Mental Health Flashcards
Sundowning
Occurs in the late afternoon and night in older people. Characterized by drowsiness, confusion, ataxia, falling, agitation, and sometimes aggression.
Hypervigilance
Excessive attention and alertness that guards against potential danger
Trance
A sleep like state with minimal environmental awareness, followed by amnesia for the experience
Echopraxia
Meaningless imitation of another person’s movements
Catatonia
Characterized by immobility or rigidity
Stereotypy
The repetition of fixed patterns of movement and speech (e.g., echolalia)
Psychomotor Agitation
Excessive motor and cognitive activity, usually nonproductive and in response to inner tension
Akathisia
The state of restlessness characterized by an urgent need for movement, usual a side effect of medication
Ataxia
The irregularity or failure of muscle coordination upon movement
Circumstantiality
Speech that is delayed in reaching the point and contains excessive or irrelevant details
Delusions
False beliefs about external reality without an appropriate stimulus that cannot be explained by the individual’s intelligence or cultural background
Compulsions
A need to act on specific impulses to relieve associated anxiety
Obsessions
Constitute a persistent thought or feeling that cannot be eliminated by logical thought
Broca’s Aphasia
Expressive aphasia. A disturbance in which the individual knows what he wants to cay, but can’t say it
Wernicke’s Aphasia
Receptive aphasia. Loss of the ability to comprehend what is being said
Nominal Aphasia
The inability to name objects
Hallucinations
False sensory perceptions that are not in response to an external stimulus
Illusions
Misperceptions or misinterpretations of real sensory events
Agnosia
The inability to understand and interpret the significance of sensory input
Apraxia
The inability to carry out specific motor tasks in the absence of sensory or motor impairment
Depersonalization
Subjective sense of being unreal or inanimate. Associated with conversion and dissociative phenomena.
Derealization
Subjective sense that the environment is unreal. Associated with conversion and dissociative phenomena.
Fugue
A state of serious depersonalization, often involving travel or relocation, in which the individual takes on a new identity with amnesia for his old identity. Associated with conversion and dissociative phenomena.
Dissociative Identity Disorder
Involved the appearance that an individual has developed two or more distinct personalities.
Dissociation
Involved the separation of a group of mental or behavioral processed from the rest of the person’s psychic activity. May involve separating an idea from its emotional tone.
Immediate Memory
recall material within seconds or minutes
Recent Memory
Recall events of the past few days
Recent Past Memory
Recall events of the past few months
Remote Memory
Recall events of the distant past
Schizophrenia - Diagnostic Criteria
- Criterion A: The presence of 2 or more of the following
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Criterion B: Disturbance in one or more areas of function such as work, relationships, or self care.
- Criterion C: Continuous signs of the illness for 6 months, including at least a month of symptoms in criterion A.
Schizophrenia - Positive symptoms
Excesses or distortions of normal function such as delusions, hallucinations, or disorganized behavior.
Schizophrenia - Negative symptoms
Represent a loss or absence of function.
- Restricted emotion
- Decreased thought and speech
- lack of motivation and initiative
- Inability to relate to others
Paranoid Schizophrenia
Characterized by preoccupation with one or more delusions of persecution or grandeur. Frequently experience auditory hallucinations, but exhibit fewer negative symptoms.
Disorganized Schizophrenia
Distinguished by marked regression demonstrating primitive, disinhibited, and disorganized behavior.
Catatonic Schizophrenia
Characterized by severe disturbance in motor behavior involving stupor, negativism, rigidity, excitement, or posturing.
Residual Schizophrenia
Used when there is continued evidence of schizophrenic behavior in the absence of a complete set of diagnostic criteria
Schizophreniform disorder
The individual meets the criteria for schoziophrenia; however, the episode lasts more than a month but less than six months (required for schizophrenia)
Schizoaffective Disorder
The person has an uniterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with symptoms that meet Criterion A symptoms for schizophrenia.
Delusional Disorder
Predominant symptoms are non-bizzare delusions with the absence of other criterion A symptoms of schizophrenia.
Brief Psychotic Disorder
The individual experiences at least one day but less than one month with one or more criterion A symtpoms of schizophrenia which result from severe psychosocial stress.
Psychotic Disorders - Impact on function
- Sensory processing deficits make interaction with the environment frightening
- Socially inappropriate and intrusive behaviors
- Difficulty with relationships
- Difficulty in all areas due to deficits in cognitive function caused by thought disorders
- Assess and monitor degree of assistance and structure needed to maintain independence
Neuroleptic Malignant Syndrome
An autonomic emergency leading to increased blood pressure, tachycardia, sweating, convulsions, and coma. A side effect of antipsychotic medications.
OT considerations for Psychotic Disorders
- Communicate simply, clearly, and concretely
- Use external structure to organize thinking
- Provide supports and tools to enable recovery
Bipolar I
- One or more manic episodes
- May be combined with depressive episodes
Bipolar II
- One or more major depressive episodes
- Must be at least one hypomanic episode
Dysthymia
At least 2 years of a depressed mood, most days, with depressive symptoms that are not severe enough to meet the criteria for a major depressive episode
Cyclothymic Disorder
At least 2 years with numerous periods of hypoanic and depressive symptoms that do not meet the criteria for a manic or major depressive episode.
Manic Episode - Impact on function
- Lack of inhibition leads to excessive spending, impulsive travel, flamboyant behavior, etc.
- May become labile, threatening, and assaultive
- May have high energy levels and require little sleep
- Poor judgement can lead to dangerous situations, poor self carel relationship problems, and substance abuse
OT considerations for Manic Episode
- Limit-setting to reduce individual’s fears of losing control
- Engagement in activities that provide for release of excess energy in a positive and therapeutic manner
- Between episodes, educate individual and family on symptom management
Major Depressive Episode - Impact on Function
- Often tearful, brooding, and isolative
- Anxiety leads to excessive concerns about physical health, complaints of pain, and alcohol abuse
- Limited interest in activity and difficulty performing tasks in all areas of occupation
OT considerations for Major Depressive Episode
- Always provide a safe environment and be aware of behaviors that might threaten safety (suicide)
- The most dangerous time is when the depression lifts and the person becomes mobile
Substance use disorders
- Dependence - must be evidence of tolerance and withdrawal
- Abuse - must be continued use dspite serious consequences
Substance-induced disorders
Includes intoxication, withdrawal, and substance-induced anxiety, affective, and psychotic disorders. Treated medically
OT considerations for Substance Abuse
- OT assists in identifying realistic expectations and discharge plans
- Address individual’s reasons for substance abuse
- Assist in developing coping skills including: social skills, work/education productivity skills, and leisure without substances.
- Support groups
Panic Attacks - Definition
- Periods of intense fear or discomfort, in which four or more symptoms develop abruptly and reach a peak within 10 minutes:
- Palpatations
- Sweating
- Trembling
- Shortness of breath
- Feelings of choking
- Chest pain
- Nausea
- Feeling dizzy or faint
- Derealization or depersonalization
- Fear of going crazy or losing control
- Fear of dying
- Paresthesias
- Chills or hot flashes
Agoraphobia - Definition
Anxiety about being in places or situations where it might be difficult or embarassing to escape. Situations are avoided or endured with anxiety about having a panic attack.
OT considerations for Anxiety Disorders
- Use cognitive behavioral appraochs and skills training to reduce avoidant behavior
- Develop relaxation and stress management skills
- Provide graded activities to promote self-efficacy
Personality disorder - Definition
Evidence of characteristics and patterns of inner experience and behavior that ddeviate markedly from the culturally accepted norms in cognition, affect, impulse control, and interpersonal relations. Behavior must be inflexible and maladaptive across a broad range of personal and social situations. Must be evidence of onset in late childhood or adolescence.
Personality disorder - Cluster A
- Paranoid, schizoid, and schizotypal
- Often perceived as odd and eccentric
Personality Disorder - Cluster B
- Antisocial, borderline, histrionic, and narcissistic
- Often perceived as dramatic, emotional, and erratic
Personality Disorder - Cluster C
- Avoidant, dependent, obsessive-compulsive, and NOS
- Often perceived as anxious and fearful
Paranoid Personality Disorder
- Characterized by long-standing suspiciousness and mistrust of people in general
- Refuse responsibility for their own feelings
- Appear hostile, irritable, and angry
Schizoid Personality Disorder
- A lifelong pattern of social withdrawal
- Discomfort with human interaction, introversion, and bland, constricted affect
- Often seen as eccentric, isolated, and lonely
Schizotypal Personality Disorder
- Appear odd or strange in thinking and behavior
- Magical thinking, peculiar ideas, ideas of reference, illusions, and derealization are frequent
Antisocial Personalilty Disorder
- Characterized by continual antisocial or criminal acts, but is not synonymous with criminality
- An inability to conform to social norms
- Have no regard for safety or feeling of others
- Lack remorse
Borderline Personality Disorder
- Experience extraordinarily unstable affect, mood, behavior, relationships, and self-image.
- Fear of real or imagined abandonment leads to frantic efforts to avoid it
- Recurent self-destructive behavior may be threatened or carried out
- Majority of patients have a history of trauma or abuse
Histrionic Personality Disorder
- Characterized by colorful, dramatic, extroverted behavior in excitable, emotional persons.
- Inability to maintain deep, long-lasting attachments with accompanying flamboyant presentation
Narcissistic Personality Disorder
- A heightened sense of self-importance and a grandiose feeling that they are special in some way
Avoidant Personality Disorder
- Extreme sensitivity to rejection, leading to a socially withdrawn life
- Not asocial. Have a great desire for companionship, but consider themselves unworthy.
- Need unusually strong and repeated assurance of acceptance
- Referred to as having an inferiority complex
Dependent Personality Disorder
- Individuals subordinate their own needs to those of others and needo thers to assume responsibility for major areas in their lives
- Lack self-confidence
- Experience discomfort when alone for more than a brief period
Obsessive-compulsive Personality Disorder
- Emotional constriciton, orderliness, perseverance, stubborness, and indecisiveness
- A pervasive pattern of perfectionism and inflexibility
- NOT the same as OCD
OT considerations for Personality Disorders
- Assist individual in identifying issues in order to increase commitment to treatment
- Cognitive behavioral approaches can increase functional skills
Delirium
- A disturbance of consciousness with a decreased ability to attend
- A change grom previous cognition
- Covers a short period of time (hours to days) and fluctuates
- Many causes, including medication, fever, cardiac disorders, brain dysfunction, etc.
Reversible Causes of Mental Confusion
- Sensory changes and problems
- Drug use and misuse of medications
- Infections/inflammation
- Metabolic problems
- Dehydration
- Depression
Korsakoff’s Syndrome
- Brain disorder caused by thiamine (B1) defeciency, usually associated with heavy alcohol use
- Symptoms include memory loss, personality changes, lack of insight into condition, and confabulation
Reisburg’s Stages of Dementia
- Stage 1: No disability noted
- Stage 2: Person forgets normal age-related information.
- Stage 3: Beginning signs and deficits are noted Difficulty with complex tasks and directions to new locations.
- Stage 4: Deficits are noted in all IADLs. Difficulty with sequencing, challenging activities, and word finding.
- Stage 5: Cannot funciton independently. Unsafe to drive. Cues and assist forADLs. Forgets self-care needs.
- Stage 6: Cannot perform ADLs without cues. Cannot speak in full sentences. Becomes incontinent.
- Stage 7: Vegetative state
OT considerations for Cognitive Disorders
- Maintain quality of life through activity and environmental modifications
- Family education
Eating Disorders - Impact on function
- ADLs (self-care, eating, feeding)
- IADLs (shopping for food and clothes, meal prep, health management)
- Focus on weight might interfere with work goals
- Leisure activity may be focused on appearance and weight, rather than meaningful activity
- Social participation can be affected by food-restriction, secrecy, and feeligns of guilt or depression
OT considerations for Eating Disorders
- Building of trust is essential
- Be honest, supportive, and gently confrontational when indicated
- Identify socio-emotional needs and replace with non-food related purposeful activities
- Education about nutrion and healthy leisure
