Psychiatric and Cognitive Disorders

Question 1

hypervigilance

Answer 1

excessive attention and alertness where the person is constantly assessing potential threats around them

Question 2

Delirium

Answer 2

disorientation with confusion, lability, and disturbances in behavior

Question 3

sundowner’s syndrome

Answer 3

• typically occurs in the late afternoon and night
• often seen with patients with dementia
• characteristics include drowiness, confusion, ataxia, falling, agitation and aggression

Question 4

flat affect

Answer 4

nonexistent expression of emotion

Question 5

procedural memory (implicit/non-declarative memory)

Answer 5

• Knowing how to perform a skill, retaining previously learned skills, and learning new skills.
• Ex. driving, playing sports, hand crafts, learning to use adaptive ADL equipment or a wheelchair.

Question 6

declarative/explicit memory

Answer 6

Knowing that something was learned, verbal retrieval of a knowledge base
such as facts and remembering everyday events.
Ex. remembering places, names, and various words.

Question 7

episodic memory

Answer 7

• Autobiographic memory for contextually specific and personal events.
• Ex. remembering the day’s events, what one had for breakfast, occurrences on the job, the content of therapy sessions.

Question 8

semantic memory

Answer 8

• Knowledge of the general world, facts, linguistic skill, and vocabulary.
• Ex. remembering the dates of holidays, the name of the president, dates of world events.

Question 9

Catatonia

Answer 9

immobility or rigidity

Question 10

Akathisia

Answer 10

serious motor restlessness

Question 11

Hallucinations

Answer 11

• false sensory perceptions
• where clients see, hear, smell, taste or even feel something that
  isn’t there. Sensory based.

Question 12

Delusions

Answer 12

ideas and beliefs that are strongly held in the mind and account for suspicious and guarded behavior

Question 13

poverty of speech

Answer 13

limited speech

ex. one word answers to questions

Question 14

expressive aphasia (Broca’s)

Answer 14

• person knows what they want to say, but cannot say it

Question 15

receptive aphasia (Werincke’s)

Answer 15

• person can’t understand what’s being said to them

Question 16

flight of ideas

Answer 16

• rapid shifts in thoughts from one idea to another

Question 17

concrete thinking

Answer 17

inability to think abstractly

Question 18

Important facts about schizophrenia

Answer 18

• evals should be top-down assessments of daily functioning and there should be an observation of their home environment
• if patient has tardive dyskinesia (abnormal body movements), let physician know immediately

Question 19

schizophrenia: impact on occupational performance

Answer 19

• deficits in attention (sustained attention)
• good short term memeory but WORKING MEMORY is the concern
• deficits in executive functioning

Question 20

Interventions for schizophrenia patients with hallucinations

Answer 20

Provide simple, structured, short-term activities such as staining glass, assembling wood kits, discussing current events, and activities with strong sensory stimulation such as dancing and watching television.

Question 21

Interventions for schizophrenia patients with delusions

Answer 21

Provide intellectually challenging verbal activities such as board games, word games, chess, computer games, current events discussion, and expressive activities like dancing.

Question 22

Overall OT treatment for schizophrenia

Answer 22

Structured tasks, expressive activities, functional living skills, sensory modulation, psychoeducation, social participation, social skills training, and vocational/educational training.

Question 23

Interventions for schizophrenia patients with negative symptoms

Answer 23

Use highly structured activities with concrete expectations and goals. Specific skill training and psychoeducation are beneficial to individuals with negative symptoms.

Question 24

Depression/ Major Depression

Answer 24

• may show poor self-esteem and low motivation
• most prevalent symptoms of depression will be loss of volition and loss of interest in formerly valued activities
• may withdraw from others and become isolated

Question 25

Interventions for Depression

Answer 25

• use an approach that is inviting and confident without being demanding
• engage in valued activities that are graded for successful completion
• step-by-step, easily achieved goals
• Disprove negative thoughts and question unrealistic belief
• activities should be concrete, tangible, short-term, simple, and success-enhancing to enhance motivation and self-concept.

Question 26

Manic episode

Answer 26

• manic episodes may have exaggerated self-esteem and difficulty completing and finishing tasks
• Cognitive and motivational symptoms result in distractibility, inability to concentrate, and a desire to initiate too many activities all at once

Question 27

Interventions for Mania

Answer 27

• Arrange the environment to limit distractions
• Provide clear expectations of the end product and parameters
• When there are unrealistic ideas, provide a realistic appraisal of behavior and end products while engaging in and after activities
• Allow the client to pick an activity, but offer only two or three choices
• Redirect to a goal-directed action whenever distracted
• Activities should be concrete, tangible, short-term, simple, and success-enhancing
• Socratic questioning is client-centered “discovery” to clarify beliefs and thoughts that may support or hinder occupational performance and goal attainment.
  - Open-ended, guiding questions that lead the client and OT to discover and solve problems.

Question 28

Substance Abuse Interventions

Answer 28

• Provide activities that are centered around leisure and activities that are playful or provide enjoyment
• Leisure exploration
• Healthy changes to routine such as weekly or structured weekly routines in the community
• Aim strategies at motivation, coping skills, cognitive beliefs, and communication skills
• Self-help groups are common
• Motivational Interviewing is designed for people who are not ready or ambivalent to change. Call attention to the discrepancy between the present behavior and the person’s goals and values. Use a pros/cons chart about a specific behavior. Brief format (typically done in one session

Question 29

Anxiety Disorder Interventions

Answer 29

Anxiety = systematic desensitization (incremental exposure to specific fear), coping, stress mgmt., CBT, relaxation training, breathing, wrtg, guided imagery

PTSD = do relaxation techniques

OCD= realistic habits and expectations, reduce rituals/ thoughts

Cognitive-Behavioral Approaches - help clients confront fears in a safe situation so they can change theirresponse or recognize that they have survived despite the physiological or cognitive emotions can reducetheir fear and decrease avoidance.

Question 30

Cluster A personality disorders

Answer 30

• Paranoid, Schizoid, Schizotypal
• Nondirective cognitive therapy, support to reduce isolation, encourage expressions of emotions, social skills training. Difficulty sustaining intimate relationships so their job should be interpersonally undemanding.
• May respond to sensory integrative/sensory-motor interventions because of the suspected neurological
  component.

Question 31

Cluster B personality disorders

Answer 31

-Borderline, Narcissistic, Histrionic, Antisocial: *most often seen in treatment\

• Social skills training, behavioral approaches, cognitive therapy, firm structure, psychoeducation, teach tolerance of interpersonal distress and not acting on impulses, self-management or mindfulness skills (reflecton one’s thoughts, feelings, and behavior), focus on a hierarchy of targeted behaviors. Promote less demanding interpersonal contacts through social networks.

Practice adaptive coping strategies, teach how to think before acting, bring awareness to emotional style and
emotional regulation, teach how to develop satisfying relationships, and assist in developing a sense of
effectiveness in the world (personal causation).

Question 32

Cluster C personality disorders

Answer 32

• Avoidant, Dependent, Obsessive-Compulsive

Tend to deal with anxiety by avoiding or procrastinating so encourage more risks and emotional expressions. Time-limited dynamic therapies are active and confrontational.

Behavior modification may be helpful in reducing anxiety for these individuals. Work on social skills training since this is the predominant deficit for these individuals.

Question 33

Personality disorder Interventions

Answer 33

opportunities for safe and supportive exploration of new personalities, validation of feelings, consistency, decreased self-esteem

Question 34

Reactive Attachment disorder

Answer 34

• individual may be inhibited or withdrawn and unable to form attachments with any one person, or disinhibited, or forming attachments with any person
• They present with a high need to be in control, frequently lie without reason, have poor eye contact except when lying, they may be overly affectionate, inappropriately related with others including strangers or lack interest in others and do not seek attention, lack a conscience and deny responsibility or project blame for their actions, they hoard or gorge on food in the absence of want.

Question 35

Reactive Attachment disorder interventions

Answer 35

• Plans for each treatment activity to assure that the child feels safe and secure (both physically and emotionally)
• View the child’s behaviors as communication and consistently responds to them
• Assist parents and caregivers to establish predictable daily rituals and routines
• Assures that the parent is involved in treatment sessions
• Include a therapy goal that each parent and child will successfully engage in mutually rewarding interactions.

Question 36

Early stage dementia

Answer 36

• Memory, forgetfulness and recall is the primary concern
• Deficits in IADL’s such as financial management, complex home tasks, and driving
• Low tech assistive devices can be effective including calendars, check lists and note taking as memory aids

Question 37

Middle stage dementia

Answer 37

• Poor concentration and decreased knowledge of recent events, and difficulty traveling alone to unfamiliar places.
• Emotional changes and disorientation
• Problems with ADL’s arise
• Difficulty self initiating
• Provide simplified schedules in a familiar environment with repetition and consistency due to disorientation
• When there are catastrophic reactions (emotional reactions like yelling and outburst due to frustration with tasks) our interventions can include reassurance, reminiscence, distraction, sensory stimulation, and calming tasks like rocking, manipulative tasks, music (classical or favorite music), massage, oral reading, dimmed lighting, and reducing clutter
• Structured activities are provided in community centers such as adult day services, assisted living facilities, and memory care units will provide leisure activities, exercise, social activities, and cognitive stimulation and respite care for caregivers

Question 38

Reality orientation

Answer 38

• The goal of reality orientation is to alleviate the disorientation associated with dementia
• The use of reality boards listing information such as the time, date, next meal, etc.
  - Name tags and labels for rooms
  - Reminiscence activities.
  - Reminding clients of names and situations

Question 39

Validation therapy

Answer 39

• Validation therapy focuses on emotional and psychological components
• Endorsing what is said rather than correcting factual errors
• look at tmpot for example

Question 40

Late stage dementia

Answer 40

• Dependence in basic self care task
• Forgets spouse name or the names of important people in their lives
• Caregivers fulfill the role as collaborators
• Interruption in sleep/wake cycles which causes wandering, and withdrawal from social or leisure activities
• Environmental adaptations, mealtime positioning, adaptive feeding strategies, and nutritional intake monitoring will be the focus
• Establish consistent performance context and reinforce well-developed habits and routines to reduce burden on caregiver
• Home adaptations to increase safety: electronic monitoring devices, door alarms, pressure gates, and video intercoms are cost-effective methods. Disconnect stoves, auto shut off appliances and camouflage exits.

Question 41

Eating disorder interventions

Answer 41

• Motivational enhancement
• OT’s commonly use meaningful occupation-based, self-expressive or psychoeducational groups that work on stress, anxiety, or time-management
• Individual therapy helps teens build autonomy, self-reliance, and assertiveness based on self-awareness and the ability to self-reflect
• Family-based therapy focus on a safe and reassuring environment so that they feel supported and not blamed at mealtime. Supportive, empathetic relationships are essential

Question 42

Oppositional Defiant Disorder

Answer 42

• individuals who cannot follow instructions or take directions
• They become anxious, aggressive, or distressed when their sense of control is threatened
• These behaviors include aggression and the tendency to be purposefully bothersome, annoying, and/or irritating to others.

Question 43

Conduct disorders

Answer 43

• individuals who engage in high-risk or harmful activities that are beyond the typical realm of acting out and involve violating the basic rights of others such as aggression to people and animals, destruction of property, and serious violations of rules

Question 44

ASD symptoms and interventions

Answer 44

• social interaction and cognitive disabilities
• non-verbal behavior
• communication issues
• repetitive motor actions
• give visual schedules over auditory conditioning
• sensory integration techniques
• observation can substitute for formal evaluation
• visual cues
• interoception = ability to perceive info from inside the body
  - difficulties w/ toileting/sensing need to go

Question 45

ADHD

Answer 45

• difficulty paying attention, listening, organizing, and focusing
• are typically forgetful, easily distracted, fidgety, on the go, have difficulty engaging quietly, impulsive, difficulty waiting, blurt things out, and often interrupts

Question 46

OT interventions for common adolescent disorders

Answer 46

• structure and consistency
• limit setting
• avoiding power struggles
• impulsivity
  - Do not put anything out on the table where you are having a group activity, ease transitions with a 5-
  minute warning before the group ends, provide a warm environment free from distractions, praise
  positive behavior as often as possible, maintain an even tone and affect while providing treatment
  - Allow autonomy to not feel as though they are being “treated like a child,” but provide enough structure to maintain a therapeutic environment for the clients
  - Provide choices so the adolescent can have the opportunity to have a sense of control and the ability to express autonomy in an acceptable, positive manner
• creating a therapeutic environment
  - “Family room” type therapy setting includes incandescent lighting (instead of fluorescent overhead lighting), rocking chairs, art, and furnishings to give the appearance of a home environment.