Final Exam

Question 1

In general, a trait is a long standing component of your personality, while a state is a temporary position you are in or a transient component of your personality?

T/F

Answer 1

True

Question 2

The signs and symptoms of dependent personality disorder include an excessive need to be taken care of, difficulty making independent decisions, and fear of disagreeing with others

T/F

Answer 2

True

Question 3

You can have more than one personality disorder even though you have one personality.

T/F

Answer 3

True

Question 4

Fidelity, a principle contained in the OT Code of Ethics, embraces the idea that OTs should treat colleagues with respect and should use conflict resolution techniques to resolve interpersonal and organization conflicts.

T/F

Answer 4

True

Question 5

List five ways the activity of gardening might help a person diagnosed with schizophrenia in the areas of occupation, performance skills, performance patterns, context, and environments, and client factors. Give one way for each of these 5 categories

Answer 5

Common cognitive symptoms of schizophrenia include:
- Disorganized thinking: Difficulty organizing thoughts and expressing them coherently, resulting in fragmented speech or language that is difficult to understand.
- Attentional deficits: Difficulty sustaining attention or maintaining focus on a task, leading to distractibility and problems with concentration.
- Executive functioning deficits: Difficulty with planning, organizing, and carrying out complex tasks, leading to difficulties with daily activities and self-care.
- Memory impairment: Difficulty with short-term memory, leading to forgetfulness and difficulty learning new information.

Occupation = Leisure Participation
Performance Skills = motor skills: calibrates and flows through the various steps in the process of gardening
Performance Patterns = routine of watering plants
Context: Environment = community garden
Client Factors = mental functions: experience of self and time

Question 6

The most common personality disorder is:

a. Histrionic
b. Borderline
c. Schizoid
d. Not otherwise specified

Answer 6

Not otherwise specified

Question 7

Beginning in early adulthood a client begins expressing suspiciousness of others, becoming preoccupied with doubts about the loyalty of his friends, and reading threatening meanings to benign remarks. Which of the following is the most likely diagnosis?

a. Paranoid personality disorder
b. Antisocial Personality disorder (irreverence of others)
c. Schizoid Personality Disorder (may have no friends but not suspicious)
d. Schizotypal Personality Disorder

Answer 7

Paranoid personality disorder

Question 8

To diagnose a personality disorder, the most indicative method is through using

a. Cluster of symptoms
b. MRI
c. Blood test
d. PET scan

Answer 8

Cluster of symptoms

Question 9

When a person suffers from a Cluster A Personality Disorder, this person will generally experience avoidance tendencies.

T/F

Answer 9

False
(Cluster A is “odd/eccentric behaviors” such as paranoid, schizoid, and schizotypal while cluster C would be avoidant (OCD, avoidant and dependent personality disorders. Cluster B is “dramatic and erratic” which are narcissistic, borderline, histrionic, and antisocial personality disorder.)

Question 10

Tarasoff Law mandates outpatient treatment.

T/F

Answer 10

False (Tarasoff requires duty to protect or warn a third party only if the therapist believes or predicts the patient posed serious risk of injury to others –> endangered individuals)

Question 11

When a patient with schizophrenia expresses thoughts that shift from one subject to another in an incoherent fashion, which has no connection to reality this is best described as which of the following?

a. Loosening of associations
b. Flight of ideas
c. Circumstantiality
d. Tangentiality

Answer 11

A

A. Loosening of associations (When you have no connection to reality, lack of connection b/w ideas)
B. Flight of ideas (seen in mania, erratic thought, rapidly shifting speech)
C. Circumstantiality (digresses to give unnecessary and often irrelevant details before arriving at the main point)
D. Tangentiality (excessive or irrelevant detail that doesn’t reach a point)

Question 12

Beneficence is a principle of the OT Code of Ethics, which means that the therapist must refrain from engaging in any sexual relationship or activity with a service recipient or their family even if it is consensual.

T/F

Answer 12

False (This describes nonmaleficence)

Question 13

Idealizing and devaluing a therapist by a client, which is also called splitting is a symptom that is associated with the follow two disorders

a. Eating and schizoid personality disorder
b. Borderline and substance use disorders
c. Social anxiety and mild neurocognitive disorders
d. Antisocial and personality and PTSD

Answer 13

Borderline and substance use disorders

Borderline Personality Disorder = pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts

Question 14

What severity level of autism would someone have who is requiring “very substantial support”?

a. Level 1
b. Level 2
c. Level 3
d. Level 4

Answer 14

c. Level 3

Level 1 (requires support)
Level 2 (requires substantial support)
Level 3 (requires very substantial support)
Level 4 (There is no level 4!)

Question 15

Schizophrenia affects individuals from some ethnic and racial groups more than others.

T/F

Answer 15

False (Some racial and ethnic groups are more likely to be DIAGNOSED with schizophrenia, but it affects/is prevalent among all groups equally - 1% of the population.)

Question 16

It is never a good idea to ask someone with schizophrenia about their hallucinations:

T/F

Answer 16

False

Question 17

The following are all true about Personality Disorders EXCEPT:

a. They are not treatable
b. They are hard to diagnose
c. They are debilitating by definition
d. They influence behavior

Answer 17

a. They are treatable (some people don’t want to change the way they are doing things which is why people think it is not treatable)

Question 18

If a patient on an inpatient unit in NYS refuses to take his psychotropic medication, and the medical team believes that it is not an emergency but is necessary for the safety of the patient and others. What is the most likely outcome?

a. The staff can force the patient to take the medication
b. The patient is assigned a paraprofessional to monitor his activities
c. The patient is assigned a mental hygiene lawyer and goes to court
d. The patient is discharged against medical advice

Answer 18

c. The patient is assigned a mental hygiene lawyer and goes to court (because it is not an emergency, but they are in danger of hurting themselves and others, so it needs to be an outside arbiter)

Question 19

Which of the following is not necessary to diagnose ASD?

a. Deficits in social-emotional reciprocity
b. Intermittent periods of catatonia
c. Restricted, repetitive patterns of behavior
d. Deficits in nonverbal communicative behaviors

Answer 19

b. Intermittent periods of catatonia (associated with schizophrenia not ASD)

Catatonia = disorder that disrupts a person’s awareness of the world around them. People with this condition sometimes react very little or not at all to their surroundings, or might behave in ways that are unusual, unexpected or unsafe to themselves or others.

Question 20

Your client Mary reports hearing voices commanding her to stop working and give up her home. This is an example of what kind of perceptual experience?

a. hallucination
b. illusion
c. delusion
d. phobia

Answer 20

a. hallucination

a. hallucination = false sensory perception experienced w/o real external stimulus
b. illusion = misperception of real external stimulus (when consciousness is reduced)
c. delusion = false beliefs despite evidence to the contrary
d. phobia = persistent, excessive, unrealistic fear

Question 21

Rochelle went to college and returned home after her first semester to visit her parents. Rochelle’s family became concerned that over her break from school, Rochelle seemed very withdrawn, spending most of her time in her room. Her mother noticed that Rochelle was talking to someone, but her phone and computer were off. Rochelle explained that her alarm clock was sending her messages to stay in her room “until the job was done”. Rochelle had never used street drugs before and denied taking any in college, so her mother called her doctor. After an examination, the doctor said Rochelle is probably experiencing the onset of …

a. personality disorder
b. Schizophrenia
c. Depression
d. phobia
e. None of the above

Answer 21

b. schizophrenia

Personality disorder = one’s way of thinking, feeling and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time, is pervasive and inflexible, leads to distress or impairment
Schizophrenia = serious mental disorder in which people interpret reality abnormally. may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling
Depression = mood disorder that causes a persistent feeling of sadness and loss of interest
Phobia = persistent, excessive, unrealistic fear

Question 22

One of the criteria that can result in a person with mental illness being involuntarily hospitalized in NY State is the expression of suicidal ideation with means and a plan.

T/F

Answer 22

True
Other criteria is homicidal thoughts (harm to yourself or others)

Question 23

The federal agency that is responsible for funding, educating the public, and disseminating information about mental health research and evidence based interventions is which of the following?

a. DHS
b. NAMI
c. SAMHSA
d. NIH

Answer 23

d. NIH

DHS (Department of Homeless Services) = help New Yorkers return quickly to their communities and to permanent housing

NAMI (National Alliance on Mental Illness) = offers educational programs, advocates for individuals and families affected by mental illness, and operates a toll-free helpline

SAMHSA (Substance Abuse and Mental Health Services) = promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes

NIH (National Institute of Health) = nation’s medical research federal agency, supporting scientific studies that turn discovery into health – responsible for funding, educating the public, and disseminating information about mental health research and evidence based interventions

Question 24

A patient with a long-lasting and inflexible pattern of cognition, affect, interpersonal functioning and impulse control that deviates significantly from the expectations of her culture is admitted to an inpatient unit. In her initial evaluation the OTR notes that this pattern causes significant stress and occupational dysfunction. What would be the most likely diagnosis that the OTR would expect to find in the patient’s chart?

a. Anxiety Disorder
b. Eating Disorder
c. Personality Disorder
d. Substance Use Disorder

Answer 24

C. Personality Disorder

Question 25

John has always been a little odd and strange, having difficulty in close relationships, illusions, and magical thinking. John probably has:

a. schizotypal personality disorder
b. paranoid personality disorder
c. histrionic personality disorder
d. borderline personality disorder

Answer 25

a. schizotypal personality disorder

Question 26

The Multiple Errands Test is an example of a performance based assessment of executive functioning

T/F

Answer 26

True (It evaluates executive functioning deficits with real world tasks that someone may do in everyday life; performance-based)

Question 27

A person with a psychotic illness is admitted voluntarily to an inpatient unit in New York City. She decides that she would like to leave without further treatment. Which of the following steps must she take to get discharged?

a. Locate a family member to sign her out
b. Obtain a two-physician certificate (2-PC)
c. Go to court with her mental hygiene attorney
d. Write a 72 hour letter

Answer 27

d. Write a 72 hour letter

Question 28

Alzheimer’s is a specific disease as opposed to dementia, which is a group of diseases.

T/F

Answer 28

True (Dementia is the broader umbrella and Alzheimer’s is a type of dementia)

Question 29

The SAFE act:

a. Stops criminals and people with mental illness from buying or owning a gun.
b. Allows mental health providers a way of ensuring those with mental illness take their medication to ensure those with mental illness take their medication to ensure their safety along with those around them.
c. Mandates people with mental illness to acquire outpatient treatment (Kendra’s Law)
d. Forces a person who is actively suicidal to be involuntarily admitted to the hospital (Mental Hygiene Law)

Answer 29

a. Stops criminals and people with mental illness from buying or owning a gun

Question 30

When admitting someone involuntarily to a psychiatric unit, who does not make a decision in the admission process?

a. Psychiatrist from the psychiatric facility who verifies this is an appropriate admission
b. The person being admitted
c. An applicant that can be a family member or someone who lives with the person
d. Two separate physicians outside of the psychiatric facility to evaluate the patient for admission

Answer 30

b. The person being admitted

Question 31

When a person suffers from a Cluster C personality disorder this person will generally experience controlling tendencies

T/F

Answer 31

False (It’s more of a withdrawn tendency; A is more paranoid (odd/eccentric), B is more dramatic and erratic)

Question 32

Kendra’s Law mandates psychotherapists to protect and prevent harm

Answer 32

False (Meant to protect a person who needs treatment in an outpatient setting → court mandated assisted outpatient therapy)

Question 33

Beginning in early adulthood a client begins talking to himself, insisting that the FBI is inserting thoughts into his head, and believes that he is a direct messenger from God. The OT student knows that the client has a diagnosis of schizophrenia and is expressing which type of symptom?

a. Flight of ideas
b. Positive symptoms
c. Intellectualization
d. Negative Symptoms

Answer 33

b. Positive symptoms

Flight of ideas = seen in mania, erratic thought, rapidly shifting speech

Positive symptoms = experiences or behaviors that are added to a person’s normal experience, meaning they are not typically present in people without schizophrenia (i.e. delusions, hallucinations, disorganized thinking & speech, abnormal motor behaviors)

Intellectualization = rational thinking and analysis to distance oneself from emotionally charged or uncomfortable situations

Negative Symptoms = experiences or behaviors that are taken away from a person’s normal experience, meaning they represent a loss of normal functions
- Alogia = difficulty w/ verbal communication or reduced speech output, resulting in brief or empty responses
- Avoilition = reduced motivation or inability to initiate and sustain goal-directed behavior, leading to difficulties with everyday activities
- Anhedonia = reduced ability to experience pleasure or enjoyment from typically pleasurable activities, such as socializing or hobbies
- Blunted Affect = reduced emotional expression and facial movements, leading to a lack of responsiveness in social situations

Question 34

COTE (Clinical Opiate Withdrawal Scale) Scale

Answer 34

COTE is a tool used to assess and measure the severity of withdrawal symptoms in individuals who are undergoing detoxification from opioid drugs

Evaluates 11 common symptoms of opioid withdrawal:

Resting pulse rate
Sweating
Restlessness
Pupil size
Bone or joint aches
Runny nose or tearing
Gastrointestinal distress
Tremor
Yawning
Anxiety or irritability
Gooseflesh skin

Each symptom is rated on a scale of 0 to 5 based on the severity of the symptom, with higher scores indicating more severe withdrawal symptoms. The total score is calculated by adding up the individual scores for each symptom, with a higher total score indicating more severe withdrawal symptoms.

Question 35

Identify, analyze, and discuss how you advocated (or would advocate) for service delivery models and policies in behavioral health FW and their potential effect on the practice of occupational therapy and opportunities to address societal needs

Answer 35

Over the years, mental healthcare has grown with the help of state and federal laws that support mental health and see it just as significant as physical health. However, there is a huge need for more policies to be put in place to make mental healthcare more equitable and accessible so it’s important to stay educated and advocate for such policies. One particular service for the mental health community l am passionate about is affordable housing. There is a participant at my fieldwork who is living with homelessness. Once my group leader and I educated him on DHS (helps New Yorkers secure permanent housing) and the steps he needs to take to receive help. He was so excited and grateful to hear about DHS.