Midterm Exam Flashcards
Involves identifying subjective conditions
Diagnosis
How we assess will change based on:
Personal history, what we’ve learned, lenses we use, information we have
Goal of diagnosis
Not to be right, but to be more reliable, document what we’re treating and why
The root word of this means “mark of shame”
Stigma
What is a mental disorder
Conditions that affect one’s emotions, thinking, and/or behavior and lead to distress or functional impairment
Subjective conditions that can be identified
Mental disorder
A biopsychosocial approach to understanding, identifying, and communicating human suffering using evidence-based and ethical practices.
Diagnosis in counseling
Parts of the counseling process that is the focus of this class
Assessment and Diagnosis
Part of the counseling process that never goes down to nothing
Assessment
Starts the first session, is biopsychosocial in nature, focuses on current issues, seeks to understand history, signs and symptoms
Assessment
Abbreviation: CL/PT
Client or Patient
Abbreviation: DA
Diagnostic Assessment
Abbreviation: Hx
History
Abbreviation: SxS
Signs and Symptoms
Something you can observe
Signs
Something that is internal and needs to be reported by client
Symptoms
Sign or Symptom ex: No eye contact, closed, tear as they speak about how hard life is
Sign
Sign or Symptom ex: Client says “I don’t think anything is going to change, I feel hopeless. I have such low energy that I can’t get up for work.”
Symptom
Abbreviation: ICD
International Classification of Diseases
Official coding system to make diagnosis and to use for documentation and billing purposes
ICD
Abbreviation: CPT
Current Procedural Terminology
Coding system used to identify services rendered and is used for billing purposes
CPT; Current Procedural Terminology
Both ICD and CPT codes need to be accepted before what?
Before treatment planning begins and to be reimbursed
The extent to which two or more raters (or observers, coders, examiners) agree
Interrater reliability
Psychodiagnosis is rooted in the sub-field of what?
Abnormal Psychology
Focuses on the assessment, causes, and consequences of maladaptive behavior (and NOT treatment)
Abnormal Psychology
Type of behavior that describes personal vulnerability combined with environmental events leading to problem(s) in living, disability, impairment (social, occupational), distress
Maladaptive behavior
Statistically different from the norm
Deviant
What is deviant does not necessarily mean it is ________.
Maladaptive
Key terms of this include: Vulnerability, Lifetime Prevalence Rate, Incidence Rate, Etiology, Risk Factors
Abnormal Psychology
Abbreviation: LPR
Lifetime Prevalence Rate
__________ is in contrast to resiliency.
Vulnerability
The likelihood that someone will respond maladaptively in a certain situation
Vulnerability
Statistics reporting proportion of a population that will experience a characteristic at some point during their lifetime.
LPR; Lifetime Prevalence Rate
Rate that means: X disorder had a prevalence rate of X% in X timeframe
Incidence Rate
Cause or set of causes for a disease or condition
Etiology
More and more, our society is moving towards __________ etiology.
Biological (etiology)
T/F: There are reliable biological markers for mental conditions.
False
T/F: Biological markers of mental conditions are indicative of correlation vs causation.
True
Characteristics associated with higher likelihood of experiencing a disease or condition
Risk Factors
T/F: Risk factors of mental conditions are indicative of causation vs correlation.
False
T/F: The more risk factors a person has, the more likely someone is for experiencing a mental condition
True
T/F: You should assess for diagnosis with the highest LPR first.
True
Patron Saint of Mental Illness
St. Dymphna
Mental illness was originally viewed as what?
Punishment from the Gods, supernatural, unseeable forces
Surgical procedure where a hole was created in the skull by removing a circular piece of bone
Trephination
T/F: In the Middle Ages, there was very little distinction between deviation and maladaptive behavior.
True
Where did the first “Public Hospital for Persons of Insane and Disordered Minds” open in 1773?
Colonial Williamsburg, VA
During this time period, anatomy was documented, hospitals were reformed, and “moral treatment” was developed
1800s
In the 1800s, this entailed daily visits from staff, proper diet, letting clients out for physical activity, attempting to separate mild from severe
Moral treatment
The current theory of maladaptive behavior is __________.
Biopsychosocial
We focus on ________-_________ interventions.
psycho-social
The ___________ of mental conditions is complex, ever-changing, and ultimately unknowable.
Etiology
In the U.S., the percentage of adults who suffer from a diagnosable mental disorder each year.
26%
Of the top 10 leading illnesses, what 4 are mental disorders?
Anxiety disorders, Depressive disorders, Bipolar disorders, Psychotic disorders
In the U.S., what is the annual incidence rate for Anxiety disorders
13.3%
In the U.S., what is the annual incidence rate for Depressive disorders
9.5%
In the U.S., what is the annual incidence rate for Bipolar disorders
1.2%
In the U.S., what is the annual incidence rate for Psychotic disorders
1.2%
In the U.S., the LPR of developing a mental disorder of any kind is approximately X%
46%
In the U.S., the LPR of Anxiety Disorders
28%
In the U.S., the LPR of Impulse-Control Disorders
24%
In the U.S., the LPR of Mood Disorders
20%
In the U.S., the LPR of Substance-Related Disorders
15-20%
ICD was developed by whom?
World Health Organization (WHO) as part of the United Nations
Current ICD edition
11
What is the main goal of the ICD?
To track mortality (death) and morbidity (current illnesses) data globally
Number of members of WHO who have agreed to the current version of ICD
194
By international treaty, every country needs to use ICD to track what?
Causes of death
Permission to use a modified version of ICD is granted to track what?
Current illnesses
Modified version of ICD used in the U.S.
ICD-10-CM (Clinical Modification)
ICD-10-CM was developed by whom?
HHS (Department of Health and Human Services)
Section F (or F-codes) includes what 3 categories used in diagnosis?
Mental, Behavioral, and Neurodevelopmental
HIPPA Law mandates that all healthcare providers must use the ICD-CM to diagnose what?
Morbidity (current illness)
When is the ICD-CM updated every year?
October
CPT (Current Procedural Terminology) was developed by whom?
American Medical Association
ICD tracks Dx for all symptoms of _____, ______, and _______ internationally.
Illness, injury, and death (including mental disorders)
DSM codes are developed by whom?
The American Psychiatric Association
Both the DSM and ICD-CM are what type of system?
Categorical diagnostic system
Person who advocated for using person-first language (i.e. a person with a MD vs a MD person)
Fred Frese
T/F: The DSM and ICD-CM attempt to imply specific disorder causes as well as legal decisions
False
This federal law requires all healthcare providers to use ICD-CM codes, which describe why a healthcare service was required/billed
Health Insurance Portability and Accountability Act of 1996
T/F: DSM codes are used for billing/tracking purposes in America and in other countries
False
Terms used for mental illness before the 1800s
“Idiocy” or “insanity”
Year ICD-1 was introduced in the U.S.
1898
Year DSM-I published and number of Dx
1952; 106 Dx
Year DSM-II published and number of Dx
1968; 182 Dx
DSM-1 and -II were based on what principles
Psychoanalytic
Year DSM-III published and number of Dx
1980; 265
Starting with this version of the DSM, Dx were atheoretical
DSM-III
Year DSM-III-R published and number of Dx
1987; 292
Year ICD-10 was published worldwide
1994
Year DSM-IV published and number of Dx
1994; 365
Year DSM-IV-TR published
2000
Year DSM-5 published
2013
This version of the DSM was published in 2022 with no major updates and still based on ICD-CM-10
DSM-5-TR
Year ICD-11 was published worldwide
2022
Number of categories in the DSM
21
1st step/question of assessment
Does this person meet the definition of a mental disorder at all?
Pre-Req for any F-Code
Person meets the definition of a Mental Disorder
T/F: Whatever the disfunction, it must not be culturally expected or accepted in their culture; locally maladaptive
True
A syndrome (collection of signs (observed) and symptoms (internal, reported)) characterized by clinically significant (disfunction (significant distress or disability) directly linked to the syndrome and must be able to be documented) disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning… associated with significant distress or disability in social, occupational, or other important activities.
Definition of a Mental Disorder
Codes used by clinicians to note stressful situations (social, economic and environmental) that might have a negative impact on mental health
Z-Codes
Codes related to diseases of the nervous syste
G-Codes
Always rule out these 2 things as reasons for syndrome
Medical conditions and Substances
Period of time most insurers will accept “unspecified”
2-3 sessions
This notation is used when you’re 95% sure of a specific diagnosis
Provisional
These conditions must be met in order for symptoms to be considered a mental disorder
They cluster in a characteristic way and must cause clinically significant distress or impairment in social or occupational functioning
T/F: The DSM mental disorders are no more than descriptive syndromes and they are not necessarily discrete diseases.
True
T/F: Having separate categories in the DSM adds information and precision, but should not imply separate causalities or need for separate treatments.
True
This type of diagnostic process is more accurate and efficient for clients who present with milder or ambiguous symptoms, or have too short a history to provide basis for future prediction
Stepped Diagnosis
Always rule out these 2 MDs first
Bipolar and Depressive Disorders
4 categories of criteria that are used in determining abnormal human behavior
Distress; Impairment; Risk to Self or Others; Socially and Culturally Unacceptable Behavior
T/F: Socially deviant behavior (for example, political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
True
This helps clinicians determine prognosis, treatment plans and potential treatment outcomes.
Diagnosis of a mental disorder
T/F: Diagnosis of a mental disorder is equivalent to needing treatment
False
This is a complex clinical decision that considers symptom severity, symptom prominence (or salience), individual’s distress or disability associated with symptom(s), risk and benefits of available treatments, etc.
Diagnosis of a mental disorder
T/F: Clinician should consider individuals to be heterogeneous even in regard to the defining features of the diagnosis and boundary cases will likely be diagnosed in a probabilistic fashion
True
This defines mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis
Subtypes
T/F: Subtypes and Specifiers provide more homogenous subgrouping of individuals
True
Social construct divides humanity into groups based on variety of superficial physical traits
Race
Culturally constructed group identity used to define people and communities
Ethnicity
Set of protocols that clinicians may use to obtain info during DA about impact of culture on key aspects of individual’s clinical presentation and care
Cultural Formulation Interview (CFI)
Among the most common and stereotyped (and stigmitized) groups of mental disorders
Substance-Related & Addictive D/O
T/F: In the DSM, the phrase “addiction” is not applied as a diagnostic term; more neutral term “substance use disorder” is what is applied
True
Dx that should be listed first if multiple
Reason for visit
Abbreviation: R/O
Rule Out
T/F: Genes do not cause addiction, but some are genetically predisposed to have a more intense or euphoric reaction to a substance
True
Unlike Alcohol Abuse Disorder, this variation includes a biological component
Dependence
Number of symptoms present for Substance Abuse label
2-3
Number of symptoms present for Substance Dependence label
4+
U.S. LPR of schizophrenia is what?
1%
U.S. LPR for all psychotic disorders is what?
2%
T/F: For Schizophrenia, prevalence rates are generally equal between men and women, but onset is earlier for women.
False, onset is earlier for men
Risk factors include: Urban residence, life stressors, high-expressed emotional environments (critical or overbearing), low SES/social support, psychoactive drug use, family Hx of related illnesses
Schizophrenia
Percentage of clients with schizophrenia who complete suicide
10-15%
Percentage of clients with schizophrenia who attempt suicide
40%
Percentage of clients with schizophrenia who have thoughts of suicide
70-80%
This fraction of the homeless population is thought to have a psychotic disorder
1/3
T/F: With schizophrenia, preteen onset is common, though after 40s is rare
False, preteen onset is also rare
Antipsychotics try to reduce these two chemicals
dopamine and serotonin
The environmental hypothesis for causation in schizophrenia is a _________ family environment.
High-Expressed Emotional (criticism, hostility and emotional over-involvement)
Factors for good prognosis in Schizophrenia
Good insight; average onset; acute onset (rapid); good premorbid functioning; good social support
Genetic vulnerability or predisposition for an illness or medical condition
Diathesis
This model is a psychological theory that suggests that schizophrenia is caused by a combination of genetic vulnerability (diathesis) and environmental stressors. According to this model, individuals who are genetically predisposed to schizophrenia will only develop the condition if they are exposed to environmental stressors.
Diathesis-Stress Model
Schizophrenia Spectrum and Other Psychotic Disorders are defined by abnormalities in these 5 domains:
Delusions; Hallucinations; Disorganized Thinking; Grossly Disorganized or Abnormal Motor Behavior; Negative Symptoms
Most common delusion type: Belief that one is going to be harmed or harassed by an individual or group
Persecutory
Delusion Type: Belief that certain gestures, comments, environmental cues are directed at oneself
Referential
Delusion Type: When an individual believes that he or she has exceptional abilities, wealth, or fame
Grandiose
Delusion Type: Belief that someone is in love with them
Erotomanic
Delusion Type: Conviction that a major catastrophe will occur
Nihilistic
Delusion Type: Preoccupations regarding health and organ function
Somatic
Most common hallucination type
Auditory
Hallucinations must occur during what?
Clear sensorium
Disorganized thinking is typically inferred through what?
The individual’s speech
T/F: In Schizophrenia, disorganized thinking must be severe enough that it impairs effective communication
True
Period in schizophrenia where symptoms start to show up
Prodromal
Period in schizophrenia where symptoms are most noticeable
Active Stage
Last stage of schizophrenia, symptoms are waning
Residual
State of being symptomatic or unhealthy for a disease or condition
Morbidity
These symptoms account for substantial portion of the morbidity associated with schizophrenia but are less prominent in other psychotic disorders
Negative Symptoms
Term meaning a decrease in motivated self-initiated purposeful activities
Avolition
Term meaning a diminished speech output, lack of fluency of speech, speaking slower
Alogia
Term meaning a decreased ability to experience pleasure
Anhedonia
Term meaning an apparent lack of interest in social interactions
Asociality
Most common countertransference reactions when treating a client with schizophrenia
Fear; next are nurturance/pity/sympathy
The number one risk that comes with better insight in schizophrenia is what?
Suicide (demoralization; especially among)
Term meaning the experiencing of helplessness and hopelessness
Demoralization
Characteristics which are “added to” persons with psychosis that the typical person does not experience
Positive symptoms
Most common type of positive symptom in psychosis
Self-generated hallucinations
Characteristics which are normally present but are “taken away from” persons with psychosis
Negative symptoms
T/F: The DSM categorizes disorganized symptoms as positive.
True
Examples of this type of symptom in psychosis are alogia and amotivation
Negative Symptoms
Sensory experiences in the absence of any external stimuli
Hallucinations
All-encompassing, systemic, tightly-held beliefs related to a certain theme and are clearly false.
Delusions
Most common delusion theme
Persecutory
Second-most common delusion theme
Grandiose
Most common symptoms include: Hallucinations, Delusions, Social Withdrawal, Suspiciousness, Blunted Affect, Motor Retardation, Lake of insight
Psychosis
Type of psychotic disorder with diagnostic criteria that includes: 1+ positive/disorganized symptom(s) with duration of less than a month
Brief Psychotic D/O
Type of psychotic disorder with diagnostic criteria that includes: 1+ delusion with duration of 1 month or greater
Delusional D/O
Type of psychotic disorder with diagnostic criteria that includes: 2+ positive/negative symptoms with duration of 1-6 months
Schizophreniform D/O
Type of psychotic disorder with diagnostic criteria that includes: 2+ positive/negative symptoms with duration of greater than 6 months
Schizophrenia
Type of psychotic disorder that is the same as Schizophrenia with the addition of a mood disorder (depressive or manic) that is concurrent (occurring 50% or more of the time) with schizophrenic symptoms
Schizoaffective D/O
3 D/Os with childhood onset
ADHD, ODD, CD
1 possible definition includes: A neurological inefficiency in the area of the brain that controls impulses, and is the center of “executive functions”
ADHD
1 possible definition includes: A performance disorder, a problem of being able to produce or act upon desired behaviors
ADHD
1 possible definition includes: A psychological disorder involving reduced ability to control one’s thoughts and emotions
ADHD
1 possible definition includes: A biopsychosocial condition linking brain/body to toxins, environmental settings, psychological/social expectations and more
ADHD
ADHD LPR for the general population
3-7%
When is ADHD usually diagnosed?
When a child enters school
ADHD is diagnosed in what percentage of school-aged children?
4-12%
Male to female ratio for ADHD
3:1
Number of symptoms required to meet either Inattentive or Hyperactive ADHD presentations
6 (6 from each if both)
LPR of ODD
2-16%
T/F: In ODD, males may be more confrontational and have more persistent symptoms
True
T/F: In ODD, although prevalence rates for males and females are similar during middle adolescence, rates are higher for girls during pre-puberty and late adolescence
False, rates are higher for boys during pre-puberty and late adolescence
Defined as a recurrent pattern of “problem” behavior toward authority figures
ODD (Oppositional Defiant Disorder)
In this D/O, symptoms are more evident with peers or adults who know the individual well and may not be apparent during clinical interview/intake
ODD (Oppositional Defiant Disorder)
Individuals with this disorder usually do not see themselves the problem; they see others as placing unreasonable demands on them
ODD (Oppositional Defiant Disorder)
Disorder similar to ODD but is more egregious and dangerous
CD (Conduct Disorder)
LPR of CD
1-10%
Cluster of characteristics that can combine in individuals with CD
Sexual offenses, bed wetting, fire setting, cruelty to animals
ODD is a common precursor to this D/O and is rarely diagnosed after 16
CD
Adolescence is what age period
10-19
