Midterm Study Guide 600 Online w-TR Rev F'24

Question 1

What are 2 main criteria that are used to determine that a person’s behavior, emotions, or experiences constitute a mental disorder?

Answer 1

Statistically atypical, maladaptive, functional impairment, or subjective distress

Question 2

What are some benefits of diagnostic labels?

Answer 2

Provide clarity and relief, guide treatment planning, determine which therapy type will be the most effective, guide learning plans for families, provide additional resources, insurance codes, support groups, school assistance, help families seek early intervention, the DSM as a guide helps keeps providers on the same page.

Question 3

What are some concerns of diagnostic labels?

Answer 3

Self-fulfilling prophecy, over identify and take it on as their personality, one size fits all treatment plans, misdiagnosis or missing a comorbid diagnosis, stigmatization, friends and family focusing on the diagnosis instead of the individual’s life experiences, excuses inappropriate behavior.

Question 4

What is meant by the presenting problem?

Answer 4

The reason they are coming to therapy.

Question 5

After the client describes the presenting concern (e.g., anxiety), why is it helpful to ask “what does anxiety mean to you?” and/or “what do you experience when you are anxious?”

Answer 5

The answers can reveal culture-specific interpretations of the symptoms and experiences. Always ask for clarification, even for such common diagnostic labels as depression and anxiety, especially when the client is different from you. Failure to consider the client’s conceptualization of his or her problems may result in nonadherence to recommended treatments and/or premature termination from therapy.

Question 6

As non-medical therapists, why do we need to know about a person’s medical/health state? Is it really possible for medical conditions or substances/medications to mimic or trigger psychiatric symptoms?

Answer 6

Knowledge of a client’s current health status provides information on potential stressors he or she is facing. In addition, some medical conditions can cause symptoms that mimic psychiatric conditions (e.g., hypothyroidism can mimic symptoms of depression, including anhedonia, forgetfulness, diminished concentration, low energy, and sleep disturbance).

Question 7

During an intake, is it appropriate to ask if the client has discussed his/her symptoms with a physician?

Answer 7

If a client presents with emotional or behavioral symptoms that may be associated with a medical condition, the clinician should refer the client for a medical evaluation.

Question 8

Note how cultural identity can impact a person’s understanding of the presenting problem, what it means to seek therapy services, and the client-therapist relationship?

Answer 8

Psychopathology must be viewed through the lens of culture and within the context of religious belief. The clinician should strive to determine if experiences that might otherwise be labeled as psychopathology are acceptable and normative within the client’s religious community.

Question 9

The Cultural Formulation Interview takes a holistic and person-centered approach. What is meant by person-centered approach and what is this approach designed to do?

Answer 9

It elicits information from the individual about their views and those of others in their network. This approach is designed to avoid stereotyping, in that each individual’s cultural knowledge affects how they interpret illness experience and guides how they seek help.

Question 10

What are some reasons that cultural concepts are important to consider with psychiatric diagnosis and treatment.

Answer 10

To enhance identification of individuals’ concerns and detection of psychopathology, to avoid stereotyping.

Question 11

Why is it important for clients and therapists to collaborate on goals?

Answer 11

Cost, readiness for change, client motivation, and expectations for treatment need to be considered.

Question 12

Regarding motivational interviewing - In what way is a client’s motivation or readiness to change relevant?

Answer 12

Helps the therapist establish the conditions in which the client can choose to change. Therapists who incorporate motivational interviewing into treatment are more likely to achieve success with ambivalent clients then those who do not.

Question 13

How relevant is the therapeutic alliance to treatment outcome?

Answer 13

It is the best predictor of treatment outcomes.

Question 14

Are the “other conditions that may be a focus of clinical attention” considered mental health disorders Ex: suicidal behavior? Why?

Answer 14

They are not a mental disorder, their inclusion in the DSM 5 is meant to draw attention to the scope of additional issues that may be encountered in routine clinical practice and provide systematic listing that is useful for documenting these issues.

Question 15

Besides “uncomplicated bereavement” what are 2 other examples of diagnoses in this category?

Answer 15

Wandering associated with a mental disorder, phase of life problem, religious or spiritual problem, adult antisocial behavior, child/adolescent antisocial behavior, nonadherence to medical treatment, overweight, malingering, age-related cognitive decline, borderline intellectual functioning, impairing emotional outburst.

Question 16

For an adjustment disorder diagnosis, how soon after a stressor do symptoms need to begin?

Answer 16

3 months

Question 17

What evidence suggests that symptoms are clinically significant?

Answer 17

Marked distress that is out of proportion to the severity or intensity of the stressor taking into account context and culture. Significant impairment.

Question 18

How does adjustment disorder differ from a Z code?

Answer 18

Meets the requirements of a disorder because it is atypical where z codes are not atypical.

Question 19

The symptoms of adjustment disorder persist within what timeframes?

Answer 19

3-6 months

Question 20

For a prolonged grief disorder diagnosis, at least one of what two symptoms characterizing the development of a persistent grief response must be present? How long must this symptom(s) be present? How long ago was the death?

Answer 20

A. Intense yearning/longing for the deceased person B. Preoccupation with thoughts or memories of the deceased person. The symptoms have to occurred nearly every day for at least the last month. The death, at least 12 months ago.

Question 21

What are some characteristics of individuals who adjust more easily to life stressors?

Answer 21

If their overall functioning is good prior to the event, if they have advanced education, and if they are in a stable relationship and financial situation.

Question 22

Characteristics of those who are more susceptible to an adjustment disorder?

Answer 22

Family conflict, poorly controlled physical pain, alcohol/substance related disorders, financial difficulties, and a history of mood or anxiety disorder.

Question 23

Primary focus of treatment for adjustment disorder?

Answer 23

Psychoeducation, brief and structured interventions, and referrals to outside sources of support can also be helpful.

Question 24

A couple of promising therapeutic approaches for adjustment disorder?

Answer 24

Problem-solving, strengthing coping skills, acceptance, relaxation, and mindfulness techinques.

Question 25

Prognosis for adjustment disorders?

Answer 25

Excellent for adults, particularly women. Many function even better because of the skills they have gained. The prognosis for men, adolescents and those with behavioral symptoms or comorbid disorders are not as good.

Question 26

What 2 forms can the outbursts in disruptive mood dysregulation disorder (DMDD) take?

Answer 26

Verbally or behavioral and can irritable or angry

Question 27

What needs to be considered about the situation and developmental level in DMDD?

Answer 27

3+ times per week and present for 12 or more months. Is present in 2+ settings. And should not be made before 6yrs or after 18yrs. Onset of behavior must occur before 10yrs.

Question 28

How frequently must symptoms of DMDD occur?

Answer 28

It should be persistent and most of the day. Not having a period of 3+ consecutive months without symptoms. Can be in a response to a situation (3+ per week)

Question 29

In DMDD, what is the person’s mood like between outbursts?

Answer 29

Irritable or angry mood

Question 30

What are common depression symptoms in the DSM-5 criteria of a major depressive episode?

Answer 30

Diminished interest in activities, weight loss or gain (5% in a month), decrease or increase in appetite, sleep disturbance, psychomotor agitation or retardation observable by others, fatigue, feeling worthless, guilt, lack of concentration, indecisiveness, thoughts of death.

Question 31

How many symptoms are required and for how long must symptoms be present for a major depression diagnosis?

Answer 31

5+ for a two-week period. One of the symptoms is depressed mood or loss of interest or pleasure.

Question 32

After the loss of a loved one – how do you distinguish typical grief from a major depressive disorder?

Answer 32

Consider if grief is the predominant effect for feelings of emptiness or loss. Also consider if the waves of sadness come from reminders of the loved one. In grief, self-esteem is typically preserved. If thoughts of death are present, they typically are around joining the deceased.

Question 33

Persistent depressive disorder requires depressed mood and how many additional symptoms?

Answer 33

Two additional symptoms.

Question 34

Over what period of time do the symptoms have to be present for the diagnosis of Persistent depressive disorder?

Answer 34

2 years for adults and 1 year for children

Question 35

Differentiate the specifiers of persistent depressive disorder:

Answer 35

Anxious distress vs. atypical features, partial remission vs. full remission, early onset (before 21) vs. late onset (21+), pure dysthymic syndrome vs. persistent major depressive episode.

Question 36

Pure dysthymic syndrome

Answer 36

falls under the persistent depressive disorder umbrella. Chronic low-level depression. Full criteria for a major depressive episode have not been met in at least the preceding 2 years.

Question 37

Persistent major depressive episode

Answer 37

Full criteria for a major depressive episode have been met throughout the preceding 2-year period.

Question 38

When is the diagnosis substance/medication-induced depressive disorder or depressive disorder due to another medical condition used?

Answer 38

Depressed mood or marked diminished interest or pleasure in all or most activities that is a direct effect of a substance. Cause clinically significant distress or impairment in social, occupational or other areas of functioning. 203, 207

Question 39

Note these other specifiers of depressive disorder:

Answer 39

Recurrent brief depression, short-duration depressive episode, Depressive episode with insufficient symptoms Major depressive episode superimposed. With anxious distress, with mixed features, with melancholic features, with atypical features, with psychotic features, with peripartum onset, with seasonal pattern, with catatonia, with peripartum onset.

Question 40

Although there is little research available on the treatment of disruptive mood dysregulation disorder (DMDD), what is the first line of treatment for children with mood disorders?

Answer 40

The first line of treatment should always be psychotherapy and parent psychoeducation. Unless the symptoms are severe enough to warrant the risk of side effects inherent in the use of psychotropic medications.

Question 41

What are some situations where the combination of medication and psychotherapy is recommended for depression?

Answer 41

When psychosis and suicidal thoughts or actions are present, if the depression is severe, recurrent, or chronic.

Question 42

What are 4 distinct evidence-supported treatments for depression?

Answer 42

Behavior activation therapy, acceptance-based cognitive-behavioral therapies (ACT, MBCT), Cognitive behavioral analysis system of psychotherapy (CBASP), and interpersonal Therapy (IPT.)

Question 43

What are a couple ways that those with persistent depressive disorder can present more of a challenge to therapists than those with major depression?

Answer 43

(Pg. 158-159) Problems with establishing a relationship, a why bother attitude, and PDD can often be treatment resistant.

Question 44

What is characteristic of separation anxiety disorder?

Answer 44

Excessive fear or anxiety concerning separation from home or attachment figures,

Question 45

Does the typical/expected separation anxiety that often occurs during childhood qualify as this diagnosis/disorder?

Answer 45

No, it needs cause clinically significant distress.

Question 46

What is involved in a specific phobia (Criteria A)?

Answer 46

Marked fear or anxiety about a specific object or situation.

Question 47

What is the duration for specific phobia?

Answer 47

Typically lasting 6+ months.

Question 48

What is the first DSM criterion for social anxiety disorder (social phobia)?

Answer 48

Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

Question 49

What is the “perceived threat?” in social anxiety. Note that there is also concern about showing anxiety symptoms, leading to negative evaluation (2nd criterion).

Answer 49

Fear that they will act in a way or show anxiety symptoms that will be negatively evaluated. Humiliating, rection, or offend others.

Question 50

Are the panic attacks in panic disorder expected or unexpected?

Answer 50

They are unexpected.

Question 51

Is one attack sufficient for a diagnosis of panic disorder?

Answer 51

No, they are characterized by recurrent unexpected attacks

Question 52

In addition to panic attacks, what else has to occur for 1 or more months (Criterion B) to meet the requirements of panic disorder?

Answer 52

1. Persistent concern or worry about additional attacks 2. A significant maladaptive change in behavior related to the attacks.

Question 53

Can someone be diagnosed with panic disorder and agoraphobia?

Answer 53

IF someone meets the criteria for both panic disorder and agoraphobia, both diagnoses are given.

Question 54

What are common symptoms of a panic attack (physiological and cognitive)?

Answer 54

Palpitations, sweating, trembling, sensations of shortness of breath, feelings of choking, chest pain, nausea, dizzy, faint, chills/heat, paresthesias, derealization, fear of losing control, fear of dying.

Question 55

How many symptoms are needed to qualify as a panic attack?

Answer 55

four or more

Question 56

What is the source of perceived threat for a person with agoraphobia?

Answer 56

Thoughts that escape might be difficult or help might not be available in the event of panic attack.

Question 57

How many settings are required for a diagnosis of agoraphobia?

Answer 57

Two or more

Question 58

Can a person be diagnosed with panic disorder and agoraphobia?

Answer 58

IF someone meets the criteria for both panic disorder and agoraphobia, both diagnoses are given.

Question 59

Can substances, medications, or medical conditions contribute to anxiety symptoms?

Answer 59

Yes

Question 60

Is it important to involve parents when treating children with separation anxiety disorder?

Answer 60

Interventions for children that also involve parents tended to reduce anxiety and have other important benefits.

Question 61

What is a concern about using medications prior to interoceptive exposure, during the treatment of phobias, or when treating other anxiety disorders?

Answer 61

Medication does not cure the problem and may actually reinforce that the fear is real.

Question 62

Is the prognosis for the treatment of specific phobias favorable?

Answer 62

It is the best of any of the anxiety disorders, with 70-85% experiencing significant improvement.

Question 63

What are 2 components of the treatment plan for social anxiety disorder?

Answer 63

Exposure therapy and cognitive restructuring.

Question 64

For a manic episode, describe 4 DSM-5 symptoms, minimal duration, and level of impairment.

Answer 64

Abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week.

Question 65

Differentiate a hypomanic episode from a manic episode (Manic = significant level of impairment, need for hospitalization, or presence of psychotic symptoms)?

Answer 65

A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days. C. Unequivocal change in functioning that is uncharacteristic of the individual. D. Disturbed mood/change in functioning is observable by others. E. Does not impair functioning.

Question 66

Differentiate bipolar I disorder and bipolar II disorder?

Answer 66

BP I is characterized by recurring mood episodes (Manic, Depressive, Hypomanic). One manic episode is necessary for the diagnosis of BP I. BP II can never include a manic episode, only hypomanic.

Question 67

Can BP I include a hypomanic episode over the course of the condition?

Answer 67

Yes, but must also cycle to manic.

Question 68

Which episode (hypomanic or depressed) causes the most impairment for BP II?

Answer 68

Depressed, unlikely to complain about hypomania and could find it desirable.

Question 69

What kinds of symptoms are involved in the mood swings for cyclothymic disorder?

Answer 69

Hypomanic and depressive

Question 70

cyclothymic disorder is when a person doesn’t have enough symptoms for a long enough time to meet the criteria for either a hypomanic or depressed episode.

Answer 70

True

Question 71

How long do symptoms need to be present for a diagnosis of Cyclothymic disorder?

Answer 71

At least 2 years there have to be numerous periods with hypomanic symptoms. Any symptom free periods cannot be longer then 2 months.

Question 72

What is the essential feature of cyclothymic disorder?

Answer 72

Fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms. Not sever enough to meet criteria for hypomanic episode or major depression episode.

Question 73

How does rapid cycling impact prognosis for bipolar disorder?

Answer 73

Rapid cycling is associated with a worse prognosis.

Question 74

What is considered to be the foundation of treatment of bipolar disorders?

Answer 74

Medication management

Question 75

What is the role of mood stabilizing medication vs. psychotherapy for bipolar disorder?

Answer 75

Mood stabilizers assist with manic episode and psychotherapy helps the depression. Antidepressants are not found to be helpful for bipolar depression. (p. 114-116)

Question 76

What psychotherapies have empirical support as adjuncts to medication in treating those with bipolar disorder?

Answer 76

Family focused therapy (FFT), Interpersonal and social rhythm therapy (IPSRT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT), and CBT with mindfulness component.

Question 77

What is the focus of social rhythm therapy?

Answer 77

Behavioral interventions stress the importance of focusing on circadian rhythms in an effort to help clients develop a sleep-wake cycle that enhances their moods and provides them with enough sleep.

Question 78

In FFT, how can family education affect the prognosis of a bipolar disorder?

Answer 78

FFT helps families understand that at least a portion of their family member’s aversive behavior is directly related to their biochemically driven illness state and not intentional behavior aimed at them.

Question 79

How is paranoid personality disorder different from delusional disorder, persecutory type or schizophrenia with paranoid delusions?

Answer 79

Paranoid personality disorders are characterized by a period of persistent psychotic symptoms (Delusions and hallucinations) whereas delusional disorder is characterized by discrete episodes of delusions

Question 80

DSM-5 symptoms for borderline

Answer 80

Efforts to avoid abandonment, instability, unstable relationships, Identity disturbance, impulsivity, recurrent suicidal behaviors, reactivity of mood, chronic feeling of emptiness, intense anger, paranoid ideation or dissociative symptoms.

Question 81

DSM-5 symptoms for histrionic

Answer 81

Uncomfortable when not the center of attention, inappropriate sexually seductive behavior, rapidly shifting and shallow expression, uses physical appearance to draw attention, speech is excessively impressionistic and lacking detail, self-dramatization, suggestible, believes relationships are more intimate than they are.

Question 82

DSM-5 symptoms for avoidant personality disorder

Answer 82

Avoids occupational activities with interpersonal contact, unwilling to get involved with people unless certain they will be liked, fear of shame or guilt in intimate relationships, preoccupied with being criticized, inhibited in new interpersonal situations, believes they are inferior to others, avoids personal risk or new activities.

Question 83

DSM-5 symptoms for dependent personality disorder

Answer 83

Difficulty making everyday decisions without approval, needs others to assume responsibility for their life, difficulty expressing disagreements, difficulty initiating things, excessive lengths for support from others, uncomfortable when alone, urgently seeks next relationship when one ends preoccupied with fears of being left.

Question 84

DSM-5 symptoms for obsessive-compulsive personality disorder

Answer 84

Control, preoccupation with details, rules, lists, order, organization or schedules, perfectionism that interferes with task completion, excessively devoted to work at the expense of personal life, inflexible about matters of morality, unable to discard worn-out items, reluctant to delegate, money is hoarded, rigidity and stubbornness.

Question 85

What are two challenges in working with a client with histrionic personality?

Answer 85

Aging for people who are flirtatious in younger age and boredom.

Question 86

What should therapist do first with clients with borderline personality disorder?

Answer 86

Establish a rapport while assessing for risk. Provide psychoeducation

Question 87

What are two ways to continue working with borderline personality clients after addressing immediate concerns?

Answer 87

Help clients identify emotions and link them to behaviors, learn to self-soothe. Therapist should address their own countertransference and therapist do not abandon their clients during crisis. You could limit the BPD clients in your caseload so you do not become burned out.

Question 88

What are 2 supported treatments for BPD?

Answer 88

DBT, Schema-focused therapy, Systems training for emotionality and problem solving, Mentalization-based psychotherapy, transference-focused, dynamic supportive therapy, medication

Question 89

What is a common way people with dependent personality disorder view their therapist?

Answer 89

The reference to the person often viewing the therapist as a “magic healer” on whom they can rely.

Question 90

What is the overall goal of treatment for a person with dependent personality disorder?

Answer 90

to improve the client’s self-reliance and autonomy in a safe context so that newly found skills can be transferred into other settings outside of therapy.

Question 91

How was “external exposure” utilized in the agoraphobia video (elevator, subway, bus) or snake phobia video?

Answer 91

The client was gradually exposed to their phobia. Starting off with a lower feared stimuli and increasing as the client stress diminished.

Question 92

Give a specific example of “habituation” in treatment.

Answer 92

the person must remain in the situation “long enough” for anxiety to reach a peak and then decline and to repeat the exposure “often enough” for habituation to occur and anxiety to extinguish.

Question 93

How was habituation demonstrated in the elevator video? How was “expectancy violation” demonstrated in the videos

Answer 93

Sedata’s belief she would get trapped and die if she was in an elevator, however that expectation was violated. Therefore, her cognitions were revised to see elevators as less threatening.

Question 94

How can therapists help by providing psychoeducation about panic symptoms (and reframing them)? Specifically, how could it help a person understand that the rapid breathing, rapid heart rate, dizziness, and tingling experienced during a panic attack are uncomfortable, but not dangerous?

Answer 94

People who understand the physiology of a panic attack are less likely to be terrified of them when one occurs.

Question 95

What is the treatment of choice for panic disorder?

Answer 95

Cognitive behavioral therapy.

Question 96

Briefly describe what is involved with interoceptive (internal) exposure in panic Control Therapy?

Answer 96

Create panic-like sensations by spinning in chair, rapid breathing, brisk exercise, breathing through a straw.

Question 97

What is helpful about evoking these interoceptive exposure therapy?

Answer 97

The person gets accustomed to and learns to cope with these symptoms and realizes that, while uncomfortable, they are not dangerous)?

Question 98

What is meant by rapid cycling for bipolar I and bipolar II?

Answer 98

Presence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode in bipolar I or hypomanic or major depressive episode in bipolar II.

Question 99

Why do people with avoidant personality disorder withdraw and become socially isolated? How does this compare to the reason for social isolation in schizoid personality?

Answer 99

Avoidant personality disorder is characterized by feelings of inadequacy and avoid social proximity because of those feelings. They want to be close to others but are unable to because of their disorder. People with schizoid personality disorder are content and prefer to be isolated.