Exam Flashcards
What is culture (4 bullet points)
- learned
- visible and invisible
- situated
- individual and shared
What does culture do? (2 bullet points)
- changes and adapts
- emerges through interaction
Culture is a process that is: (5 points)
- learned
- localized
- patterned
- confers and expresses values
- Persistent but adaptive
Culture is learned:
-listening to, observing and assessing
-shared with those who you learn and who you teach
-institutions may formally transmit culture (schools, religious groups)
-learning is more complex as we age
(initially family –> to peers)
Culture is localized:
- culture is shared within societies
- culture is situated in what is personally meaningful (may not be universally shared)
- culture can exist in multiple contexts (including virtual)
- the strength of shared culture may be more binding than proximity
- most societies have cultural subgroups
Culture is Patterned
patterning is essential for social success and maintaining societies
-patterns set social expectations
Made up of: routines, habits that organize daily life
-rituals, a formal pattern of behaviours, create and maintain cultural cohesion
-Routines can become rituals when they have meaning beyond fulfilling a biological need
Culture confers and expresses values:
4 points about values
- values assign moral and ethical judgement to ideas and behaviours
- Values define concepts and behaviours that are important within a society
- values reflect shared meaning and are needed within a society for cohesion
- Values can be contradictory and are contingent on context
Primary Values: consistent value categories across culture
- Conception of innate human nature
- Relationship to nature and the use of technology
- Temporal focus of human life (time)
- Conception of human activity
- Conception of human relationships to others
Values as an integrated system:
value orientation vs a discrete set of values
- may be embedded in religion or standard of morality
- reinforced by economic, political or family structures ( professional code of ethics)
- reinforced by social groups, people who differ may feel stigmatized
- personal orientation evolve overtime
- generations may show differences
Culture is Persistent but adaptive:
- Cultural identity is usually stable, but can adapt
- changes over a person’s life course
- Change may be experiences across a society simultaneously with similar responses
Culture vs Society:
Culture: shared understandings that give private meaning to people’s behaviour
Society: the organization of people, arranged around significant dimensions
Societies:
- include many cultural groups and subgroups
- organized around patterned behaviours
- structured around institutions
- institutions are organized around central themes
- ->hospitals are institutions organized around health care
Universal Institutions
-Economic and political
-family groups
-religion
groups help meet individual and social needs
groups –> institutions –? societies
Status
Position in society --> comes with rights and responsibilities --> reciprocal expectations Ex: parent and child health care provider and patient/client
ascribed status
from birth, cannot be altered
Achieved status
acquired through effort and /or competition
Q what could restrict or limit status
Race
Inherited traits, physically visible, categorized by language, skin colour, religion
Ethnicity:
Presumed place or origin, believed similarities of a group (physical and customs)
- May be mistaken for culture
- may be part of someone’s identity
Race and Ethnicity (3 points)
-Both socially constructed categories
-no empirical evidence for categories
-discrimination experienced is real
-
Stereotypes
generalizations about groups based on common features (appearance, ethnicity, gender)
- -> human tendency to categorize different vs. sam
- -> what are stereotypes about OT
Bias
prejudice in favor of or against typically considered to be unfair
–> examples of bias in the media recently?
How might bias play out in health care
Social role: (4 points)
expected behaviour based on a status position in a specific situation
- -> takes into accounts rights and expectations
- expectations may differ from culture to culture
- roles have occupations associated with them
(e. g Student and professor)
Roles evolve as culture evolves (eg)
-men’s and women’s roles in North America in 1950s vs 2019
Family roles:
spouse, parent, child, sibling etc.
Economic/Productive roles
manager, worker, professor, student, etc.
Political roles:
City councilor, bureaucrat, Prime Minister, etc.
Community Roles:
Coach, volunteer, etc.
Religious Roles
spiritual leader, church member, etc.
Social roles ex. categories
Family roles,
economic/productive roles
political roles, community roles, religious roles
->Roles may overlap and belong to more than one category
–> what roles do you currently occupy
Role Conflict (4 points)
- people occupy multiple roles with differing demands
- role conflict happens when the demands of one role clash with those of another
- -> first responder who is also a parent
- Values and beliefs may influence how we allocate our time within different roles
- Outside factors may also impact this
- -> economic factors, social pressure, family expectations etc.
Role Checklist (occupational roles)
-Occupational roles organize behaviour by contributing to one’s personal identity, conveying social expectations for performance, organizing use of time and including the individual within the social structure
Role Checklist (OT)
–>unique view of disability involves understanding how illness or injury affects occupational role performance. Successful adaptation after illness or injury may be depend on a person’s ability to competently resume or to establish new occupational roles
Role Checklist (written inventory)
-requires approx 15 min to administer, and is appropriate for use with adolescent, adult or elderly population. It is divided into 2 parts.
Role Checklist part 1
assess along temporal continuum, the major occupational roles that organize an individual’s daily life
Role Checklist Part 2:
identifies the degree to which each occupational role is valued
Why study time use???
3 main points
- understand what people do in their day
- -> context, social elements
- Rhythms and patterns of participation
- ->eg. Day/night, sleep/wake, self-care/productivity/leisure
- time use is linked to health and well-being
- ->gives info about roles and what is valued
Time use is a socio-cultural construct (3 points)
- time is a human construction
- 24 hour clock is dominant method of time (keeping 12 or 24 increments)
- ->How did people keep time before clocks?
- Context is important
- ->E.g time keeping at work vs. home
Occupational Patterns
Habit
Routine
Enfolded activity
Habit
Familiar pattern of activities that become automatic
- -> brush teeth
- ->make coffee
Routine
anchored pattern of activity, sequenced daily or over long time periods, offers structure and order to daily life
Daily routine: get up, make bed, shower, have coffee, check email, go to work
Eg Weekly: water plants, buy groceries, vacuum house
Enfolded Activity
doing more than one thing at a time
–> eg. Playing with dog while making breakfast
Time Use is socio-cultural construct Part 2 (2 points)
- Constructions of time and time use are culturally-based
- ->E.g. Differences in how time and time use is viewed for example:
- -> Future/present/past-oriented
- -> linear vs. multi-active vs cyclical
- Time as a commodity
Linear Time
Past –> over
Present –> today’s task
A–>B–>C–>D–>E
Future –> plans for January, worried for February
Linear vs Multi_active Time
Theory : all perfectly timed
Reality: things take longer than you think
Linear Vs. Cyclical time:
western (linear) A through F
Oriental: a circle with all letters inside and then comes out to form other letters
Sociological applications (5 points)
- National time use surveys for informing policy
- Differences in time use between groups of people
- ->gender/age
- -> Attend to social and economic value of range of occupations
- ->evaluate impact of technology/urban geography on the time use of the population
Time Use of Adult Canadians
- 26 hours on self-care
- 69 Productivity
- 15 lesure
- 89 rest
Time Use of retired Canadians
3.4 self-care
4.3-productivity
8 leisure
8.3 rest
Time use Survey (subcategories)
-consider the sub-categories of activities described on the daily activity codes from the Time Use Survey
Productivity = paid work + housework + voluntary work + education
Leisure = socializing +active + passive
Stats Canada about Time use
-2015 women spent an average of 2.8 hours more on household work (54 more then men)
over the past 30 years has decreased by an average of 42 min per day
me increased 24 min
Time spent on paid work and unpaid housework and caregiving in combination was similar
women generally spending more unpaid work.
women aged 25-54 spent an average of 3.9 unpaid work (1.5 Hours) large than men but 1.3 hours less on paid work
As OT (time use) 3 points
- interested in understanding time use from the perspective of health and well-being
- Do the finding from the time use survey provide any information relevant to understand the health and well-being of Canadians?
- What are the limits of this information with respect to understanding health and well-being
How might time use influence health and well being?????
activity patterns associated with health and well-being (4 points)
- demonstrate a balance between self-care, productivity, leisure
- Provide structure for a “needed” routine/amount of activity, some sense of “structure”
- Balance between “active”: activities and passive activities/rest
- Demonstrate opportunities for a range of social contacts
DO LIVE WELL Table
Dimensions of experience: range of experiences are needed –>
Health and Wellness Outcomes: Everyday activities have an important impact on health and well-being
Personal and social forces impact all 3 levels:
many forces can affect experiences, activity patterns and outcome
DLW: Dimensions of experience: ( 8 points)
- Activating your body, mind and senses
- Connecting with Others
- Contributing to community and society
- Taking care of yourself
- Building security/prosperity
- Developing and expressing identity
- Developing capabilities and potential
8 Experiencing pleasure and joy
- Activating your body, mid and senses
activities are associated with activation can take many forms, from physical exercise (activating one’s body) to completing crossword puzzles (activating one’s mind) to listening to music (activating one’s sense’s). Some activities may involve multiple sources of activation, such as taking dance lessons with a partner or walking in nature
- Connecting with others:
this Dimension involves an emotional attachment within a social group. Connecting may take many forms (face-to-face versus virtual) and involves a range of “others” (family, friend, neighbours, coworkers, acquaintances, and even animals).
- Contributing to community and society
This dimension involves imparting socially valued human capacities or resources (eg. time, money, information) toward the good of social groups. Examples include paid or volunteer work, parenting, caregiving and civic engagement (e.g participation in advocacy initiatives)
- Taking care of yourself
This dimension involves attending to personal physical, psychosocial, and spiritual needs. Self-care may include a range of activities, such as exercising, eating well, taking vitamins, spending time with loved ones, and taking time to relax and rejuvenate
5 Building Security/Prosperity
This dimension captures the broader process of achieving financial and social security. Ex. of activities that contribute toward this dimension of experience include engagement in paid employment, planning and managing finances, household management, and investing in stable housing and safe neighbourhoods
6 Developing and expressing identity
interests, preferences, values, personal strengths and other characteristics of identity fuel engagement in preferred activities, which may include sports, and participating in cultural activities
- Developing capabilities and potential
this dimension involves developing skills, knowledge abilities, aptitudes and capacities. It involves challenging oneself, setting goals and striving towards one’s potential or ideal self
- experiencing Pleasure and joy
this dimension includes activities associated with experiences of enjoyment and contentment
Time use and health well-being (4 points)
- these dimensions of activity health have both individual and social features
- No “ideal” for activity patterns exists; patterns can “suggest” issues/problems
- activity patterns and expressions of dimensions of health are likely highly individual
- ongoing social changes influence activity patterns - and impact of these changes on health and well-being are not readily known
- -> (i.e. influence of technology)
Time Use and Disability
- Higher levels of unemployment
- Occupations are less varied
- Fewer activities outside the home
- more passive leisure
- personal care may take more time
- may need more rest
- may experience more poverty and decreased access to resources
Time Use Assessment methods
- Time diaries
- The modified Occupational Questionnaire
- Action Over Inertia
- Profiles of Occupational engagement in Person with Schizophrenia
Intrinsic Value of occupation
-not to be occupied and not to exist amount to the same thing. One must give oneself all the occupation one can to make life supportable in this world…. If you do not want to commit suicide, always have something to do …. Voltaire
Occupation and Health Ann Wilcock
Lack of occupation or the wrong kind or mix of occupations may be more lethal than tripping over rugs
Wilcock Three way link between occupation, health and survival
Survival: primary Human Drive
Health: Biological Needs Met
Occupation: provides, protects, maintains, Nurtures
Occupational balance -chistiansen
the satisfactory organization of one’s day
Occupational Balance - Backman –> 2004 4 points
- Self-defined and individualized
- work-life equilibrium
- most people desire occupations from each category
- Also are most satisfied with their own perception of balance
Evolving Perspectives (occupational Balance )
- Characteristics of occupations matters
- -> variety
- ->challenge
- -> meaning
- -> social connection
- Persoal perception of balance and satisfaction, is key
Risk Factor for Occupational Dysfunction (stress) ( 5 points)
- Stress and perceived control can impact the link between health and occupation
- Low job control with high demands is detrimental to health
- stress can result from over-occupation
- conflicting work and family demands
- under-occupational can also be stressful
Occupational Imbalance
“a disproportion of occupation resulting in decreased well-being –> Wilcock
- Removal of occupation increases stress, physiological changes and decreased health
- over-occupation can result in burn-out
Occupational Balance Questions 6
-when have you felt most balanced?
Least Balanced ?
What changes have you made to maintain your balance?
What might OT’s do with clients who have:
–> imbalance because of too many demands
–> imbalance because of boredom
Client-centred Practice
demonstrate concerns for clients, involve clients in decision-making, advocate with and for clients’ needs, and otherwise recognize clients’ experience and knowledge
cultural competence
is a set of congruent behaviours, attitudes and policies that come together ina system, agency, or among professionals to work effectively in cross-cultural situation
Health Council of Canada ( health of aboriginals)
-well documented that many underlying factors negatively affect the health of Aboriginal people in Canada, including poverty and the intergeneration a effects of colonization and residential schools
one barrier to good health lies squarely in the lap of the health-care system itself. Many Aboriginal people don’t use mainstream health care services because they don’t feel safe from stereotyping and racism and because the Western approach to health care can feel alienating and intimidating
Cultural Safety
what is felt or experienced by a patient when a health care provider communicates with the patient in a respectful, inclusive way, empowers the patient in decision-making .and builds a health care relationship where the patient and provider work together as a team to ensure maximum effectiveness of care. Culturally safe encounters require that health care providers treat patients with the understanding that not al individuals in a group act the same way or have the same beliefs
Cultural Safety in Action (4 points)
- recognize the inhererent power imbalance in health care
- respect nationality, culture, age, sex, gender and sexual orientation, political and religious beliefs
- reinforce the idea that each person’s knowledge and reality is valid and valuable
- recognize the healthcare professional as the bearer of his or her own culture and attitudes
- acknowledge the history, contributions and wisdom of social groups, as in example of Aboriginal traditional knowledge and medicine practices
Key Components of Aboriginal Cultural Safety in practice: (5 points)
- educating yourself on the colonial narrative
- self reflecting
- shifting power imbalances
- level of cultural safety defined by recipient of care
- commitment to life-long learning
Meaning
our search for uniqueness and self-hood with our search for community and belonging
Motivation
a natural human process for directing energy to accomplish a goal
Meaningful Occupations
occupation that have personal and social significance importance and value
Meaning through Occupational Engagement (4 points)
-to be occupied to participate
-focus on the experiental and meaning-related dimensions of occupation
Meaning is experiences and draws knowledge from real world experiences (–>experience
Meaning From Everyday Occupations
For participation to be meaningful, it must offer the opportunity to: 11 points
- become better at something (accomplishment)
- connect to others (belonging)
- Express self, talents, interests
- exercise agency and authority
- Appreciate beauty and experience joy
- connect to something larger than yourself
- rest, reflect, relax
- care and be good to oneself
- care for others and be cared for
- contribute to family, community, society
- prosper socially and economically
Loss of Alteration of meaning (4 points)
- Experiences of illness and disability may alter meaning
- mismatch in opportunities can lead to a sense of meaninglessness (occupational alienation)
- meaninglessness linked to boredom, apathy, loss of direction
- resulting “inertia” can have health consequences
Flow Theory
-a peak experience of immersion in activity with leading to pleasurable emotions
Applying flow to OT: (3 points)
- Provide environments that foster flow
- Help clients identify activities and learn to engage
- Build on client interests, strengths, skills and positive experiences
FLow Theory (flow pattern)
open enviro –> change to engage –> reflect on experience
Engagement in Meaningful Activities survey Purpose: Population Age Range: Requirement:
Purpose: to identify the extent to which a person is engaged in subjectively defined meaningful activity
Population: Any
Age Range: Adults 18+
Requirement: Need to read/understand the questions
Engagement in Meaningful Activities Survey (EMAS)
* look at the 12 questions in slide 12 lecture 4
Scoring : (3 points)
-scoring is conducted by summing the responses (ranging from 1= Rarely to 4= Always) of the 12 EMAS items for a possible score range of 12-48
-Persons may be classified as perceiving the meaningfulness of their activities as being either low (EMAS <29), moderate (EMAS 29-41) or high (EMAS >41)
-STandard deviations for EMAS include:
college students 33.4 (5.80)
Post 9/11 veterans with disabilities in post-secondary education 29.7 (7.7)
community-dwelling older adults 36.4 (6.2)
Meaning-focused Occupational Analysis (4 points)
- going beyond “performance” aspects of occupations
- Get curious about client experiences, even in mundane daily activities
- Explore interpersonal elements and context
- Examine barriers and facilitators to participation
What about lack of drive or Drive for things that cause harm examples:
not completing self-care -not exercising -not eating Problem Gambling -Substance Misuse -Overeating
Theories of Motivation: (3)
Biological
Psychological
Social
Biological theory (repeat) What is the three-way link between occupation, health and survival
Survival: Primary Human Drive
Health: Biological Needs Met
Occupation: provides, protects, maintains, nurtures
Psychological Theory (3 points)
- External environment interacts with psychological and emotional processes
- Drive to seek rewards and avoid punishment
- -> internal rewards include enjoyment, interest, pride (flow)
- -> goals and life tasks need meaning
Social Theory (4 points)
- Position within broader culture and society
- love, belonging, friendship, self-esteem
- social structures may enable to constrain motivation
- Environmental Context is important
Strength-Based Approach
Attend to evidence of interests and meaning in the environment
- understand past interests and activities
- Prompt and listen to stories about life events and activities
- Talk about current events
- learn about cultural influences
- Observe interactions with the environment
Practice Principles (arrow with 5 points)
engage in “doing” –>Address challenges –> range of experiences –> psycho-education –> Raise the profile
Transtheoretical Model of Change (circle 5 points)
Precontemplation-contemplation-preparation-action-maintenance
Readiness Ruler: Purpose: Population Age Range: Requirement:
Purpose: to measure a person’s subjective readiness for change
Population: any
Age Range: teens and adults
Requirement: need to read/understand the questions
Readiness ruler
* remember to look at it
slide 26
scoring breakdown
-not ready (0 to 3)
-unsure (4 to 7)
Ready to change (8 to 10 )
Readiness for change activity:
3 points
think about a behavioural change you think about making, but haven’t been successful with yet
-complete the readiness Ruler
-Answer these questions
why are you at your current score and not zero
-what would it take to move to a higher score
-What has made this change important to you so far
Case Study: Lt. Dan Taylor
Questions
Talk about this one
- What occupation did Lt. Dan previously find meaningful
2. What level of motivation did he previously experience?
3. What’s missing today?
4. What Specific skills/techniques will you use to engage him in finding new meaning and increase his motivation
Spiritual Occupations
Religion and Spirituality
Religion: a personal set or institutionalized system of religious attitudes and practices
Spirituality: the way individuals seek and express meaning and purpose, the way they experience connectedness to the moment, to others, to the self, to nature, and to the significant or sacred
Spiritual Occupations (5)
-Creative occupations
-Nature
-Social Participation
-Mindfulness and reflection
formal religious practices
Creative occupations
Drawing, Painting, playing music, singing, writing poetry, dancing,
Nature
-Hiking, camping, sailing, swimming, gardening, star-gazing
Social Participation
-Attending religious service or event, support group, mentoring
Mindfulness and reflection
-meditation, journaling, gratitude, yoga
Formal religous practices
-worship, prayer, rituals, holy days
Assessment Questions of Enabling Spiritual Occupations
-Are there spiritual activities that are important to you?
What are they?
What helps you most when times are difficult?
-Would you like to tell me more
FICA
Faith and belief (what gives you life meaning)
-Importance (how important is this)
Community (belonging to social or religious groups)
-Address in care (how would the person prefer their beliefs be addressed in care)
Spiritual Intervention 2 points
- Be aware of your own beliefs and biases to ensure cultural sensitivity
- consider level of connection and experience with spiritual occupations
- -> e.g Client wants to use meditative practices to cope with stress. Have they tried this before? What context are they interested in? Alone with an app? Join a meditation class? go to church?
Spiritual Occupation Intervention Examples
PEO
-Person-level: social skills training to increase social participation
Environment-level: work with faith community to enhance inclusion of people with disabilities
Occupational-level-Adapt the level of participation, start solo before moving to group
Lt Dan’s Journey (discuss)
How could you assess Dan’s spirituality
What intervention would you add to complement your previous efforts in meaning and motivation
Evolution of Psychosocial Practice: 3
Arts and Crafts movement -Late 19th century Settlement house movement Late 19th Century -Mental Hygiene movement -Late 19th to Early 20th Century
Arts and Crafts Movement 4 points
- Emerged in response to poor working conditions associated with the industrial revolution
- Anti-industrial approach
- Art and craft occupations were seen as ways of encouraging a more human society
- Focused on promoting inclusion of marginalized populations
Settlement House movement
- Inspired by arts and craft movement
- Settlement houses’ helped immigrant and impoverished persons to develop skills to better manage in their everyday lives
- Run by social reformers who actively participate in community initiatives
- Contributed a “social justice” perspective to OT
Mental Hygiene movement
-Focused on improving hospital care and preventing mental illness
-Lack of meaningful occupation associated with poor mental health
-engagement in occupation associated with poor mental health
-Engagement in occupations was seen to promote health and prevent illness
-Mental hygiene associations were the early equivalent of modern mental health associations
(CMHA)
-Eleanor Clarke Slagle and Goldwin Howland were pioneers
What are the two main perspectives of mental hygiene movement
Humanitarianism and Humanism
Humanitarianism
all people are of value and are entitled to dignity
-belief that society has an obligation to help all persons who are marginalized
Humanism
- Humanitarian approach
- Acknowledges the unique perspectives of people as they make decisions that shape their lives
- closely linked to client-centred approaches
institutions (4 points)
- underlying humanitarian and humanistic ideologies
- Mental illness was viewed as a result of faulty habits
- “Asylum” from harsh living condition where people not accepted
- Belief that re-engaging in “normal activities” may help a person to overcome mental illness
- However, people were separated from local communities
- -> came to include people who didn’t fit into society and people with developmental disabilities
- -> Eventually not seen as a refuge and “asylum” took on a harsher meaning
De-Institutionalization (5 points)
- Scientific approaches to treating mental illness- Medication became more available
- Enhanced possibility for community care
- Anti-psychiatry and criticism of institutions 1950s/1960s
- Community Mental Health acts developed in many countries
- Expectation that community services would support the needs of persons with persistent mental illness
- community services continue to be revised
what does Psycosocial mean ?
The Human
-Psychological
-emotional
-social
function and experience that occurs within daily occupations carried out in context
Psychosocial Dimensions
Person level, internal factors often linked to socialization
Such as: Beliefs, values, attitudes, morals, standards
Highly variable across age, gender, culture, personal experience, etc.
Psychosocial Dimensions are particularly salient for occupations that are:
- reflections of the self (‘I’)
- interpersonal (the personal self connecting with the social self - “me”)
Psychosocial in
CMOP-E:
PEO:
CMOP-E: Affect
PEO: Person
A framework of Psychosocial factors
- Core domain is occupation
- Integral to the performance and experience of all activities of occupation
Performance
observed behaviours
Experience:
Self-agency, sense of belonging and contributing, integrity, pleasure, investment, sense of well-being
What are the foundation of occupational engagement
- Motivation
- Meaning
Motivation:
a natural human process for directing energy to accomplish a goal
Meaning:
our search for uniqueness and self-hood with our search for community and belonging
Psychological, emotional and social elements of Occupation
Elements that enable occupation, and are enabled by occupation: (5 points)
- Self-perceptions –> I think this should say Self-evaluations ???
- Affect/mood
- Thought Processes
- Interpersonal Processes
- Coping Processes
Occupational Self-evaluations
self-esteem
- body image
- self compassion
- self-identity
- Locus of control
Occupational Mood/Affect
Emotions -Happiness, love, joy -flow VS -Distress -Anxiety -Fear -Boredom -Grief
Occupational Thought Processes
- perceptions
- interpretations
- reasoning
- logic
- rationality
Occupational interpersonal Processes
- Receiving and interpreting social information
- Empathy and understanding of the needs and feelings of others
- Respect
- Trust
- Interactional style
Occupational Actions
Coping/Resilience
Self-regulation
-Self-monitoring
Context (the other ring of the framework model)
Context can both enable and interfere
- Such as: access to resources, economic status, family relations, social networks, cultural influences, life experiences
- Developmental factors are important too
Case Study –> 20 year old student–> undergrad a t queens
DISCUSS
LOOK AT NOTES
The Recovery Model:
Common Ideas about recovery (4 points)
it is a process as well as an outcome
- it is a personal journey …. people recover-we can’t make them recover
- Recovery does not depend on a “cure”
- Involves (re)defining self identity with illness conceptualized as only one element of the self
Key points about the Recovery Model (4 points)
- Hope is powerful
- Recovery can occur even when symptoms persist
- Recovery is no a linear process
- The consequences of the illness may be more difficult to recover from than the illness itself
Stages of Recovery ( 4points in a arrow)
- Discovering a more active self
- Taking stock of the self
- Putting the self into action
- Appealing to the self
The recovery Benefits of activity participation
* look at slide
circle with 8 circles surrounding
- Becoming empowered and exercising citizenship
- Finding Social support
- assume control
- manage symptoms
- Overcome stigma
- Live a full life - not an illness
- Redefine self
- Renew hope
Criteria Of Recovery
Criterion: Hope –> Components: Spirituality
Criterion: Taking Personal Responsibility –>Components: Illness Management Healthy Lifestyle
Criterion: Getting on With Life–> components: identity, relationships, work, recreation
Getting on with Life:
Targeted OT intervention to Address:
identity
- relationships
- work
- recreation
Where have you seen this in action?
What could OT’s do more of?
Occupational Perspective on Recovery:
-you have to become active
-Occupations:
Education
Work
Music
Walking
Holidays
Relationships with family and friends
-Safe environment, social support and cohesion
-Occupations support autonomy, competence, meaning, purpose
Importance of Peers:
- lived experience
- social support
- hope
- lower perceived pressure vs. health professionals
Importance of Peers:
Building in peer support:
ACT team with built in peer roles
- hospital with peer support programs
- many towns and cities have peer support organizations
Recovery Stories: Janet and Ian discuss:
How has she been “getting on with life”
identity, relationships work, recreation
What is anxiety: 2 points
An unpleasant subjective feeling of apprehension
-may range from uneasiness to terror
Anxiety may be: and OR
-adaptive or protective reaction
-And, propel us to act, cope and perform
OR
-Debilitating and oppressive
-Paralyzing and performance limiting
The CNS and Anxiety
Prefrontal cortex
involved in interpretation of information that provokes fear/anxiety responses
The CNS and Anxiety
Hypothalamic-pituitary-adrenocortical (HPA) axis
Activates autonomic nervous systems
- -> sympathetic NS (fight/flight/freeze response)
- Activates endocrine system
- -> adrenals (adrenalin)
The CNS and Anxiety
homeostasis
- Need to return to homeostasis
- -> chronic anxiety taxes our system and can lead to physical and mental issues
Behaviour at centre of circle
bodily responses –> emotional responses –> cognitive Evaluations/response
When is anxiety a disorder or “unhealthy” (5 points )
- the response to a stimulus is greater than expected
- when anxiety persists after the stimulus is removed
- when anxiety leaves the person ineffective in dealing with the threat
- when it hinders daily function
- “anxiety becomes disabling when it persists without simulating positive action to resolve the stressor or ward off distress
Why do people develop these disorders ( 4 reasons)
-Genetics
-Biology
-Cognitive and psychological:
Environment
Why do people develop these disorders Genetics:
variation in coping styles as well as family links to disorders
Why do people develop these disorders Biology:
dysregulation of HPA axis, Neurotransmitter change (increase cortisol decrease GABA)
Why do people develop these disorders -Cognitive and psychological:
misinterpret or overinterpret experiences
Why do people develop these disorders Environment
Coping skills of parents and family, messaging at home and in school, negative or frightening experiences, cultural experiences or expectations
Anxiety Disorders (DSM-V) 5 points
Difficult to control anxiety and worry
–> recurrent, significant, persistent (e.g 6 months), excessive
–> impairs social, occupational and other areas of functioning
Anxiety is associated with many health conditions
–> primary symptom, or secondary response?
-Anxiety can be associated with acute stressor (e.g surgery, illness, loss)
-medication effects: alcohol withdrawal; caffeine and nicotine
-most relevant diagnoses in adult mental health settings: panic disorder, GAD (generalized), SAD (social)
Canadian Prevalence 2016 4 points
- 3/4 of Canadians who used health services for a mental illness annually consulted for mood and anxiety disorder
- in 2009/10 almost 3.5 million (10%) used health services for mood and anxiety disorder
- highest prevalence was people aged 30-54 followed by 55 and older
- adolescent and adult females (especially those middle ages) were most likely to use health services for mood and anxiety compared to males
Percentage of those with mood and or anxiety disorders 18 and older
64% –> family doctor
- 7% –> Psychiatrist
- 2% –> other medical doctor or specialist
- 2% other health professional
GAD (6 points) Stats Canada (having it/commonality)
GAD is the broadest anxiety disorder in its case, and one of the most common
- 8.7% lifetime prevalence in Canada
- Twice as common in Women
- most often begins in childhood or adolescence, but onset in adulthood is not uncommon
- onset is typically gradual, with symptoms likely developing more slowly than other anxiety disorders
- stressful life event may cause the onset of symptoms
Generalized anxiety Disorder
Characterization 3 points
- generalized and persistent excessive anxiety and worry, accompanied by somatic symptoms such as muscle tension
- Thinking about the “what ifs” and fear the worse in every situation
- This worry is exaggerated and unrealistic, everyday concerns such as work health or fiances can cause marked discomfort and distress
Panic Disorder
What Is it?
Unexpected and recurrent panic attacks (3 points)
- sudden episode of intense fear, with heart palpitations, chest pains, nausea, trouble breathing/shortness of breath, flushing or chills, terror, fear of losing control or dying, peak within 10 minutes of onset
- may think they are having a heart attack or stroke and go to the emergency department thinking they are dying
- between attacks, the individual may experience considerable anxiety and fear in anticipation of having further attacks, which may be more disabling than having attack itself
Panic Disorder (diagnosis, when it develops / lifetime prevalence) 3 points
- Diagnosed with recurrent panic attacks ( minimum four in a four-week period)
- -> at least one of the attacks is accompanied by one or more physical symptoms, and/or a significant change in behaviour due to the attacks
- begin in late adolescence or young adulthood, but children and older adults can also be affected
- lifetime prevalence rates are approx 1-2%
Social Anxiety Disorder (social Phobia)
-Fear of situations in which there is potential for embarrassment or humiliation in front of others
Two subtypes:
fear of speaking in front of people
-more generalized anxiety and complex fears, such as eating in public or using public washrooms
Social Anxiety Disorder (social Phobia) how does it become worse (3 points)
when individual anticipates/fears they will do something embarrassing
- aware that is anxiety is excessive and unreasonable they cannot overcome it
- avoid these situations, causing interference in work, school or other daily activities
Social Anxiety Disorder (social Phobia) (Stats CANADA) Prevalence and gender/age) (4 bullets)
- lifetime prevalence rates are 8-13%
- women have a higher prevalence than men
- childhood or early adolescence onset
- -> critical time period for developing social skills
- -> social phobia rarely develops in later adulthood
- Symptoms may fluctuate with stress and demands, and may enter remission
Psychosocial Factors and anxiety (all factors affected 4 points)
self-evaluation -sense that processes and outcome is out of your control
- thought processes - evaluations may/may not be rooted in reality
- actions - many demands placed on this determinant
- -> coping/resilience, self-monitoring and regulation play a role in adaptation
- mood and interpersonal processes can be also impacted
Anna’s story DISCUSS
TALK ABOUT IT, LOOK AT NOTES
What are the occupational Performance issues with anxiety and mood disorders ( 5 points)
- may be at increased risk for physical illness
- may have impaired attention, concentration and memory
- may disrupt productive occupations
- may become socially isolated
- risk for substance abuse
Level of difficulty experienced with basic activities by type of activity among those with mood and/or anxiety disorder(s), 18 years and older
interesting graph take a look at it …… not a huge difference between activity
recreation/leisure and hobbies –> found pretty difficult
Travelling/taking vacation–> not found very difficult
Assessments (symptoms and screening for mood or anxiety disorder)
Beck Anxiety Inventory (BAI): (5 points)
-measure anxiety levels
-age range: 17 though 80 years
Administration: 5 to 10 minutes
-21 items with a Likert scale ranging from 0 to 3 (0 not at all -3 severe) and raw scores ranging from 0 to 63
-score of 0-21 = low anxiety
score of 22 -35 = moderate anxiety
score of 36 and above = potentially concerning levels of anxiety
Occupational function and meaning assessments
-time use log
-occupational Questionaire (OQ)
Action Over Inertia (AOI) worksheet
-Canadian Occupational Performance Measure (COPM)
Assessments for Goals (mood and anxiety disorder)
- Goal Attainment Scale (GAS) (rating 5 options range -2 to 2+) +2 much more than expected
- 2 much less than expected
- Readiness Ruler
Treating Anxiety Disorders
Evidence-based treatments for anxiety disorders 3 points)
- Psychopharmacology
- -> benodiazepines and antidepressants
- -> may not “fix “ the issue but relieve symptoms
- Cognitive Behavioural Therapy
- -> change responses to events by changing beliefs
- Relaxation, Meditation, Biofeedback
- -> reduce arousal levels
- -> may be used with exposure to anxiety provoking situations
Cognitive approaches to treating anxiety disorders
2 points
-the process of changing cognitive distortions, or “faulty thinking”
-Goal is to replace one’s counter-factual or irrational belief a with more realistic and helpful ones
“ I can fail Although it would be nice, I don’t have to be the best in everything”
Cognitive Triad (circle)
Behaviours –> thoughts–> feelings
The role of interpretation
Talk about the activity about I texted my friend last night and he still hasn’t replied
Feelings?
Behaviours?
Socratic Questioning (4 points)
-open-ended, neutral questions
-Guided discovery of thoughts
-possibility to create new beliefs
Questions:
-informational
-empathic
-attend to relevant information
-Analyze and synthesize
Socratic Questioning:
Situation ( student gets a 70% believes she is a terrible student) what are guiding questions (3 )
What is the evidence for and against this belief,
what are the alternative explanations of the even of the event of situation?
What are the real implications or consequences if the belief is correct?
What are the four phases of socratic Questioning
- Asking informational Questions that the client can answer to help make concerns explicit and for the client to feel heard
- Asking questions that reflect empathic listening and summarize issues related to the problem
- . Asking questions that draw the client’s attention to information relevant to the issue being discussed, but which may be outside the client’s current focus
- Asking analytic or synthesizing questions that guide the client toward new information to reevaluate a previous conclusion or construct a new idea
Self Management statistics
5 points
64% reported that they exercised or participated in physical activity
71% reported that they adopted good sleep habits
28% reported they have developed a care or crisis plan
43% reported that they have engaged in reflective or meditative practices
83% said they have educated themselves about their disorder
personal agency and stress
Resources for coping:
confidence, self-worth, optimism
- problem solving with persevering
- Constructing
personal agency and stress:
Constructing new meaning
–>turning misfortune into a mission
High self-esteem and sense of control may be protective
–> lower rates of anxiety and depression
Social support is a powerful buffer
- Client-centredness -ensuring the person is an “active” participant ( anxiety)
3 points
(first step is called active participation and information)
- providing knowledge/information about anxiety and occupation
- providing knowledge/information about interventions/evidence fo interventions
- engaging the individual quickly in manageable, supported change
Information ( anxiety) 3 questions
under 1 Client centredness
what specific education/information would the client need?
how might education/information need to be individualized?
What “quick” changes might you implement even after first visit or two
- Addressing the physiology of Anxiety (3 steps)
A. learning relaxation response:
ex. Breathing techniques, progressive relaxation techniques, meditation, mindfulness
B. Planning for maintaining control in the early stages of panic
C. Application of relaxation response to daily life situations
- Addressing the cognitive component (2 points)
- interventions to neutralize the thoughts connected to the fears that interfere with occupation
- applying these strategies within occupation
- Enabling Behaviour (3 points)
-Planned and graded introduction of performance with application of strategies
E.g, Grading supports, grading time engaged, grading complexity
-Use of knowledge about the personal meaning of occupation
-Use occupational engagement to enable health and well-being
Client EXAMPLE
June is 20 year women who lives at home with her parents in a small city
LOOK AT NOTES DISCUSS
LOOK AT NOTES
Emotional functions include:
“appropriateness of emotion, regulation and range of emotion, regulation and range of emotion; affect; sadness, happiness, love, fear, anger, hate, tension, anxiety, joy sorrow; lability of emotion; flattening of affect.”
emotions, physical sensations, attitudes and moods
-Affect includes
emotions, physical sensations
Moods versus Emotions
Moods: Gradual onset -lack of a specific referent or object -more enduring -lower intensity -make senak up on us -Global signal of the person's general state Emotions: -Quicker onset -Connected to specific referent or object -limited duration more intense -more aware of them -provide specific information
Clinical depression (10 points)
-depressed mood, passive, withdrawn
-lack of pleasure in daily activities
-hopelessness
-feelings of worthlessness or inappropriate guilt
-fatigue or lack of energy
-Paralysis of will and initiation
Poor appetite or overeating
Insomnia or too much sleep
-indecisiveness or lack of concentration
-recurring thoughts of death suicidal thoughts
Depression
Occupational performance issues
“unipolar” - absence of mania
- pain and physical illness
- decreased endurance, increased fatigue
- Difficulty in social and work situations
- -> decreased motivation for participation
- -> changes in emotional experience (lack of pleasure, increased distress)
- -> common feeling of worthlessness and guilt regarding roles that are not being fulfilled
Psychosocial Factors and depression
occupational enabling affect is initially disrupted and leads to many other disruptions:
5 points
motivation - decreased motivation to participate
self evaluations
-self -esteem of worthlessness
-agency/control and self-efficacy - sense that events are out of your control
Though processes - evaluation may/may not be rooted in reality
Actions
coping/resilience -many demands placed on this determinant
-self-awareness, self-monitoring and regulation -play a role in adaptation
interpersonal processes -may become withdrawn
Cause of depression
-both behvaioural and genetic roots
-1% lifetime prevalence in canada 2: 1 f/m
-many link to early childhood experiences
–> early losses, trauma, stressful environment
-Unexpected or traumatic experiences
–> loss of a loved one , severe medical illness or injury, an accident, violent attack
May be related to long-term stress
-HPA axis (stress-anxiety-depression)
-changes to brain chemistry
–> each episode increased the odds of recurrence
–>severity of first episode may predict recurrence
Rates of depression by age and sec
most common in 15-24 then 25-44 then 45-64
Bipolar disorder - Manic
- euphoric mood
- creative/imaginative; expansive thinking
- boundless energy, driven
- high sense of self-worth and empowerment
- decreased concentration and attention
- racing thoughts
- agitation, distraction, low frustration tolerance
- diminished judgment
- loss of appetite; sleep disturbances
Bipolar I disorder
- focuses on episodes of mania
- may experience depressive episodes as well
Bipolar II disorder
- depressive episodes as well as hypomanic episodes
- impairment mostly during depressive episodes
Cyclothymic Disorder
chronic (2 years +) fluctuating depressive and hypomanic experiences
Occupational Performance Problems with bipolar disorder
- increased energy, decreased sleep
- -> issue with memory, concentration, attention
- Risk for accidents or exposure to unsafe situations
- Difficulty in social and work situation
- -> self-awareness and regulation are decreased
- -> difficulty reading social cues or relating to others
- -> unrealistic appraisal of abilities
Psychosocial factors and bipolar disorder
occupation enabling affect is initially disrupted and leads to many other disruptions
motivation - increased motivation to participate
-self-evaluations
-self -esteem - inflated feeling of worth
-agency/control and self-efficacy - sense that events are within your own control
thought processes-evaluations may/may not be rooted in reality
actions:
–> self awareness, self-monitoring and regulation - may be decreased
interpersonal processes
–> may be more aggressive or irritable
Causes of Bipolar
- strong genetic roots
- 1.5%-2.5% lifetime prevalence in Canada (no gender differences)
- unexpected or traumatic experience as a trigger
- -> severe medical illness or injury, an accident, violent attack
- Exposure to substances may be a trigger
- -> pain killers, alcohol, marijuana, psychoactive drugs
- changes to brain chemistry
- -> increase brain activity and speed of signal transmission
- -> rapid cycling patterns 4+ episodes /year) predict poorer functional outcomes
Key behavioural factors to depression
passive avoidant inertia -unable to multitask --> simple things are often overwhelming
Key behavioural factors of hypomanic or manic
-Agressive
-Intrusive
-overactive
take on too many tasks/projects - can be grandiose
Key cognitions: thoughts about self/other in depression
i am not worthwhile i'm inadequate -i should feel happy -I can't make a decision -I'm overwhelmed -i cannot concentrate -i cannot remember
Key cognitions: thoughts about self/other in hypomanic/Manic
- they want me
- i know best
- they are moving too slow
- i love my ideas
- live today. Tomorrow will be even better
Coping and Occupation (5 points)
- managing and adapting
- both adaptive and maladaptive coping strategies (e.g going to the gym vs. using substances)
- managing stress
- managing symptoms
- identifying and drawing on personal strengths
Coping and Occupation in crisis (4 points)
may need external help in coping (in-patient and out-patient supports)
- focus on here-and now problem-solving vs distress
- encourage self-reliance
- safety planning
- -> warning signs
- -> internal coping strategies
- –>social supports and settings
- -> professional and resources
Coping Strategies
emotional expression
- behavioural approaches
- cognitive behavioural approaches
Coping Strategies inventory (CSI)
-72 questions with 1-5 scale (never =1 very often = 5)
-children and adults, self-report
8 categories
–> problem solving
–> cognitive Restructuring
–> express emotions
–>social support
–> problem avoidance
–> wishful thinking
–> self criticism
–> social withdrawal
Example q: i try to see the issues from several perspectives
-I try not to think about the issue
Resilience and occupational adaptation
3 points
- resilience and vulnerability are important factors in occupational adaptations
- self-evaluations are keys
- Resilient individuals have
- -> positive sense of Self
- -> Internal locus of control
- ->Occupationally engaged lives
- -> seek assistance and social support
what leads to greater resilience
8 points
- create a more resilient brain
- -> sleep nutrition and exercise
- positive coping strategies
- mindfulness
- emotional connection
- healthy support systems
- optimism
- sense of humour
- spirituality
Quick coping
relaxing minute
mindful minute
Activity
- breath deeply for the next minute
- be sure your breath fills your chest and abdomen
Notice five things center yourself and connect with your environment pause for a moment look around notice five things listen carefully notice five things five things your body is in contact with
Depression: patient Health Questionnaire (PHQ-9)
-experiences over last 2 years
-measures depressive symptoms
-Age range: adults
Administration: 5 to 10 minutes (self-reported)
9 questions with 0-3 scale
Depression Severity
-0-4 none
-5-9 mild
10-14 moderate
15-19 moderate severe
20-27 severe
Mania: Young Mania Rating Scale (YMRS)
-experiences over past 48hrs
-measure symptoms of mania
Age range: adults and children
Administration: 15-30 min completed by clinician
11 questions (0-4 scale and 0-8 scale)
-score of 13 or higher indicates elevated mood
-score of 20 indicated hypomania (bipolar II and cyclothmia)
Score of 25 indicates mania (bipolar I)
Assessments for depression and biopolar disorder
occupational function and meaning -time use log -occupational Questionnaire (OQ) Action Over Inertia (AOI) worksheets Canadian Occupational Performance Measure Interest and Role Checklist
Assessments for Goals
Goal Attainment Scale
Readiness Ruler
Medical Treatment of Depression
-anti-depressant (SSRIs/SNRIs)
Medical Treatment of Bipolar disorder
-mood stabilizers and anticonvulsants
interpersonal and social rhythm therapy (IPSRT)
Medical Treatment for both depression and bipolar
Psychotherapies
-Cognitive Behavioural therapy (CBT) and interpersonal Therapy (IPT ) [both]
-
OT approach for depressed state
-encourage for engaging in occupation
OT approach for manic state
-Honest and realistic appraisal of behaviour and end products while engaging in occupation
OT approach for both (depressed and manic)
- Concrete simple activities
- clear expectations
- repetition
- distraction-free environment
- prompting, redirecting when distracted
- self-exploration activities
- self-expression
Re-establish normal routines
- look at use of time-typical day
- re-establish normal routines, maximizing, purposeful and meaningful use of time
- pacing for difficult times of day
- therapist is active and directive initially then shift towards person own initiatives, decision-making and activity
-enable person to resume roles and functional activities of everyday living.
May involve:
rating their mood per and post occupation
-coaching occupational/behavioural experiments to modify thought related to roles and activities
OT approach - Mood Continuum
activity –> Extremes of depression or mania
Structure --> increased Task --> repetitive, simple, tangible Time --> short term Limits --> consistent, often, direct, and understandable Directions--> simple demonstrable
OT approach - Mood Continuum Activity –> as mood stabilizes
Structure –> decreased
Task –> new steps, more complex and abstract
Time –> longer term
Limits –> less needed
Directions–> more complex. more abstract
- Client-centredness -ensuring the person is an “active” participant ( depression and BP )
- providing knowledge/information about mood disorder and occupation
- provide knowledge/information about interventions/evidence for interventions
- -> engaging the individual quickly in manageable, supported change
information (mood)
Repeat of Anxiety slide
Coping ( mood)
a. rountines
b. planning for maintaining control in the early stages of depression or mania (managing symptoms)
c. Active coping skills (emotional expression, behavioural and cognitive behavioural strategies)
- Addressing the cognitive and interpersonal components
- interventions to address thoughts and interpersonal processes
- may need to develop communication skills
- applying these strategies within occupation
- Enabling Behaviour
-Planned and graded introduction of performance with application of strategies
-e.g Grading supports, grading time engaged, grading complexity
use of knowledge about the personal meaning of occupation
-use occupation engagement to enable health and well-being
LOOK AT CLIENT EXAMPLES FOR BIPOLAR and Depression DISCUSS
DICUSS
What is psychosis
A mental state characterized by disturbances in the experience of “reality”
- Approximately 3% of the population will experience some form of psychosis in their lifetime
- first episode psychosis generally develops in the late teens, early twenties
- psychosis is not specific to male, female, culture or socioeconomic status
Psychosis is ….
a group of symptoms
that can be associated with a diagnosis of schizophrenia
“positive symptoms”
symptoms in excess of/added to an individual’s normal functioning:
hallucinations
delusions
Hallucinations:
seeing, hearing, feeling, smelling or tasting something that isn’t there
Delusions:
(false beliefs): -implausible beliefs; non-bizarre-plausible but untrue in reality
Types of Delusions in Psychosis
Delusions of grandeur Delusions of persecution somatic delusions paranoid delusions ideas of reference thought broadcasting thought insertion thought withdrawal though control magical thinking
Negative symptoms:
symptoms that reflect a loss/absence in normal functioning:
- flat affect/ emotion
- alogia/lack of speech
- avolition/apathy (difficulty sticking with things)
- amotivation
- isolation/withdrawal
Disorganized symptoms
thoughts and behaviours that don’t follow a normal processes ( include speech, grossly disorganized or catatonic behaviour)
Psychosis
about diagnosis and symptoms
psychosis is associated with many health conditions
- psychosis is a set of symptoms, not a diagnosis, ie. cough (systom), pneumonia (diagnosis)
- Schizophrenia is one (of many) possible diagnoses
- often difficult to make a diagnosis during a first episode
- -> a firm diagnosis requires long-term consistency in symptoms
Types of Psychosis
- organic psychosis
- substance/medication-induced psychosis***
- brief Psychotic Disorder
- Brief Psychotic disorder
- Other Specified Schizophrenia Spectrum and Other Psychotic Disorder/Psychosis NOS (not otherwise specified)
- Delusion Disorder
- Major Depression with Psychotic Features
- Bipolar Disorder with Psychotic Features
Types of Psychosis (continued)
- Schizophreniform Disorder
- Schizophrenia Disorder
- Some disorders of personality (Schizotypal Personality Disorder, Borderline Personality Disorder)
- Disorder of eating
- Appears to be a normal human adaptive response to extreme survival conditions, extreme sensory deprivation etc.
DSM-V Criteria for Schizophrenia
A. Two or more of the following percent during 1 month:
1. Delusions
2. Hallucinations 3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms;
B. Social/occupation/self-care dysfunction;
C. Continous for 6 months - including 1 month of criteria (A)
D. No significant mood disorder;
E. Not associated with substance use or medical condition;
Schizophrenia subtypes
-Catatonic
-Paranoid
-Disorganized
-Undifferentiated
Phases of Psychosis
(Prodromal Phase)
The prodromal phase is the period during which the individual is experiencing changes in feelings, thought, perceptions and behaviour although they have not yet started experiencing clear psychotic symptoms such as hallucinations, delusions or thought disorder.
- changes in mood
- changes in thinking
- changes in behaviour
- changes in role function
- progression without treatment is seen to affect illness course
- psychosocial treatment as important as medication (early psychosis intervention - within first 3 years of symptom onset)
Phases of Psychosis
acute phase
typical symptoms of psychosis emerge characterized by positive, negative, and disorganized symptoms
Recovery Phase
response to treatment resulting in a normalization of life prior to the psychosis
Psychosis
- a group of symptoms, not a diagnosis in itself
- may be related to another illness (ie. MD, bipolar Disorder, substance Use)
- Can be transitory
Schizophrenia
- is not attributable to another disorder
- long-term, chronic condition
- cognitive difficulties related to illness
Unlikely to persist across the lifespan
- Brief Psychotic Disorder
- substance-induced psychosis
May Persist across the lifetime:
- other specified Schizophrenia Spectrum and Other psychotic Disorder/Psychosis NOS
- Delusional Disorder
Likely to persist across the lifespan:
Schizophrenia
-Schizoaffective Disorder
What causes Psychosis
- Genetic factors
- biochemical abnormalities
- abnormal brain structure
- environmental influences
- street drug use
- some medical conditions
Diathesis Stress model
Orange: Family history Genetic Vulnerability Psychological Resilience Blue: Life stress Trauma Substance Use Environmental Stressors Red: (blue combine with orange) Likelihood of illness manifestation (ie. Schizophrenia)
The stress Vulnerability Bucket
layer 1: genetic factors
layer 2: Physical stress - eg. late nights, poor diet, lack of routine, illness, drug use
Layer 3 -Environmental Stress: living situation, financial problems, school demands
layer 4: emotional stress: peer pressure, relationship issues, conflicting cultural values and beliefs
Layer 5 (tipping point): Increased drug use
How brain cells communicate:
Axon –> transmitter –> receptor- Axon
How does how brain cells communicate relate to psychosis (3 reasons)
- one theory about why symptoms of psychosis occur is the Dopamine Hypothesis
- Dopamine is involved with perception (ie. the 5 senses)
- People with psychosis have been shown to have increased dopamine activity in their brain
Normal vs Excess Communication
What happens when things go wrong? Sometimes the communication system breaks down because there is too much or too little of a neurotransmitter in the brain (there is a chemical imbalance). When this happens, information isn’t processed correctly and the brain starts to make mistakes when it tries to interpret information or tell the rest of the body how to act. The effects of chemical imbalances can change based on the area of the brain that is affected and the neurotransmitters that are involved. Psychotic disorders are linked to abnormally high amounts of dopamine and low amounts of glutamate in many different parts of the brain, including areas that are involved in gathering and processing information about the world, controlling the body’s movement and emotions, thinking critically, and learning new things.
Why is psychosocial factors of occupation and psychosis important
-adolescence and emerging adulthood is a high-risk time for mental disorders
Psychosis and Occupational Performance (5 points)
- not a diagnostic criterion, but present among many diagnosed persons
- degree of cognitive impairment varies with symptoms
- if cognitive changes occur they usually onset with illness but remain stable over time
- Attention, memory, and executive function are particularly affected
- behavioural change is challenging and may require a lot of direction/encouragement
Health, Wellness and Occupational Performance
- 20% shorter life expectancy
- “Poorer health interpersonal support, and beliefs that health was not within their control”
- side effects of antipsychotic medication
- high smoking rates
- oral disease
Stigma, Social Issues, and Occupational Performance
- highly stigmatized mental illness
- effects of poverty on community integration/participation
- A primary disturbance of “self”
Lived Experience of Psychosis
TALK ABOUT VIDEO
Services Where OTs Support Persons with Psychosis/Psychotic Disorders
- Inpatient Psychiatric Units
- Early Psychosis Intervention Programs
- Assertive Community Treatment Teams
- Mental Health Case Management Services
- Crisis Teams
- Tertiary Care Psychiatric Hospitals
- Forensic Programs
Assessment Approaches in Psychosis
-psychosis rarely presents in “neat parcels” and clients rarely volunteer the information
observation….observation…..observation
Open-ended, non-leading questions
–> Ask for general description of experiences
-Use language they will understand/avoid medical jargon
-understand cultural context which information is presented
-Mental status Examination (MSE) / Mini Mental Status Examination (MMSE)
-Symptom Checklist
Occupation Focus:
OT specific Assessments in Psychosis
Occupational focused:
- ADL/independent Living Skills (i.e Kitchen assessment, safety responses, community navigation)
- Time Use Log
- Vocational/productivity Assessment
- Action Over Inertia (AOI) worksheets
- Leisure Checklists
- Canadian Occupational Performance Measure
Symptom Focused:
- positive and negative symptom Scale (PANSS)
- Cognitive Assessments (Memory, attention, Executive Function)
- Beck Depression Inventory Scale (BDI–II)
- test of everyday attention (TEA)
- Rivermead Behavioural Memory Test (RBMT-3)
- Patient Health Questionnaire (PHQ-9)
Early Psychosis Intervention (EPI)
- early intervention -prevent life trajectory of persistent impairment, disability, and disrupted participation as a result of psychosis
- Development of separate services with their own mission/standards/policies for early intervention (EPION) (ontario network)
- current emphasis in service delivery
- -> interdisciplinary perspective
- research suggest that EPI programs may improve outcomes, especially if duration of untreated illness is minimized. which is a major EPU program goal
Medical Approaches to Treat Psychosis
- most people with psychosis are prescribed antipsychotic medication
- sometimes individuals with psychosis are also prescribed antidepressants, mood stabilizers and/or anti-anxiety medications
- ongoing medical investigations for metabolic issues due to medication side effects
How Medications Help
- antipsychotic medication can block the dopamine receptors, so the excess chemicals don’t pass on too many messages
- medications help to restore the chemical balance in the brain
Client Centeredness -ensuring the person is in an “active” participant (psychotic disorders)
- Providing knowledge /information about psychotic disorders and occupation
- providing knowledge/information about interventions and evidence for interventions
- engaging the individual quickly in manageable, supported change
Information (psychotic disorders)
-what specific education/information would the client need?
How might education/information need to be individualized
-what “quick” changes might you implement, even after you first visit or two
- Coping with Psychosis:
- Routines
- planning for maintaining control in the early stages of psychosis (managing symptoms)
- active coping skills (behavioural and cognitive strategies, healthy lifestyle changes)
- Addressing the cognitive and interpersonal components (psychosis)
- interventions to address thoughts and interpersonal processes
- may need to develop communications skills
- applying these strategies within occupation
Enabling Behaviour (psychosis)
- planned and graded introduction of performance with application of strategies
i. e Grading supports, grading time engaged, grading complexity - use of knowledge about the personal meaning of occupation
- use occupational engagement to enable health and well-being
Recovery in Psychosis Questions
What does recover mean to you
What is the difference between rehbailiation and recover that Patricia Deegane outlined in your reading
Disabled persons are not passive recipients of rehabilitation services .. Rather, they experience themselves ·as recovering a new sense of self
and of purpose within and beyond the limits·of the disability.
This distinc-
. tion between rehabilitation and recovery is important. Rehabilitation
refers to the services and technologies that are made available to disabled
persons so that they might learn to adapt to their world. Recovery refers to
the lived or real life experience of persons as they accept and overcome the
challenge of the disability. We might say that rehabilitation refers to the
“world pole” and that recovery refers to the “self pole” of the same phenomenon.
Later I learned the reason
for this: when one lives without hope, (when one has given up) the willingness to “do” is paralyzed as well.
We rebuilt our lives on the three cornerstones of recovery- hope, willingness, and responsible action. We
learned to say: “I am hopeful”; “I am willing to try”; and “I discover that
I can do” (Knowles, 1986).
Recovery in Psychosis
- recovery from a mental illness is different from many physical illnesses
- recovery in mental health often does not mean a cur
- recovery is an attitude, a stance, a way of approaching the day’s challenges
- recovery is about being happy in life, trusting and respecting oneself
- recovery is about having hope for the future
- recovery can be related to vocational or interpersonal functioning
- recovery is not a perfectly linear journey
- each person’s journey of recovery is unique
- each person most find what works for them
Relapse Prevention in psychosis is:
a process of gradual decline in function which leads to the recurrence of psychotic symptoms
-often preventable if individuals can recognize the warning signs and symptoms, and take charge by making change for prevention
Possible Warning Signs/symptoms
- disturbances in thinking perception
- changes in feeling
- behavioural changes
- changes in sleeping patterns
- return to substance use
LOOOK AT CASE STUDY FOR Psychosis
DISCUSS
Summary
- psychosis is a group of symptoms, which is associated with a variety of diagnoses
- schizophrenia is a disorder involving psychosis
- psychosis can have a profound impact on interpersonal, occupational, and thought processes
- OT’s have an important role in supporting the recovery of persons with psychosis and psychotic disorders to improve daily life functioning
