Midterm Study Guide 600 PDF

**Exam is 65 multiple-choice or true/false items.** **STUDY GUIDE -- Midterm** 1. 2. - Diagnostic labels provide a common language for clinicians, enabling clear communication about a patient\'s condition and facilitating collaborative treatment planning. 1. **Guides Treatment De...

**Exam is 65 multiple-choice or true/false items.** **STUDY GUIDE -- Midterm** 1. 2. - Diagnostic labels provide a common language for clinicians, enabling clear communication about a patient\'s condition and facilitating collaborative treatment planning. 1. **Guides Treatment Decisions:** - A specific diagnosis informs the selection of appropriate evidence-based interventions, improving the chances of successful treatment outcomes. 2. **Enables Access to Resources:** - Having a formal diagnosis can enhance access to medical, psychological, and social support services, as well as eligibility for insurance coverage and community resources. - **Stigmatization**: Diagnostic labels can lead to stigma and discrimination, causing individuals to be viewed negatively by society, which may deter them from seeking help. - **Oversimplification of Complex Issues:** Labels can oversimplify complex psychological conditions, diverting attention from the individual's unique experiences and broader context. - **Potential for Misdiagnosis:** Misdiagnosis can occur due to symptom overlap among disorders, leading to ineffective or harmful treatments that do not address the individual\'s actual needs. **[Intake Interviewing]** **NOTE**: As mentioned in the Week 2 Engagement Questions, access this article in Unit 2.1 Overview section of our course in the Digital Campus. These numbers refer to pages within that article/chapter. 1\. What is meant by the presenting problem? 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?" (24-25) - The **presenting problem** refers to the primary issue or concern that a client brings to therapy or counseling. It is the specific symptom, challenge, or situation that the individual is experiencing and is seeking help for. This could manifest as a mental health condition (like anxiety or depression), a specific life stressor (such as relationship problems or job loss), or any other emotional or psychological difficulty that prompts the client to seek support. - First, it helps therapists understand the individualized context of the client's anxiety, revealing how personal beliefs and past experiences shape their emotional response. Second, this inquiry allows clients to identify specific symptoms and triggers associated with their anxiety, providing valuable information for developing tailored coping strategies. Third, such questions promote self-reflection and awareness, empowering clients to articulate their feelings and thoughts more clearly. Ultimately, this dialogue fosters a collaborative therapeutic relationship, enhancing trust and engagement, which are essential for effective treatment. 2\. 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? (27) During an intake, is it appropriate to ask if the client has discussed his/her symptoms with a physician? 1. **Identifying Medical Conditions:** Many physical health issues, such as thyroid disorders, neurological conditions, or chronic illnesses, can present with symptoms that mimic or trigger psychiatric symptoms. For example, conditions like hyperthyroidism can lead to anxiety and mood disturbances, while neurological issues may lead to changes in behavior or cognition. Recognizing these connections is essential for a proper therapeutic approach and referral to appropriate medical professionals if needed. 2. **Substances and Medications:** The use of certain substances, including alcohol, drugs, and even prescribed medications, can induce psychiatric symptoms or exacerbate existing mental health conditions. For instance, withdrawal from substances like alcohol or benzodiazepines can lead to severe anxiety or agitation. Understanding a client's substance use and medication history is vital for effective diagnosis and treatment. 3. **Holistic Treatment Planning:** Mental health does not exist in a vacuum; it interacts with physical health. Non-medical therapists must consider the client\'s overall well-being to create a holistic treatment plan. This may involve collaboration with healthcare providers to ensure comprehensive care that addresses both psychological and medical needs. 4. **Risk Assessment:** Knowing a client's medical history can help therapists assess risks, particularly when symptoms may indicate an urgent health issue that requires immediate medical attention. This ensures the safety of the client and helps prevent any potential crises. **Discussions with a Physician** During an intake, it is appropriate to ask if the client has discussed their symptoms with a physician. This question can provide insight into whether the client has sought medical evaluation for their symptoms and if they have received any pertinent diagnoses or treatment recommendations. Encouraging this communication also helps emphasize the importance of a collaborative approach between mental health and medical professionals, fostering a more integrated care model for the client. It can also indicate the seriousness of their symptoms, guiding the therapist in developing an appropriate treatment plan. 3\. 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? (30-31) 1. **Understanding of the Presenting Problem:** - Cultural beliefs and values shape how individuals interpret their symptoms and experiences. For example, certain cultures may prioritize collective well-being and community harmony over individual expression, leading individuals to view emotional distress through a lens of familial or societal expectations. This can affect how they articulate their problems in therapy and what they perceive as acceptable coping mechanisms, potentially causing misunderstandings in treatment. 2. **Attitude Toward Seeking Therapy:** - Cultural identity can influence the stigma associated with mental health issues and seeking therapy. In some cultures, mental health concerns may be seen as taboo or a sign of weakness, leading individuals to be reluctant to pursue help. Conversely, in cultures that prioritize mental wellness and self-care, seeking therapy may be viewed as a proactive and positive step. Understanding a client\'s cultural context can help therapists address any apprehensions about therapy and create a more supportive environment. 3. **Client-Therapist Relationship:** - The cultural backgrounds of both the client and therapist can affect the therapeutic alliance. Factors such as language, values, communication styles, and shared experiences can either enhance rapport or create barriers. For instance, a therapist's lack of cultural competence might lead to misunderstandings or unintentional insensitivity, making clients feel misunderstood or alienated. On the other hand, cultural humility and sensitivity from the therapist can foster trust, enhance collaboration, and help clients feel valued and understood. 4. **Cultural Perceptions of Healing:** - Cultural identity may also influence what clients believe constitutes effective healing or intervention. Some cultures may value holistic or alternative healing practices alongside or instead of conventional therapy. Acknowledging and integrating these beliefs into the therapeutic process can empower clients and show respect for their cultural identity, ultimately enhancing their engagement in treatment. [**DSM--5-TR: Cultural Formulation**](https://dsm-psychiatryonline-org.lib.pepperdine.edu/doi/full/10.1176/appi.books.9780890425787.Culture_and_Psychiatric_Diagnosis) 1. The **person-centered approach**, articulated by psychologist Carl Rogers, is a therapeutic framework that prioritizes the individual\'s subjective experience and emphasizes the importance of the therapeutic relationship. This approach is characterized by several fundamental principles: 1. **Empathy:** The therapist actively seeks to understand the client's feelings and perspectives. 2. **Unconditional Positive Regard** providing a non-judgmental space, clients are encouraged to express themselves openly and explore their feelings without fear of disapproval. 3. **Self-Actualization:** the idea that individuals have an inherent drive toward personal growth and self-fulfillment. The therapist facilitates this process by helping clients identify their own goals and values. 4. **Authenticity:** The therapist presents their true self, fostering an environment of honesty and openness. This authenticity encourages clients to be genuine as well, promoting deeper self-exploration. 1. **Facilitate Self-Exploration:** It creates a supportive environment where clients can explore their thoughts and feelings, leading to greater insight and understanding of their issues. 2. **Enhance Self-Acceptance:** By providing unconditional positive regard, this approach fosters self-acceptance, helping clients embrace their worth and emotions, which is essential for emotional healing. 3. **Strengthen Therapeutic Relationship:** Emphasizing a strong therapeutic alliance, it builds trust between the therapist and client, enabling a secure space for sharing vulnerabilities and facilitating effective treatment. 4. **Culturally Responsive Care:** This approach encourages therapists to consider the client's cultural identity and values, integrating these factors into the therapy process for more effective and personalized care. 2. What are some reasons that cultural concepts are important to consider with psychiatric diagnosis and treatment. (p. 872-873) 3. **Influence on Symptom Expression:** Cultural background affects how individuals express and experience symptoms, impacting diagnostic accuracy. Variations in emotional expression can lead to misinterpretation of mental health conditions. 4. **Cultural Beliefs about Mental Health:** Different cultures have varying beliefs regarding mental health, illness, and treatment. Understanding these beliefs can help clinicians approach treatment with sensitivity and increase client engagement. 5. **Impact on Treatment Engagement:** A client's cultural identity influences their willingness to participate in therapy. Recognizing cultural norms can foster trust and improve communication. 6. **Tailored Interventions:** Incorporating cultural concepts allows for personalized treatment that aligns with clients\' values, enhancing acceptance and effectiveness of care. **[Seligman Chapter 1: Introduction to Effective Treatment Planning]** 1. 2. **Assessment of Engagement:** Understanding a client's readiness to change helps therapists gauge their level of engagement and willingness to participate in the therapeutic process. This knowledge allows therapists to adapt their approach to better support the client's needs. 3. **Facilitating Effective Interventions:** When therapists recognize and respect a client's current level of motivation, they can use strategies that resonate with the client's readiness. For example, if a client is ambivalent, the therapist may focus on exploring the pros and cons of change, while motivated clients can work on actionable steps toward their goals. 4. **Enhancing Outcomes:** Addressing motivation ensures that interventions are aligned with where the client is in their change process. By fostering motivation, therapists can help clients move through stages of change effectively, ultimately leading to more successful outcomes. 5. 6. **Trust and Safety:** A strong alliance creates a safe environment where clients feel comfortable sharing their thoughts and feelings, leading to deeper exploration of issues. 7. **Client Engagement and Motivation:** When clients feel understood by their therapist, they are more likely to engage actively in therapy and commit to their treatment plans. 8. **Facilitates Communication:** A positive alliance encourages open dialogue, allowing therapists to tailor interventions to better meet clients\' needs. 9. **Influences Treatment Retention:** Clients are more likely to attend sessions consistently when they have a strong therapeutic connection, which is vital for achieving lasting change. 10. **Predicts Positive Outcomes:** Research shows that a robust therapeutic alliance is a key predictor of positive treatment outcomes, often more influential than the type of therapy or theoretical orientation. [**DSM-5-TR: Other Conditions That May Be a Focus of Clinical Attention**](https://dsm-psychiatryonline-org.lib.pepperdine.edu/doi/full/10.1176/appi.books.9780890425787.Other_Conditions_Z_codes) 1. In summary, while the conditions in this chapter are important for understanding an individual\'s overall clinical picture and guiding treatment, they are not classified as mental health disorders according to the DSM-5-TR criteria. They serve to alert practitioners to potential influences on mental health that could be addressed in therapy or treatment planning. 2. 3. **Relational Problems:** This category includes issues such as family conflict, partner relational distress, and problems related to parenting. These relational dynamics can significantly affect an individual\'s mental health and well-being. 4. **Post-Traumatic Stress Disorder (PTSD) Related to Specific Situations or Events:** While PTSD itself is a distinct diagnosis, in this category, clinicians may note the impact of specific traumatic events or ongoing stressors that do not fully meet the criteria for PTSD but still warrant clinical attention. [**DSM-5-TR: Adjustment Disorders**](https://dsm-psychiatryonline-org.lib.pepperdine.edu/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders#BABCBEHF) 1. For an adjustment disorder diagnosis, how soon after a stressor do symptoms need to begin? What evidence suggests that symptoms are clinically significant? 319 How does this differ from a Z code? 2. For an **adjustment disorder** diagnosis, symptoms must begin within **three months** of the onset of a specific stressor. This prompt emergence of symptoms is crucial for distinguishing adjustment disorders from other conditions. - Difficulty performing daily tasks (e.g., work, school). - Increased absenteeism due to emotional distress. - Problems in relationships or social withdrawal. 3. The symptoms of adjustment disorder persist within what timeframes? 319 **adjustment disorder symptoms should appear within 3 months of the stressor and typically resolve within 6 months after the stressor has ended. If symptoms continue beyond 6 months, they may indicate chronic adjustment difficulties.** [**DSM-5-TR: Prolonged Grief Disorder**](https://dsm-psychiatryonline-org.lib.pepperdine.edu/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders#BABDFEFGF9) 1. 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? (p. 323) 2. **Symptoms Required for Diagnosis:** a. At least one of the following symptoms must be present to characterize the development of a persistent grief response: i. **Persistent, intense yearning for the deceased.** ii. **Persistent, intense sorrow or emotional pain in response to the death.** 3. **Duration of Symptoms:** b. These symptoms must be present for **6 months or longer** following the death. 4. **Time Since Death:** c. The death must have occurred at least **6 months prior** to the assessment or diagnosis for Prolonged Grief Disorder. 1. **What are some characteristics of individuals who adjust more easily to life stressors? Characteristics of those who are more susceptible to an adjustment disorder?** - ***Individuals who adjust more easily often have strong coping skills, social support, and resilience. Conversely, those more susceptible to adjustment disorders may exhibit lower self-esteem, lack of coping strategies, and higher levels of neuroticism.*** 2. **Primary focus of treatment for adjustment disorder? A couple of promising therapeutic approaches?** - ***The primary focus of treatment for adjustment disorder is to help individuals develop effective coping strategies and support systems to manage their emotional responses to stressors. Promising therapeutic approaches include cognitive-behavioral therapy (CBT) and supportive therapy.*** 3. **Prognosis for adjustment disorders?** - ***The prognosis for adjustment disorders is generally favorable, as symptoms often resolve with appropriate intervention, typically within six months after the stressor is removed or resolved.*** 1. **What 2 forms can the outbursts in disruptive mood dysregulation disorder (DMDD) take? What needs to be considered about the situation and developmental level? How frequently must they occur? What is the person's mood like between outbursts?** - ***The two forms of outbursts can be verbal (e.g., temper tantrums) and physical (e.g., physical aggression). It\'s important to consider the developmental level of the child and the context of the outbursts. The outbursts must occur on average three or more times per week, and the individual's mood is typically irritable or angry between outbursts.*** 2. **What are common depression symptoms in the DSM-5 criteria of a major depressive episode? How many symptoms are required and for how long must symptoms be present?** - ***Common symptoms include depressed mood, loss of interest in activities, changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or guilt, and impaired concentration. A minimum of five symptoms is required, and they must persist for at least two weeks.*** 3. **After the loss of a loved one -- how do you distinguish typical grief from a major depressive disorder?** - ***Typical grief includes intermittent feelings of sadness and loss but generally allows for moments of happiness. In contrast, major depressive disorder involves persistent, pervasive symptoms that significantly impair functioning, lack of interest, and may include intense feelings of worthlessness or suicidal thoughts.*** 4. **Persistent depressive disorder requires depressed mood and how many additional symptoms? Over what period of time? Differentiate the specifiers: pure dysthymic syndrome and persistent major depressive episode.** - ***Persistent depressive disorder requires a depressed mood plus two additional symptoms for at least two years in adults. The specifiers differentiate between pure dysthymic syndrome (without major depressive episodes) and persistent major depressive episode (with major depressive episodes occurring during this time).*** 5. **When is the diagnosis substance/medication-induced depressive disorder or depressive disorder due to another medical condition used?** - ***This diagnosis is used when depressive symptoms are directly linked to substance use or withdrawal or are due to another medical condition, necessitating a distinction between primary mood disorders and those conditioned by substances or medical issues.*** 6. **Note these other specifiers: with psychotic features, with peripartum onset, with seasonal pattern.** - ***Psychotic features involve delusions or hallucinations. Peripartum onset applies to women who experience depressive symptoms during pregnancy or within the first few months postpartum. Seasonal pattern refers to episodes that occur at a particular time of year, usually in winter.*** 1. **Although there is little research available on the treatment of DMDD, what is the first line of treatment for children with mood disorders? Are psychotropic medications recommended?** - ***While there is limited research, the first line of treatment for children with mood disorders, including DMDD, is usually psychotherapy, particularly cognitive behavioral therapy (CBT). Psychotropic medications are generally not recommended as first-line treatment for DMDD due to insufficient evidence of effectiveness.*** 2. **What are some situations where the combination of medication and psychotherapy is recommended for depression?** - ***Combining medication and psychotherapy is often recommended for severe depression, depression with suicidal ideation, or when individuals do not respond adequately to psychotherapy alone.*** 3. **What are 4 distinct evidence-supported treatments for depression?** - ***Four distinct evidence-supported treatments for depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), mindfulness-based cognitive therapy (MBCT), and psychodynamic therapy.*** 4. **What are a couple of ways that those with persistent depressive disorder can present more of a challenge to therapists than those with major depression?** - ***Individuals with persistent depressive disorder may present a greater challenge because their symptoms are chronic and can lead to a sense of hopelessness that is more entrenched. This chronic nature can lead to a prolonged treatment duration and difficulty achieving meaningful progress, as compared to clients with major depression who may respond more quickly to treatment.*** **DSM-5-TR: Anxiety Disorders** 1. **What is characteristic of separation anxiety disorder? Does the typical/expected separation anxiety that often occurs during childhood qualify as this diagnosis/disorder?** - ***Separation anxiety disorder is characterized by excessive fear or anxiety about separation from attachment figures, often leading to distress when anticipating or experiencing separation. Typical separation anxiety that occurs during childhood is not classified as a disorder unless it is excessive and persistent beyond developmental expectations.*** 2. **What is involved in a specific phobia (Criteria A)? Duration?** - ***Criteria A for a specific phobia involves a marked fear or anxiety about a specific object or situation, leading to avoidance behavior. The duration for symptoms is typically six months or longer.*** 3. **What is the first DSM criterion for social anxiety disorder (social phobia)? What is the \"perceived threat?\"** - ***The first criterion for social anxiety disorder involves excessive fear or anxiety regarding one or more social situations where the individual may be scrutinized or judged. The perceived threat is the fear of being negatively evaluated or embarrassed in social interactions.*** 4. **Are the panic attacks in panic disorder expected or unexpected? Is one attack sufficient? In addition to panic attacks, what else has to occur for 1 or more months (Criterion B)?** - ***Panic attacks in panic disorder are typically unexpected. One attack is not sufficient for diagnosis; in addition to recurrent panic attacks, Criterion B requires the presence of one month or more of persistent worry about having additional attacks or significant behavioral changes related to the attacks.*** 5. **What are common symptoms of a panic attack (physiological and cognitive)? How many symptoms are needed to qualify as a panic attack?** - ***Common symptoms of a panic attack include rapid heart rate, shortness of breath, dizziness, sweating, trembling, feelings of choking, and fears of losing control or dying. To qualify as a panic attack, a person must experience at least four symptoms from the DSM-5 criteria.*** 6. **What is the source of perceived threat for a person with agoraphobia? In the event of developing panic-like symptoms, the person is concerned that \_\_\_\_\_ or \_\_\_\_\_. How many settings?** - ***For a person with agoraphobia, the perceived threat arises from situations where escape might be difficult or help unavailable in the event of a panic attack. The individual is concerned that developing panic-like symptoms could lead to embarrassment or incapacitation. The symptoms and fears must occur in two or more settings (e.g., using public transportation, being in crowded places, or being outside alone).*** 7. **Can substances, medications, or medical conditions contribute to anxiety symptoms?** - ***Yes, substances (like alcohol or drugs), medications, and certain medical conditions can contribute to or exacerbate anxiety symptoms. It is essential to evaluate these factors to provide an accurate diagnosis and effective treatment.*** **Reichenberg Chapter 6 and Related Class Material on Anxiety Disorders** 1. **Is it important to involve parents when treating children with separation anxiety disorder?** - ***Yes, involving parents is crucial in treating children with separation anxiety disorder as they can help implement coping strategies and support the child's progress, creating a more effective treatment environment.*** 2. **How was "external exposure" utilized in the agoraphobia video (elevator, subway, bus) or snake phobia video?** - ***In the agoraphobia video, external exposure involved gradually exposing the individual to feared situations (like elevators and subway rides). For habituation to occur, the person must remain in the anxiety-provoking situation "long enough" for anxiety to peak and then decline, and practice exposure "often enough" to extinguish the anxiety. For example, repeatedly using the elevator until the anxiety lessens demonstrates habituation. Expectancy violation occurs when individuals confront their fears---like anticipating panic in the elevator but realizing they can cope, leading to revised, less fearful cognitions.*** 3. **What is a concern about using medications prior to interoceptive exposure, during the treatment of phobias, or when treating other anxiety disorders? Is the prognosis for the treatment of specific phobias favorable?** - **\*A concern about using medications before interoceptive exposure is that they may dampen the physiological responses associated with anxiety, hindering the exposure process and the opportunity for habituation to occur. The prognosis for treating specific phobias is generally favorable, especially with exposure therapy combined** **EXAM FORMAT**: 65 multiple-choice items.