This week, we're moving on to Axis III -- Medical Conditions. A medical condition warrants recording on Axis III of a DSM-IV-TR diagnosis when it affects the client's mental health (so if someone has diabetes, but has had it for years and is managing it well, it might not be recorded). Here's one way this topic will almost certainly come up on the exam:
A 47 year-old man seeks services from a social worker for symptoms of depression. In the initial session, the man reports that he has had difficulty sleeping, has been feeling hopeless, and has been suffering from near-constant headaches since losing his job a month ago. After completing a risk assessment, what should the social worker do NEXT?
A. Refer the client to a job-placement program
B. Refer the client to a psychiatrist for a medical evaluation
C. Initiate cognitive behavioral therapy to address the client's depression
D. Refer the client to a primary care physician for a medical evaluation
I cannot stress enough the importance of recognizing physical and cognitive symptoms on the exam and responding accordingly. Test-makers (and the states that you all live in!) want to make sure that you will: 1) recognize the impact of medical conditions on a client's mental health; 2) rule out medical conditions before providing a psychological diagnosis or treatment; and 3) refer to a physician when faced with physical or cognitive symptoms. These symptoms are what I refer to as "trump cards" in test items -- they effectively trump almost every other problem that might be presented (danger to self/danger to others notwithstanding).
It's probably no surprise that the answer to the question above is D. The difficulty sleeping and headaches give the social worker a clear indication that a medical referral is necessary. A, B, and C are all good interventions, but would not occur until a medical condition is ruled out or addressed. One other hint: If you are presented with a similar question and the option to send your client to a primary care physician or a specialist, go for the primary care doctor first (unless the stem indicates the client has already been) -- a primary care physician would then make a referral to a specialist once other medical conditions were ruled out.
Coming up next week: Factors Affecting Mental Health (Axis IV)
Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you're preparing for a social work exam, check out our Social Work Study Materials. If you're preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.
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