After taking the exam, realized there was quite a bit more about the DSM on the exam than I had anticipated. Therefore, I bring you another 'difference between' entry. The difference between Anorexia and Bulimia is a really sticky one. Sometimes you hear people say, 'I was anorexic and bulimic'. Well no, they were anorexic: purging type. Some people with anorexia will occasionally binge and purge, and some will eat small meals and purge. Both anorexia and bulimia have symptoms of abusing laxatives or diet pills, purging, and excessive exercising.
People with anorexia will always see themselves as fat no matter how thin they get. In order to get the diagnosis of anorexic, the person must refuse to maintain a healthy weight. Women will often stop menstruating.
People with bulimia tend to stay an average weight. They binge frequently and feel like once they start eating they are not able to stop.
In an oversimplified nutshell, remember that people with anorexia are irrationally convinced they are fat and are obsessed with being thin. People with bulimia are obsessed with food and purge/abuse pills/excercise to compensate for their binging. Anorexics are always underweight and bulimics are usually at an average weight.
Showing posts with label substance abuse. Show all posts
Showing posts with label substance abuse. Show all posts
Wednesday, December 17, 2008
Tuesday, December 2, 2008
Group Work
The following are types of groups and a brief description of them.
Education Group
In an education group, the facilitator's main goal is to provide information. Some discussion is appropriate. Examples include youth learning study skills and dialysis patients learning about transplant.
Discussion Group
In a discussion group, the participants discuss topics and not their personal issues. The facilitator is just the person in charge and not necessarily an expert. An example would be a book club.
Task Group
A task group is a group that forms in order to accomplish a task. When the task is completed, the group is dissolved. Examples include students working on a group project, or a committee planning an event.
Growth or Experiential Groups
This type of group's task is to grow as individuals. Examples include spiritual encounter retreats, and physical challenge retreats.
Counseling Groups
Counseling groups are typically for individuals who are experiencing life challenges such as divorce, making friends, life changes, etc. The facilitator may guide the group on topics and tease out details of an individuals situation. The group members are encouraged to help each other.
Therapy Groups
Therapy groups are typically for individuals with problems that are more severe than those in counseling groups. There are many techniques for group therapy and they may look radically different from each other. Examples include groups for women who have been assaulted, individuals in residential addiction rehabilitation, and people with anxiety.
Support Groups
A support group is a group where the members have something in common and meet regularly to support each other. Support groups allow members to realize there are people with the same struggles they have. Members should talk to each other and the facilitator role should be minimal. Examples include groups for people living with a specific illness, parents who have lost children, or people who experienced a common event (such a school shooting).
Self Help Groups
Self help groups do not have social workers are their leaders; they are lead by one of the participants. They typically follow the AA model.
Adapted from:
Jacobs, E., Masson, R., & Harvill, R. Group counseling strategies and skills (5th ed.) Belmont: Thomson.
Education Group
In an education group, the facilitator's main goal is to provide information. Some discussion is appropriate. Examples include youth learning study skills and dialysis patients learning about transplant.
Discussion Group
In a discussion group, the participants discuss topics and not their personal issues. The facilitator is just the person in charge and not necessarily an expert. An example would be a book club.
Task Group
A task group is a group that forms in order to accomplish a task. When the task is completed, the group is dissolved. Examples include students working on a group project, or a committee planning an event.
Growth or Experiential Groups
This type of group's task is to grow as individuals. Examples include spiritual encounter retreats, and physical challenge retreats.
Counseling Groups
Counseling groups are typically for individuals who are experiencing life challenges such as divorce, making friends, life changes, etc. The facilitator may guide the group on topics and tease out details of an individuals situation. The group members are encouraged to help each other.
Therapy Groups
Therapy groups are typically for individuals with problems that are more severe than those in counseling groups. There are many techniques for group therapy and they may look radically different from each other. Examples include groups for women who have been assaulted, individuals in residential addiction rehabilitation, and people with anxiety.
Support Groups
A support group is a group where the members have something in common and meet regularly to support each other. Support groups allow members to realize there are people with the same struggles they have. Members should talk to each other and the facilitator role should be minimal. Examples include groups for people living with a specific illness, parents who have lost children, or people who experienced a common event (such a school shooting).
Self Help Groups
Self help groups do not have social workers are their leaders; they are lead by one of the participants. They typically follow the AA model.
Adapted from:
Jacobs, E., Masson, R., & Harvill, R. Group counseling strategies and skills (5th ed.) Belmont: Thomson.
Sunday, November 23, 2008
Depression and Dysthymic Disorder
The criteria for the two disorders follow, directly from the DSM-IV TR. (emphasis added) An explanation follows at the end.
The criteria for Dysthymic Disorder is:
A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. No Major Depressive Episode (see p. 356) has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
E. There has never been a Manic Episode (see p. 362), a Mixed Episode (see p. 365), or a Hypomanic Episode (see p. 368), and criteria have never been met for Cyclothymic Disorder.
F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
* Early Onset: if onset is before age 21 years
* Late Onset: if onset is age 21 years or older
The criteria for a major depression episode is:
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode (see p. 365).
# The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
D. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
So there is a very marked difference between Dysthymic Disorder and a Major Depression Episode. A huge difference is that in order to get the dysthymic diagnosis, one has to display the symptoms almost everyday for two years! For a major depression episode, the individual must show five symptoms nearly every day for two weeks. Personally, I think the time frame difference is a bit too much... two weeks for one and two years for another? I suppose if I wrote the book I'd lessen the time period for Dysthymic Disorder to maybe a year. But once again, the writers of the book did not ask me.
There are some other key points to remember here. When any mood change happens, be it depression, agitation, mania, etc., it is important to screen for substance use; both prescription and recreational. I had a therapist (who was a social worker) tell me that chronic marijuana use can mirror Dysthymic Disorder. I haven't seen the research on this, but it sounds plausible. And having experienced taking Topamax, I can say first hand that prescriptions can not only make you feel depressed but actually slow your psychomotor functioning. There are also medical conditions that would cause mood changes, such as hyper or hypothyrodism, brain tumors, even UTIs in the elderly. Lastly, when a patient presents with depressive symptoms it is imperative to screen for possible manic or hypomanic episodes.
The criteria for Dysthymic Disorder is:
A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. No Major Depressive Episode (see p. 356) has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
E. There has never been a Manic Episode (see p. 362), a Mixed Episode (see p. 365), or a Hypomanic Episode (see p. 368), and criteria have never been met for Cyclothymic Disorder.
F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
* Early Onset: if onset is before age 21 years
* Late Onset: if onset is age 21 years or older
The criteria for a major depression episode is:
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode (see p. 365).
# The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
D. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
So there is a very marked difference between Dysthymic Disorder and a Major Depression Episode. A huge difference is that in order to get the dysthymic diagnosis, one has to display the symptoms almost everyday for two years! For a major depression episode, the individual must show five symptoms nearly every day for two weeks. Personally, I think the time frame difference is a bit too much... two weeks for one and two years for another? I suppose if I wrote the book I'd lessen the time period for Dysthymic Disorder to maybe a year. But once again, the writers of the book did not ask me.
There are some other key points to remember here. When any mood change happens, be it depression, agitation, mania, etc., it is important to screen for substance use; both prescription and recreational. I had a therapist (who was a social worker) tell me that chronic marijuana use can mirror Dysthymic Disorder. I haven't seen the research on this, but it sounds plausible. And having experienced taking Topamax, I can say first hand that prescriptions can not only make you feel depressed but actually slow your psychomotor functioning. There are also medical conditions that would cause mood changes, such as hyper or hypothyrodism, brain tumors, even UTIs in the elderly. Lastly, when a patient presents with depressive symptoms it is imperative to screen for possible manic or hypomanic episodes.
Thursday, November 20, 2008
Substance Abuse and Substance Dependence
The DSM-IV TR criteria for substance ABUSE:
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
B. The symptoms have never met the criteria for Substance Dependence for this class of substance.
The DSM-IV TR criteria for substance DEPENDENCE:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1. tolerance, as defined by either of the following:
a. a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
b. markedly diminished effect with continued use of the same amount of the substance
2. Withdrawal, as manifested by either of the following:
a. the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
b. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3. the substance is often taken in larger amounts or over a longer period than was intended
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of substance use
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
Specify if:
With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)
Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)
To summarize, substance abuse is when a person uses a substance dangerously, or the use of the substance damages the person's home/work/school life. Substance dependence is more severe. The person does not have to be physiologically addicted to the substance if there is an intense psychological need for the substance. The person spends lots of time on the substance; thinking about it, trying to find it, using it, recovering from it, wanting to stop or cut back but being unable to.
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
B. The symptoms have never met the criteria for Substance Dependence for this class of substance.
The DSM-IV TR criteria for substance DEPENDENCE:
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1. tolerance, as defined by either of the following:
a. a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
b. markedly diminished effect with continued use of the same amount of the substance
2. Withdrawal, as manifested by either of the following:
a. the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
b. the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
3. the substance is often taken in larger amounts or over a longer period than was intended
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of substance use
7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
Specify if:
With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)
Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)
To summarize, substance abuse is when a person uses a substance dangerously, or the use of the substance damages the person's home/work/school life. Substance dependence is more severe. The person does not have to be physiologically addicted to the substance if there is an intense psychological need for the substance. The person spends lots of time on the substance; thinking about it, trying to find it, using it, recovering from it, wanting to stop or cut back but being unable to.
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