Final Terms Flashcards
What is Sleep?
Sleep is a naturally recurring state and a universal experience across all cultures
Circadian Clock
regulates hormones and temperatures during sleep resulting in effective or restful sleep.
Internal clock
regulates the “perfect” amount of sleep a person needs for best functioning
Sleep Deprivation/Sleep debt
owes” sleep hours towards rest
REM sleep:
sleep that occurs at intervals during the night and is characterized by rapid eye movements,
** more dreaming and bodily movement, and faster pulse and breathing.
Non REM (NREM) sleep:
sleep is dreamless* sleep. During NREM, the brain waves on the electroencephalographic (EEG) recording are typically slow and of high voltage,
**breathing and heart rate are slow and regular, the blood pressure is low, and the sleeper is relatively still.
Acute Stress:
body stress is normal important for survival; adrenaline cortisol is released; can affect bodies ability to calm down and sleep
Chronic Stress:
long exposure to stress; hippo campus functions poorly, accelerated neuron death
Insomnia
sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms: Difficulty falling asleep. Waking up often during the night and having trouble going back to sleep
Psychophysiological insomnia (Conditioned insomnia)
individuals say that can’t sleep in a certain room or bed or they may avoid it- but object has noting to do with their insomnia
Stimulus Control Therapy
de-conditioning, break cycle of problems
(go to bed when sleepy, use the bed only for sleeping, don’t lay in the bed and can’t sleep; awaken the same time/avoid napping)
Sleep Restriction Therapy
increase sleep efficiency , decrease amount of time lying in bed, be aware of daytime sleepiness, don’t sleep at other times of the day,
Relaxation Therapies
Progressive relaxation, Guided imagery (don’t do with pt who experiences hallucinations), Deep breathing
Biofeedback:
use physiologically marks to increase self-awareness
Cognitive Training:
targets negative emotional thoughts
Hypersomnolence Disorder
Excessive sleepiness that is serious, debilitating, and can be life threatening
Narcolepsy
Sleep attacks of irresistible sleepiness leading to 10-20 min of sleep, feel refreshed briefly
Obstructive Sleep Apnea Hypopnea
Repetitive collapse of the upper airway during sleep
Results in reduced oxygen and transient arousal then respiration resumes
Central Sleep Apnea
Occur in elderly, absence of breathing due to lack of respiratory effort, Like OSA but NO breathing is seen in abdominals or chest
Idiopathic central sleep apnea
high CO2 in arteries, low CO2 in veins, daytime sleepiness, wake up with shortness of breath
Cheyne-Stokes breathing
prolong hyper-pena, alternating with apena, hypo-pena, respiratory rate changes fast to slow to absent seen in older man with CHF or stroke
Central sleep apnea co-morbid with opioid use
causes impairment of neuro-muscular respiration
Circadian Rhythm Sleep-Wake Disorders: Delayed sleep phase type
natural biological clocks run slower, more alert in the evening, more tired in the morning (night owl)
Circadian Rhythm Sleep-Wake Disorders: Advanced sleep phase type
shifts earlier, wake earlier, tired in the evening, early bird
Circadian Rhythm Sleep-Wake Disorders: Irregular sleep-wake type
sleep wake cycle is absent,, sleep is unpredictable, fragments sleep -individuals who has Alzheimer
Circadian Rhythm Sleep-Wake Disorders: Free running (24 hour sleep wake type):
greater or less than 24 hrs and reset every morning (TBI or blind)
Circadian Rhythm Sleep-Wake Disorders: Shift work type
insomnia, excessive sleepiness, results in sleep deprivation
Circadian Rhythm Sleep-Wake Disorders: Jet Lag:
disorder, travel across time zone
night owl have time traveling east, early birds have trouble traveling west
Parasomnias
disruptive sleep disorders that can occur during arousals from rapid eye movement (REM) sleep or arousals from non-rapid eye movement (NREM) sleep. They can result in undesirable physical or verbal behaviors, such as walking or talking during sleep
Restless Legs Syndrome:
general twitching
Periodic Limb Movement Disorder
twitch
Sleep-related Bruxism
grinding, clenching teeth
Alcohol Use Disorder:
binge drinking; drink non-alcoholic beverages
Alcohol Intoxication:
drunkenness, stumbling
Alcohol Withdrawal:
seizure, delirium, if untreated can cause mortality, can occur up to 1 week after stop drinking
Alcohol-induced Persisting Amnestic Disorder
memory loss due to prolong abuse, drinking for a long period of time, rare under 35 yrs old
Alcohol-Induced Mood Disorder
depressant, 80% results in depression
Alcohol-Induced Anxiety Disorder
can last for several hours, or even for an entire day after drinking. … It’s common for people with social anxiety disorder to drink alcohol to cope with social interactions
Alcohol-Induced Sexual Dysfunction:
unable to perform sexually
Alcohol-Induced Sleep Disorder:
difficult sleeping
Hallucinogen Related Disorders
Intoxicants: associated with panic attack, delirium, mood and anxiety
Inhalant related Disorders
Volatile substances or solvents turn into gastric fumes (aerosol more common gasoline etc)
Other Personality Disorders: Depressive
What is it?
Pessimistic, duty bound, self doubting, chronically unhappy, lonely solemn, gloomy, submissive, self deprecating
4 Dimensions of Temperament
Harm Avoiding
Novelty Seeking
Reward Dependence
Persistence
4 Dimensions of Temperament: Harm Avoiding
High = pessimistic, fearful, shy, fatigable Low = optimistic, daring, outgoing, energetic
4 Dimensions of Temperament: Novelty Seeking
High = exploratory, impulsive, extravagant, irritable Low = Reserved, deliberate, thrifty, stoical
4 Dimensions of Temperament: Reward Dependence
High = sentimental, Open warm, affectionate
Low = detached, aloof, cold, independent
4 Dimensions of Temperament:Persistence
High = industrious, determined, enthusiastic, perfectionist
Low = lazy, spoiled, underachiever, pragmatist
PEO: Person
Person is mind, body, and spirit
PEO: Environment
Context in which occupation takes place
Cultural
Physical
Social
PEO: Occupation
Everyday life activities that are goal directed, meaningful to individual and culturally relevant
Personality Disorders:
Cluster A
odd, aloof features
schizotypal, schizoid, paranoid
Often comorbid with schizophrenia
Personality Disorders:
Cluster B
dramatic, impulsive, erratic features (borderline, antisocial, narcissistic, histrionic)
Borderline PD often comorbid with depression
Antisocial PD often comorbid with alcohol abuse
Histrionic PD often comorbid with somatosensory disorder
Personality Disorders:
Cluster C
anxious and fearful features (avoidant, dependent, obsessive-compulsive)
Personality Disorders: Fantasy
seek solace and satisfaction within themselves by creating imaginary lives & imaginary friends
Personality Disorders: Dissociation
the replacement of unpleasant affects with pleasant ones; they may be labeled as histrionic personalities
Personality Disorders: Isolation
a characteristic of controlled, orderly persons who are often labeled as obsessive-compulsive;
Personality Disorders: Projection
atients attribute their own unacknowledged feelings to others; fault-finding and sensitivity to criticism
Personality Disorders: Splitting
the people whom patients’ are feeling ambivalent are divided into good and bad
Personality Disorders: Passive aggression
turning their anger against themselves; also called masochism
Personality Disorders: Acting out-
tantrums, apparently motiveless assaults, child abuse, and pleasureless promiscuity are common examples
Personality Disorders: Projective identification
occurs mainly in borderline personality disorder– long-standing suspicion and mistrust of people in general
Paranoid personality disorder
- Long-standing suspicion and mistrust of persons in general
- They refuse responsibility for their own feelings and assign responsibility to others & they are often hostile, irritable, and angry
- Muscular tension, inability to relax, constantly scanning the environment, & their manner is often humorless and serious
Schizoid personality disorder: Cluster A
viewed as eccentric, isolated, or lonely
Discomfort with human interaction
Introversion
Bland & constricted affect are noteworthy
May seem cold and aloof; may appear quiet, distant, seclusive, and unsociable; little need for emotional ties
Non-competitive, lonely jobs, they may have non-human interests (e.g. astronomy, mathematics, strongly attachment to animals
Appear lost in daydreams & self-absorbed, but they have normal capacity to recognize reality
Schizotypal:
Strikingly odd or strange, even to laypersons
Magical thinking, peculiar notions, ideas of reference, illusions, and derealization are part of a schizotypal person’s everyday world
May have brief psychotic episodes when under stress, but they never persist (differentiates from schizophrenia)
Clinical features: disturbed thinking and communicating; their speech may be distinctive and peculiar, may have meaning only to them, and often needs interpretation
Antisocial:
Inability to conform to the social norms that ordinarily govern many aspects of a person’s adolescent and adult behavior
These patients can act composed and credible, however, within them lurks tension, hostility, irritability, and rage
Failure to conform to social norms with respect to lawful behavior, indicated by repeatedly performing acts that are grounds for arrest, lack of remorse, consistent irresponsibility, reckless regard for safety of self of others
May appear normal and even charming
lying , truancy, running away from home, thefts, fights, substance abuse, and illegal activities are typical behaviors
They exhibit no anxiety or depression
Borderline personality disorder:
On the border between neurosis and psychosis
Extraordinarily unstable affect, mood, behavior, object relations, and self-image
Almost always appear to be in a state of crisis, mood swings are common
Patients can be argumentative one moment, depressed the next, then complaining they have no feelings the next
May have short lived psychotic episodes
Highly unpredictable behavior
Repetitive self-destructive acts (to elicit help from others, to express anger, or to numb themselves to overwhelming affect)
They feel both dependent and hostile– they are dependent on those whom they are close with & when frustrated, can express enormous anger towards them
Cannot tolerate being alone, frantic search for companionship, no matter how unsatisfactory to their own company
Histrionic:
Are excitable and emotional and behave colorful, dramatic, extroverted fashion
However, unable to maintain deep, long-lasting attachments
High degree of attention-seeking behavior
They tend to exaggerate their thoughts and feelings to make everything sound more important than it really is
They display temper tantrums, tears, and accusations when they are not the center of attention or receiving praise or approval
Seductive behaviors, may act on their sexual impulses to reassure themselves that they are attractive to the other sex, flirtatious, superficial relationships, vain, self-absorbed, fickle, overly trusting and gullible
Defense mechanisms: repression and dissociation
Narcissistic personality disorder:
Characterized by a heightened sense of self-importance, lack of empathy, grandiose feelings of uniqueness
Underlyingly, their self-esteem is fragile & vulnerable to even minor criticism
They consider themselves special and expect special treatment
Handle criticism poorly
Ambitious to achieve fame or fortune
Avoidant personality disorder
Show extreme sensitivity to rejection and may lead to socially withdrawn lives
Although shy, they are not asocial and show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance
Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
Preoccupied with being criticized or rejected in social situations
Views self as socially inept, personally unappealing, or inferior to others
Hypersensitivity to rejection & timid
They are afraid to speak up in public or make requests of others
They are apt to misinterpret other persons’ comments as derogatory or ridiculing
Rarely attain much personal advancement or exercise much authority; often take jobs “on the sidelines”
Dependent personality disorder:
Subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience severe discomfort when alone for more than a brief period
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood & present in a variety of contexts
Difficulty making everyday decisions
Needs others to assume responsibility for most major areas of their lives
Difficulty with initiation
Obsessive-compulsive personality disorder
Characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness
Essential feature: a pervasive pattern of perfectionism and inflexibility
Stiff, informal, and rigid demeanor with flat or blunted affect, lack spontaneity & usually a serious mood
Their answers to questions are unusually detailed
Preoccupied with details, rules, lists, order, organization, and schedules to the extent that the major point of the activity is lost
Perfectionism that interferes with task completion
Insist that rules be followed rigidly and cannot tolerate what they consider infractions
Passive aggressive personality
Characterized by covert obstructionism, procrastination, stubbornness, and inefficiency
Procrastinate, resist demands for adequate performance, find excuses for delays, and finds fault with those on whom they depend, they refuse to extricate themselves from the dependent relationships
Lack assertiveness and are not direct about their own needs and wishes
Depressive personality
Pessimistic, anhedonic, duty bound, self-doubting, and chronically unhappy
Sadism
the desire to cause others pain
Masochism
the achievement of sexual gratification by inflicting pain on themselves
Engagement
Occupational engagement is integral to a human and focus of OT. Human experience of occupation must be considered.
State of actively being involved or occupied.
Different levels of engagement (fully absorbed to passively involved)
Enabling
Enabling as a focus of OT, enabling implies giving people the means to do or make a difference in their own health/wellbeing
Positively influences autonomy, self efficacy, coping, and problem solving
Enabling skills
Spirituality
Essences of self, sense of purpose and meaning, relationship of self to larger society and the world
Humans express their spirituality through their occupations and experiences with occupations
Client-centered practice and empowerment
Therapist client relationship is collaborative and a partnership
Clients actively involved, negotiates goals/interventions, and exercises choices
Client centered practice increases personal agency, autonomy, self confidence, and self efficacy
Key Values of CMOP
Relationship between occupation, health, and wellbeing
Center of CMOP is
spirituality
Occupation & Meaning:
-Meaning found in 3 ways:
what are they?
1) doing deeds and creating work
2) life experience, encounter with people
3) suffering and adversity
Occupation & Meaning:
4 Human needs of meaning what are they?
- 4 Human needs of meaning:
1) event has purpose
2) consistent with persons values
3) sense of control
4) self worth of the individual
Define Occupational Alienation
demeaning tasks to a client
*example giving an older adult task that finds it demeaning “babyish”
ACL
- 0
- 6
- 0
- 6
- 2
- 0
- 6
- 8
- 2
- 8
- 4
- 0
- 0 Premeditated activity(independent)
- 6 Social Bonding, Anticipates safety, Driving, Child care
- 0 Intonations in speech
- 6 Live alone
- 2 Discharge to street
- 0 Independent Self Care
- 6 Cause & Effect
- 8 Grab bars
- 2 Walking
- 8 Pivot Transfer
- 4 Swallow
- 0 Conscious
ACL 1 2 3 4 5 6
Level 1
Custodial care
Level 2
Mobile but Dependent in self care
Level 3
24 hr S and Mod A
Level 4
Min A IADLs
Level 5
Independent living
Level 6
Independent
Canadian Triple Model
Defines how humans experience meaning through occupations and interaction between the person and environment
Canadian Process Practice Framework
8 steps for delivering services that promote enablement of occupations in a client-centered manner
Canadian Model of Client-Centered Enablement (CMCE)
** 8 steps for delivering services that promote enablement of occupations in a client-centered manner.**
Identifies and develops a range of enablement skills for occupations with sensitivity to collaboration, power, equity, and justice
CMOP-E
Experience meaning
Describes how humans experience meaning through occupations/interaction between the person + environment
CMCE
** enable skills**
Develops + identifies a range of enablement skills for occupations with sensitivity to collaboration, power, equity & justice
Assertive Community Treatment
Social (ACT)
ACT: community reintegration to improve social functioning, vocational functioning, quality of life, and medication management.
Diagnosis: schizophrenia, homelessness, correctional facilities (inmates), substance abuse, veterans with disabilities, bipolar disorder
Social Skills Training
Social skills are the basis of effective social performance and the training should be tailored to the particular job of the individual.
Diagnosis: Borderline personality disorder, depression, anxiety disorders,
Supported Employment
Employment is essential to positive mental health and community participation. Supported employment helps people with psychiatric diagnoses find jobs and sustain employment
Diagnosis: Schizophrenia Bipolar 1 & 2 PTSD OCD Anxiety Disorders Substance Abuse Disorders
Family Intervention (FI)
Outcomes for individuals with psychiatric disorders are related to the family environment. FI reduces relapse rates, enhance social adjustment of people with psychotic disorders. This reduces caregiver stress, burden, and improves coping skills.
Diagnosis:
Schizophrenia, DID, bipolar disorder
Motivational Interviewing
Four principles for treatment:
expressing empathy (let the client know that the change process is difficult)
develop discrepancy (identify differences between current bx and personal goals/values)
roll with resistance (avoid confrontation)
support self-efficacy (indicate that you believe the client is capable of making a change)
Typically offered in a brief format (sometimes just one session)
In contrast to typical behavioral change interventions, motivational interviewing using a collaborative approach and seeks to engage the client to want to change.
Diagnosis:
Substance abuse, smoking cessation, weight loss, and to increase interest in physical exercise
Dialectical Behavior Therapy
combination of cognitive and behavioral therapy
Diagnosis:
borderline personality disorder
Schizophrenia
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behavior
- Negative symptoms (i.e
Schizophrenia: paranoid type
preoccupation with one or more delusions or frequent auditory hallucinations
Schizophrenia: disorganized type
marked regression to primitive, disinhibited, and unorganized behavior and by the absence of symptoms that meet the criteria for the catatonic type
Schizophrenia: catatonic type
marked disturbance in motor function; this disturbance may involve stupor, negativism, rigidity, excitement, or posturing.
Schizophrenia: Undifferentiated Type
patients who clearly have schizophrenia cannot be easily fit into one type or another.
Schizophrenia: Residual Type
Emotional blunting, social withdrawal, eccentric behavior, illogical thinking, and mild loosening of associations commonly appear in the residual type
Dissociative Amnesia
inability to recall important personal information, usually of a traumatic or stressful nature
Localized Amnesia
inability to recall events related to circumscribed period of time
Selective Amnesia
ability to remember some but not all events related to a circumscribed period of time
Generalized Amnesia
failure to recall one’s entire life
Continuous Amnesia
failure to remember successive events as they occur
failure to remember a category of info (such as memories of family or just one person in particular)
Systematized Amnesia
is a condition characterized by sudden onset of memory loss and confusion.
Transient Global Amnesia:
Define fugue
purposeful movement from one place to another
Anorexia nervosa
induced starvation to a significant degree—a behavior.
relentless drive for thinness or a morbid
fear of fatness—a psychopathology.
presence of medical signs and symptoms resulting from starvation—
Anorexia nervosa: Restricting type
weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
- attempts to consume fewer than 300 to 500 calories per day and no fat grams
- relentlessly and compulsively overactive, with overuse athletic injurie
Anorexia nervosa: Binge-eating/purging type
Purging represents a secondary compensation for the unwanted calories, most often accomplished by self-induced vomiting, frequently by laxative abuse, less frequently by diuretics, and occasionally with emetics
Bulimia nervosa
episodes of binge eating combined with inappropriate ways of stopping weight gain; typically maintain a normal body weight
binge eating disorder
engage in recurrent binge eating during which they eat an abnormally large amount of food over a short time.
Night Eating Syndrome
consumption of large amounts of food after the evening meal
Purging Disorder
recurrent purging behavior after consuming a small amount of food in persons of normal weight who have a distorted view of their weight or body image.
-Purging behavior includes self-induced vomiting, laxative abuse, enemas, and diuretics
Obsessive-compulsive disorder (OCD)
represented by a diverse group of symptoms that include intrusive
thoughts, rituals, preoccupations, and compulsions.
-recurrent obsessions or compulsions cause severe distress to the person.
Substance-Induced Obsessive-Compulsive/related disorder
emergence of obsessive-compulsive or related symptoms as a result of a substance, including drugs, medications, and alcohol.
Olfactory Reference Syndrome
characterized by a false belief by the patient that he or she has a foul body odor that is not perceived by others
Body dysmorphic disorder
by a preoccupation with an imagined defect in appearance that
causes clinically significant distress or impairment in important areas of functioning.
Hoarding Disorder
acquiring and not discarding things that are deemed to be of little or no value, resulting in excessive clutter of living spaces.
Hair-Pulling Disorder (Trichotillomania)
chronic disorder characterized by repetitive hair pulling, leading to variable hair loss that
may be visible to others.
Excoriation (Skin-Picking) Disorder
characterized by the compulsive and repetitive picking of the skin.
Factitious dermatitis
a disorder in which skin-picking is the target of self-inflicted injury
and the patient uses more elaborate methods than simple excoriation to self-induce skin lesions.
Major Depressive Disorder:
Depressed mood most of the day, nearly every day (per subjective report)
- Markedly diminished interest or pleasure in all (or almost all) activities most of the day, nearly every day
- Significant weight loss when not dieting OR weight gain OR a decrease or increase in appetite nearly every day
Bipolar I Disorder:
must experience a manic episode (at least 1 lifetime manic episode is required for the diagnosis of bipolar I disorder)
- manic episode is often preceded by hypomanic or major depressive episode
Bipolar II Disorder
episodes of major depression and hypomania
Postpartum depression
onset of symptoms within 4 weeks postpartum
Anxiety and related disorders
associated with significant morbidity and often are chronic and resistant to treatment.
include (1) panic disorder, (2) agoraphobia, (3) specific phobia, (4) social anxiety disorder or phobia, and (5) generalized anxiety disorder.
Panic Disorder:
An acute intense attack of anxiety accompanied by feelings of impending doom
Agoraphobia
a fear of or anxiety regarding places from which escape might be difficult. **most disabling of the phobias*
specific phobia
excessive fear of a specific object, circumstance, or situation.
Social anxiety disorder (
fear of social situations, including situations that involve scrutiny or contact with strangers.
Generalized anxiety disorder and treatment
excessive anxiety and worry about several events
