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Axis I

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Most significant diagnoses; Vcodes

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Axis II

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Personality Disorders and Mental Retardation

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Axis III

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Medical conditions

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Axis IV

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Psychosocial/ Environmental stressors

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Axis V

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GAF

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Mental Retardation

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IQ of 70 and below

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Borderline Intellectual functioning

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IQ 71-84

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Mild MH

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IQ 55-70 (educable)

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Moderate MH

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IQ 35-55 (trainable)

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Severe MH

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IQ 20-35 institutionalized

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Profound MH

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IQ 20 or below

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Autistic Disorder

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Age of onset before age 3; self stimulating/injuring behavior (rocking, spinning, head banging) often present; 3 times more common in males

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Rett's disorder

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Female only; deceleration in head growth; problems develop between 5-24 months of age; loss of previously acquired hand skills; impaired language functioning and generally associated with severe or profound mental retardation

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Childhood Disintegrative Disorder

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Normal development until 2 then drastic decline followed by loss of previously acquired skills and development of autistic like symptoms

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Asperger's Disorder

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Autistic like symptoms without language impairment; severely impaired social functioning; normal or above normal IQ

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ADHD

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Symptoms must persist for at least 6 months; onset usually before age 7; impulsive type often in trouble at school; inattentive type often have poor grades

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Pica

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Repeated eating of non-nutritive substances for one month, onset age 1 or 2

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Tourette's disorder

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Vocal and motor tics that are present at the same time and last for at least one year

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Enuresis

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Elimination disorder involving urine during day or night

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Encopresis

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Elimination disorder involving feces or "soiling" in inappropriate places; occurs one time per month for 3 months; must be at least 4 years old

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Separation Anxiety Disorder

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Involves excessive anxiety over separation from home or whom attached; Begin before age 18; early onset before age 6

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Stranger Anxiety

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Normal reaction experienced by infant when startled or feeling threatened

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Separation Anxiety

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Feelings of anxiety and fear that result after being separated from a significant other

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Selective Mutism

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Persistent refusal to talk or inability to speak or understand spoken language; Must last at least one month (excludes first month of school), must impair functioning

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Delirium

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Abrupt onset of symptoms that fluctuate, clouded sensorium (ability to think clearly or concentrate), brief duration; can happen to young and old

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Dementia

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Relatively stable symptoms that do not fluctuate, no clouded sensorium (ability to think clearly or concentrate), long duration, must have disturbance in occupational and social functioning, characterized by multiple cognitive deficits

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Substance Abuse

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Less severe, continue to use knowing it is causing harm

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Substance Dependence

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Need to take larger amounts with unsuccessful attempts to quit

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Substance Intoxication

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Condition related to recent ingestion of psychoactive substance

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Substance withdrawal

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Maladaptive cognitive and behavioral declines due to reduction of a substance; usually associated with dependence; two most problematic substances are alcohol and heroin

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Polysubstance dependence

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Criteria for any one substance is not met, the client abuses more than one substance and takes them together

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Schizophrenia, disorganized type

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Marked incoherence, lack of systematized delusions, silly affect

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Schizophrenia, catatonic type

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Stupor, rigidity, bizarre posturing, waxy flexibility(decreased response to stimuli and tendency to remain in an immobile posture), and excessive motor activity

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Schizophrenia, paranoid type

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1 or more systemized delusions, or auditory hallucinations with a similar theme

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Schizophrenia, undifferentiated type

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"garbage can" bits of all types

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Schizophrenia, residual type

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Not currently displaying symptoms displayed in the past

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Schizophrenia disorder

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Criteria for diagnosis include psychotic symptoms, deterioration in adaptive functioning, 6 months in duration with active phase lasting 1 month, antipsychotic drugs used to treat

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Brief psychotic disorder

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Symptoms last no longer than 1 month (at least a few hours) with a sudden onset linked to a psychosocial stressor

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Schizophreniform Disorder

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Psychotic disorder where episode lasts less than six months

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Schizoaffective Disorder

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Psychotic disorder with mixture of symptoms suggestive of both an affective disorder and schizophrenia

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Shared Psychotic Disorder

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Psychotic disorder where two people share and create a delusional system

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Positive symptoms

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Hallucinations(inaccurate perceptions where auditory stimuli is most common) and delusions (strong beliefs held against strong contrary evidence)

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Negative Symptoms

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Refers to lack of movement(avolition) or speech (alogia)

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Antipsychotic medications

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Haldol, Thorazine, Mellaril, Risperdal, Zyprexa; Common side effect is drowsiness or sleepiness

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Tardive Dyskenisia

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Permanent neurological condition that can result from older antipsychotic medications and not taking anything to control EPS side effects

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Manic episode

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Mood episode that last for one week; must have at least 3 symptoms (psychomotor agitation, flight of ideas, decreased need for sleep, grandiosity, sexual preoccupation, hallucinations, delusions)

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Hypomanic episode

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Mood episode that is similar to manic but not severe enough to interfere with functioning; expansive, irritable, elevated mood that lasts at least 4 days

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Major depressive episode

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Depressed mood lasting approximately 2 weeks; also change in sleep or eating, fatigue, reduced ability to concentrate, delusions possible

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Mixed episode

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Alternating moods lasting approximately 1 week, must meet criteria for both manic and depressive

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Bipolar I Disorder

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One or more manic episodes, usually with history of depressive episodes (can have psychotic aspects)

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Bipolar II Disorder

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One or more depressive episodes with at least 1 hypomanic episode, no psychosis

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Cyclothymic Disorder

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Persistent mood disturbance lasting at least 2 years, must not be without for 2 months, less severe than bipolar

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Major Depressive Disorder

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1 or more major depressive episodes that last at least 2 weeks

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Dysthymia

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2 year history of depressed mood (constant), must not be without for 2 months, less severe than major depression

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Treatment of Mood Disorders

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Antidepressants (Prozac, paxil, zoloft), tricyclics(imipramine, elavil), lithium (manics), antianxiety, ECT, psychotherapy, anticonvulsants (depakene, depakote, clonzapepam)

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Side Effects of Lithium

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Drowsiness, weakness, nausea and vomiting, fatigue and hand tremor

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Endogenous depression

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Caused by internal events

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Exogenous depression

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Cased by external events

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Post Traumatic Stress Disorder

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Symptoms must last at least 1 month, if more than 6 months after event (delayed onset), must be outside range of usual experience, often relive situation

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Generalized Anxiety Disorder

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Undue persistent worry for at least 6 months about at least 2 or more life circumstances (worry wart)

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Acute Stress Disorder

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Acute reactions to extreme stress, within 4 weeks of the stressor and lasts for 2 days to 4 weeks

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Anti-anxiety medications

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Potentially addictive; Xanax, valium

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Anxiety treatment

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Systemic desensitization and crisis management

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Somatoform Disorders

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Consist of physical symptoms that have no known physiological cause; prior to diagnosis a physical exam should be completed.

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Somatization disorder

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Recurrent and at least 13 somatic complaints (symptoms with no known cause); begins in teens with onset before age 30

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Conversion disorder

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Change or loss in physical functioning that is not due to a physical condition and individual does not have voluntary control of symptoms

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Body Dysmorphic disorder

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Preoccupation with imagined body flaw

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Factitious Disorder with physical symptoms

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Munchausen syndrome-person is creating these physical symptoms for attention

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Factitious Disorder NOS

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Munchausen by proxy-person creating physical symptoms in others for attention

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Dissociate Amnesia

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Sudden inability to remember essential personal information, too extreme to be considered ordinary forgetfulness

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Dissociative fugue

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Abrupt unexpected travel away from home and work

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Dissociative identity disorder

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One person with at least 2 distinct personalities, one is dominant at a particular time; 5 year history of the problem

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Depersonalization Disorder

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One or more episodes of depersonalization causing significant distress for the individual, during episodes reality testing remains in tact

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Ideas of reference

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Incorrect interpretation of a causal incident as having a particular or unusual meaning to the person

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Delusion of reference

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Beliefs are held with delusional conviction

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Personality disorders with odd/ eccentric behavior

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Paranoid, schizoid, schizotypal

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Personality disorders with emotional, dramatic, erratic behavior

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Antisocial, borderline, narcissistic, histrionic

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Personality disorders with anxious or fearful behavior

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Avoidant, dependent, obsessive compulsive

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Borderline intellectual functioning

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IQ 71-84

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Malingering

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Voluntarily produce symptoms in presence of exaggerated voluntary physical symptoms with an obvious recognizable goal

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Normal t-cell count

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Range from 400-1700

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AIDS

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t-cell count falls below 200

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Assessing danger to self

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When ideation and intent are clear, immediately seek/ recommend hospitalization; do not use "no harm/ suicide" contract

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Functional Theory

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Problem solving focus with free will; Jesse Taft and Virginia Robinson; diagnosis is related to the use of services and is expected to change as client needs to change

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Psychosexual Theory and Development

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Freud; individuals were subject to the unconscious secual desires and motivations, beyond their control; 5 stages: oral, anal, phallic, latency, and genital; personality structure has 3 divisions: id, ego, superego

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Oral (stage 1)

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Age birth to 12 months; primary conflict is weaning; outcome-fixation produces passivity, dependence

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Anal (stage 2)

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Ages 1-3 years; primary conflict is toilet training; fixation produces selfishness, rigidity, stinginess

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Phallic (stage 3)

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Ages 3-6 years; Primary conflict is Oedipus/Electra complex; successful completion results in proper identification with same sex parent and helps develop superego; fixation may result in exploitation of self or others

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Latency (stage 4)

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Ages 6-12 years; focus is on social skills

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Genital (stage 5)

answer

Ages 12 and up; sexuality becomes focused in mature, genital love and adult sexual satisfaction

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Id

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Libido energy, child like, impulsive

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Ego

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Mediating force, developed in normal adults

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Superego

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Conscience or moral stopper

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Ego Psychology

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Psychodynamic theory; Ana Freud and Eric Erikson; focus on the effect of the conscious and unconscious; individuals are products of the past and understanding the past explains the present.

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Transference

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Feelings from client to therapist

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Countertransference

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Feelings from therapist to client

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Gestalt Therapy

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Founder is Fritz Perls; focus on the here and now; unexpressed guilt is viewed as "unfinished business", techniques often include empty chair, dream work, psychodrama, skillful frustration; speak in present tense; use "I" language; avoid why questions (focuses attention away from self)

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Object Relations Therapy

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Human growth and development theory; Mahler and associates; a child must separate from mother/child unit to become member of the family; child uses objects (bear, blanket) to separate from mother;

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Client Centered Therapy

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Human relations theory; founder is Carl Rogers; techniques are active listening and passive, nonjudgmental listening

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Systems Theory

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Work of Pincus and Minahan and Garvin; based upon the belief that society has the obligation to ensure that people have access to resources and opportunities; involves goal oriented planned change, problems are viewed as in the system, not the client

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Family Systems/ Therapy

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Founder is Ackerman; family is the core of treatment, but not dependent on all members participating; once a part of a system changes, the other parts will also change; "prescribing the system " is often used; helps to identify influential relationships

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Communications family therapy

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Founder is Satir and Whitaker; experiential (family sculpting); it is impossible to not communicate; emphasis is placed on behavior as communication

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Extended family systems

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Bowen; rational processes are applied to better understand current and intergenerational relationships; discussed triangulation and that dysfunction can come through several generations; genograms and ecomaps often used

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Structural family therapy

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Minuchin; "action comes before insight"; behaviors are established through changes in transactional patterns; if you improve the process, you improve the family; best for deriving specific outcomes

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Strategic family therapy

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Haley; combination of systems theory, communication theory and behaviorism; focus on action rather than insight; therapist is active in forcing the family to respond differently to situations

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Behavioral family therapy

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Liberman; focused on behaviorism and social learning theory; behavior modification where behavior is maintained by consequences

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Social Learning theory

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Albert Bandura; learning takes place through observation and reinforcement in the social system; intermittent reinforcement is the key to maintaining behavior

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Classical conditioning

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Pavlov; relationship between stimulus and a response is unlearned or prewired (dog salivating to bell ringing), emphasis on antecedents

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Operant conditioning

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Skinner; learning and reinforcement (rats wanting food and learning to press lever to get it) emphasis on consequences

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Reinforcement

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Behavior increase or strengthens

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Punishment

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Behavior decrease or weakens

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Rational Emotive Therapy

answer

Albert Ellis; cognitive-behavioral treatment; dysfunctional behavior is the result of irrational thoughts/beliefs; ABCDE model

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Problem Solving Model

answer

Perlman; 4P's: place, person, problem (stated in specific terms), process; used as the foundation of brief therapy and crisis intervention

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Task Centered

answer

William Reid; focused on tasks to be completed; problems are defined in specific elements for change

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Brief Planned Treatment

answer

5 essential characteristics: prompt intervention, high level of therapist activity, specific goals, identification and maintenance of a clear focus, setting a time limit

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