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Psych of OT

Chapters 1-6 and Handouts

QuestionAnswer
How common is schizophrenia and how many people does it affect? Very common disorder affecting approx. 1 out of every 100 people.
According to the National Institute of Mental Health approx. how many people will develop schizophrenia in their lifetime? 2 million
How long as schizophrenia probably existed? As long as humankind.
What are some symptoms of schizophrenia? Hallucinations (Auditory), delusions, bizzare behavior
What type of disorder is schizophrenia referred to as? A thought disorder...but not all forms of the disorder include long-term cognitive deficits.
What is the other type of disorder that schizophrenia is referred to as? A psychotic disorder...yet psychosis may be present only for some period during the course of the disease, not as a chronic condition.
List the 8 common myths of schizophrenia: split personality, bad parenting, drug experimentation, lack of motivation, rising incidence, institutionalization & disability, low intelligence, danger & violent
Does a person with schizophrenia have a split personality? NO! It is not a personality disorder...bipolar is a personality disorder.
Is schizophrenia a product of bad parenting? NO! It is caused by a combination of factors including hereditary predisposition. Stess may cause illness to manfest earlier but environment alone not a factor.
Is schizophrenia caused by drug experimentation? No! It is not caused by takng drugs, but it is not uncommon for peopl w/schizophrenia to have coexisting diagnosis of substance abuse. In many cases these people may use drugs & alcohol in an attempt to control their symptoms & related distress.
Is schizophrenia caused by a lack of motivaion? People w/schizophrenia do try to get better. They benefit the most from consistent and maintained intervention.
Is schizophrenia a rising incidence? NO! Because of out stressful society - people w/schizophrenia may be more seriously diabled by condition.
Does a person w/schizophrenia always live in an institution, and are they always disabled? NO! Schizophrenic individuals do not always live in institutions and are not always profoundly disabled. Most live w/families, in residential care facilities in the the community, or independently. Can be disabling but is highly variable.
Does a schizophrenic person have low intelligence? Schizophrenic people do not have a below average intelligence. The acutal range of IQs is highly variable. It is possible to be quite brilliant; also possible to have a coexisting developmental disability.
What are some cognitive deficits of schizophrenia? Poor obstruction, judgement, and processing time. These can be misunderstood as low intelligence.
Are all schizophrenic people dangerous and violent? Generally not! More likely to hurt themselves. Major predictions of violent behavior are male gender, younger age, past history of violence, noncompliance with antipsychotic medication & substance abuse.
Causes of schisophrenia: Constantly changing. Thought to have some level of organic involvement. Possible predisposition is hereditary. COMBINATION!!!
What may play a role in the onset of episodes of schizophrenia and the severity of the disorder? Stress
What are some of the brain structure anomalies discovered in schizophrenic people? Lesion in the brain stem, enlargement of the ventricles, brain atrophy, and abnormalities in the limbic structures, cerebellum, and corpus callosum. There is a growing body of evidence that frontal lobe dysfunction, possibly related to basal ganglia.
What is the significance of schizophrenia and the neurotransmitter dopamine? It is hypotesized that there is an excess of dopamine or an excessive quantity of dopamine receptors in a person w/schizophrenia. Assumed that this is related to positive symptoms.
Role of viruses and schizophrenia: Viruses may stay inactive for many years and start to grow slowly. Possible that exposure to certain viruses prenatally while involved ares of the brain are being developed. Possible autoimmune reaction triggered by virus.
Common possible causes of schizophrenia: Low birth weight, advanced paternal age a the time of birth of the offspring. Foods: fish oil and fatty acids.
Common age onset of schizophrenia: usually after adolescence, or early 20's
What is the criticism about schizophrenia? Tends to be over diagnosed w/people demonstrating bizarre or flagrant behaviors. Some societies more than others appear to tolerate "eccentric" behavior w/out necessarily considering it pathological.
DSM-IV-TR stands for what? Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised
2 ways to classify schizophrenia: 1. DSM-IV-TR 2. Positive/Negative Symptoms
DSM-IV-TR Minimum Criteria: A. Characteristic Symptoms B. Social/occupational dysfunction C. Some signs of the disorder must be continuously present for at least six months.
DSM-IV-TR Minimum Criteria: A. Characteristic Symptoms - 2 or more of the following, each present for a significant protion of time during a one-month period 1.delusions 2.hallucinations 3.disorganized speech 4.grossly disorganized or catatonic behavior 5.negative symptoms (affective flattening, alogia, or avolition)
DSM-IV-TR Minimum Criteria: B. Social/occupational dysfunction For a significant protion of the time since the onset of the disturbance
Positive Symptomatology: Type 1 most common (for sure), most common positive symptoms - delusions, hallucinations, perceptional distortions.
Positive Symptomatology - Language Disturbances include: Bizarre speech, echolalia, incoherency, pressured speech, motor responses (pacing, rocking, restlessness & lethargy), disturbance is sleep patterns
Positive Symptomatology: Delusions - Usually very paranoid - Forms: Thought broadcasting - can transmit thoughts; Thought Control
Positive Symptomatology: Hallucinations Most common & Hallmark symptom Auditory are most common presentation
What creates a greater level of dysfunction? presence of negative symptoms cognitive deficits and poor ability to manage environmental stimuli decrease ability to cope with hallucinations.
Negative symptomatology: Type 2 Scale for the Assessment of Negative Symptoms: Affective flattening or blunting, Alogia, Avolition, Anhedonia, Inattention
What is limited ability to express emotions and feelings? Affective flattening or blunting
What is impoverished thought process that is manifested in speech patterns? Alogia
What is the lack of interest or engergy unaccompanied by depressed affect? Avolition
What is an inability to experience pleasure or sustain interest in activities? Anhedonia
What is an inability to sustain concentration or attention; person may be totally unaware? Inattention
What is decreased enjoyment? Hypohedonia
What is an inability to experience joy at all? Anhedonia
Why is it essential that the therapist understand the nature of negative symptoms? Bc the occupational therapy emphasis is on activities of self-care, work, and leisure.
A meaningful treatment plan reflects an awareness of these symptoms and efforts to be made to help the individual cope with, and compensate for, existing deficits.
Tx formats for schizophrenia: structured tasks, expressive activities, functional living skills, psychoeducation, social skills training, vocational training
Tx formats: Structured tasks Provide habit training, diversion, coping skills, time management training. Potential for leisure skill development. May also build sef-esteem through successful completion.
Tx formats: Expressive Activities Nonverbal Communication Emotional and creative outlets, Potential for leisure skill development May also build self-esteem through successful completion
Tx formats: Functional Living Skills May include basic self-care hygiene, grooming, dressing. Includes independent living skill (IADL'S) - Meal prep. and money management
Tx formats: Psychoeducation Can be used to teach living skills. Also used for teaching symptom management. Teach health and safety awareness, assertive training.
Tx formats: Socail Skills Training Especially effective in groups. Includes verbal/nonverbal communication. Role playing = 1 technique used
Tx formats: Vocational Training Basic skill prep. Time management. Social Skills. Vocational pursuits must be carefully graded and may require ongoing support.
What is a descriptor for an agent ususally a prescribed drug that directly affects the brain? Psychotropic
What is a significant impairment of reality testing and daily functioning due to presence of positive symptoms? Psychosis
The outcome. Prognosis
Schizophrenia is a serious and persistant mental illness... but data on its prognosis in unreliable.
Severity and prognosis of schizophrenia maybe affected by... Cultural and environmental influences.
Severity and clinical presentation are also partially determined by... Gender
Which gender has later onset of schizophrenia? Women; less severe
Role dysfunction can be minimized if diagnosed when? Early
How long would it take for someone to possibly have a natural remission? Two to Three decades. So recovery rates may actually be much higher than previously estimated, but only after a prolonged course of illness.
Interdisciplinary Tx: Team of physicians working together.
Interdisciplinary Tx: Acute Phase Have to be hospitalized. Typical hospitalization stays have shortened considerably over the last decade - usually only occurs if individual is having a severe psychotic episode.
Interdisciplinary Tx: Goal of Acute Hospitalization Provide thorough evaluation and stabilization w/meds.
Interdisciplinary Tx: Goal of Acute Hospitalization Also help stablize by providing a safe environment w/adequate rest and nutrition.
Schizophrenia Tx should include: psychotropic medication, supportive services, and rehabilitation that includes both verbal and nonverbal and activity-based therapies.
Interdisciplinary Tx: Goal Setting Should involve individual along w/family and significant others if patient gives consent. Cooperative goal setting can also be hampered by individauls pathology (symptoms)
Who may be incapable of healthy and realistic goal setting, which will also hamper cooperative goal setting? People with delusions, poor insight, concrete thinking, avolition
Realistic Goals: The goals of the team may be quite different from those of the person with schizophrenia, whose ideas may also differ from the goals and expectations of the family.
Realistic Goals: But every effort should be made to seek out and honor his expressed interest/desires even if they conflict w/team.
Client-centered OT: Target outcome is a vision of the future shared by client and therapist and driven by dream and desire of individual.
Client-centered OT: Dreams are unique to each individual thus targeted outcome will be also.
Psychotropic Medication: Role of drug therapy Often misunderstood. Does not cure schizophrenia. Typically decreases symptoms.
Psychotropic Medication: Role of drug therapy Primary benefit is to stabilize the individuals sufficiently so that he or she may benefit from other tx. Side effects do occur and #1 reason clients are noncompliant.
Psychotropic Medication: Drug Trials and Noncompliance Closely moniter. Noncompliance is usually caused by side effects of meds, symptoms my prevent them taking meds., cognitive deficits (i.e. forgetful thinking, confusion and poor time management)
How do you minimize non-compliance? Educate patient
OT Intervention: Treatment At beginning start one on one then progress to group therapy. Group work is most common approach used by OT.
Activities for Positive Symptoms: Hallucinations etc. benefit from activities that benefit from activities that divert attention from their symptoms. Can learn self-help coping strategies to minimize positive symptomology.
Activities for Negative Symptoms: Need highly structured activities w/concrete operations and espectations and goals. Less creativity. Specific Skill Training good for n. symptoms. Many need ongoing support to utilize skills.
OT Intervention: Evaluation and Assessment Tools Allens Cognitive Levels Test, Kohlman Evaluation of Living Skills, Assessment of Motor and Process Skills, Adult Sensory Profile, Canadian Occupational Performance Measure
What is the diagram that looks like a grotesque little man? The Homunculus
Homunculus is latin for... "little man"
What is a mapping out of areas of the brain connections to body that tells scientists which parts of the brain control various parts of body? Homunculus
MOHO Model of Human Occupation
MOHO emerged around 1980 - further definition of occupational behavior therapy
Engagement in activity of occupation in itself will produce and maintain health Occupational Behavior Theory
MOHO was developed by... Gary Kielhofner - synthesized occupational behavior theory concepts in to practice model
MOHO model includes: playful, restful, serious, and productive activities
Activites in the MOHO model are all carried out by individuals... in their own ways, based on their beliefs, preferences, and experiences and environment in which they live.
As humans we maintain constant interaction with the environment... which provides input. Input produces a behavior called output. The person sees the results of their actions, these results are calle feedback.
Offers and opportunity for certain behaviors at the same time that requires others. External Environment (ex. Chef)
External Environment A lack of objects or too many objects can lead to psychosocial dysfunction. Must find a balance.
Internal Environment: Subsystems Volition, Habituation, Mind-Brain-Body Performance
Volition: Involves anticipating, experiencing and choosing, and interpreting occupational behavior. Know what you have to accomplish that day. Awareness of being an "Active Doer"
Volition: Comprised of 3 Areas - Personal Causation, Values, Interest
knowing limits, awareness of capacity and control Personal Causation
convictions people have that help assign standards to performance. Usually a sense of obligation... Values
Attractions we have toward certain occupations... Interest
Volitions: Many mentally ill pt. see themselves as helpless and under control of external forces. We must help them to believe that they have control over their lives and to believe that they have skills needed to overcome external forces.
Habituation: Subsystem with roles and habits as its components.
Habituation: Habits Inernalized Roles (teacher, spouse)
Habits and inernalized roles that have to do with they typical way in which one performs a particular occupation, how the performance or occupations is organized into a typical day and the style the person puts into occpuations. Habituation Subsystem
Habituation: Interests to the OT are specific occupational behaviors that encompass a role, the style in which actions in the role occur and the way in which a person's roles are prioritized or organized in relation to time.
Role dysfunction may not be a consequence of mental illness... but a cause as well.
An ex of role dysfunction: Abused children growing up to be abusive bc that was their experience of the parent role.
Role dysfunction: There can be too many roles, with each demanding time at the expense of the other roles. Too few roles may be detriment because the person lacks enough responsibility.
The habit patterns of most people with mental illness often gravitate toward being... extremely rigid or lacking any consistency from day to day. Either negatively impacts roles.
Mind-Brain-Body Performance Musculoskeletal Neurological Cardiopulmonary Symbolic Images
Mind-Brain-Body Performance: All the components required to perform an occupation are represented in this subsystem. It is through this subsystem that ineraction with the environment occurs.
Performance deficits... can be obvious or very subtle.
In example, borderline personality disorder people seem intact cognitively with perceptual motor functioning intact... However when it comes to solve problems they are unable to sequence tasks appropriately to meet a goal and have trouble anticipating consequences of their actions.
Schizophrenia pt. when observed have obvious deficits in communication/interaction, process and perceptual motor skills... Usually we will observe difficulties with motor coordination, sequencing, and tasks completion as well.
Many deficits lead to a circle of tragedy: Organic causes may slow movement in psychomotor retardation and we will see depression bc of the retardation and then the movement will become slower bringng on more depression.
Usually we as health care professionals, will only focus on one or two traits of dysfunction... Time will probably inhibit us to fully explore the extent of the dysfunction.
Created by: Brittany Barfield Brittany Barfield on 2010-09-11



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