Mental Health Conditions / Environments: Community Based Mental Illness Flashcards
1
Q
Intellectual Disabilities: Causes
A
- genetic, biological, disease, malformation related, caused by something prenatal, or injury
- 34-39% of cases, mostly mild, have no known cause
- onset is in childhood
2
Q
ID: Features
A
- cognitive impairment (IQ<70)
- impairment in adaptive functioning (self-care, social skills, self-direction, safety, etc)
- difficulty with independent functioning in daily life
- most frequent source of disability in childhood
- mild, moderate, severe, or profound
- high comorbidities with everything - mobility, sensory, vision, hearing, weight, all organ systems, skin
3
Q
ID: Occupational Performance
A
- Health: more susceptible to poor health due to genetics, environment and behavior
- – Physical Health: increased risk, obesity
- – Sensory Impairments
- – Mental Health: higher rates, esp GAD, ADHD, conduct disorder, DD
- Adaptive Skills: a person must demonstrate impairment in two areas for diagnosis
- — social skills, language and communication, mobility, community participation
- — Task analysis - OTs find the right fit for individuals
4
Q
ID: Role of OT
A
- Early Intervention
- School setting, pediatric outpatient
- Help individuals develop strategies and acquire skills as well as promote self-determination and self-advocacy
- Improve conditions associated with ID (ex. poor physical health)
- Increasing health promotion behaviors (i.e. incorporating new habits, supporting healthy eating)
- Compensate for sensory impairments by modifying the environment (ex. reduced hearing and vision)
- Consider mental health issues, increase their access to care
- Improve adaptive skills: promoting the development of social skills, using adaptive equipment, sign language to promote communication in important occupation
- Promote community participation: matching jobs with interests
- Environmental factors that increase the risk for ID include poor access to health care and poverty.
- Education to communities, families, and individuals
5
Q
Eating Disorders: Features
A
- overwhelming obsession with thinness
- Anorexia
- Bulimia Nervosa
6
Q
Eating Disorders: Anorexia
A
- calorie restrictions, extreme weight loss, weight control behaviors
- intense fear of gaining weight
- disturbance in how the person views his/her weight
- low weight manifests in physical symptoms - hypothermia, bradycardia, loss of muscle, hormonal problems, etc
- associated with perfectionism and control
- Restrictive Type
- Binge Eating/Purging Type
7
Q
Eating Disorders: Bulimia Nervosa
A
- binging followed by purging/diuretics/laxatives
- recurrent episodes at least twice a week
- often associated with impulsivity
8
Q
Eating Disorders: Occupational Performance
A
- difficulty achieving relationships
- establishing an identity with strong self-esteem
- Anorexia: accomplished academically, struggle socially
- Bulimia: seek out gratification/comfort from others’ approval, dissatisfaction and frustration
- Struggle with stress management, communication, eating as a coping mechanism for feelings
- See habits as a lifestyle choice instead of a clinical problem
9
Q
Eating Disorders: Role of OT
A
- improve self-esteem
- develop positive roles, habits, routines, MOHO
- eating preparation, leisure, social participation
10
Q
Personality Disorders: Features
A
- Cluster A: Paranoid, Schizoid, Schizotypal
- Cluster B: Antisocial, Borderline, Histrionic, Narcissistic
- Cluster C: Avoidant, Dependant, Obsessive-Compulsive
11
Q
Personality Disorders: Cluster A: Paranoid, Schizoid, Schizotypal
A
- Discomfort in interpersonal situations and relationships
- Emotionally distant, distrustful, and suspicious,
- People tend to interpret the intentions and actions of others as negative and prefer to be alone
- Cognitive or perceptual distortions and eccentricities of behavior that are odd or inappropriate
12
Q
Personality Disorders: Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic
A
- Excessive, unstable, and inappropriate expression of emotions
- Maladaptive interpersonal relationships, and a disregard for the needs and rights of others,
- Impulsivity, irritability, and attention-seeking behaviors
- Identity disturbances
- Narcissistic personality disorder: lack empathy and constantly seek attention and admiration of others, grandiose sense of self.
13
Q
Personality Disorders: Cluster C: Avoidant, Dependent, and Obsessive-Compulsive
A
- The primary trait is anxiety
- Social discomfort, a sense of helplessness, an inability to make decisions, and perfectionism and inflexibility.
- Avoidant personality disorder: socially inhibited and often feel inadequate and overly sensitive, fear of rejection and humiliation
- Dependent personality disorder: fear separation and can exhibit submissive and clinging behavior, need to be taken care of
- Obsessive-compulsive personality disorder: preoccupied with perfectionism, mental and interpersonal control, causing them to be inflexible or inefficient.
14
Q
Personality Disorders: Occupational Performance
A
- social participation impairments
- Poor emotional modulation: high intensity, wild quick swings
- Poor coping skills: small problems seem big
15
Q
Personality Disorders: Role of OT - Interventions
A
- Mood stabilization due to often extreme fluctuations
- Appropriate expression of feelings
- Increasing self-concept, self-esteem, insight, and judgment
- Development of appropriate interpersonal relationships
- Effective coping strategies to deal with life stressors and feelings of anxiety
- Conflict resolution skills, social skills, assertive communication
16
Q
Personality Disorders: Role of OT - Approaches to Intervention
A
- Engaging clients in life skills groups to provide opportunities to develop ways of tackling problems and expand their coping skills
- Decrease feelings of anxiety by engaging in relaxation activities or simple tasks to facilitate success and increase self-esteem
- Examining the tasks required and the clients skills available to complete a task
- Potentially supported employment interventions
- Engaging the client in group games and activities that allow the client to experience a sense of fun
17
Q
Mood Disorders: Features
A
- o mood fluctuates more than what is typical for other people and may involve extended periods of extreme sadness or elevated mood
- Depression
- Dysthymic Disorder: similar to depression, less severity, lasts longer, > 2 years
- Bipolar Disorder
- – BPD 1: manic episode or mixed (fluctuates between elevated and depressed)
- – BPD 2: manic episode + hypomanic episode (less severe)
- Cyclothymic Disorder: chronic disorder that involves fluctuations between hypomanic and hypodepressive episodes
18
Q
Mood Disorders: Occupational Performance
A
- alter amount of sleep
- eating routines and appetite
- role performance
- social isolation
- workers with bipolar lose more jobs than workers with depression because they have more severe longer lasting depressive episodes
19
Q
Mood Disorders: Role of OT
A
- Promote health and well-being
- OTs can promote decreasing stigma and early intervention by doing workplace education on the condition
- OTs could also provide screenings and stress management and resilience training in workplaces and to other large groups
- Help clients with health management through education on wellness tools, helping people better understand their symptoms, and helping them explore the best way to respond to them
- Use interventions to promote motivation and self esteem, and/or help with medication management if the client is interested in that
- Use aspects of cognitive behavioral therapy (For example they may use CBT to teach techniques to attend to tasks and use more effective thinking so that clients can engage in activities that they need to do or want to do)
20
Q
Anxiety Disorders: Features
A
- overwhelming and prolonged state of fear that interferes with daily functioning
- protective behavioral pattern of fight or flight
- Panic Disorder
- Agoraphobia
- GAD
- OCD
- PTSD
- Social Phobia
- Specific Phobia
21
Q
Anxiety Disorders: Features - PTSD
A
- re-living the event
- intense psychological distress at internal or external cues that resemble the event
- avoidance of stimuli associated with the event
- numbing of general responsiveness
- increased arousal
22
Q
Anxiety Disorders: Occupational Performance
A
- Panic has a high comorbidity with cardiac problems
- Cognitive impairments: difficult time following directions, recalling what has been heard, and a decrease in short-term and verbal memory.
- Psychosocial impairments: disrupt individuals ability to be in social settings, education, and career development –> impact financial status –> increased hopelessness
23
Q
Anxiety Disorders: Role of OT
A
- Reduce effect of anxiety on occupational performance
- CBT
- Use a variety of preparatory relaxation techniques
24
Q
Schizophrenia: Features
A
- Delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behaviors
- negative symptoms
25
Schizophrenia: Features - Positive Symptoms
- hallucinations
- delusions
- racing thoughts
- disorganized behavior
26
Schizophrenia: Features - Negative Symptoms
- flat aspect
- social withdrawal
- reducing speaking
- reduced feeling of pleasure in everyday life activities
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Schizophrenia: Features - Disorganized Symptoms
- disorganized speech
- confusion
- disorientation
- memory problems
- dress inappropriately for the weather, shout for no reason, speak to themselves continually
28
Schizophrenia: Occupational Performance
- cognitive dysfunction + poor hygiene = higher morbidity and mortality
- social struggles and lack of employment
- executive functioning and attention
- -- problems with IADLs
29
Schizophrenia: Role of OT
- Evaluate cognitive functioning and how it impacts occupational performance
- -- cognitive remediation, compensatory strategies
- Coping mechanisms and methods to manage stress, reduce exposure to stress, additional supports when experiencing stress
- -- Schizophrenics are 4x more likely to die from serious cardiac events than the general population
- Interventions that support their engagement in safer health behavior.
- Illness management and recovery, assertive community treatment, family psychoeducation, supported employment and integrated dual diagnosis treatment.
30
Intermediate Care
- Person requires a longer period of treatment for stabilization
- Longer length of stay (months)
- Serving people with serious and persistent mental illness
- Emphasis on Recovery Principles
31
Treatment in Intermediate Care
- focus on health and wellness
- art and music therapy
- vocational activities - gardening, working in the gift shop
- groups - cooking, other activities
32
Development of Community Transitions Program
- Before: people were doing well enough to leave the hospital, but did not have strong enough life skills or understanding of resources to do ok in community, esp after months in hospital
- CTP focuses on Community Living Skills
33
CTP Program
- Time limited (6-8 weeks)
- Closed group (identified discharge plan)
- Skill building in the following areas:
- -- Symptom management
- -- Safety and health
- - Meal planning/preparation
- -- Home management
- -- Community mobility
- -- Managing daily routine
- A lot of group activities: lunch group, outings, life after discharge, group discussions
- Goal- Setting
- Community Trips
- WRAP: Wellness Recovery Action Plan for managing your own condition after discharge
34
CTP Enrollment Requirements
- able to learn new skills
- -- do not take people with dementia
- discharge to place with mostly independent living
- wants to participate
- needs to develop life skills
- able to attend and participate in a 45 minute group session
- able to maintain good behavioral control
35
Partial Hospital
- like an inpatient rehabilitation program but not 24 hours
| - in between hospital and community
36
Day Treatment
- Provides structure and support for rehabilitation
- Helps transition clients to less treatment intensive settings
- Emphasis on group treatment
- Few day treatment options, longer length of stay than partial hospital, OT may not be part of team
37
Psychosocial Clubhouses
- concept of membership
| - staff as coworkers not therapists
38
Role of OT at the Clubhouse
- Consultant
- Activity analysis
- Teach skills
- Modify the environment
39
Recovery Learning Community
- Peer run organization
- Provides support, education and advocacy
- Supports individual paths to recovery
- Peer specialists bring hope
- OT is not on site - OTs just make people aware of these
40
Community Mental Health Practice
- Supported Housing
- Supported Employment
- Supported Education
- Peer operated services
- Community Based Flexible Supports
- Outpatient Occupational Therapy
41
Role of OT in Community Based Care
- Home visits
- -- evaluate environment/physical area
- -- evaluate person's ability to complete ADLs
- Behavioral and Functional consultation
42
How to approach a client who has poor self-care?
used skilled observation, PEO, task analysis, all that stuff we learn in our other classes
43
How to approach a client who has poor self-care?
used skilled observation, PEO, task analysis, performance patterns and skills, client factors - OTPF 3
