Chapter 4

Question 1

What are the risks in creating classification of mental health conditions?

Answer 1

Labels create a group that can then be stigmatized and discriminated against and the power to define “pathological” is by association to power to define “normal”

Question 2

How does APA (medical model) define what a disorder is?

Answer 2

A significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with significantly increased risk of suffering death, pain, disability, or a significant loss of freedom… must not be a respectable and culturally sanctioned response to a particular event… It must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the individual.

Question 3

What are Corcoran and Walsh’s analyses of what a disorder is?

Answer 3

Underlying disturbances w/in the person = “disease model” of abnormality.
Deviant behavior or conflicts between person and environment are not disorders unless the cause of the issue falls within the individual.
Therefore, the person must change to be considered healthy.

Question 4

What does a diagnosis consist of?

Answer 4

Signs and symptoms
(Symptoms reported by the client, signs observed by the clinician, and the real-world functional impact of both of these things)

Question 5

T or f? The DSM diagnoses are descriptive based on symptoms.

Answer 5

T

Question 6

T or f? What we are really assessing is the whole person.

Answer 6

T

Question 7

T or f? And even though we’re basing diagnoses on these checklists of symptoms and how many signs they may have or not have, we must take it into account how these other factors might impact symptom presentation. Things like their social network, their quality of life, the quality of their family relation, and work coping abilities and their experiences of things like violence and discrimination.

Answer 7

T

Question 8

So from the DSM 5 standpoint, what is the goal of classification of mental health conditions?

Answer 8

To provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders. Now we’ve talked about a lot of these during the first module– the potential intrinsic value of a diagnosis what does it tell you about yourself to take your experiences and put a name to them? And how some have found that helpful in that it helps solidify this idea.

Question 9

T or f? What do these experiences mean to me? And do others share them? Can also be in some ways damaging to have that label?

Answer 9

T

Question 10

How is communication a major benefit?

Answer 10

Allows us to communicate with other providers and with family members and to have some common language for how we describe the symptoms and experiences. The classification’s central to the study of etiology of mental health conditions in developing a treatment based on an understanding of where these conditions come from. And again, at the end of the session, we’ll revisit the concept of risk and how these labels have a negative flip side in which they expose people to also discrimination and stereotypes that they may otherwise not experience.

Question 11

T or f? There is also a decision that is slowly being reversed to think about diagnoses categorically and not as dimensions of behavior.

Answer 11

T

Question 12

T or f? Accurate diagnosis considered necessary for selecting interventions.

Answer 12

T

Question 13

Who do we use the DSM-5?

Answer 13

Accurate diagnosis considered necessary for selecting interventions.
Competency in diagnosis allows social workers to claim “expertise” as a health profession.
Practitioners can use a common language across disciplines.
Similarly, training on the DSM is shared across professional education programs.
State social work licensing exams require knowledge of the DSM.

Question 14

Why do we sometimes not want to use the DSM-5?

Answer 14

Person is not a diagnosis–reductionist thinking
Promotes a medical model
Views clients in isolation from environment and each other
No provisions for client strengths
Despite evidence that social support, coping style, etc. impact prognosis
Labeling
Modified labeling theory
Poor validity of diagnoses: high use of “NOS” and high comorbidity
Partly addressed in DSM-5
Financial incentives for APA and pharmaceutical industry make its objectivity questionable

Question 15

Who said that madness and sanity are of equal value?

Answer 15

Socrates

Question 16

Moving forward substantially to the 20th century. Adolph Meyer had a psychiatrist who had a view very similar to many social workers. What was that view?

Answer 16

diagnosis may be important but is secondary to presenting problems in understanding an individual’s experiences within what is now known as a biopsychosocial framework.

Question 17

What issue did the anti-psychiatry movement raise?

Answer 17

Diagnosis is a problem

Question 18

Some of the views from the critical schools of thought include what?

Answer 18

Medical naturalism, which suggests that mental illness is real objective and biological and diagnoses are used to label them– very much the psychiatric viewpoint, radical constructivism, which is the idea that mental illness is entirely a social invention, which corresponds to the anti-psychiatry movement. And social work probably falls somewhere close to what we know as critical realism, that there is some objective component to mental illness. There are actual symptoms that people experience, but the way we define and diagnose them is based on the social context, which may or may not be currently done with validity.

Question 19

What type of science states that mental illness is real, objective, and biological, and diagnoses are used to label them?

Answer 19

Medical naturalism

Question 20

What type of science states mental illness is a social intervention?

Answer 20

Radical constructivism

Question 21

What type of science states there is an objective component to mental illness that is defined/diagnosed based on social context, not necessarily with validity?

Answer 21

Critical realism

Question 22

T or f? The person-in-environment (PIE) approach is really based on the preference of many social workers and social work as a field, not to classify individuals as abnormal or disordered. Instead, they consider the fit between that person and the environment as an ongoing transactional process that either facilitates or blocks one’s ability to experience a satisfactory quality of life and social function. And so there are types of person-in-environment situations, like the reduced problems in social functioning, things like stressful life transitions or relationship problems that could perhaps be addressed as part of the interaction between the social worker and the client.

Answer 22

T

Question 23

What is the perspective?

Answer 23

Really a practice guiding principle that highlights the importance of understanding an individual and individual behavior within the environmental context, and even though we often rely on the DSM in the International Classification of Disease type systems to develop, conceptualize our diagnoses, and then discuss individuals across the coworkers, across the field among different professions. This person-in-environment perspective gives us a framework within which to understand assessment and diagnosis.

Question 24

What is the PIE?

Answer 24

A holistic, four-factor classification system used to describe and code social functioning difficulties with common underlying terminology. And these four factors are social roles in relationship to others, social environment, and then mental and physical health. And we’re going to focus on the first two, and particularly the first one, social roles in relationship to others.

Question 25

What are the advantages of PIE?

Answer 25

For one, it provides an opportunity to learn social work's way of conducting a social functioning assessment from a more holistic perspective that considers mental health conditions as part, but not the whole, of our assessment, and provides a clear sense of what a practical next step should be in providing social work assistance. So we talked about some of the social causes of mental health issues before, and how understanding those gives you a target for your interventions and a target for how you want to work with the client to address the underlying causes of their difficulties. The person-in-environment perspective really emphasizes that and helps to identify what these social causes are. The development of this perspective really came out of the growing need for a standardized social or classification system that was especially supported by Dr. Janet Williams, who is a social work representative on the DSM development committees. And she essentially tasked her colleagues with the challenge to come up with a social work rough equivalent, or one that's more appropriate to the social work profession. A small group of researchers and clinicians in California primarily headed up this effort and developed this system where we break down our assessment into looking at social roles, social environment, and then mental and physical health. So I mostly want to talk about Factor I, which is really one of the main unique contributions to this perspective. Factor I addresses the social roles one fulfills or is described by, and recognized and often regulated positions in society. And there are different types of interactive relationships that are covered here, including familial, occupational, interpersonal, and special life situations, or things that come up outside of these contexts. And what this system allows is a formal coding approach to recording and, in a sense, diagnosing or indicating the presence of these different social contexts or situations. So it's done with a seven-number system in which the first two numbers identify the role of a group in a specific role, such as family or parent role. The second two numbers identify the relationship type, such as uncertain or ambivalent or secure. The remaining three numbers provide a code to indicate the severity, duration, and coping, the extent to which someone is able to cope with or handle this potential environmental strength or stressor. Here's some examples to give you an idea of what this looks like. So we have these codes that indicate, for example, interactions with family, or parents, child, adults, interpersonal relationships, friends, family members, occupational things like-- roles like inpatient, outpatient roles, and then even more specific things like if you're in a prison setting or a parole setting. And then the second two digits indicate what the experience of that role is. So is there a sense of co-dependence between someone and their parents? Is there loss around someone and their close friend, like did they lose a close friend? And you could assess and record both who the relationship is with, with the first two numbers, and then with the second two, what that experience is subjectively like for the client you're working with.

Question 26

What is the structure of PIE?

Answer 26

``` There are four factors. PIE is a holistic, four-factor classification system used by social workers to describe and code social functioning problems with common descriptors. The four factors address problems and strengths under the following headings: Social roles in relationship to others Social environment Mental health Physical health ```

Question 27

What are PIE's two exciting features?

Answer 27

Provides an opportunity to learn social work's way of conducting a social functioning assessment from a holistic perspective, and it provides the user with a clear sense of what the practical next step should be in providing social work assistance.

Question 28

What is factor II in PIE?

Answer 28

Environment

Question 29

What do factors III and IV draw in on?

Answer 29

Are largely relegated to the diagnosis drawn from the mental health and health coding systems.

Question 30

How is the DSM organized and how may you use it to reference symptoms that a client may have and to then-- based on that, identify the appropriate diagnosis as well as a couple other bits of information that you could record within this diagnostic system?

Answer 30

So the DSM-5 current version was published May 18, 2013 and was a revision of the DSM-IV that tried to reflect some changes in the field as well as increasing knowledge and understanding of mental health conditions, as well as trying to emphasize some of the more continuous, underlying nature of mental health conditions. The current undertaking was a massive project that took about 12 years and involved quite extensive reconsideration of the mental health diagnostic system.

Question 31

What is the cornerstone of the DSM-5?

Answer 31

Reliability and that has allowed a common language to be shared among mental health clinicians in that we could reliably use one diagnosis and have a sense of what that terminology meant and to know what each other means when one of us says agoraphobia, or one of us says panic disorder, or one of us says borderline personality disorder and to have that common language.

Question 32

T or f?

Answer 32

Despite this, there's a general scientific consensus that in some ways, these are not fully validated diagnoses. So they're reliably applied. They're used in the same way. But they're not necessarily directly corresponding to actually discrete or unique in the health or illness into these. So really, what it means is that we have a useful system that is logistically valuable in mental health treatment, but is still based on kind of an evolving and not yet finished underlying science. The structure of the DSM-- it's broken up. The diagnoses are broken up into 21 categories, each with its own chapter. And they're really based around broader categories that share some underlying components. Neuro-developmental disorders are primarily childhood onset conditions that have some sort of biological foundation

Question 33

T or f? Schizophrenia spectrum disorders include schizophrenia as well as other disorders that include psychotic symptoms like hallucinations and delusions, but are not primarily mood symptoms, which is then covered in bipolar and related disorders, and depressive disorders, and so forth down the list. And while we won't get to all of these categories during this course, we will cover quite a few of them in more depth. These disorders are grouped by common themes. And each disorder has a specific code, similar to the coding system we talked about with the person and environment framework.

Answer 33

T

Question 34

What is the structure of the DSM-5?

Answer 34

The structure of the DSM-- it's broken up. The diagnoses are broken up into 21 categories, each with its own chapter.

Question 35

T or f? Disorders are grouped by common themes. And each disorder has a specific code, similar to the coding system we talked about with the person and environment framework. And some of these have additional specifiers that give you more specific information, perhaps about what some prominent symptoms are or specifiers for the severity of the condition and so forth. And each disorder has very specific symptom criteria that need to be met where there'll be a list of symptoms.

Answer 35

T

Question 36

What is the broad diagnostic domain within the DSM framework. That includes any of the developmental, mental, addictive, or substance use disorder diagnoses with the related codes. Medical conditions and diagnoses based on

Answer 36

Diagnosis I

Question 37

The DSM-5 allows for a common language. T or f?

Answer 37

T

Question 38

Finish the sentence: Now, before we get into the discussion of what stigma means, let's take a look at this advertisement-- one of the early advertisements for the Haldol antipsychotic. And think about what they're trying to portray with this advertisement. And this advertisement carries a lot of implications, for one thing around

Answer 38

race,

Question 39

T or f? Adolescents living with families in the bottom of the social class hierarchy are more likely than those living in affluent families to develop personality disorders, even when childhood symptoms are statistically controlled, suggesting that environmental conditions may contribute to the onset of personality disorders (Johnson et al., 1999).

Answer 39

T

Question 40

T or f? The research presented in this paper focuses on adolescent aggression, because aggression is both a problem in its own right and a frequent constituent of specific personality disorders

Answer 40

T

Question 41

T or f? Research demonstrates that neighborhood heterogeneity is positively associated with juvenile and adult criminality

Answer 41

T

Question 42

There is a consensus, however, that populations characterized by high percentages of youth may be more prone to what?

Answer 42

Social disorganization

Question 43

Fill in the blank: In the United States, neighborhoods with young populations report more _____crimes.

Answer 43

Property

Question 44

Fill in the blank: Fourth, researchers in delinquency often examine the degree to which a neighborhood is urban or rural (e.g., De Coster, Heimer, & Wittrock, 2006), with observed effects generally suggesting that _____ environments foster delinquent behavior

Answer 44

Urban

Question 45

Fill in the blank: _________ adolescents were only marginally more likely to be involved in delinquent activities than adolescents low in impulsivity if they were living in affluent neighborhoods.

Answer 45

Impulsive

Question 46

What characteristics may influence their likelihood of being affected by particular neighborhoods?

Answer 46

Individualistic

Question 47

What has also been studied concerning delinquency?

Answer 47

Genetic factors

Question 48

What is a is "a caregiver report questionnaire of early language and social communication intended for typically developing children between the ages of 8 and 30 months" (Lord et al., 2007, p. 668)?"

Answer 48

The MacArthur-Bates Communicative Developmental Inventory (CDI)

Question 49

T or f? Through their research with the CDI, Lord and colleagues found that although this inventory was initially intended for typically developing children, it is a good predictor for children with developmental delays, such as ASD, as well.

Answer 49

T

Question 50

What is another informal tool that was originally developed for teachers to identify children with high levels of autistic functioning (Mash & Terdal, 1997)?

Answer 50

The ABC (Autism Behavior Checklist)

Question 51

What is the initial phase of the diagnosis?

Answer 51

Informal assessment

Question 52

What is one of the most widely used assessment tools for the diagnosis of autism?

Answer 52

ADOS (Autism Diagnostic Observation Schedule)

Question 53

Which is one of the earliest screening tools specifically for the diagnosis of autism

Answer 53

CARS (Childhood Autism Rating Scale)

Question 54

Fill in the blank: Many effective social workers use what is known as an ______________ to services, which is based on systems theory.

Answer 54

Ecological approach

Question 55

Please fill in the blank: Perhaps the most widely used and popular assessment instrument, the __________ has been used to validate other assessment tools and scales and to assess a vast array of developmental challenges, such as autism, fragile X syndrome, language delays, psychiatric disorders, and children with attention-deficit/hyperactivity disorder

Answer 55

Vineland II

Question 56

T or f? Regarding the Vineland II, there is no indication that the test has been normed for use with any specific cultures or ethnicities.

Answer 56

T

Question 57

What assesses both adaptive and maladaptive behaviors for infants and adults through age 80?

Answer 57

The SIB-R

Question 58

T or f? The SIB-R is the only one of the instruments discussed herein that specifically lists Hispanic origin in its standardization review.

Answer 58

T

Question 59

What uses the measure of adaptive behavior as a way to directly assess services that students, clients, or patients might need. Parents, teachers, guardians, or other care providers may either complete the assessment themselves or avail themselves of a service provider, such as a social worker?

Answer 59

ICAP

Question 60

T or f? In the final analysis, it is evident that instruments for the assessment of adaptive behaviors have, in fact, changed with the times

Answer 60

T

Question 61

As ________continues to play a vital role in child and family development, it is the duty of the social worker to remain vigilant in considering the role of culture in adaptive behavior.

Answer 61

culture

Question 62

T or f? Although the instruments discussed in this article offer valid and reliable measures for use in the assessment of children, it remains imperative that social workers use them in addition to, and not in isolation from, their own education, practice wisdom, observation, and other sources of data, including psychological reports, student grades, teacher and parent observations, and environmental assessments

Answer 62

T

Question 63

When selecting an assessment tool, practitioners should keep in mind that a sensitive and accurate assessment calls for a holistic approach to evaluation.. T or f?

Answer 63

T

Question 64

Sue and Sue (1990) later refined the concept of cultural competence, stressing the importance of the following three factors. What are they? These three factors are intimately connected to the notion of informed interventions

Answer 64

Beliefs/ attitudes, knowledge, and skills

Question 65

It is imperative for social workers to remain cognizant of what?

Answer 65

Their local cultures, the social climate toward specific populations, demographics of their area, and cultural norms that differ from their own or from that of the majority.

Question 66

Fill in the blank: In their discussions of fortifying evidence-based criteria for child and adolescent assessment, both Mash and Hunsley (2005) and Achenbach (2005) highlighted the lack of _________________ in much of the assessment realm and not merely in the instruments discussed earlier

Answer 66

cultural consideration

Question 67

Who pointed out pointed out that cultural consideration is necessary for many reasons, including the growing potential for professionals to serve populations that are different from their own and the rising populations of immigrants, refugees, and native-born ethnic minorities.

Answer 67

Achenbach

Question 68

Why is cultural consideration necessary?

Answer 68

The growing potential for professionals to serve populations different from their own and the rising populations of immigrants, refugees, and native-born ethnic minorities.

Question 69

What is a "multidimensional scale of functional impairment for children and adolescents?"

Answer 69

Brief impairment scale

Question 70

T or f? Pinel followed those principles faithfully and in the process developed the early principles of epidemiology.

Answer 70

T

Question 71

T or f? The philosophy of the Enlightenment was the second philosophical tradition that shaped the development of modern psychiatry and inspired its early leaders such as Pinel, the Tukes, Rush, or Chiarugi.

Answer 71

T

Question 72

T or f? There are many famous statements of these principles: We hold these truths to be self-evident….that all men are created equal….4 Know then thyself, presume not God to scan; The proper study of mankind is man…5 In this system of being, there is no creature so wonderful in its nature, and which so much deserves our particular attention, as man, who fills up the middle space between the visible and invisible world….6 Guided by these principles, the early psychiatrists attempted to develop therapies that might help to relieve mental pain in as humane and effective a manner as possible.

Answer 72

T

Question 73

T or f? In an era when no pharmacological treatments were available, it emphasized a variety of psychotherapeutic techniques that included personalizing the care to the individual's needs, using nonintrusive and compassionate approaches, appealing to reason when possible, and giving the patient some responsibility for improving symptoms and behavior. Because the philosophy of the Enlightenment encouraged the conceptualization of human beings—including those suffering from mental illness—as endowed with reason and individual dignity, the psychiatric writings of this era did not tend to dissociate the psyche or mind from the brain

Answer 73

T

Question 74

T or f? For example, the first editor of The American Journal of Psychiatry, Amariah Brigham, stated in 18447: … the brain is the instrument which the mind uses in this life, to manifest itself, and like all other parts of our bodies, is liable to disease, and when diseased, is often incapable of manifesting harmoniously and perfectly the powers of the mind…it is as if, in some very complicated and delicate instrument, as a watch for instance, some slight alteration of its machinery should disturb, but not stop, its action.

Answer 74

T

Question 75

T or f? Thus, the gifts of modern science and the philosophy of the Enlightenment to the creation of our specialty of psychiatry included stressing the importance of careful observation in order to understand disease mechanisms and progression, an emphasis on the dignity of the individual, the value of “moral treatment,” and the integration of “mind,” “spirit,” and “brain” rather than a dualistic understanding. This has given psychiatry a firm conceptual and moral grounding that it should strive to maintain.

Answer 75

T

Question 76

T or f? The ideas of Sigmund Freud, developed in the early- to mid-20th century, offered an interesting alternative approach to many psychiatrists, however.

Answer 76

T

Question 77

T or f? A variety of changes occurred as a result of psychoanalytic dominance. First, psychoanalysis led to a significant de-emphasis on diagnosis and nosology

Answer 77

T

Question 78

Defining the nature and source of intrapsychic conflicts was the goal instead in psychoanalysis.

Answer 78

T

Question 79

Second, psychoanalysis, therefore, also led to a significant de-emphasis on careful observation of signs and symptoms—the “bread and butter” of the early humanistic psychiatrists and the basis for developing a phenomenology. T or f?

Answer 79

T

Question 80

The analyst must dig beneath self-report to reach the real truth. T or f?

Answer 80

T

Question 81

While other countries also had prominent psychoanalysts and psychoanalytic movements, the US acceptance of psychoanalysis was extreme. This distanced most of American psychiatry from Anglo-European traditions and approaches, which continued to teach phenomemology and nosology. T or f?

Answer 81

T

Question 82

Please fill in the blank: Despite their small numbers and relative isolation from the rest of American psychiatry, the ____________ made some significant contributions to psychiatry during the 1970s.

Answer 82

Mid-Atlantas

Question 83

The Task Force articulated a group of lofty goals that shaped their efforts- what were they?

Answer 83

To improve communication between clinicians To provide reliable diagnoses that would be useful in research To enhance teaching: to train psychiatry students in clinical interviewing and differential diagnosis To realign American psychiatry with the rest of the world and to be consistent with International Classification of Diseases, Ninth Revision. To achieve these goals, they made major modifications in the old DSM-II.

Question 84

This new textbook contained a variety of new principles and innovations. What were they?

Answer 84

Atheoretical about etiology (because for most diagnoses etiology is in fact unknown) Use of diagnostic criteria Dropping of the term “neurosis” Provision of a glossary to define the terms used in the criteria Multiaxial approach to classification in order to incorporate medical and psychosocial components of a clinical evaluation.

Question 85

T or f? The ultimate painful paradox: the study of phenomenology and nosology that was so treasured by the Mid-Atlantics who created DSM is no longer seen as important or relevant. Research in psychopathology is a dying (or dead) enterprise.

Answer 85

T

Question 86

T or f? An accurate diagnosis is considered necessary for selecting interventions.

Answer 86

T