5: Treatment of Mood Disorders

A

Psychopharmacology

Interpersonal/Psychodynamic Therapy

Behavioral Therapy

Cognitive Therapy

Group Psychotherapy

Self-Help Groups

Generalized Anxiety Disorder (GAD)

159
Q

Treatment of Mood Disorders: Psychopharmacology

A

antidepressants for major depressive disorder and dysthymia

anti-psychotics if mood disorder is accompanied by psychotic features

mood stabilizers if bipolar I

administration and monitoring for effectiveness and side effects

160
Q

DSM-5: Anxiety Disorders Criteria

A

characterized by excessive worry, fear, and/or avoidance rituals or repetitive thoughts

161
Q

DSM-5: Panic Disorder Criteria

A

brief recurrent intense fear in the form of panic attacks with physiological or psychological symptoms

may include agorophobia, anxiety about being in places or situations from which one cannot escape or where one might have a panic attack and not be able to get help

162
Q

DSM-5: Phobia Criteria

A

fear of specific objects or situations

163
Q

DSM-5: Social Phobia Criteria

A

social anxiety disorder

unreasonable fear of embarrassment or humiliation in social settings

164
Q

DSM-5: Obsessive Compulsive Disorder

A

intrusive recurrent thoughts or compulsive behaviors distressing the person and which are time-consuming, even interfering with the person’s routine or functioning

165
Q

DSM-5: Post-traumatic Stress Disorder (PTSD) Criteria

A

more than one month of persistently re-experiencing a severe trauma

avoidance of things associated with the trauma or numbness

person demonstrates arousal-anxiety symptoms

166
Q

DSM-5: Acute Stress Disorder Criteria

A

within one month of experiencing a trauma, anxiety and dissociative symptoms develop

167
Q

DSM-5: Generalized Anxiety Disorder

A

excessive worry, cognitive, and physiological symptoms of distress

chronic and last at least six months in duration

168
Q

DSM-5: Treatment of Anxiety Disorders

A

Psychopharmacology

Psychotherapy

Group Therapy

Inpatient Hospitalization

169
Q

Treatment of Anxiety Disorders: Psychopharmacology

A

short-acting anti-anxiety medications may be used for episodic symptoms such as panic attacks

antidepressants are used in the longer term for diagnoses such as social phobia or obsessive compulsive disorder

170
Q

Treatment of Anxiety Disorders: Psychotherapy

A

supportive therapy, cognitive-behavioral therapy, dialectical behavior therapy, and EMDR for PTSD

171
Q

Treatment of Anxiety Disorders: Inpatient Hospitalization

A

when there is danger to self or others

172
Q

DSM-5: Somatoform Disorders Criteria

A

characterized by multiple physical/somatic symptoms with no organic findings

symptoms cause distress and impair functioning in social work arenas

173
Q

DSM-5: Somatoform Disorders

A

Body Dysmorphic Disorders

Conversion Disorder

Hypochondriasis

Somatization Disorder

Pain Disorder

174
Q

DSM-5: Body Dysmorphic Disorders Criteria

A

Preoccupation with some imagined defect in appearance

175
Q

DSM-5: Conversion Disorder Criteria

A

motor or perceptual symptoms suggesting physical disorder, but reflect emotional conflicts

176
Q

DSM-5: Conversion Disorder Criteria

A

motor or perceptual symptoms suggesting physical disorder, but which reflects emotional conflicts

177
Q

DSM-5: Hypochondriasis Criteria

A

unrealistic interpretation of physical signs as abnormal, and preoccupation with a fear or belief of serious illness

178
Q

DSM-5: Somatization Criteria

A

recurrent and multiple somatic complaints of several years

179
Q

DSM-5: Pain Disorder Criteria

A

preoccupation with pain that causes impaired functioning

180
Q

DSM-5: Treatment of Somatoform Disorders

A

As there is no definitive treatment, the goal is early diagnosis to stop unnecessary medical/surgical interventions

Attempt to turn attention from symptoms to problems of living

Supportive Therapy

A long-term relationship with a single physician

No medication

181
Q

Treatment of Somatoform Disorders: Supportive Therapy

A

helping to cope with symptoms

182
Q

DSM-5: Dissociative Disorders Criteria

A

characterized by a disturbance in the normally integrative functions of identity, memory, consciousness, or perception of the environment

trauma is a common precipitant, but dissociative symptoms may occur in other disorders

trance states are a variation of dissociative disorders in some cultures

183
Q

DSM-5: Types of Dissociative Disorders

A

Dissociative Identity Disorder (formerly multiple personality disorder)

Dissociative Fugue

Dissociative Amnesia

Depersonalization Disorder

184
Q

DSM-5: Dissociative Identity Disorder Criteria

A

existence within the person of two or more personalities, of which each is dominant at a particular time

185
Q

DSM-5: Dissociative Fugue Criteria

A

sudden and unexpected travel from home, with assumption of a new identity and inability to recall ones previous identity

186
Q

DSM-5: Dissociative Amnesia Criteria

A

sudden inability to recall important personal information, not due to organic causes and more than forgetfulness

187
Q

DSM-5: Depersonalization Disorder Criteria

A

feeling detached from, and an observer of, one’s mental processes or body

188
Q

DSM-5: Treatment of Dissociative Disorders

A

psychotherapy with goals of working through unconscious conflict or recovering memories of trauma, and integrating feeling states with memories or events

189
Q

DSM-5: Sexual Gender Identity Disorders

A

Sexual Desire Disorder

Sexual Aversion disorder

Sexual Arousal Disorder

Premature Ejaculation

Sexual Pain Disorders

Paraphilias

Gender Identity Disorder

190
Q

DSM-5: Sexual Dysfuntions

A

characterized by problems in sexual functioning due primarily to psychological factors

191
Q

DSM-5: Sexual Desire Disorder Criteria

A

lack of desire for sex that causes distress or interpersonal problems

192
Q

DSM-5: Sexual Aversion Disorder Criteria

A

aversion or avoidance of genital sexual activity

193
Q

DSM-5: Sexual Arousal Disorder Criteria

A

inability to maintain an erection or to attain and maintain sexual excitement

194
Q

DSM-5: Paraphilia Disorder

A

unusual or bizarre imagery or act typically concealed and engaged in by a small percentage of the population for sexual excitement

these acts adapt to societal changes and are widely divergent from societal norms or are harmful to others

examples include exhibitionism, fetishism, frotteurism, pedophilia, sexual sadism, sexual masochism, voyeurism, zoophilia)

195
Q

DSM-5: Treatment of Sexual Disorders

A

Psychopharmacology

Psychotherapy

196
Q

Treatment of Sexual Disorders: Psychopharmacology

A

medications such as Viagra

197
Q

Treatment of Sexual Disorders: Psychotherapy

A

sex therapy

behavioral techniques

198
Q

DSM-5: Gender Identity Disorder Criteria

A

characterized by strong and long-standing cross-gender identification and discomfort with one’s assigned gender

199
Q

DSM-5: Eating Disorders

A

Anorexia Nervosa

Bulimia Nervosa

200
Q

DSM-5: Anorexia Nervosa Criteria

A

refusal to maintain body weight at minimal norms

intense fear of gaining weight and becoming fat

patients have distorted body image and may suffer from amenorrhea

201
Q

DSM-5: Bulimia Nervosa Criteria

A

recurrent episodes of binge eating, and self-induced vomiting/laxatives/fasting/vigorous exercise to prevent weight gain

persistent over-concern with body shape and weight

at least two binge eating episodes a week for three months

202
Q

DSM-5: Treatment of Eating Disorders

A

Psychopharmacology

Individual and/or Family Therapy

Medical Supervision

Hospitalization

203
Q

Treatment of Eating Disorder: Medical Supervision

A

weight, vital signs, and blood values

204
Q

Treatment of Eating Disorder: Hospitalization

A

if necessary for close behavioral and medical supervision

205
Q

DSM-5: Sleep Disorder Criteria

A

sleep difficulties that which is normal and transient

examples include insomnia, hyperinsomnia, narcolepsy, nightmare disorder, sleep terror disorder, sleepwalking disorder

206
Q

DSM-5: Factitious Disorders Criteria

A

intentionally produced or feigned physical or emotional symptoms

motivated by wish to play the role of a sick person

207
Q

DSM-5: Impulse-control Disorders

A

Intermittent Explosive Disorder

Pathological Gambling

Kleptomania

Pyromania

Trichotillomania

208
Q

DSM-5: Intermittent Explosive Disorder Criteria

A

episodes of aggression in the form of serious assaults on others or destruction of property

209
Q

DSM-5: Kleptomania Criteria

A

impulsively stealing things not needed

210
Q

DSM-5: Pyromania Criteria

A

fire-setting for pleasure or tension relief

211
Q

DSM-5: Trichotillomania Criteria

A

hair pulling for pleasure or tension relief that results in hair loss

212
Q

DSM-5: Adjustment Disorders Criteria

A

response to specific psychosocial stressors characterized by anxiety, depression, or conduct problems starting within three months of the stressor and lasting less than six months

chronic stressors or stressors that have long-term consequences may cause chronic adjustment disorders

213
Q

DSM-5: Personality Disorders Criteria

A

characterized by an enduring and inflexible pattern or maladaptive personality traits that cause either significant impairment in social or occupational functioning, or subjective distress

thought to serve as coping and defensive styles due to ego deficits and early developmental problems

214
Q

DSM-5: Differential Diagnosis for Schizoid Personality Disorder

A

no psychotic symptoms such as delusions and hallucinations

as seen in delusional disorders and schizophrenia

215
Q

DSM-5: Schizoid Personality Disorder

A

indifference to social relationships, and a restricted range of emotional experience and expression

inability to form intimate social relationships or experience warmth and tenderness for others, and uncaring about the responses of others

216
Q

DSM-5: Differential Diagnosis for Schizotypal Personality Disorder

A

deficits in interpersonal relatedness

various thought, perception, speech, and behavior pecularities

217
Q

DSM-5: Treatment of Paranoid Personality Disorder

A

as there is trouble with trust and intimacy, the social worker should respond in a straightforward manner with courtesy, honesty, and respect

218
Q

DSM-5: Antisocial Personality Disorder Criteria

A

a history of chronic irresponsible and antisocial behavior that began in childhood or early adolescence

violations of the rights of others and failure at work over several years

often starts with lying and stealing, and continues with acting-out sexual behavior, drinking, and drugs

continues with adult failure at work and at home, and adult violations of social norms

219
Q

DSM-5: Treatment of Antisocial Personality Disorder

A

long-term therapy

self-help groups

establishing limits and boundaries

220
Q

DSM-5: Borderline Personality Disorder Criteria

A

instability in relationships. mood, and self-image

impulsive and unpredictable acting-out, at times self-destructive

intense mood shifts from rage to normal state

chronic fear of being alone and dread of feelings of emptiness

may have transient paranoid or dissociative symptoms

221
Q

DSM-5: Treatment of Borderline Personality Disorder

A

supportive counseling

clear boundaries and limit setting

avoid splitting, and help client verbalize rather than act on feelings

222
Q

DSM-5: Histrionic Personality Disorder Criteria

A

excessive emotionality and attention seeking

constantly seeking reassurance, approval, or praise

overly dramatic and intense behavior

223
Q

DSM-5: Treatment of Histrionic Personality Disorder

A

psychotherapy to temper egocentricity and increase capacity for empathy in relationships

224
Q

DSM-4: Narcissistic Personality Disorder Criteria

A

a grandiose sense of self-importance

fantasies of unlimited success

chronic exhibitionism

difficulty in dealing with criticism

indifference to others

difficulty in relationships characterized by feelings of entitlement

taking advantage of an exploiting others

extreme polarities of idealizing and devaluing others

225
Q

DSM-5: Treatment of Narcissistic Personality Disorder

A

supportive counseling

empathic mirroring

increase capacity for empathy in relationships

226
Q

DSM-5: Avoidant Personality Disorder Criteria

A

social discomfort

fear of negative evaluation

timidity leading to extreme sensitivity to the possibility of social rejection

fear of social relationships

social withdrawal despite the desire for closeness

low self-esteem

227
Q

DSM-5: Dependent Personality Disorder Criteria

A

a pervasive pattern of dependent and submissive behavior

lack of self-confidence

inability to function independently

individual seeks others to assume responsibility for his/her life

limited ability to show positive emotions

perfectionism with over-concern for trivial detail

demands others submit

preoccupied with work

miserly with money

228
Q

DSM-5: Treatment of Personality Disorders

A

the purpose of intervention is often to alleviate symptoms, decrease social or emotional disability, or deal with societal/interpersonal need for symptom management

psychotherapy promotes recognition of the person’s covert dependence and often unexpressed fearfulness

awareness of countertransference is important because of treatment-resistant and other behaviors displayed, including mistrust of the social worker, lack of boundaries, and lack of recognition of the worker as a person

psychoactive medication is not used

229
Q

Defense Mechanisms: Substance Abuse

A
  1. Regression, Projection, Rationalization, Denial
  2. Fragmentation: form of denial, refers to time
  3. Minimization refers to quantity
230
Q

Defense Mechanisms: Schizophrenia

A
  1. Fixation, Regression
  2. Symbolization: keeps demons away
  3. Identification
231
Q

Defense Mechanisms: Delusional Disorders

A
  1. Paranoid - Projection
  2. Erotomania - Projection
  3. Grandeur - Reaction formation, Omnipotence
  4. Somatic - Regression
232
Q

Defense Mechanisms: Mood Disorders (Depression)

A
  1. Introjection: Loss, Anger
  2. Reaction Formation: Mania
233
Q

Defense Mechanisms: Generalized Anxiety Disorder

A

Regression or Repression

234
Q

Defense Mechanisms: Phobias

A

Displacement, Symbolization, Avoidance

235
Q

Defense Mechanisms: Obsessive Compulsive Disorder

A
  1. Isolation of Affect: Ignore others’ feelings
  2. Undoing: Washing
  3. Reaction Formation
  4. Regression
236
Q

Defense Mechanisms: Somatoform

A
  1. Repression, Somatization, Conversion
  2. Body Dysmorphia Disorders: Repression, Dissociation, Distortion, Symbolization
237
Q

Defense Mechanisms: Dissociative Disorders (amnesia, multiple personalities)

A

Repression, Dissociation

238
Q

Defense Mechanisms: Personality Disorders

A
  1. Paranoid - Projection
  2. Histrionic - Dissociation
  3. Borderline - Splitting, Acting Out, Projective Identification
239
Q

Defense Mechanisms: Always Pathological

A

conversion

somatization

240
Q

Schizophrenia and Psychotic Symptoms: Old Antipsychotics

A

Haldol (haloperidol)

Thorazine (chlorpromazine)

Mellaril (thioridazine)

Stelazine (trifluoperazine)

Prolixin (fluphenazine)

Navane (thiothixene

Clozaril (clozapine)

241
Q

Schizophrenia and Psychotic Symptoms: Newer or Atypical Antipsychotics

A

Clozaril

Risperdal

Seroquel

Olanzapine

Abilify

242
Q

Schizophrenia and Psychotic Symptoms: Clinical Notes

A

old antipsychotics are effective, but major drawback is the potential side effect, Tardive Dyskinesia

T.D. is irreversible and causes involuntary movements of the face, tongue, mouth, or jaw

other potential side effects such as Parkinson-like tremor or muscle rigidity are reversible and may be countered with the addition of Cogentin

243
Q

Schizophrenia and Psychotic Symptoms: Clinical Notes (newer or atypical antipsychotics)

A

Clozaril requires biweekly blood blood testing due to the risk of agranulocytosis, a blood disorder that decreases white blood cells and increases the risk of infection

other atypical antipsychotics carry much less risk of Tardive Dyskinesia, however they are very expensive and can cause weight gain, affect blood sugar, and lipid profile

244
Q

Bipolar Disorder: Drugs

A

Mood Stabilizers: Lithium, Tegretol, Depakote, Lamictal

245
Q

Bipolar Disorder: Clinical Notes

A

Mood stabilizers are effective

Often cause weight gain

Regular blood work is required to monitor for therapeutic drug levels and for potential side effects

Lithium can cause kidney or thyroid problems

Tegretol and Depakote can cause liver function problems

246
Q

Unipolar Depression: Drugs

A
  1. SSRI’s (Selective Serontonin Reuptake Inhibitors): Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro
  2. Atypical Antidepressants: Effexor, Wellbutrin, Cymbalta
  3. Tricyclic Antidepressants: Imipramine, Amitriptyline, Elavil
  4. MAO Inhibitors: Nardil, Parnate, Marplan
247
Q

Unipolar Depression: Clinical Notes

A

SSRI’s have fewer side effects than other antidepressants

Cannot overdose on SSRI’s alone

They take several weeks to be effective

SSRI’s are expensive, often cause a loss of libido, and can lose effectiveness after years of usage

In a small number of clients, SSRI’s have the paradoxical effect of creating agitation or suicidal ideation or manic symptoms in the first days or weeks of usage and should be discontinued by the prescriber

248
Q

Unipolar Depression: Clinical Notes (Atypical Antidepressants)

A

Wellbutrin does not cause loss of libido

It is sometimes prescribed in combination with SSRI to potentiate the positive antidepressants effect of an SSRI or to counter sexual side effects

Cymbalta is recommended for depression associated with somatic complaints

249
Q

Unipolar Depression: Clinical Notes (Tricyclic Antidepressants)

A

Can cause sides effects such as dry mouth

These medications are not commonly used now due to cardia monitoring issues

250
Q

Unipolar Depression: Clinical Notes (MAO Inhibitors)

A

not commonly used as they require a special diet to be safe

251
Q

Anxiety: Drugs

A

Benzodiazepines: Ativan (Lorazepam), Xanax, Klonopin, Valium

252
Q

Anxiety: Clinical Notes

A

Effective, quickly relieve anxiety, short-acting

These medications should be used for as short a time as possible and with appropriate therapeutic intervention because of their potential for addiction

In the elderly, long-term use of Benzodiazepines can cause psychotic symptoms that are reversible by discontinuing the medication

253
Q

Attention Disorders: Drugs

A

Amphetamine-like: Ritalin (short-acting), Long-Acting Ritalin, Concerta, Adderall (short-acting), Adderall XR (long-acting)

Non-Amphetamine-like: Strattera

254
Q

Attention Disorder: Clinical Notes (Amphetamine-like)

A

Relieve symptoms quickly

Can take these medications on selected days or part-days if desired

Can be abused

Can suppress appetite and cause weight loss

Cause an edgy feeling like too much caffeine and can cause increased pulse rate

255
Q

Attention Disorder: Clinical Notes (Non-Amphetamine)

A

Less appetite suppressing, so weight loss is less a problem

Takes two-four weeks to be effective

Must take everyday

Monitor for rarely occurring liver problem

Cannot be abused

LMSW Exam (12 decks)

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