Quiz 2

Question 1

what are the components of DO A CLIENT MAP?

Answer 1

Diagnosis, Objectives, Assessments, Clinician Characteristics, Location/Level of Care, Intervention, Emphasis, Numbers, Timing, Medication, Adjunct Services, Prognosis

Question 2

what does collaboration in treatment planning look like?

Answer 2

patient involvement in the treatment planning process increases the likelihood of adherence to the plan and objectives being met

Question 3

what factors should you be mindful of when drafting objectives?

Answer 3

patient’s perceptions of psychotherapy; patient’s expectations for treatment; patient’s preferences; resources; the language in which they’re written; target dates

Question 4

what are the considerations for determining the most appropriate level of care?

Answer 4

degree of functional impairment; nature/severity of symptoms; what’s likely to give the patient the most optimal care; goals of treatment; cost; support system; ability to keep appointments; nature and effectiveness of prior treatments

Question 5

what are the considerations for selecting interventions for a particular client?

Answer 5

diagnosis; symptoms; functional impairment; research on what’s shown efficacy with similar disorders and target populations; readiness to change; theoretical model used

Question 6

what is the transtheoretical model/stages of change?

Answer 6

precontemplation stage; contemplation stage; preparation stage; action stage; maintenance stage

Question 7

what is the precontemplation stage of the transtheoretical model?

Answer 7

client is unaware or under-aware of their problems; they have no intention to change behavior in the foreseeable future; they’re usually there for treatment because of pressure from others

Question 8

what is the contemplation stage of the transtheoretical model?

Answer 8

client is aware that a problem exists and is considering doing something to make a change but they haven’t made a commitment to do so

Question 9

what is the preparation stage of the transtheoretical model?

Answer 9

client might report some small behaviors toward change and they intend to take more substantial action in the very near future

Question 10

what is the action stage of the transtheoretical model?

Answer 10

there’s a considerable commitment to time and energy; modifications of behavior(s) are visible to others

Question 11

what is the maintenance stage of the transtheoretical model?

Answer 11

work to consolidate gains and prevent relapse

Question 12

what is the importance of matching interventions with current stage of change?

Answer 12

if treatment doesn’t match stage of change, it will likely not be effective for the client

Question 13

example(s) of problem statements?

Answer 13

John is experiencing obsessive thoughts and compulsive behaviors.

Question 14

example(s) of long-term goals?

Answer 14

John will experience a decrease in the frequency and intensity of obsessive thoughts and compulsive behaviors

Question 15

example(s) of short-term objectives?

Answer 15

John will refrain from engaging in compulsive behaviors or avoidance when confronted with anxiety-provoking situations by December 15, 2023.

Question 16

example(s) of interventions?

Answer 16

Weekly individual cognitive-behavioral therapy for 50 minutes with Michael D’Addona, Psy.D. Therapist will educate John about how engaging in compulsive behavior and avoidance reinforces anxiety.

Question 17

what are the factors that influence prognosis?

Answer 17

the nature/severity of the diagnosis/problems; patient’s motivation to make positive changes; patient’s level of intelligence; ability to tolerate frustration and delay gratification; history of successfully managing past difficulties; degree of resilience; psychosocial support; psychosocial problems; character/personality pathology

Question 18

what is the role of psychotherapy in disorders that seem largely biologically based?

Answer 18

there might not be an identifiable reason for the individual to be experiencing what they’re going through

Question 19

which situations would typically warrant a referral for psychiatric evaluation?

Answer 19

neurovegetative symptoms; risk of harm to self or others (e.g., suicidal ideation, present risk factors for suicidal ideation); psychosis or mania; substantial functional impairment

Question 20

what factors influence the appropriateness of psychopharmacologic treatment/referral for a medication consultation?

Answer 20

presence of sustained physiological symptoms; presence of patient factors that preclude a reasonable expected benefit from psychotherapy; severity of symptoms and associated functional impairment; presence of risk of harm or comorbid risk factors for suicide

Question 21

what is the role of the counselor with respect to psychopharmacologic treatments?

Answer 21

help patients understand potential side effects, the relapsing nature of the disorder, and that medication treatment will be 1 year or more; discuss premature termination of medication

Question 22

what are the concerns/cautions in the use of benzodiazepines and psychostimulants?

Answer 22

benzos = don’t address obsessional symptoms well; anxiety symptoms might come back when medication is reduced or discontinued; may impede progress in therapy; potential for addiction, dependence, and physiological dependence can develop over many weeks; withdrawal; possibility of grand mal seizure if there’s sudden discontinuation; long-term use should be slowly tapered off; caution with patients that have a personal/family history of substance abuse

psychostimulants = risk of abuse

Question 23

what are the types of extrapyramidal side effects (EPS)?

Answer 23

parkinson-like: muscular rigidity, flat affect, tremor, slowed motor responses, need to be distinguished from negative symptoms

akathesia: uncontrolled state of inner restlessness, must be distinguished from anxiety

acute dystonias: muscle spasms, prolonged muscular contractions

tardive dyskinesia: usually late onset, serious and often irreversible, involuntary sucking/smacking movements of mouth and lips, may include involuntary movements of the trunk and extremities, not only causes the syndrome but tends to mask it

Question 24

what is agranulocytosis?

Answer 24

depletion of white blood cells

Question 25

what medication is particularly associated with the risk of developing the syndrome of agranulocytosis?

Answer 25

antipsychotics

Question 26

what are the principles of change for depression and bipolar disorder?

Answer 26

depression = challenging cognition and behavior; increasing positive reinforcements and decreasing negative reinforcements; improving interpersonal functioning; improving marital, family, and social environments; fostering emotional awareness, acceptance, and regulation; treatment is structured and focused

bipolar = improve awareness of symptoms; increase motivation for medication adherence; increase treatment engagement; reduce risk factors for episodes; improve family functioning; develop plans to foster an appropriate support network; promote regular sleep and activity cycles; diminish excessive engagement in overly ambitious goal pursuits; practice self-calming skills after goal attainment events; address interpersonal stress and social isolation; address maladaptive thoughts

Question 27

what are the phases of treatment for bipolar disorders?

Answer 27

acute –> if psychotherapy is attempted: structured and concrete; short, frequent sessions focusing primarily on behavior

stabilization –> relapse prevention plan - address medication noncompliance and failure to recognize early signs of relapse; use of collaborative care contracts // educate the family // individual psychotherapy

maintenance –> maintaining recovery/preventing episode relapse; adjunct treatment

Question 28

what are the lifestyle management factors that could help prevent episode relapse and maintain mood stability in bipolar disorders?

Answer 28

regular bed times and times for awakening; avoiding sleep deprivation; avoiding shift work; trying to keep bright light exposure stable throughout the year; avoiding alcohol and illicit drugs; avoiding stimulating substances and those that interfere with sleep such as caffeine

Question 29

which classes of medication are usually associated with the treatment of anxiety disorders, depressive disorders, bipolar disorders, psychosis, OCD, and ADHD?

Answer 29

antidepressants = depressive disorders, anxiety disorders, OCD

buspirone = anxiety disorders

benzodiazepines = anxiety disorders

mood stabilizers = bipolar disorders

antipsychotics = psychosis and bipolar 2nd gen

psychostimulants = ADHD

Question 30

antidepressants? (in relation to depressive disorders, anxiety disorders, and OCD)

Answer 30

often first line medication treatment for anxiety

anti-obsessional effects (SSRIs and clomipramine)

SSRIs may lead to increased anxiety as a side effect during the first few weeks of treatment

panic disorder: usually lower initial doses and slower upward titration

OCD: higher doses compared to treatment of depression (primarily SSRIs, although TCA clomipramine [anafranil] could be used)

Question 31

buspirone? (in relation to anxiety disorders)

Answer 31

not habit forming, no abuse potential

safety profile comparable to SSRIs

requires 3-6 weeks of daily use to achieve max anxiolytic effect

usually need to increase dose gradually to 30-60mg per day to produce max effect

efficacy for GAD and as an adjunct to antidepressants for depression

doesn’t block panic attacks, not effective as a primary treatment for OCD, PTSD, or social anxiety disorder

Question 32

benzodiazepines? (in relation to anxiety disorders)

Answer 32

effects: anxiolytic, sedative (at a higher dose), muscle relaxant, anticonvulsant

may be used with antidepressants, which take longer to show therapeutic effects

quick-acting, can be useful for occasional panic attacks

continuously a week or more for GAD

doesn’t address obsessional symptoms well

symptoms of anxiety may return when the meds are reduced or discontinued

could facilitate or impede progress in therapy

sedative properties – caution in older patients

potential for addiction, dependence

physiological dependence can develop over many weels

Question 33

mood stabilizers? (in relation to bipolar disorders)

Answer 33

lithium, depakote, lamictal, topamax, tegretol, trileptal

Question 34

antipsychotics? (in relation to psychosis and bipolar 2nd gen)

Answer 34

atypical (2nd gen) antipsychotics have mood stabilizing properties and are commonly used in treatment of BPD

Question 35

1st gen (typical) versus 2nd gen (atypical) antipsychotics?

Answer 35

similar efficacy

clozapine requires routine bloodwork before it’s given due to elevated risk of agranulocytosis (rapid depletion of white blood cells)

need to try some other antipsychotics that failed before trying clozapine

weekly for first 6 months, biweekly for next 6 months, monthly after that (regarding bloodwork)

atypical antipsychotics are typically better tolerated

first gen antipsychotics typically carry greater EPS risks compared to second gen

second gen antipsychotics typically carry greater metabolic risks than first gen

Question 36

primary side effects of antipsychotics?

Answer 36

sedation, anticholinergic (drying), extrapyramidal, weight gain, metabolic

Question 37

psychostimulants? (in relation to ADHD)

Question 38

which diagnoses have shown only a partial response to medication?

Answer 38

personality disorders and delusional disorders

Question 39

which disorders almost always require medication as an essential part of treatment?

Answer 39

schizophrenia spectrum and psychotic spectrum disorders; bipolar, ADHD (depending on severity), and major depressive disorder (double check about this)

Question 40

what factors suggest that medication may be indicated for addressing depression?

Answer 40

severe depression (psychotherapy could be just as effective as meds for mild to moderate depression); sustained physiological symptoms or vegetative symptoms (could indicate underlying biochemical dysfunction); patient factors that preclude a reasonable expected benefit from psychotherapy; severe symptoms and functional impairment; elevated risk of harm/comorbid risk factors for suicide

Question 41

what are the effectiveness levels and side effects among the antidepressant classes for the treatment of depressive disorders?

Answer 41

monoamine oxidase inhibitors (MAO-I): first class of antidepressants; interact with certain meds and foods resulting in a hypertensive crisis that can be fatal; often only considered as a 3rd or 4th line treatment choice

cyclics: affect neurotransmission of serotonin and norepinephrine; a 2-week supply of MAO-Is or TCAs can be lethal

selective serotonin reuptake inhibitors (SSRIs): no more effective than TCAs or MAO-Is but side effects are considerable less severe; greater margin of safety; interact with fewer meds; safer for patients with suicide risk

serotonin and norepinephrine reuptake inhibitors (SNRIs):

atypicals: