class test two (wk 4-8) Flashcards
what are types of risks in mental health?
- self harm
- harm to others
- aggression/violence
- absconding
- suicide
what are the aims of a risk assessment?
Identify those at risk
Identify clinical management
what are static risk factors for someone suicidal?
fixed and historical
what are types of static risk factors for someone suicidal?
- previous self harm
- diagnosis of mental illness
- past substance abuse
- family history
- recent stressors or loss
- age, gender and marital status
what are dynamic risk factors for someone suicidal?
changeable and fluctuate
what are types of dynamic risk factors for someone who is suicidal?
- active suicidal ideation
- prone to impulsivity
- hopelessness, guilt or dramatic change in mood
- current substance use
- psychosocial stressors
- social withdrawal, unstable supports
- increased agitation, anxiety, sleep disturbance
- available means to suicide
- feeling alone, trapped or burden on others
what are protective factors for someone who is suicidal?
- availability of healthcare
- restrictions on lethal means
- safe and supportive community enviro
- connectedness
- supportive relationship with healthcare providers
- coping and problem solving skills
- reasons for living
- moral objections
what are questions to ask about ideation in relation to suicide?
do you have frequent thoughts of suicide- how strong, intrusive and frequent?
what are questions to ask about the plan in relation to suicide?
what, where and when?
what is intent in relation to suicide?
attempt in progress, plan to skill self (method known), predatory behaviour, expressed intent to die
what is CPR in regards to suicide assessment?
C- current plan
P- previous exposure to suicide
R- resources- what the person has or can use thats helpful
what are some questions to ask in regards to an individual’s current plan in a suicide risk assessment?
> may be vague or specific
> what?- how and access to means
> where?
> when?
what is the current plan in relation to suicide risk assessment?
elements of a person’s plan, the more concrete the greater the risk
what are some questions to ask in regards to an individual’s previous exposure in a suicide risk assessment?
- previous attempt- when? What was the care after?
- someone close to them has killed themselves
what are resources in regards to suicide risk assessment?
what the person has or can use that is helpful
what are types of resources that an individual has in regards to suicide assessments?
> positive, protective factors to reduce risk
> resources person finds useful
> three types- internal, external and peripheral
what are the three types of resources in a suicide assessment?
internal, external and peripheral
what are examples of internal resources in a suicide assessment?
> coping strategies > distraction > safety plan > engaging in meaningful occupation > values
what are examples of external resources in a suicide assessment?
> family/friends/pets/significant other
what are examples of peripheral resources in a suicide assessment?
> helplines
> therapists etc.
> teachers
> clergy
what are examples of risk assessment questions for CPR?
-do you want to kill yourself/do you have suicidal thoughts?
Current Plan: 1. How would you kill yourself? 2. Do you have access to…? 3. When do you plan to kill yourself?
Previous Exposure: 1. Have you tried to kill yourself before? 2. If so how long ago was that? 3. Do you know anyone who has killed themselves?
Resources: 1. Who in your life do you turn to when you need someone to talk to? 2. What stops you from killing yourself or what keeps you alive? 3. Do you have any other supports?
what are some risk management actions you could take?
- rapport, active listening
- involve family, caregivers and support networks
- if required inform supervisor and refer to other professionals
- consider substance use disorders, mental illness and personality disorders
- management plan needs to be individualised and informed by risk assessment
- conduct MSE
- provide resources
- address dynamic risk factors
- document
what is low risk in risk management for suicide?
-depressed, no social ideation, no plan/intent
what should occur if an individual is a medium risk in risk management for suicide?
- engaged in more collaborative approach, help with access to info/resources but ultimately leaving things up to individual
- seek manager input and refer on if any suicidal ideation/plan/intent
what should occur if an individual is a high risk in risk management for suicide?
- engaged directively, with helper taking steps to ensure immediate and ling-term safety and connecting them to resources
- seek manager immediate and direct input
how should an individual with low risk for suicide be treated?
with empathy and respect and empowered to make decision for themselves
what are some resources for suicide risk patients?
- safety plans
- helplines
- follow up appointments/calls
- online resources
- enlist family/support persons
- referrals
- local hospital triage
- CATT- crisis and assessments treatment teams
- call 000 or go ED
what is PTSD?
is a type of anxiety disorder that can occur at any age after witnessing or experiencing a traumatic event that involved the threat of injury or death
what can PTSD follow?
> natural disaster > life threatening illness > assault > domestic abuse > prison stay > rape > terrorism > war
what does procedural memory formation relate to?
motor skills that are learnt, automatic
what does declarative memory formation relate to?
life events
what does the hypothalamus-suprachiasmatic nucleus affect with sleep?
- circadian rhythm area
- receives sensory info about light/dark cycle ‘entrains’ sleep rhythm
how is the brainstem involved with sleep?
- communicates with SCN and reduces activity of the ARAS
- GABA
how is the thalamus involved with sleep?
- relay of external sensory info to the cortex decreases
- in REM sleep it is active relaying info from within the brain
how is the pineal gland involved in sleep?
- secretes melatonin in response to signals from the SCN and visual system
- melatonin synchronises
how is the basal forebrain involved with sleep?
-helps regulate sleep cycles by increasing drive to sleep
how is the amygdala involved with sleep?
-becomes active during REM sleep
what is the purpose of sleep?
- homeostatic need for sleep regulated centrally
- metabolic role- NREM- rise in ATP- increased protein synthesis
- growth hormone release
- immune system
- neurotrophic factors released- synaptic consolidation and generation> synaptic plasticity and learning
how does PTSD influence sleep?
- hyperarousal > problems with sleep transition
- REM arousal due to intrusive dreams
- REM behaviour disorder due in older sufferers
- evidence of increased activation of amygdala in REM
what occurs in the neurobiology of chronic PTSD?
- increased circulating levels of noradrenalin
- increased reactivity of a2- adrenergic receptors> blood vessel reactivity
- increased thyroid hormone levels
- explains some of the somatic symptoms
- increased catecholamine levels potentiate threat response of amygdala
does the hippocampus have a higher for lower volume for PTSD sufferers?
lower
what occurs in the 1st stage of stress?
shock
what occurs in the 2nd stage of stress?
resistance, body fights back > adrenaline and cortisol release
what occurs in the 3rd stage of stress?
if too much cortisol for too long: > exhaustion > impaired immune function > chronic hypertension > obesity > atherosclerosis
what are some possible treatments for PTSD?
> CBT > eye movement desensitisation reprocessing (EMDR) > brief psychodynamic psychotherapy > stress management > supportive counselling/therapy > narrative exposure therapy > group therapy > expressive therapies- art/drama
what are some pharmacological treatments for PTSD?
> antidepressants
> TCAs, MAOIs, SSRI
> benzodiazepines and other sleeping meds
> B blockers- anxiolytic
> antihistamines- for sedative effect
> antihypertensives
> experimental- Acetylcholinesterase inhibitors
what are some physical treatments for PTSD?
> ECT
> transcranial magnetic stimulation- dorsolateral prefrontal cortex
what are some adjunctive therapies for PTSD?
> engagement in meaningful individual/group occupation
> healthy behaviours
> exercise
> sleep hygiene
what is involved in trauma informed care?
- safe/supportive enviro that protects against physical harm and re-traumatisation
- Understand clients and symptoms, background, experiences and culture
- Collaboration between service provider and client throughout
- Understanding of symptoms and survival responses required to cope
- View of trauma as a fundamental experience that influences identity rather than a discrete event
what are treatment principles for OTs working disasters?
> multi level- individual, families, groups, community- dynamic
> appreciate each individual/communities have their way of coping
> can’t be prescriptive
what should be provided immediately after exposure to trauma at immediate intervention?
> info
> emotional support
> practical assistance
what is involved in psychological first aid for those experiencing acute stress responses or risk of impaired function?
- Contact and engagement
- Safety and comfort
- Stabilisation
- Info gathering
- Practical assistance
- Connection with social supports
- Info on coping
- Linkage with collaborative services
what are five post disaster early intervention principles?
Promote:
- sense of safety
- calm
- social connectedness
- self-efficacy
- hope
what are some early interventions in the immediate days/weeks out disaster?
- basic practical support, set up familiar routines- reengage in daily activity
- need sense of belonging
- occupational balance
- engage in some positive occupations to balance difficult experiences
- psychoeducation
what are some treatment principles in PTSD?
- psychoeducation
- skills- how to cope
- therapy
what are some occupational issues associated with PTSD/disasters?
- sleep issues, decreased self care
- avoid/limited leisure and productive activity
- isolated from social enviro impacting everyday function
- difficulty initiating participation in community activity
- poor time management- occupational imbalance
- social skill difficulty impacting relationships
what are some models that can be utilised when dealing with PTSD or disaster?
- biopsychosocial model
- recovery model
- systems theory
what are some interventions that can be used for PTSD?
- graded exposure
- CBT
what are some assessments that can be apart of a PTSD program?
- initial
- CAPS (clinician administered PTSD scale)
- other scales such as DASS
what does psychoeducation about PTSD involve education about?
> trauma memory network
> problems commonly associated with PTSD
> impact on families and relationships
> neuropsychology
> medications used
what does skills treatment/training for PTSD involve?
> substance use issues
> relaxation training
> communication skills
> anxiety/anger management
what are some lifestyle based treatments for PTSD?
> exercise > outing group > managing change > occupational issues > sleep > gender issues
what are some types of therapy that can be beneficial for PTSD sufferers?
> group therapy > individual therapy > couples therapy > creative expression > children’s group
what is traumatic stress?
human response to traumatic, catastrophic or adverse events
what is trauma?
deeply distressing experience, emotional shock following stressful event
what are the different types phenomena that can be referred to as trauma?
> physical- injury to body
> emotional- psychological and emotional injury
> physical and emotional- traumatised both physically, psychologically and emotionally
> psychic- trauma to the psyche (soul, mind, spirit)
> psychosocial- Psychological and social (community) response to event
when does a crisis response occur?
few days immediately after experience
when does an acute stress response occur?
few months after
what awesome trauma and stressor related disorders identified by the DSM-V?
- reactive attachment disorder- children
- disinhibition social engagement disorder- children
- PTSD- symptoms more than 1 month in adults, adolescents and children older than 6 years
- PTSD for children 6 and under- symptoms more than 1 month
- acute stress disorder (3 days-1month)
- adjustment disorder- no traumatic event but response to an identifiable stressor within 3 months
what PTSD diagnoses are no longer in the DSM?
- acute PTSD- less than 3 months
- chronic PTSD- longer than 6 months
- delayed onset PTSD
- complex PTSD- disorders of extreme stress not otherwise specified