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Psychosocial 3
Exam 3
| Question | Answer |
|---|---|
| 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. |
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