mental health Flashcards
affect
observable component of emotion
inappropriate affect
inconsistent, incongruent with accompanying idea, thought, speech
restricted/constricted affect
reduced range & intensity
blunted affect
severe lack of affect (does not demonstrate ability to change)
flat affect
lack of signs of affective expression (monotone voice, expressionless face, immobile body)
labile affect
rapid, abrupt changes in affect
anhedonia
unable to experience pleasure
(depression, schizophrenia, some other mental illnesses)
free floating anxiety
pervasive anxiety with no specific focus
fear
anxiety focused on real danger
compulsion
- Repetitive behavior to prevent/relieve anxiety
- Rule bound
- Client feels must be performed to ward off distress
obsession
persistent unwanted thoughts that produce distress
consciousness
responds to external stimuli
disorientation
orientation disturbed to person, place, time, situation (sometimes)
delirium
- acute, REVERSIBLE disorder
- disturbance of consciousness, decreased ability to attend
- short period of time (hrs to days)- tends to fluctuate
- Disoriented with confusion, lability, disturbed behavior (aggression)
- Fear & hallucinations (sometimes)
- causes: brain dysfunction, medication, endocrine disorders, cardiac disorders, fever, liver function disorders
confusion
- inappropriate reactions to environmental stimuli
- Disordered orientation to person, place, time
sundowner syndrome
- late afternoon/night in older people (dementia)
- Drowsiness, confusion, ataxia, falling, agitation, aggression
- sedation/oversedation
- changes in orienting cues (light, familiar people, objects)
defense mechanisms
To safeguard mind against feelings/thoughts that are too difficult for conscious mind to cope with
denial
- best known
- unable to face reality or admit obvious truth
- part of grieving
- may become angry or resistant with feedback
repression
keeping info out of conscious awareness
sublimation
act out unacceptable impulses by converting behaviors into more acceptable forms
EX:
Using kickboxing to vent frustration
projection
taking unacceptable qualities/feelings & ascribing them to other people
intelletualization
reduce anxiety by thinking about events in cold/clinical way
rationalization
explaining unacceptable behavior/feeling in rational or logical manner to avoid true reason for behavior
regression
when confronted by stressful event, people sometimes abandon coping strategies & go back to earlier patterns of behavior
reaction formation
- reduces anxiety by taking up opposite feeling, impulse, formation
EX:
Treating someone you don’t like in excessively friendly manner to hide true feelings
dissociative disorders
- disconnection, lack of continuity between thoughts, memories, surroundings, actions, identity
- Escape from reality in involuntary, unhealthy way
- Reaction to trauma, keep difficult memories at bay
dissociative amnesia
Severe memory loss (more than normal)- (unable to remember info about yourself, events, people in life)
dissociative identity disorder
multiple personality disorder, switching to alternative identities
depersonalization-derealization disorder
- ongoing/episodic detachment (outside self)
- Observing actions, feelings, thoughts, self from a distance (depersonalization)
- Others seem foggy, dreamlike, time feels slow/fast, world seems unreal (derealization)
euthymia
- living without mood disturbances
- mood disorders
- Feeling cheerfulness & tranquility, increased level of stress resilience
euthymia with reactive affect
respond appropriately to subject of a conversation
euthymia with congruent affect
emotions match situation & in agreement with situation
euphoria
- Desirable, natural occurrence when from happy events
- Excessive when not linked to events
- Hypomania, mania, bipolar, side effect of some drugs
apathic mood
- Lack motivation to do things
- Don’t care about what is happening around you
elated mood
- Very happy
- Full of energy
- Self-important
- easily-distractible
agoraphobia
Fear of being outside
psychosis
- Sensory experiences of things that don’t exist, not reality (hallucinations/delusions)
psychotherapy
- talking with a psychiatrist, mental health provider
- Learn about moods, feelings, thoughts, behaviors
hypochondriasis
Preoccupation with/fear of having particular disease rather than focus on individual symptoms
conversion disorder
Unexplained neurological deficit in movement/sensory perception caused by psychological factors
somatization disorder
- Before age 30, lasts for years
- Multiple systems
- Combination of pain, GI distress, neurological problems (numbness), sexual dysfunction
in personality disorders, what does a client have difficulty with?
- interpersonal skills & relationships, negative social interactions
- coping skills
- Deep need for praise/honor
- Very high view of self
- Poor social skills
- little/no concern for others or their feelings
- Aggression
- Entitlement
- Pride
- Inability to build/maintain relationships
- emotional modulation/appropriate affect
Antisocial personality disorder
- Continual antisocial or criminal acts
- Inability to conform to social norms
- No regard for safety or feelings of others, lack remorse
- Precursor is untreated or unresponsive conduct disorder
- Difficulty with authority relationships (interpersonal issue)
avoidant personality disorder
- Extreme sensitivity to rejection
- Socially withdrawn
- desire for companionship but consider themselves unworthy of it
- feeling of uncritical acceptance
- Inferiority complex (feeling inferior to others all the time)
Borderline Personality Disorder
- Extraordinarily unstable affect, mood swings/behavior, relationships, self-image
- Fear of real or imagined abandonment with frantic efforts to avoid it
- Suicidal thoughts
- Alternating extremes of idealization & devaluation (splitting)
- Recurrent self-destructive or self-mutilating behavior
- emptiness feeling
- trauma history
- self-absorption
- difficulty with interpersonal skills: relationships
- communication issues
dependent personality disorder
- others needs before their own
- Need others to take responsibility for major areas in their life
- no self-confidence
- discomfort when alone for a long time
histrionic personality disorder
- Colorful, dramatic, extroverted behavior in excitable, emotional persons
- Unable to maintain deep, long-lasting attachments
- Accompanying flamboyant presentation
narcissistic personality disorder
- Heightened sense of self-importance
- Grandiose feeling that they are special in some way
Obsessive Compulsive personality disorder
(not to be confused with OCD
- Emotional constriction
- Orderliness
- Perseverance
- Stubborn
- Indecisive
- Pervasive pattern of perfection & inflexibility
paranoid personality disorder
- Long standing suspiciousness & mistrust of persons
- Appear hostile, irritable, angry
schizoid personality disorder
- Frequently diagnosed in those with lifelong pattern of social withdrawal
- Eccentric (odd), isolated, lonely
- Discomfort with human interaction
-introverted - bland constricted affect
schizotypal personality disorder
- Odd or strange in thinking/behaviors
- Magical thinking, peculiar ideas, ideas of reference
- Illusion, derealization
in schizophrenia, what does a client have difficulty with?
sensorimotor components
schizophreniform disorder
Symptoms of schizophrenia but lasts 1-6 months instead of lifetime
schizophrenia
- Delusions, hallucinations
- lack of motivation
- disorganized thinking (speech)
- grossly disorganized or abnormal motor behavior (catatonia)
- negative symptoms
- Secondary depression leading to withdrawal
- avoidance – use rewards as motivational strategies (offering a snack as an incentive to attend a group)
- Abnormal social behavior
- Self harm or harm to others
- Extremely volatile, unstable, sometimes dangerous
- Significant cognitive impairment
- Genetic, brain chemistry, environmental roles
AFFECTS:
- cognition: EF, memory, attention, screening of relevant vs irrelevant stimuli
- compromised health/wellness
- recovery hindered by stigma
requirements for schizophrenia dx
- at least 2 symptoms for at least 1 month with ongoing signs for 6 months
- disturbance in 1+ areas of work, interpersonal relations, self care
rule out other dx, medical condition, substance
-
schizophrenia medications & side effects
- traditional antipsychotics: infrequently used, occasionally prescribed
- SIDE EFFECTS: dry mouth, blurry vision, photosensitivity (sun sensitivity), constipation
, orthostatic hypotension (be careful of certain activities which aggravate OH: parachute activity), dystonias (hyperextension or hyperflexion of the wrist & digits), akathisia (restless anxiety provoking need for movement), cardiovascular disorders
Complications:
- Tardive dyskinesia (not safe to operate a vehicle, should explore safer transport means)
- Neuroleptic-induced parkinsonism: muscle stiffness, cog-wheel rigidity, shuffling gait, drooling, stooped posture
- atypical antipsychotics
- SIDE EFFECTS: dry mouth, blurry vision, sedation, dizziness, hypotension, insomnia, confusion
tardive dyskinesia
repetitive muscle movements in face, neck, arms
- should not drive when experiencing this
- complication of medication (antipsychotics for schizophrenia)
shuffling gait
dragging one’s feet along or without lifting the feet fully from the ground
body dysmorphic disorder
- Preoccupied with perceived physical flaws (imagined or slight) that are not significant to others
- Concerns with appearance cause repetitive thoughts/behaviors to conceal/improve “flaws”
- Interrupts social, occupational functions
hoarding disorder
- Perceived need to save items, difficulty discarding possessions regardless of value, need, practicality
- Thought of discarding = distress, justification on why items is needed
- Cramped, cluttered living conditions - impacts safety and cleanliness in home
Trichotillomania
- Hair pulling disorder (scalp, eyelashes, eyebrows)
- Bald, patchy spots
- Impacts social, occupational functioning
Excoriation disorder
- Skin picking repeatedly - results in skin lesions
- Disrupts daily occupations
medications for obsessive disorders
- anxiolytic meds (xanex, valium):
- Side effects: drowsy, ataxia, headache, nausea, depression, dependence - Antidepressants (prozac, zoloft)
- Antiobsessional meds (Luvox)
- Side effects similar to SSRIs - Hypnotic meds to induce sleep
Side effects similar to anxiolytics
open-ended questions
longer, more detailed
(use with major depression)
closed ended questions
- when seeking specific info
- discourage communication
- Appropriate for psych patients who answer questions in unfocused, tangential manners
EX: yes/no questions, one word answers (did you get to work by bus or train? Is the sky blue?)
leading questions
suggest desired response
double questions
ask 2 questions at once to force a choice
Socratic questioning
- explore complex ideas, concepts, and beliefs by asking questions that challenge assumptions, clarify meaning, and reveal underlying principles
- CBT approach to challenge maladaptive thoughts
- What do you mean by that?
- Why do you think that’s true?
- Is that the only way?
- What’s the worst that can happen?
- Are there any counter arguments?
- How did we arrive at that conclusion?
concrete response
literal response
insightful response
includes reasons leading up to event
distractible response
Changes topic or stops in middle of responding
delusional response
Completely off topic
meal prep for person with mental health disorder
always start with cold meal prep then progress to hot meal due to safety concerns
EX: cold pasta salad to instant soup
sequencing issues
- Difficulty planning or enacting the steps of an activity
EX: Drying hands before using soap when washing
INTERVENTION:
Most appropriate INITIAL activity: baking cookies following a recipe
(structure with specific sequence of tasks)
emotional dysregulation
Uncontrolled anger, laughing, crying
lack of self awareness
- not recognize errors or use feedback
- False beliefs about abilities
- surprised/confused when given feedback
EX: What do you mean
social skills group
- interactive Intervention
- empathy development, relationships with others, nonverbal & verbal communication skills, social interactions
aggression
Forceful, angry, destructive speech or behavior
hyperactivity
Restless, sometimes aggressive/destructive activity associated with brain pathology
shifting attention
alternate attention between tasks with different cognitive or motor requirements
selective attention
- avoiding distractions
- pay attention to relevant stimuli
- Dysfunction = random errors in testing (not neglect)
sustained attention
Ability to consistently engage in an activity over time
Ex: playing a simple, repetitive card game in a quiet environment
mental tracking
tracking 2 stimuli in one activity
(EX: looking in car mirror while watching the road)
detecting & reacting
Able to detect & react to gross changes in environment
EX: Phone ringing , name being called
divided attention
two tasks at once
EX: Walking & bouncing a ball simultaneously
distractibility
can’t concentrate without being drawn to irrelevant stimuli
hypervigilence
Excessive attention & alertness that guards against potential danger
amnesia
Not remembering past experiences or personal identity
retrograde amnesia
Not remembering events that occurred PRIOR to trauma
anterograde amnesia
Unable to recall events AFTER trauma
cluster A personality disorders
paranoid PD, schizoid PD, schizotypal PD
- eccentricity (abnormal), distrust, lack of interest in social contact
cluster B personality disorders
antisocial PD, borderline PD, histrionic PD, narcissistic PD
- intense emotions, no empathy, unpredictable behaviors
acute distress disorder
- Similar to PTSD but immediately follows event
- no symptoms after 1 month
cluster C personality disorders
avoidant PD, dependent PD, obsessive compulsive PD
- low social drive, sensitive to criticism
intermediate/short term memory
Recall material within seconds/minutes
recent memory
Remember events of past few days
recent past memory
Able to recall events of past few months
remote memory
- Recall events of distant past
- Long term memory
procedural memory
how to perform tasks/skills
declarative memory
- Recall consciously learned facts
EX: School subjects
semantic memory
Knowing the meaning of words & able to CLASSIFY information
- info about the world
episodic memory
know own personal experiences
working memory
- Temporary
- track info while working on task
- IMMEDIATELY recall info after exposure
- able to focus conscious attention
prospective memory
- Capacity to remember to carry out future actions
-EX: Knowing you have appointments scheduled, turn off the stove, pay bills on time - Important for SAFETY & living independently
echopraxia
meaningless imitation of other person’s movements (in schizophrenia)
catatonia
immobility/rigidity
- strange movements
- uncomfortable positions without moving
- erratic & extreme movements
- echolalia
!! can be emergency if lasting for hours!!
stereotypy
meaningless repetition of words (echolalia)- in ASD, delirium, dementia, tourettes
psychomotor agitation
- Excessive, non productive motor/cognitive activity
- in response to inner tension
psychomotor retardation
decreased/slowed motor & cognitive activity
acting out
Physical expression of thoughts/impulses
akathisia
- State of restlessness
- Urgent need for movement
- Side effect of medication
ataxia
irregular involuntary muscle movements
psychoeducation groups
- CBT
- group with same diagnosis
- teaching info that requires learning capacity that may be impaired with acute illness
NDT groups
Enhances SI in chronic schizophrenia
to be diagnosed with major depression, what are the requirements?
- must have at least 5 symptoms for at least 2 weeks
- 1/5 symptoms must include depressed mood or notable loss of interest/pleasure
major depression
- Irritability
- Anhedonia
- Unintentional weight loss/gain
- insomnia/hypersomnia
- Psychomotor agitation or retardation
- Fatigue/loss of energy
- Feelings of guilt or worthlessness
- Poor concentration
- Continual, long term sadness, emptiness, despair, isolation, hopelessness
- Feeling trapped
- SUICIDAL thoughts or behavior
- irritable, anxious, phobias, obsessive thinking
- difficulties with social, relationships, sexual functioning
- somatic complaints: excessive self focus on physical symptoms
- Can be subtle
- can lead to malnutrition, GI issues, overall decline in physical health
medications for major depression
- Antidepressants that work on neurotransmitters (serotonin, norepinephrine, dopamine) to regulate mood; not for pediatric but for adolescents and up
- SSRIs: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), citalopram (Celexa)
- SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)
- (MAOIs): phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), selegiline (Emsam)
- electroconvulsive therapy
Side effects: excessive thirst
assessments for major depression
- COPM
- play scale: Knox Preschool Play Scale, Test of Playfulness
- social skills : Social Skills Rating system
- School Function Assessment
- OT Psychosocial Assessment of Learning
- Miller Function & Participation Scales
in mood disorders, what does a client have difficulty with?
ADLs/IADLs
dysthymia/persistent depressive disorder
- “low grade” version of depression
- Less severe depressive symptoms FOR AT LEAST 2 YEARS with periods of no more than 2 months at a time symptom FREE
- May coexist with Axis I (general diagnostic categories) or Axis III (general medical conditions) disorders
Impacts function (may hold job/relationship but loses interest & often appears LETHARGIC)
In Children: school phobia, difficulty sleeping, negative behaviors in school
medications for dysthymia
SSRIs
disruptive mood dysregulation disorder
- Temper outbursts
- Severe & recurrent verbal or behavioral episodes
- Uncharacteristic for expectations of developmental level
- Overreaction to stimuli
- Diagnosed between 6 & 18 years old
premenstrual dysphoric disorder
- Marked affective lability
- Irritability or anger
- Increased interpersonal conflicts
- Depressive symptoms & mood
- Marked anxiety
hypomanic episode
- Symptoms same as manic episode but not severe enough to cause social/occupational impairment
- Last for 4 days rather than 1 week
bipolar disorder
- Fluctuations in mood/behavior
- alternating mania & depression
- genetic, chronic
- Long-term psychotropic medication tx
- low self-esteem and motivation
- Affects family and work roles through mood
- Manic episodes disrupt daily routines
- High work loss rates
- Suicidal thinking/behaviors
- Intense emotional states
bipolar disorder medications
- Mood stabilizers: lithium carbonate
- Anticonvulsants: carbamazepine, gabapentin
- Electroconvulsive therapy: cognitive side effects
bipolar I
1 or more manic episodes combined with hypomanic or major depressive episodes
bipolar II
- one or more major depressive episodes and at least 1 hypomanic episode
- NO MANIC episodes
cyclothymic disorder
- “low grade” version of bipolar disorder
- chronic (at least 2 years) MOOD disturbance, with fluctuating HYPOMANIC & DEPRESSIVE symptoms
- Vocational function impaired with depressed moods
- Social function impaired with unpredictable mood swings - Substance abuse potential problem
manic episode/mania
elevated/irritated mood with AT LEAST 3 OF THE FOLLOWING for at least 1 WEEK:
1. Grandiosity (feeling superior)/impulsive/inflated self-esteem
2. decreased need for sleep
3. Talkativeness/social hyperactivity/pressured speech
4. flight of ideas
5. Distractibility
6. increased activity
7. excessive involvement in pleasurable activities with disregard for consequences
8. Making decisions quickly
9. No sense of risk or danger, risky behaviors
10. Sleeping very little/not at all
11. Feeling of being “high” or “on top of the world” without any rational reason
12. restlessness
13. mood consistently elevated or irritable
14. psychomotor agitation
Can be symptom of manic depressive disorder, bipolar
Need to be watched closely for quick turn from manic to depressed
- First appear in late teens/early 20s, rapid, abrupt onset
- Independent functioning by maintenance treatment (medication)
- tend to be resistant to treatment
- promiscuous, gambling, excessive spending, giving things away, suggestive dress, irritable/assaultive/suicidal behavior
- increased substance abuse risk
manic episode medications
- Mood stabilizing medications (1st line treatment)- Lithium
- Prevent bipolar disorder - antipsychotics
- Anticonvulsants: Depakote, tegretol, lamictal, topamax, neurontin, trileptal
group dynamics
Internal & external factors
group maintenance roles
- members contribute to overall performance of group
1. Harmonizer: manage conflict
2. Compromiser:
3. Follower
4. social-emotional leader: maintenance roles
5. supporter: encourage others
6. tension releaser: funny towards whole group
7. interpreter: manages diversity
8. central negative: argues against ideas
9. monopolizer: makes excessive verbal contributions, preventing others from participating
10. self-confessor: tries to use group as therapy session
11. insecure compliment seeker: seeks validation/recognition
12. joker: pranks, sarcastic
13. blocker: keeps things from getting done
14. withdrawer: mentally/physically removes self from group
15. aggressor: puts others down, attacks others
16. doormat: gives in when challenged
group task roles
- Roles that group individuals assume to accomplish tasks related to overall group objective
1. Information-provider: gives knowledge
2. Information-seeker: asks for more information
3. Energizer: keeps group energy
4. Recorder: takes notes
5. leader/facilitator
6. gatekeeper: manages conversation flow for balance
group norms
- Implicit & explicit rules
- established by group leader or members
group leader
Role in therapeutic group that includes
1. Facilitating participation/process
2. Defining expectations/norms
3. Teaching needed skills
4. Guiding actions towards achieving desired outcomes
Mosey: cooperative group
(9-12 years)
- Advisory leadership: OT is guide
- SHARING & LISTENING
- NO GOAL or changing behavior
- Eager to interact with other members, express ideas, problem solve
- Sustained interest in longer projects
EX: group collage (share emotions, challenges)
associative group
difficulties with social skills, problem-solving
- Shorter attention spans
Mosey: mature group (begins 15-18 years)
- participatory leadership (OT group member, consultant)
- group functions independently (self help group)
- members lead
- accomplish task in limited time frame
- task completion is most important
- GOAL: help members identify roles within group & function well within them (group needs over self desires)
home health setting
- perform functional tasks, safety, environmental concerns
DOCUMENTATION: - If client has medicare/medicaid: must have OASIS completed
supportive housing
- Independent housing with community based mental health services
- Staff provide case management, support, rehab
- halfway houses, group homes, supervised apartments
Custodial housing/long term care/SNF
- long term care is NOT COVERED BY MEDICARE
- be familiar with Medicare requirements (primary payer of OT services)
- Provide information for the multidisciplinary evaluation: Minimum Data Set (MDS): Used to determine specific level of care needed
assisted living
- older adults who need assistance with medication management, light housework, meals, activities
- Provide structure
- IS NOT COVERED BY MEDICARE
partial hospitalization programs
- Outpatient
- comes after inpatient
- structure & professional support for patients who need high level of care but not at inpatient level
directive group
- for most severely & acutely mentally ill
- Most minimally functioning patients
- Structured in organization/leadership
Mosey: parallel group
(18m-2y)
- directive leadership
- Little to NO interaction
- Work alongside one another
Ex: therapist run aerobics class
Mosey: project/associative
(2-4 y)
- modified directive leadership
- Specific, outcome-based activity or project
- Members have SOME interaction through sharing & cooperation, healthy competition
- together for short time to complete short projects while cooperating with other members
OT presents short task (under 30 min), assists if needed
Mosey: egocentric-cooperative group
(5-7 years)
- facilitative leadership
- Members COLLABORATE to complete specific task in LONG TERM SETTING & choose level of interaction with each other
sensorimotor group
- pediatric & geriatric
- sensory experiences through movement or play in structured group
life skills group
- address barriers to specific skills for participating in occupations
1. Daily living tasks
2. Conflict resolution
3. Anger management
4. Communication skills
5. Time management
6. Clarification of values
discussion-oriented group
- Peers interact while learning skills for personal growth
1. Stress management
2. Sleep hygiene education
3. Advocacy training
4. Caregiver support
activity groups
- Require higher level of task behavior
- Require ability to engage in occupation to enable skill development
clubhouse program
- model of psychological rehabilitation
- adults/elders with current mental illness or history of mental illness
- All members with equal access regardless of functional level or diagnosis (only those who pose significant safety threat are excluded)
- Operates with a blend of staff and members to assume leadership for all clubhouse operations with an egalitarian and strength-based context
- members pursue personal goals related to their recovery, uplighting, supportive
- concept of the work ordered day and conveys the expectation of members and staff to run the clubhouse side-by-side at least 5 days per week
- unpaid members who are willing participants (not clients/patients)
- Transitional employment offered by the clubhouse but positions are PAID
- Members of group homes can opt to participate in clubhouse during the DAY
- OT acts as a peer in the group
- Nontraditional OT setting
authoritarian group leader
- Leader has high level of control, directs group members
- Members minimally contribute to group decision-making process
- Members have LOW cognitive level
facilitative group leader
- group members who are functioning at a HIGHER cognitive level
- Group leader acts as educator and resource
- egocentric-cooperative level groups
- Group members contribute to decision-making process under guidance of the leader
advisor group leader
- group members functioning at a HIGHEST level
- Groups occurring in community (health and wellness group)
- Group members responsible for functioning of the group
- OT is advisor in cooperative level groups, offers guidance/direction as needed
co-leadership
- 2 or more practitioners from same or different disciplines
- support each other, combine their knowledge, take on different roles
- Greater objectivity when measuring group member performance
perseveration
- continued speech with repetition
- Often in response to different stimuli or questions
global aphasia
Loss of all language skills (has all aphasias)
expressive/Broca’s aphasia
knows what they want to say but can’t say it
receptive/Wernicke’s aphasia
Loss of comprehension what has been said to him/her
Nominal aphasia/anomia or amnestic
unable to name objects
fugue
- State of serious depersonalization
- Often involves travel/relocation
-new identity with amnesia for old identity
adjustment disorder
- clear stressor causes onset of emotional & behavioral symptoms within 3 months of stressor & symptoms disappear within 6 months of stressor removal
- causes marked distress in social, occupational function
disinhibited social engagement disorder
- Child initiates interaction with unfamiliar adults with at least 2 of the following
1. Little reservation when approaching strangers
2. Overly familiar use of words/actions despite novelty & unfamiliar relationship
3. Willing to leave with unfamiliar adult - Upbringing includes: social neglect, deprivation, caregiver changes = insufficient care for forming stable relationships
- occurs at min of 9 month old developmental age
Reactive Attachment Disorder (RAD) of Infancy or Early Childhood (inhibited type)
inhibition = unable to relax/self conscious
- hypervigilant, ambivalent (indecisive), contradictory interactions
- do NOT show affection, withdraw, don’t want to hug
Reactive Attachment Disorder (RAD) of Infancy or Early Childhood (disinhibited type)
- Excessive familiarity with strangers, - lack of selectivity
Reactive Attachment Disorder (RAD) of Infancy or Early Childhood
CAUSES:
- social neglect/instability of caregivers, leading to constant changing care
- disregard of child’s emotions, basic physical needs, repeated primary caregiver changes
- onset before age 5
BEHAVIORS:
- High need for control
- Frequent lying
- affectionate/overly related with strangers
- Hoarding, gorging on food without physical need
- Denial of responsibility
- Projecting blame for actions on others
- Can be frustrating to work with/difficult to parent
what do eating disorders impact?
- maladaptive eating and lifestyle habits
- meal prep and independent living skills
- communication and assertion skills
- stress management skills
- Resistance to change
Distorted body image
Fear of gaining weight
Unhealthy relationship with food
Excessive exercise
Fasting
Induced vomiting
May develop as way to control their environment, self punishment
anxiety disorder impacts
- difficulty responding to stress in PTSD and cardiac problems in panic disorder
- difficulty following directions & concentrating, lower memory capacity
- disruption in relationship and career
medications for anxiety
- Benzodiazepines
- SSRIs
- Tricyclic antidepressants
abstraction
extending information from idea to generalize to another situation
metacognitive strategy
- Self management method
- identify cognitive challenges during everyday activities to create strategies
external memory strategy
- Therapeutic method used in neurorehabilitation
- Support ability to retrieve cognitive information at later time
1. Checklists
2. calender (schedule management)
2. Day planner
3. Posted signs/wall chart (written instructions, steps, illustrations of routine tasks, daily activities, placed in close proximity to where performance is expected)
internal memory strategy
- aid in mentally organizing cognitive info for later retrieval
- Therapeutically used in conjunction with external strategies
1. Visual imagery
2. mnemonics
electronic memory aids
- Technology solutions to aid in retrieval of information during daily activities (smartphone apps)
- Consider matching current abilities to device & simplicity of use
Mini Mental State Exam/Folstein Mini Mental
- Quick screening test of cognitive functioning
- Structured tasks
- interview
- For cognitive or psychiatric dysfunction
Short Portable Mental Status Questionnaire
- Assess intellectual function
- Short questionnaire
- For cognitive or psychiatric dysfunction
Allen Cognitive Level Test
- standardized
- assesses cognitive level according to ACL (determines abilities & limitations)
- leather lacing task that progresses with complexity
- used for cognitive or psychiatric dysfunction, dementia, acquired brain injuries
level 2: no running stitch
level 3: can imitate running stitch, 3 stitches
level 4: imitates whip stitch, 3 stitches
level 5: imitates single cordovan stitch using physical trial and error (3 stitches)
level 6: imitates single cordovan stitch using mental trial & error (3 stitches)
available in 3 forms:
1. ACLS (standard)
2. LACLS (large) for vision or hand function problems
3. LACLS (D) disposable large for single or serial use with clients who require infection control precautions
Beck Depression Inventory
- measures presence/depth of depression
- interview or questionnaire
- Adolescents and adults
elder depression scale
- Assesses depression in elderly
- 30 item checklist (yes/no items)
Hamilton Depression Rating Scale
- Measures illness severity & changes
- Rates diurnal variation, depersonalization, paranoid symptoms
- for mood disorder, depressive illness
Schroeder-Block-Campbell Adult Psychiatric Sensory-Integration Evaluation
- assesses sensory integration
- physical assessment, abnormal movement, childhood history
- Identifies movements (akathisia, tardive dyskinesia)
- Identities developmental delays or neuro soft signs
- Person drawing (for body image)
- Used with adults with psychiatric dx
Bay Area Functional Performance Evaluation
- Assess cognitive, affective, performance, social interaction skills to perform ADLs
- interview, task oriented assessment: timed
- measure cognition, performance, affect, qualitative signs, referral indicators
- Social interaction scale
- adults with psychiatric, neurological, developmental diagnosis
acceptance
- no longer in denial (accept reality)
- Important when dealing with difficult situation
- OT should help client move from denial to acceptance, give practical skills to move forward with hope
apraxia
- Caused by brain disease/injury
- Can affect speech, motor skills
- physically able to but brain can’t communicate words/movement to body
acquired apraxia
more common in patients 40+
developmental apraxia
children, affects ability to form words
undifferentiated somatoform disorder
Unexplained physical symptoms lasting at least 6 months but do not meet dx for somatization disorder
Kubler-Ross Model 5 Stages of Grief
denial, anger, bargaining, depression, acceptance
hallucinations
- Experiencing something as reality when it is not
- auditory = most common (can affect any of senses)
- Sign of serious mental illness/brain damage or due to exhaustion
- Can be short or long term
locus of control
- Extent that people feel that they have control over events that influence their lives
- CONTINUUM (lie somewhere between the two locusts)
- Impacts how patient copes with stress, motivation
internal locus of control
- belief that you have control over what happens, own actions have impact
- Positive attribute/desirable
EX:
Student who passed their exam would say “I totally aced that test because the teacher had the class participate in a really good review
external locus of control
- belief of no control over what happens, blame external variables for failure/success
- Believe in self as a passive bystander who is caught up in the flow of life
EX: A student who failed their exam would say “I failed that test because the teacher didn’t provide me with a good enough study guide”
stigma
- Society labels someone as tainted/less desirable
3 elements
1. Lack of knowledge (ignorance)
2. Negative attitudes (prejudice)
3. Discrimination
Two types of stigma with mental health problems
1. Social stigma
2. Self stigma
- Causes people to feel ashamed for something out of their control
- Prevents people from seeking the help they need
panic attack
- Episode of extreme anxiety (not a coded dx)
- 4+ symptoms develop and peak at 10 min
- Fast breathing/SOB
- Not being able to catch your breath
- Chest pains
- Stomach pains
- Shaking
- Sweating or chills
- Irregular heartbeat
- Nausea
- GI issues
- sensation of choking
- derealization
- loss of control
- fear of dying
- paresthesia (pins & needles)
- agoraphobia (anxiety in places where escape may be difficult/embarrassing leading to avoidance of situation)
evaluation group
- Assessment of skills & limitations through OBSERVATION in certain setting/group
- No changes to person’s behavior made during evaluation
- short-term activity to observe with no planned intervention
Task-oriented group
- builds SELF AWARENESS of self & others
- develop new behaviors while working with others to complete specific task
- end goal/product that members complete together
- OT very involved at first (active-assisting) but becomes less involved
EX: cooking group (planning, preparing, serving)
developmental group
- Interactional skills developed in specific sequence
- Purpose: teach, develop group members interaction skills
- Continuum of groups (parallel, project, egocentric, cooperative, mature)
- Each group builds upon previous groups and adds another level of self-awareness for participations
- OT role decreases with each type of group as members develop more leadership, interpersonal skills
topical group
- members to engage in activities outside group more effectively (become independent)
- themes: Education, skills training, problem solving, expectations
anticipatory topical groups
- activities where members will be involved in upon discharge
- Focus on what patient needs to be prepared in the future
concurrent topical groups
- focus on activities in which member is already carrying out in community
- immediately helpful education, training
thematic group
- Learn new skills for specific activity via PRACTICE
- Extremely focused group, simulated structured setting directly relating to acquired skills with feedback
- No focus on interaction unless it interferes with activity (conflict)
instrumental group
- Maintenance
- Helps members function at highest level for as long as possible
- No major change expected, no need to try to change person’s behavior in this group
- OT provides unconditional positive regard
unconditional positive regard
accepting and respecting others as they are without judgment or evaluation
inpatient psychiatric unit
- short term hospitalization/emergency care
- Most patients won’t need any type of long-term hospitalization
- Address patient’s fears about inpatient setting
long-term hospitalization
- Patients with extreme symptoms, no response to treatment, seen as risk to themselves or others
- Recognize patterns that may have gone unnoticed when patient was not receiving 24/7 care
community based mental health services
- Alternative to inpatient- simple, less invasive
- Minimize stigma associated with mental illness
- Allows patient to continue to function & flourish in their own community
- OT maintains aspects of self care, lifestyle, medications, education
(Self care training, social skills, job readiness) - Individual and group therapy sessions
supportive housing/community residential setting
- Independent housing with provision of community based mental health services
- Step between outpatient and inpatient settings
- Maintains some structure & supervision while providing some freedom
- halfway houses, group homes, supervised apartments
- Clarifies if patient is ready for life on their own or not
supported employment
- Collaboration between patient, OT, employer to improve workplace skills
- Vocational rehab
Cole’s 7 Steps
- introduction
- activity
- sharing
- processing
- generalizing
- application
- summary
Comprehensive OT Evaluation Scale
observe/rate behavioral changes, ONLY SHORT TERM ACUTE CARE, adults with acute psych issues
activities health assessment
- time usage, configurations of activities, roles, underlying skills, habits
- adults through elders
adolescent role assessment
- Assesses development of internalized roles within family, school, social settings
- Semi-structured interview
- adolescent ages 13-17
barth time construction
- Assesses time usage, roles, underlying skills/habits
- Used with adolescent through elder
COPM
- Identifies perception of satisfaction with performance & changes over time in areas of self-care, productivity, leisure
- Semi-structured interview
- Used with clients ages 7+ or parents of small children
Occupational Case Analysis Interview Rating Scale
- Assesses occupational adaptation
- Semi-structured interview
- Used with adult through elder with psychiatric dx but is also being used more broadly
occupational performance history interview
past & present occupational performance
- Interview
- from adolescent to elder
role checklist
- from adolescent to elder with physical or psychosocial dysfunction
AMPS
- Examines functional competence in 2 or 3 familiar & client-chosen BADL or IADL tasks from list of over 60 standardized tasks
- Used with ages 3+ regardless of dx (Appropriate for those living with cognitive/perceptual deficits)
Arnadottir OT Neurobehavioral Evaluation
- To detect underlying neurobehavioral dysfunction
- Structured observations of BADL, mobility skills
- Used with adult population with cognitive/perceptual (neurobehavioral deficits)
Rivermead Perceptual Assessment Battery
- To detect cognitive & perceptual impairments
- assess form & color constancy, object completion, figure-ground, body image, inattention, spatial awareness
- Used with 16+ ages with visual-perceptual deficits after head injury or stroke
Rivermead Behavioral Memory Test
- initial evaluation of memory function, indicates appropriate treatment areas, monitors memory skills
- Used with persons with memory dysfunction
Behavioral Inattention Test
- presence of neglect & its impact
- Used with adults with unilateral neglect
Lowenstein OT Cognitive Assessment
- Measures basic cognitive functions for every day tasks
- orientation, visual spatial perception, visualmotor organization, thinking operations
- Used with stroke, TBI, tumor clients
assertive community treatment (ACT)
Programs for Assertive Community Treatment (PACT)
- Comprehensive, community-based intervention models for severe mental illness
- intensive treatment, rehabilitation, support services in homes, jobs, social settings
- Multidisciplinary mental health team (mobile mental health agency)
- interdisciplinary/interprofessional team approach to treating individuals
Individual Placement & Support (IPS)
- Model of supported employment for people with serious mental illness
- Helps people living with behavioral health conditions work at regular jobs of their choosing
directive/autocratic/authoritarian leader
- high level of control
- Defines group, sets goals, selects activities, structures, gives feedback, performs group roles
- Members low cognitive level (cognitive impairments, poor insight, poor verbal skills, poor social skills, low motivation)
fascilitative/democratic leader
- members at higher cognitive level (Must be self aware, intelligent, insightful, self-understanding
Capable of some reasoning/insight) - OT is educator, resource: provides needed information, structure, equipment, supplies, eductor
- Delegates some leadership roles to members
- Most likely to lead to group cohesiveness, client-centered approach
- FOR: MOHO, developmental, psychodynamic
advisory/laissez faire leader
- group members functioning at a HIGHEST level (Problem-solving, health & wellness or attitude change groups, Families, caregivers, professionals, self-help groups, community organizations, clubhouse members)
- Group members responsible for functioning of the group
- Roles independently assumed by members
- Feedback as natural part of group’s self directed process
- Leader offers guidance/direction as needed- consultant: not providing structure, goals, Resource, gives advice if needed
PTSD
Anxiety
Loneliness
Unable to sleep
Unable to feel joy
Anger
Aggression
Nightmares (night terrors)
Feeling guilty
Risky behaviors
Self harm
Suicidal thoughts
- intrusion symptoms (1 month)
generalized anxiety disorder (GAD)
- 6 months of persistent & excessive unfocused anxiety & worry
Tension
Nervousness
Panic attacks
Increased heart rate
Worry
Trouble sleeping
Sweating
GI problems
Overwhelming sense of dread
Intense fear of death, injury, bad things happening
Apprehension about change
Fear of unknown - may/may not have specific focus
running stitch
- OT judges client abilities to complete BADLs
- help coach caregivers on supports
whip stitch
- OT judges client’s problem solving abilities
- determines if they can prepare a meal, remember to take meds, respond to emergency situations like smoke detector
cordovan stitch
- OT judges client’s ability to process information
- determines if they can hold a job, drive, take care of others
all players must get extra points
Automatic
Postural
Manual
Goal-directed
Exploratory
Purposeful
conditions ACLs is used with
- alzheimer’s disease & senile dementia
- CVA/TBI
- developmental disability
- PSYCHOTIC DISORDER: schizophrenia
- MOOD DISORDERS: bipolar disorder, chronic depression
- substance abuse
- PTSD & other anxiety disorders
- post operative cognitive dysfunction
Tuckman’s Stages of Groups
- Forming: orientation, plan for group formation
- Storming: power struggle, members engage
- Norming: cooperation & integration, members establish rules about how to achieve goals
- Performing: synergy, conflict resolved
- Reforming/Transforming:
adjourning, group dissolves, reflect on history, evaluate what went well
stages of group
- initial: orientation & exploration, expectations (trust, roles, goals), leader: structure, models trust, ground rules, actively listens, empathy
- transition: dealing with resistance, members anxious about sharing feelings - leader: provides safe environment, clear boundaries
- working: cohesion & productivity, build trust, cohesive, shared responsibility, after kinks worked out, leader: continues to model, support, less structure
- final: consolidation, termination, reflection, feelings of sadness, feedback, task completed
most common form of dementia
alzheimer’s disease
schizoaffective disorder
- Combination of schizophrenia & mood disorder (depression, bipolar disorder)
pressured speech
rapid, increased in amount, may be difficult to understand/interpret
poverty of speech
limited in amount (one word answers)
poverty of content in speech
adequate in amount but vague
nonspontaneous speech
responses only given when spoken to directly
stuttering
repetition or prolongation of sounds or syllables
circumstantiality
speech that is delayed in reaching point, contains excessive/irrelevant details
tangentiality
abrupt change of focus to loosely associated topic
perseveration of thought
persistent focus on previous topic or behavior after new topic/behavior has been introduced
flight of ideas
rapid shifts in thought from one idea to another
thought blocking
interruption of thought process before carried to completion
loosening of association
shift from one subject to another
Montreal Cognitive Assessment (MoCa)
- highly sensitive, detects mild cognitive decline and early signs of dementia
- longer to administer than SLUMS
- Short term memory
- Visuospatial abilities
- Executive functions
- Attention, concentration and working memory
- Language
- Orientation to time and place
St Louis University Mental Status (SLUMS)
- detecting mild cognitive impairment and dementia
- more sensitive than the Mini Mental, shorter to administer
brief psychotic disorder
- one or more sensory, behavioral, cognitive, psychomotor symptoms (hallucinations, delusions, catatonia)
- ranges from 1 day to 1 month followed by complete resolution of symptoms and return to PLOF
Chlorazil
atypical antipsychotic
- side effect is agranulocytosis: decrease in certain WBCs, potentially fatal
anorexia nervosa
- low body weight
- fear of gaining weight despite being underweight
- in denial of body weight
- food restrictive type
- binge eating/purging type
- begins mid teens, more girls
- OCD behavior, depression, anxiety, rigidity, perfectionism, poor sexual adjustment
bulimia nervosa
- ongoing binge eating of much larger portions than expected, unable to control consumption to avoid gaining weight
- vomiting, laxatives, fasting, extreme exercise
- normal weight (not underweight)
- self concept defined by size, obsession with personal appearance
binge eating disorder
- unable to control recurrent periods of consuming exorbitant amounts of food in discrete situation
- eating until uncomfortably full, not hungry
- eating more at faster pace
- experiencing guilt/depression after excessive eating
- result in distress
Pica
-eating nonfoods
- present for at least 1 month
rumination disorder
- repeated, unintentional regurgitation of undigested/partial digested food followed by rechewing & either swallowing or spitting out food
- at least 1 month
avoidant/restrictive food intake disorder
- persistent failure to meet nutritional needs resulting in:
nutritional deficiency, significant weight loss, reliance on oral nutritional supplements or alt feeding methods (enteral feeding via pump), clinical disturbance in psychological functioning
assertiveness training
- for dependent personality disorders (difficulty making decisions, depend on guidance/support from others that is out of proportion to situation)
- helps patient gradually empower themselves to make their own decisions, ask for help, provide constructive criticism when appropriate
good starting point is obtaining information
EX: before buying a product, ask sales clerk more information about it (non confrontational- then progress to more confrontational requests)
positive schizophrenia symptoms
excess or distortion of normal function (eg, delusions, hallucinations, disorganized behavior)
negative schizophrenia symptoms
No behaviors related to motivation (avolition, anhedonia, asociality) or expression (blunted affect, alogia)
alogia
decreased thought & speech
psychoeducation
- education offered to those with mental illnesses/families to empower them to deal with their condition optimally
- strengthens capabilities, resources, coping skills
- includes homework, teacher-student format
- used with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, personality disorders
Depressive episode
lasts at least 2 weeks to 6-8 months
- major or minor
neuropsychiatric symptoms of dementia
aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition
- affects dementia pts across stages/etiologies
- poor patient/caregiver outcomes
handling aggression when caregiver is involved
- determine CAUSE & TRIGGERS
- warn caregiver not to confront or return physicality
- discuss other self-protection strategies with caregiver (distract, back away, leave them alone if they are safe & seeking help)
- limit access to/remove dangerous items
- create calm, soothing environment
psychosomatic
caused by a mental factor (internal conflict or stress)
assertiveness training group
learn to identify irrational beliefs/fears about social situations via role playing (CBT)
- will teach them to make requests, teach coping strategies
neurocognitive disorders
decline in cognition (thinking) abilities
- not present at birth
- loss of previously acquired skills/functions
what distinguishes GAD from OCD?
most similar but
- compulsions only in OCD
- thought patterns characteristic of these disorders
- GAD thoughts are worries (not obsessions)
mixed feature major depression
- manic symptoms & depression (don’t meet criteria for manic episode)
anxious distress major depression
anxiety & depression
reminiscence group
- BRIEF, STRUCTURED intervention
- participants share personal past events with peers, pride in past life experiences
- improves wellbeing, reduces depressive symptoms among institutionalized elders
mild cognitive impairment
- decline from the past but function nearly independently in daily life in a manner indistinguishable from the past
- losing things often, forgetting to go to events/appointments
- having more trouble coming up with words than people of the same age
handling aggressive patients
- ensure their safety
- DO NOT move closer to them or take on more assertive role
- keep them in safe position, acknowledge their aggression
- try to help them calm down
- call for help if needed
handling akinesia
(difficult to sit still)
1. allow patient to move as needed
2. GM activities over FM when possible
handling delusional behavior
- don’t deny it to them (“that’s not real”)
- orient to reality
- avoid discussions reinforcing delusions
handling demented behavior
- routine of enjoyable activities
- ensure patient safety
- eye-contact
- friendly/positive expression
handling escalating behavior
- avoid challenging them, maintain distance, actively listen
- avoid making them feel trapped
- calm, non patronizing tone
- if escalation continues, remove them from others and call for help
handling hallucinations
- distraction free environment
- high structure activities
- redirect
(DONT ISOLATE THEM)
handling lack of participation/initiation
- offer choices to motivate
handling manic/monopolizing behavior
- high structure activities
- thank them for input, move to next patient (redirect your attention)
handling offensive behavior (physical or verbal)
- set limits, immediately address behavior
- be clear about reasons why its not acceptable & consequences
- ensure needs of entire group & protect them from harm
handling poor self esteem
- provide constant reassurance that activity is going well (allow them to know what is coming next)
addressing group conflict
- lower your voice
- eliminate threatening behavior (if they stand, tell them to sit down; if they yell, tell them to lower their voices)
- repeat back (ask group members to repeat what other has said to feel heard)
- remove tension (ask them to talk to you about source of their anger instead of each other)
illusions
misinterpretations of real sensory events
agnosia
unable to understand/interpret significance of sensory input
visual agnosia
unable to recognize people/objects
astereognosis
unable to identify objects by touch
adiadochokinesia
unable to perform rapidly alternating movements
anergia
lack of energy
delusional disorder
- 1 or more delusions for 1 month or longer
- no criteria for schizophrenia
horticulture group
gardening group
- consider med side effects beforehand (photosensitivity with antipsychotics)
what happens when there are high levels of lithium in the blood?
due to mood stabilizing meds for manic episodes or bipolar
- nerve damage or death
early symptoms of toxicity
motoric disturbances
major depressive disorder
- 1+ major depressive episodes
substance abuse disorder
2 symptoms present within 12 month period
- substances used in larger quantities than intended, effects last for longer than anticipated (tolerance over time)
- significant amount of time dedicated to it
- unsuccessful efforts to reduce use
- continues despite potential for harm
- attempts to stop = withdrawal
signs of withdrawal
autonomic hyperactivity, insomnia, nausea, vomiting, hallucinations, psychomotor agitation, anxiety, generalized tonic clonic seizures
- may result in reoccuring substance use
adverse affects of substance use
brain & liver damage, heart disease, fetal problems during pregnancy
results of substance use
- disinterest/inability to care for self & others
- difficulty with & loss of personal relationships
- unable to be productive & maintain employment
- absence of leisure & social pursuits not involving substance abuse
gambling disorder
4 or more symptoms in a year
- thoughts of gambling most of the day
- multiple unsuccessful attempts to stop
- increased gambling with stress
- serious financial trouble due to it & asks others for money
- continues even after losing money to try to chase losses
- lying to downplay use
- problematic & recurrent (not due to mania)
panic disorder
- recurrent panic attacks followed by at least 1 concern for recurrence
selective mutism
anxiety disorder
- consistent inability to speak in social situations when expected (school) but able to speak in other circumstances
- at least 1 month
separation anxiety disorder
- clients (esp young children) excessively attached to another individual and have severe anxiety when separated
- developmentally inappropriate, unwarranted in circumstances
social phobia
clinically significant anxiety from certain types of social/performance situations leading to avoidance
specific phobia
clinically significant anxiety from specific object/situation leading to avoidance
systematic desensitization
for phobias
- requires training
- incremental exposure in attempt to diminish anxiety related to specific fears through use of imagery/relaxation and then contact with image or actual object
- exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities or situations with relaxation
major neurocognitive disorder
- significant impairment in cognitive functioning
- decline from PLOF
mild neurocognitive disorder
cognitive deficits not interfere with everyday activity independence
to determine level at which patient with schizophrenia is functioning, including problem-solving ability, which activity should be used as an assessment tool?
simple craft project
This is a setting to which a patient is admitted if they exhibit extreme symptoms, do not respond to treatment, or are seen to be a risk to themselves or others
long term hospitalization
This model of supported employment is for people with serious mental illness and it aims to help them find work at regular jobs of their choosing
Individual Placement and Support (IPS)
This is a state of elevated energy, mood, and behavior, most often seen in those with bipolar disorder, schizoaffective disorder, or those who have taken certain drugs
mania
This developmental group focuses on developing interaction between people while they work on individual tasks
parallel
This type of activity group centers around a verbal discussion which focuses on an activity that members are engaged in or will become engaged in, in the future
topical group
intervention for social anxiety disorder/social phobia
- progressive in vivo exposure
progressive in vivo exposure
directly facing fear in real life to help conquer fears
(fear of public speaking = have them give a speech in front of an audience
imaginal exposure
vividly imagining the feared object, situation or activity (PTSD patient asked to recall/describe trauma to reduce fear of it)
interoceptive exposure
deliberately bringing on physical sensations that are harmless, yet feared
(someone with panic disorder instructed to run in place in order to make heart speed up, and therefore learn that this sensation is not dangerous)
flooded exposure therapy
begin exposure with the most difficult tasks
graded exposure
helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones
people with major depression tend to have most difficulty with
initiation
- provide verbal/tactile cues to start task
purpose of a questionnaire
Forming goals by which progress can be measured
divergent thinking
coming up to solutions when there is no single correct answer
convergent thinking
coming up with the best answer to a question using our memory, resources around us, or logic
The person shuts down emotionally, mentally and physically. People appear to be paralyzed. They have no facial expression and may stand still for long periods of time. There is no drive to eat, drink or urinate
catatonic schizophrenia
unreasonable suspicion and primarily positive symptoms (common to this condition and typically respond to medical treatment), preoccupied with at least one delusion (usually persecutory in nature) or is experiencing frequent auditory hallucinations; other symptoms of schizophrenia — such as disorganized speech, flat affect, catatonic, or disorganized behavior — are not present or are less prominent than these positive symptoms
paranoid schizophrenia
how to handle poor self-concept
foster self-esteem by having the patient discover positive feelings through the group process
What are the advantages of community-based mental health treatment
minimizes the stigma associated with mental illness, is more cost-effective than inpatient mental health treatment, it provides services and supports for a wide range of concerns
the first step to practicing skills in the outside world is
community residential setting
This is the only type of developmental group where members can be functioning at different levels and activities can be adapted according to the appropriate cognitive levels of the patients
parallel group
groups designed for learning a specific skill
thematic groups
which type of memory is impaired in schizophrenia?
working memory
peer support group
- topical group
- similar diagnoses/situations lend emotional support to one another
What type of group provides an awareness of group’s goals, norms and willingness to follow them?
egocentric-cooperative
provides assistance in basic self-care in a home environment in which there are 20 or less residents living in the home. The resident must not be exit-seeking and must be mobile with or without a mobility device
adult group home or board & care
group home where client is required to use the call button
assisted living, long term care
