Final Exam Flashcards
Steps to creating a relapse prvention plan (4)
1) develop a list of symptoms
2) Develop a list of ways to “stay well”
3) Brainstorm a list of triggers
4) Developing strategies
Wellness Action Recovery Plan (WRAP) - 3 aspects
Daily maintenance (defining wellness; what is required to stay well each day/week etc.)
Early warning signs
When things are breaking down (Signs things are getting worse/advanced care directive)
Define social role valorisation
Involves establishing, enhancing, maintaining social roles for people at risk. Welfare is dependent on the social roles people have and those who are socially devalued by others experience wounds.
first generation antipsychotics
Chlorpromazine Flupenthixol Fluphenazine Halperidol Thioridazine
second generation antipsychotics
Clozapine Aripiprazole Amisulpride Olanzapine Risperidone Quetiapine
Positive Symptoms: major psychotic conditions (3)
Hallucinations
Delusions
Disorganised thoughts
Negative symptoms: major psychotic conditions (3)
Blunting of affect
lack of motivation or pleasure
social withdrawal
Mood symptoms: major psychotic conditions
Insight
Depression/euphoria
Suicide
Key features of personality disorders
Disturbances in self-image
inability to have successful interpersonal relationships
Poor impluse control
Treatment personality disorders
Antipsychotics (calm)
Lithium carbonate (moods)
Antidepressants
Substance missuse (deal) Help person cope with or avoid situations that cause distress Talk therapies like DBT
Key goals of the NDIS
Ensures support by mainstream services
Building independence and increasing participation
Ablity to achieve goals and to be included in community life
Choice and control through reasonable and necessary supports!
How to provide person centred supports (WK 5 intellectual disability) (6)
1) know person’s preferred routines, likes, dislikes, skills, hopes and goals
2) identify meaningful occupations
3) support friendships/networks
4) support engagement in community life
5) support communication
6) assist new learning in natural contexts
Define Complex Communication Needs (CNN)
People with disabilities who have severe speech and language impairments
What is Augmentative and Alternative Communication (AAC)?
Other types of communication used to enhance or replace speech
e.g. gestures, sign, facial expression, alphabet picture boards and even computer programs
Core communication skills (3) for people with CNN using AAC
1) identify/develop a method to initiate conversation
2) Indentify or develop an intelligible “yes/no”
3) Competent and supportive communication partners
Manual systems - low tech AAC devices (3)
1) Visual communication aids (signs, cards, boards, buttons)
2) visual reminders (may help give choice or an order they can do things in; adaptive communication to aid with regulation)
3) Pragmatic Organisation Dynamic Display (PODD) or Electronic/high-tech systems (complex system; may be used on an ipad display or some for books)
General communication tips for people with CCN
Respond to gestures like words Know the power of your own gestures Keep language simple Use moderate or slow speech rate Pacing (allow longer time for response) Consider your affect & how to support the person's own affect regulation Ask open questions were possible Make comments back to person
What kind of housing supports can be provided under the NDIS? (wk6 intellectual disability)
Capacity building supports Assistance with daily living Support with personal care, help around home Home modificaitons or assistive tech Life transation planning
How can an OT support home and community living? (wk6 itellectual disability)
Housing selection
Identify lvl of support needed in home
Home modifications
Community skill training
Working with a person to identify possible new occupations at home or in the community
Considering environment when addressing specific occupational or task areas
How do we best support occupations at home and in the community? (wk6 itellectual disability)
Skill development Adapt task Environmental adaptions Support workers, family & person; education, coaching, problem solving Record keeping/info sharing is critical
What is active support in the context of accomodation services (wk6 intellectual disability)
Doing with, not for - Designed to bridge to participation in everyday activities for people who lack the skills to participate independently.
If participation leads to skill development and independence, this is a bonus
Key housing considerations
wk6 intellectual disability
Safety issues
Need for support systems to be accommodated
Space for separate activities/privacy
Consideration of needs (e.g. location of windows if person is unaware of privacy)
Consideration of future needs
Cultural considerations (e.g. diet, religion)
What was the purpose of the Burdekin report (National Inquiry into Human Rights of People With Mental Illness)?
To address the ignorance of the nature and prevalnce of mental illness in the community, address discrimination and to dispel misconceptions that people with mental illness are dangerous and never recover
How has the Burdekin report informed practice? (Key principles)
Services =optimal quality of life Facilitating sustained recovery Consumers involved in care Choice Right to nominated carer(s) involved in all aspects of care Carers' needs/capacity should be considered Tailored to individual needs Least restriction on rights/choices
What to consider in the MSE heading: APPEARANCE
Grooming/clothing Weight/size Unique physcial features (e.g. tattoos) Facial features Gender Age Hair/beard Ethnicity
What to consider in the MSE heading: BEHAVIOUR
Psychomotor agitation or retardation Repetition (e.g. tremour or fidgeting) Gait (hunched vs chest out) Eye contact (severe, intense or avoiding) Checking doors, looking around Posture (down/up)
What to consider in the MSE heading: SPEECH
Not what is said but rather HOW - includes rate, volume, tone, articulation
What to consider in the MSE heading: MOOD
Self-reported
Consider the intensity, significance, time and variability of their mood.
Includes neurovegetative disturbances in appetite, sleep, libido and motivation
What to consider in the MSE heading: AFFECT
Affect is what you see
Range of emotion - restricted or full range
Does intensity of emotion match what the person is saying or is it exaggerated, blunt or flat
Does emotional expression change rapidly without any apparent reason? Is it labile? Stable? Mobile? Reactive?
Emotional expression congruent with reported mood?
What to consider in the MSE heading: PERCEPTIONS
Hallucinations
Illusions
What to consider in the MSE heading: THOUGHT CONTENT
Delusions Preoccupations Obsessions Paranoia Compulsions Phobias
What to consider in the MSE heading: THOUGHT FORM
Process/pattern of thoughts - easy to follow or disordered?
Circumstantiality (asking one Q and getting info about somethign random)
Tangentiality (not getting back to point)
Flight of ideas
Derailment/loosening of association (starts off typically before going random)
Thought blocking (talking and thought “disappears”)
Thought
What to consider in the MSE heading: COGNITION
Alertness Orientation to time person place Memory (recall) Concentration Capacity to make informed decisions
What to consider in the MSE heading: JUDGEMENT
Ability to assess situation and organise an appropriate behavioural response. Good, impaired or poor?
Behaviour longitudinally - rapid, unplanned, spontaneous, impulsive or socially inappropriate behaviour. Do they consider primary or secondary consequences?
What to consider in the MSE heading: INSIGHT
Awareness of situation - generally if someone is aware they are unwell and of what their symptoms are. This can be graded (poor, partial, good) but examples should be given to justify.
Key characteristics of traditional risk assessment measures
Score likelihood risky behaviour
Done as a single form at end of a case review doc
Little evidence/reliability
How to assess risk
Be direct/unambiguous (e.g. are you going to end your life?) Consider language (e.g. "commit""successful/unsuccessful") Try to avoid saying "you're not thinking/going to..."
Prevention-oriented risk prevention
1) clinical data
2) Risk status (risk relative to subpopulation)
3) Risk state (risk compared to baseline or other times)
4) Availabile resources (to draw upon in crisis)
5) Forseeable changes (that could affect risk)
OT specific Assessments
1) interests (NPI interest checklist)
2) Daily activity (pie chart, diaries)
3) Role function (role checklist, history & change)
4) Occupational performance (living skills like Community Living Skills Scale (CLSS))
5) Environment
6) Strengths (personality, motivations etc.)
Generic assessments
1) MH assessment (problem, history, medical, personal)
2) Ongoing assessment of mental/physical health, social needs, family/carer needs, risk & daily living
3) MSE
4) Risk Assessment
5) Cognitive Screening (Mini mental status examination MMSE)
6) Goals & aspirations (recovery star)
7) Outcome measures (e.g. life skills profile)
Describe Cognitive Remediation therapy (CRT)
Behaviour-based training techniques used to improve cognitive functioning. Uses preparatory methods, purposeful activities (develop skills to enhance engagement) and meaningful activities (occ as means). Focuses on promoting a positive learning experience that gives the person confidence to acquire new skills.
Remotivation process
1) exploration: aim to increase sense of capacity, personal significance & security (explore, choices, pleasure & validation)
2) Competence: increase sense of efficacy/control over performance and deciisions (internal through goals and ext. through telling story)
3) Achievement: aim to increase motivation for participation (autonomy, finding/seeking challenges)
Key characteristics of Cognitive behavioural therapy (CBT)
1) Establish link between thoughts, feelings and actions
2) Correcting misperceptions, irrational beliefs and behaviours
3) Monitoring thoughts, feelings and behaviours
4) challenging distorted cogntions
All around illness/symptoms
Describe the ABC method in Cognitive behavioural therapy (CBT)
Activating event/antecedents (event & immediate interpretations)
Beliefs of the event (this evaluation can be rational or irrational OR behaviour)
Consequences (how you feel, what you do and other thoughts you have)
Key characteristics of Dialectical Behavioural Therapy (DBT)
Designed for clients w/ BPD or self-harming behaviours
Mindfullness= method to acces the wise mind (middle-ground) - acknowledges facts & emotions (rational and emotional mind coming together to create the wise mind)
TEACHING SKILLS TO REGULATE EMOTIONS
Part one of Dialectical Behaivoural Therapy (DBT)
1) Individual Psychotherapy Sessions: once-weekly where you explore a difficult behaviour/event from the past week in detail.
Begins with chain of events leading to event
Go through alternate solutions that could have been used and what kept the client from using potentially more adaptive solutions
Part two of Dialectical Behaivoural Therapy (DBT)
Group therapy sessions each week for 2.5 hours
Exploring distress tolerance/reality acceptance skills, emotional regulation and mindfulness skills
Key charcteristics of Solution-Focused Therapy (SFT)
Working with person rather than problem (person-centred)
Asking what the person wants to be different
Comes from belief that no problem happens ALL the time - increase behaviours that are working/curiosity
3 types of questioning used in Solution-Focused Therapy (SFT)
Miracle: set problem-free goals
Scaling: evaluate where now vs where they would like to be…evaluate progress confidence, motivation etc.
Exception: Looking for times problem has not existed or happened less to see strengths, resources and that they are managing well
Key characteristics of Narrative therapy
Involves “re-authoring” situations (therapist co-author)
Problem = problem (not person)
Centres around ppl. as experts in their lives (with skills, believes values and abilities to assist)
Exteranlising the probelm form the person (the problem has…)
Benefits of group interventions
Cost efficient Opportunity to use social skills Empower ppl. with similar experiences Behaviour change Learning opportunities Build self-esteem Role Modelling
DIY: Group Development
1) Needs analysis (how to address goals/needs, content, resources & evaluation; Recovery focused)
2) Developing programme (what content according to consumer, literature & professional knowledge)
3) Running a programme (resources: group members, facilitators and physical needs like space/whiteboard)
4) Evaluation & revision (what measures/when; evaluate form/structure, group purpose, leadership, dynamics)
Interaction problems (in groups)
1) Withdrawal
2) confluct between members
3) expressed emotion
4) Domination by one member
5) Intermittent Participation
ACE questions
Childhood abuse (emotional. physical or sexual) Household dysfunction (one household member alcholic/drug user and/or mentally ill and/or imprisoned, mother treated violently, one household member imprisoned & loss of biological parent)
ACEs increase the risk of:
Heart disease Chronic lung disease Liver disease Injuries HIV and STDs & other risks for leading causes of death
How does ACE scores influence the way that we might look at addiction or depression?
Because it considers how these characteristics correlate with these people’s childhood to change brain chemistry/responses
ACE and adoption of risks
ACE –> social, emotional and cognitive impairment –> adoption of health-risk behaviours –> disease, disability & social problems –> early death
How to explain sensory modulation to others?
‘Improving the way you feel and function by using your senses’
‘Altering the internal physiology and level of arousal by using sensory modalities and sensorimotor activities’
OTs use sensory modulation to:
- Build rapport
- Promote ‘doing’ - therapeutic use of tailored activity, trialling of what works.
- Promote recovery – ↑ self management and mastery
- Adopt trauma informed care – ↑ feelings of safety
Rules for sensory modulation
Client driven Use clinical reasoning Calming first Safety first Appropriate, accessible ADL and regular activities
When to use sesnory modulation
1) Sympathetic nervous system (e.g, anger, anxiety)
2) Dorsal Vagal Parasympathetic NS (physiological state, spacey/numb, shame)
3) Distress tolerance
4) Cogntive impairment (cognitive strategies innappropriate)
5) Trauma background
MoHO and sensory modulation: Volition: values, interests and personal causation
Sensory patterns and preferences influence volition
Harnessing sensory approaches to build volition
(appropriate/meaningful sensory activities or kits to facilitate activity engagement)
Sensory modulation to support activity engagement SENSORY KITS
Collection of individual items, strategies and techniques…e.g. shelf at home, pencil case in bag or card reminders
MoHO and sensory modulation: Habituation: Habits and roles
Sensory patterns and preferences influence skill set promotion and encourage health habits
MoHO and sensory modulation: Performance capacity
Physical and mental capabilities involve the lived experiences that shape performance. Sensory modulation can affect change in objective and subjective performance
MoHO and sensory modulation: Environment
Consider light, noise, temp & smell
Greenscape/bluescape
Sensory spaces
Why is returning to employment important (7)
1) housing (opportunities and less eviction)
2) Protects against disabilities that are secondary to the illness
3) Self-efficacy & esteem
4) Reduce stigma & Marginalisation
5) Measure recovery based outcomes with work/education acheivements
6) Positive relationships
7) Opportunity for social integration & inclusion in community
Predictors of successful employment
Person’s motivation
Nature of employment service provided
7 Principles of Individual placement and support (IPS)
1) Goal of competitive employment
2) Service eligibility based on individual’s choice (no “work readiness” just desire to work)
3) Integration of MH & employment services
4) Rapid commencement of job search activities/placement
5) Individualised job selection based on individual’s interests & preferences
6) ongoing assitance to retain employment
7) Personalised welfare benefits and counselling
OT Role and work
Use standardised assessment Assist w/ career-planning Assist w/ disclosure plans/decisions Consider skill/confidence Ensure relapse management plans have work issues incl. Address performance anxiety Ensure habits support worker role Ensure E & P fit workplace
