Wednesday, January 25, 2012

Personality Disorders

-Begin early in life and effects functioning but doesn't prevent it.

-Always ends in "personality disorders"
-All go on axis 2
- no date of onset. lifelong patterns of behavior.

Cluster A: paranoid, schizoid, and schizotypal Disorders (also referred to as "odd or eccentric behavior disorders"). Thinks the world is out to get them. Socially Isolated and Withdrawn.

Cluster B: impulsivity and/or affective dysregulation disorders (also referred to as "dramatic, emotional, or erratic disorders").Cluster B includes: antisocial, borderline, histrionic, and narcissistic personality disorders.

Cluster C: anxiety and compulsive disorders (also referred to as "anxious or fearful disorders").
Finally Cluster C includes: obsessive/compulsive, avoidant, and dependent personality disorders.

The additional category for indeterminate behaviors that appear to characteristic of a personality disorder is called: "personality disorder, NOS" (not otherwise specified). Clusters tend to run in families.


The Duty to Protect as derived from the Tarasoff case has been rigorously debated in terms of other mechanisms of harm. A situation where a client is human immunodeficiency virus (HIV) positive and is known to be having unprotected sex with a victim who is not aware of the client's HIV positive status is one. Given the deadly nature of the sexually and blood-to-blood transmitted HIV, it has been determined that a social worker or other clinician may be warranted in breaching confidentiality if education about the dangers and efforts at counseling have failed to alter the HIV positive client's behavior. However, the following 5 specific criteria must be met: 1) The client must be known to be HIV positive. 2) The client must be engaging in unprotected sex or sharing drug injection paraphernalia. 3) The behavior must actually be unsafe. 4) The client must indicate an intent to continue the behavior even after counseling regarding potential harm. 5) HIV transmission must be likely to occur.

Monday, January 23, 2012

Piaget Cognitive Development

Sensorimotor: 0-2 - learning is through feeling and movement. -Obtain Object Permanence.

Preoperational: 2-7- Achieve Irreversibility ie. death is final. Children learn symbols and can use them to communicate.

       2 sub stages: Preconceptual- 2-4 yrs
      Intuitive: 4-7
-children are still egocentric until 6.

Concrete Operational: 7-11 yrs old. understand symbols.
-Achieve Conservation.

Formal Operational: abstract thinking -only half of adults achieve this. Can solve problems in head no just on finger or paper. Develop inner value system and moral judgement.

Kohlberg's Stages of Moral Development

6 stages

Pre-conventional: (4-10)
Stage 1: Punishment and Obedience- can't reason with the kids. has to punish to get them to understand.
Stage 2: Instrumental-Relative- bribery. motivation is rewards to get to them to do what they need to do. Adults- "Whats in it for me?"

Conventional Morality (10-13)
Stage 3: Peer Pressure, acceptance of social group, wants to avoid disapproval. It's wrong when others disapprove. Golden Rule
Stage 4: Law and order orientation, judgement is made according to if it is legal. Understand their own impact

Post-Conventional Morality (adolescent and up)
Stage 5: Social Contract Orientation, ie. law makers, have beliefs but willing to negotiate them.
Stage 6: Universal Ethical Stage. My beliefs are more important than the law. Greater law for all humans. ie. MLK, he believed human rights were more important than the law.

Erikson- Psychosocial Development

Great video of the stages makes them interesting.

0-12/18 mo Oral/Sensory, Trust vs. Mistrust- clearly attached to caregiver Outcome:trust/optimism

12/18 mo-3 yrs Autonomy vs. Shame and Doubt- exploring the world, Outcome: self-esteem, self control

3-6 yrs Initiative vs. Guilt- doing things on your own successfully, Outcome: sense of purpose

6-12 Industry vs. inferiority- comparing self to the world, Outcome: productivity/competence

12-18 identity vs. role confusion- who am I? Outcome: Ability to view self as an individual

19-35(40) Early Adulthood. Intimacy vs. Isolation -establishing significant relationships, Outcome: love

40-65 Generality vs. Stagnation -career and family focus successfully, Outcome: concerns for the future

65-80 Integrity vs. Despair- did I accomplish what I was supposed to in life?, Outcome: Wisdom

Psychosexual Development- Freud

5 stages:

Oral- 0-12/18 mo, everything has to do with the mouth. primary conflict weaning. arrested development here results in passivity or dependence. ex. excessive eating, smoking, nail biting

Anal: 1-3 yrs, primary conflict- toliet training, those whose development have stopped here often exhibit obsessions with neatness (anal-retentive), selfishness, rigidity, stinginess or are excessively reckless and disorganized (anal-expulsive).

Phallic: -3-6 yrs. electra/oedopis complex develops. Wants to have sex with parent of opposite sex & hate for same sex parent, extreme fear of being found out. successful development is ability to ID with same sex parent & development of the superego.

Latency: 6-12 yrs. development is focused on social skills not sexual ones.

Genital: 12 yrs or beginning of puberty. mature (adult) sexual love begins

*Goal of therapy bring the unconscious to the conscious so that it can be overcame to move on. Techniques "primary process thinking" used are slips of tongue, dream analysis, free association, projective techniques

ID- unconscious, primal, and reflexive
Ego- attempt to control ID impulses as to what is socially acceptable.
Superego- guilt, conscious, moral development.

Substance Abuse

Know dependence and abuse.

Both are using substances even though it causes you harm.

Substance Abuse is LESS severe than dependence.

Withdrawal goes with Dependence.

Most problematic withdrawal are alcohol and heroin.

Common signs of withdrawal are  nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety

11 Classes of substance-related disorders:

1. Polysubstance Dependence- Is not exclusively one specific type of use. Is 3 or more types taken together.

2. Alcohol- can lead to DTs or delirium tremors  -can be fatal if not monitored closely -Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats.

3. Opiods (morphine, heroin, condone, Oxycodone, hydrocodone) -most addicts have comorbid SMI -produces euphoria when using -withdrawal symptoms are

DTs- Delirium Tremens usually includes extremely intense feelings of "impending doom". Can occur in alcohol & sedative hypnotics such as benzos and barbituates.

The main symptoms of Delirium Tremens are confusion, diarrhea, insomnia, nightmares, disorientation and agitation and other signs of severe autonomic instability (fever, tachycardia, hypertension.

-can be fatal if not monitored closely -Other common symptoms include intense perceptual disturbance such as visions of insects, snakes, or rats.

Physical warning signs of drug abuse

  • Bloodshot eyes, pupils larger or smaller than usual.
  • Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
  • Deterioration of physical appearance, personal grooming habits.
  • Unusual smells on breath, body, or clothing.
  • Tremors, slurred speech, or impaired coordination.

Behavioral signs of drug abuse

  • Drop in attendance and performance at work or school.
  • Unexplained need for money or financial problems. May borrow or steal to get it.
  • Engaging in secretive or suspicious behaviors.
  • Sudden change in friends, favorite hangouts, and hobbies.
  • Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse

  • Unexplained change in personality or attitude.
  • Sudden mood swings, irritability, or angry outbursts.
  • Periods of unusual hyperactivity, agitation, or giddiness.
  • Lack of motivation; appears lethargic or “spaced out.”
  • Appears fearful, anxious, or paranoid, with no reason.

Warning Signs of Commonly Abused Drugs

  • Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
  • Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
  • Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
  • Inhalants (glues, aerosols, vapors):  Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.
  • Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
  • Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.
For more symptoms and effects of commonly abused drugs, see the Helpguide PDF Factsheet.

Warning signs of teen drug abuse

While experimenting with drugs doesn’t automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce. The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:
  • Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs.
  • Skipping class; declining grades; suddenly getting into trouble at school.
  • Missing money, valuables, or prescriptions.
  • Acting uncharacteristically isolated, withdrawn, angry, or depressed.
  • Dropping one group of friends for another; being secretive about the new peer group.
  • Loss of interest in old hobbies; lying about new interests and activities.
  • Demanding more privacy; locking doors; avoiding eye contact; sneaking around.