LMSW EXAM - Bootcamp

Areas to identify in each question (PPL) Answer- 1. Problem 2. Person 3. Last Sentence (guide to answer question) Key words Answer- 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 Answer- 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 Answer- 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? Answer- 90% of exam is SAFETY FIRST. How does the exam want you to have a CLEAR understanding of client's issues? Answer- ASSESS BEFORE ACTION. RUSAFE Answer- 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 Answer- 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 Answer- 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 Answer- 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 Answer- 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 Answer- SW may be req'd by law to disclose confidential information COE: Ethical responsibilities to colleagues Answer- 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 Answer- 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 Answer- 1. MONITOR/EVALUATE policies and implementation of programs 2. ADVOCATE when necessary HMO Insurance/Short term Care/MANAGED CARE Answer- 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 Answer- Autism, ADHD, Oppositional Defiant Disorder, Conduct Disorder, Enuresis, Separation Anxiety Disorder Adult Disorders Answer- Delirium, Dementia, Amnestic/Cognitive Disorders, Schizophrenia and other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders Autistic Disorder Answer- 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 Answer- 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 Answer- 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 Answer- 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 Answer- 1. Repeatedly urinating during day/night 2. Up to 5 years old 3. Rule out medical first Separation Anxiety Disorder Answer- 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 Answer- Trichotillomania, Intermittent Explosive Disorder, Gambling, Kleptomania, Pyromania, Delirium Answer- 1. Disoriented 2. Short period of time 3. Sometimes due to medical condition/substance use: DEHYDRATION, HEAD TRAUMA Dementia Answer- 1. Slow onset 2. Deterioration of memory/cognition 3. Alzheimer's, HIV, Parkinson's Amnestic Disorders Answer- Memory impairment w/out cognitive impairment Korsakoff's Syndrome Answer- Chronic alcoholism causes inability to recall previously learned information Schizophrenia Answer- 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 Answer- 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 Answer- 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 Answer- 1. 1 Symptoms of criterion A Schizophrenia 2. DURATION LESS THAN 1 MONTH Psychotic symptoms may also occur during which other conditions? Answer- 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 Answer- 1. Delusions occur in both 2. Schizophrenia experience other symptoms (hallucinations, bizarre delusions) 3. DD less functional impairment schizoaffective disorder Answer- Same symptoms of schizophrenia with a major depressive episode, manic episode, or mixed episode Disruptive Mood Dysregulation Disorder Answer- 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 Answer- 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 Answer- 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 Answer- 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 Answer- 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 Answer- - 1 or more depressive episodes with at least 1 or more hypomanic episode - NO manic episodes or mixed episodes Depressive Symptoms Answer- Sadness, loss of interest in usual activities, sleep/appetite disturbance, feelings of worthlessness/guilt, difficulty concentrating, suicidal thoughts/death Neurovegetative symptoms of depression Answer- changes in appetite of weight, sleep disturbances, fatigue, decrease in sexual desire/function Rapid Cycling Answer- 4 or more manic episodes of illness over 12-month period Mixed State Answer- Both depression and Mania occur at the same time Children and Adolescents with Bipolar Disorder Answer- 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 Answer- Mania Hypothyroidism can mimic Answer- Depression Mood disorder Answer- 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 Answer- 1. Brief, recurrent, panic attacks 2. Followed by persistent worry of another panic attack and behavior change 2. TX = Desensitization techniques social anxiety disorder Answer- intense fear of social situations, leading to avoidance of such Generalized Anxiety Disorder Answer- 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 Answer- Substance Induced Anxiety Disorder or Mood Disorder Panic attack caused by medical illness Answer- Anxiety or Mood disorder caused by General Medical Condition Somatoform Disorders Answer- 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 Answer- An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Body Dysmorphic Disorder Answer- 1. Excessive preoccupation with one body part 2. Severe, impairment in functioning 3. Cause of decline = obsessing about defect Conversion Disorder Answer- Involuntary loss of voluntary function, however client does not control or produce them voluntarily Factitious vs. Malingering Answer- 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 Answer- Faking an illness/producing symptoms to receive sympathy as patient Munchausen's By Proxy Answer- Abuse of another (typically a child) in order to seek attention for the abuser PTSD Answer- 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 Answer- PTSD symptoms that appear for a month or less Reactive Attachment Disorder Answer- 1. Disorder caused by lack of attachment to caregiver - NEGLECT