Fragile X syndrome is the most common inherited form of cognitive disability
Indicate whether the statement is true or false
True
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Randomized assignment of subjects to both control and treatment groups are necessary
characteristics for: A) A-B design research B) Experimental design research C) Single subject design research D) All of the above
The Norwegian term Jantelov (the law of Jante) means that
a. no one person is above any other b. individual achievement is an important virtue c. one must love one's neighbor as oneself d. one must obey society's laws
Is there evidence that Jamie experiences internalized transphobia?
DSM Diagnosis F64.1 Gender dysphoria in adolescents and adults F41.0 Panic disorder Rationale Jamie qualifies for the diagnosis of gender dysphoria because he: 1. Has experienced a lifelong incongruence between his experienced (male) and assigned (female) gender, including a desire to have male sex characteristics, be a male, be treated as a male, and the conviction that his typical feelings and reactions are those of the male gender; 2. Experiences associated clinically significant distress in social and occupational functioning. Jamie also qualifies for the diagnosis of panic disorder because he: 1. Has recurrent and unexpected panic attacks characterized by the following six symptoms (four are required): palpitations, pounding heart, and accelerated heart rate; sweating; trembling and shaking; sensations of shortness of breath; feeling dizzy, unsteady, and light-headed; and fear of losing control of going crazy. 2. Has a persistent concern that additional panic attacks will occur, and fears what their consequences might be. 3. These symptoms are not attributable to substance abuse, a medical condition, or another mental disorder. Additional Information Required More information needs to be ascertained about Jamie’s psychological history, including the tumultuous years with his parents, to understand how it may have influenced his attachment style, interpersonal patterns, and ways of dealing with conflict. He has not yet stated his long-term interpersonal and occupational goals, and these may have influence on decisions he makes about presenting his gender identity to others. Finally, details of his panic experiences will be necessary to uncover to know how best to behaviorally minimize the possibility of their recurrence. Risk and Resilience Assessment Nothing is known of Jamie’s genetic or biological characteristics and the influences they have had on his development of a male gender identity. The same can be said of his psychological influences; that is, it cannot be determined at this time how they may have influenced his gender development. Socially, he experienced an absence of cultural acceptance of gender incongruity, many episodes of victimization and related interpersonal conflicts, and a lack of adequate peer and social support, all of which are risk influences. Regarding protective influences, Jamie always had cognitions that supported his alternative gender identification and he has had as a supportive mother and eventually some supportive friends. The disclosure of his transgender identity to a few significant others is also a protective influence. What techniques could be used to assess for additional strengths in this client? In the next meeting with Jamie the practitioner could ask: “You are concerned that you might lash out physically against a co-worker, but have not yet done so. What coping techniques have you been able to mobilize so this did not happen?” “How would you summarize your interpersonal skills?” “You have an interest in landscaping as a career. What is it about that profession that appeals to you? Do you have other interests?” “What are some of the way in which you manage conflict constructively with the people close to you?” “Your panic attacks are serious but as of yet not debilitating, in that after a break you are able to attend to your activities of daily living. How are you able to manage that?” “You have experienced a great deal of negativity from others because of your gender identity. Is there anything about your identity that makes you a better person in the context of relationships?” Intervention Plan Jamie’s reasons for seeking help include desires to develop strategies to better manage his distress related to having to withhold his gender identity from others; to eliminate his episodes of intense anger and anxiety; and to possibly generate more support from family members or significant others. He is not seeking help in dealing with his physical transformation but the social worker will monitor the psychological and social outcomes of his hormone injections. His initial goals and objectives will thus include: Goal #1: To develop a broader range of coping skills when dealing with direct and indirect personal criticism and prejudice. ? Objective: Jamie will learn at least two new active and passive stress management strategies that do not involve physical aggression by participating in a behavioral assessment so that physical, emotional, behavioral, social, and environmental triggers of stress responses can be evaluated, and learning about and rehearsing at least two new cognitive/behavioral strategies as replacement responses. Goal #2: To become able to monitor internal emotional states and express them outwardly. ? Objective: To increase sensitivity to positive and negative emotional states so that they can be appropriately expressed and modulated by reflecting with the social worker on experiences of all emotions, including anxiety, that is, identifying them and predicting their occurrence and expressions, and developing two new strategies for expressing anxiety outwardly Goal #3: To experience a positive physical gender confirmation process ? Objective: To monitor the psychological, social, physical, sexual, occupational implications of hormone treatments, by differentiating safe from unsafe situations in the social environment; exploring the actions of significant others to any physical changes, and understanding the risks and benefits of additional self-disclosure practices. Critical Perspective Jamie’s presentation epitomizes the controversy surrounding the diagnosis of gender dysphoria. That is, the distress he experiences and which accounts for his coming to the agency has nothing to do with personal dysphoria about his gender identity; it is due instead to his reactions when feeling judged, oppressed, and ridiculed by intolerant other persons. If our society was accepting of transsexualism as a legitimate lifestyle, a direction in which it appears to be heading, Jamie would not have to deal with the negative attitudes that cause him distress. He might seek help from a mental health practitioner for anxiety, depression, and impulse control problems, but they would be diagnosed without reference to his gender identity. Yet, at this point in time, the American Psychiatric Association’s DSM-5 compromise position keeps Jamie’s gender identity in the forefront of his assessment.
Does Paul show any evidence of memory impairment?
DSM Diagnosis 294.11 (F02.81) Major Neurocognitive disorder due to Alzheimer’s disease, Without Behavioral Disturbances, Severe 319.F71 Intellectual Disability- moderate 331.0 Alzheimer’s disease 758.0 Down syndrome V61.8 Sibling relational problem 704.0 Alopecia 562.13 Diverticulosis of colon, unspecified Recent seizure activity V60.0 (Z59.0) Homelessness V61.8 (Z62.891) Rationale Paul qualifies for the diagnosis of Alzheimer’s disease. He has been experiencing memory impairment for more than two years. He has experienced apraxia (difficulty walking and maintaining balance), agnosia (not recognizing objects such as utensils, clothing articles), and disturbances in executive functioning (no longer recalling how to dress self or bathe himself). These cognitive deficits have caused significant decline from his previous level of functioning. There was a gradual onset of these characteristics, and he has experienced continuing cognitive decline. The cognitive deficits are not due to a central nervous system condition, any other known medical condition, or a substance induced condition. They do not occur during the course of delirium or are not better accounted for by another diagnosis. The particular specifiers were chosen because there have been no significant behavior disturbances and the age of onset of the cognitive symptoms was approximately age fifty-four. The diagnosis of an intellectual disability was given prior to entering the current agency system. The agency has no record of his IQ score, but the diagnosis was deemed appropriate during a psychological evaluation performed 13 years ago. Paul had impairments in several adaptive functioning areas prior to onset of dementia, including his home living, use of community resources, academic skills, and work. Paul was further diagnosed with two V codes: homelessness, because his living situation is uncertain once he is discharged; and sibling relational problem because his brother is not in contact with him. Additional Information Required To validate the diagnosis of an intellectual disability the social worker needs to find records that indicate Paul’s tested levels of cognitive functioning. At this time new testing would not be practical because of the dementia. To validate the diagnosis of a Neurocognitive Disorder, Alzheimer’s type, additional medical testing may be necessary. While his onset was slow, he had a few periods of rapid decline in cognitive functioning. The social worker should also talk more with the staff at the nursing home in which he currently lives for additional details about his functioning level. Additional information about Paul’s childhood and his parents’ health would provide clues about what risk and protective influences he was exposed to pertaining to all his current diagnoses. One particular fact that would be helpful to know about is whether his parents smoked or if he was ever exposed to some environmental toxins, since these are risk influences for Alzheimer’s disease. Risk and Resilience Assessment Onset Biological risk influences for the onset of Paul’s dementia include his having Down’s syndrome and a probable small stroke in adulthood. Psychological risk influences include his history of depression. Socially, he has come from a background of low socio-economic and educational status. Protective influences for Paul's dementia include his male gender, European-American cultural background, lack of history of smoking, steady pattern of exercise, and his generally low-fat, high-vitamin diet. Alzheimer’s disease has an unremitting downward course, although the speed of Paul’s decline is likely influenced by its early onset (before age 60). Protective mechanisms include his regular exercise, use of medications to combat the cognitive decline, good communication skills, and positive attitudes. Regarding the course of his intellectual disability, Paul has developed adequate coping skills, lived in an environment for most of his life that concentrated on the principles of empowerment, normalization, and independence, and received skills training in independent living and employment. Treatment The primary treatment strategy for Paul should be to focus on promoting his safety, comfort, and productivity for as long as possible. As previously stated, many measures have already been put in place to assure this, particularly in regards to ensuring his safety. To keep him comfortable, the staff should surround him with items that are familiar to him. Recently, they were able to move some of the furniture from his old room, as well as some photographs and paintings, into his room at the nursing home. Paul should also be helped to live as enriching a life as possible. Keeping him involved in physical and cognition-stimulating activities can help toward that end (Bharani & Snowden, 2005). The nursing home does have group outings twice a week, many times to places that Paul enjoys, and he should be encouraged to join in on such activities. Visits from friends who get him engaged in conversation will also be beneficial. To keep him productive, Paul should return to some type of structured day program. His guardian has been looking into job or day program placements that might fit his needs for constructive and pleasurable activities. Paul should be encouraged to do as much for himself as he can. Since he has shown evidence of forgetting how to perform many self-care tasks, his caretakers can work on skills training with him. Even if such skills reviews work only on a short-term basis, staff can jog his memory by using them again the next day. Paul should also be encouraged to participate in recreational and art therapies since these provide both cognitive stimulation and leisure opportunities to him. Another essential part of Paul’s treatment is to ensure that he is linked with appropriate doctors and other medical personnel. He needs to be on anti-seizure medication, but this should be routinely monitored to ensure he does not build up toxic levels again. He should also be in contact with a dietician to ensure he is getting enough nutrients since he no longer eats solid food. His caretakers also need to remain aware of available sources of support. They should continue looking into the least restrictive living environment possible. They should also contact his insurance companies to see what services they cover. The guardian might be able to hire a home health aide to work with him a few hours a day. Lastly, Paul's caretakers need to be educated on how to work with a person who has both mental retardation and Alzheimer’s disease, so that they can preserve their own well-being and be appropriately supportive of him (Burns, Nichols, Martindale-Adams, Graney, & Lumus, 2003). Since people are unsure what abilities he has developed throughout his life, Paul is often treated differently than other Alzheimer’s patients. Since he has no family members involved in his life, his friends can be helped to advocate for him when necessary. Since Alzheimer’s is a progressive disease, Paul’s needs will most likely change over time and he will become less able to speak up for himself. Critical Perspective While it seems clear that Paul has dementia, there are some current issues related to the course of his disorder. Since he has an intellectual disability, many of his early symptoms might have been overlooked; he may have been suffering from this disease longer than the people around him thought. This might be why the medication Aricept did not seem to stabilize his condition, even temporarily. Paul actually began to decline rapidly after its introduction and some staff are concerned that it was actually the trigger to his rapid decline. This process may be a coincidence, but having such a sudden and extreme loss of cognition and abilities could be a sign of a different form of dementia, since Alzheimer’s disease features a gradual process. Some tests were done, like checking for a stroke, but there are numerous conditions mentioned in the DSM that can trigger Vascular Dementia. Since he had Down’s syndrome, which is considered a considerable risk mechanism for Alzheimer’s disease, the assumption was made that he had Alzheimer’s.