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Preparation forNCMHCE Exam

DSM-5

Preparation forNCMHCE Exam

DSM-5

Dr. Linton Hutchinson

Assessment and Diagnosis

Counseling and Psychotherapy

Administration, Consultation and

Supervision

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Exam Framework and Knowledge Base

Exam Framework and Knowledge Base

Difference Between

DSM-IV-TRAnd

DSM-5Exams

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NBCC is pleased to report that there were no major structural changes to either the NCE or the NCMHCE as a result of the DSM-5. There were no

changes to the framework or the competencies of either examination. The knowledge assessed is common

to both manuals. Modifications to the examination content involved changes

in diagnostic terminology only.

From the NBCChttp://NBCC.ORG

While the number of items regarding

the DSM-5 will not increase, the new

edition does contain new diagnostic

terminology, so reviewing the

differences between the two editions

may be helpful.

What Does That Mean?What Does That Mean?

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1. Social (Pragmatic) Communication Disorder 2. Disruptive Mood Dysregulation Disorder 3. Premenstrual Dysphoric Disorder (DSM‐IV appendix) 4. Hoarding Disorder 5. Excoriation (Skin‐Picking) Disorder 6. Disinhibited Social Engagement Disorder (split from Reactive Attachment Disorder) 7. Binge Eating Disorder (DSM‐IV appendix) 8. Central Sleep Apnea (split from Breathing‐Related Sleep Disorder) 9. Sleep-Related Hypoventilation (split from Breathing‐Related Sleep Disorder) 10. Rapid Eye Movement Sleep Behavior Disorder (Parasomnia NOS) 11. Restless Legs Syndrome (Dyssomnia NOS) 12. Caffeine Withdrawal (DSM‐IV Appendix) 13. Cannabis Withdrawal 14. Major Neurocognitive Disorder with Lewy Body Disease (Dementia Due to Other Medical Conditions) 15. Mild Neurocognitive Disorder (DSM‐IV Appendix)

New Disorders in the DSM-5

1. Language Disorder 2. Autism Spectrum Disorder 3. Specific Learning Disorder 4. Delusional Disorder 5. Panic Disorder 6. Dissociative Amnesia 7. Somatic Symptom Disorder 8. Insomnia Disorder 9. Hypersomnolence Disorder 10. Non-Rapid Eye Movement Sleep Arousal Disorders 11. Genito‐Pelvic Pain/Penetration Disorder 12. Alcohol Use Disorder 13. Cannabis Use Disorder 14. Phencyclidine Use Disorder 15. Other Hallucinogen Use Disorder 16. Inhalant Use Disorder 17. Opioid Use Disorder 18. Sedative, Hypnotic, or Anxiolytic Use Disorder 19. Stimulant Use Disorder 20. Stimulant Intoxication 21. Stimulant Withdrawal 22. Substance/Medication-Induced Disorders

Combined Specific Disorders in DSM-5Combined Specific Disorders in DSM-5

1. Language Disorder (Expressive Language Disorder & Mixed Receptive Expressive Language Disorder) 2. Autism Spectrum Disorder (Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, & Rett’s disorder) 3. Specific Learning Disorder (Reading Disorder, Math Disorder, & Disorder of Written Expression) 4. Delusional Disorder (Shared Psychotic Disorder & Delusional Disorder) 5. Panic Disorder (Panic Disorder Without Agoraphobia & Panic Disorder With Agoraphobia) 6. Dissociative Amnesia (Dissociative Fugue & Dissociative Amnesia) 7. Somatic Symptom Disorder (Somatization Disorder, Undifferentiated Somatoform Disorder, & Pain Disorder) 8. Insomnia Disorder (Primary Insomnia & Insomnia Related to Another Mental Disorder) 9. Hypersomnolence Disorder (Primary Hypersomnia & Hypersomnia Related to Another Mental Disorder) 10. Non-Rapid Eye Movement Sleep Arousal Disorders (Sleepwalking Disorder & Sleep Terror Disorder) 11. Genito‐Pelvic Pain/Penetration Disorder (Vaginismus & Dyspareunia) 12. Alcohol Use Disorder (Alcohol Abuse and Alcohol Dependence) 13. Cannabis Use Disorder (Cannabis Abuse and Cannabis Dependence) 14. Phencyclidine Use Disorder (Phencyclidine Abuse and Phencyclidine Dependence) 15. Other Hallucinogen Use Disorder (Hallucinogen Abuse and Hallucinogen Dependence) 16. Inhalant Use Disorder (Inhalant Abuse and Inhalant Dependence) 17. Opioid Use Disorder (Opioid Abuse and Opioid Dependence) 18. Sedative, Hypnotic, or Anxiolytic Use Disorder (Sedative, Hypnotic, or Anxiolytic Abuse and Sedative, Hypnotic, or Anxiolytic Dependence) 19. Stimulant Use Disorder (Amphetamine Abuse; Amphetamine Dependence; Cocaine Abuse; Cocaine Dependence) 20. Stimulant Intoxication (Amphetamine Intoxication and Cocaine Intoxication) 21. Stimulant Withdrawal (Amphetamine Withdrawal and Cocaine Withdrawal) 22. Substance/Medication-Induced Disorders (aggregate of Mood, Anxiety, and Neurocognitive)

Combined Specific Disorders in DSM-5Combined Specific Disorders in DSM-5

QUESTION:I already have a copy of the DSM-IV-TR and that’s what my agency is currently using. Do I really have to have access to the DSM-5?

ANSWER:Only if you want to pass the exam.

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• Assumptions of the Exam

• Rating Scale

• Information Gathering

• Decision Making

• DSM-5 (You’re on your own here)

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When taking the exam, consider yourself anindividual therapist in private practice, or working in an agency, school setting, group home or even a prison.

You are a competent therapist and have a knowledge base to treat ALL diagnoses in the DSM-5.

You can select assessment tools that are relevant to case study. Assume you have been trained to give or do an evaluation using ALL assessment tools.

Assumptions of the ExamAssumptions of the Exam

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• You should not base your diagnosis on insurance concerns; diagnose and treat the client as you would in a “perfect world”

• Once an option is selected it can not be unselected

• Diagnoses, Treatment items and Assessment instruments presented in a simulation are "real" and do exist.

• Simulations can wander seemingly looking like a specific diagnosis but along the way additional information is given that changes what your final diagnosis is.

• On CHOOSE ONLY ONE options you have to continue selecting until you get the correct answer. It will not let you go on until the correct answer is selected.

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• There is no deception in the case study

Example:

Kelli's husband has just died and she claims that she is not upset and she is doing fine

You need to take this as a true statement and Kelli is not in denial.

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• This is the rating scale for each of the possible answers for every question and they are based on the degree to which the client is affected.

+3 Of central importance for good client care; omission would result in serious damage to the client in terms of COST, TIME, PAIN, and risk of MORBIDITY and/or MORTALITY

+2 Strongly Facilitative of good client care

+1 Mildly Facilitative of good client care

Option Uncovering ScaleOption Uncovering Scale

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0: Does not contribute to client care, but

does not cause the client any harm in terms of increased cost, pain, risk of morbidity and/or mortality; and/or may be a controversial option due to regional differences.

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-1 Mildly detrimental to client care in terms of cost, time, risk of morbidity and/or mortality.

-2 Seriously detrimental to client care in terms of cost, time, pain, risk of morbidity and/or mortality.

-3 Gravely damaging to client care and very costly to the client's welfare in terms of cost, time, pain, risk of morbidity and/or mortality.

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Overlying Principles for Uncovering ItemsOverlying Principles for Uncovering Items

• Everything uncovered should be directly linked in a logical manner - try to think “Diagnosis” from the beginning

• Items uncovered should be linked back to the symptoms, problems, and level of functioning presented in the case study

• Address and treat everything that is written in the case study

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If the case says the client has problems 1, 2, and 3, then you must treat all three problems even if treating 1 would make 2 and 3 go away

Example: Hamilton is a student in high school. He spends much of his time smoking ‘weed’ with his buddies. Since this habit started, his grades have dropped significantly and his parents have threatened to disown him.

If during therapy, Hamilton stops smoking weed, his other problems (bad grades, bad relationship with parents) will probably go away. Even so, you must address these other problems separately.

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1. Information Gathering (IG)

2. Decision Making (DM)

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Areas of the ExamAreas of the Exam

• Both Information Gathering and Decision Making Areas have aggregate scores based on the total of ten simulations. You must pass both the IG and the DM areas

• You do not have to pass every simulation!

• Points are given for correct responses and deducted for incorrect responses

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1. Information Gathering (IG)

• How well can you gather appropriate clinical information required to evaluate a situation

• Do you ask appropriate questions of the client

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2. Decision Making (DM)

• How well can you utilize information in making judgments and decisions?

• Can you make decisions that result in the best treatment for the client?

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SPLAT

1. Symptom Identification

2. Problem Recognition

3. Level of Functioning

4. Assessment Tools

5. Treatment Progress

Information GatheringInformation Gathering

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TOASTED

1. Treatment Techniques2. Objectives and Goals3. Adjunct Services4. Services during treatment5. Termination and Referrals6. Ethics7. Diagnosis

Decision MakingDecision Making

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DevelopmentalIssues

Intake Family

AssessmentTools

PresentingProblem

Medical

Career

Personal

Pre-Diagnosis Flow Chart

PreliminaryDiagnosis

PreliminaryDiagnosis

Adjusted Diagnosis

Referrals

Client Strengths

Interventions

TX PlanAdjust Treatments

Treatment Goals

Treatment Approach

Professional Issues

Pre-Diagnosis Flow Chart (cont.)

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