question

Delirium, dementia, and amnesia

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characterized by clinically relevant changes in thinking and memory in contrast to previous thinking and memory abilities

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DMS-IV-TR essential features of dementia

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aphasia, apraxia, agnosia, loss of executive function

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Impact dementia has on occupational performance

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a. all areas of daily functioning affected b. ADLs, IADLs, work, leisure, social participation, and sleep all require assessment

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OT interventions

answer

a. Environmental adaptations for safety b. Caregiver education c. Behavioral intervention to manage fatigue and sleep-wake cycles

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Aphasia

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absence or impairment of ability to communicate through writing, speech or signs

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Apraxia

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inability to perform purposive movements without sensory or motor impairment

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Agnosia

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loss of comprehension of visual, auditory, or other sensations

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Loss of executive function

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impairment in ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behaviors

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Substance-related disorders (drug dependence and addiction)

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Drugs of abuse (e.g., street drugs, illegally obtained substances), medications, and other toxins (e.g., inhalants, paint fumes, heavy metals) resulting in a combination of cognitive, behavioral, and physiological symptoms that lead to addiction and compulsive actions to obtain desired substance and maintain ongoing use

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DMS-IV-TR classifications for substance abuse

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a. Substance dependence b. Substance abuse c. Substance intoxication d. Substance withdrawal

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Impact substance abuse has on occupational performance

answer

a. All areas of occupational functioning negatively affected b. Routines and roles negatively affected c. Substance use heavily interwoven in daily life

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OT interventions for substance abuse

answer

a. Psychosocial therapies, including coping, stress management, and social skills training b. Cognitive-based interventions geared toward increasing client's motivation and control of life

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Schizophrenia and other psychotic disorders

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Psychotic symptoms, including delusions and hallucinations, primarily characterize this category of disorders

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At least two conditions need to last for a dx. of schizophrenia according to DMS-IV-TR

answer

a. Delusions b. Hallucinations c. Disorganized speech d. Disorganized or catatonic behaviors e. Negative symptoms

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What are the subtypes of schizophrenia?

answer

a. Paranoid type b. Disorganized type c. Catatonic type d. Undifferentiated type

question

Impact schizophrenia has on occupational performance

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a. Cognitive impairments, including problems with attention, memory, executive functions, and screening of relevant versus irrelevant information b. Compromised health and wellness c. Recovery and reintegration hindered by community barriers and social stigma c. Family psychoeducation d. Supported employment e. Integrated dual diagnosis treatment for co-occurring mental illness and substance abuse

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OT interventions for schizophrenia

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Illness management and recovery, including group and individual programs b. Assertive Community Treatment to provide support and skills training in natural environments

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Mood disorders (depression and mania)

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Feelings of severe and sustained sadness and hope- lessness and contrasting feelings of euphoria, both of which can alter thinking and behavior in detri- mental ways. Severity and sustained presence of depressive, manic, or combined symptoms determine specific diagnoses within this group of disorders

question

Categories of mood disorders:

answer

a. Depressive disorders, including major depressive disorder b. Dysthymic disorder, characterized by major depressive symptoms that are less severe and pres- ent chronically for a period of at least 2 years

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Bipolar disorder I

answer

one or more manic episodes or mixed episodes

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Bipolar disorder II

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one or more major depressive episodes and at least one hypomanic episode

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Cyclothymic disorder

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chronic (at least 2 years) mood disturbance with fluctuating hypo- manic and depressive symptoms

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Impact mood disorders have on occupational performance

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a. Low self-esteem and motivation levels, compromising successful completion of daily tasks b. Family and work roles affected by mood c. Daily routines disrupted during manic episodes d. High work loss rates

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Ot interventions for mood disorders

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Cognitive-bx. therapy and interpersonal psychotherapy

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Cognitive-behavioral therapy

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Uncover distorted beliefs and faulty thinking

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Interpersonal psychotherapy

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Improve interpersonal and psychosocial functioning

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Pharmacological intervention: depression disorders

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i. Selective serotonin reuptake inhibitors ii. Serotonin iii. Antidepressants

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Selective serotonin

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italopram, escitalopram, fluoxetine, paroxetine, sertraline

question

Serotonin

answer

norepinephrine reuptake inhibitors: duloxetine, venlafaxine

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Antidepressants

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bupropion, mirtazapine

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Pharmacological intervention: Bipolar disorders

answer

Mood stabilizers & Anticonvulsants

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Mood stabilizers

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Lithium carbonate

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Anticonvulsants

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carbamazepine, divalproex sodium, gabapentin

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Anxiety disorders

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characterized by panic, stress, and generalized anxiety resulting in alteration of behavior, emotions, and cognitive processing for the purpose of avoiding the associated negative physi- ological, emotional, and psychological impact

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General DSM-IV-TR categories of anxiety disorders

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a. Panic disorder b. Agoraphobia c. Generalized anxiety disorder d. Obsessive-compulsive disorder e. Posttraumatic stress disorder f. Social phobia g. Specific phobia h. Substance-induced anxiety disorder i. Anxiety disorder attributable to a general medical condition

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Agoraphobia

answer

Characterized by fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

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Anxiety disorder's impact on occupational performance

answer

physical, cognitive, and psychosocial impairments

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physical impairments

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difficulty physically responding to stress in posttraumatic stress disorder and cardiac problems in panic disorder

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Cognitive impairments

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difficulty following directions and concentrating because of hyperaroused states and lowered memory capacity because of trauma

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Psychosocial impairments

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disruptions in relationships and career development

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OT interventions for anxiety disorders

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cognitive-bx. training, relaxation therapy, expressive writing

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Cognitive-behavioral training

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enable clients to approach situations that cause anxiety, under- stand the fear cycle, and challenge distorted cognitions related to fear

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Relaxation therapy

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breathing, meditation, visualization, and progressive muscle re- laxation

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Pharmacological treatment for anxiety disorders

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Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants

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Benzodiazepines

answer

Alprazolam, lorazepam

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Selective serotonin reuptake inhibitors

answer

fluoxetine, paroxetine, fluvoxamine, sertraline, citalo- pram

question

Somatoform disorders

answer

An experience of physical symptoms that have a psychiatric source; frequently encountered in settings outside mental health settings b/c of the association of the disorders with physical illness. Occupational therapy practitioners may be the first health practitioners to recognize symptoms related to these disorders. The pain and discomfort related to these disorders are real and should not be mistaken as malingering or symptom magnification for secondary gain

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Eating disorders

answer

Severe disturbances in eating and behaviors related to eating characterize these disorders, which are life threatening. Anorexia nervosa and bulimia nervosa are the primary diagnoses encountered in this category

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Bulimia nervosa

answer

condition characterized by recurrent binge eating and frenetic compensatory behaviors

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Anorexia nervosa

answer

characterized by intense fear of being fat, disturbance of body im- age, and obsession with food and thinness

question

Eating disorders impact on occupational performance

answer

a. Maladaptive eating habits and impaired meal preparation skills b. Maladaptive lifestyle habits and impaired independent living skills c. Impaired communication and assertion skills d. Impaired stress management skills e. Resistance to change

question

General principles for OT interventions for eating disorders

answer

physical harm reduction, cognitive reconstruction, psychosocial functional enablement

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Specific intervention

answer

i. Menu planning and meal preparation ii. Lifestyle redesign and independent living skills training iii. Communication and assertiveness training iv. Stress management v. Projective artwork and use of crafts vi. relapse prevention vii. body image improvement

question

Personality disorders

answer

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

question

PD Cluster A:

answer

Paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder

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Cluster B:

answer

Antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder

question

Cluster C:

answer

Avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder

question

Impact on occupational performance

answer

Social participation: limited interpersonal skills, negative interactions

question

Impact on occupational performance cluster A

answer

eccentricity, distrust, lack of interest in social contact

question

Impact on occupational performance cluster B

answer

intense emotions, lack of empathy, unpredictable behaviors

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Emotional modulation

answer

difficulty effectively modulating emotions and responding to situations with appropriate affect

question

Coping

answer

limited skills to meet daily life challenges

question

OT interventions for PD:

answer

a. Development and maintenance of collaborative relationships b. Consistency during treatment c. Validation of the client's feelings d. Development and maintenance of motivation for change e. Mood stabilization and expression of appropriate emotions f. Promotion of increased self-concept, self-esteem, insight, and judgment g. Development of interpersonal relationships

question

Inpatient setting:

answer

Admitted to the psychiatric unit of an acute care hospital as a result of active and uncontrolled symptoms related to mental illness; brief, manage behavior, stabilize clients on medication, and refocus clients on engagement in occupation.

question

Long-term setting:

answer

distressing and uncontrollable symptoms or serious threat to self or others, clients may be hospitalized for extended periods of time; Interprofessional teams work closely with the client to stabilize symptoms, ensure adherence to medication protocols, and habitualize patterns of daily activity and self-care.

question

Community-based mental health clinics:

answer

Designed for clients to meet with mental health professionals for ongoing medication management, lifestyle management, self-care activities, and group therapies. General monitoring of health conditions and referral to other health professionals is a component of these clinics.

question

Consumer-based, nonprofit, or health systems-based day treatment programs:

answer

Lifestyle man- agement programs are designed to assist clients over an extended period and provide meaningful occupational engagement as tolerated for clients with more chronic mental health conditions.

question

Skilled nursing residential care and home health care:

answer

Clients with chronic mental illness may reside here to receive ongoing care when conditions are not suitable for living with family/friends or independently; sometimes home health care is required for clients with chronic mental health conditions to continue aging in place or residing in their homes.

question

Community residential settings (halfway houses or adult foster care)

answer

Concept is to provide temporary supervision under group living conditions to encourage healthy occupational engagement and independent living. Adult foster care does much the same thing but with a smaller group or with one person at a time.

question

Supported employment, transitional employment, and prevocational and vocational rehab

answer

supported employment—in which on-the-job assistance and therapeutic intervention are provided and strong collaboration occurs seems to work best. The clubhouse model offers a physical space in which people with mental illness can receive support for community living and explore work potential

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