LCSW_ Assessment, Diagnosis, and Treatment Planning

Conduct Disorder - Etiology

According to Moffitt, there are two basic types of conduct disorder: · Life-course-persistent type begins early in life and gets progressively worse over time. This kinds of conduct disorder may be a result of neurological impairments, a difficult temperament, or adverse circumstances. Adolescence-limited type is usually the result of a temporary disparity between the adolescent's biological maturity and freedom. Adolescents with this form of conduct disorder may commit antisocial acts with friends. It is quite common for children with adolescence-limited conduct disorder to display antisocial behavior persistently in one area of life and not at all in others.

Acute Stress Disorder

Acute stress disorder has symptoms similar to those of post-traumatic stress disorder. Acute stress disorder is distinguished by symptoms that occur for more than 3 days and but less than one month. An individual is diagnosed with acute stress disorder when they have 9 or more symptoms from any of the following 5 categories, which begin after the trauma: · Intrusion · Negative mood · Avoidance symptoms · Dissociative symptoms · Arousal symptoms An individual with acute stress disorder persistently relives the traumatic event, to the point where they take steps to avoid contact with stimuli that bring the event to mind, and experience severe anxiety when reminiscing about the event.

Additional Trauma- and Stressor-Related Disorders

Additional trauma- and stress-related disorders include: Reactive attachment disorder Child rarely seeks or responds to comfort when upset, usually due to neglect of emotional needs by caregiver (e.g., children who are institutionalized or in foster care). Reactive attachment disorder is characterized by a markedly disturbed or developmentally-inappropriate social relatedness in most settings. This condition typically begins before the age of five. In order to definitively diagnose this disorder, there must be evidence of pathogenic care, which may include neglect or a constant change of caregivers that made it difficult for the child to form normal attachments. Disinhibited social engagement disorder Child has decreased hesitations regarding interacting with unfamiliar adults. Does not question leaving normal caregiver to go off with a stranger. Adjustment disorder The individual has behavioral or emotional changes occurring withing 3 months of a stressor. These changes cause distress for the individual and are disproportional to the actual stressor.

Adjustment Disorders

Adjustment disorders appear as maladaptive reactions to one or more identifiable psychosocial stressors. In order to make the diagnosis, the onset of symptoms must be within three months of the stressor, and the condition must cause impairments in social, occupational, or academic performance. The symptoms do not align with normal grief or bereavement. Symptoms remit within six months after the termination of the stressor or its consequences. The adjustment disorder should be specified with at least one of the following: · Depressed mood · Anxiety · Mixed anxiety and depressed mood · Disturbance of conduct Mixed disturbance of emotions and conduct

Bipolar Disorders - Etiology and Treatment

Among all mental disorders, Bipolar I and II disorders are the most clearly linked to genetic factors. Identical twins are overwhelmingly more likely to develop the disease than are fraternal twins. Research suggests a traumatic events may precipitate the first manic episode, although later manic episodes do not need to be preceded by a stressful episode. The most effective treatment for Bipolar I and II is lithium. Lithium reduces manic symptoms and eliminates mood swings for more than 50% of individuals. One major problem with lithium is that it works so well, many individuals consider themselves cured and stop taking it, causing a relapse. Pharmacotherapy is most effective when combined with psychotherapy. Individuals who do not respond to lithium treatment are given anticonvulsants like carbamazepine and divalproex sodium. Anticonvulsants are also used in lieu of lithium for individuals who have rapid cycling or dysphoric mania.

Internal Control that Minimize Risk

An agency minimizes risk internally through many different means, ranging from scheduling and infrastructure to excellence in supervision. Some examples of risk management include attending to the physical safety of workers and clients, ensuring that members of staff understand their ethical obligations, creating a work environment where cooperation and self-reflection are encouraged, and developing staff to the highest possible level of competence.

Factitious Disorder

An individual diagnosed with factitious disorder (FD) intentionally manifests physical or psychological symptoms to satisfy an intrapsychic need to fill the role of a sick person. The individual with FD presents the illness in a exaggerated manner and avoids interrogation that might exposure the falsity. These individuals may undergo multiple surgeries and invasive medical procedures. They often hide insurance claims and hospital discharge forms. A disturbing variation of FD is factitious disorder imposed on another (sometimes referred to as Munchausen's syndrome by proxy), in which a caregiver intentionally produces symptoms in another individual. Usually, a mother makes her young child ill.

Panic Disorder - Diagnosis

An individual may be diagnosed with panic disorder if they suffer recurrent unexpected panic attacks, and one of the attacks is followed by one month of either persistent concern regarding the possibility of another attack or a significant change in behavior related to the attacks. Panic attacks are brief,, defined periods of intense apprehension, fear, or terror. They develop quickly, and usually reach their greatest intensity after about ten minutes. Attacks must include at least 4 characteristic symptoms, which include: · Palpitations or accelerated heart rate (tachycardia) · Sweating · Chest pain · Nausea · Dizziness · Derealization · Paresthesia (pins and needle or numbness) · Shaking · Shortness of breath · Fear of losing control · Fear of dying · Chills or heat sensation Feeling of choking

PTSD - Diagnosis

An individual may be diagnosed with post-traumatic stress disorder (PTSD) if they develop symptoms after exposure to an extreme trauma. Examples of extreme trauma include: witnessing the death or injury of another person, experiencing injury to self, learning about the unexpected or violent death or injury of a family member or friend, or repeatedly being exposed to trauma (such as first responders or military soldiers). The traumatic event must elicit a reaction of intense fear, helplessness, or horror. The characteristic symptoms of PTSD are: · Persistent re-experiencing of the event · Persistent avoidance of stimuli associated with the trauma · Persistent symptoms of increased arousal (difficulty concentrating, staying awake, or falling asleep) These symptoms must have been present for at least a month; symptoms may not begin until three or more months after the event.

Drugs for Schizophrenia and Psychotic Symptoms

Antipsychotic drugs are the drug of choice used to treat schizophrenia and psychotic symptoms. There are both older first-generation antipsychotic drugs and newer atypical/second generation antipsychotic drugs. First-Gen Antipsychotics: Haldol (haloperidol) Thorazine (chlorpromazine) Stelazine (trifuoperazine) Prolixin (fluphenazine) Navane (thiothixene) Atypical/Second-Gen Antipsychotics: Clozaril (clozapine) Risperdal (risperidone) Seroquel (quetiapine) Zyprexa (olanzapine) Abilify (aripiprozole)

Antisocial Personality Disorder

Antisocial personality disorder is a general lack of concern for the rights and feelings of others. In order to receive a diagnosis of antisocial personality disorder, the individual must: · Be at least 18 · Have had a history of conduct disorder before age 15 · Have shown at least three of the following symptoms before the age of 15: - Failure to conform to social laws and norms - Deceitfulness - Impulsivity - Reckless disregard for the safety of self and others - Constant irresponsibility - Lack of remorse - Irritability or aggressiveness Antisocial personality disorder may also include an inflated opinion of self, superficial charm, and a lack of empathy for others.

Sexual Dysfunction - Physical and Psychological Components and Treatments

Any individual with sexual dysfunctions should be given a medical evaluation for diabetes, pelvic scars, kidney disease, hypertension, and drug interactions. Use sleep studies to determine if an impotent male gets an erection at night, and determine whether the cause of impotence is physical or psychological. Psychological impotence can be treated with cognitive-behavior therapy. Sex therapy is most helpful in treating premature ejaculation. Sensitive focus is used to reduce performance anxiety and increase sexual excitement. Kegel exercises, which strengthen the pubococcygeus muscle, can improve sexual pleasure. As for pharmacotherapy, Viagra is helpful in attaining and maintaining erections.

Bulimia Nervosa - Gender, Age, Etiology, and Treatment

As with anorexia, the bast majority of people with bulimia are female. The onset is typically in late adolescence or early adulthood and may follow a period of dieting. There are indications of a genetic etiology for bulimia. Also, there are links between bulimia and low levels of the endogenous opioid beta-endorphin, as well as low levels of serotonin and norepinephrine. The main point of any treatment for bulimia is encouraging the individual to get control of eating, and modifying unhealthy beliefs about body shape and nutrition. Treatment often involves cognitive-behavioral techniques like self-monitoring, stimulus control, cognitive restructuring, problem-solving, and self-distraction. Some antidepressants, like imipramine, have been effective at reducing instances of binging and purging.

Assessment of Coping Abilities

Assessment of coping abilities is done through observation and interview and begins with determining if the client has developed effective coping strategies. The following should be considered as elements required for effective coping: · Habits that sustain good health: Balanced diet, adequate exercise, adequate medical care, leisure activities, relaxation exercises. · Satisfaction with life: Work, family, activities, sense of humor, religious/spiritual beliefs, artistic endeavors. · Support systems: Family, friends, religious/spiritual affiliation, clubs, organizations, online supports. Healthy response to stressful circumstances: Problem-solving as opposed to avoidance, utilizing support systems instead of blaming self and taking no positive action, reframing and realistically assessing positives and negatives rather than utilizing wishful thinking that everything will be alright.

ADHD - Diagnosis

Attention-deficit/hyperactivity disorder, commonly known as ADHD, can be diagnosed only if a child displays at least six symptoms of inattention or hyperactivity-impulsivity. Their onset must be before the age of 12, and they must have persisted for at least 6 months. The symptoms must not be motivated by anger or the wish to displease or spite others. Inattentiveness Symptoms (must have 6 for diagnosis for children): · Forgetful in everyday activity · Easily distracted (often) · Makes careless mistakes and doesn't give attention to detail · Difficulty focusing attention · Does not appear to listen, even when directly spoken to · Starts tasks but does not follow through · Frequently loses essential items · Finds organizing difficult · Avoids activities that require prolonged mental exertion Impulsivity/Hyperactivity Symptoms (must have 6 for diagnosis for children): · Frequently gets out of chair · Runs or climbs at inappropriate times · Frequently talks more than peer · Often moves hands and feet, or shifts position in seat · Frequently interrupts others · Frequently has difficulty waiting on turn · Frequently unable to enjoy leisure activities silently · Frequently "on the go" and seen by others as restless Often finishes other's sentences before they can

Autism Spectrum Disorder - Prognosis

Autism spectrum disorder (ASD) is frequently first suspected when an infant does not respond to their caregiver in an age-appropriate manner. Babies with ASD are not interested in cuddling, do not smile, and do not respond to a familiar voice. They are often misdiagnosed as profoundly deaf. The current scientific consensus is that four different disorders previously believed to be separate are actually just different degrees on the autism spectrum. Many children with ASD severity level 1 may escape diagnosis until a much later age. At the higher end of the spectrum (which was once referred to as Asperger's syndrome), individuals have impairment in social interactions and a limited repertoire of behaviors, interests, and activities, but they do not display other significant delays in language, self-help skills, cognitive development, or curiosity about the environment. They are extremely sensitive to touch, sounds, sights, and tastes, and have strong clothing preferences. The prognosis of the individual with ASD will largely depend on whether they are on the spectrum. Unfortunately, even a small degree of improvement in ASD take a great deal of work. Only one-third of children with autism will achieve some independence as adults. Those with ASD who have developed the ability to communicate verbally by age 5-6 and have an IQ over 70 have the best chance for future independence.

Avoidant Personality Disorder

Avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. A person with avoidant personality disorder exhibits at least four of these symptoms: · Avoiding work or school activities that involve interpersonal contact · Unwillingness to associate with any person who may withhold approval · Preoccupation with concerns about being criticized or rejected · Conception of self as socially inept, inferior, or unappealing to others · General reluctance to take personal risks or engage in dangerous behavior · Does not reveal self in intimate relationships, due to fear of shame Not able to excel in new situations due to fear of inadequacy

Behavioral Pediatrics - Disclosure

Behavioral pediatrics, otherwise known as pediatric psychology, has become a more popular field because research revealed that many psychological disorders originate in childhood. For the most part, a pediatric mental health provider should be open with the child about their condition. Children may need some psychological help if they are to undergo any major medical procedures. Providers must relay any information related to the mental or medical condition in language the child can understand. Multicomponent cognitive-behavioral interventions, in which the child is given information about their condition and armed with some coping strategies, are especially helpful.

Major Depressive Disorder - Etiology

Besides the catecholamine and indolamine hypotheses, there are a few other proposed ideas for the etiology of major depressive disorder. Some researchers speculate depression is caused by hormonal disturbances, like an increased level of cortisol. Cortisol is one of the stress hormones secreted by the adrenal cortex. Other researchers speculate there is a connection between depression and diminished new cell growth in certain regions of the brain, particularly the subgenual prefrontal cortex and hippocampus. The subgenual prefrontal cortex is the part of the brain associated with the formation of positive emotions. Many antidepressant drugs seem to stimulate new growth in the hippocampus.

Drugs for Bipolar Disorder

Bipolar disorder is treated with mood stabilizers: · Lithium · Tegretol (carbamazepine) · Depakote (sodium valproate) · Lamictal (lamotrigine) Mood stabilizers can cause weight gain. Regular blood work is necessary to monitor for therapeutic drug levels and for potential side effects. Lithium can cause kidney and thyroid problems, and Tegretol and Depakote can cause problems with liver function.

Bipolar Disorders - Documentation and Gender Influences

Bipolar disorder should be documented with current (or most recent) features, whether manic, hypomanic, or major depressive episode noted. The current severity of mild, moderate, or severe should also be noted as well as any applicable specifiers. Partial or full remission should be noted when applicable. Example: bipolar I disorder, current episode manic, moderate severity, with anxious distress. Bipolar specifiers include: · With anxious distress · With melancholic features · With peripartum onset · With seasonal pattern · With psychotic features · With catatonia · With atypical features · With mixed features · With rapid cycling Bipolar II is distinguished from Bipolar I by the fact that the individual has never had either a manic or a mixed episode. Males and females develop Bipolar I disorder equally, but Bipolar II is much more common for females. On average, the age of onset for the first manic episode is the early 20s.

Borderline Personality Disorder

Borderline personality disorder is a pervasive pattern of instability in social relationships, self-image, and affect, coupled with marked impulsivity. A diagnosis of borderline personality disorder requires five of the following symptoms: · Frantic efforts to avoid being abandoned · A pattern of unstable and intense personal relationships, in which there is alternation between idealization and devaluation · Instability of self-image · Potentially self-destructive impulsivity in at least two areas · Recurrent suicide threats or gestures · Affective instability · Chronic feelings of emptiness · Inappropriate anger · Paranoid ideation or dissociative symptoms The changes in self-identity may manifest as shifts in career goals and sexual identity; impulsivity may manifest in unsafe sex, reckless driving practice, and substance abuse. Borderline personality disorder is most common in people between the ages of 19 and 34. Most individuals see substantial improvement over a period of 15 years. Impulsive symptoms are the first to recede. Dialectical behavior therapy (DBT) is often used to treat borderline personality disorder; it combines cognitive-behavioral therapy with the assumption of Rogers that the individual must accept their problems before any progress can be made. There are three basic strategies associated with dialectical behavior therapy: · Group skills training · Individual outpatient therapy · Telephone consultations Regular DBT has reduced the number of suicides and violent acts committed by individuals with borderline personality disorder.

Autism Spectrum Disorder - Diagnosis

Both categories of symptoms will be present in the ASD diagnosis. Severity levels are: Level 1 (requiring support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support). Of note, ASD encompasses four disorder that were previously separate under DSM-IV: autistic disorder, Asperger's disorder, childhood integrative disorder, and pervasive developmental disorder. Individuals with ASD associated with other known conditions or language/intellectual impairment should have the diagnosis written: autism spectrum disorder associated with (name of condition/impairment). It should also be specified if catatonia is present.

Data - Objective vs. Subjective Data

Both subjective (qualitative) and objective (quantitative) data are used for research and analysis, but the focus is quite different: Subjective Data: Subjective data depend on the opinions of the observer or the subject. Data are described verbally or graphically, depending upon observers to provide information. Interviews may be used as a tool to gather information, and the researcher's interpretation of data is important. Gathering this type of data can be time-intensive, and it usually cannot be generalized to a larger population. This type of information gathering is often useful at the beginning of the design process for data collection. Objective Data: Objective data are observable and can be tested and verified. Data are described in terms of numbers within a statistical format. This type of information gathering is outlined, usually in later stages. Tools may include surveys, questionnaires, or other methods of obtaining numerical data.

Schizophrenia - Etiology

Both twins and adoption studies have suggested that there is a genetic component to the etiology of schizophrenia. The rates of instance (concordance) among first-degree biological relatives of people with schizophrenia are greater than among the general population. Structural abnormalities in the brain linked to schizophrenia are enlarged ventricles and diminished hippocampus, amygdala, and globus pallidus. Functional abnormalities in the brain linked to schizophrenia are hypofrontality and diminished activity in the prefrontal cortex. An abnormally large number of people with schizophrenia in the Northern Hemisphere were born in the late winter or early spring. There is speculation that this may be because of a link between prenatal exposure to influenza and schizophrenia.

Brief Psychotic Disorder

Brief psychotic disorder is characterized as a delusion that has sudden onset and lasts less than one month. Brief psychotic disorder is a classification of the schizophrenia spectrum and other psychotic disorders. Criteria A: At least one of the following symptoms: delusions, hallucinations, disorganized speech, or catatonic behavior. Criteria B: The symptoms last most than one day but less than one moth. The individual does eventually return to baseline functioning. Criteria C: The disorder cannot be attributed to another psychotic or depressive disorder.

Behavioral Pediatrics - Hospitalization, Compliance, and School Adjustment

Children who need to be hospitalized for a significant period of time are especially at risk of developing psychological problems, in large part because they have been separated from their families. Children and adolescents are generally less compliant with medical regimens. This may be because of poor communication, parent-child problems, or a general lack of skill. For adolescents, peer pressure and the desire for social acceptance may motivate noncompliance with potentially embarrassing medical programs. Children with serious medical conditions are more likely to have trouble adjusting to school. Problems may be caused by the illness itself, by the frequent absences it necessitates, or by the social stigma of illness. Some treatments, like chemotherapy, are associated with deficits in neurocognitive functioning and greater risk of learning disabilities.

Mental Status Exam

Clients with evidence of dementia or short-term memory loss, often associated with Alzheimer's disease, should have cognition assessed. The Mini-Mental State Exam (MMSE) is commonly used. The MMSE requires the client to carry out specified tasks and scores on a scale of 0-9 based on their ability to do so: Memory: Remembering and later repeating the names of 3 common objects Attention: Counting backward from 100 by increments of 7 or spelling "world" backward. Following simple 3-part instruments, such as picking up a piece of paper, folding it in half, and placing it on the floor. Language: Naming items as the examiner points to them. Repeating common phrases. Reading a sensitive and following directions. Writing a sentence. Orientation: Providing the date and the location of the examiner's office, including city, state, and street address. Visual-Spatial Skills: Copying a picture of interlocking shapes. Scoring for the MMSW is as follows: · 24-30: Normal cognition · 18-23: Mild cognitive impairment 0-17: Severe cognitive impairment

Common Single System Experimental Designs

Common single system experimental designs are described below: · The A-B-A design begins with data collection in the pre-intervention phase (A) and then continuously during the intervention phases (B). The intervention is then removed (returning to "A") and data are again collected. In this way an experimental process is produced (testing without, with, and then again without intervention). Interferences regarding causality can be made, and two points of comparison are achieved. However, the ethics of removing a successful intervention leaves this study poorly recommended. · The A-B-A-B study overcomes this failure by reintroducing the intervention ("B") at the close of the study. Greater causality interferences are obtained. However, even temporary removal of a successful intervention is problematic (especially if the client drops out at that time), and this design is fairly time-consuming. The B-A-B design (the "intervention repeat design") drops the baseline phase and starts and ends with the intervention (important in crisis situations and where treatment delays are problematic), saving time and reducing ethical concerns.

Conduct Disorder - Diagnosis

Conduct disorder criteria are as follows: Criteria A: Persistent pattern of behavior in which significant age-appropriate rules or societal norms are ignored, and others' rights and property are violated (theft, deceitfulness); aggression to people and animals and destruction of property are common. To meet diagnosis criteria individuals will display three of the fifteen possible symptoms over the course of a year. All the symptoms can be categorized as belonging to one of the four categories below: · Aggression to people or animals · Destruction of property · Deceitfulness or theft · Serious violations of rules Criteria B: The patterns of behavior cause academic, social, and other impairments. Criteria C: The behaviors couldn't better be classified as antisocial personality disorder. Individuals with conduct disorder persistently violate either the rights of others or age-appropriate rules. They have little remorse about their behavior, and in ambiguous situations, they are likely to interpret behavior of other people as hostile or threatening.

Catatonia

Criteria for catatonia include at least three of the following: · Catalepsy · Defying or refusing to acknowledge instruction · Echolalia · Echopraxia · Little to no verbal response · Grimacing · Agitation · Semi-consciousness · Waxy flexibility · Posturing · Mannerism Stereotypy

Cyclothymic Disorder

Cyclothymic disorder is characterized by chronic, fluctuating mood with many hypomanic and depressive symptoms, which are not as severe as either Bipolar I or bipolar II. The criteria are as follows: Criteria A: The individual experiences a considerable number of hypomania symptoms without meeting all the criteria for hypomanic episodes and experiences depressive symptoms that do not meet the criteria for major depressive episode for two years or more (can be for one year or more in <18 years of age). Criteria B: During the above time period, the individual exhibits the symptoms more than half of the time and they are never symptom free for more than two months at a time. Criteria C: The individual has not met the criteria for manic, hypomanic, ,or major depressive episodes. Criteria D: the episode doesn't meet criteria for schizophrenia spectrum or other psychotic disorder. Criteria E: The episodes cause significant impairment socially or functionally.

Gender Dysphoria

DSM-5-TR defines gender dysphoria (formerly gender identity disorder) as a marked incongruence between one's expressed gender and assigned gender that causes significant distress or impairment over a period of at least 6 months. Informally, gender dysphoria is used to describe a person's persistent discomfort and disagreement with their assigned gender. DSM-5-TR criteria for diagnosis in children include: · Strong desire to be of the other gender or insistence that one is the other gender · Strong preference for clothing typically associated with the other gender · Strong preference for playing cross-gender roles · Strong preference for activities stereotypically of the other gender and rejection of those activities stereotypical of one's assigned gender · Strong preference for playmates of the other gender · Strong dislike of one's own sexual anatomy · Strong desire for the sex characteristics that match one's expressed gender DSM-5-TR criteria for diagnosis in adolescents and adults include: · Marked incongruence between expressed gender and one's existing primary and secondary sex characteristics · Strong desire to rid oneself of these sex characteristics for this reason · Strong desire for the sex characteristics of the other gender · Strong desire to be of the other gender and to be treated as such Strong conviction that one's feelings and reactions are typical of the other gender

Suicidal Ideation

Danger to self or suicidal ideation occurs frequently in clients with mood disorders or depression. While females are more likely to attempt suicide, males actually successfully commit suicide 3 times more than females, primarily because females tend to take overdoses from which they can be revived, while males close more violent means, such as jumping from a high place, shooting, or hanging. Risk factors include psychiatric disorders (schizophrenia,, bipolar disorder, PTSD, substance abuse, and borderline personality disorder), physical disorders (HIV/AIDS, diabetes, stroke, traumatic brain injury, and spinal cord injury), and a previous violent suicide attempt. Passive suicidal ideation involves wishing to be dead or thinking about dying without making plans while active suicidal ideation involves making plans. Those with active suicidal ideation are more at risk. People with suicidal ideation often give signals, direct or indirect, to indicate they are considering suicide because many people have some ambivalence and want help. Others may act impulsively or effectively hide their distress.

Data Analysis

Data analysis involves the examination of testing results within their context, assessing for correlations, causality, reliability, and validity. In testing a hypothesis (the assertion that two variables are related), researchers look for correlations between variables (a change in one variable associated with a change in another, expressed in numerical values). The closer the correlation is to +1.0 or -1.0 (a perfect positive or negative correlation), the more meaningful the correlation. This, however, is not causality (change in one variable responsible for change in the other). Since all possible relationships between two variables cannot be tested (the variety approaches infinity), the "null hypothesis" is used (asserting that no relationship exists) with probability statistics that indicate the likelihood and the hypothesis is "null" (and must be rejected) or can be accepted indicates a "reliability" and "validity" are also needed.

Delirium

Delirium is characterized by a clinically significant deficit in cognition or memory as compared to previous functioning. In order for delirium to be diagnosed, the individual must have disturbances in consciousness and either a change in personality or the development of perceptual abnormalities. These changes in cognition may appear as losses of memory, disorientation in space and time, and impaired language. The perceptual abnormalities associated with delirium include hallucinations and illusions. Delirium usually develops over a few hours or days, and may vary in intensity over the course of the days and weeks. If the cause of the delirium is alleviated, it may disappear for an extended period of time. The criteria for delirium are as follows: Criteria A: A disturbance in consciousness or attention. Criteria B: Develops over a short period of time, and fluctuates throughout the day. Criteria C: Accompanied by changes in cognition Criteria D: Not better explained by another condition. Criteria E: Caused by a medical condition or is substance related. Five groups of people at high risk for delirium: · Elderly people · Those who have a diminished cerebral reserve due to major neurocognitive disorder (formerly dementia), stroke, or some other medical condition · Those who have recently undergone cardiotomy · Burn victim s · Individuals who are drug-dependent and in withdrawal Delirium can also by caused by: · Systemic infections · Metabolic disorders · Fluid and electrolyte imbalances · Postoperative states · Head trauma · Long hospital stays, such as those in the intensive care unit The treatment of delirium usually aims at curing the underlying cause of the disorder and reducing the agitated behavior. Antipsychotic drugs can be good for reducing agitation, delusions, and hallucinations, while providing a calm environment can decrease the appearance of agitation.

Delusional Disorder

Delusional disorder is typified by the presence of a persistent delusion. Delusion may be persecutory type, jealous type, erotomaniac type (that someone is in love with delusional person), somatic type (that one has physical defect or disease), grandiose type, or mixed. The following are the criteria for delusional disorder: Criteria A: The individual experiences at least one delusion for at least one month or longer. Criteria B: The individual does not meet criteria for schizophrenia. Criteria C: Functioning is not significantly impaired, and behavior except dealing specifically with delusion is not bizarre. Criteria D: Any manic or depressive episodes are brief. Criteria E: The symptoms cannot be attributed to another medical condition or a substance. It should be specified if the delusions are bizarre. Severity is rated by the quantitative assessment measure "Clinician-Rated Dimensions of Psychosis Symptom Severity".

Dependent Personality Disorder

Dependent personality disorder is excessive reliance on others. A diagnosis of dependent personality disorder requires five of these symptoms: · Difficulty making decisions without advice · Need for others to assume responsibility for one's actions · Fear of disagreeing with others · Difficulty self-initiating projects · Feelings of helplessness or discomfort when alone · Goes to great lengths to get support from others · Seeks new relationships when an old one ends Preoccupied with the thought of having to care for self

Depressive Disorder with Seasonal Pattern

Depressive disorder with season pattern, formerly called seasonal affect disorder (SAD), is a depressive disorder that afflicts people in the Northern Hemisphere from October to April. Symptoms of this disorder are hypersomnia, increased appetite, weight gain, and an increased desire for carbohydrates. Research suggests this disorder is caused by circadian and seasonal increases in the level of melatonin production by the pineal gland from lack of sunlight. Affected individuals are treated with phototherapy (exposure to full-spectrum white light for several hours each day), aerobic exercise, and SSRIs.

Dissociative Disorders

Dissociative disorders are a disruption in consciousness, identity, memory, or perception of the environment that is not due to the effects of a substance or a general medical condition. These are all characterized by a disturbance in the normally integrative functions of identity, memory, consciousness, or environmental perception. Dissociative Identity Disorder (previously multiple personality disorder): Two or more personalities exist within one person, with each personality dominant at a particular time. Dissociative amnesia: Inability to recall important personal data, more than forgetfulness. It is not due to organic causes and comes on suddenly. Depersonalization/derealization disorder: Feeling detached from one's mental processes or body, as if one is an observer. Cultural influences can cause or amplify some of the symptoms of dissociative disorders, so take these into account when making a diagnosis. For instance, many religious ceremonies try to foster a dissociative psychological experience; individuals participating in such a ceremony may display symptoms of dissociative disorder without requiring treatment.

Down Syndrome

Down syndrome (Trisomy 21) occurs when a person has three #21 chromones instead of two. Down syndrome causes 20-30% of all cases of moderate to severe intellectual disability (1:800 births). Around 80% of Trisomy 21 pregnancies end in miscarriage. Classic physical characteristics associated with Down syndrome are slanted, almond-shaped eyes with epicanthic folds; a large, protruding tongue; a short, bent fifth finger; and a simian fold across the palm. Individuals with Down syndrome age rapidly. Medical conditions that often accompany Down syndrome can cause individuals to have a shorter life expectancy than normal, or poor quality of life, include heart lesions, leukemia, respiratory and digestive problems, cataracts, and Alzheimer's disease.

Drugs for Anxiety

Drugs most often used for anxiety are benzodiazepines, including the following: · Ativan (lorazepam) · Xanax (alprazolam) · Klonopin (clonazepam) · Valium (diazepam) Benzodiazepines are effective, short-acting, and quickly relieve anxiety. They should be used for as short a time as possible and in conjunction with appropriate therapeutic interventions because of their potential for abuse and addiction. In the elderly, long-term use of these drugs can cause psychotic symptoms that can be reversed by discontinuing their usage.

Enuresis and Encopresis

Encopresis and enuresis make up the two major categories of elimination disorders. Enuresis is repeated urinating during the day or night into the bed or clothes at least twice a week for three or more months. Most of the time this urination is involuntary. Enuresis is diagnosed only when the child has reached an age at which continence can be reasonably expected (at least age five for DSM-5-TR criteria), and they do not have some other medical condition that could be to blame, like a urinary tract infection. Enuresis is treated with a night alarm, which makes a loud noise when the child urinates while sleeping. This is effective about 80% of the time, especially when it is combined with techniques like behavioral reversal and overcorrection. Desmopressin acetate (DDAVP) nasal spray, imipramine, and oxybutynin chloride (Ditropan) may help control symptoms. Encopresis is the involuntary fecal soiling in children who have already been toilet trained. Encopresis diagnosis cannot be made until the child is at least 4 years of age per DSM-5-TR criteria.

Ethical Concerns with Study Design Selection

Ethical concerns involved with selecting a study design include the following: · Research must not lead to harming clients. · Denying an intervention may amount to harm. · Informed consent is essential. Confidentiality is required.

Evaluation in the Assessment Process

Evaluation is the process of accumulating data in order to improve a person's ability to make a decision based on reliable standards. The accumulated data is given careful consideration and appraisal by the evaluator to ensure that it is complete and accurate. The evaluator must make some kind of interpretation or inference about the data that has been collected. The inference is known as a value judgment and is a common task for the social worker who uses a methodical and well-organized system to aid in the evaluation of the assessment process.

Single System Study Designs

Evaluation of the efficacy and functionality of a practice is an important aspect of quality control and practice improvement. The most common approach to such an evaluation is the single system study approach. Selecting one client per system (n=1), observations are made prior to, during and following an intervention. The research steps are: 1. Selection of a problem for change (the target) 2. Operationalizing the target into measurable terms 3. Following the target during the baseline phase, prior to the application of any intervention 4. Observing the target and collecting data during the intervention phase, during which the intervention is carried out. (There may be more than one phase of data collection.) Data that are repeatedly collected constitute a single system study "time series design". Single system designs provide a flexible and efficient way to evaluate virtually any type of practice.

ADHD - Associated Features

Even though they are found to have average or above-average intelligence, children with ADHD typically score lower than average on IQ tests. Almost every child with ADHD will have some trouble in school, with about a quarter having major problems in reading. Also, social adjustment can be difficult for children with ADHD. Various reports give the co-diagnosis of Conduct Disorder with ADHD occurring 30-90% of the time. Other common co-diagnosis include Oppositional Defiant Disorder, Anxiety Disorder, and Major Depression. About half of all children who are diagnosed with ADHD are also suffering from a learning disorder.

Assessment of Executive Function

Executive functions are cognitive features that control and regulate all other abilities and behavior. These are higher-level abilities that influence attention, memory, and motor skills. They also monitor and provide the capacity to initiate, stop, and change behaviors, to set goals and plan future behavior, and to solve problems when faced with complex tasks and situations. Executive functions allow one to form concepts and think abstractly. Deficits in executive functioning are evident in the reduced ability to delay gratification, problems with understanding cause and effect (i.e., concrete thinking), poor organization and planning, difficulty following multi-step directions, preservation with an idea in the face of superior information, and overall poor judgement. Various assessment tools exist to evaluate executive functioning, including the following: · Trail making test · WAIS-IV · Closk drawing tests When combined with observations and the social work assessment, these tests can expose deficiencies in executive function that may disrupt the client's ability to participate in daily activities. From this assessment, the social worker can identify needs and resources to better support the client.

Schizophrenia - Associated Features

Features commonly associated with schizophrenia are: · Inappropriate affect · Anhedonia (loss of pleasure) · Dysphoric mood · Abnormalities in motor behavior · Somatic complaints One of the more troublesome aspects of schizophrenia is that the afflicted individual rarely has any insight into their own condition and so is unlikely to comply with treatment. People with schizophrenia often develop substance dependencies, especially to nicotine. Though many people believe that those with schizophrenia are more likely to be violent or aggressive than individuals in the general population, there is no statistical information to support this assertion. The onset of schizophrenia is typically during the ages of 18-25 for males and 25-35 for females. Males are slightly more likely to develop the disorder.

Schizophrenia - Disorganized and Negative Symptoms

For many psychologists, the classic characteristic of schizophrenia is disorganized speech. Disorganized speech manifests as: · Incoherence · Free association that make little sense · Random responses to direct questions Disorganized behavior manifests as: · Shabby or unkempt appearance · Inappropriate sexual behavior · Unpredictable agitation · Catatonia and decreased motor activity Negative symptoms of schizophrenia include: · Restricted range of emotions · Reduced body language · Lack of facial expression · Lack of coherent thoughts · Inability to make conversation Avolition (the inability to set goals or to work in a rational, programmatic manner)

Schizophrenia and Dopamine

For many years, the professional consensus was the schizophrenia was caused by either an excess of the neurotransmitter dopamine or oversensitive dopamine receptors. The dopamine hypothesis was supported by the fact that antipsychotic medicals that block dopamine receptors had some success in treating schizophrenia, and by the fact that dopamine-elevating amphetamines amplified the frequency of delusions. The dopamine hypothesis has been somewhat undermined, however, by research that found elevated level so norepinephrine and serotonin, as well as low levels of GABA and glutamate in schizophrenics. Some studies have shown that clozapine and other atypical antipsychotics are effective in treating schizophrenia, even though they block serotonin rather than dopamine receptors.

Somatoform Disorders - Functional Neurological Symptom Disorder

Functional neurological symptoms disorder (formerly conversion disorder) is a somatoform disorder characterized by either loss of bodily functions or symptoms of a serious physical disease. The individual becomes blind, mute, or paralyzed in response to an acute stressor. Occasionally, individuals develop hyperesthesia, analgesia, tics, belching, vomiting, or coughing spells. These symptoms do not conform in physiological mechanisms, and testing reveals no underlying physical disease. The sensory loss, movement loss, or repetitive physical symptoms are not intentional. The individual is not malingering to avoid work, or factitiously seeking attention. The symptoms of a functional neurological symptom disorder can often be removed with hypnosis or Amytal interview. Some researchers believe that simply suggesting that these symptoms will go away is the best way to relieve them. The individual can develop complications, like seizures, from disuse of body parts.

Genito-Pelvic Pain/Penetration Disorder and Categories of Sexual Dysfunctions

Genito-pelvic pain/penetration disorder is persistent difficulty with genital pain associated with sexual intercourse or involuntary spasms in the pubococcygeus muscle in the vagina, which make it difficult to have sexual intercourse, or fear or anxiety related to anticipation of pain during intercourse. Sexual dysfunctions are categorized as lifelong or acquired, and generalized or situational, depending on their cause. Generalized dysfunctions occur with every sexual partner in all circumstances. Situational dysfunctions only occur under certain circumstances. ' The cause may be psychological, physical, or both.

Histrionic Personality Disorder

Histrionic personality disorder is excessive emotionality and attention-seeking behavior. Five symptoms form the following list must be present: · Annoyance or discomfort when not receiving attention · Inappropriate sexual provocation · Rapidly shifting and shallow emotions · Vague and impressionistic speech · Exaggerated expression of emotion · Easily influenced by others · Believed relationship are more intimate than they actually are Uses physical appearance to draw attention to self

Neurocognitive Disorder due to Vascular Disease

In order to be diagnosed with neurocognitive disorder due to vascular disease, the individual must have cognitive impairment and either focal neurological signs or laboratory evidence of cerebrovascular disease. Neurocognitive disorder has varying symptoms, depending on where the brain damage lies. Focal neurological signs may include exaggerated reflexes, weaknesses in the extremities, and abnormalities in gait. Symptoms gradually increase in severity. Risk factors for vascular neurocognitive disorder are hypertension, diabetes, tobacco smoking, and atrial fibrillation. In some cases, an individual may be able to recover from neurocognitive disorder due to vascular disease. Stroke victims, for instance, will notice a great deal of impairment in the first six months after the cerebrovascular accident. Most of this improvement will be in their physical, rather than cognitive, symptoms.

Sampling - Terms Used in Sampling

In sampling, the following concepts are considered: · A population is the total set of subjects sought for measurement by a researcher. · A sample is a subset of subjects drawn from a population (a total population testing is usually not possible). · A subject is a single unit of the population. Generalizability refers to the degree to which specific findings obtained can be applied to the total population.

Indicators of Behavioral Dysfunction

Indicators of behavioral dysfunction may be present upon assessment, including the following: Unkempt appearance: Sloppily dressed, dirty, smelly. Substance Abuse: Burnt fingers, constricted pupils, needle tracks, runny nose, slurred speech, tremors, smell of alcohol. Labile emotions: May have sudden mood swings or outburst of anger and may appear angry much of the time. May be wildly talkative or withdrawn and silent. Self-injury: Signs of cutting, excessive piercings, picking at scabs, head banging. Counter-culture Identification: May identify with extreme or marginal groups, or dress in the "uniform" of one of these groups. Attitude: May be disrespectful, scatological, demanding, using expletives, and argumentative. May refuse to follow rules. May refuse to answer questions or respond to social worker. Dishonesty: May lie and try to deceive. May have a history of stealing (shoplifting is common). Truancy/Absence: May have a history of skipping classes or failing to attend school at all, running away, or staying out all night.

Indicators of Sexual Dysfunction

Indicators of sexual dysfunction that may present upon assessment include the following: · History of promiscuity or prostitution: Both may indicate that the client was sexually abused at one time or needed to resort to sex to gain income, acceptance, or to pay for drugs or alcohol. · Sexualized behavior: In children and adolescents, this usually indicates sexual abuse. In adults, it often indicates that the individual uses the body as an expression of power. · Asexual behavior: Client may dress or act in such a manner as to appear sexually unattractive as a means of self-protection. · Bragging: Those who feel insecure about their sexuality may resort to bragging about sexual exploits. · Paraphilias: Clients rarely admit to paraphilias (which usually have onset during adolescence), such as sadism, pedophilia, peeping, and exhibitionism, but may come in contact with social services as part of the criminal justice system. Gender dysphoria: Clients may bind breast, tuck penis, or cross dress.

Dissociative Amnesia

Individuals may be diagnosed with dissociative amnesia if they have more than one episode in which they are unable to remember important personal information, and this memory loss cannot be attributed to ordinary forgetfulness. The gaps in the individual's memory are likely to be related to a traumatic event. The three most common patterns of dissociative amnesia are: · Localized, in which the individual is unable to remember all events around a defined period. · Selective, in which the individual cannot recall some events pertaining to a circumscribed period. · Generalized, in which memory loss spans the individual's entire life. It should be specified if this is with dissociative fugue, a subtype of dissociative amnesia, which is a purposeful travel that is associated with amnesia.

Generalized Anxiety Disorder

Individuals may be diagnosed with generalized anxiety disorder (GAD) if they have excessive anxiety about multiple events or activities. This anxiety must have existed for at least six months and must be difficult for the individual to control. The anxiety must be disproportionate to the feared event. Anxiety must include at least three of the following: · Restlessness · Fatigue on exertion · Difficulty concentrating · Irritability · Muscle tension · Sleep disturbance The treatment for GAD usually entails a multicomponent cognitive-behavioral therapy, occasionally accompanied by pharmacotherapy. SSRI antidepressants and anxiolytic buspirone have both demonstrated success in diminishing the symptoms of GAD.

Schizophrenia - Prognosis and Differential Diagnosis

Individuals typically develop schizophrenia as a chronic condition, with very little chance of full remission. Positive symptoms of schizophrenia tend to decrease in later life, though the negative symptoms may remain. The following factors tend to improve prognosis: · Good premorbid adjustment · Acute and late onset · Female gender · Presence of a precipitating event · Brief duration of active-phase symptoms · Insight into the illness · Family history of mood disorder · No family history of schizophrenia Differential diagnoses for schizophrenia include bipolar and depressive disorders with psychotic features, schizoaffective disorder, and the effects of prolonged and large-scale use of amphetamines or cocaine.

Neurocognitive Disorder - Diagnosis

Individuals who suffer from neurocognitive disorders are likely to manifest a few cognitive deficits, most notably memory impairment, aphasia, apraxia, agnosia, and impaired executive functioning. Depending on the etiology of the neurocognitive disorders, these deficits may get progressively worse or may be stable. These individuals could have both anterograde and retrograde amnesia, meaning that they find it difficult both to learn new information and to recall previously learned information. There may be a decrease in language skills, specifically manifested in an inability to recall the names of people or things. Individuals may also have a hard time performing routine motor programs, and may be unable to recognize familiar people and places. Abstract thinking, planning, and initiating complex behaviors are difficult.

Neurocognitive Disorder Due to HIV Infection

Individuals with AIDS develop a particular form of neurocognitive disorder. In its early stages, the Human Immunodeficiency Virus causes major neurocognitive disorder (formerly dementia), which appears as forgetfulness, impaired attention, and generally decelerated mental processes. Neurocognitive disorders due to HIV progresses include poor concentration, apathy, social withdrawal, loss of initiative, tremor, clumsiness, trouble with problem-solving, and saccadic eye movements. One of the ways that neurocognitive disorders due to HIV is distinguished is by motor slowness, the lack of aphasia, and more severe forms of depression and anxiety. It shares these features with neurocognitive disorders due to Parkinson's and Huntington's diseases.

Neurocognitive Disorder due to Huntington's Disease

Individuals with Huntington's disease suffer degeneration of the GABA-producing cells in their substantial nigra, basal ganglia, and cortex. This inherited disease typically appears between the ages of 30 and 40. The affective symptoms of Huntington's disease include irritability, depression, and apathy. After a while, these individuals display cognitive symptoms as well, including forgetfulness and dementia. Later, motor symptoms emerge, including fidgeting, clumsiness, athetosis (slow, writhing movements), and chorea (involuntary quick jerks). Because the affective symptoms appear in advance of the cognitive and motor symptoms, many people with Huntington's are misdiagnosed with depression. Individuals in the early stages of Huntington's are at risk for suicide, as they are aware of their impending deterioration, and will have the loss of impulse control associated with the disease.

Illness Anxiety Disorder

Individuals with illness anxiety disorder (formerly hypochondriasis) have an unrealistic preoccupation with having or getting a serious illness that is based on a misappraisal of bodily symptoms. This preoccupation is disproportional to symptoms or medical evidence. Individuals with illness anxiety disorder likely know a great deal about their conditions, and frequently go to a number of different doctors searching for a professional opinion that confirms their own. They likely either experience frequent health related checks ()either by doctors or by self-checks) or avoidance of doctors and healthcare facilities. The symptoms of this disorder have been present for at least six months, however, the specific illness that the individual fears may change.

Information Sources for Assessment

Information can also be collected from various external sources to contribute to the assessment of the client: Social services agency: Record of previous contact with the client and interventions made, as well as the reason for termination or continuation of the case. Employer: History of employment, including the type of work, the duration, attendance record, skills needed for the jobs, problems encountered, and job-related injuries. Medical records: Names of healthcare providers, diagnoses and treatments prescribed, medication list, history of chronic disorders and need for ongoing treatment and assessment. Psychological records: Psychosocial assessment, diagnoses of mental health problems, types of therapies utilized, client goals, and recommendations for ongoing care. Legal records: History of offenses and juvenile detention and adult incarceration/parole. Evidence of history of violence toward self or others. School records: Attendance records indicate compliance with schooling, grades suggest cognitive ability, disciplinary actions may indicate behavioral problems. 504 plans and IEPs indicate students with disabilities and outline needs for special education and/or accommodations, auxiliary aids, and service.

Study Designs - Selecting a Study Design

Key considerations that guide the selection of a study design include the following: · Standardization: Whether or not data can be collected in an identical way from each participant (eliminating collection variation). · Level of certainty: The study size needed to achieve statistical significance (determined via power calculations). · Resources: The availability of funding and other resources needed. · The time frame required. The capacity of subjects to provide informed consent and receiving ethics approval via Human Subjects Review Committees and Institutional Review Boards.

Data Collection

Key points in data collection include the following: · Data should ideally be collected close to the time of intervention (delays may result in variation from forgetfulness, rather than from the intervention process). · Frequent data collection is ideal, but subject boredom or fatigue must be avoided as well. Thus, make the data collection process as easy as possible (electronic devices can sometimes help). · Keep the data collection process short to increase subject responsiveness. · Standardize recording procedures (collect data at the same time, place, and method to enhance ultimate data validity and reliability). Choose a collection that fits the study well (observation, questionnaires, logs, diaries, surveys, rating scales, etc.) to optimize the data collection process and enhance the value of the data obtained.

Neurocognitive Disorders

Major and minor neurocognitive disorders (NCD) may be due to any of the following: Alzheimer's disease, Frontotemporal lobar degeneration, Lewy body disease, vascular disease, traumatic brain injury, substance or medication use, HIV infection, prion disease, Parkinson's disease, Huntington's disease, another medical condition, and multiple etiologies. Criteria are as follows: Criteria A: A change in cognitive ability from baseline. This information can be determined by the individual, a well-informed significant other, family member, or caretaker, or it can be determined by neuropsychology testing. Criteria B: For a major neurocognitive disorder, the cognitive change interferes with ADLs and independence. For a minor neurocognitive disorder, the cognitive change doesn't interfere with normal ADLs and independence, if accommodations are used. Criteria C: The cognitive change cannot be defined as delirium only. Criteria D: The cognitive change is not better described as another mental disorder.

Major Depressive Disorder - Diagnosis and Gender

Major depressive disorder is diagnosed when an individual has one or more major depressive episodes without having a history of manic, hypomanic, or mixed episodes. There are a few different specifiers (categories of associated features) for major depressive disorder issued by the DSM-5-TR: · With anxious distress · With melancholic features · With peripartum onset · With seasonal pattern · With psychotic features (mood-congruent or mood-incongruent) · With catatonia · With atypical features · With mixed features Some studies estimate that 20% of women will have symptoms worthy of a diagnosis of major depressive disorder after giving birth. From the beginning of adolescence on, the rate of major depressive disorder is about twice as great for females as for males. Before adolescence, the rates are about the same. Most major depressive disorders occur in the mid-twenties.

Malingering vs. Factitious Disorder

Malingering is feigning physical symptoms to avoid something specific, like going to work, or to gain a special reward. Consider malingering as a possibility when: · A person obtains a medical evaluation for legal reasons or to apply for insurance compensation. · There is marked inconsistency between the individual's complaint and the objective findings, or if the individual does not cooperate with a diagnostic evaluation or prescribed treatment. · The individual has an antisocial personality disorder. Malingering contrasts with factitious disorder because in FD the individual does not feign physical symptoms for personal growth or to avoid an adverse event, but does it with no obvious external rewards.

Separation Anxiety Disorder - Onset

Many children who suffer from separation anxiety disorder will refuse to go to school, and may claim physical ailments to avoid having to leave the home. In some cases, the child will actually develop a headache or stomachache as a result of anxiety from separation form the home or from an individual to whom they are attached. The refusal to go to school may begin as early as 5 or as late as 12. If the separation anxiety occurs after the age of 10, however, it is quite possibly the result of depression or some more severe disorder. There are various treatment plans for separation anxiety disorder, all of which recommend that the child immediately resume going to school on a normal schedule.

Psychiatric Illness and Sexuality

Many times, psychiatric illness can affect a person's sexuality. Mental illness, such as depression, can often decrease the client's sexual desire, while the manic client will often become hypersexual. Bipolar clients can experience a lack of sexual inhibition and may have many sexual affairs or act very seductively or overly sexual. Psychotic clients may experience hallucinations or delusions of a sexual nature, and the schizophrenic client may exhibit inappropriate sexual behaviors such as masturbation in public. Clients residing in long-term care facilities must be kept safe from sexually transmitted infections, unwanted pregnancies, and unwanted sexual advances or assaults from others. The social worker must be aware of these risks and provide support and advocacy accordingly.

Measures of Variability and Correlation

Measure of variability (or variation) include the following: · The range, or the arithmetic difference between the largest and the smallest value (idiosyncratic "outliers" often excluded). · The interquartile range, or the difference between the upper and lower quartiles (e.g., between the 75th and 25th percentiles). · The standard deviation, or the average distance that numerical values are dispersed around the arithmetic mean. Correlation refers to the strength of relatedness when a relationship exists between two or more numerical values, which, when assigned a numerical value, is the correlation coefficient ( r). A perfect (1:1) correlation has an r value of 1.0, with decimal values indicating the lesser correlation as the correlation coefficient moves away from 1.0. The correlation may be either positive (with the values increasing or decreasing together) or negative (if the values are inverse and move opposite to each other).

Drugs for Unipolar Depression

Medications used for treating unipolar depression include the following: Selective serotonin reuptake inhibitors (SSRIs): Prozac (fluoxetine) Zoloft (sertraline) Paxil (paroxetine) Luvox (fluvoxamine) Celexa (citalopram) Lexapro (escitalopram) Atypical antidepressants: Effexor (venlafaxine) Wellbutrin (bupropion) Cymbalta (duloxetine) Tricyclic antidepressants: Tofranil (imipramine) Elavil (amitriptyline) MAO inhibitors (MAOIs): Nardil (phenelzine) Parnate (tranylcypromine) Eldepryl (selegiline)

Suicide Statistics and Correlates - Psychiatric Disorders and Biological Correlates

Most of those who commit suicide are suffering from some mental disorder, most commonly major depressive disorder or bipolar disorder. Suicide associated with depression is most likely to occur within three months after the symptoms of depression have begun to improve. The risk of suicide among adolescents with depression increases greatly if the adolescent also has conduct disorder, ADHD, or is a substance abuser, particularly of inhaled solvents. As for biological correlates, people who commit suicide have been found to have low levels of serotonin and 5HIAA (a serotonin metabolite). Individuals at risk for suicide need immediate psychological interventions and a 24-hour suicide watch.

Motor Disorders - Treatment

Most successful treatments for Tourette's syndrome include pharmacotherapy. The antipsychotics haloperidol (Haldol) and pimozide (Orap) are successful in relieving the symptoms of Tourette's syndrome because they inhibit the flow of dopamine in the brain; their success has led many scientists to speculate that Tourette's Disorder is caused by an excess of dopamine. In some cases, psychostimulant drugs amplify the tics displayed by the individual. In some cases, a doctor may treat the hyperactivity and inattention of Tourette's with clonidine or desipramine. The former of these is a drug usually to treat hypertension, with the latter is typically used as an antidepressant.

Motor Disorders

Motor disorders are a type of neurodevelopmental disorder. Motor disorders can be classified as developmental coordination disorders, stereotypic movement disorders, and tic disorders. Tic disorders are further classified as Tourette's disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Tics are defined in the DSM as "sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations that feel irresistible yet can be suppressed for varying lengths of time."

Narcissistic Personality Disorder

Narcissistic personality disorder is grandiose behavior along with a lack of empathy and a need for admiration. The individual must exhibit five of these symptoms for diagnosis: · Grandiose sense of self-importance · Fantasies of own power and beauty · Belief in personal uniqueness · Need for excessive admiration · Sense of entitlement · Exploitation of others · Lack of empathy · Envious of others or believes others envy them Arrogant behaviors

Obsessive-Compulsive Disorder - Gender Issues, Etiology, and Treatment

OCD is equally likely to occur in adult males and adult females. The average age of onset is lower for males, so the rates of OCD among male children and adolescents are slightly higher than among females. Evidence suggests that OCD is caused by low levels of serotonin, Structurally, OCD seems to be linked to overactivity in the right caudate nucleus. The most effective treatment for OCD is exposure with response prevention in tandem with medication, usually either the tricyclic clomipramine or an SSRI. Therapies that provide help with stopping through patterns seems to be especially successful in battling OCD. When drugs are used alone, there remains a high risk of relapse.

Obsessive-Compulsive Personality Disorder

Obsessive-Compulsive personality disorder is a persistent preoccupation with organization and mental or interpersonal control. Four of these symptoms are required for the diagnosis of obsessive-compulsive personality disorder: · Preoccupation with rules and details · Perfectionism that interferes with progress · Excessive devotion to work · Counterproductive rigidity about beliefs and morality · Inability to throw away old objects · Reluctance to delegate authority to others · Rigid or stubborn Hoards money without spending

The Role of Observation in Assessment = Levels of Observation

One form of assessment involves nonstandard procedures that are used to provide individualized assessments. Nonstandard procedures include observations of client behaviors and performance. There are three levels of observation techniques that can be applied: · The first level is causal informational observation, where the provider gleans information from watching the client during unstructured activities throughout the day. · The second level is guided observation, an intentional style of direct observation accomplished with a checklist or rating scale to evaluate the performance or behavior seen. The third level is the clinical level, where observation is done in a controlled setting for a lengthy period of time. This is most often accomplished on the doctoral level with applied instrumentation.

Stages of Alzheimer's Disease

Over half of all cases of neurocognitive disorder are caused by Alzheimer's disease. Alzheimer's begins slowly and may take a long time to become noticeable. Researchers have outlined three stages of Alzheimer's disease: · Stage 1 usually comprises the first 1-3 years of the condition. The individual suffers from mild anterograde amnesia, especially for declarative memories. They are likely to have diminished visuospatial skills, which often manifests itself in wandering aimlessly. Also common to this stage are indifference, irritability, sadness, and anomia. · Stage 2 can stretch between the second and tenth years of illness. The individual suffers increasing retrograde amnesia, restlessness, delusions, aphasia, acalculia, ideomotor apraxia (the inability to translate an idea into movement), and a generally flat mood. · In Stage 3 of Alzheimer's disease, the individual suffers severely impaired intellectual functioning, apathy, limb rigidity, and urinary and fecal incontinence. This late stage usually occurs between the eight and twelfth years of the condition. Alzheimer's disease is quite difficult to diagnose directly, so it is usually only diagnosed once all the other possible causes of major neurocognitive disorder (formerly dementia) have been eliminated. A brain biopsy that indicates extensive neuron loss, amyloid plaques, and neurofibrillary tangles can give solid evidence of Alzheimer's disease. Individuals who develop Alzheimer's disease usually only live about ten years after onset. The disease is more common in females than males, and is more likely to occur after the age of 65.

Paranoid Personality Disorder

Paranoid personality disorder is a pervasive pattern of distrust and suspiciousness that involves believing the actions and thoughts of other people to be directed antagonistically against oneself. In order to make the diagnosis, the individual must have at least four of the following symptoms: · Suspects that others are somehow harming them · Doubts the trustworthiness of others · Reluctant to confide in others · Suspicious without justification about fidelity of one's partner · Reads hidden meaning into remarks or events · Consistently has grudges Believes there are attacks on their character that others present do not perceive

Paraphilic Disorders

Paraphilic disorders are intense, recurrent sexual urges or behaviors involving either nonhuman objects, non-consenting partners (including children), or the suffering or humiliation of oneself or one's partner. Common paraphilias include: · Fetishistic disorder · Transvestic disorder · Pedophilic disorder · Exhibitionistic disorder · Voyeuristic disorder · Sexual masochism disorder · Sexual sadism disorder · Frotteuristic disorder (rubbing against a non-consenting person) The most common treatment for paraphilia was previously in vivo aversion therapy, but now it is more common for treatment to include covert sensitization, in which the imagination is given aversion therapy. The medication Depo-Provera has been found to relieve paraphiliac symptoms for many men, although this relief ceases as soon as the man stops taking the drug.

Neurocognitive Disorder Due to Alzheimer's Disease

Particular kinds of Alzheimer's disease have been linked with specific genetic abnormalities. For instance, those with early-onset familial Alzheimer's often have abnormalities of chromosome 21, while individuals whose onset is later are likely to have irregularities on chromosome 19. Those with Alzheimer's disease have also been shown to have significant aluminum deposits in brain tissues, a malfunctioning immune system, and a low level of acetylcholine. Some of the drugs used to treat Alzheimer's increase the cholinergic activity of the brain. These drugs, which include the trade names Cognex and Aricept, can temporarily reviser cognitive impairment, though these improvements are not sustained when the drugs are removed.

Cluster A, B, and C Personality Disorders

Personality disorders are clustered into three groups: Cluster A (eccentric or odd disorders): · Paranoid · Schizoid · Schizotypal Cluster B (dramatic or excessively emotional disorders): · Antisocial · Borderline · Histrionic · Narcissistic Cluster C (fear- or anxiety-based disorders): · Avoidant · Dependent Obsessive-Compulsive

Personality Disorders

Personality disorders occur when an individual has developed personality traits so maladaptive and entrenched that they cause personal distress or interfere significantly with functioning. There are five traits involved in personality disorders: · Neuroticism · Extraversion/introversion · Openness to experience · Agreeableness/antagonism · Conscientiousness The following are the criteria for personality disorders: Criteria A: Long-term pattern of maladaptive personality traits and behaviors that do not align with the individual's culture. These traits and behaviors will be found in at least two areas: · Impulse control · Inappropriate emotional intensity or responses · Inappropriately interpreting people, events, and self · Inappropriate social functioning Criteria B: The traits and behaviors are inflexible and exist despite changing social situations. Criteria C: The traits and behaviors cause distress and impair functioning. Criteria D: Onset was adolescence or early adulthood and has been enduring. Criteria E: The behaviors and traits are not due to another medical disorder. Criteria F: The behaviors and traits are not due to a substance.

PKU

Phenylketonuria (PKU) is one cause of intellectual disability. It occurs when an infant lacks the enzyme to metabolize the amino acid phenylalanine, found in high-protein foods and aspartame sweetener. PKU is a rare recessive genetic disorder diagnosed at birth by a simple blood test. It affects mostly blue-eyed, fair babies. Expectant mothers can reduce the hazard of PKU by maintaining a diet low in phenylalanine. Untreated PKU typically lead to some form of intellectual disability. Some of the symptoms common to individuals with PKU are impaired motor and language development and volatile, erratic behavior. PKU can be treated if it is diagnosed in a timely fashion. Individuals must monitor their diet to keep phenylalanine blood levels at 2-10 mg/dL. Some phenylalanine is required for growth.

Pica and Rumination Disorder

Pica is the persistent eating of non-food substances such as paint, hair, sand, cloth, pebbles, etc. Those with pica do not show an eversion to food. In order to be diagnosed, the symptoms must persist for at least a month without the child losing an interest in regular food. Also, the behavior must be independent and not a part of any culturally acceptable process. Pica is most often manifested between the ages of 12 and 24 months. Pica has been observed in developmentally disabled children, pregnant women, and people with anemia. Rumination disorder is the regurgitation of re-chewing of food.

Policies and Procedures that Minimize Risk

Policies that help minimize risk may include rules about the number of staff present in the office or at particular interview, when and how a worker should seek assistance from another staff member or from the police, and how the agency will respond to complaints or threats from clients or their acquaintances. When an issue of risk arises, agencies should have clearly defined ways of handing the problem. Training staff members in procedures concerning suicide prevention is one way to minimize risk; making sure they're current in their understanding of child protection laws is another. Documentation procedures can help an agency defend itself in cases of litigation.

Addressing Critical Incidents and Debriefing

Posttraumatic stress and vicarious posttraumatic stress can affect even the most balanced, educated worker, and many of the daily events of a social worker's life are difficult, unpleasant, and upsetting. Agencies have a duty to their employees to provide them with supervision, mental health care, and ways to process and work through critical incidents. Agencies should either have trained staff to manage debriefings after traumatic events or should contract with outside companies to provide these services. Employee assistance programs (EAPs), on-site supervision sessions targeted to the incident, and policies regarding time off for self-care after critical events are ways agencies can help employees regain and maintain their emotional stability.

Indicators of Psychosocial Stress

Psychosocial stress (which occurs when one perceives a threat as part of social interaction with other individuals) causes a sympathetic nervous system response ("fight or flight") with the release of stress hormones (cortisol, adrenaline, dopamine), which can cause the heart rate and blood pressure to increase. Clients who are facing the need for resocialization (such as after incarceration), role change (after divorce, job loss), or situation change (foster care, rehab) are especially at risk for psychosocial stress. Indicators include the following: Self-injury: Signs of cutting, excessive piercings, picking at scabs. Speech alterations: Some may speak very quickly while others may say little or nothing. Demeanor: May be very withdrawn or nervous and agitated. Self-comforting measures: Licking lips, rubbing hands together, sitting with arms folded, taking deep breaths. Substance abuse: Use of alcohol or drugs to alleviate distress and provide an escape from problems. Stress-related ailments: Hypertension, headaches, GI upset. Sleep impairment: Insomnia or excessive drowsiness and sleep periods. Mental health issues: Depression is a common response to stress.

Quality Assurance

Quality assurance is an aspect of quality improvement and risk management and includes all processes involved in planning and operations to ensure that care provided is of high quality. Quality assurance (also referred to as quality control) includes those methods used to ensure compliance and a specific level of quality in providing services or products. Quality assurance includes devising standards as well as means of ensuring compliance through guidelines, protocols and written specifications. One of the primary goals of quality assurance is to identify and correct errors that affect outcomes. Quality assurance reviews should be carried out on an ongoing basis, and reports should be issued so that staff members are aware of their progress in eliminating errors and working efficiently. Quality assurance units and personnel should be independent of the programs and processes they are reviewing in order to prevent bias and should use standardized and validated instruments for assessment purposes whenever possible.

Reliability and Validity

Reliability refers to consistency of results. This is measured via test-retest evaluations, split-half testing (random assignment into two subgroups given the same intervention and then comparison of findings), or in interrater situations, where separate subjects' rating scores are compared to see if the correlations persist. Validity indicates the degree to which a study's results capture the actual characteristics of the features being measured. Reliable results may be consistent but invalid. However, valid results will always be reliable. Methods for testing validity include the following: Concurrent validity: Comparing the results of studies that used different measurement instruments but targeted the same features. Construct validity: The degree of agreement between a theoretical concept and the measurements obtained (as seen via the subcategories of (a) convergent validity, the degree of actual agreement on measures that should be theoretically related, and (b) discriminant validity, the lack of a relationship among measures which are theoretically not related). Predictive validity: Concerning whether the measurement can be used to accurately extrapolate (predict) future outcomes.

Suicide Statistics and Correlates - Cognitive Correlates and Life Stress

Research into suicide has indicated that hopelessness is the most common predictor of an inclination to self-destruction. It is a more accurate predictor even than the intensity of depressive symptoms. Self-assigned or society-assigned perfectionism has also been blamed for suicide. Many suicides are preceded by some traumatic life event, like the end of a romantic relationship or the death of a loved one. For adolescents, the most common precipitant of suicide is an argument with a parent or rejection by a boyfriend or girlfriend. Among adolescents, the common warning signs of suicide are talking about death, giving away possessions, and talking about a reunion with a deceased individual.

Treatment for Conduct Disorder and Oppositional Defiant Disorder

Research suggest that conduct disorder interventions are most successful when they are administered to preadolescents and include the immediate family members. Some therapists have developed programs of parent therapy to help adults manage the antisocial behavior of their children, as this has been demonstrated to have good success. Most programs advise rewarding good behavior and consistently punishing bad behavior. Oppositional Defiant Disorder is similar to conduct disorder and is characterized by: · Patterns of negative or hostile behavior towards authority figures · Frequent outbreaks of temper and rages · Deliberately annoying people · Blaming others · Spite and vindictiveness This pattern of negative, hostile, defiant behavior, and vindictiveness however, is less serious violations of the basic rights of others that characterize conduct disorder. Behavior is motivated by interpersonal reactivity or resentful power struggle with adults.

Schizoid Personality Disorder

Schizoid personality disorder is characterized by a pervasive lack of interest in relationships with others and limited range of emotional expression in contacts with others. Four of these symptoms must be present: · Avoidance of or displeasure in close relationships · Always chooses solitude · Little interest in sexual relationships · Takes pleasure in few activities · Indifference to praise or criticism · Emotional coldness or detachment Lacks close friends except first-degree relatives

Schizophrenia - Diagnosis

Schizophrenia is a psychotic disorder. Psychotic disorders are those that feature one or more of the following: delusions, hallucinations, disorganized speech or thought, or disorganized or catatonic behavior. Schizophrenia diagnostic criteria are as follows: Criteria A: Diagnosis requires at least two of the following symptoms, one being a core positive symptom: · Hallucinations (core positive symptoms) · Delusions (core positive symptom) · Disorganized speech (core positive symptom) · Severely disorganized or catatonic behavior · Negative symptoms (i.e., avolition, diminished expression) Criteria B: Individual's level of functioning is significantly below level prior to onset. Criteria C: If the individual has not had successful treatment there are continual signs of schizophrenia for more than six months. Criteria D: Depressive disorder, bipolar disorder, and schizoaffective disorder have been ruled out. Criteria E: The symptoms cannot be attributed to another medical condition or a substance. Criteria F: If the individual has had a communication disorder or Autism since childhood, a diagnosis of schizophrenia is only made if the individual has hallucinations or delusions.

Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by pervasive social deficits, oddities or cognition, perception, or behavior. Diagnosis requires five of the following: · Ideas of reference · Odd beliefs or magical thinking · Lack of close friends except first-degree relatives · Bodily illusions · Suspiciousness · Social anxiety (excessive) · Inappropriate or constricted affect Peculiarities in behavior or appearance

Separation Anxiety Disorder - Symptoms

Separation anxiety disorder is characterized by age-inappropriate and excessive anxiety that occurs when an individual is separated or threatened with separation from their home or family unit. In order to be diagnosed with separation anxiety disorder, the child must exhibit symptoms for at least four weeks and onset must be before the age of 18. Individuals with separation anxiety disorder will manifest some of the following symptoms: · Excessive distress when separated from home or attachment figures · Persistent fear of being alone · Frequent physical complaints during separation Children with separation anxiety tend to be from loving, stable homes. For many, the disorder begins to manifest after the child has suffered some personal loss.

Sleep-Wake Disorders

Sleep-wake disorders include the following: Insomnia disorders Difficulty falling asleep, staying asleep, or early rising without being able to go back to sleep. Hypersomnolence disorder Sleepiness despite getting at least 7 hours with difficulty feeling awake when suddenly awoke, lapses of sleep in the day, feeling unrested after long periods of sleep. Narcolepsy Uncontrollable lapses into sleep, occurring at least three times each week for at least 3 months. Obstructive sleep apnea hypopnea Breathing related sleep disorder with obstructive apneas or hypopneas. Central sleep apnea Breathing related sleep disorder with central apnea. Sleep-related hypoventilation Breathing related sleep disorder with evidence of decreased respiratory rate and increased CO2 level. Circadian rhythm sleep-wake disorder Sleep wake disorder caused by a mismatch between the circadian rhythm and sleep required by person. Non-rapid eye movement sleep arousal disorder Awakening during the first third of the night associated with sleep walking or sleep terrors. Nightmare disorder Recurring distressing dreams that are well remembered and cause distress. Rapid eye movement sleep behavior disorder Arousal during REM sleep associated with motor movements and vocalizing. Restless legs syndrome The need to move legs due to uncomfortable sensations, usually relieved by activity.

Social Workers' Responsibilities to Clients and Community

Social workers have an ethical obligation to protect the identity of their clients and the duty to protect vulnerable members of the population. Confidentiality and informed consent documentation tell clients that if they intend to harm themselves or someone else, the social worker's ethical obligation is to get help, even at the expense of confidentiality. In ethical concerns, the word client could be expanded to mean every member of the population; protecting human rights and safety also includes the duty to warn, which extends to anyone the worker believes is in harm's way.

Somatic Symptom Disorder

Somatic symptom disorder is a somatoform disorder, meaning that is suggests a medical condition but is not fully explainable by the medical condition, substance abuse, or other medical disorder. Individuals with somatic symptom disorder often describe their problems in dramatic, overstated, and ambiguous terms. They excessively worry or think about the symptoms and spend much time and energy worrying about health issues. Somatic symptom disorders cause clinically significant distress or impairment, and are not produced intentionally. A somatic symptom disorder involves recurrent multiple somatic complaints and though no one symptom has to be continuous, some symptoms are present for at least six months. Medical attention has been sought, but no physical explanation has been found.

Neurocognitive Disorders - Differential Diagnosis

Some of the cognitive symptoms of major depressive disorder are very similar to those of neurocognitive disorders. Indeed, this kind of depression is frequently referred to as pseudodementia. One difference is that the cognitive deficits typical of neurocognitive disorders will get progressively worse, and the individual is unlikely to admit that they have impaired cognition. Pseudodementia, on the other hand, typically has a very rapid onset and usually causes the individual to become concerned about their own health. There are also differences in the quality of memory impairment in these two conditions: Individuals with neurocognitive disorder have deficits in both recall and recognition memory, while individuals who are depressed only have deficits in recall memory.

Autism Spectrum Disorder - Characteristic Behavior Patterns

Some very noticeable, specific behavior patterns characteristic of autism spectrum disorder include: · Lack of eye contact and disinterest in the presence of others · Infants who rarely reach out to a caregiver · Hand-flapping · Rocking · Spinning · Echolalia (the imitating and repeating the words of others) · Obsessive interest in a very narrow subject, like astronomy or basketball scores · Heavy emphasis on routine and consistency, and violent reactions to change in their normal environment One half of people with autism remain mute for their entire lives. The speech that does develop may be abnormal. The majority of people with autism have an IQ in the intellectual disability range.

ADHD - Treatment

Somewhat counterintuitively, central nervous system stimulants like methylphenidate (Ritalin) and amphetamine (Dexedrine) control the symptoms of ADHD. Side effects include headaches,, gastrointestinal upset, anorexia, sleep difficulty, anxiety, depression, blood sugar and blood pressure increase, tics, and seizures. Research has consistently shown that pharmacotherapy works best when it is combined with psychosocial intervention. Many teachers have used the basic elements of classroom management to control the symptoms of ADHD. This involves laying out clear guidelines and contingencies for behavior, so that students do not have to speculate on what will happen in class or what they should be doing. Therapy that tries to increase the child's ability to self-regulate behavior has been shown to be less successful. It is always helpful when parents are involved in the treatment program.

Prognosis and Etiology of Learning Disorders

Specific learning disorders include specific learning disorder with impairment in reading, specific learning disorder with impairment in mathematics, and specific learning disorder with impairment in written expression. Research has shown that boys are more likely to develop specific learning disorders with impairment in reading than girls. Although learning disorders are typically diagnosed during childhood or adolescents, they do not go away without treatment, and indeed may become more severe with time. Children who have a learning disorder with impairment in reading are far more likely than others to display antisocial behavior as an adult. At present, many researchers believe that reading disorders derive from problems with phonological processing. Proposed causes of learning disorders include: · Incomplete dominance and other hemispheric abnormalities · Cerebellar-vestibular dysfunction Exposure to toxins, like lead

Statistical Significance

Statistical tests presume the null hypothesis to be true and use the values derived from a test to calculate the likelihood of getting the same or better results under the conditions of the null hypothesis (referred to as the "observed probability" or "empirical probability", as opposed to the "theoretical probability"). This likelihood is referred to as statistical significance. Where this likelihood is very small, the null hypothesis is rejected. Traditionally, experiments have defined a "small chance" a the 0.05 level (sometimes called the 5% levels) or the 0.01 (1% level). The Greek letter alpha (α) is used to indicate the significance level chosen. Where the observed or empirical probability is less than or equal to the selected alpha, the findings are said to be "statistically significant", and the research hypothesis would be accepted. Tests: Three examples of tests of statistical significance are: · The chi square test (a nonparametric test of significance), which assesses whether or not two samples are sufficiently different to conclude that the difference can be generalized to the larger population form which the samples were drawn. It provides a degree of confidence by which the research hypothesis can be accepted or rejected, measured on a scale from 0 (impossibility) to 1 (certainty). · A t-test is used to compare the arithmetic means of a given characteristic in two samples and to determine whether they are sufficiently different from each other to be statistically significant. Analysis of variance, or ANOVA (also called the "F test"), which is similar to the t-test. However, rather than simply comparing the means of two problems, it is used to determine whether or not statistically significant differences exist in multiple groups or samples.

Suicide Statistics and Correlates - Gender, Race, and Marital Status

Statistics indicate that 4-5 times as many males as females successfully commit suicide. However, females attempt suicide about 3 times as often as males. The reason for this disparity is that men tend to employ more violent means of self-destruction, including guns, hanging, and carbon monoxide poisoning. Among racial and ethnic groups, the suicide rate is highest among whites. The exception is American Indian and Alaskan Natives aged 15-34, for whom suicide is the second leading cause of death. As for marital status, the highest rates of suicide are among divorced, separated, or widowed people. The suicide rate for single people trails that of those groups, but it remains higher than the suicide rate for married people.

Suicide Statistics - History, Age, and Drugs and Choice

Suicide is the eighth leading cause of death for males in the United States, and sixteenth for females. Indicators that a person is at risk for suicide attempt include: · Previous suicide attempt in 60-80% of cases · Warning issues by the prospective suicide in 80% of cases Drug suicides are the most common (>70% annually). In order of preference, suicides use: Sedatives (especially benzodiazepines), antidepressants, opiates, prescription analgesics, and carbon monoxide from car exhaust. The most likely persona to commit a successful suicide is a male, Caucasian, 45-49 years of age. Women are more likely to be saved from an attempted suicide through treatment of an Emergency Department. The average age of those saved is 15-19. A sharp increase in suicides aged 10-19 may be due to the increased use of antidepressants, which now carry an FDA black box warning. Around 25% of suicide attempts are seniors over age 65 are successful.

Major Depressive Disorder - Symptoms

Symptoms of major depressive disorder vary with age. For children, common symptoms are: · Somatic complaints · Irritability · Social withdrawal Male preadolescents often display aggressive and destructive behavior. When elderly individuals develop a major depressive disorder, it manifests as memory loss, distractibility, disorientation, and other cognitive problems. Many major depressive episodes are misdiagnosed as major neurocognitive disorder (formerly dementia). It is very common in non-Anglo cultures for the symptoms of depression to be described solely in terms of their somatic content. Latinos, for instance, frequently complain of jitteriness or headaches, with Asians commonly complain of tiredness or weakness.

Distinguishing Symptoms of Agoraphobia

Symptoms that distinguish panic disorder form agoraphobia include the fear of being in a situation or place from which it could be difficult or embarrassing to escape, or of being in a place where help might not be available in the event of a panic attack. Agoraphobia usually manifests when the individual is alone outside of the home, is in a crowd, or is traveling in a train or automobile. Those who suffer from agoraphobia will typically go to great lengths to avoid problematic situations, or they will only be able to enter certain situations with a companion and under heavy distress. One of the main problems with agoraphobia is that it causes the individual to severely limit the places they are willing to go. These individuals often become reclusive.

ADHD - Prognosis

The behavior of children with ADHD is likely to remain consistent until early adolescence, when they may experience diminished overactivity, but continue to suffer from attention and concentration problems. ADHD adolescents are much more likely to participate in antisocial behaviors and to abuse drugs. More than half of all children who are diagnosed with ADHD will continue to suffer from it as adults. These adults are more susceptible to divorce, work-related trouble, accidents, depression, substance abuse, and antisocial behavior. Children with ADHD who are co-diagnosed with Conduct Disorder are especially likely to have these problems later in life.

Anorexia Nervosa - Diagnosis

The characteristics of anorexia nervosa are: Criteria A: Extreme restriction of food, lower than requirements, leading to low body weight. Criteria B: An irrational fear of gaining weight or behaviors that prevent weight gain, despite being at low weight. Criteria C: Distorted body image or a lack of acknowledgement of severity of current weight. A general standard used to determine the minimum healthy body weight is that is should be at least 85% of the norm for the individual's height and weight. People with restricting type anorexia lose weight through fasting, dieting, and excessive exercise. People with binging/purging type anorexia lose weight by eating a great deal and then either vomiting it or inducing immediate defecation with laxatives. People with anorexia are preoccupied with food. The physical symptoms of starvation are constipation, cold intolerance, lethargy, and bradycardia. The physical problem associated with purging are amenia, impaired renal function, cardiac abnormalities, dental problems, and osteoporosis.

Bulimia Nervosa - Diagnosis

The characteristics of bulimia nervosa are: Criteria A: Cyclical periods of binge eating characterized by discretely consuming an amount of food that is larger than most individuals would eat in the same time period and situation. The individual feels a lack of control over the eating. Criteria B: Characterized by binge eating followed by purging via self-induced vomiting/laxatives/fasting/vigorous exercise in order to prevent weight gain. Criteria C: At least one binge eating episode per week for three months. Criteria D: It is marked by a persistent over-concern with body shape and weight. Criteria E: The eating and compensatory behaviors do not only occur during periods of anorexia nervosa. Binges are often caused by interpersonal stress and may entail a staggering caloric intake. The medical complications associated with bulimia are fluid and electrolyte disturbances, metabolic alkalosis, metabolic acidosis, dental problems and menstrual abnormalities.

Social Anxiety Disorder

The characteristics of social anxiety disorder or social phobia are a marked and persistent fear of social situations or situations in which the individual may be called upon to perform. Typically, the individual fears criticism and evaluation by others. The response to the feared situation is an immediate panic attack. Those with social phobia either avoid the feared situation or endure it with much distress. The fear and anxiety regarding these social situations have a negative impact on the individual's life, and is present for at least six months. Adults should be able to recognize that their fear is excessive and irrational. As with other phobias, social phobia is best treated with exposure in combination with social skills and cognitive therapy. Antidepressants and the beta-blocker propranolol are helpful for treating social phobia.

Panic Disorder - Prevalence and Gender Issues

The consensus of research is that 1-2% of the population will suffer panic disorder at some point during their lives, and 30-50% of those individuals will also suffer agoraphobia. Panic disorder has a higher rate of diagnostic comorbidity when it is accompanied by agoraphobia. Panic disorder is far more likely to occur in females than males, and females with a panic disorder have a 75% change of also having agoraphobia. There is a great deal of variation in the age of onset, but the most frequent ages of occurrence are in adolescence and the mid-30s. Children can experience the physical symptoms of a panic attack, but are unlikely to be diagnosed with panic disorder because they do not have the wherewithal to associate their symptoms with catastrophic feelings. The individual can be diagnosed with agoraphobia even if they are not diagnosed with panic disorder, but the two are commonly diagnosed together.

Major Depressive Disorder - Major Depressive Episode

The criteria for a major depressive episode are as follows: Criteria A: The individual experiences 5 or more of the following symptoms during 2 consecutive weeks. These symptoms are associated with a change in their normal functioning. (Note: Of the presenting symptoms, either depressed mood or loss of ability to feel pleasure must be included to make this diagnosis): · Depressed mood · Loss of ability to feel pleasure or have interest in normal activities · Thoughts of death · Fatigue (daily) · Inappropriate guilt or feelings of worthlessness · Observable motor agitation or psychomotor retardation · Weight loss or gain of more than 5% in one month · Hypersomnia, or insomnia (almost daily) Criteria B: The episode causes distress or social or functional impairment. Criteria C: The symptoms cannot be attributed to a substance or another condition or disease. Criteria D: The episode does not meet the criteria for schizophrenia spectrum or other psychotic disorder. Criteria E: The individual does not meet criteria for manic episode or a hypomanic episode.

Avoidant/Restrictive Food Intake Disorder - Diagnosis

The criteria for avoidant/restrictive food intake disorder are as follows: Criteria A: A disruption in eating evidenced by not meeting nutritional needs and failure to gain expected weight or weight loss, nutritional deficiency requiring nutritional supplementation, or interpersonal interference. Criteria B: This disruption is not due to lack of food or culture. Criteria C: There does not appear to be a problem with the individual's body perception. Criteria D: The disturbance can't be explained by another medical condition.

Bipolar I Disorders

The criteria for bipolar I disorder are as follows: Criteria A: The individual must meet the criteria (listed below) for at least one manic episode. The manic episode is usually either proceeded or followed by an episode of major depression or hypomania. Criteria B: The episode cannot be explained by schizophrenia spectrum and other psychotic disorders criteria. The manic episode criteria are as follows: Criteria A: An episode of significantly evaluated, demonstrative, or irritable mood. There is significant goal-directed behaviors, activities, and an increase in the amount of energy the individual normally has. These symptoms are present for most of the day and last at least one week. Criteria B: During the period described in criteria A, the individual will experience 3 of the following symptoms (if the individual presents with only an irritable mood, 4 of the following symptoms need to be present for diagnosis): · Less need for sleep · Excessive talking · Inflated self-esteem · Easily distracted · Flight of ideas · Engages in activities that have negative consequences · Engages in either goal directed activity or purposeless activity Criteria C: The episode causes significant impairment socially. Criteria D: The symptoms cannot be attributed to a substance.

Bipolar II Disorders

The criteria for bipolar II disorder are as follows: Criteria A: The individual has had one or more major depressive episodes and one or more hypomanic episodes. Criteria B: The individual has never experienced a manic episode. Criteria C: The episode doesn't meet criteria for schizophrenia spectrum or other psychotic disorder. Criteria D: The depressive episodes or alterations between the two moods cause significant impairment socially or functionally. The hypomanic episode is severe enough to be a clear departure from normal mood and functioning, but not severe enough to cause a marked impairment in functioning, or to require hospitalization. The criteria for hypomania are as follows: Criteria A: An episode of significantly evaluated, demonstrative, or irritable mood. There are significant goal-directed behaviors, activities, and an increase in the amount of energy the individual normally has. These symptoms are present for most of the day and last at least 4 days. Criteria B: During the period described in criteria A, the individual experiences 3 of the following symptoms (if the individual presents with only an irritable mood, 4 of the following symptoms need to be present for diagnosis): · Less need for sleep · Excessive talking · Inflated self-esteem · Easily distracted · Flight of ideas · Engages in activities that have negative consequences · Engages in goal directed activity or purposeless activity Criteria C: The episode causes a change in the functioning of the individual. Criteria D: The episode causes changes noticeable by others. Criteria E: The episode does not cause social impairments. Criteria F: The symptoms cannot be attributed to a substance.

Persistent Depressive Disorder

The criteria for persistent depressive disorder are the following: Criteria A: For at least two years, the individual experiences for most of the day, more days than they don't experience it, a depressed mood. Criteria B: The individual experiences 2 or more of the following when depressed: · Low self-esteem · Decreased appetite or overeating · A feeling of hopelessness · Fatigue · Difficulty concentrating · Insomnia or hypersomnia Criteria C: During the episode the individual has not had relief from symptoms for longer than 2 months at once. Criteria D: The individual may have met the criteria for a major depressive disorder. Criteria E: The individual does not meet criteria for cyclothymic disorder, manic episode, or hypomanic episode. Criteria F: The episode does not meet the criteria for schizophrenia spectrum or other psychotic disorder. Criteria G: The symptoms cannot be attributed to a substance. Criteria H: The symptoms cause distress or impairment socially or functionally. Of those with persistent depressive disorder, 25-50% of individuals show sleep EEG abnormalities. Women are 2-3 times more likely to suffer from persistent depressive disorder than men. Around 75% of individuals with persistent depressive disorder develop major depressive disorder within 5 years. First degree relatives are likely to also suffer major depressive or persistent depressive disorder. Treatment programs for persistent depressive disorder usually include a combination of antidepressant drugs (especially fluoxetine) and either cognitive-behavior therapy or interpersonal therapy.

Schizoaffective Disorder

The criteria for schizoaffective disorder are as follows: Criteria A: For diagnosis the individual must have at least two of the following symptoms, one being a core positive symptom. The individual will experience the symptoms during a continuous period of illness during which there will also be significant manic or depressive mood episode. · Hallucinations (known as a core positive symptom) · Delusions (known as a core positive symptom) · Disorganized speech (known as a core positive symptom) · Severely disorganized or catatonic behavior · Negative symptoms (such as avolition or diminished expression) Criteria B: Individual experiences hallucinations or delusions for at least two weeks during illness that do not occur during a significant depressive or manic mood episode. Criteria C: The individual experiences significant depressive or manic mood symptoms for most of the time of the illness. Criteria D: The symptoms cannot be attributed to another medical condition or a substance.

Schizophreniform Disorder

The criteria for schizophreniform disorder are as follows: Criteria A: Diagnosis requires at least two of the following symptoms, one being a core positive symptom: · Hallucinations (known as a core positive symptom) · Delusions (known as a core positive symptom) · Disorganized speech (known as a core positive symptom) · Severely disorganized or catatonic behavior · Negative symptoms (such as avolition and diminished expression) Criteria B: An illness of at least one month must be less than six months duration. Criteria C: Depressive disorder, bipolar disorder, and schizoaffective disorder have been ruled out. Criteria D: The symptoms cannot be attributed to another medical condition or a substance.

Functional Neurological Symptom Disorder - Primary Gain, Secondary Gain, and Differential Diagnoses

The etiology of functional neurological symptom disorder is explained in terms of two psychological mechanisms: · It may be used for primary gain when the symptoms keep an internal conflict or need out of the consciousness. · It may be used for secondary gain when the symptoms help the individual avoid an unpleasant activity or obtain support from the environment. In order to diagnose a functional neurological symptom disorder, there must be evidence of involuntary psychological factors. Functional neurological symptom disorder is occasionally confused with factitious disorder and malingering, both of which are voluntary.

Five-Phase Aggression Cycle

The five-phase aggression cycle is as follows: Triggering: Client responds to a triggering event with anger or hostility. Client may exhibit anxiety, restlessness, and muscle tension. Other signs include rapid breathing, perspiration, loud angry voice, and pacing. Escalation: Client's responses show movement toward lack of control. Client's face flushes and they become increasingly agitated, demanding, and threatening, often swearing, clenching fists, and making threatening gestures. Client is unable to think clearly or resolve problems. Crisis: Client loses emotional and physical control. Client throws objects, hits, kicks, punches, spits, bites, scratches, screams, shrieks, and cannot communicate clearly. Recovery: Client regains control. Client's voice lowers, muscle tension relaxes, and client is able to communicate more rationally. Post-crisis: Client may attempt reconciliation. Client may feel remorse, apologize, cry, or become quiet or withdrawn. Client is now able to respond appropriately.

Obsessive-Compulsive Disorder

The following are the criteria for obsessive-compulsive disorders: Criteria A: The individual exhibits obsessions, compulsions, or both. Obsession: continuous, repetitive thoughts, compulsions, or things imagined that are unwanted and cause distress. The individual will try to suppress thoughts, ignore them, or do a compulsive behavior. Compulsion: recurrent behavior or thought the individual feels obliged to perform after an obsession to decrease anxiety; however, the compulsion is usually not connected in an understandable way to an observer. Criteria B: The obsessions and compulsions take at least one hour per day and cause distress. Criteria C: The behavior is not caused by a substance. Criteria D: The behavior could not better be explained by a different mental disorder. Note if the criteria are met with good insight (individual realizes OCD beliefs are not true), poor insight (individual thinks the OCD beliefs are true), or absent insight (individual is delusional, truly believing OCD beliefs are true). Note if the individual has ever had a tic disorder. Other obsessive-compulsive and related disorder include: · Body dysmorphic disorder · Hoarding disorder · Trichotillomania (hair-pulling disorder) Excoriation (skin-picking disorder)

Sampling Techniques

The following are types of sampling techniques: Simple random sampling: Any method of sampling wherein each subject selected from a population has an equal chance of being selected (e.g., drawing names from a hat). Stratified random sampling: Dividing a population into desired groups (age, income, etc.) and then using a simple random sample from each stratified group. Cluster sampling: A technique used when natural groups are readily evident in a population (e.g., residents within each county in a state). The natural groups are then subjected to random sampling to obtain random members from each county. The best results occur when elements within clusters are internally heterogeneous and externally (between clusters) homogenous, as the formation of natural clusters may introduce error and bias. Systematic sampling: A systematic method of random sampling (e.g., randomly choosing a number n between 1 and 10 - perhaps drawing the number from a hat) and then selecting every nth name of a randomly generated or already existing list (such as the phone book) to obtain a study sample.

Instruments Used During the Observation Process

The following instruments can be sued in an observation: · The checklist is used to check off behaviors or performance levels with a plus or minus sign to indicate that the behavior was observed or absent. The observer can converse with the client as they mark the checklist. · The rating scale is a more complex checklist that notes the strength, frequency, or degree of an exhibited behavior. Likert scales are applied using the following ratings: 1. Never; 2. Rarely; 3. Sometimes; 4. Usually; and 5. Always. The evaluator of the behavior makes a judgment about whatever question has been asked on the rating scale. · The anecdotal report is used to record subjective notes describing the client's behavior during the specific time or in a specified setting and is often applied to evaluate a suspected pattern. Structural interviews, questionnaires, and personal essays or journals may also be useful in the observation process, depending on the client's ability to participate in these exercises.

Neurocognitive Disorder due to Parkinson's Disease

The following symptoms are commonly associated with neurocognitive disorder due to Parkinson's disease: · Bradykinesia (general slowness of movement) · Resting tremor · Stoic and unmoving facial expression · Loss of coordination of balance · Involuntary pill-rolling movement of the thumb and forefinger · Akathisia (violent restlessness) Most people with Parkinson's will suffer from depression at some point during their illness, and 20-60% will develop major neurocognitive disorder (formerly dementia). Research indicates that those with Parkinson's have a deficiency of dopamine-producing cells and the presence of Lewy bodies in the substantia nigra. Many doctors now believe that there is some environmental cause for Parkinson's, though the etiology is not yet clear. The medication L-dopa (Dopar, Larodopa) alleviates the symptoms of Parkinson's by increasing the amount of dopamine in the brain.

Neuropsychological Assessments

The following tools are used to assess for psychological deficits caused by neurological disorders: · The Benton Visual Retention Test (BVRT) assesses visual memory, spatial perception, and visual-motor skills in order to diagnose brain damage. The subject is asked to reproduce from memory the geometric patterns on a series of ten cards. · The Beery Developmental Test of Visual-Motor Integration (Beery-VMI-6) assesses visual-motor skills in children; like the BVRT, it involves the reproduction of geometric shapes. · The Wisconsin Card Sorting Test (WCST) is a screening test that assesses the ability to form abstract concepts and shift cognition strategies; the subject is required to sort a group of cards in an order that is not disclosed to them. · The Stroop Color-Word Association Test (SCWT) is a measure of cognitive flexibility; it tests on individual's ability to suppress a habitual reaction to stimulus. · The Halstead-Reitan Neuropsychological Battery (HRNB) is a group of tests that are effective at differentiating between normal people and those with brain damage. The clinician has control over which exams to administer, though they are likely to assess sensorimotor, perceptual, and language functioning. A score higher than .60 indicates brain pathology. · The Lurla-Nebraska Neuropsychological Battery (LNNB) contains 11 subtests that assess areas like rhythm, visual function, and writing. The examinee is given a score between 0 and 2, with 0 indicating normal function and 2 indicating brain damage. The Bender Visual-Motor Gestalt Test (Bender-Gestalt 11) is a brief examination that involves responding to 16 stimulus cards containing geometric figures, which the examinee must either copy or recall.

Measurements - Categories of Measurement

The four different categories of measurement are as follows: Nominal: Used when two or more named variables exist (male/female, pass/fail, etc.). Ordinal: Used when a hierarchy is present but when the distance between each value is not necessarily equal (e.g., first, second, third place). Interval: Hierarchal values that are at equal distance from each other. Ratio: One value divided by another, providing a relative association of one quantity in terms of the other (e.g., 50 is onehalf of 100).

Steps of the Initial Social Work Assessment

The initial social work assessment is used to gain information about the client's needs (employment, rehabilitation, monetary support, housing, education, safety). It should include client goals and be the basis of intervention plans. Steps include the following: 1. Schedule an interview and review all pertinent documents (medical records, police reports, housing reports, previous social services records). 2. Utilize a theoretical framework as the basis for the assessment based on the needs of the client. 3. Utilize a standardized form if required by the agency. 4. Ask open-ended questions and avoid "why" questions, rapid questioning, or repeated questioning without pause for reflection. Utilize active listening. 5. Develop a problem list of things that may require intervention. 6. Outline interventions to assist with resolving the client's problems. 7. Assist the client to develop specific time-sensitive goals and outline the client's responsibilities. 8. Summarize the findings of the assessment and review the summary with the client. Set up a follow-up interview.

Research Process

The key steps in the research process are as follows: 1. Problem or issue identification: Includes a literature review to further define the problem and to ensure that the problem has not already been studied. 2. Hypothesis formulation: Creating a clear statement of the problem or concern, worded in a way that it can be operationalized and measured. 3. Operationalization: Creating measurable variables that fully address the hypothesis. Study design selection: Choosing a study design that will allow for the proper analysis of the data to be collected.

Basic Single System Design and Additional Types of Case Study or Predesigns

The most basic single system design is the A-B design. The baseline phase (A) has no intervention, followed by the intervention phase (B) with data collection. Typically, data are collected continuously through the intervention phase. Advantages of this design include the following: · Versatility · Adaptability to many settings, program styles, and problems · Clear comparative information between phases A significant limitation, however, is that causation cannot be demonstrated. Three additional types of case or predesigns are: · Design A, an observational design with no interventions · Design B, an intervention-only design without any baseline Design B-C, a "changes case study" design (where no baseline is recorded, a first intervention (B) is performed and then changed (C), and data are recorded)

Panic Disorder - Treatment and Differential Diagnosis

The most effect treatment for panic attacks appears to be controlled in vivo exposure with response prevention, known as flooding. Flooding is typically accompanied by cognitive therapy, relaxation, breathing training, or pharmacotherapy. Antidepressant medications are often prescribed to relieve the symptoms of panic disorder. If stand-alone drug treatment is used, the risk of relapse is very high. Differential diagnosis for panic disorder include social phobia, and medical conditions like hyperthyroidism, hypoglycemia, cardiac arrhythmia, and mitral valve prolapse. Panic disorder can be distinguished from social phobia by the fact that attacks will sometimes occur while the individual is alone or sleeping.

PTSD - Treatment

The preferred treatment of PTSD is comprehensive cognitive-behavioral approach that includes: · Exposure · Cognitive restructuring · Anxiety management · SSRIs to relieve symptoms of PTSD and comorbid conditions Some psychologists criticize single-session psychological debriefings, because they believe one session amplifies the effects of a traumatic event. Another controversial therapy used to treat PTSD is eye movement desensitization and reprocessing; the positive benefits of this therapy may be more to do with the exposure that goes along with it than with the eye movements themselves.

Major Depressive Disorder - Prognosis and Catecholamine Hypothesis

The severity and duration of a major depressive episode varies from case to case, but symptoms usually last about six months before remission to full function. 20-30% of individuals have lingering symptoms for months or years. About 50% of individuals experience more than one episode of major depression. Oftentimes, multiple episodes are precipitated by some severe psychological trauma. The catecholamine hypothesis suggests major depressive episodes are due to deficiency of the neurotransmitter norepinephrine. The indolamine hypothesis proposes that depression is caused by inferior levels of serotonin.

Biopsychosocial History

The social work assessment must gather client information in a comprehensive, accurate, and systematic manner. A history is taken from clients and others (such as family members) to complete the assessment. Information relevant to the client's biopsychosocial history includes the following: · Appearance of the client · Previous hospitalizations and experience(s) with healthcare · Psychiatric history: Suicidal ideation, psychiatric disorders, family psychiatric history, history of violence, and/or self-mutilation · Chief complaint: Client's perception of the problem · Use of complementary therapies: Acupuncture, visualization, and meditation · Occupational and educational background: Highest level of education, issues while in the school setting, employment record, retirement, and special skills · Social patterns: Family and friends, living situation, typical activities, support system · Sexual patterns: Orientation, practices, and problem · Interest and abilities: Hobbies and sports · Current and past substance abuse: Type, frequency, drinking patterns, use of recreational drugs, and overuse of prescription drugs · Ability to cope: Stress reduction techniques · Physical, sexual, emotional, and financial abuse: Older adults are especially vulnerable to abuse and may be reluctant to disclose out of shame and fear · Spiritual/cultural assessment: Religious/Spiritual importance, practices, restrictions (such as blood products or foods), and impact on health and health decisions · Mental status, gleaned from the following: - General attitude: Behavior and reaction to being interviewed - Mental activity: Logical or loosely associated - Speech profile: Normal, childlike, or pressured - Emotional state: Depressed, agitated, or calm - Level of consciousness: Alert or stuporous - Orientation: Normal or disoriented - Through processes: Pressured thoughts (excessively rapid), flights of ideas, thought blocking, disconnected thoughts, tangentiality and circumstantiality, etc. - Judgment: Good, fair, poor, or none - Mood: Cooperative or agitated - Insight: Good, fair, poor, or none Memory: Intact or presence of deficits

Assessment of Communication Skills

The social worker can assess communication skills through both interview and observation. Additionally, the social worker may provide the client with written information and ask the client to read and discuss the information to determine if the client has adequate ability to read and understand. The social worker should directly ask about which language the client communicates best with and whether there are problems, such as hearing deficit, that may impact communication so that accommodations can be provided. Techniques include the following: · Ask questions to determine client's ability to understand and respond appropriately. · Observe for signs of incongruence where words, body language, and tone of voice are inconsistent. · Ask the client to summarize or restate information according to their understanding. · Observe the client's ability to initiate and maintain conversation. · Note the client's ability to understand and/or use metaphoric language. · Observe the client's turn-taking and response to language cues. Note the client's use of appropriate nonverbal language, such as gestures and nodding head.

Focuses of the Social Work Assessment

The social worker's assessment may focus on any or all of the following: · Intrapsychic dynamics, strengths, and problems · Interpersonal dynamics, strengths, and problems · Environmental strengths and problems · The interaction and intersection of intrapsychic, interpersonal, and environmental factors The social worker's role in the assessment process is to ask questions, ask for elaboration and description in the client's response, observe client's behavior/affect, and organize data to create a meaningful psychosocial or diagnostic assessment.

Schizophrenia - Positive Symptoms

The symptoms of schizophrenia may be positive, negative, or disorganized. Positive symptoms are delusions and hallucinations. Delusions are false beliefs that are held despite clear evidence to the contrary. The delusions suffered by a schizophrenic usually fall into one of three categories: · Persecutory, in which the person believes that someone or something is out to get them. · Referential, in which the person believes that messages in the public domain (like song lyrics or newspaper articles) are specifically directed at them. · Bizarre, in which the person imagines that something impossible has happened. The most common sensory mode of hallucinations is sound, specifically the audition of voices.

ADHD - Etiology

The theory of ADHD is a genetic disorder is supported by data that shows slightly higher rates of the disorder occur among biological relatives than among the general population, and there are higher rates among identical twins, rather than fraternal twins. ADHD is associated with structural abnormalities in the brain, like subnormal activity in the frontal cortex and basal ganglia, and a relatively small caudate nucleus, globus pallidus, and prefrontal cortex. Symptoms of ADHD vary widely, depending on the child's environment. Repetitive or boring environments encourage symptoms, as do those in which the child is given no chance to interact. One theory of ADHD asserts that it is the result of an inability to distinguish between important and unimportant stimuli in the environment.

Common Study Designs

The three common study designs used in the research process include the following: · An exploratory research design is common when little is known about a particular problem or issue. Its key feature is flexibility. The results comprise detailed descriptions of all observations made, arranged in some kind of order. Conclusions drawn include educated guesses or hypotheses. · When the variables chosen have already been studied (e.g., in an exploratory study), further research requires a descriptive survey design. In this design, the variables are controlled partly by the situation and partly by the investigator, who chooses the sample. Proof of causality cannot be established, but the evidence may support causality. Experimental studies are highly controlled. Intervening and extraneous variables are eliminated, and independent variables are manipulated to measure effects in dependent variables (e.g., variables of interest) - either in the field or in a laboratory setting.

Specific Phobia - Etiology and Treatment

The two-factor theory proposed by Mower asserts that phobias are the result of avoidance conditioning, when an individual associates a neutral or controlled stimulus with an anxiety-causing, unconditioned stimulus. The phobia reinforces a strategy of avoidance because it prevents anxiety (even though the neural stimulus was not to blame for the anxiety in the first place). Another theory for the etiology of phobias is offered by social learning theorists, who state that phobic behaviors are learned by watching avoidance strategies used by one's parents. As with panic disorder, in vivo exposure is considered the best treatment for a specific phobia. Relaxation and breathing techniques are also helpful in dispelling fear and controlling physical response.

Major Depressive Disorder - Treatment

The typical treatment program for major depressive disorder combines antidepressant drugs and psychotherapy. Three classes of antidepressant medication are commonly prescribed: · Selective serotonin reuptake inhibitors (SSRIs) are prescribed for melancholic depressives; they have lower incidence of serious adverse side effects than do tricyclics. · Tricyclics (TCAs) are prescribed for classic depression, involving vegetive bodily symptoms, a worsening of symptoms in the morning, acute onset, and short duration of moderate symptoms. Monoamine oxidase inhibitorsare prescribed at last resort for individuals who have an unorthodox depression that includes phobias, panic attacks, increased appetite, hypersomnia, and a mood that worsens as the day goes on.

Anorexia Nervosa - Gender, Age, Etiology, and Treatment

The vast majority of people with anorexia are female, and the onset of anorexia is usually in mid-to-late adolescence. Onset may be associated with a stressful life event. Some studies associated anorexia with middle- and upper-class families that have a tendency towards competition and success. Girls with anorexia are likely to be introverted, nonassertive, and conscientious. Their mothers are likely to also be very concerned about food intake and weight. The immediate goal of any treatment program is to help the individual gain weight. Sometimes this requires hospitalization. Cognitive therapy is also often employed to correct the individual's misconceptions about health weight and nutrition.

Warning Signs of Suicide

The warning signs of suicide include the following: · Depression · Prior suicide attempts · Family suicide history · Abrupt increase in substance abuse · Reckless and impulsive behavior · Isolation · Poor coping · Support system loss · Recent or anticipated loss of someone special · Verbal expression of feeling out of control · Preoccupation with death · Behavioral changes not otherwise explained (a sudden changed mood from depressed to happy, the giving away of one's personal belongings, etc.) Where risk of suicide is suspected, the client should be questioned directly about any thoughts of self-harm. This should be followed by a full assessment and history (particularly family history of suicide). Where the threat of suicide is not imminent, one commonly used intervention is the no-suicide contract, in which the client signs a written agreement promising to contact the suicide hotline or a counselor, social worker, or other specified professional rather than carry out an act of suicide. While commonly used, these contracts have not been proven to reduce suicide attempts and therefore should not be used in isolation as an intervention for suicide risk, nor should they be used when threat of suicide is high. When a client already has a plan for suicide, or has multiple risk factors, hospitalization must be arranged. If any immediate attempt has already been made, a medical evaluation must occur immediately.

Autism Spectrum Disorder - Etiology and Treatment

There are a few structural abnormalities in the brain that have been linked to autism spectrum disorders. These include a reduced cerebellum and enlarged ventricles. Research has also suggested that there is a link between autism and abnormal levels of norepinephrine, serotonin, and dopamine. The support for a genetic etiology of ASD has been increased by studies indicating that siblings of children with autism are much more likely to have autism themselves. As for treatment, the most successful interventions focus on teaching individuals with autism the practical skills they need to survive independently. Therapy should also include development of social skills and the reduction of undesirable behavior. Individuals with autism who reach a moderate level of functioning can be giving direct vocational training.

ADHD - Subtypes

There are three subtypes of ADHD: · Predominantly inattentive type is diagnosed with a child has six or more symptoms of inattention and fewer than six symptoms of hyperactivity-impulsivity. · Predominantly hyperactive-impulsive type is diagnosed when there are six or more symptoms of hyperactivity-impulsivity and fewer than six of inattention. · Combined type is diagnosed when there are six or more symptoms of both hyperactivity-impulsivity and inattention. ADHD is 4-9 times more likely to occur in boys than in girls, although the gender split is about half and half for Predominantly Inattentive Type. The rates of ADHD among adults appear to be about equal for both males and females.

Autism Spectrum Disorder - Symptoms

There are two categories of symptoms necessary for a diagnosis of autism spectrum disorder. The first category is deficits in social interaction and social communication, which includes: · Absence of developmentally appropriate peer relationships · Lack of social or emotional reciprocity · Marked impairment in nonverbal behavior · Delay or lack of development in spoken language · Marked impairment in the ability to initiate or sustain conversation · Stereotyped or repetitive use of language or idiosyncratic language · Lack of developmentally appropriate play The other category of symptoms necessary for diagnosis of autism spectrum disorder is restricted, repetitive patterns of behavior (RRBs), interests, and activities. These include: · Preoccupation with one or more stereotyped and restricted patterns of interest · Inflexible adherence to nonfunctional routines or rituals · Stereotyped and repetitive motor mannerisms Persistent preoccupation with the part of objects

Alzheimer's Disease - Treatment

Though Alzheimer's disease is a degenerative condition with no known cure, there are a number of different treatments that can provide help to those who suffer from the disease: · Group therapy that focuses on orienting the individual in reality and encourages them to reminisce about past experiences · Antidepressants, antipsychotics, and other pharmacotherapy · Behavioral techniques to fight the agitation associated with Alzheimer's · Environmental manipulation to improve memory and cognitive function Involving the individua's family in interventions

Major Depressive Disorder - Cognitive-Behavioral Etiologies

Three major cognitive-behavioral etiologies have been offered for major depressive disorder: · The learned helplessness model proposed by Seligman suggests afflicted individuals have been exposed to uncontrollable negative events in the past and have a tendency to attribute negative events to internal, stable, and global factors. · Rehm's self-control model suggests depression occurs in individuals who obsess over negative outcomes, set extremely high standards for themselves, blame all of their problems on internal factors, and have low rates of self-reinforcement coupled with high rates of self-punishment. Beck's cognitive theory suggests depression is the result of negative and irrational thought and beliefs about the depressive cognitive triad (the self, the world, and the future).

Tourette's Syndrome

Tourette's syndrome is a neurological disorder characterized by at least one vocal tic and multiple motor tics that appear simultaneously or at different times, and appears before the age of 18. Those with Tourette's syndrome typically have multiple motor tics and one or more vocal tics. Those with chronic motor or vocal tic disorder have either motor or vocal tics. Individuals with Tourette's syndrome are likely to have obsessions and compulsions, high levels of hyperactivity, impulsivity, and distractibility.

Schizophrenia - Treatment

Treatment for schizophrenia begins with the administration of antipsychotic medication. Antipsychotics are very effective at diminishing the positive symptoms of schizophrenia, though their results vary from person to person. Antipsychotics have strong side effects, however, including tardive dyskinesia. Medication is more effective when it is taken in combination with psychosocial intervention. Many people with schizophrenia are prone to relapse if they receive a great deal of criticism from family members, so it may be a good idea to initiate family therapy in which the level of expressed emotion in the family is discussed. Those who are recovering from schizophrenia also benefit from social skills training and help with employment.

Anxiety Disorders

Types of anxiety disorders include the following: Panic disorder Recurrent brief but intense fear in the form of panic attacks with physiological or psychological symptoms. Specific phobia Fear of specific situations or objects. Generalized anxiety disorder Chronic psychological and cognitive symptoms of distress and excessive worry lasting at least 6 months. Separation anxiety disorder Excessive anxiety related to being separated from someone the individual is attached to. Selective mutism Inability to speak in social settings (when it would seem appropriate) though normally able to speak. Social anxiety disorder Anxiety about social situations. Agoraphobia Anxiety about being outside of the home or in open places.

Statistical Error

Types of statistical error include the following: · Type I error: Rejecting the null hypothesis when it is true Type II error: Accepting the null hypothesis when it is false and t he research hypothesis is true (concluding that a difference doesn't exist when it does)

Drugs used for Attention Disorders

Typical drugs used for attention disorders are either amphetamine-like or non-amphetamine like. The amphetamine-like drugs can be short- or long-acting and include the following: · Ritalin (methylphenidate): short-acting · Ritalin LA: Long-acting · Concerta (methylphenidate): Long-acting · Adderall (dextramphetamine-amphetaimine): Short-acting · Adderall XR: Long-acting These medications relieve symptoms quickly and individuals can take them on selected days or partial days if desired. These have potential for abuse, can suppress appetite and cause weight loss, and can cause feelings of edginess similar to that resulting from excessive caffeine. Amphetamine-like drugs can also cause an increased heart rate. The non-amphetamine-like drugs most commonly used for attention disorder is Strattera (atomoxetine). Strattera is less appetite-suppressing; therefore, weight loss is less of a problem. This medication takes 2-4 weeks to be effective and must be taken every day. The client must be monitored for a rarely occurring liver problem. This drug has low risk for abuse.

Methods of Psychological Testing

Various methods of psychological testing exist, which can be used in conjunction with one another, based on the client's needs: · A standardized test is one in which the questions and potential responses from all tests can be compared with one another. Every aspect of the test must remain consistent. · A behavioral assessment assumes that an individual can only be evaluated in relation to their environment. Behavioral assessments must include a stimulus, organism, response, and consequences (SORC). · A dynamic assessment involves systematic deviation from the standardized test to determine whether the individual benefits from education. It is an interactive assessment that includes a process called "testing-teaching-retesting", in which an examinee is provided a problem to solve and their ability to solve it is assessed. They are then provided education to increase their sense of competence on the subject, and finally they are asked to solve the same problem again. In the retest, they are given sequence of stronger support (or "clues") to hep solve the problem if needed, until it is solved. This reflects the client's ability to respond to education and apply it in problem solving; therefore, providing insight to the social worker on the client's need for intervention. Domain-referenced testing breaks evaluation into specific domains of ability - for instance, reading or math ability.

Intellectual Disabilities

Very few (approximately 5%) cases of intellectual disability are hereditary. Hereditary forms of intellectual disability include Tay-Sachs, fragile X syndrome, and phenylketonuria. Most cases of intellectual disability (about 30%) are due to mutations in the embryo during the first trimester of pregnancy. Babies born with Down Syndrome or those exposed to environmental toxins while in the uterus fall into this category. Almost 10% of cases of intellectual disability are due to pregnancy or perinatal problems, like fetal malnutrition, anoxia, and HIV. About 5% of those with intellectual disability have general medical conditions (like lead poisoning, encephalitis, or malnutrition) suffered during infancy or childhood. Approximately 20% are intellectually disabled because of either environmental factors or other mental disorders (e.g., sensory deprivation or autism). In the remaining 30%, etiology is unknown.

Signs and Risk Factors of Client's Danger to Others

Violence and aggression are not uncommon among clients and pose a danger to others. Risk factors include mental health disorders, access to weapons, history of personal or family violence, abuse, animal cruelty, fire setting, and substance abuse. Violence and aggression should be handled as follows: · Violence is a physical act perpetrated against an inanimate object, animal, or other person with the intent to cause harm. Violence often results from anger, frustration, or fear and occurs because the perpetrators believe that they are threatened or that their opinion is right and the victim is wrong. It may occur suddenly without warning or following aggressive behavior. Violence can result in death or severe injury if the individual attacks, so anyone in the presence of an actively violent client should back away and seek safety. Aggression is the communication of a threat or intended act of violence and will often occur before an act of violence. This communication can occur verbally or nonverbally. Gestures, shouting, speaking increasingly loudly, invasion of personal space, or prolonged eye contact are examples of aggression requiring the client be redirected or removed from the situation.

Side Effects and Other Relevant Factors

While antidepressants can be extremely effective in the treatment of unipolar depression, they also have many side effects, which both the social worker and client must be aware of: · SSRIs have fewer side effects than other antidepressants, and one cannot overdose on SSRIs alone. SSRIs take several weeks to be effective, can cause a loss of libido, and can lose effectiveness after years of usage. In a few individuals, SSRIs can cause agitation, suicidal ideation, or manic symptoms (in which case, the prescriber should discontinue). · Of the atypical antidepressants, Wellbutrin does not cause libido loss and is sometimes prescribed in combination with an SSRI to counter the sexual side effects or to increase the positive antidepressant effect of the SSRI. Cymbalta is recommended for depression lined with somatic complaints. · Tricyclic antidepressants can cause side effects such as dry mouth, and an overdose can result in dangerous complications such as cardiac dysrhythmias. For this reason, tricyclic antidepressants are less commonly used today, but still have their place in treating depression in some clients. MAO inhibitors are also less commonly used to treat depression due to their required dietary limitations and possibly dangerous side effects (severe hypertension and serotonin syndrome). They are considered a third line treatment of depression for this reason.

Managing Active Threats of Homicidality by Clients

A client may be deemed a threat to others if: · Client makes a serious threat of physical violence. · The threat is made against one or more specifically named individuals. When a threat meeting these criteria is made, even in the context of a privileged-communication relationship, a duty to protect is generated. In such a situation, the professional is required not only to notify appropriate authorities and agencies charged to protect the citizenry, but also to make a good-faith effort to warn the intended victim or, failing that, someone who is reasonably believed to be able to warn the intended victim. The duty to warn stems form the 1976 legal case of Tarasoff v. Regents of the University of California, where a therapist heard a credible threat and called only law enforcement authorities, failing to notify the intended victim. The murder occurred, and the case was appealed to the California Supreme Court, form which the rubric of duty to protect an intended victim has been established.

Dissociative Fugue and Depersonalization Disorder

A dissociative fugue is a subtype of dissociative amnesia and is an abrupt, unexpected, purposeful flight from home, or another stressful location, coupled with an inability to remember the past. The individual is unable to remember their identity and assumes a new identity. Fugues are psychological protection against extreme stressors like bankruptcy, divorce, separation, suicidal or homicidal ideation, and rejection. Fugues happen in wars, natural disasters, and severe accidents. Fugues affect 2 in every 1,000 Americans. There will be no recollection of events that occur during the fugue. Individuals in a fugue state may seem normal to strangers. Dissociative fugue is a specifier that can be sued with dissociative amnesia. Depersonalization/derealization disorder is diagnosed when an individual has recurrent episodes in which they feel detached from their own mental processes or body or to their surroundings. In order to be diagnosed, this condition must be intense enough to cause significant distress or functional impairment.

Side Effects and Other Relevant Factors

A major drawback and potential side effect for the older antipsychotics (which are effective) is tardive dyskinesia (TD). TD is irreversible and causes involuntary movements of the face, tongue, mouth, or jaw. Other possible side effects for the older antipsychotics include Parkinsonia syndrome (tremor, shuffling gait, or bradykinesia) or muscle rigidity; these are reversible and can be counteracted with benztripine. Among the newer antipsychotics, clozapine requires frequent blood testing due to the risk of agranulocytosis, a blood disorder that decreases white blood cells and increases the risk of infection. Though some atypical antipsychotics have much less risk of TD, they are very expensive and can cause weight gain, affect blood sugar, and affect the lipid profile.

Communication Disorders

A number of disorders are lumped together under the heading of communication disorders: · Language disorders · Speech sound disorders · Childhood-onset fluency disorders (stuttering) · Social communication disorders Childhood-onset fluency disorder (stuttering) typically beings between the ages of 2 and 7, and is more common in males than females. Research shows stuttering can be controlled through the removal of psychological stress in the home. Children who are constantly told not to stutter tend to stutter all the more. Many children find success through controlled and regular breathing exercises, accompanied by positive encouragement. In most cases, though, the child will spontaneously stop stuttering before the age of 16. Many conditions that previously fell under the DSM-IV category of pervasive developmental disorders meet the criteria for communication disorders in DSM-5 and the revised DSM-5-TR. Because autism spectrum disorder has social and communication deficits as part of its defining characteristics, it is important to note that communication disorders should be diagnosed when there are repetitive behaviors or narrowed interests or activities.

Components of a Risk Assessment

A risk assessment evaluates the client's condition and their particular situation for the presence of certain risk factors. These risks can be influenced by age, ethnicity, spirituality, or social beliefs. They can include risk for suicide, harming others, exacerbation of symptoms, development of new mental health issues, falls, seizures, allergic reactions, or elopement. This assessment should occur within the first interview and then continue to be an ongoing process. The client's specific risks should be prioritized and documented, and then interventions should be put into place to protect this client from these risks.

Sexual Dysfunctions

A sexual dysfunction is any condition in which the sexual response cycle is disturbed or there is pain during sexual intercourse, and this causes distress or interpersonal difficulty. Types of sexual dysfunctions: · Delayed ejaculation · Erectile disorder · Female orgasmic disorder · Female sexual interest/arousal disorder · Genito-pelvic pain/penetration disorder · Male hypoactive sexual desire disorder · Premature ejaculation · Substance-induced sexual dysfunction Male erectile disorder is the inability to attain or maintain an erection. This condition is linked to diabetes, liver and kidney disease, multiple sclerosis, and the use of antipsychotic, antidepressant, and hypertensive drugs. Orgasmic disorders are any delay or absence of orgasm after the normal sexual excitement phase. Premature ejaculation is orgasm that occurs with a minim of stimulation and before the person desires it. Premature ejaculation may be in part due to deficiencies in serotonin.

Learning Disorders and Associated Conditions

A specific learning disorder is diagnosed as learning and academic difficulty, as evidence by at least one of the following for at least six months (after interventions have been tried): · Incorrect spelling · Problems with math reasoning · Problems with math calculation and number sense · Difficulty reading · Problems understanding what is read · Difficulty using grammar and syntax A child will be diagnosed with a learning disorder when they score substantially lower than expected on a standardized achievement test and confirmed by a clinical assessment. The expectation for the child's score should be based on age, schooling, and intelligence, and the definition of "substantially lower" is a difference of two or more standard deviations. Learning disorders are frequently attended by delays in language development or motor coordination, attention and memory deficits, and low self-esteem. Learning disorders can be graded by severity as mild, moderate, or severe.

Phobias - Diagnosis

A specific phobia is a marked and persistent fear of a particular object or situation, other than those associated with social phobia or agoraphobia. When an individual with a phobia is exposed to the feared object or event, they will have a panic attack or some other anxiety response. Adults with a specific phobia should be able to recognize that their fear is irrational and excessive. The onset of a specific phobia is typically in childhood or in the mid-20s. According to the DSM-5-TR, there are five subtypes of specific phobia: · Animal · Natural environment · Situational · Blood-injection-injury · Other The blood-injection-injury subtype has different physical symptoms than the others. Individuals with blood-injection-injury phobia have a brief increase in heart rate and blood pressure, followed by a drop in both, often ending in a brief loss of consciousness (fainting). Other phobic reactions just entail the increase in heart rate and blood pressure, without loss of consciousness.

Statistics and Measures of Central Tendency

A statistic is a numerical representation of an identified characteristic of a subject. · Descriptive statistics are mathematically derived that represent characteristics identified in a group or population. · Inferential statistics are mathematical calculations that produce generalizations about a group or population form the numerical values of known characteristics. Measures of central tendency identify the relative degree to which certain characteristics in a population are grouped together. Such measures include: · The mean, or the arithmetic average · The median, or the numerical value above which 50% of the population is found and below which the other 50% is located. The mode, or the most frequently appearing value (score) in a series of numerical values.

Suicide Risk Assessment

A suicide risk assessment should be completed and documented upon initial interview, with each subsequent visit, and any time suicidal ideations are suggested by the client. This risk assessment should evaluate and score the following criteria: · Would the client sign a contract for safety? · Is there a suicide plan, and if so, how lethal is the plan? · What is the elopement risk? · How often are the suicidal thoughts? · Have they attempted suicide before? Any associated symptoms of hopelessness, guilt, anger, helplessness, impulsive behaviors, nightmares, obsessions with death, or altered judgment should also be assessed and documented. A higher score indicates a higher the risk for suicide.