NCMHCE Study Set Review 2023

NCMHCE Study Set Review 2023 Always read if loved one put something on assessment - Always read if loved one put/left you a note If there is an injury in the case study always look at medical history - Cognitive functioning must be evaluated in order to assess for the possible presence of disturbed cognitive processes associated with psychoses and abnormal content associated with mood or anxiety disorders. - However, there was abnormal cognitive content in the form of thoughts of helplessness, anxiety about her physical condition, and worry about the future. If the case study mentions job, or something happened at the job that lead to symptoms, you must inquire about it - Refer for medical evaluation question-always look to make sure they aren't already involved - Supportive psychotherapy is a type of intervention that emphasizes "ego-building" and is characterized by the use of interventions such as clarification (helping the client articulate something that is difficult to put into words), encouragement ("I want to encourage you to learn to access a computer"), empathic validation ("I can understand why you feel depressed about that"), advice and praise ("I am very pleased that you were able to set limits on those things that are hurtful for you"), and affirmation ("uhhuh" or "yes, I see what you mean"). Education and providing information can also be very supportive ("depression is often caused by inadequate neurotransmission of key chemicals in the brain"). - Only do pharmacotherapy if the symptoms are severe enough - Mindfulness is a group-based therapy is weekly, each of 8 sessions last 2.5-3 hours and consists of exercises designed to raise consciousness and to anchor stressful thoughts in the present experience or moment. Two and a half to three hours might be too long initially but the therapy can be started once the therapist and client have processed the stress reduction benefits. See treatment discussion box after completing the scenario for more information. - at the end when it asks what recommendtaions should the counselor make during termination, be careful of the word "refer" - Do not refer for medication until a diagnosis has been made - After completing initial evaluation, and asks for recommendations, do not give strategies like supportive therapy - Formal testing, including the MMPI-II and Beck's Depression Inventory, may be helpful to ascertain the presence of hidden symptoms and the severity of symptoms. It does seem that a diagnosis can be made without additional costs since finances are a concern stated by Mary Jones. There has been no indication that Mary has personal psychological health benefits (insurance) or that her company has an associated health plan benefit. - Family history is always important, particularly to determine the possibility of a history of mood and anxiety disorders. - Referral for psychological testing with the MMPI-II was not recommended due to cost efficiency and that the diagnosis can be made without an additional expense. - Therapy recommendations are typically made after a diagnosis is confirmed. If like an adjustment disorder can do SFBT - The use of psychotropic drugs such as antidepressants prescribed for adjustment disorder with anxious or depressed mood is not properly founded and should be avoided in less severe forms of this disturbance (van der Klink, Blonk, Schene, & van Dijk, 2003; Cartay, Balestrieri, Murree, & Hardoy, 2009). However, antidepressant medications are typically prescribed for individuals who prefer them and are not candidates for psychotherapy. - Observing the severity of physical symptoms is useful since physical symptoms, particularly pain, tend to improve when depression and anxiety are lessened. - Monitoring her level of engaging in interpersonal and social activities is a subjective measurement and an indication of symptom relief. - The Beck Depression Inventory can be used to monitor however it is recommended that a pre-post measure is taken. Assuming this inventory was used during the initial information gathering process, the Beck Depression Inventory can be an objective and inexpensive self-reporting instrument that could be easily administered as a way of monitoring improvement during treatment. - sleep log as self if there is a sleep diagnosis or if sleep was an important symptom - Predispositions may be discovered in a family history of substance use, mood disorders, tics, and eating disorders. - Relationship evaluation may be good for treatment but not needed for diagnosis - slurred speech/crazy symptoms=get medical history - During provisional diagnosis page=can do beck inventory so that can do it later - With alcohol or drugs mentioned always ask for legal issues - With drugs or alcohol always ask for suicidal ideation/history/etc. - Research with this addiction scale suggests it may be a risk rather than an indicator (Nichols, 2001). A referral for the administration of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; MAC-R [Revised]), a subscale of the MMPI-2- Revised, has been successfully used to screen for alcohol abuse and dependent behaviors (DSM-IV) or alcohol use disorder (DSM-5). The MAST and the CAGE are two instruments that are not cost prohibitive and easy to administer one or more times by counselors who would find them to be within the scope of their practice. - The SCL-90-R is considered a screening tool; however, it is useful in assessment and is intended to pick up on psychological distress and psychopathology. A 'caseness' is determined when The Global Severity Index (GSI) T-score is 63 or greater or any of the nine scales reach that same T-score. The SCL-90-R scales include somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Caseness was not determined for Margaret Alcy on any of the SCL-90-R scales or the GSI. - Psychodrama is a powerful therapeutic tool, particularly to resolve emotional distress related to prior interpersonal conflicts. - The standard treatment for alcohol abuse (dependency) or alcohol use disorder begins with the acute management of withdrawal symptoms in detoxification programs. This is followed by long-term management of dependence and prevention of relapse (Klerman et al., 1994). The client, if she agrees with the 12 step principles, should also be active in an AA 12-Step program. - with AoD to check for improved symptoms look at the following: - nature of relationships, AA attendance with AoD-termination recommendations - discontinue unhealthy relationships ALWAYS START WITH CBT Techniques on test and then move to others - On test after you are given symptoms, think what diagnosis do you think this is, and then choose a test for it - Minimally/plausible required is a right answer - off the symptoms, think what diagnosis, then ask questions based on what you think is right diagnosis - civic organization= community resources - interpersonal reminiescene: personal refelection - cat - feline Provisional diagnosis - Real deal diagnosis-you have enough to make the diagnosis Plausible diagnosis - Broadly describe the client with broad brush strokes- ex. Some anxiety but don't know enough info to make precise. Then ask you which diagnosis would be plausible- think what category, then choose all the fit. Ex. Maybe agoraphobia, panic disorder...LOOK AT specific time frames for this. ex. someone struggled with anxiety for four months and GAD is an option. Do not choose it because must be six months. These are could be diagnosis. Differential diagnosis - What are all of the other diagnosis that goes with bi-polar, PTSDthink categorically...Think mood vs. anxiety. Think which class it falls into. Which diagnosis can you rule out? - Read question carefully!!! When ask what can ruleout (exclude), think which one isn't a match for what chose thus far. LOOK AT TIME FRAMes-if worried for four months then can't be GAD because it takes six months...also, if they have anxiety, then cross of bi-polar. On test, you can order test outside of scope of practice. Select any test that makes sense on any plausible diagnosis. ex. minor having problem in school, can order IQ test. - When get unspecified as part of diagnosis option, think of critieria- time duration severity-does it fit? - NEED 71%-get not indicated, relax, say stupid test, and re-read question - Anxiety disorders - Yoga and art therapy can help treat what Consider working and building rapport/trust with client prior to referral-exam favors thisreal world should refer - If don't know culture or not familiar with diagnosis used in group or family therapy - Enactment therapy consult, discuss with supervisor, further assessments, review treatment plan-take steps - if don't reach goal in several weeks what do? could have adjustment disorder - pregnant woman who is struggling - If anxiety or mood ask about medical conditions - 18 y/o or older, give insurance info to them, not to parents even if parents have the insurance let radar go up for ADHD - see word "impulsivity" Substance Abuse Issues - Mental status exam does not assess for - If client is focused on having a disease, go with illness anxiety disorder. if focused on process like having heart attack, then panic disorder kids. Always integrate family/kids. - Include parents when counseling - flooding, implosion-not indicated for anxiety even though it is favored on exam for even alcoholism - empty chair - Memory is part of mental status exam only share if part of informed consent - working with divorced couples - DONT FALL FOR CIGARETTE DEPENDENCE DISORDER-not in DSMonly refer to what is available in the jail - Working with incarcerated clients If no other kids involved, then give them information about shelters, empower then, educate them, but we don't jump in - pregnant woman abused what do? parents/kids aren't providers - which providers give reports? could be specific phobia, situational - test taking panic you should check for drug and alcohol - With teens, problem behavior indicated - go back and re-read presenting problems to bring in symptoms to track progress - If clients miss appointments don't terminate can be a symptom of panic disorder - Blanking out - Follow up with medical doctor for medical conditions or refer for gyncological exam for sexually active - May send full records to other therapist, clients do not get full access to notes - lots of energy= hypno manic Continues...