OTA 110 - Ch. 5, 8, 10, 11

Question 1

Changes from DSM-4 to DSM-5

Answer 1

• DSM-4 used Axis system; DSM-5 non-axial
• DSM-4 used “mental retardation”; 5 uses “intellectual disability”
• DSM-4 used “gender identity disorder”; 5 uses “gender dysphoria”
• DSM-4 used PDD-NOS (pervasive developmental disorder-not otherwise specified), Asperger’s, etc.; 5 uses “autism spectrum disorder”

Question 2

DSM-5 structure

Answer 2

20 chapters based on disorder types (neurodevelopmental, psychotic, depressive, anxiety, trauma, substance use, personality, etc.)

Question 3

MAOI

Answer 3

Monoamine oxidase inhibitors (Nardil, Parnate) – antidepressant drugs. Often used when other antidepressants ineffective. CAUTION: Must follow a special diet! Amino acid “tyramine” interacts and can be life-threatening! Avoid foods such as aged cheese, wine/beer, yogurt, tea/coffee, avocados, bananas, yeast, raisins/dates, and more.

Question 4

Tyramine reaction

Answer 4

When foods containing amino acid tyramine interact with MAOIs; causes life-threatening hypertensive crisis (sudden loss of blood pressure), which could lead to cerebral hemorrhage and death.

Signs: sweating, palpitations, headache.

Question 5

Tardive dyskinesia

Answer 5

(TD); side effect of antipsychotic drugs (Thorazine, Haldol, Seroquel, Risperdal). Movement disorder usually associated with older, first-gen drugs. Initial signs are involuntary facial movements, writhing tongue, writhing fingers. Can become permanent unless med is stopped.

Question 6

Six major categories of psychotropic drugs:

Answer 6

1) Antipsychotic drugs
2) Antidepressant drugs
3) Antimanic drugs
4) Antianxiety drugs
5) Psychostimulant drugs
6) Antiparkinsonian drugs

Question 7

Antipsychotic drugs

Answer 7

For people with schizophrenia and other psychotic disorders. Control hallucinations/delusions. Help reduce violent/dangerous behaviors.

Examples: Thorazine, Haldol, Seroquel, Risperdal

Most serious side effect is tardive dyskinesia (TD). Also photosensitivity.

Question 8

Antidepressant drugs

Answer 8

Relief of depression/suicide. Newer meds tend to have fewer side effects (less libido loss/weight gain). May take up to 3 weeks to be effective.

Examples: Wellbutrin, Paxil, Zoloft, Prozac

Side Effects: may increase suicidal tendencies; older drugs (MAOIs) may cause tyramine reaction.

Question 9

Antimanic drugs

Answer 9

Mood stabilizers; reduce intensity of mood swings, mania. (Sometimes anticonvulsants also work). Used with bipolar disorder.

Example: Lithium (toxic, causes fine hand tremor)

Question 10

Antianxiety drugs

Answer 10

To control anxiety in disorders that are not psychotic (anxiety disorder, personality disorder).

Examples: Valium, Xanax (can be very addictive)

Question 11

Psychostimulant drugs

Answer 11

Stimulate and increase mental/physical activity. Paradoxical effect on children with ADHD. Improve attention span, reduce hyperactivity.

Examples: Ritalin, Adderall

Side effects: impaired growth, tics, insomnia (sometimes loss of appetite)

Question 12

Side effect: Nausea

Answer 12

• Have soda/graham crackers or bread

* OTC antacids sometimes recommended by dr., but get their approval in case it interferes with meds

Question 13

Side effect: Photosensitivity

Answer 13

Extreme sensitivity to sunlight/easily sunburns (side effect of antipsychotics)
• Teach patient about these effects
• Wear sunscreen/sleeves/hat/sunglasses
• Keep time in sun brief
• Observe closely for signs of sunburn

Question 14

Side effect: Dry mouth

Answer 14

• Allow water whenever thirsty
• Have hard candies available (lemon drops/mints)
• Teach about dehydration effects of caffeine/alcohol

Question 15

Side effect: Blurred vision

Answer 15

• Help patient select activities that don’t require fine visual attention
• Use mats/soft equipment in gross motor activities
• Use large pieces in crafts (ie: 1-inch mosaic tiles)
• Provide magnified reading glasses

Question 16

Side effect: Postural hypotension

Answer 16

Patient feels faint/blacks out when rising.
• Notify physician
• Teach patient to sit/stand up slowly; be prepared to support them at waist
• Encourage use of furniture/supports for balance
• Avoid activities with sudden postural changes
• Avoid gross motor activities to reduce sudden movements

Question 17

Side effect: Hand tremors

Answer 17

(Ataxia). Common side effect of Lithium.
• If patient on new trial of lithium-based med and tremor is gross, notify dr. (may be sign of toxicity).
• Common if on lithium for month+. Help patient learn to compensate by stabilizing elbow/arm.
• If taking antipsychotic and tremor is wormlike/writhing, notify dr. Could indicate TD.

Question 18

Side effect: Akathisia

Answer 18

Restlessness, muscular tension (often worse in legs).
• Help patient select activities that allow for movement (getting up, etc.)
• Avoid activities requiring prolonged sitting/standing
• Put patient at separate table if movement disrupts others.

Question 19

Nonadherence

Answer 19

Not taking medication as prescribed. Some reasons:
• Feels unnatural; feel like it’s making them sicker
• Unpleasant side effects
• Hard to follow dosing/multiple meds overwhelming
• Cost
• Preference to street drugs
• Difficulty opening containers/swallowing/memory

Question 20

Role of OTP re: Medication

Answer 20

1) Observe/report functional level
2) Adherence/other substance issues
3) Management of side effects
4) Driving/safety concerns
5) Med education/management

Question 21

What does safety as an OTA include?

Answer 21

1) Keeping client safe from self and others
2) Keeping yourself and staff safe from clients
3) Keeping other clients safe from your client
4) Teaching client how to be safe elsewhere

Question 22

Universal precautions

Answer 22

Set of procedures recommended to prevent spread of infection.

Question 23

Most effective method of disease prevention

Answer 23

Regular and thorough hand washing

Question 24

“S. E. A.”

Answer 24

Suicide, elopement, assault: the three psychiatric emergencies.

Question 25

Suicide

Answer 25

One of 3 psychiatric emergencies (“S.E.A.”) • Avoid dangerous tools/supplies (toxins, flammables, sharps, rope-like objects) • Count items before/after activities • Accompany patients leaving the room

Question 26

Risk factors for suicide

Answer 26

* Major mental disorder * Past suicide attempts, lethal methods (gun) used * Comorbidities * Adverse childhood experiences * Sexual abuse * Substance abuse * Unemployment/lack of future plans/goals * **Depressed clients who show increased activity/mood are actually increased risk!**

Question 27

Signs of suicidal intent

Answer 27

* Talking about wanting to die * Making if/then statements about future * Recent acquisition of means (meds, gun) * Making a will/getting life insurance * Giving away belongings * Seeking promises “if something happens to me” * Passive suicidal behavior (not eating, alcoholism, unsafe behavior)

Question 28

Steps in handling assault

Answer 28

1) Call for more staff 2) Remove other patients from area 3) Attempt to calm the patient * Talk to them if you can * Avoid physical force–only as last resort if trained!

Question 29

Elopement

Answer 29

One of 3 psychiatric emergencies (“S.E.A.”) Leaving facility without discharge. • Secure doors/windows • Never leave keys unattended • Don’t turn back on patient when escorting

Question 30

Independent Living Safety Topics

Answer 30

1) Medication safety 2) First Aid 3) Emergency procedures 4) Personal hygiene 5) How/when to obtain medical care 6) Personal safety (locks, strangers) 7) Safe sex techniques 8) Safety when using electronics/devices

Question 31

“RICE”

Answer 31

Rest, Ice, Compression, Elevation (for strains, sprains, bruises, contusions)

Question 32

How to handle client having seizure

Answer 32

* Stay calm, reassure person you’re there * Time the duration of seizure * Get them on their side, loosen tight clothing, protect from nearby objects * Do not put anything in mouth or do CPR (call 911 first) * Stay until breathing returns to normal and person is fully awake * Let them know what happened, check for injuries * Record what happened and notify doc/health team

Question 33

How to control your environment

Answer 33

1) Keep track of your keys 2) Do not bring restricted items in (glass, wire, cord, etc.) 3) Have everything ready before patient arrives/never leave patient from locked ward unattended 4) Use shatterproof mirrors 5) Use judgment about who comes to OT (is other staff nearby? Is activity safe for this person?) 6) Organize supplies for easy count. Keep sharp/dangerous items locked. 7) Alert client to potential dangers (ie: splinters) 8) Follow precautions for toxins 9) Use safety equipment (goggles, gloves, etc.) 10) Observe fire codes 11) Attention to floor conditions (no spills/hazards) 12) Eliminate electrical hazards 13) Food safety guidelines (and burn prevention) 14) Techniques for energy conservation/ergonomics 15) Provide more structure for lower cognitive levels

Question 34

How major mental disorders effect performance of occupation?

Answer 34

1) Anxiety: low attention span, need to move, fear of unfamiliar 2) Depression: need for success/self-control, more motivated by helping others, prefers familiar, simple activity, less stimulation/less choice 3) Mania: low focus, need to move, short-term activities, simplicity, easily distracted/hard to control 4) Hallucinations: need for calm, low stimulation, prefer social, needs structure/short-term activities 5) Delusions: keep attention on activity/reality, stimulation, avoid topics relating to delusion 6) Paranoia: need space/patience, reliable environment, controllable activities 7) Aggression: may need isolation, avoid touching/contact, avoid dangerous objects, simple activities (low frustration) 8) Seductive Behavior: avoid crowds/physical contact, use forceful gross motor, reinforce appropriate behavior 9) Negative Neurocog. Behavior: avoid startling/stressing, distract with positives/familiar activities, sensory stimulation 10) Cognitive Deficits: keep simple/label things, familiarity, simple choices, modify known instead of introducing new 11) Attention Deficits: limit distractions/supplies, social interaction helps, simple/definite activity, match activity to cognition

Question 35

Define Symptom; how they are guides

Answer 35

Symptom: behaviors that show that a disease/abnormal state is causing the person to act this way. May be visible behavior or subjective feelings reported by client. Symptoms are not the disease! • Help identify unmet needs or conflicts • Are the way the person deals with anxiety • Impair functioning in predictable ways, showing where person may be having difficulty • May be response to event or environment (also clues to help person)

Question 36

Response variables

Answer 36

Tools OTA uses to help someone behaving oddly/ uncomfortably to function the best they can. We can change them to meet the individual’s needs. 1) Self (therapeutic use of); how to talk/act with client 2) Environment; context modified for client 3) Activity; what is done together, chosen for person

Question 37

Temporary vs. Permanent Cognitive Deficits

Answer 37

Temporary/Transitory: Give simple, structured, short-term activity (1 day preferred); reintroduce to known roles/skills Permanent: If STABLE, teach ways to adapt activities/simplify the familiar; If PROGRESSIVE, help maintain skills as long as possible, encourage independence, familiar/necessary activities

Question 38

Role of OTA in promoting wellness/self-management of symptoms

Answer 38

Helping develop lifestyle of physical and psychological balance to reduce symptoms. Develop a wellness recovery action plan: • list daily maintenance (routines/activities) • list personal triggers and ways to respond • list early warning signs, ways to respond • ways to recognize worsening symptoms, ways to respond • crisis plan or advance directive • productivity • participation in meaningful activity

Question 39

Why mental disorders make safety considerations important?

Answer 39

* client may harm themselves or others * may be suicidal or self-mutilating * may have history of violence * may be confused/careless * **safety education/training can improve client’s functional independence in community**

Question 40

Examples of antipsychotic drugs

Answer 40

Thorazine, Haldol, Seroquel, Risperdal

Question 41

Examples of MAOI antidepressants

Answer 41

Nardil, Parnate

Question 42

How OTA can help client on psychiatric medications

Answer 42

* Observe closely/regularly * Notice effects of meds on functional level * Communicate findings with doc to adjust dose * Adapt activities to enable success despite side effects * Educate client on med effects * Listen to complaints about med; encourage adherence * Provide recommendations for adjustments to routine/environment

Question 43

Psychiatric disorders and how they affect performance of occupations

Answer 43

Neurodevelopmental: Affect learning/skill development, social functioning, perceptual-motor deficits Schizophrenia: Social interaction, behavioral issues, ADL issues, executive function issues Bipolar: Cognitive issues, behavior issues, symptom/med effects Depressive: ADL/IADL deficiencies, impaired function with school/work, interpersonal relationships Anxiety: High stress, stimulus-specific fears Obsessive-Compulsive Related: Body dysmorphia, hoarding, trichotillomania/excoriation Trauma/Stressor Related: Sensory processing issues, emotional triggers, substance abuse Feeding/Eating Disorders: Self esteem/assertiveness issues, food issues Substance Abuse/Addictions: Need to fill new leisure time, cognitive/perceptual issues, social skills, need for new roles/occupations Neurocognitive: Declining function, need for roles/routines, memory, judgment, social/emotional skills Personality: Need for psychoeducation, social skills, societal role, aggressiveness

Question 44

Enabling

Answer 44

A codependent behavior; removing the natural consequences to the addict of his behavior. Making excuses for them, giving them money, etc.

Question 45

Denial

Answer 45

Defense mechanism used by addict. Not admitting there is a problem; refusal to admit truth or reality.

Question 46

Rationalization

Answer 46

Defence mechanism used by addicts. Making excuses/justifications for behavior. Blaming it on something/someone else. “I did it because....”

Question 47

Projection

Answer 47

Transferring one’s own unacceptable feelings onto others. Addicts use this as defense mechanism.

Question 48

Co-dependency

Answer 48

Unhealthy involvement of non-substance abuser such as a spouse. A codependent person is someone who sacrifices their own needs in order to meet needs of other (addict).

Question 49

Important to address in Substance Abuse interventions:

Answer 49

Evaluation/intervention focus on: • Performance patterns (bad habits?) • Use of time (filling it, especially leisure) • Relapse prevention • Cognitive and perceptual functions/skill development • Social interaction, social skills, self-expression • Daily living skills (ADLs may be affected) • Acquisition, development, maintenance of valued occupational and social roles (ie: work?)