LMSW EXAM - Boot camp, LMSW, LMSW

3 Areas to identify in each question (PPL) Ans- 1. Problem 2. Person 3. Last Sentence (guide to answer question) Key words Ans- 1. Person/Client "hot seat" 2. SAFETY Red Flags - suicide, abuse, life-threatening, ...

3 Areas to identify in each question (PPL) Ans- 1. Problem 2. Person 3. Last Sentence (guide to answer question) Key words Ans- 1. Person/Client "hot seat" 2. SAFETY Red Flags - suicide, abuse, life-threatening, unexplained marks, alcohol, recent loss 3. Strong words/adjectives 4. Age 5. Diagnosis 6. Symptoms/Duration 7. Who are you? 8. Where are you in session? 9. Quotations 10. Direct requests/concerns 11. Qualifiers (First/Next/Best) Distractors Ans- FARM GRITS ROAD - Answers that look appealing at first glance but are often wrong - ELIMINATE! Exam is here and now DO NOT CHOOSE FARM GRITS ROAD Ans- 1. FOCUS on unresolved issues/past 2. ADVICE - giving/judging 3. RECOMMEND "to a support group" 4. MAKE an appt. 5. GIVE pamphlets/literature 6. RECOMMEND a session 7. INFORM parents/speak to parents (when child/ado) 8. TERMINATE (Exceptions: Moving, client reaches goals/no new crisis, client does not pay) 9. SPEAK to supervisor (except transference/counter) 10. RESPECT self-determination (If mentally UNSTABLE) 11. OFFER contract as a reminder 12. ALLOW the clients to lead the session 13. DO nothing/say nothing How do you answer first/next questions? Ans- 90% of exam is SAFETY FIRST. How does the exam want you to have a CLEAR understanding of client's issues? Ans- ASSESS BEFORE ACTION. RUSAFE Ans- 1. RULE out medical 2. UNDER the influence/delusional/hallucinating Do Not Treat 3. SAVE Lives - Safety first (Answers: Duty to warn, report child/elder abuse, 911, mobile crisis, ER) 4. ASSESS before action - (Answers: ASSESS, ASK or DICE - Determine, Identify,Clarify, Explore) 5. FEELINGS - (Answers: ACKNOWLEDGE person's feelings) CONCERNS (AID ASSIST, INFORM client, DISCUSS concerns) 6. EMPOWER - If client is mentally stable/alert (Answers: Respect client's decisions) COE: Ethical responsibilities towards clients Ans- 1. Client's best interests are primary 2. Respect/promote right to self-determination if client is mentally alert/stable, NOT unstable/intoxicated/psychotic 3. Informed consent, written agreement by client to undergo treatment, risks/benefits/costs disclosed 4. Avoid conflicts of interest (Things that interfere with SW's impartial judgment/discretion) 5. DO NOT promote individual therapy sessions to ppl who have a relationship w/ each other (except couples, family, group treatment) - Provide family members with appropriate referrals 6. Avoid dual/multiple relationships 7. Avoid bartering (unless common practice in community) 8. Obtain a professional translator FIRST if client does not speak the language of SW 9. Do not disclose client information w/out consent unless req'd by law 10. Provide client with reasonable access to records (First explore/discuss reason for request) Follow laws of state. 11. Ensure CONTINUITY of services 12. NO relations with clients past or present Mandated reporting Ans- SW's are req'd and responsible for reporting any instances of abuse that is suspected. Abuse includes physical, emotional, sexual, neglect, CHILD AND ELDER ABUSE Duty to Warn Ans- SW's MUST WARN a threatened victim of any harm that his/her client may cause when there is a REAL INTENT (PLAN) HIV Decisions Ans- NOT DUTY TO WARN! 3 options: 1. FIRST urge client to disclose to partner 2. FIRST encourage client to engage in safe sex 3. Research/follow state laws as needed Subpoena by the court Ans- SW may be req'd by law to disclose confidential information COE: Ethical responsibilities to colleagues Ans- 1. Refer to colleague who may be better trained in an area than SW. SW can take client but must be COMPETENT. 2. When CONSULTING with colleague, disclose least amount of information 3. FIRST speak to a colleague to discourage/prevent/correct unethical behavior 4. AVOID relationships with colleagues (conflict of interest) COE: Ethical responsibilities in practice settings Ans- 1. Accurately document services in client's records while keeping best interests in mind 2. Maintain records securely for a period of time consistent with state laws COE: Ethical responsibilities as professionals Ans- 1. MONITOR/EVALUATE policies and implementation of programs 2. ADVOCATE when necessary HMO Insurance/Short term Care/MANAGED CARE Ans- 1. Emphasizes short term, discourages long term treatment 2. Cases assigned to case manager to whom provider must justify necessity for treatment for payment and services. 3. More precise diagnosis = greater likelihood of reimbursement 4. Encourages Cognitive/Behavioral short term TX. 5. Contracts are INFLEXIBLE, abide by rules to receive reimbursement Disorders in Infancy, Childhood, Adolescence Ans- Autism, ADHD, Oppositional Defiant Disorder, Conduct Disorder, Enuresis, Separation Anxiety Disorder Adult Disorders Ans- Delirium, Dementia, Amnestic/Cognitive Disorders, Schizophrenia and other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders Autistic Disorder Ans- 1. Deficits in social interaction and nonverbal COMMUNICATION 2. Lack of peer relationships. eye contact, abnormal body movement, 3. Restricted, repetitive patterns of behavior 4. Inflexibility to routine, Fixed interests Attention Deficit Hyperactivity Disorder Ans- 1. Symptoms at least 6 months 2. Inattentive: Difficulty focusing, staying on task follow-through, listening, easily distracted, loses things, forgetful 3. Hyperactive: Impulsive, fidgeting, running around, talking excessively 4. Several symptoms present prior to age 12 5. Must occur in 2 or more settings 6.. Behaviors can increase/decrease based on settings. 7. TX: Behavior modification Oppositional Defiant Disorder Ans- At least 6 months - Angry, irritiable, defiant, talking back to adults, rebellious behavior, attitude, blames others, cursing, lying - NO SERIOUS VIOLATIONS OF OTHERS RIGHTS Conduct Disorder Ans- 1. Violates other's rights, bullies, shoplifts, truancy, DX up to age 17 2. TX: Family, schools, community, client, parent/child behavior modificationq skills Enuresis Ans- 1. Repeatedly urinating during day/night 2. Up to 5 years old 3. Rule out medical first Separation Anxiety Disorder Ans- 1. Excessive distress when separated from major attachment figures. 2. Clinging, school refusal, sleep refusal 3. School Phobia is a form of separation anxiety. 4. Brought on when leaving home/family members to attend school. 5. At least 1 month of symptoms Impulse control disorders Ans- Trichotillomania, Intermittent Explosive Disorder, Gambling, Kleptomania, Pyromania, Delirium Ans- 1. Disoriented 2. Short period of time 3. Sometimes due to medical condition/substance use: DEHYDRATION, HEAD TRAUMA Dementia Ans- 1. Slow onset 2. Deterioration of memory/cognition 3. Alzheimer's, HIV, Parkinson's Amnestic Disorders Ans- Memory impairment w/out cognitive impairment Korsakoff's Syndrome Ans- Chronic alcoholism causes inability to recall previously learned information Schizophrenia Ans- 1. Hallucinations, delusions, disorganized speech, disordered/catatonic behavior, impaired thinking, negative symptoms (diminished emotional expression or avolition) THOUGHT DISORDER 2. Duration at least 1 month, but more than 6 months 3. TX = Medication and ego-supportive therapy (No INSIGHT therapy!) Schizophreniform Ans- 1. Same symptoms of schizophrenia 2. DURATION is at least 1 month, but less than six months 2. Triggered by turmoil/high stress 3. TX = Mediation and supportive therapy Delusional Disorder Ans- 1. NON-BIZARRE/IRRATIONAL beliefs/delusions 2. Hallucinations absent or not prominent 3. Persecutory/Jealous Types of delusions 4. NO IMPAIRED FUNCTIONING Brief Psychotic Disorder Ans- 1. 1 Symptoms of criterion A Schizophrenia 2. DURATION LESS THAN 1 MONTH Psychotic symptoms may also occur during which other conditions? Ans- Bipolar 1 Disorder, Major Depression, Substance Induced Mental Disorders, Mental disorders due to a medical condition (ex. Amphetamine induced psychotic disorder with delusional features), Delusional Disorder, Borderline Personality Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder Differential diagnosis Schizophrenia and Delusional Disorder Ans- 1. Delusions occur in both 2. Schizophrenia experience other symptoms (hallucinations, bizarre delusions) 3. DD less functional impairment schizoaffective disorder Ans- Same symptoms of schizophrenia with a major depressive episode, manic episode, or mixed episode Disruptive Mood Dysregulation Disorder Ans- a childhood disorder (diagnosed after age 6, before age 18) marked by severe recurrent temper outbursts along, persistent irritable or angry mood, 3 or more times per week period of 12 months Major Depressive Disorder Ans- 1. Symptoms: (most of day, nearly every day for 2 weeks) -Depressed mood -Lack of pleasure -weight loss/gain -insomnia/hypersomnia, -psychomotor agitation -sad/empty/worthlessness -suicidal ideation - fatigue - difficulty concentrating - excessive guilt MDD and bereavement differences- excessive guilt, anhedonia, suicidality Dysthymic Disorder Ans- 1. MDD symptoms but LESS SEVERE 2. Chronic 3. Duration more than 2 years (Children 1 year) 4. Symptoms cannot be absent for longer than 2 consecutive months Bipolar 1 Disorder Ans- 1. One or more manic episodes (Elevated, expansive, irritable mood, or excessive mood and increased energy) usually accompanied by a major depressive episode) 2. Symptoms may last at least 1 week to a few months 3. 3 or more manic symptoms 4. Impaired functioning Manic symptoms Ans- Inflated self-esteem, decreased need for sleep, loud/rapid speech, restlessness, racing thoughts, increased sociability and goal-directed activity, impairment of normal activities/relationships Bipolar II Disorder Ans- - 1 or more depressive episodes with at least 1 or more hypomanic episode - NO manic episodes or mixed episodes Depressive Symptoms Ans- Sadness, loss of interest in usual activities, sleep/appetite disturbance, feelings of worthlessness/guilt, difficulty concentrating, suicidal thoughts/death Neurovegetative symptoms of depression Ans- changes in appetite of weight, sleep disturbances, fatigue, decrease in sexual desire/function Rapid Cycling Ans- 4 or more manic episodes of illness over 12-month period Mixed State Ans- Both depression and Mania occur at the same time Children and Adolescents with Bipolar Disorder Ans- 1. Can occur, more likely if parents have illness 2. Children/Ados may experience very fast mood swings b/t depression and mania in one day 3. Children with mania likely to be irritable and prone to tantrums than to be overly happy 4. Bipolar difficult to tell apart from other problems in this age group Hyperthyroidism can mimic Ans- Mania Hypothyroidism can mimic Ans- Depression Mood disorder Ans- Refers to a disturbance of mood and other symptoms that occur together for a minimal duration of time and not due to physical/mental illness Panic Disorder Ans- 1. Brief, recurrent, panic attacks 2. Followed by persistent worry of another panic attack and behavior change 2. TX = Desensitization techniques social anxiety disorder Ans- intense fear of social situations, leading to avoidance of such Generalized Anxiety Disorder Ans- 1. Excessive worry and physical symptoms (restlessness, fatigue, headache, stomachache) 2. Ex. client reports frequently irritable and unable to focus, tension, insomnia 3. At least six months 4. Worry impedes functioning Panic attack or depression caused by substance Ans- Substance Induced Anxiety Disorder or Mood Disorder Panic attack caused by medical illness Ans- Anxiety or Mood disorder caused by General Medical Condition Somatoform Disorders Ans- Disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of physical disease (emotional connection) obsessive-compulsive disorder Ans- An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Body Dysmorphic Disorder Ans- 1. Excessive preoccupation with one body part 2. Severe, impairment in functioning 3. Cause of decline = obsessing about defect Conversion Disorder Ans- Involuntary loss of voluntary function, however client does not control or produce them voluntarily Factitious vs. Malingering Ans- 1. Intentionally produced symptoms, differing incentives 2. Malingering fakes symptoms for external gain/goal 3. Factitious produces symptoms due to need to be "sick patient" Munchausen's Syndrome Ans- Faking an illness/producing symptoms to receive sympathy as patient Munchausen's By Proxy Ans- Abuse of another (typically a child) in order to seek attention for the abuser PTSD Ans- 1. Exposure and response to life-threatening event 2. Arousal, intrusive, avoidance symptoms (distressing memories, dreams, dissociations, 3. LAST A MONTH AND BEYOND 4. Impairment to functioning/life pursuits acute stress disorder Ans- PTSD symptoms that appear for a month or less Reactive Attachment Disorder Ans- 1. Disorder caused by lack of attachment to caregiver - NEGLECT 2. Adjustment disorder Ans- a disorder in which a person's response to a common stressor, is maladaptive and occurs within 3 months of the stressor Disinhibited Social Engagement Disorder (DSED) Ans- a trauma-related attachment disorder characterized by indiscriminate, superficial attachments and desperation for interpersonal contact Somatization Disorder Ans- Recurrent/multiple somatic complaints that cannot be explained medically of several years. STRESS. Substance related Disorder Ans- Drug/Alcohol Intoxication and Withdrawal, Drug/Alcohol Abuse and Dependence Disorders that are chronic Ans- All personality disorders, Schizophrenia (> 6 months), Dysthymic and Cyclothymic (> 2 years), Generalized Anxiety Disorder (> 6 months), Hypochondrias (> 6 months), Somatization Disorder (several years) Paraphilias vs. Sexual Sexual Dysfunction Ans- Inappropriate sexual object or practice vs. inhibition of sexual response Parasomnias vs. Dyssomnia Ans- Abnormal event that occurs during sleep, b/t sleep/waking VS. disturbance in amount/timing of sleep Personality Disorders Ans- 1. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture 2. 2 or more areas (cognition, affectivity, interpersonal functioning, impulse control) Cluster A personality disorders Ans- odd/eccentric paranoid, schizoid, schizotypal Schizoid PD Ans- LONER, introverted, withdrawn, detachment from social relationships, RESTRICTED RANGE OF EMOTIONAL EXPERIENCE AND EXPRESSION, NO DESIRE FOR FOR SOCIAL RELATIONSHIPS Paranoid PD Ans- Interpreting actions of others as deliberately threatening or demeaning, distrustful and suspicious Schizotypal Ans- Odd/strange/bizarre behavior/beliefs/mannerisms and interpersonal/social deficits due to fear/paranoia Magical thinking Ans- ideas that one's thoughts or behaviors have control over specific situations ideas of reference Ans- The false impression that outside events have special meaning for oneself. Cluster B personality disorders Ans- dramatic, emotional, erratic antisocial, borderline, histrionic, narcissistic antisocial personality disorder Ans- 1. Disregard for the rights of others, Impulsive/irresponsible/callous 2. Must be > 18 (symptoms can occur at 15) Borderline PD Ans- 1. Unstable in interpersonal relationships, behavior, mood, and self-image. 2. Abrupt and extreme mood changes 3. Stormy interpersonal relationships 4. Fluctuating self-image 5. self-destructive actions Narcissistic PD Ans- Exaggerated self-importance, absorbed fantasy for success, seek constant attention/admiration, oversensitive to failure Histrionic PD Ans- Melodramatic, attention-seeking, excessive emotionality, sexually seductive Cluster C personality disorders Ans- Anxious, fearful avoidant, dependent, obsessive compulsive Avoidant PD Ans- Hypersensitive to rejection, unwilling to be involved, fear of not being liked Dependent PD Ans- Pattern of dependent and submissive behavior Obsessive Compulsive PD Ans- preoccupation with perfection, control, and orderliness Multiple Personality Disorder Ans- Dissociative Identity Disorder Mental Status Exam Ans- Structured way of observing and describing current state of mind - appearance, attitude, affect, behavior, cognition, insight, judgment, mood, perception, speech, thought process, thought content Displacement Ans- Place unwanted/unpleasant feelings onto someone less threatening or innocent bystander - ex. angry at boss, take it out on spouse Dissociation Ans- A person often loses track of time or themselves and their usual thought processes and memories. People who have a history of any kind of childhood abuse often suffer from some form of dissociation Projection Ans- Taking your emotions and placing it on others - ex. All of my coworkers are greedy, but I am not