Psychiatric and cognitive disorders, evaluation and intervention Flashcards
disorientation
disturbance of orientation to person, place or time
situation is sometimes a 4th consideration
delirium
acute, reversible disorder that presents as disoriented reaction with confusion, lability, and behavior (aggression)
confusion
involves inappropriate reactions to environmental stimuli
sundowner syndrome
occurs in late afternoon/night in older people (often dementia)
- drowsiness, confusion, agitation, falling
types of affect
blunted - dulled response, doesn’t change
flat - absent of any emotion
labile - rapid and abrupt changes
types of memory
immediate - short term sec/min
recent - recall past few days
recent past - past few months
remote - recall events of distant past (long term mem)
procedural - automatic sequence of behavior (conditioned responses)
declarative - recall specific facts
semantic - knowing meaning of words
episodic - knowledge of personal experiences
prospective - carry out future actions (important for safety and living independently)
types of motor behavior
echopraxia - meaningless imitation of another person’s movements
catatonia - immobility or rigidity
stereotypy - repetition of fixed patterns of movement and speech (echolalia)
psychomotor agitation - excessive motor and cognitive activity
hyperactivity - restlessness
psychomotor retardation - slow
akathisia - urges need for movement (often side effect of med)
ataxia - irregularity or failure of muscle coordination upon movement
disturbances in perception
- hallucinations: false sensory perceptions
- illusions: misinterpretations of real sensory events
conversion and dissociative phenomena
in response to repressed material and involve physical symptoms that are not associated with a physical disorder
- depersonalization: unreality about self
- derealization: environment is unreal
- fugue: serious depersonalization with travel/relocation/new identity
- dissociative identity disorder: multiple personalities
disturbances in thought
circumstantiality: speech that is delayed in reaching the point, contains irrelevant details
tangentiality: abrupt changing of focus to a loosely associated topic
perseveration: persistent focus on a topic
flight of ideas: rapid shift one to another
thought blocking: interruption of a thought
delusions: false beliefs
compulsions: need to act on impulses to relieve anxiety
obsessions: persistent thought
concrete thinking: actual things, inability to think abstractly
anergia
lack of energy and initiative
often incorrectly interpreted as lack of motivation
Neurocognitive disorders presenting signs and functional impact (Reisberg levels)
Level 1 - no cog decline
Level 2 - very mild cognitive decline (independent)
Level 3 - mild cog impairment (compensation strategies)
Level 4 - moderate neurocognitive decline (independent in simple ADLs, verbal cues)
Level 5 - major/moderately severe decline (very structured repetitive familiar ADLs)
Level 6 - severe (components of familiar tasks with cues)
Level 7 - very severe (dependent)
task management strategy for dementia
- keep things they like in easy reach
- put items away that are not needed
- show/demonstrate
- use pictures and bright colors
- easy clothing
- do simple, repetitive chores
- ignore person’s mistakes
- routine
intervention in acute hospitalization
- focus of managing behaviors that threaten safety and well being
- stabilize behaviors
- engagement in activities that enable success (self confidence, motivation, participation)
long term hospitalization focus
- self determined goal achievement
- normalizing environment
- engagement
- graded activities
- relaxation and stress management skills
- external supports
community settings focus
- facilitate recovery and maintenance
- community living skills, social participation, valued roles
- ongoing recovery supports (WRAP)
- IADLs
areas assessed during evaluation
- performance skills (cognitive, perceptual, psych, social)
- client factors, conditions
- impact
- roles and behaviors
- precautions and safety issues
- goals and outcomes
- fam support
Mini mental state examination (folstein)
widely used, quick screening test of cognitive functioning
interview with verbal responses
writing, naming, following directions, copying
short portable mental status questionnaire
intellectual function
questions: day of the week, president, subtraction
beck depression inventory
presence and depth of depression
rates their feelings associated wit depression
elder depression scale
assesses depression in older adults
30 item checklist
hamilton depression rating scale
measures severity of illness and changes over time in people diagnosed with depression or a mood disorder
bay area functional performance evaluation (BAFPE)
assesses cognitive, affective, performance, and social interaction skills required to perform ADL
- task orientation assessment (TOA)
social interaction scale (SIS)
comprehensive OT eval scale (COTE)
structured method for observing and rating behaviors and changes in general, interpersonal, and task skills
activity card sort (ACS)
involvement in different activities
89 cards they sort into never done, gave up doing, do less than in the past, do the same, do more than in the past)
activities health assessment
completes idiosyncratic activities configuration schedule by constructing a color coded chart that depicts the way their time is spent during a typical week
barth time construction
time usage, roles, skills, habits
constructs a color coded chart with how they spend their time during the week
goal attainment scale
active participation in goal setting process
identify desired outcomes that are personally relevant to them
score/rating on likelihood of achievement/predicted level of performance
others (p 408)
Occupational circumstances assessment interview rating scale
occupational performance history interview
occupation self-assessment
role checklist
projective assessments
based on psychodynamic/analytic models
allow clients to project content and resolution with processing an activity
*typically not used with psychotic disorders
populations: children/adolescents, trauma survivors, someone with insight and willingness to change
ex:
- house-tree-person, draw-a-person
- magazine picture collage
indicators for 1-1 intervention
- refusal to attend groups
- unable to tolerate group interaction
- disruptive behaviors
- suicidal precautions/danger to self or others
indicators for group intervention
- more cost effective
- help with social interaction
- group dynamics
factors that influence the effectiveness of intervention
- therapeutic use of self
- understand someones cognitive abilities
- explore needs and wants of the person
- establish realistic goals
- skill with activity analysis
- realities of tx and intervention contexts
- prioritizing goal directed use of the persons time
managing hallucinations
create an environment free of distractions
highly structured, simple, concrete activities
attempt to redirect to reality
auditory - written directions with a structured, expected outcome
managing delusions
*do not attempt to refute the delusion
redirect the thoughts to reality based thinking
avoid discussions that validate/reinforce the delusion
managing akathisia
allow them to move around as needed
select gross motor activités over fine motor
managing offensive behavior
set limits and immediately address the behavior
reasons should be clearly presented
consequences of repeated behavior should be clearly communicated
*must keep everyone safe
explain OT-pt relationship and discourage the behavior
managing lack of initiation/participation
identify the reasons with the individual
motivational hints - activities of interest, success, fun, curiosity, positive feedback, food, offer choices, encourage
managing manic or monopolizing behavior
highly structured activities that hold their attention
thank them for their participation and redirect attention to another group member
managing escalating behavior
avoid what can be perceived as challenging behavior
maintain comfortable distance
actively listen
calm voice, clear, simple
*avoid positions where you or the person feel trapped
o Escalating behavior: leave the group because of safety after already attempting to intervene (escort is a good way of it being put)
acting out behavior in children
- interpretation (verbalize what their behavior is)
- redirection
- limit setting
- time out
most of the time, don’t remove them, redirect them to individual activities (especially with peds)
how to work with people with dementia
make eye contact to show you are interested
value and validate what is said
positive and friendly demeanor and facial expressions
create a routine of enjoyable activities
do not rush them
note time effects on the day and behavior/performance
domestic abuse - RADAR approach to screen for and respond to it
R = routinely ask (in a general eval Q)
A = affirm and ask: acknowledge and support the person, ask direct clients to determine risk
D = document objective findings
A = assess and address safety (weapons? more violent?)
R = review options and referrals
phases of adjustment as a reaction to disability
correct board answers will be respetcful of a person’s or family’s stage of adjustment and include intervention approaches that foster adaptation to disability
- shock, anxiety, denial, depression, internalized anger, externalized anger, acknowledgement, adjustment
phases of adjustment to death and dying
- denial, anger, bargaining, depression, acceptance
depression interventions
making decisions
borderline interventions
manipulative, volatile relationships
focused on forming better relationships
substance abuse intervention
leisure - need to find a new activity to replace
Suicide
QPR: question, persuade, refer
Expression of suicidal ideation by a student warrants immediate contact with the interprofessional team and a referral to the student’s primary care physician.
eating disorder Qs
NO food or exercise in the response for intervention
right answer ex: volunteer activities at patient’s place of worship (social support at familiar and comfortable space)
psychotropic meds side effects
Photosensitivity (botanical garden Q)
Orthostatic hypotension (activity, like parachute)
side effect of long term use of psych drugs
Tardive dyskinesia
MAOIs (parnate, nardil) for depression dietary restrictions
no aged cheese, pickled items, cured or smoked meat, yogurt, ripen fruit, chocolate, soy, beer and wine
displacement, reaction formation, acting out
Displacement: a person redirects an emotion from one object to another (anger on adaptive equipment)
Reaction formation: switching of an unacceptable impulse into its opposite (hugging someone you want to hit)
Acting out: violating societal norms (sexually physical behavior)
post ECT
6 hours after ECT, individual can do a structured task but not one with memory involved
regression
common reaction to trauma - refer to a social worker
approach with paranoid personality disorder
avoid confrontation, and progressively engage the client to develop a trusting and effective therapeutic relationship.
oppositional defiant disorder
have difficulty with impulse control, attention span, and short term memory. Hinder ability to complete tasks
