Quiz 2 Flashcards
what are the components of DO A CLIENT MAP?
Diagnosis, Objectives, Assessments, Clinician Characteristics, Location/Level of Care, Intervention, Emphasis, Numbers, Timing, Medication, Adjunct Services, Prognosis
what does collaboration in treatment planning look like?
patient involvement in the treatment planning process increases the likelihood of adherence to the plan and objectives being met
what factors should you be mindful of when drafting objectives?
patient’s perceptions of psychotherapy; patient’s expectations for treatment; patient’s preferences; resources; the language in which they’re written; target dates
what are the considerations for determining the most appropriate level of care?
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
what are the considerations for selecting interventions for a particular client?
diagnosis; symptoms; functional impairment; research on what’s shown efficacy with similar disorders and target populations; readiness to change; theoretical model used
what is the transtheoretical model/stages of change?
precontemplation stage; contemplation stage; preparation stage; action stage; maintenance stage
what is the precontemplation stage of the transtheoretical model?
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
what is the contemplation stage of the transtheoretical model?
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
what is the preparation stage of the transtheoretical model?
client might report some small behaviors toward change and they intend to take more substantial action in the very near future
what is the action stage of the transtheoretical model?
there’s a considerable commitment to time and energy; modifications of behavior(s) are visible to others
what is the maintenance stage of the transtheoretical model?
work to consolidate gains and prevent relapse
what is the importance of matching interventions with current stage of change?
if treatment doesn’t match stage of change, it will likely not be effective for the client
example(s) of problem statements?
John is experiencing obsessive thoughts and compulsive behaviors.
example(s) of long-term goals?
John will experience a decrease in the frequency and intensity of obsessive thoughts and compulsive behaviors
example(s) of short-term objectives?
John will refrain from engaging in compulsive behaviors or avoidance when confronted with anxiety-provoking situations by December 15, 2023.
example(s) of interventions?
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.
what are the factors that influence prognosis?
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
what is the role of psychotherapy in disorders that seem largely biologically based?
there might not be an identifiable reason for the individual to be experiencing what they’re going through
which situations would typically warrant a referral for psychiatric evaluation?
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
what factors influence the appropriateness of psychopharmacologic treatment/referral for a medication consultation?
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
what is the role of the counselor with respect to psychopharmacologic treatments?
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
what are the concerns/cautions in the use of benzodiazepines and psychostimulants?
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
what are the types of extrapyramidal side effects (EPS)?
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
what is agranulocytosis?
depletion of white blood cells
what medication is particularly associated with the risk of developing the syndrome of agranulocytosis?
antipsychotics
what are the principles of change for depression and bipolar disorder?
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
what are the phases of treatment for bipolar disorders?
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
what are the lifestyle management factors that could help prevent episode relapse and maintain mood stability in bipolar disorders?
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
which classes of medication are usually associated with the treatment of anxiety disorders, depressive disorders, bipolar disorders, psychosis, OCD, and ADHD?
antidepressants = depressive disorders, anxiety disorders, OCD
buspirone = anxiety disorders
benzodiazepines = anxiety disorders
mood stabilizers = bipolar disorders
antipsychotics = psychosis and bipolar 2nd gen
psychostimulants = ADHD
antidepressants? (in relation to depressive disorders, anxiety disorders, and OCD)
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)
buspirone? (in relation to anxiety disorders)
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
benzodiazepines? (in relation to anxiety disorders)
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
mood stabilizers? (in relation to bipolar disorders)
lithium, depakote, lamictal, topamax, tegretol, trileptal
antipsychotics? (in relation to psychosis and bipolar 2nd gen)
atypical (2nd gen) antipsychotics have mood stabilizing properties and are commonly used in treatment of BPD
1st gen (typical) versus 2nd gen (atypical) antipsychotics?
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
primary side effects of antipsychotics?
sedation, anticholinergic (drying), extrapyramidal, weight gain, metabolic
psychostimulants? (in relation to ADHD)
which diagnoses have shown only a partial response to medication?
personality disorders and delusional disorders
which disorders almost always require medication as an essential part of treatment?
schizophrenia spectrum and psychotic spectrum disorders; bipolar, ADHD (depending on severity), and major depressive disorder (double check about this)
what factors suggest that medication may be indicated for addressing depression?
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
what are the effectiveness levels and side effects among the antidepressant classes for the treatment of depressive disorders?
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:
