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THE BOARDS > Psychiatric and cognitive disorders, evaluation and intervention > Flashcards

Psychiatric and cognitive disorders, evaluation and intervention Flashcards

1
Q

disorientation

A

disturbance of orientation to person, place or time
situation is sometimes a 4th consideration

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2
Q

delirium

A

acute, reversible disorder that presents as disoriented reaction with confusion, lability, and behavior (aggression)

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3
Q

confusion

A

involves inappropriate reactions to environmental stimuli

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4
Q

sundowner syndrome

A

occurs in late afternoon/night in older people (often dementia)
- drowsiness, confusion, agitation, falling

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5
Q

types of affect

A

blunted - dulled response, doesn’t change
flat - absent of any emotion
labile - rapid and abrupt changes

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6
Q

types of memory

A

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)

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7
Q

types of motor behavior

A

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

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8
Q

disturbances in perception

A
  • hallucinations: false sensory perceptions
  • illusions: misinterpretations of real sensory events
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9
Q

conversion and dissociative phenomena

A

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

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10
Q

disturbances in thought

A

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

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11
Q

anergia

A

lack of energy and initiative
often incorrectly interpreted as lack of motivation

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12
Q

Neurocognitive disorders presenting signs and functional impact (Reisberg levels)

A

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)

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13
Q

task management strategy for dementia

A
  • 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
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14
Q

intervention in acute hospitalization

A
  • focus of managing behaviors that threaten safety and well being
  • stabilize behaviors
  • engagement in activities that enable success (self confidence, motivation, participation)
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15
Q

long term hospitalization focus

A
  • self determined goal achievement
  • normalizing environment
  • engagement
  • graded activities
  • relaxation and stress management skills
  • external supports
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16
Q

community settings focus

A
  • facilitate recovery and maintenance
  • community living skills, social participation, valued roles
  • ongoing recovery supports (WRAP)
  • IADLs
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17
Q

areas assessed during evaluation

A
  • performance skills (cognitive, perceptual, psych, social)
  • client factors, conditions
  • impact
  • roles and behaviors
  • precautions and safety issues
  • goals and outcomes
  • fam support
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18
Q

Mini mental state examination (folstein)

A

widely used, quick screening test of cognitive functioning
interview with verbal responses
writing, naming, following directions, copying

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19
Q

short portable mental status questionnaire

A

intellectual function
questions: day of the week, president, subtraction

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20
Q

beck depression inventory

A

presence and depth of depression
rates their feelings associated wit depression

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21
Q

elder depression scale

A

assesses depression in older adults
30 item checklist

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22
Q

hamilton depression rating scale

A

measures severity of illness and changes over time in people diagnosed with depression or a mood disorder

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23
Q

bay area functional performance evaluation (BAFPE)

A

assesses cognitive, affective, performance, and social interaction skills required to perform ADL
- task orientation assessment (TOA)
social interaction scale (SIS)

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24
Q

comprehensive OT eval scale (COTE)

A

structured method for observing and rating behaviors and changes in general, interpersonal, and task skills

25
Q

activity card sort (ACS)

A

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)

26
Q

activities health assessment

A

completes idiosyncratic activities configuration schedule by constructing a color coded chart that depicts the way their time is spent during a typical week

27
Q

barth time construction

A

time usage, roles, skills, habits
constructs a color coded chart with how they spend their time during the week

28
Q

goal attainment scale

A

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

29
Q

others (p 408)

A

Occupational circumstances assessment interview rating scale
occupational performance history interview
occupation self-assessment
role checklist

30
Q

projective assessments

A

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

31
Q

indicators for 1-1 intervention

A
  • refusal to attend groups
  • unable to tolerate group interaction
  • disruptive behaviors
  • suicidal precautions/danger to self or others
32
Q

indicators for group intervention

A
  • more cost effective
  • help with social interaction
  • group dynamics
33
Q

factors that influence the effectiveness of intervention

A
  • 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
34
Q

managing hallucinations

A

create an environment free of distractions
highly structured, simple, concrete activities
attempt to redirect to reality

auditory - written directions with a structured, expected outcome

35
Q

managing delusions

A

*do not attempt to refute the delusion
redirect the thoughts to reality based thinking
avoid discussions that validate/reinforce the delusion

36
Q

managing akathisia

A

allow them to move around as needed
select gross motor activités over fine motor

37
Q

managing offensive behavior

A

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

38
Q

managing lack of initiation/participation

A

identify the reasons with the individual
motivational hints - activities of interest, success, fun, curiosity, positive feedback, food, offer choices, encourage

39
Q

managing manic or monopolizing behavior

A

highly structured activities that hold their attention
thank them for their participation and redirect attention to another group member

40
Q

managing escalating behavior

A

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)

41
Q

acting out behavior in children

A
  • 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)

42
Q

how to work with people with dementia

A

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

43
Q

domestic abuse - RADAR approach to screen for and respond to it

A

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

44
Q

phases of adjustment as a reaction to disability

A

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
45
Q

phases of adjustment to death and dying

A
  • denial, anger, bargaining, depression, acceptance
46
Q

depression interventions

A

making decisions

47
Q

borderline interventions

A

manipulative, volatile relationships
focused on forming better relationships

48
Q

substance abuse intervention

A

leisure - need to find a new activity to replace

49
Q

Suicide

A

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.

50
Q

eating disorder Qs

A

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)

51
Q

psychotropic meds side effects

A

 Photosensitivity (botanical garden Q)
 Orthostatic hypotension (activity, like parachute)

52
Q

side effect of long term use of psych drugs

A

Tardive dyskinesia

53
Q

MAOIs (parnate, nardil) for depression dietary restrictions

A

no aged cheese, pickled items, cured or smoked meat, yogurt, ripen fruit, chocolate, soy, beer and wine

54
Q

displacement, reaction formation, acting out

A

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)

55
Q

post ECT

A

6 hours after ECT, individual can do a structured task but not one with memory involved

56
Q

regression

A

common reaction to trauma - refer to a social worker

57
Q

approach with paranoid personality disorder

A

avoid confrontation, and progressively engage the client to develop a trusting and effective therapeutic relationship.

58
Q

oppositional defiant disorder

A

have difficulty with impulse control, attention span, and short term memory. Hinder ability to complete tasks

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