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Psychosocial 3

Exam 3

anorexia disorder descibed as the intense fear of being fat, a disturbance of body image, and an obsession with food and thinness, associated with refusal to maintain a normal wt for one's age and height. Severe food restriction & extreme wt control behaviors
bulimia wt fluctuations, lack of impulse control, secretive in nature
Russell's sign callous on on back of hand due induced vomiting
purging vomiting, diuretics and laxatives; 74% of individuals
non-purging exercising and fasting; 24% of individuals
Onset of Bulima teens
Secondary problems associated with eating disorders? electrolyte imbalances, heart failure, GI problems, dental problems, adrenal problems
What are pre-disposing factors of eating disorders? individual factors (ex. personality), family functioning and social/culture factors
What are precipitaing factors of eating disorders? stressful life events- negative perception of self, change in environment, views/comments from others
What are perpetuating factors of eating disorders? what "helps" maintain disorder such as compliments, thought patterns, self perception slow to change (still seeing themselves as Fat
What are protective factors of eating disorders? helps prevent onset of disorder. Individual (independence), Family (healthy relationships), Social (not seen as pretty)
Prognosis for eating disorders? depends on the onset and duration of illness, 50% recover, 30% see improvement, 20% long lasting, some die
Axis 1 in DSM includes: Main psychiatric disorders and Clinical Dx except mental retardation and personality disorders. Examples include anxiety, mood, substance abuse, schizophrenia, eating disorders and dissociative disorders.
Axis 2 in DSM includes: Developmental Delay and 10 different Personality disorders. Examples include Paranoid, Anti-social, Narcissistic, Borderline and Dependent disorders.
Axis 3 in DSM includes: Medical Conditions. Examples include Diabetes, obesity and all diseases.
Axis 4 in DSM includes Environmental and Social problems. Examples include homelessness, relationship problems, educational and occupational problems.
Axis 5 in DSM includes: GAF (Global Assessment of Functioning) score. 100= superior functioning. 50= serious symptoms or impairment in social, occupational or school functioning. 10= persistent danger of severely hurting self or others.
When did psychotropic drugs come about? 1950’s…radically changing MH care
What are the 6 major categories of psychotropic drugs? Antipsychotic, anti-parkinsonian, anti-depressants, anti-manic, anti-anxiety, psychostimulants
What is the role of COTA when it comes to medication? Observation, compliance, education, address skills when meds have taken affect and allow client to work issues
What is the definition of psychotropic medications and how what do they affect? Mind altering, specifically related to drugs used in treating MH by affecting neurotransmitters
What is EPS (Extrapyramidal symptoms)? brain structures affecting bodily movement (somatic) except motor neurons, motor cortex and pyramidal tract; in association with neuroleptic drugs. Akathisia, Akinesia, Ataxia, Dystonic reactions, Tardive dyskinesia & Neuroleptic MalignantSyndrome (NMS)
What is Akathisia? Inability to remain in sitting posture due to motor restlessness, intolerance in activity, mm quivering, mm tension worse in legs than arms; jumpy and distractive
What is Akinesia? Loss of voluntary motion (complete or partial); immobility; weakness and fatigue
What is Ataxia? Incoordination, difficulty coordinating voluntary movement “clumsy”
What are dystonic reactions? Dystonia= a state of abnormal mm tone anywhere; mm spasms, painful; often affecting jaw, neck, eyes, back, may arch back and roll eyes
What is tardive dyskinesia? Extrapyramidal effect of certain meds; difficulty in performing voluntary movements; suppressible; stereotyped movements often suppressed during sleep; may become permanent; may be life threatening; associated with neuroleptics
What is Neuroleptic Malignant Syndrome (NMS)? fatal, catatonic rigidity, hyperthermia, sweating, altered mental status, kidney failure, seizures; occur after use of drugs that alter level of dopamine in brain or after withdrawals of meds that increase CNS dopamine related to neuroleptic drugs
What is Postural Hypotension? Orthostatic
Definition of Recovery-Oriented Practice? When the professional prescribes what is best for the client- acknowledging the person, treating them as equals, use first person language and addressing symptoms and DX
True or False: A MH client experiences pain more intensely than the rest of us? true
What are the 5 key cognitive affecting the motivation in persons with eating disorders? Overevaluation of wt., shape and their control, mood intolerance, core low self-esteem, perfectionism and interpersonal problems
What are the 5 stages leading to behavior change in those with eating disorders? Pre-contemplation (In denial, unwilling to change), Contemplation (thinking about change), determination (preparing for change), action (implementing change) and Maintenance (permanence)
What are the general principles of the intervention when working with those who have an eating disorder? physical harm reduction, cognitive reconstruction and psychosocial functional enablement
What could be the problem with online support groups for those with an eating disorder? Some support groups encourage the illness
What are some specific OT interventions when working with those who have an eating disorder? Menu planning meal preparation, lifestyle redesign and independent living skills, communication and assertion training, stress management, projective art, crafts, relapse prevention and body image improvement
Acronym PLEASE? Plan-know triggers, Look out for triggers, Eat 3x a day, A- be assertive, Seek support, express yourself
Why are meds used for those with an eating disorder? Symptom reduction- will not fix problem
Action Stage stage during which the individual is implementing behavioral change
Cognitive Reconstruction- One of the elements for eating disorder Tx, delivered via individual and/or group therapy to improve ego strength, conflict resolution, personal identity and self-acceptance at normal body wt.
Contemplation Stage - stage during which an individual starts to consider change
Determination Stage stage during which a person considers change, recognizes the challenges, but also builds a determination to at least start to change some of the behaviors
Maintenance Stage stage during which an individual is learning to maintain the change they have implemented.
Precontemplation Stage stage during which a person can resist change as he or she cannot see any reason to change behavior
States- associated with specific point in time. Example “car wreck”
Traits - endures over time, worries over everything, exist across situations and contexts, can be adaptive or maladaptive, affects how we address problems in life
Cluster A of personality disorders include: Paranoid, schizoid and schizotypal
Cluster B of personality disorders include: Antisocial, borderline, histrionic and narcissistic
Cluster C of personality disorders include: Avoidant, dependent, and OCD
Which Axis are all personality disorders included in? Axis 2
What are typical traits of those in Cluster A? Does not like to be around others, emotional distancing and isolation, lack trust, not in touch with feelings, and feel like others are “out to get them”
Paranoid: Suspiciousness, no trust
Schizoid: Detachment from social relationships
Schizotypal: Intimidated by close relationships
What are traits associated with those in Cluster B? Inappropriate outburst and emotions, have problems with relationships, problem with anger and manipulation. “It’s all about me”
Which personality disorders suffer the greatest dysfunction? Borderline and Antisocial
Traits of antisocial disorder? Disregard for, and violation of, rights of others; lack of remorse. Theft
Traits of borderline disorder? Unstable relationships; burn bridges; “you don’t care about me”, impulsive and risk behavior leading to STD’s; goes from one extreme to the other- either all good or all bad
Traits of Histrionic disorder? Excessive emotions; drama; seek attention and over reactive
What are traits of Narcissistic disorder? “Me, me, me”; they feel they are most important; lack of empathy
What traits are associated with the disorders in Cluster C? Fear rejections, always want someone around, perfection, unable to make decisions and social discomfort
What traits are associated with avoidant disorder? Hypersensitive- may take comment the wrong way, avoid social interaction
What traits are associated with dependent disorder? Excessive need to be taken care of even at an older age
What traits are associated with OCD? Wants to be perfect, certain routines
Neuroticism (part of 5 factor model) Emotional instability or inclination toward unpleasant emotions such as anxiety, anger, depression, self-consciousness, impulsivity and vulnerability
Extroversion (part of 5 factor model) Sociability, talkativeness, energetic, and expression of affect; “surgency”
Openness to experience (part of 5 factor model) Appreciates experiences for their own sake; curious, adventurous, creative and unconventional
Agreeableness (part of 5 factor model) Compassionate, good natured, trusting, helpful, forgiving, and altruistic
Conscientiousness (part of 5 factor model) Self-disciplined, persistent, and motivated in goal directed behavior
Which cluster has highest concurrence of genetic links? Cluster A
OT should understand defense mechanisms associated with personality disorders. What are they? Splitting (perceive only “Good or Bad”), Denial, Repression and Projection (putting blame on someone else)
What are some OT interventions when working with those that have personality disorders? Help build relationships and improve trust; consistency; validation; motivation for change; coping skills, life skills,
What is most common psychiatric disorder? Anxiety disorder
What is a common characteristic of anxiety disorders? inappropriate expression of fear; mild uneasiness to immobilizing terror
Panic Attack is a symptom of panic disorder; happens once; discrete period of time of intense fear or discomfort
Panic Disorder requires recurring panic attacks, impairs function, may be with or without agoraphobia
Agoraphobia fear of having a panic attack in public; not a Dx in itself
Generalized Anxiety Disorder (GAD) persistent and excessive worrying about many things, occurs more days than not for at least 6 months, chronic may last for years, low rates of remission
OCD anxiety disorder; persistent thought, repetitive behavior, chronic, may last a lifetime
Obsessions recurrent or persistent thoughts
Compulsions repetitive behavior or mental act person feels driven to perform
Post-traumatic Stress Disorder been exposed or witnessed traumatic event; persistently re-experience traumatic event, last longer than 1 month, co-morbidity with major depression and substance abuse
Social Phobia avoids social situations; fears embarrassment and humiliation; fear is excessive or unreasonable; onset at age 14
Specific Phobia afraid or worried about specific event, object or situation
What are the 2 key centers of the brain that deals with anxiety disorders? Amygdala and Hippocampus
What is the first medication of choice for anxiety disorders? anti-depressents
What is the second medication of choice for anxiety disorders? Benzodiazepines (Many side effects)
What are other Dx often associated with mood disorders? heart disease, chronic pain, diabetes, asthma, COPD=anxiety which leads to social isolation
What is leading cause of disabilities world wide? mood disorders
Mood disorders is common cause of _____ suicide (15%)
Depressive Episodes Anhedonia lasting at least 2 weeks
Anhedonia no pleasure from anything
Manic Episode elevated and expansive mood, think they can do anything, not safe, lasting a week
Mixed Episode mixture of ups and downs, rapid changes, may occur daily
Hypomanic similar to manic episode but less intense, does not usually impair function
Melancholic Subtype loss of pleasure in almost all activities, wt loss, decreased sleep, increased depression
Atypical Subtype liven up for special events, increase in sleep and appetite, arms and body may feel like lead, depression worse at night
Postpartum depression Dx within 4 weeks after delivering baby, affects roles, can have delusions
Delusions distortion of thoughts, false beliefs
Hallucinations distortion in perception; any sensation usually auditory
congruent goes along with mood
incongruent does not fit mood
Are psychotic features more common on bipolar or unipolar disorders? bipolar
Major Depressive Disorder unipolar meaning usually only one end of the spectrum usually depression; must be present for 2 weeks; can happen once or more than once; impacts function; more c/o pain and physical disabilities
Dysthymic Disorder similiar to major depressive disorder but less severe, must be chronic lasting 2 or more weeks
Bipolar 1 one or more manic episodes, manic more than depressed, recurs in 90% of people, rapid cycling (4 or more cycles in 1 yr), impacts functions
Bipolar 2 one or more depressive episodes and at least one hypomanic episode, more depressive episodes leading to impairment of function
Cyclothymic bipolar disorder chronic at least 2 years, hypomanic and depressive symptoms but not severe enough to classify as episodes
What is cause of mood disorders? unknown, possibly genetics, early life stressors
What is happening in brain when a person has depression? too little neural firing, limbic-cortical system; stress is a factor
What is happening in brain when a person has mania? too much neural firing
How many Americans have depression? 1 out of 5
Does Bipolar occurs more in men than women? no it is equal between men and women
What percentage of people that have mood disorders use alcohol? 40%
What are some factors that could increase risk of suicide in individuals that have mood disorders? if a family history of suicide, substance abuse, impulsivity, access to guns or meds, recent loss in family, lack of support, religious beliefs,
What medication is often used for Bipolar disorder? Lithium but comes with many side effects
cognitive Behavioral therapy an active, problem oriented treatment task that seeks to identify and change maladaptive beliefs attitudes, and behaviors that contribute to emotional distress
bizarre delusion outside of the realm of possiblity
executive dysfunction inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior
negative symptoms any abnormality indicative of a mental or physical disorder characterized by absence of typical function, such as flat effect or social withdrawal
nonbizarre delusion a belief that in actuality is untrue but is in the realm of possibility
polygenetic involving the combined actions of multiple genes
positive symptoms hallucinations, delusions, disorganized thinking, and disorganized behavior
prodromal period time between the emergence of early signs of the illness and the point at which the diagnostic criteria for the disorder are met
catatonic behavior nonresponsive, orally and motorically
disorganized schizophrenia flat or inappropriate affect, disorganized speech and behavior, do not exhibit catatonic features
echololia repeating speech
echopraxia repeating movement
undifferentiated schizophrenia meet DSM-IV criteria but do not meet criteria for other subtypes
residual schizophrenia at least one episode but currently without prominent psychotic symptoms
what does COD stand for? Co-Occurring Disorder
T or F: It is easy get a dual diagnosis (or COD). False: It is hard to get a dual diagnosis because once the one diagnosis is found often the search for problems stops and symptoms of different d/o mimic each other.
Define Co-Occurring Disorder One or more substance related disorder plus one or more mental health disorders. (both must be DIAGNOSED)
Poly–Substance Dependence abuses at least 3 types of substances
PD Physical Disabilities
ETOH Alcohol
What are examples of hallucinogens? LSD, mushrooms, Psychotic, Trips, Flashbacks, cause long term effects
Psychotherapeutics are _______________________ prescriptions overuse/abuse(more middle of a upper class issue)
SPD's Serious Psychological Distress
T or F: Most people with serious psychological distress have no other problems. One in four people with SPD's also have substance abuse disorders.
4 most probable causes for high rate of COD's mental d/o contribute to use of substances, substance abuse contributes to onset of mental disorders, common causes for both d/o, overestimation of prevalence
What are the complications of COD's? Homelessness(78% of homeless inmates had COD), Incarceration, Infectious Diseases, Trauma, PTSD(20-30% may lead to substance d/o)
T or F: Infectious disease and COD have a poorer prognosis. True
What is the course stages of COD? Remission, Recovery, Relapse. (These can occur in any order)
Recovery Proactively improving their ife
T or F: Relapse is considered a normal aspect of CODs. True
What are the levels of Integration? Minimal Coordination, Consultation, Collaboration, Full Integration
Minimal Coordination No contact or follow up between providers
Consultation Informal, occasional communication
Collaboration Planned communication, deliberate sharing between 2 separate facilities
Full Integration One location, ideal, single intervention plan addresses all CODs
Due to CODs there is a push to include screenings where? In all health care provider locations. (they may come in for a foot problems, but not for mental/substance assistance)
Integrated Screenings 1st contact, determines need for further assesments
Integrated Assessments Done if screening was positive, typically ongoing, determines diagnosis(1<),readiness of client to change, strengths, weaknesses
Integrated Intervention All aspects of COD addressed in single plan.
Which health care settings should have screenings, assessments, and interventions? All health care settings such as primary care criminal justice/jail, & welfare should have screenings, assessments, and interventions.
Do symptoms of different disorders mimic each other? Yes
Does long term substance abuse cause delirium? Yes
What are substance-induced MH symptoms & signs? occur w/in 4 wks of withdrawal, expected to resolve w/recovery of substance abuse
What should be an important key to treatment of CODs? Trying to determine the relationship between MH & Substance Abuse and which came first. Are they interrelated?
What areas of life impact disorders? All ...Person, Occupation, & Environment can all impact a person for good or bad.
What can OT do to help a person with COD? Address specific real-life problems early, Planning for cognitive & functional impairments, Find & incorporate proper SUPPORT SYSTEMS
How many over the age of 12 use alcohol? 50%
Most common age for substance use? 18-25yrs
Substance use is higher in what gender? males
What percentage use drugs? 8%
T or F : Everyone's degree of tolerance for substances is the same. False: There are varying degrees of tolerance, withdrawal, symptoms, relapse, psychological & physical consequences depending on a multitude of factors.
What is the most common drug used? Cannabis
Substance Abuse causes negative consequences but does not reach level of tolerance or withdrawal
Substance Dependence causes withdrawal and major life disruptions
Substance-Induced Disorders disorders related to drug use but not drug dependency. Includes intoxication & withdrawal
T or F: Toxins can cause substance induced disorders even if you are not using. True
Are COD's more common with sever MI? Yes
?What is FASD and what does it stand for?Peo Fetal Alcohol Spectrum Disorder - ETOH consumption in utero
Signs of FASD Broad nose, wide-set eye's, thin lips, small/slow growth,impulsive, self regulating difficulties, attention problems, (1 in 100)
T or F: Spinal cord injury and TBI are seldom caused by ETOH or drug use. False: 40-80% of TBIs & SCIs occurred due to ETOH/drug uses
What is the main cause of disability to 20-21 yr olds? Substance abuse
T or F: CODs are more complicated due to dual issues which must be addressed. True
T or F: Genetics plays no role in likelihood of substance abuse. False: Genetics increases likelihood of substance abuse by 3-4X's with immediate family. % decreases with distant relatives
T or F: Some illegal drugs cause substance induced mental disorders. True
What are some of the substance induced mental d/o symptoms? Delirium, persisting dementia, persisting amnesic d/o, psychotic d/o, mood d/o, anxiety d/o, sexual dysfunction, & sleep d/o
Which substance induced mental d/o symptoms can persist? persisting dementia & persisting amnesic d/o
T or F:People with substance abuse disorders always associate their abuse with the effects of them. False: They often do not recognize the link between the behavior and the consequences.
____________ have a greater use of Alcohol/Illicit drugs. Men
Prescription drugs ___________ the desire for substance abuse, but do not eliminate it. reduce
Antabuse Makes one severely ill.
Barriers to getting help for substance abuse are $, not ready to stop, feel they can handle it themselves.
T or F:Harm reduction's end goal is always 100% abstanence. False:Harm reduction is a gradual step by step reduction of drinking, not necessarily intended to end in 100% abstanence.
Created by: kcjesusaves
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