Exam 1 Flashcards
What are the 4 dimensions of Recovery?
Health
Home
Purpose
Community
What are the supports to recovery?
- supportive people
- effective medication
- concrete resources (food, shelter, clothing, medical, etc)
What are the barriers to recovery?
- substance abuse
- environmental context
- social disadvantage
- age of onset schizophrenia
models of care support the biopsychosocial nature of these illnesses and are shifting to adopt a recovery philosophy
Special mental health sector
Biomedical/Biopsychosocial models
hospital based care
Rehabilitation model
1.psychiatric/psychosocial rehabilitation
2. case management
Continuum of care/ service delivery in specialty mental health sector
- Inpatient/Residential
- Partial Hospital Program
- Assertive Community Treatment
- involves short stays, averaging 4-10 days; 24- hour supervision/care endanger of hurting self or others)
Inpatient Hospital
- more long-term and not as common in MH treatment; more for Substance Abuse Tx
endanger of hurting self or others
Residential Hospital
- Step down from inpatient or used to prevent inpatient hospitalization; clients go home at night
- Time frames vary, but average 3-4 weeks – attend 3-5 groups daily, at least 5 days a week
Partial Hospital Program (PHP)
- Service delivery model, high intensity, 24 hour/day availability
- Multidisciplinary and community based – alternative to inpatient and works well for those who often discontinue attendance at programs
Assertive Community Treatment (ACT)
- Step down from PHP – often transitioning back to work/school while attending
- Usually evening hours, though this depends on the program/facility
- Shorter in duration, attend fewer groups
Intensive Outpatient Program (IOP)
see psychiatrist or therapist anywhere from once a week to once a month
Outpatient Treatment
- Least intensive, often long-term attendance but can come and go as wanted (clubhouse model)
- Skill based programming; case management services common
- OT often functions as a program coordinator, consultant, or supervises students since the level of care may not indicate need for skilled OT, so do not bill for services
Psychosocial/ Psychiatric Rehabilitation Program (CRP/PRP)
- Least intensive services often consumer/client driven (also viewed as voluntary support network)
- Drop- in centers, advocacy and support structures, peer to peer support
- Services may or may not be a part of a structured program
Goal: Community integration as defined by the consumer - OT may be involved in particular aspects, as a consultant or other role–family education/support, other group or individual teaching, etc.
Other Community services
Social Determinants of Health by Category:
- Neighborhood and Built Environment
- Health Care Access and Quality
- Social and Community Context
- Education Access and Quality
- Economic Stability
the idea that OT will only do something if there is research showing that it work
Evidence Based Practice
EBP in Psychosocial Interventions:
- Assertive Community Treatment
- Social Skills Training
- Supported Employment
- Cognitive Behavioral Therapy
- Family Intervention
- Motivational Interviewing
- Dialectical Behavior Therapy
- Illness Management & Recovery
Promote social functioning/help understand how to mend problems around social areas
Social skills training
Person Client Factors:
- Cognitive skills and beliefs
- Motivation
- Sensation
- Emotion
- Communication
- Pain
- Coping
- First developed to treat depression/anxiety
- Also used with pharmacology to decrease delusions/hallucinations & prevent relapse
- Problem oriented approach to change distorted thinking
- Teaches individual adaptive cog/behavioral skills
Cognitive Behavioral Therapy (CBT)
Family Intervention:
- Purpose: reduce relapse rates; enhance social adjustment; decrease caregiver stress and burden
- Uses psycho-education, problem solving, crisis management, crisis intervention
- Multiple family groups more ideal than individual family group
Dialectical Behavior Therapy:
- Developed by Marsha Linehan for Borderline PD
- Based on cognitive and behavioral approaches, combines individual tx and group skills training
- Group skills tx is best suited for OT
- Dialectic is the coming together of opposites; Major dialectic is acceptance & change
- DBT focuses on:
Mindfulness
Interpersonal effectiveness
Emotion regulation
Distress tolerance - Seek to validate person’s experience of emotions & use interventions to improve tolerance of unpleasant emotions
- Emphasizes development of healthy coping skills to decrease self harm, suicidal behaviors, and risk-taking behaviors
Illness Management & Recovery:
Goals of IMR:
1. Instill hope that change is possible.
2. Help people establish personally meaningful goals.
3. Teach information about mental illness and treatment options.
4. Develop skills for reducing relapses, dealing with stress, and coping with symptoms.
5. Provide information about where to obtain needed resources.
6. Help people develop or enhance their natural supports for managing their illness and pursing goals
a model that involves the relationship between person and environment
PEO Model
degree of congruence or fit as a result of overlap of person, environment, and occupation spheres.
Occupational performance
“integrated whole who incorporates spirituality, social and cultural experiences, and observable occupational performance components”
Person
beliefs, values, goals, shaped by environment and gives meaning to occupations”
Spirituality at the core
beliefs shape your environment and occupations, or occupations shape environment and beliefs
Transactive Relationship
the broad construct that encompasses environmental factors and personal factors
Context
aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives
Environmental factors
the particular background of a person’s life and living; consist of the unique features of the person that are not part of a health condition or health
Personal factors
clusters of activities and tasks in which people engage while carrying out various roles in multiple locations
Occupations
What are the occupational based models?
- Canadian Model of Occupational Performance & Engagement (CMOP-E)
- Model of Human Occupation (MOHO)
- Ecology of Human Performance (EHP)
Canadian Model of Occupational Performance & Engagement (CMOP-E):
- Occupations
- Person level components
- Environmental components
how people experience meaning through occupation; transaction between person and environmental elements.
CMOP-E focal point
What do OT’s enable?
Occupational engagement
Model of Human Occupation (MOHO):
A framework for understanding threats to, or problems with, participation in occupations that people experience whether due to life transitions, changing capacities with aging, ill-health, developmental delay, and environmental restrictions
MOHO Subsystems:
- Volitional
- Habituation
- Mind-Brain-Body Performance
Volitional subsystem includes:
- personal causation
- values
- interests
Habituation subsystem includes:
- Includes one’s habits and roles
- Influences occupational behavior
Mind-Brain-Body Performance subsystem includes:
- Musculoskeletal: muscles, joints & bones
- Neurological: CNS & PNS that carry sensory and motor messages
- Cardiopulmonary: cardiovascular and pulmonary systems
MOHO Environment:
Environment affords opportunities
Environment presses behaviors
MOHO Evaluation:
Holistic & Top Down
Interviews plus observation of performance/skills.
Include interaction with the environment.
OT Role: evaluate, plan, monitor, model, teach
MOHO Assessments:
- Occupational Performance History Interview (OPHI)
- Interest Checklist *Role Checklist *Occupational Questionnaire
- Assessment of Motor & Process Skills (AMPS)
- Skills assessments
Ecology of Human Performance (EHP):
Interested in the interrelationship of humans and their contexts and the effect of these relationships on performance.
EHP Interventions:
- Establish/Restore: Develop or remediate skills(eg: coping skills).
- Alter: change the actual context or environment rather than the person (eg: move to one story home)
- Adapt: change the context to support performance (eg: reduce clutter).
- Prevent: Prevent problems with performance (eg: stretch before running).
- Create: Create circumstances that support performance; does not assume dysfunction (eg: early intervention programs)
What are the five interventions of EHP:
Establish/Restore
Alter
Adapt
Prevent
Create
a disorder that may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling
Schizophrenia
Positive (present) symptoms of schizophrenia:
- delusions
- hallucinations
- disorganized thinking (speech)
- grossly disorganized motor behavior- odd mannerisms, hyperactivity, waxy rigidity
Negative (absent) symptoms of schizophrenia:
Alogia, flat affect, avolition, anhedonia, attentional impairment
distortions in thought or belief
Delusions
distortions in perceptions
Hallucinations
What are the types of delusions?
- persecutory
- grandiose
- referential
- somatic
- erotomanic
a type of delusion where the person feels harmed/harassed by an individual or organization
persecutory
a type of delusion where the person feels exceptional abilities, wealth, or fame
grandiose
a type of delusion where the person feels gestures, comments, environmental cues, etc. are directed to them
referential
a type of delusion where the person focuses on preoccupations regarding health and organ fx
somatic
a type of delusion where the person feels a False belief that another is in love with them
erotomanic
Psychotic disorders:
- Brief psychotic disorder
- Schizoaffective disorder
- Schizophrenia disorder
- Psychosis associated with major depression, bipolar disorder, or other diagnosis
A disorder of thought and perception that may impact all areas of function
schizophrenia
Must have 2 or more psychotic symptoms; 1 of these must be delusions, hallucinations, or disorganized speech
schizophrenia
What are the positive symptoms of schizophrenia?
delusions
hallucinations
disorganized speech
disorganized Bx
What are the negative symptoms of schizophrenia?
Social withdrawal
Extreme apathy
Lack of drive /initiative
Emotional unresponsiveness
a program whose purpose is to reduce disability and enhance the likelihood that a person with early signs of psychosis will be able to manage their illness, move successfully through the appropriate developmental stages of growth, and establish a life of their choosing.
Early Intervention Program
What is the cognitive impact of schizophrenia?
Attention/memory/executive functions
Loose associations or concrete thinking
a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
mental disorder
Risk factors for mood disorders:
: current or past suicidal ideation and/or suicide attempts; previous psychiatric hospitalizations; previous losses; substance use or abuse; lack of social support; family history; hopelessness
Protective factors for mood disorders:
access to care; strong family or social support; faith; future orientation; coping skills
the primary function is to regulate the stress response (Fight or Flight)
Hypothalamic-Pituitary-Adrenal (HPA) Axis
impact limbic-cortical circuits & stress reactivity = elevated cortisol, difficulty adapting to stress & modulating negative affective states.
Adverse Childhood Experiences (ACE)
5 or more signs/symptoms occurring nearly every day for a 2-week period; reflects a change in the usual level of function
Major depressive disorder
Signs/Symptoms of major depressive disorder:
Sign weight loss or weight gain
Increased or decreased sleep
Psychomotor agitation or retardation
Fatigue or energy loss
Feelings of worthlessness
Decreased ability to concentrate
Thoughts of death
Psychosis (may be present in 20%
Treatment for depressive disorders:
- inpatient hospitalization
- antidepressant medications and Electroconvulsive Therapy (ECT
- cognitive behavioral therapy (CBT), interpersonal therapy, family psychoeducation, peer support programs
identifying and changing negative thinking patterns
Cognitive restructuring
ID automatic thoughts/cognitive distortions and replace them with neutral or positive thoughts
thought stopping
establish a schedule of enjoyable and goal-directed activities
activity scheduling
a disorder that has severe fluctuations in mood; including episodes of both mania and depression
bipolar disorder
A type of Bipolar disorder that has intermittent manic and major depressive episodes. Most debilitating
Bipolar 1
A type of Bipolar disorder that has intermittent hypomania and major depressive episodes, spend long periods of depression, and mood instability.
Bipolar 2
A type of Bipolar disorder that has longstanding hypomanic and depressive periods without meeting criteria for other mood d/o
Subthreshold bipolar
Manic episode:
Signs/symptoms: abnormally elevated or irritable mood; abnormally increased activity or energy lasting at least a week; significant impairment in function; may be abrupt.
* grandiosity or inflated self-esteem
* pressured speech
* decreased need for sleep
* distractibility
* racing thoughts
* impulsivity (spending, promiscuity, gambling, substances
Treatment for bipolar disorder/manic episode:
- inpatient treatment
- antipsychotic medication, mood stabilizers, anticonvulsants
- Individual and/or group cognitive behavioral therapy,
Housing support & other community resource identification, Employment support, Case management
Mood disorders: OT treatment
Establish/reestablish healthy routines (sleep, exercise, nutrition)
Goal setting and sense of meaning/purpose
Engagement in productive occupations
Sleep hygiene
Sensory modulation/sensory coping
Structured leisure
Establish/reestablish social engagement
Experience success and feelings of competence
Bipolar disorder: OT-focused strategies and intervention
- Set limits, but do not engage in arguments
- Ignore comments about superior skills and gently encourage to engage in meaningful tasks
- If possible, allow autonomy
- Redirect energies to physical activity
- Simple, structured, engaging tasks to improve attention
- Decrease sensory stimuli if needed; avoid music during group, minimize loud noises, fewer people, etc.
- Sensory based strategies to manage mood and energy
- Develop routines and structure in their daily schedule
- Structured leisure opportunities
a human experience; a warning signal; an adaptive function.
Anxiety
Symptoms of anxiety:
physical, nervousness/fright, confusion/misperceptions of the situation; may be intense.
the body’s 3 stage reaction to a stressor = arousal/adaptation/exhaustion (from prolonged stress); may lead to impaired immune response or other illnesses.
General Adaptation Syndrome (GAS)
persistent irrational fear about one or more social situations: social interactions, being observed, or performing in front of others
Social anxiety
recurrent, unexpected panic attacks after which a state of persistent worry of another attack or significant maladaptive change in behavior lasts 1 month or more.
Panic disorder
irrational fear involving avoidance of objects/situations extremely unlikely to cause harm and that most people approach without discomfort.
Phobia
fear of open spaces, or enclosed spaces, or crowded spaces; includes fears that escape might be difficult or help not available in case of panic.
Agoraphobia
marked fear or anxiety about a specific object/situation; may be less debilitating if one can avoid the thing; the typical person with specific phobia fears 3 things/situations; Claustrophobia is a specific phobia.
Specific phobia
recurrent, intrusive thoughts, feelings, ideas, sensations; increases anxiety.
obsession
recurrent thought/behavior, such as counting, checking or avoiding; decreases anxiety; when compulsions are resisted, anxiety increases.
compulsion
Four Themes/Dimensions: Obsessive-compulsive
- Obsession of contamination and compulsive cleaning.
- Obsession of harm and compulsive checking or avoiding.
- Forbidden or taboo thought obsessions and related compulsions.
- Symmetry obsessions and repeating, ordering and counting compulsions.
individual must have been exposed to emotional stress that would be traumatic for anyone (6 y/o or older).
Exposure may include direct experience; witnessing trauma to others; learning about trauma of a close friend/family; combat veterans, 1st responders
Post-traumatic stress disorder
Treatment for anxiety disorders:
Treatment for trauma:
What are the characteristics of autism?
- social communication
- restrictive and repetitive behaviors of interests
- sensory
- cognitive
- motor
- emotional vulnerability
appears unresponsive, has poor eye contact, has difficulty making friends or joining activities, has difficulty recognizing the thoughts and feelings of others, has difficulty understanding language with multiple meanings such as humor or sarcasm, and has difficulty reading facial expressions and other nonverbals.
social communication characteristic of autism
strong need for sameness, problems with transition and change, repetitive motor movements or speech
Restricted and Repetitive Behaviors and Interests characteristic of autism
hyper or hypo-sensitive to sounds, smells, and textures, seeks to avoid activities that provide touch, pressure, or movement
sensory characteristic of autism
excellent memory for details, challenges with organization or problem-solving, literal understanding of concepts
cognitive characteristic of autism
awkward motor movements, difficulty grasping/holding objects, poor motor coordination, balance, and starting or completing actions
motor characteristic of autism
anxious, depressed, stressed with novel situations, SIB, low frustration tolerance and low self-esteem
emotional vulnerability characteristic of autism
What are the co-occurring conditions of autism?
Epilepsy
Mood disorders
Anxiety disorders
Attention-Deficit/Hyperactivity Disorder (ADHD)
Obsessive-Compulsive Disorder (OCD)
Tourette Syndrome/Tic Disorders
Oppositional Defiant Disorder (ODD)
Learning Disabilities
What are the theoretical perspectives of autism?
1.Executive Dysfunction
2.Theory of Mind (ToM)
3. Central Coherence
*Advantages and disadvantages?
task initiation, planning sequencing, time management, task completion, mental flexibility, self-regulation
Executive dysfunction
ability to understand the mental states of others (beliefs, thoughts, feelings) and predict the actions of others; related to mindblindness (difficulty recognizing the feelings and thoughts of others)
Theory of Mind (ToM)
ability to integrate information into a meaningful whole; focuses on the details, but unable to understand the bigger picture
Central Coherence
DSM-V Autism diagnosed
Deficits in social communication and interaction (three areas)
Restrictive and repetitive behaviors (two out of four)
Present in early development
Functional impairment
Social
Occupational
Not explained by intellectual disability
Treatment for Autism:
Behavioral
Developmental
Educational
Social-Relational
Pharmacological
Psychological
Complementary/Alternative
encourages desired behaviors and discourages undesired behaviors
Behavioral treatment for Autism
improving language and physical skills (OT, PT, Speech)
Developmental treatment for Autism
improve academic outcomes; verbal instructions complimented with visual or physical demonstrations
Educational treatment for Autism
improve social skills and emotional bonds
Social-Relational Treatment for Autism
help with treating co-occurring symptoms to improve functioning (anxiety, depression, seizures, sleep, GI issues)
Pharmacological treatment for Autism
CBT (thoughts, feelings, behaviors); coping with anxiety, depression, and other mental issues
Psychological treatment for Autism
special diets, herbal supplements, animal and/or art therapy, mindfulness
Complementary/Alternative Treatment for Autism
OT Occupations for Autism:
ADLs
IADLs
Rest/sleep
Education
Work
Leisure
Social participation
puts the person ahead of the diagnosis; frames the diagnosis as something the person “has” rather than something they “are”
Person first language
puts the diagnosis or identity at the forefront (example : blind woman)
Identity first language
Bias, prejudice, and discrimination against people with disabilities
ableism
Types of albeism
Institutional
Interpersonal
Internal
a type of ableism that affects medical institution’s teaching, policy, and patient care
Institutional ableism
a type of ableism that takes place in social interactions and relationships (Ex: a parent with a disabled child might try to cure the disability rather than accept it)
Interpersonal ableism
a type of ableism where the person consciously or unconsciously believes in harmful messages they hear about disability and applies them to themselves. (Ex: a person may feel that disability accommodations are a privilege and not a right)
internal ableism
Actively working to dismantle ableism
Recognizing that nondisabled people benefit (privilege)
Anti-ableism
A person with privilege on a particular axis who makes a conscious choice to work against oppression on the axis
Ally
How Do I Become a Disability Ally?
Self-education
Awareness Raising and Advocacy
Direct Action
conceptualizes how multiple systems of oppression uniquely shape people’s experiences based on one’s identities
Intersectionality
Benefits of the Intersectional Approach:
Recognizes the heterogeneity among, between, and within disabled populations
Highlights concepts such as “double disadvantage” and “prominence”
Acknowledges that power affects one’s identity
describes an accumulation of disadvantages that occurs for marginalized individuals who are multi-marginalized
double disadvantage theory
occurs when a person is stigmatized or oppressed based on an identity factor that is perceived as most salient within a given context
prominence
Models of disability:
- Medical model
*Rehabilitation model - Social model
- Identity model
- Neurodiversity model
- Moral/religious model
- Charity model
- Empowering model
- Human rights-based model
- Economic model
a type of disability model that views disability as a problem or disease that needs to be fixed: aim for a cure.
medical model
a type of disability model that views disability as needing to be fixed by a professional
rehabilitation model
a type of disability model that “disability” is socially created by the environment which includes barriers from people participating in areas of social life and favors the able-bodied
social model
a type of disability model that claims disability as a positive identity
identity model
a type of disability model where people are morally responsible for their disability; punishment of sins
moral/religious model
a type of disability model that views people with disability as victims of circumstance; deserving pity
charity model
a type of disability model disabled person decides the course of their treatment while the provider offers guidance
empowering model
a type of disability model that shifts from dependence to independence where the individual addresses social justice and discrimination
human-rights based model
a type of disability model that defines disability as the person’s inability to participate in work
economic model
18th-19th Century
asylums with deplorable conditions; evolution of moral treatment
20th Century
- Emergence of the mental hygiene movement
- Arts and crafts movement, pre-WWI
Mid-1940’s
Most state hospitals delivered long-term custodial care
When was the Mental Health Act enacted?
1946
When was the National Institute of Mental Health enacted?
1949
When was the Community Mental Health Centers Act enacted?
1963
When was the Community Mental Health Centers Act Amendment enacted?
1965
When was Medicare and Medicaid enacted?
1965
When was the Rehabilitation Act enacted?
1963
When was the Mental Health Parity Act enacted?
1996
When was the Passage of the Affordable Care Act enacted?
2010
