Depression/ Bipolar
What are symptoms of Major Depressive Disorder?
A - 5 or more of the following symptoms must be present for during the same 2 week period.
1- Depressed mood most of the day, nearly every day (feeling sad, empty, hopeless).
2- Anhedonia - markedly diminished interest or pleasure in all, or almost all, activities most days or every day.
3- Significant weight change without dieting or increase in appetite (more than 5% of body weight in a month)
4- Insomnia or hypersomnia nearly every day
5- psychomotor agitation or slowness nearly every day
6- Fatigue or loss of energy nearly every day
7- Feelings of worthlessness or excessive/ inappropriate guilt nearly every day
8- Inability to think or concentrate nearly every day
9- Recurrent thoughts of death or SI
B - Symptoms cause clinically significant distress or impairment to social or occupational functioning
C- Symptoms cannot be attributed to substance use or other medical condition
D- Symptoms are not better explained by Schizophrenia or Schizoaffective
E- There has never been an episode of mania or hypomania (excluding substance induced episodes)
What are symptoms of Generalized Anxiety Disorder?
A- Excessive anxiety or worry more days than not for at least 6 months about a number of events or activities
B- The individual finds it difficult to control worry.
C- Anxiety/ worry are associated with three (or more) of the following:
1- Feeling restless or on edge
2- Being easily fatigued
3- Difficulty concentrating or mind going blank
4- Irritability
5- Muscle Tension
6- Difficulty falling asleep, staying asleep, or unsatisfying sleep
D- Symptoms cause significant distress or impairment in functioning
Name the two of the Psychotic Disorders we treat in ACPR/ ITCD
Schizophrenia
Schizoaffective Disorder
Delusional Disorder
Schizotypal Disorder
Unspecified Psychosis Not Due to a Substance or Known Psychical Condition
Other Psychotic Disorder Not Due to a Substance or Known Psychical Condition
Shared Psychotic Disorder
List Three Interventions for Clients in the Pre-Contemplation or Contemplation Stage of Change
25 bonus points will be awarded for any extra interventions listed.
1- Assertive outreach
2- Practical assistance
3- Building rapport
4- Meeting the individual where they are (Unconditional Positive Regard)
5- Offering honest hope
6- Acceptance and empathy
7- Reinforcing honest communication
8- Creating the recognition that things can be different
9- Asking their thoughts about recovery
10 - Satisfaction inventories about areas of life
11- Quality of life assessment
12- Picture their recovery goals
13- Meeting peers who have achieved their own recovery goals
14- Communicating that there is fulfillment in life beyond a diagnosis
15- Decreasing emotional stress by reducing symptoms
16- Positive self image instilled
What are the symptoms of Mania/ Hyopmania?
A- A distinct period of elevated, expansive, or irritable mood
B- During this time, three of the following must be present:
1- Inflated self-esteem or grandiosity
2- Decreased need for sleep (ex: feels rested after only 3 hours)
3- More talkative than usual or feels pressure to keep talking
4- Flight of ideas or subjective experience that thoughts are racing
5- Easily distracted
6- Increase in goal-directed activity
7- Excessive involvement in high risk activities (ex: unrestrained spending, substance use, foolish business investments)
Fun Fact:
Mania lasts at least one week and can often lead to social and occupational impairments. Mania can also require hospitalization to prevent harm to self or others.
Hypomania has a much shorter time frame. It can last at least 4 consecutive days. We can see a change in the person's mood and functioning, but we do not usually see the same social/occupational impairments as mania. A hypomanic episode does not generally require hospitalization. If there are psychotic features, the episode is considered manic.
What are symptoms of PTSD?
A- Exposure to actual or threatened death, serious injury, or violence in one or more of the following ways:
1- directly experiencing the event
2- witnessing the event as it occurs to others
3- learning that a traumatic event happened to a close friend or family member
4- experiencing repeated or extreme exposure to aversive details of a traumatic event.
B- One or more of the following intrusive symptoms:
1- Recurrent, involuntary, and intrusive distressing memories about the traumatic event
2- Recurrent distressing dreams in which content of the dreams are related to the traumatic event.
3- Dissociative reactions (ex: flashbacks) in which the individual feels or acts as if the traumatic events are recurring.
4- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize the event.
5- Marked psychological reactions to internal or external cues that represent the event.
C- Persistent avoidance of stimuli associated with the traumatic event
1- Avoidance of or efforts to avoid distressing memories, thoughts, or feeling related to the traumatic event
2- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about the traumatic event
D- Alterations in cognition and mood associated with the traumatic event, as evidenced by two of the following:
1- Inability to remember an important aspect of the traumatic event
2- Persistent and exaggerated negative beliefs or expectations about oneself or others ("I'm bad" or "no one can be trusted")
3- Persistent negative emotional state (fear, anger, horror, guilt, shame)
4- Markedly diminished interest or participation in activities
5- Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others.
6- Feelings of detachment or estrangement from others
7- Persistent inability to feel positive emotions (happiness, satisfaction, feelings of love)
E- Marked alterations in arousal and reactivity associated with the traumatic event, as evidenced by two or more of the following:
1- Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects
2- Reckless or self-destructive behavior
3- Hypervigilance
4- Exaggerated startle response
5- Problems with concentration
6- Difficulty falling asleep, staying asleep, or restless sleep
F - Duration of Symptoms (B, C, D, E) last more than 1 month
True or False:
Psychotic Disorders are always caused by substance use.
FALSE
Psychotic symptoms may be induced by substance use, medications, toxins, and other medical conditions. However, a person can be predisposed to conditions like Schizophrenia and Schizoaffective Disorder through genetics.
List Three Interventions for Clients in the Preparation Stage of Change.
25 bonus points will be awarded for any extra interventions listed.
1 - Asking permission to discuss target behavior change
2- Begin education to support motivation to change
3- Envisioning life differently
4- Stabling more meaningful activities
5- Peer and family support development
6- Envisioning life differently if things were different
7- Exploring progress made
8- Review of natural supports toward recovery
9- Envision life not limited by illness
10- Risk taking assessment toward change
11- Pros and cons
Name three coping skills for Major Depressive Disorder.
1- Self-Care/ Maintain a Regular Hygiene Schedule
2- Regular Exercise
3- Medication Compliance
4- Healthy Diet/ Regular Eating Habits
5- Healthy Sleep Hygiene
6- Maintain a Regular Schedule
7- Engaging with Social Supports
8- Engage in Leisure Activities
You are assisting a client to the grocery store. They express to you they are nervous about going into the store. They become increasingly agitated and fidgety the longer they are away from home. They confirm they have their shopping list and wallet multiple times. What interventions do you use to assist your client that is experiencing anxiety?
- practice/ model deep breathing skills.
- review and encourage the use of coping skills for anxiety
- review budget and shopping list
- use open ended questions to talk about miscellaneous topics.
- build rapport with client by talking about pets or family
Define Hallucinations
Hallucination are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions. They are involuntary. They can occur in any sensory modality, but auditory hallucinations are most common.
Fun Fact: It can be normal to experience auditory hallucinations when falling asleep (hypnagogic) or when waking up (hypnopompic).
List Three Interventions for Clients in the Action Stage of Change.
25 bonus points will be awarded for any extra interventions listed.
1- Empirically supported counseling may begin
2- Skills and coping training begins
3- Self help groups and supports added to treatment
4- Normalizing relapse
5- High-risk situation planning
6- Sharing the recovery plan with others
7- Utilization of WRAP plans
8- IMR training
9- Reminders of strengths
10- Talents and achievements
11- Celebrate goal achievement steps
12- Using relapse prevention skills
13- Development of trust in one’s own abilities
14- Accountability and responsibility awareness
The med clinic calls you and informs you that your client with Bipolar Disorder has missed their appointment. They are unable to contact them to reschedule them. You know this means they will be out of meds. You attempt to call them, and they answer the phone. They report to you that they don't feel well, but they allow you to drop by. When you get there, you notice that their house is cluttered, their clothes and hair are unwashed, and there are dirty dishes scattered around the house. Client expresses to you that they have not had the energy to clean their home or take a shower. They express embarrassment and shame and state they did not want to attend their appointment today due to these feelings. What interventions do you use to assist your client?
- Assist with scheduling a new med appointment.
- Provide assistance to med appointment to hold client accountable for attendance.
- Build or review safety plan
- Review and encourage coping skills for depression
- Review med compliance
Name three coping skills for Panic Attacks
- Grounding Exercises (5, 4, 3, 2, 1 Exercise)
- Deep Breathing Exercises (Box Breathing, Diaphragmatic Breathing)
- Positive Affirmations
- Progressive Muscle Relaxations
- Distractions
- Chewing on Ice Cubes
- Sour Candies
- Visualization
Define Delusions
Delusions are fixed, false beliefs that are not based in reality, even when presented with evidence to the contrary. The distinction between delusion and a strongly held belief can be difficult to determine and depends on the degree of conviction despite clear and reasonable contradictory evidence. It is important to consider a person's culture and religion.
Persecutory: Belief that one is going to be harmed or harassed by an individual, organization, or other group.
Grandiose: A belief that he/she has exceptional abilities, wealth, or fame.
Erotomanic: A delusion that another person, often someone prominent, is in love with him/her.
Somatic: Believing he/she has a physical defect or medical condition.
Nihilistic: the belief that a major catastrophe will occur
List Three Interventions for Clients in the Maintenance Stage of Change.
25 bonus points will be awarded for any extra interventions listed.
1- Relapse planning and adjustments as needed
2- Expanding recovery to other life areas
3- Application of psychiatric rehabilitation skills
4- Transfer of skills
5- Recovery journey assessment and celebration
6- Assisting and supporting others in recovery
7- Assessment of how life is different now
8- Set new recovery goals
9- Exploring results of goal achievement
10- Continued accountability and new goal setting
Name three coping skills for Mania/ Hypomania
1- Medication Compliance
2- Maintain a Regular Self-Care Schedule (bathing, grooming, eating, etc.)
3- Avoid Major Life Decisions
4- Avoid Caffeine and Other Stimulants
5- Stay Hydrated
6- Maintain Healthy Sleep Hygiene
7- Create a Wellness Recovery Action Plan (WRAP)
Define Obsessions and Compulsions
Obsessions are intrusive, unwanted thoughts, images, or urges that cause anxiety (the mental part).
Compulsions are the repetitive physical or mental actions (like excessive washing, checking, or praying) performed to neutralize anxiety, offering only temporary relief.
Define a Negative Symptom in relation to a Psychotic Disorder.
Negative symptoms are characterized by a reduction or absence of normal behaviors, emotions, and motivations, essentially representing things that are "taken away" by the illness. They are considered deficits in functioning, leading to withdrawal, apathy, poor self-care, and difficulty engaging with life.
Diminished Emotional Expression (Blunted Affect) - reduction in the expression of emotion, eye contact, intonation of speech, and other non-verbal communication that normally give emotional emphasis to speech.
Avolition - decrease in self-initiated purposeful activities, leading to a person sitting for a long period of time showing no interest in participating in social or occupational activities.
Alogia - diminished speech output
Anhedonia - decreased ability to experience pleasure or joy in doing things
Asociality - lack of interest in social interactions
Give an example of each Stage of Change
Pre-Contemplation: "I don't have a problem with alcohol"
Contemplation: "I think I need to start cutting back how much meth I use. I might have a problem."
Preparation: "I went to CR last night and it was good. I plan on going back next week." Client also make plans with their CC to attend other groups in their community.
Action: "I have not used in a month."
Maintenance: "I have not used meth in six months. I'm so proud of myself."