Addiction and Mental Illness Part 1 Study Guide

ADDICTION AND MENTAL ILLNESS PART 1 STUDY GUIDE

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Study Guide

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“ADDICTION AND MENTAL ILLNESS”

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STUDY GUIDE

ADDICTION AND MENTAL ILLNESS

Chapter 5: Assessing the Psychiatric Disorder and Planning the Appropriate Level of Care

Multiaxial Assessment Based on the DSM-IV

Diagnosing mental health and substance abuse disorders is both a science and an art. There are 297 different diagnoses in the DSM so many disorders have signs and symptoms in common with each other. A DSM diagnosis is made based upon the information that you gathered during the biopsychosocial interview and upon your knowledge of mental health and substance abuse disorders. As you become more experienced and more skilled, assigning a diagnostic code will become easier. Please note that only trained and licensed professional mental health counselors are able to diagnose an individual with a mental health or substance use disorder.

A diagnosis is written out in the format of a Multiaxial Assessment that is common among mental health and substance abuse treatment professionals. The system involves assessment on multiple axes where each axis refers to a different domain of information and is written in a way that encompasses both functional and differential diagnoses. The Multiaxial Assessment format allows for information to be clearly disseminated and understood amongst the treatment team and any other medical personnel.

q Axis I is where clinical disorders and other conditions that may be of focus of clinical attention are recorded. Examples of disorders recorded on Axis I include Substance Dependence or Abuse, Depression, Anxiety, Bipolar, and Dysthymic disorder and is often the reason the client seeks treatment.

q Axis II is where Personality Disorders and Mental Retardation diagnoses are recorded.

q Axis III is where General Medical Conditions are indicated. Medical conditions are potentially relevant to the understanding or management of the individual's mental disorder. Examples of Axis III disorders could be Cardiac arrest, Asthma, Diabetes, or even Obesity.

q Axis IV is where Psychosocial and Environmental problems are recorded. Problems with primary support group, problems related to the social environment, educational problems, occupational problems, housing problems, economic problems, problems with access to health care services, problems related to interaction with the legal system/crime, and other psychosocial and environmental problems are examples that would be recorded on Axis IV (American Psychiatric Association, 2000).

q Axis V is the Global Assessment of Functioning or GAF. A GAF score ranges from 1 to 100 (where one is the lowest score and 100 is the highest score) and is based on the clinician’s judgment of the individual's overall level of functioning. This information is useful in planning treatment and measuring its impact, and in predicting outcome.

1. What is the difference between a functional diagnosis and a differential diagnosis?

2. Both functional and differential diagnoses drive the ______.

3. According to your text, what is included in a comprehensive assessment?

4. Why is it important to conduct a comprehensive assessment?

5. What is a Mental Status Exam?

6. The mental status exam helps to ensure a comprehensive evaluation of the client’s ______, ______, and ______.

7. What are the 10 areas covered in the mental status exam?

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8. Assessing the risk of harm to self or others is central during the psychiatric assessment. How comfortable are you with directly asking a person if he or she is suicidal or homicidal?

9. If the client admits to suicidal or homicidal thoughts during the assessment, what questions should you ask the client?

10. What is the best predictor of risk for suicidal or homicidal thoughts?

11. List several other risk factors found in your text.

12. What type of intervention is recommended for the low-risk client?

13. What type of intervention is recommended for the medium -risk client?

14. What type of intervention is recommended for the high -risk client?

Note: Check with your state laws regarding confidentiality in regards to duty to protect and warn others when credible threats are made. Generally, you will be allowed to break confidentiality in order to protect the client or someone else from harm. Also, treat all threats of suicide or homicide as if they are serious.

15. List the seven decision rules (four major ones and three subsidiary ones) your authors use to establish a dual diagnosis.

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16. According to your text, Ries and Miller (1993) have proposed a typology of dually diagnosed clients to assist in treatment planning. They define groups of clients with dual disorders and associated treatment needs. Identify each type of client and their treatment needs:

§ Type I Clients:

§ Type II Clients:

§ Type III Clients:

§ Type IV Clients