Mental Health Flashcards
Mood disorders
spectrum of disturbances from very low (depression) to very high (mania)
Major categories:
- Major depressive disorder (MDD)
- Bipolar disorders (BPD)
Other disorders:
- substance induced
- medical condition induced
MDD and Dysthymic Disorders (unipolar disorder)
Requires one major depressive episode followed by at least 2 weeks of severe functional impairment
Dysthymic - sad most of the time
NOT situational depression
Seasonal depression can turn into MDD if it stays around for a long time because it will cause chemical changes in the brain.
Bipolar disorders
Involve at least one depressive episode followed by elevated mood
Symptoms of MDD
- sadness
- hopelessness
- guilt
- irritability
- poor concentration and decision making
- anhedonia: inability to feel pleasure
- altered sleep
- fatigue
- impaired memory or cognition
- thoughts of death or suicide
Symptoms of BPD
- grandiosity
- persistent elevated mood
- little need for sleep
- babbling or excessive talking
- flights of fancy
- easily distracted
- impulsive, dangerous activity
- excessively goal directed - won’t give up
Types of BPD
BPD I: manic and depressive episodes - very high to very low
BPD II: similar to BPD I but major depressive episode then hypomania instead of mania
Cyclothmic: hypomanic episodes with depression symptoms (milder than I or II)
Clinical symptoms associated with mood disorders
- affect
- anhedonia
- avolition
- dysphoria
- euphoric
- flight of ideas
- grandiosity
- hypomania
- psychomotor agitation
- psychomotor retardation
- psychosis
affect
display of emotions (facial expressions), flat-animated
anhedonia
lack of interest in something that was previously enjoyed
avolition
lack of drive, no goals
dysphoria
depressed or negative state
euphoria
exaggerated feeling of elation
flight of ideas
disconnected, changing thoughts
grandiosity
inflated idea of self
hypomania
elevated mood, but less than mania
psychomotor agitation
fidgeting, pacing, wiggling
psychomotor retardation
slow or frozen
psychosis
delusions or hallucinations without insight
Suicidal ideation
can occur with MDD and BPD
- feelings of helplessness or hopelessness
- decrease in personal hygiene
- vocalizing death wish
- risky behaviors
- social withdrawal
- saying goodbye
- suicide note, plan, or previous attempt
- believing their situation will never change or they are doomed
Etiology of mood disorders
complex mixture of factors
- genetics
- biologic
*neurotransmitters
*endocrine system
- drugs
- stress
- cognitive vulnerability
- trauma
- negative coping styles
* big piece of OT is teaching good coping skills
Incidence and prevalence of mood disorders
Up to 16% of US population will be diagnosed as MDD
5% with BPD
Women diagnosed more than men.
Lower socioeconomic groups –> lower treatment adherence
Situational depression can cause MDD
All levels of society are affected
Diagnosis of MDD
At least one major depressive episode
Interference with function
At least 5 symptoms in a 2 week period
Diagnosis of BPD
At least one manic, depressed, or mixed episode
With manic as the dominant trait
Change in function
Pharmacologic intervention for MDD
Antidepressants-regulate neurotransmitters, specifically serotonin and norepinephrine
- Vilazodone (Viibryd)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Fluoxetine (Prozac Weekly, Prozac)
- Trazodone (Desyrel)
- Escitalopram (Lexapro)
- Paroxetine (Paxil, Paxil CR)
- Venlafaxine (Effexor, Effexor XR)
Side effects: nausea, headache, sexual dysfunction, dry mouth, blurred vision, general sedation
Pharmacologic intervention for BPD
Acute vs Maintenance treatment
Lithium (Lithobid)- most common mood stabilizer
- Valproic acid (Depakene)
- Divalproex sodium (Depakote)
- Carbamazepine (Tegretol, Equetro, others)
- Lamotrigine (Lamictal)
Side effects: weight gain, sedation, skin rash, blurred vision, sun sensitivity
Poor adherence, why?
Other interventions for MDD and BPD
Electroconvulsive therapy (ECT)
- “shock” therapy
- Historically used
- Resistant to pharmacologic intervention
- Now used in conjunction with anesthesia
*Induces a seizure, not sure how it works
- Risks
* Memory loss
* Death
Repetitive Transcranial Magnetic Stimulation (rTMS)
- Fewer side effects
- Doesn’t require sedation
- Side effects
* Tingling in face
* Light headed
* Headaches
* Mania
How do mood disorders affect occupations?
ADLS
- Basic hygiene
- Maintaining routines
- Taking meds
IADLS
- Budgets
- Childcare
- Paying rent
Health Management
- Poor outcomes without support
- Weight gain
Education
- Less likely to get a degree or complete training
Work
- Less likely to work outside the home
Play, Leisure, Social Participation
Difficulty maintaining relationships
Schizophrenia spectrum and psychotic disorders causes
Chronic and lifelong disorder
- 21 million people world wide
- Less than 1% of the population but rising
Genetic link
Alteration in Neurotransmitters
- Dopamine
Brain Structure
- Smaller hippocampus, amygdala and thalamus
- Larger lateral ventricle volume
Prenatal and Birth Complications
- O2 loss
- Infections and drugs
Trauma
Urban vs rural settings
Substance Use
Positive (easier to see) symptoms and sighs of schizophrenia spectrum and psychotic disorders
Delusions
Hallucinations
Disorganized speech
Abnormal motor behavior
Types of delusions
Persecutory: Out to get me
Referential: That song is about me
Somatic: I have cancer
Grandiose: I am Elvis’ child
Erotomatic: Beyoncé loves me
Religious: I am the favorite
Nihilistic: The world is going to end
Hallucinations
Auditory, visual, tactile, gustatory or olfactory
Disorganized speech
Tangential thoughts-barely related
Loose association-not on topic
Incoherence (word salad)- no sense at all
Abnormal motor behavior
Catatonic, rigidity
Agitation
Odd or silly
Mimicking
Echolalia – repeat something they heard over and over
Negative (harder to detect) symptoms and sighs of schizophrenia spectrum and psychotic disorders
Diminished Emotional Expression (affect is flat)
Avolition-lack of motivation to do something with an end goal
Alogia-diminished speech output
Anhedonia-lack of ability to experience pleasure
Asociality-lack of socialization
Anosognosia-no insight or awareness of the disease
Diagnosis and prognosis for schizophrenia spectrum and psychotic disorders
No single test or assessment
Usually follows a “psychotic break,” usually in late adolescence or early adulthood
- Two Positive or negative symptoms
- Which includes delusions, hallucinations or disorganized speech
- For 6 months
- Impact to at least one major life area of occupation
Stages of Schizophrenia spectrum and psychotic disorders
- Premorbid: no or few symptoms
- Prodromal: subtle symptoms, mild cognitive decline but doesn’t meet the criteria
- Syndromal: worsening of symptoms, functional decline, FORMAL diagnosis
- With treatment 60-80% respond and go into remission or partial remission
- Others progress
- Up to 30% are treatment resistant and often end up hospitalized
*Intervention is predominantly medication based - Progressive: individuals who relapse repeatedly
- Chronic or residual: continual decline but less than syndromal
Treatment for Schizophrenia spectrum and psychotic disorders
Pharmacological
- Most common
- Severe side effects
- Typicals: been around for 20 years; patients will start with these; acute extrapyramidal side effects (EPS)
* Tremors, psychomotor slowing, pill rolling (roll fingers as if there’s a pill between them)
- Atypicals: weight gain, sexual dysfunction, cardiac issues, dry mouth
* Clozapine: lowers white blood cell levels to the point that pt will almost end up with leukemia
Neuromodulation
- Electric shock (ECT) and magnetic therapies (TMS)
OT:
A mind busy and occupied can help create a better outcome
Psychosocial
CBT-Cognitive Behavioral Therapy
- Self monitoring
- Coping skills
- Requires insight
Self Management programs
- Similar to CBT, includes goal setting and planning
Skills Training
- Role modeling, goals setting, rehearsal, practice
Cognitive Rehabilitation
- Focus on rehabilitation of the cognitive deficits (symptomatic)
* Memory, attention
Family Psychoeducation
- The key
- If they don’t have this and no services are available, they are doomed.
Social Skills Training
- Like CBT or skills training just focus on Social Skills
- Important in early diagnosis
Importance of Early Intervention
Delusional disorder
- 1 or more delusions for more than one month
- No other symptoms
Brief Psychotic Disorder
- Just like Schizophrenia but lasts 1 day to 1 month
- Sometimes drug or disease induced
Schizophreniform Disorder
- “Pre-Schizo”
- Symptoms last 1-6 months
Schizoaffective Disorder
- Same symptoms plus a major episode of depression or mania
- Function is not always affected
- Hallucinations are present