1 – C: Allow the patient to move into his motor home.
The patient has a plan sufficient to meet his needs for food, clothing, and shelter. He has the legal right to choose where he wishes to live, even if others are not comfortable with his choice. Calling the police will not help, as they cannot force him to return to the facility. Adult protective services may have a subsequent role, if the patient begins to exhibit marked self-neglect or cognitive changes, but they cannot force the patient either. Finally, the patient is not eligible for an involuntary hold, as he is not placing himself or others in danger based upon a diagnosable mental illness, intoxication, or other substance abuse. Careful collateral planning, however, will be important (ensuring the daughter visits and checks in on him, etc) to try and maximize his potential for success. After coping with the hardships of independent living, he may willingly return to assisted living.
2 – C: Adjustment disorder with depressed mood.
Criteria for this disorder includes a time-limited nature, usually beginning within three months of the stressful event, and lessening within six months-either with removal of the stressor or through new adaptation skills. Adjustment disorder is a “sub-threshold disorder,” allowing for early classification of a temporary condition when the clinical picture remains vague. While the patient does have insomnia, it arises from the stressful loss and not as an independent condition. Many of the essential criteria for a major depression are absent (weight loss, psychomotor agitation, blunted affect, etc), although without successful treatment this condition could emerge. The diagnosis of acute stress disorder is not appropriate as the precipitating event did not involve threatened or actual serious injury or death.
3 – B: Refuse to use the form.
No client or client population is beneath the ethical standards of the field. An appropriate information release form stipulates a limited period of time beyond which the form expires, the specific kind of information to be released, the specific purpose for which the information is to be provided, and a specific individual or entity to whom/which the information will be provided. While obtaining an information release is indeed a “hassle” it is the ethical standard of care in the field, and deviation from it can open a practitioner to legal liability. The fact that a given client, or client population, may be unaware of this does not excuse the therapist from using an ethically appropriate form in keeping with expected standards of care. Any limitations to confidentiality-such as mandatory reporting if a client expresses intent to commit a crime or harm another-belong on a treatment consent form, rather than on an information release form.
4 – C: Rejecting the null hypothesis when the null hypothesis is true.
A failure to randomize research participants will potentially introduce bias, and may provide grounds upon which to invalidate a study, but it is not a type I error. Assuming a normal statistical distribution when it is skewed will violate the assumptions necessary to apply a proper statistical model to the analysis of data.
5 – B: “Identify problems” is the third step in the Roberts crisis intervention model.
6 – D: Transmuting internalization.
Empathic mirroring is the process by which the mother demonstrates (“reflects”) care and understanding of the child, in turn helping the child to develop a self-identity. Rapprochement is a term from object relations theory, indicating the need for an infant to seek independence while still retaining security. Differentiation is a substage in object relations theory, where an infant begins to look at the outside world, as opposed to the inward focus common to infants younger than five months of age.
7 – D: Alfred Adler.
Adlerian theory also includes a biological view, largely absent in Psychoanalytic Theory, recognizing that hormonal changes, physical illness, chemical imbalances, and neurological disorders can dramatically influence capacity and behavior. It is important to note, however, that Alder still locates false beliefs, irrational thoughts, and misconceptions in the unconscious mind.
8 – A: Conventional Level, Stage 3.
The Theory of Moral Development was created by Lawrence Kohlberg, to extend and enhance Jean Piaget’s theory. Overall, Kohlberg felt that the process of moral development was more complex and extended than that put forth by Piaget.
9 – D: Borderline personality disorder.
Individuals with this diagnosis will exhibit: frantic efforts to avoid real or imagined abandonment; unstable and intense interpersonal relationships (especially extremes of idealization and devaluation); an unstable sense of self; extreme impulsivity (e.g., spending, sex, drug use, reckless driving, binge eating, etc); recurring suicidal behavior (gestures or threats, or self-mutilating behavior); affective instability due to reactivity of mood; chronic feelings of emptiness; intense anger (e.g., frequent displays of temper, recurrent physical fights); transient, stress-related paranoid ideation; or severe dissociative symptoms. However, as with all Axis II disorders, this diagnosis cannot properly be made during a first contact, but must be substantiated over a course of clinical contacts sufficient to compel the diagnosis to be made (DSM-IV).
10 – D:
Although it is ideal for social workers to receive specific training regarding each of the individual minority populations they typically serve, they should still ensure that someone from an unfamiliar background receives needed services even where no staff with special training in that background is available.
11 – B: Axis V; Axis III; Axis II; Axis IV; and Axis I.
Clinicians should assess clients on all five axes to ensure a thorough evaluation.
12 – A: Oppositional Defiant Disorder.
Disruptive Behavior Disorder, not otherwise specified (NOS) is an umbrella term for behavior disturbances that lack sufficient clarity for the assignment of a more specific diagnosis. Impulse-Control Disorder is only appropriate when a behavior is compulsive in nature. While anger may be a part of that picture, it tends to be an overreaction to a provocation; other relevant compulsions include gambling, skin-picking, kleptomania, etc. The hallmark of Conduct Disorder is deliberate cruelty, and wanton disregard for others rights and property. This client lacks any pervasive and long-standing evidence in this regard.
13 – A: The voluntary or involuntary passage of stool in an inappropriate place by a child over the age of four (i.e., past toilet training).
This is a frequently misused term. It is most frequently applied to children and developmentally delayed adults. Adults with psychosis may warrant use of the term, although the term “fecal incontinence” is more commonly used for adults. A British literature review found only one use of the term in an adult that was not either psychotic or mentally retarded-a 1932 case of a 36-year-old diagnosed with “infantile neurosis.” The most typical etiology is stool impaction (constipation) compromising sphincter control and allowing leakage into the underclothing. However, emotional disorders, anxiety, or oppositional defiant disorder can sometimes underlie the behavior. Incidence of the condition drops steadily after age six.
14 – C: Substance abuse typically involves narcotics, while dependence typically involves non-narcotic drugs.
In general, narcotics are more addictive than non-narcotic substances. Even relatively “benign” substances of abuse, such as marijuana, can produce dependence if used often enough, and mounting clinical and preclinical evidence suggests that a marijuana withdrawal syndrome also exists (however, it is not yet in the DSM). Common treatment medications include: Antabuse (disulfiram; for alcohol abuse); ReVia (naltrexone; for alcohol and narcotics); and Trexan (naltrexone; for alcohol and opioid dependence).
15 – D: Affect, associations, ambivalence, and autism.
In 1911, Eugen Bleuler coined the term schizophrenia, and defined it using his now-classic four “As:” Affect (blunted emotional response to stimuli); associations (loosening, disordered thought patterns), ambivalence (an inability to make decisions due to poor information integration and processing), and autism (a preoccupation with the self and one’s thoughts). Common medications for treatment: Clorazil (clozapine), Haldol (haloperidol), Loxitane (loxapine), Mellaril (thioridazine), Prolixin (fluphenazine), Risperdal (risperidone), Stelazine (trifluoperazine), Thorazine (chlorpromazine), and Zyprexa (olanzapine).
16 – B: Bipolar I, single manic episode, in full remission.
There is no evidence of frank psychosis, thus brief psychotic disorder can be ruled out. Hypomania does not appear appropriate, as the client’s behavior would likely have resulted in hospitalization had anyone been able to evaluate him during his period of mania. Cyclothymic disorder does not appear appropriate, as the client’s conduct exceeded the threshold severity for hypomania, and no information is provided regarding depressive symptoms (though he may well have them). Finally, the Bipolar I, single manic episode is identified to be in full remission, as the client’s manic symptoms appear to have completely resolved.
17 – B: Psychoanalytic approach.
This approach is built upon the concepts and theory of Sigmund Freud and others who have followed him. The approach is also sometimes called a “psychodynamic” approach.
18 – C: Group development.
During these stages, the social worker needs to: 1) facilitate familiarity and elicit participation; 2) clarify roles; 3) develop group cohesion; 4) support individual differences; and 5) foster independence. The use of a “Sociogram” (a chart or diagram depicting group member relationships) can aid the social worker in revealing, monitoring, and intervening (if necessary) in group member interactions and bonding.
19 – D: Partialization.
For example, “Well, if we take these things one at a time, maybe we can start with…”
20 – A: Their practice.
The evaluation process involves: 1) problem identification (called the “target” of the research); 2) operationalization (selecting indices that represent the problem that can be measured; 3) determining the “phase” (the time over which measurement will occur), including a “baseline phase” (without intervention) and an “intervention phase.” This may also include a “time series design,” where data is collected at discrete intervals over the course of the study.