MH Final Study Guide
100 questions, multiple choice
Anything in blue is something I believe will be on the final
● History of DSM
○ have general idea of how DSM originated and evolved, number of
diagnoses increased with each revision
● DSM-5 (since 2013)
○ Provides a common language amongst interdisciplinary team (doctors,
MH counselors, psychologists, etc.)
○ Necessary for reimbursement
○ Need to diagnose before treatment
○ DOES NOT RECOMMEND TREATMENT/INTERVENTION
○ Be mindful of the power of a diagnosis
■ Dr. Matis errs on lighter Dx at first, as long as client is not
dangerous to self/others, in order for her clients to access same
levels of treatment
○ “Rule-Out”
■ Looking to rule-out certain diagnoses
○ Electronic health record
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Guidelines not like “bible” …imperfect
Manual reflects “current science”
Not to be used as cook-book
Combined with ICD-10 (International Classification of Disorders)
Pros: uniform language, improved diagnosis, all we have
Cons: lead to stigmatizing labels, limited psychosocial information, no
guidelines for intervention
● DSM-5 Diagnostic Categories
○ Neurodevelopmental disorders
○ Schizophrenia Spectrum and Other Psychotic Disorders
○ Bipolar and Related Disorders
○ Depressive Disorders
○ Anxiety Disorders
○ Obsessive Compulsive and Related Disorders
○ Trauma- and Stressor-Related Disorders
○ Dissociative Disorders
○ Somatic Symptom and Related Disorders
○ Feeding and Eating Disorder
○ Elimination Disorders
○ Sleep-Wake Disorders
○ Sexual Dysfunctions
○ Gender Dysphoria
○ Disruptive, Impulse-Control, and Conduct Disorders
○ Substance-Related and Addictive Disorders
○ Neurocognitive Disorders
○ Personality Disorders
○ Paraphilic Disorders
○ Other Mental Disorders
● Diagnosis and Assessment
● How are they related:
○ All diagnoses have assessments; not all assessments have diagnoses
■ Assessment- gathering information (ONGOING)
■ Diagnosis- Taking the assessment information to properly
diagnosis a client.
● “The process of identifying a problem (social, mental,
medical)...and its underlying causes and formulating a
solution”
● Principal Diagnosis
○ is to be used when more than one diagnosis for an individual is given in
most cases as the main focus of attention or treatment:
○ The Principal diagnosis is often harder to identify when a
substance/medication related disorder is accompanied by a nonsubstance-related diagnosis since both may have contributed equally to
the need for admission or treatment.
○ Principal diagnosis is listed first
■ the term "Principal diagnosis" follows the diagnosis name
■ Remaining disorders are listed
● in order of focus of attention and treatment
○ Comorbidity- more than one mental health diagnosis at once
■ 52-92% of clients
■ Often with anxiety and depression
■ Be cautious when there are too many diagnoses
● Ex) OCD falls under anxiety
○ Dual diagnosis- mental health and substance abuse
○ Labels are for jars, not for people
■ Never reduce people to diagnosis
● Person first language
○ Ex: A student with anxiety, a child with autism, etc.
■ Diagnosis can help with others feeling less alone, learning that
others also have similar conditions
● Assessment Considerations:
○ Self-awareness
○ Cultural awareness
○ Ethnocentrism (having a difficult time seeing outside of your own
perspective/norms)
○ What was said/not
○ Self-reporting
○ Strengths-based
○ Past, present and future
○ Biopsychosocial & spiritual
○ Person in environment (PIE)
■ All systems
■ Problems in social functioning, ADLs (activities of daily living),
social roles
○ Social and environmental factors
■ Social (those they pay)/societal help-seeking
■ Occupational participation
■ Social support
■ Family support
■ Ethnic/religious affiliation
■ ADLs
■ Environment
■ Cultural considerations
● Completing a Diagnostic Assessment
○ Formulating facts
○ Tentative hypothesis
○ ONGOING
○ Think about influencing factors (culture)
○ Examine information
■ Said (verbal and nonverbal)
■ Unsaid
■ Accuracy?
○ Accurate definition of the problem
■ Operational definition of problem
● Examples
■ Time frame
■ Changes (good, bad, indifferent)
○ Client beliefs
■ Impact of the interpretation of the problem
○ Client Culture
■ Cultural humility
■ Intersectionality
●
■ Cultural Formulation Interview (CFI)
● 16 questions to understand impact of culture, improve
sensitivity/understanding
○ Cultural concepts of distress
○ Diversity of presentation
■ Ex: social anxiety
● Prevalence varies from Asia (less) to US
(more)
○ Generally, in Asia people are
more concerned with causing
embarrassment vs being
embarrassed while in the US
(and most Western societies) we
are concerned with both
■ “Nervous attacks” common in Latin America,
similar to dissociative disorder, panic attacks,
convulsions
■ Differences in symptomatology
● Cultural variations in symptomatology
■ 3 interviews
● 1) general
● 2) for informants
● 3) supplementary/in depth/modules
● (For children, immigrants, refugees,
etc.)
■ Enhancing communication w clients
■ Be flexible within model
○ Client Strengths
■ Strengths based perspective
● Values based, resilient, collaborate with clients
■ Resources
■ Resourcefulness
● “When there’s a will there’s a way”
■ Avoid focusing on deficits
■ Collaborate WITH Clients
■ Empower
● Completing a Diagnostic Assessment
○ BIOPSYCHOSOCIALSPIRITUAL
○ Biomedical info
■ Medical conditions (current/past, chronic/acute, meds?)
■ Perceived health status
■ Maintenance and continued health and wellness
○ Psychological info
■ Mental functioning
■ MENTAL STATUS EXAM CONSISTS OF
● Appearance
● Behavior
● Speech
● Mood
● Affect/Presentation
● Thought Process
● Thought Content
● Cognition
● Insight/Judgment
(Example MSE)
● Mental status
○ Appearance
■ Clothing, grooming, body habits, scars,
posture, odor, tattoos/piercings, religious
symbols/attire, anything out of place or a
change (make COMMENT in notes)
○ Behavior
■ Level of agitation (calm, cooperative, irritable,
impatient, angry, sleepy, etc)
■ Psychomotor agitation or retardation
■ Eye contact, gait, tremor
○ Speech
■ Rate, rhythm, volume, content
○ Mood
■ Emotional state
■ Self-reported
○ Affect/Presentation
■ Dysphoric (sad)
■ Eurythmic (neutral)
■ Euphoric (happy)
■ Anxious, irritable, excited, annoyed, frustrated?
■ BROAD (can change in assessment)
○ Thought process
■ (How client gets from question to answer)
● Tangential
○ A to C to F to C to A
● Linear
○ Makes sense A → B
● Flight of ideas
○ A string of unconnected tangents
● Word salad
○ Words all over the place
● Clanging
○ Words linked/all together
● Loosening of association
○ a string of loosely related
thoughts/tangents
○ Thought content
■ Hallucinations
● SENSORY
○ usually auditory or visual
■ Delusions
● Fixed, false beliefs firmly held in spite of
contradictory evidence
○ Control: outside forces are
controlling actions
○ Erotomanic: a person, usually of
higher status, is in love with the
patient
○ Grandiose: inflated sense of selfworth, power or wealth
○ Somatic: patient has a physical
defect
○ Reference: unrelated events
apply to them
○ Persecutory: others are trying to
cause harm
○ Cognition
■ Executive function
■ Language
■ Memory
■ Recognition
■ Coordination
■ Level of attention
○ Insight & Judgement
■ Insight
● An awareness of one’s own situation or
condition
■ Judgment
● The ability to anticipate the
consequences of one’s behavior and
make decisions that protect oneself and
others in the context of one’s own moral
compass
○ Social and Environmental Factors
■ Social/societal help-seeking
● Social- those paid to be in their life
● Societal- family, friends, peers
■ Occupational participation
■ Social and Family support
■ Ethnic/religious affiliation
○ Important considerations
■ ADLs (activities of daily living)
■ Environment
■ Cultural considerations
● Documentation
○ If you did not DOCUMENT it, it didn’t happen
○ SOAP NOTES
■ Subjective
■ Objective
■ Assessment
■ Plan
○ SMART Objectives
■ Specific
■ Measurable
■ Attainable
■ Relevant
■ Timely
○ Goals
■ Big and broad
■ Objectives are what are smart
Basic Medical Terminology
(ALWAYS RULE OUT MEDICAL)
● Acute- of abrupt onset, in reference to a disease
● Anhedonia- loss of the capacity to experience pleasure
○ The inability to gain pleasure from normally pleasurable experiences
○ Anhedonia is a core clinical feature of depression, schizophrenia, and
some other mental illnesses.
● Chronic- lasting a long time
○ A chronic condition is one that lasts 3 months or more
○ Chronic diseases are in contrast to those that are acute (abrupt, sharp,
and brief) or subacute (within the interval between acute and chronic)
● Comorbid-refers to a disease or condition that occurs at the same time as
another illness
● Compulsion- powerful impulse
○ a recurrent, unwanted, and distressing urge to perform an act
○ a compulsive act or ritual; a repetitive and stereotyped action that is
performed to ward off some untoward event, although the patient
recognizes that it does not do so in any realistic way
○ it serves as a defensive substitute for unacceptable unconscious ideas or
impulses
■ Failure to perform the compulsive act gives rise to anxiety and
tension
○ Common compulsions involve hand-washing, touching, counting, and
checking
● Delusions- fixed false beliefs
○ strongly held belief despite evidence that the belief is false
● Dementia- umbrella term- impairment of attention, orientation, memory,
judgment, language, motor and spatial skills, and function
○ All cases of Alzheimer's have Dementia
○ Mental disorder or disability
○ Deals with intellect, memory, and judgment
● Encopresis- voluntary and involuntary inability to control the elimination of stool
● Enuresis- voluntary and involuntary urinary incontinence
○ wetting whether in the clothing during the day or in bed at night
● Etiology- cause, origin specifically
○ the cause of a disease or abnormal condition
● Hallucination- absence of stimuli, but still believe something is there (auditory,
touch, visual, smell, taste)
○ a profound distortion in a person's perception of reality, typically
accompanied by a powerful sense of reality
○ A hallucination may be a sensory experience in which a person can see,
hear, smell, taste, or feel something that is not there
● Magical Thinking- the belief that one's ideas, thoughts, actions, words, or use of
symbols can influence the course of events in the material world
● Somatic- of, relating to, or affecting the body
● Tardive dyskinesia- causes stiff, jerky movements of your face and body that you
can't control (often caused by side effects of antipsychotics)
Defense Mechanisms
● Ways to cope/self protect
○ DO NOT want to TAKE AWAY a defense without REPLACING
(LOOK IN SHARED FOLDER FOR BLANK QUIZZES TO USE FOR PRACTICE)
Understand examples that are different for test
○ Repression- going to hold it all in/stuff it down
■ ex) Monica’s closet on friends
■ an unconscious defense mechanism to keep disturbing or
threatening thoughts from becoming conscious.
■ Forgetting something bad, like an unpleasant experience, in the
past, such as a car accident or type of trauma
○ Regression- acting at different developmental level than what is
appropriate
■ reverting to an earlier stage of development usually in response to
stressful situations.
■ Functions as form of retreat, enabling a person to psychologically
go back in time to a period when the person felt safer.
■ When we are troubled or frightened, our behaviors often become
more childish or primitive.
● A child may begin to suck their thumb again or wet the bed
when they need to spend some time in the hospital.
○ Reaction Formation- take true thoughts, push them down, have
OPPOSITE (different) reaction
■ when a person goes beyond denial and behaves in the opposite
way to which he or she thinks or feels.
■ ex) I really love this boy, but I can’t show him so I’ll punch him
○ Rationalization- justifying, making things make sense (even when they
really don’t)
■ We do it often enough on a fairly conscious level when we provide
ourselves with excuses
● Ex) I got an F on that paper because the professor doesn’t
like me
○ Displacement- taking out feelings on inappropriate individual/situation
■ Displaced feelings onto someone/something else
● The target can be a person or an object that can serve as a
symbolic substitute
● Ex) You hate your mother (but that is
unwanted/unacceptable) so you “believe” that she hates you
○ Sublimation- similar to displacement, take inappropriate/unacceptable
feelings, drives, and urges, and find HEALTHIER and more SOCIALLY
ACCEPTABLE ways to express
■ Ex) Feelings of anger- turns to boxing
■ Many great artists and musicians have had unhappy lives and have
used the medium of art of music to express themselves.
○ Projection- projecting unwanted thoughts, feelings and motives (about
self) onto another person.
■ Someone who is cheating on their husband accuses him of being
adulterous
Cognitive and Behavioral Therapy (CBT)
● Time-sensitive
● Present-oriented
● Goal-directed
● CBT helps with automatic negative thoughts (ANTS) through providing evidence
for/against (see worksheet)
○ ANTS
■ Negative
■ Make you feel bad about yourself
■ Self-sabotaging
■ Uninvited
■ Biased
Understand process of the CBT worksheet
Trauma and Stressor-Related Disorders
● “Normative Stress Reaction”- 2-3 days
● Definition of trauma: the occurrence of emotionally traumatic events that
overwhelms an individual
● We, as social workers and individuals, need to know about trauma as it is
EXTREMELY common and need to be trauma informed
○ Adverse Childhood Experience (ACE) Study
■ Over 17,000 Participants
■ ACEs CAN affect an individual’s physical and emotional health
throughout the life-span
■ Trauma/traumatic experiences are FAR more prevalent than
previously recognized
● Trauma requires a trigger event(s)
● Trauma is an experience that overwhelms the victim and can leave the victim
with a changed perspective of the world and a loss of feeling safe
○ Two Types of Trauma:
■ Type 1: Simple trauma
● Single event lasts a short time
■ Type 2: Complex trauma
● Repeated such as bullying, or family violence
○ Is subjective, in how someone responds
■ Trauma responses include activation of survival responses
(fight,flight,freeze), hyperarousal, re-experiencing (flashbacks),
avoidance/withdrawal, feelings of helplessness/hopelessness
○ Trauma can affect emotions, body and behaviors
● Prolonged exposure to trauma/traumatic events MAY
○ Cause an individual’s natural alarm system to no longer function as it
should
○ Create emotional and physical responses to stress
○ Result in emotional numbing and psychological avoidance
○ Effect an individuals’ sense of safety and capacity to trust others
● Trauma and the Brain
○ “Hand brain”
■ Limbic system (fist) “EMOTIONAL BRAIN”
● Emotions stored
■ Prefrontal cortex (4 fingers) “RATIONAL BRAIN”
● Rational, problem solving, executive functioning, logical
○ VERY difficult to use limbic system and prefrontal cortex at same time
○ Psychoeducation to individual (at any age- “lizard vs wizard” brain) is
extremely helpful and affirming
■ “You’re not crazy”
○ DIFFERENCE between TRAUMA and TBI (traumatic brain injury)
● Impact of Trauma
○ Dependent on several factors including
■
■
■
■
■
Magnitude of the event
Past experiences (how many times exposed)
Nature of the exposure
Protective factors of the individual
SUPPORT SYSTEM (even 1 person)
Reactive attachment disorder (RAD)- PRIOR TO 5 years old
● a condition in which an infant or young child does not form a secure, healthy
emotional bond with his or her primary caretakers (parental figures).
● Children with RAD often have trouble managing their emotions. They struggle to
form meaningful connections with other people.
○ Avoids comfort from caregiver (when comfort is provided, they may
respond minimally or appear distressed)
○ Flat blunted affect, unpredictable bouts of anxiety, sadness, and irritability
○ In the past, the child did not receive adequate caregiving/response to
needs MISTRUST
Disinhibited social engagement disorder● New to DSM-5
● Childhood DO, early onset
● an attachment disorder that consists of "a pattern of behavior in which a child
actively approaches and interacts with unfamiliar adults."
● Significantly impairs young children’s abilities to relate interpersonally to adults
and peers.
Post-Traumatic Stress Disorder (PTSD)- A person experiences what they perceive to
be a traumatic event
● Direct personal experience
● Vicarious trauma
○ Witnessing of learning about events
○ Hazard of helping professions
Adjustment Disorders
● Occur in relation to an identifiable stressor
● Onset within 3 MONTHS of the stressor
● When the response does not match the intensity of the stressor
● Criteria for another category is not met
● IF it lasts LONGER THAN 6 MONTHS- the diagnosis should be
RECONSIDERED
Trauma Informed Care
● Aims to avoid re-victimization
● Appreciated many problem behaviors as understandable attempts to cope
● Strives to maximize CHOICES for the survivor and CONTROL over the healing
process
● Model of treatment (move through at CLIENTS pace)
○ Safety and Stabilization
○ Processing of Traumatic Material
○ Reconnection and Reintegration
● Specific types of treatment include EMDR and Trauma-focused- CBT
Resilience
● The ability to bounce back
● Aligns with the strengths perspective
● Various risk and protective factors
Post-traumatic Growth
● Increased sense of personal strengths
● Strengthening of relationships/sense of connection
● Awareness of increased possibilities
FROM YOUTH MENTAL HEALTH FIRST AID BOOK
● Signs and Symptoms of Major Depressive Disorders
❏ An unusually sad mood
❏ Loss of enjoyment and interest in activities that was previously
enjoyable
❏ Lack of energy and tiredness
❏ Feeling worthless or guilty when they are not really at fault
❏ Thinking about death or wishing to be dead
❏ Difficulty concentrating or making decisions
❏ Moving more slowly or sometimes become agitated and unable to
settle
❏ Having sleeping difficulties or sleeping too much
❏ Loss of interest in food or sometimes eating too much
❏ Changes in eating habits, which may lead to either weight loss or
weight gain
At home, young people may
❏ Complain of tiredness, even if they are sleeping more than
usual
❏ Have difficulty doing household chores, either forgetting to
do them or not doing them thoroughly
❏ Withdraw from family, spending a great amount of time in
their bedroom
❏ Snap at family members, behave irritably, or pick fights with
parents or siblings
❏ Avoid discussing important future events, such as decisions
about further education or work opportunities
In school, young people may
❏ Show a decline in school grades because they do not
complete work, do not do as good a job as they used
to do, or miss school
❏ Fail to engage in classroom discussions or struggle to
understand and communicate
❏ Snap at or start fights with other students or engage
in vandalism
❏ Struggle to work effectively in the morning, but do
better in late afternoon classes
These symptoms can all have an impact on school
achievement. Some may result in disciplinary
responses. Teachers may also notice that a student
chooses topics such as depression, suicide, or selfinjury to write about in health or social science
classes or as the subject for creative writing or art.
In a social setting, young people may
❏ Avoid spending time with friends altogether
❏ Spend more time with friends who appear to be
depressed as well
❏ Become ostracized from their usual social
group, either because they continually refuse
invitations or friends find the individual difficult
to spend time with
❏ Use alcohol or other drugs to deal with
emotional symptoms
Many of the major symptoms of depression in
youth and adults are also symptoms of
depression in very young children. Children
younger than age 12 with depression may
show aggressive behaviors, be more fearful of
new people and challenges, or show delays or
regression in important developmental
milestones.
Signs and Symptoms of Anxiety
❏ Pounding heart, chest pain, rapid heartbeat, and blushing
❏ Rapid, shallow breathing, and shortness of breath
❏ Dizziness, headache, sweating, tingling, and numbness
❏ Choking, dry mouth, stomach pains, nausea, vomiting, and
diarrhea
❏ Muscle aches and pains (especially neck, shoulders, and
back), restlessness, tremors, and shaking
Psychological
❏ Unrealistic or excessive fear and worry (about past
and future events)
❏ Racing thoughts or mind going blank
❏ Decreased concentration and memory
❏ Indecisiveness
❏ Irritability
❏ Panic attack. Anxiety can also vary in how long it lasts
from a few moments to many years.
❏ An anxiety disorder differs from normal anxiety in the
following ways:
❏ It is more severe
❏ It is long lasting
❏ It interferes with the person’s studies, other activities,
and family and social relationships
❏ Impatience
❏ Anger
❏ Confusion
❏ Feeling on edge
❏ Nervousness
❏ Sleep disturbance
❏ Vivid dreams
Behavioral:
❏ Avoidance of situations
❏ Obsessive or compulsive behavior
❏ Distress in social situations
❏ Phobic behavior
❏ Increased use of alcohol or other drugs
The symptoms are similar in both adults and youth.
Some anxiety symptoms are particularly common in
youth. These symptoms include worry in general, but
particularly worry about what others think of them,
fear in social situations, and anxiety about past
imperfections.
ALGEE● Action Plan for Youth Mental Health : ALGEE
○ Assess for risk of suicide or harm
○ Listen non judgmentally
○ Give reassurance and information
○ Encourage appropriate professional help
○ Encourage self help and other support strategies
● Helpful to us professionally/personally
● Useful to teach others
ANXIETY DISORDERS
● Different types, times, duration, etc.
● More than “normal” stress and worry
● Separation Anxiety- persistent and consistent excessive worry about being
separated or losing attachment (Children has to be present for 4 weeks) (Adults
has to be present for 6 months) Children experience nightmares and somatic
conditions/ Child not wanting to leave
● Selective mutism- consistent failure to speak in specific social situations, can
speak, but have anxiety, not shyness, or a lack of language
● Specific phobia- Explicit marked and intense fear of something/ Brings up fear
and anxiety, persistent and consistent/ Panic like or panic attacks
● Social anxiety- Fear about social situations and perceive other people are
judging, social situations avoided/ Present for 6 months (Performance
only/speaking in public)
● Panic disorder- symptoms similar to a heart attack, heart palpitations,
accelerated heart rate, sweating/recurring panic attacks-subjective
● Agoraphobia- Own diagnostic code/ Own classification, using public
transportation, being in public or closed spaces. Lines or crowds, being outside
or home alone
● Generalized anxiety- GAD, excessive anxiety of worry more days than not for
more than 6 months/ Control the worry, restlessness, fatigue, irritability, sleep
disturbances, Anxious-Up Depression- Down / Cycle through over and over
again/ Good assessment is ongoing assessment
Symptoms of a Panic Attack
● Pounding heart
● Rapid heartbeat
● Chest pain,discomfort
● Sweating
● Chills or hot flashes
● Trembling or shaking
● Numbness or tingling
● Shortness of breath
● Dizziness
● Nausea
Schizophrenia Spectrum and Other Psychotic Disorders
● The key to determine diagnosis for Schizophrenia is TIME.
○ All three diagnosis have the exact same symptomatology (MEMORIZE IN
ORDER OF TIME)
■ Schizophrenia-symptoms must last six months or more
■ Schizophreniform-symptoms must last longer than one month but
shorter than six months
■ Brief Psychotic Episode-symptoms last less than a month
■ Hallucinations (auditory, visual)
■ Delusions (false personal belief that does not change)
■ Thought Disorders
● difficulty processing thoughts
■ Disorders of movement
● involuntary movements, odd facial expressions, repetition of
movement, catatonia (immobility)
■ Negative symptoms
● A loss or decrease in ability to do things
■ Cultural Considerations
■ Fearful
■ Withdrawn
■ Difficulty having relationships with others
■ Early 20’s age of onset
Depressive Disorders
● Diagnosis depends on
●
●
●
●
●
●
●
○ DURATION
○ TIMING
○ PRESUMED ETIOLOGY (CAUSE)
Exogenous- external trigger (environmental/situational)
○ ex) a breakup, death, loss of job, etc.
Endogenous-internal trigger (symptoms related directly to biological factors)
○ ex) chemical imbalance, neurotransmitter dysfunction, etc.
Disruptive Mood Dysregulation DO
○ New to DSM-5
○ Addressing increase in childhood bipolar diagnoses
○ Children 7-18
○ Irritability that is persistent, severe & continuous
■ Irritable and angry moods that are more than age appropriate
temper tantrums
■ Behaviors must be significantly out of proportion to the antecedent
■ Must involve verbal outburst and rage or behavioral manifestations
■ Collateral information is necessary
● Parents, teachers, others
Premenstrual Dysphoric DO
○ New to DSM-5
○ Women who have severe depressive symptoms, irritability and tension
before menstruation
Substance/Medication-Induced Depressive DO
Depressive DO due to Medical Condition
Leading cause of disability worldwide
Category of symptoms-affect emotions, thinking, behavior and physical factors
○ Idiosyncratic
■ Based on various factors
● Life stage
● Gender
○ In males, depressive symptoms can be masked as
anger
■ Self-Reporting
● Based on client interpretation
● Over or understated
● SUBJECTIVE experience
○ Leading cause of disability worldwide
Major Depressive Disorder
○ MUST HAVE TOTAL OF 5 SYMPTOMS:
■ 1) Depressed mood
■ 2) Markedly diminished interest or pleasure
○ AND 3 of THESE for AT LEAST 2 WEEKS
■ Appetite changes (increase or decrease)
■ Sleep disturbances (increase or decrease)
■ Psychomotor agitation
■ Fatigue or loss of energy
■ Feelings of worthlessness or guilt
■ Diminished concentration or indecisive thoughts
■ Recurrent thoughts of death
● Persistent Depressive Disorder (AKA Dysthymia)
○ 2 YEARS OR LONGER
○ 1 year (for kids)
○ Early/late onset 21 years old
● Combination of THERAPY and MEDICATION most EFFECTIVE treatment for
depression
● Age of consent for mental health treatment in PA: 14
○ NO age of consent for Drug & alcohol Tx
● Brain doesn't fully develop until mid 20s
Neurodevelopmental Disorders
● Abnormalities in brain development
● Affecting
○ Emotion, learning, ability, self control, memory
● Categories:
○ Intellectual disabilities
■ Significant impaired cognitive functioning & deficits in adaptive
functioning
○ Communication DO
■ Language, speech, childhood fluency (stutter), social (pragmatic)
communication DO, Unspecified, Other
○ Autism Spectrum DO
■ A range from low to high functioning (Aspergers)
○ Specific Learning DO
■ Developmental Coordination DO
■ Stereotypic Movement DO
○ Tic DO
■ Tourette’s DO
■ Persistent Motor or Vocal Tic DO
■ Provisional Tic DO
■ Other Specified
■ Unspecified
○ Other
● Autism
○ Severe deficits/impairments in social communication and social interaction
across multiple contexts and
○ Restricted, repetitive patterns of behavior, interests, or activities
○ “Normal” Growth & Development:
■ Progressive increase in skill or capacity
■ Observations
■ Continuous process
■ Predictable sequence
■ Varying rates
■ Individual uniqueness
○ Levels of autism
■ Severity is based on social communication impairments and
restricted, repetitive patterns of behavior (refer to table)
■ Level 1● Requiring support
■ Level 2● Requiring substantial support
■ Level 3● Requiring very substantial support
Substance Abuse Disorders
● Opioid epidemic (know other topics speaker brought up)
○ What would you notice if someone was on opiods?
■ Euphoria or extreme happiness
■ Sedation or tiredness
■ Confusion
■ Constricted pupils
■ Nodding off at random times or loss of consciousness
■ Slower breathing rate
○ Vivitrol- shot to doesn’t allow you to feel high
○ Narcan- lasts 2-4 hours, no side effects/safe, stop OD, immediate
withdrawals-can be dangerous for the indv who administered
Personality Disorder Clusters
● *know each cluster, characteristics and disorders of each*
○ * Personality Disorders do not get diagnosed until 18 years of age*
■ A- characterized by odd and/or eccentric behaviors
(Paranoid, schizoid, schizotypal)
● Paranoid personality disorder- pervasive distrust and
suspiciousness of others such that their motives are
interpreted as malevolent, beginning by early adulthood and
present in a variety of contexts.
● Schizoid personality disorder- pervasive pattern of
detachment from social relationships and a restricted range
of expression of emotions in interpersonal settings,
beginning by early adulthood and present in a variety of
contexts.
● Schizotypal personality disorder- pervasive pattern of
social and interpersonal deficits marked by acute discomfort
with, and reduced capacity for, close relationships as well as
by cognitive or perceptual distortions and eccentricities of
behavior, beginning by early adulthood and present in a
variety of contexts.
■ *B* (most common)- characterized by dramatic, emotional,
and/or erratic behaviors
(Antisocial, borderline, histrionic, and narcissistic)
● Antisocial personality disorder○ DISREGARD for rights of others
○ a failure to conform to social norms, lawful and ethical
behavior
○ deceitfulness/lying, impulsive, irresponsible, disregard
for safety of self/others
○ Lack of remorse
○ an egocentric, callous lack of concern for others
accompanied by deceitfulness, irresponsibility,
manipulativeness, and/or risk taking
○ DO NOT CONFUSE WITH CONDUCT OR
OPPOSITIONAL DEFIANT DISORDER (seen in
those under 18)
■ ODD → Conduct defiant DO → Antisocial
personality DO
■ WOULD LIKE MORE INFO ABOUT
ODD?CONDUCT- here or
● Borderline personality disorder○ Difficult diagnosis to have on caseload, do not call
them “borderlines”
○ DBT- best practice
■ Best modality- group therapy w DBT
○ Pattern of instability related to relationships, emotions,
affect, impulsivity
○ Often see fear of abandonment, often recurrent
suicidal ideation, self-harm, threats
○ Mood is very REACTIVE
■ Often there is inappropriate/intense anger that
is difficult to control
○ Often seen in women (narcissistic PD more often in
men)
● Histrionic personality disorder-
○ Pervasive pattern of excessive emotionality and
attention seeking
○ Needs to be CENTER of ATTENTION
○ May be sexually suggestive or provocative
○ Often suggestable (easily influenced)
○ Often view relationships as more than what they
actually are
○ More common in women
○ Beginning by early adulthood and present in a variety
of contexts.
● Narcissistic personality disorder○ Pervasive pattern of grandiosity/self-importance (in
fantasy or behavior)
○ Need for admiration, and lack of empathy
○ Often preoccupation with success, power, beauty,
brilliance
○ Believe they are special and unique
○ Sense of ENTITLEMENT and ARROGANCE
○ EXPLOIT others for their own desires
○ Beginning by early adulthood and present in a variety
of contexts.
■ C- characterized by anxious or fearful behaviors
● Avoidant personality disorder- pervasive pattern of social
inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation, beginning by early adulthood and
present in a variety of contexts.
● Dependent personality disorder- pervasive and excessive
need to be taken care of that leads to submissive and
clinging behavior and fears of separation, beginning by early
adulthood and present in a variety of contexts.
● Obsessive-compulsive personality disorder- pervasive
pattern of preoccupation with orderliness, perfectionism, and
mental and interpersonal control, at the expense of flexibility,
openness, and efficiency, beginning by early adulthood and
present in a variety of contexts.
Psychopaths
● Unable to form interactions, relationships, emotional attachments
● “Hannibal Lector”
● Often manipulative, violent, predatory, unremorseful, enjoy attention, project
“aura” of self-confidence, grandiose, see people as obstacles, shallow, parasitic
● Not ALL criminals
● Most serial killers NOT psychopaths
Hare’s Psychopathy Checklist
1. Glibness or superficial charm
2. Grandiose sense of self-worth
3. Need for stimulation and proneness to boredom
4. Pathological lying
5. Coming and manipulative traits
6. Lack of remorse or guilt
7. Shallow affect
8. Callousness and lack of empathy
9. Parasitic lifestyle
10. Poor behavioral controls
11. Promiscuous sexual behavior
12. Early behavior problems
13. Lack of realistic long-term goals
14. Impulsivity
15. Irresponsibility
16. Failure to accept responsibility for actions
17. Many short-term marital relationships
18. Juvenile delinquency
19. Revocation of conditional release
20. Criminal versatility
Psychopath vs Sociopath
Both fall under antisocial personality disorder
● Psychopath
○ NOT emotional
○ Detached
○ Often due to genetics
● Sociopath
○ EMOTIONAL
○ Fly into rage
○ Easily agitated
○ Often due to early trauma/nurture
Psychotropic Medications
● Antipsychotic drugs
○ Treat psychotic symptoms
■ Often for schizophrenia, sometimes for other DO, like bipolar
disorder
○ Some address POSITIVE SYMPTOMS (+) (ADDITION OF)
■ ex) hallucinations, delusions, thought disorders, disorders of
movement
○ Others address NEGATIVE SYMPTOMS (-) (LOSS/DECREASE OF)
■ ex) slow speech, flat affect, general loss of interest/ability to do
things
○ MOST intense and LONG LASTING SIDE EFFECTS
○ Side effects
■ Sedation, weight gain, photophobia (sensitivity to light), sexual
dysfunction/lack of sexual interest, disassociation
● And tardive dyskinesia- INVOLUNTARY movement (can be
temporary, may be permanent)
■ Harder on the body and sometimes will need to run various tests to
determine liver function, etc.
■ Examples
● Thorazine, Prolixin, Haldol
■ Antipsychotics used for schizophrenia and bipolar include: Abilify,
Saphris, Vraylar, Clozaril, Latuda, Zyprexa, Seroquel. Risperdal,
Geodon
● Antidepressant drugs
○ (BLACK BOX WARNINGS- CAN LEAD TO SUICIDAL THOUGHTS)
○ TCAs (tricyclic antidepressants- older class)
■ Harsher and more toxic
■ Have to take for 2-3 weeks before see benefits
■ Can monitor levels in blood
■ Contraindicated for people w/ heart disease, risk of
overdose/suicide
○ MAOIS
■ Helpful in treating atypical, non endogenous depression (caused by
chemical imbalance)
■ Dietary restrictions- avoid ALL food that have been aged (beer,
cheese, wine, etc)
○ SSRIS/SNRIS
■ Most common antidepressant class used today
■ Used when risk of suicide
○ Side effects- dry mouth, blurred vision, heat sensitivity, constipation, etc.
● Mood Stabilizing Drugs
○ Lithium
○ Anticonvulsants
● Anxiety Drugs
○ Antidepressant medications
■ SSRIS
■ SNRIS
■ Benzodiazepines
● Antabuse is often used for those battling alcohol abuse
○ Makes individual sick after ingesting alcohol
Suicide
● Currently at highest levels in nearly 30 years
● Highest in April, June and July
● Rates inversely correlate to education level and SES
● Highest in white males
● Common methods
○ Guns, hanging, pills
● Risk Factors:
○ Highest: after discharge from psychiatric hospitalization for suicide
■ Best practice: see client the DAY they leave the hospital and
AGAIN in that FIRST week
○ Next highest: substance abuse, firearm in home, on disability/unemployed
○ 75-80% of patients provide some warning
■ Burden, lack of connection, seeking means, depressed,
overwhelmed, sadness, helplessness, loss of energy, no
motivation, fatigue
● Population groups at risk:
○ Undiagnosed, untreated or ineffectively treated MH disorder
■ 90% of suicides suffer from a MH disorder
■ Low medication/treatment compliance
○ White, middle-aged, males
○ Rate increasing in women
○ Military veterans
○ First responders
○ physicians/ med students/dentists
● Protective Factors:
○ Connectedness
○ Support
○ Connectedness
○ Positive self image, esteem and emotional wellness
○ Physical health in tact
○ Hope for the future
○ Seeking and engaging in treatment
○ Positive social determinants in place
● Self harm DOES NOT mean suicide
○ What do we do?
■ Substitute other behaviors that can be equally soothing and provide
a similar emotional release
● Different types of Suicidal Ideation
○ Passive
■ Morbid ideation
■ Preoccupation with death
■ Wishing one was dead w/o suicide content
○ Active
■ Has thought about how to harm self
■ Lacks specific plan, details
○ Specific
■ Has plan
Level of Risk after Assessment
● Low Risk
○ Passive, fleeting, suicidal thoughts. No intent
○ SAFETY PLAN
● Moderate Risk
○ Frequent suicidal thoughts w infrequent intensity and duration
○ Suicidal ideation but no intent/plan
○ SAFETY PLAN
● High Risk
○ Strong, active suicidal ideation
○ Verbalizing desire to die
○ Specific plan
○ HOSPITALIZE with choice and nonjudgmentally
Safety Plan
● Contract w client- both sign
○
○
○
○
List coping strategies
Removing lethal methods
Emergency numbers
“If no one is available, I have tried all coping strategies, I might be in
danger, I will go to emergency room and/or call 911” (Both sign)
IF YOU DIDN’T DOCUMENT IT YOU DIDN’T DO IT
BEST PRACTICE: Assessing for Suicide
● Ask DIRECTLY about suicide
● Open language
○ Ask open ended questions
● Must address patient fears of hospitalization/being sent away (GIVE CHOICES:
re: hospital, want to call someone, etc.)
● TRUST is critical so continue to focus on history and be mindful not to overreact
● Be calm and non-judgmental
● Never promise unlimited confidentiality
One can never PREDICT suicide- one must always ASSESS
Assess for Suicide with SLAP
○ Suicidal Ideation
○ Lethality
○ Access
○ Plan
● Is Path Warm
○ Ideation
○ Substance abuse
○ Purposelessness
○ Anxiety
○ Trapped
○ Hopelessness
○ Withdrawal
○ Anger
○ Recklessness
○ Mood Changes
● Level of Care
● Least to most restrictive:
○ Outpatient therapy
■ Intensive outpatient therapy
● Partial hospitalization
○ Long-term structured residence
■ Short-term psychiatric hospitalization
● Long-term psychiatric hospitalization
● When is it ok to hospitalize?
○ Self Determination Limits
■ “Social workers respect and promote the right of clients to selfdetermination and assist clients in their efforts to identify and clarify
their goals. Social workers may limit clients’ right to selfdetermination when, in the social workers’ professional judgment,
clients’ actions or potential actions pose a serious, foreseeable,
and imminent risk to themselves or others.”
● Maslow's Hierarchy of Needs
● Social workers must be aware of the chart and work from the bottom up.
● We all cycle up and down the hierarchy, even throughout a day, depending on
our needs.
○ Ex: We might not be our best selves when we are tired and hungry, but
after we remedy that, we can move up and meet belonging, love, esteem
and potentially self-actualization needs.
○ Ex. A client arrives in your office and reports a history of depression,
anxiety. The client has had a physical altercation with her partner. The
client reports her depression is becoming severe. What is the first thing
the social worker should do with the client?
■ Answer: Assess basic needs and assure client has a safe place to
stay etc.
FEW QUESTIONS ON IDENTIFYING DIFFERENCE BTW HALLUCINATIONS AND
DELUSIONS:
Hallucination- Sensory experiences that happen without the support of the appropriate
stimuli.
Delusion- A belief held with extreme conviction, although others do not believe it; when
compared with evidence to the contrary, the belief is clearly incorrect or unfounded.
● SOCIAL WORK
○ Social Workers MUST know
■ 1) What is your ROLE
■ 2) What is your GOAL
○ Social workers are the LARGEST group of mental health providers in the
US
■ (nearly 70%)
○ Social workers should be CURIOUS
■ Don’t do FOR; we do WITH
○ Code of Ethics/Core Values
○ “Just Come Into Social Work, I did”
■ (social) Justice
■ Competence
■ Importance of human relationships
■ Service
■ Integrity
■ Dignity and Worth of Individual