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OTA 110 - Mental Health > OTA 110 - Ch. 5, 8, 10, 11 > Flashcards

OTA 110 - Ch. 5, 8, 10, 11 Flashcards

1
Q

Changes from DSM-4 to DSM-5

A
  • DSM-4 used Axis system; DSM-5 non-axial
  • DSM-4 used “mental retardation”; 5 uses “intellectual disability”
  • DSM-4 used “gender identity disorder”; 5 uses “gender dysphoria”
  • DSM-4 used PDD-NOS (pervasive developmental disorder-not otherwise specified), Asperger’s, etc.; 5 uses “autism spectrum disorder”
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2
Q

DSM-5 structure

A

20 chapters based on disorder types (neurodevelopmental, psychotic, depressive, anxiety, trauma, substance use, personality, etc.)

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3
Q

MAOI

A

Monoamine oxidase inhibitors (Nardil, Parnate) – antidepressant drugs. Often used when other antidepressants ineffective. CAUTION: Must follow a special diet! Amino acid “tyramine” interacts and can be life-threatening! Avoid foods such as aged cheese, wine/beer, yogurt, tea/coffee, avocados, bananas, yeast, raisins/dates, and more.

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4
Q

Tyramine reaction

A

When foods containing amino acid tyramine interact with MAOIs; causes life-threatening hypertensive crisis (sudden loss of blood pressure), which could lead to cerebral hemorrhage and death.

Signs: sweating, palpitations, headache.

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5
Q

Tardive dyskinesia

A

(TD); side effect of antipsychotic drugs (Thorazine, Haldol, Seroquel, Risperdal). Movement disorder usually associated with older, first-gen drugs. Initial signs are involuntary facial movements, writhing tongue, writhing fingers. Can become permanent unless med is stopped.

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6
Q

Six major categories of psychotropic drugs:

A

1) Antipsychotic drugs
2) Antidepressant drugs
3) Antimanic drugs
4) Antianxiety drugs
5) Psychostimulant drugs
6) Antiparkinsonian drugs

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7
Q

Antipsychotic drugs

A

For people with schizophrenia and other psychotic disorders. Control hallucinations/delusions. Help reduce violent/dangerous behaviors.

Examples: Thorazine, Haldol, Seroquel, Risperdal

Most serious side effect is tardive dyskinesia (TD). Also photosensitivity.

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8
Q

Antidepressant drugs

A

Relief of depression/suicide. Newer meds tend to have fewer side effects (less libido loss/weight gain). May take up to 3 weeks to be effective.

Examples: Wellbutrin, Paxil, Zoloft, Prozac

Side Effects: may increase suicidal tendencies; older drugs (MAOIs) may cause tyramine reaction.

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9
Q

Antimanic drugs

A

Mood stabilizers; reduce intensity of mood swings, mania. (Sometimes anticonvulsants also work). Used with bipolar disorder.

Example: Lithium (toxic, causes fine hand tremor)

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10
Q

Antianxiety drugs

A

To control anxiety in disorders that are not psychotic (anxiety disorder, personality disorder).

Examples: Valium, Xanax (can be very addictive)

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11
Q

Psychostimulant drugs

A

Stimulate and increase mental/physical activity. Paradoxical effect on children with ADHD. Improve attention span, reduce hyperactivity.

Examples: Ritalin, Adderall

Side effects: impaired growth, tics, insomnia (sometimes loss of appetite)

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12
Q

Side effect: Nausea

A
  • Have soda/graham crackers or bread

* OTC antacids sometimes recommended by dr., but get their approval in case it interferes with meds

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13
Q

Side effect: Photosensitivity

A 
Extreme sensitivity to sunlight/easily sunburns (side effect of antipsychotics)
• Teach patient about these effects
• Wear sunscreen/sleeves/hat/sunglasses
• Keep time in sun brief
• Observe closely for signs of sunburn
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14
Q

Side effect: Dry mouth

A
  • Allow water whenever thirsty
  • Have hard candies available (lemon drops/mints)
  • Teach about dehydration effects of caffeine/alcohol
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15
Q

Side effect: Blurred vision

A
  • Help patient select activities that don’t require fine visual attention
  • Use mats/soft equipment in gross motor activities
  • Use large pieces in crafts (ie: 1-inch mosaic tiles)
  • Provide magnified reading glasses
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16
Q

Side effect: Postural hypotension

A

Patient feels faint/blacks out when rising.
• Notify physician
• Teach patient to sit/stand up slowly; be prepared to support them at waist
• Encourage use of furniture/supports for balance
• Avoid activities with sudden postural changes
• Avoid gross motor activities to reduce sudden movements

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17
Q

Side effect: Hand tremors

A

(Ataxia). Common side effect of Lithium.
• If patient on new trial of lithium-based med and tremor is gross, notify dr. (may be sign of toxicity).
• Common if on lithium for month+. Help patient learn to compensate by stabilizing elbow/arm.
• If taking antipsychotic and tremor is wormlike/writhing, notify dr. Could indicate TD.

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18
Q

Side effect: Akathisia

A

Restlessness, muscular tension (often worse in legs).
• Help patient select activities that allow for movement (getting up, etc.)
• Avoid activities requiring prolonged sitting/standing
• Put patient at separate table if movement disrupts others.

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19
Q

Nonadherence

A

Not taking medication as prescribed. Some reasons:
• Feels unnatural; feel like it’s making them sicker
• Unpleasant side effects
• Hard to follow dosing/multiple meds overwhelming
• Cost
• Preference to street drugs
• Difficulty opening containers/swallowing/memory

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20
Q

Role of OTP re: Medication

A

1) Observe/report functional level
2) Adherence/other substance issues
3) Management of side effects
4) Driving/safety concerns
5) Med education/management

21
Q

What does safety as an OTA include?

A

1) Keeping client safe from self and others
2) Keeping yourself and staff safe from clients
3) Keeping other clients safe from your client
4) Teaching client how to be safe elsewhere

22
Q

Universal precautions

A

Set of procedures recommended to prevent spread of infection.

23
Q

Most effective method of disease prevention

A

Regular and thorough hand washing

24
Q

“S. E. A.”

A

Suicide, elopement, assault: the three psychiatric emergencies.

25
Q

Suicide

A

One of 3 psychiatric emergencies (“S.E.A.”)
• Avoid dangerous tools/supplies (toxins, flammables, sharps, rope-like objects)
• Count items before/after activities
• Accompany patients leaving the room

26
Q

Risk factors for suicide

A
  • Major mental disorder
  • Past suicide attempts, lethal methods (gun) used
  • Comorbidities
  • Adverse childhood experiences
  • Sexual abuse
  • Substance abuse
  • Unemployment/lack of future plans/goals
  • Depressed clients who show increased activity/mood are actually increased risk!
27
Q

Signs of suicidal intent

A
  • Talking about wanting to die
  • Making if/then statements about future
  • Recent acquisition of means (meds, gun)
  • Making a will/getting life insurance
  • Giving away belongings
  • Seeking promises “if something happens to me”
  • Passive suicidal behavior (not eating, alcoholism, unsafe behavior)
28
Q

Steps in handling assault

A

1) Call for more staff
2) Remove other patients from area
3) Attempt to calm the patient
* Talk to them if you can
* Avoid physical force–only as last resort if trained!

29
Q

Elopement

A

One of 3 psychiatric emergencies (“S.E.A.”)
Leaving facility without discharge.
• Secure doors/windows
• Never leave keys unattended
• Don’t turn back on patient when escorting

30
Q

Independent Living Safety Topics

A

1) Medication safety
2) First Aid
3) Emergency procedures
4) Personal hygiene
5) How/when to obtain medical care
6) Personal safety (locks, strangers)
7) Safe sex techniques
8) Safety when using electronics/devices

31
Q

“RICE”

A

Rest, Ice, Compression, Elevation (for strains, sprains, bruises, contusions)

32
Q

How to handle client having seizure

A
  • Stay calm, reassure person you’re there
  • Time the duration of seizure
  • Get them on their side, loosen tight clothing, protect from nearby objects
  • Do not put anything in mouth or do CPR (call 911 first)
  • Stay until breathing returns to normal and person is fully awake
  • Let them know what happened, check for injuries
  • Record what happened and notify doc/health team
33
Q

How to control your environment

A

1) Keep track of your keys
2) Do not bring restricted items in (glass, wire, cord, etc.)
3) Have everything ready before patient arrives/never leave patient from locked ward unattended
4) Use shatterproof mirrors
5) Use judgment about who comes to OT (is other staff nearby? Is activity safe for this person?)
6) Organize supplies for easy count. Keep sharp/dangerous items locked.
7) Alert client to potential dangers (ie: splinters)
8) Follow precautions for toxins
9) Use safety equipment (goggles, gloves, etc.)
10) Observe fire codes
11) Attention to floor conditions (no spills/hazards)
12) Eliminate electrical hazards
13) Food safety guidelines (and burn prevention)
14) Techniques for energy conservation/ergonomics
15) Provide more structure for lower cognitive levels

34
Q

How major mental disorders effect performance of occupation?

A

1) Anxiety: low attention span, need to move, fear of unfamiliar
2) Depression: need for success/self-control, more motivated by helping others, prefers familiar, simple activity, less stimulation/less choice
3) Mania: low focus, need to move, short-term activities, simplicity, easily distracted/hard to control
4) Hallucinations: need for calm, low stimulation, prefer social, needs structure/short-term activities
5) Delusions: keep attention on activity/reality, stimulation, avoid topics relating to delusion
6) Paranoia: need space/patience, reliable environment, controllable activities
7) Aggression: may need isolation, avoid touching/contact, avoid dangerous objects, simple activities (low frustration)
8) Seductive Behavior: avoid crowds/physical contact, use forceful gross motor, reinforce appropriate behavior
9) Negative Neurocog. Behavior: avoid startling/stressing, distract with positives/familiar activities, sensory stimulation
10) Cognitive Deficits: keep simple/label things, familiarity, simple choices, modify known instead of introducing new
11) Attention Deficits: limit distractions/supplies, social interaction helps, simple/definite activity, match activity to cognition

35
Q

Define Symptom; how they are guides

A

Symptom: behaviors that show that a disease/abnormal state is causing the person to act this way. May be visible behavior or subjective feelings reported by client. Symptoms are not the disease!
• Help identify unmet needs or conflicts
• Are the way the person deals with anxiety
• Impair functioning in predictable ways, showing where person may be having difficulty
• May be response to event or environment (also clues to help person)

36
Q

Response variables

A

Tools OTA uses to help someone behaving oddly/ uncomfortably to function the best they can. We can change them to meet the individual’s needs.

1) Self (therapeutic use of); how to talk/act with client
2) Environment; context modified for client
3) Activity; what is done together, chosen for person

37
Q

Temporary vs. Permanent Cognitive Deficits

A

Temporary/Transitory: Give simple, structured, short-term activity (1 day preferred); reintroduce to known roles/skills

Permanent: If STABLE, teach ways to adapt activities/simplify the familiar; If PROGRESSIVE, help maintain skills as long as possible, encourage independence, familiar/necessary activities

38
Q

Role of OTA in promoting wellness/self-management of symptoms

A

Helping develop lifestyle of physical and psychological balance to reduce symptoms. Develop a wellness recovery action plan:
• list daily maintenance (routines/activities)
• list personal triggers and ways to respond
• list early warning signs, ways to respond
• ways to recognize worsening symptoms, ways to respond
• crisis plan or advance directive
• productivity
• participation in meaningful activity

39
Q

Why mental disorders make safety considerations important?

A
  • client may harm themselves or others
  • may be suicidal or self-mutilating
  • may have history of violence
  • may be confused/careless
  • safety education/training can improve client’s functional independence in community
40
Q

Examples of antipsychotic drugs

A

Thorazine, Haldol, Seroquel, Risperdal

41
Q

Examples of MAOI antidepressants

A

Nardil, Parnate

42
Q

How OTA can help client on psychiatric medications

A
  • Observe closely/regularly
  • Notice effects of meds on functional level
  • Communicate findings with doc to adjust dose
  • Adapt activities to enable success despite side effects
  • Educate client on med effects
  • Listen to complaints about med; encourage adherence
  • Provide recommendations for adjustments to routine/environment
43
Q

Psychiatric disorders and how they affect performance of occupations

A

Neurodevelopmental: Affect learning/skill development, social functioning, perceptual-motor deficits

Schizophrenia: Social interaction, behavioral issues, ADL issues, executive function issues

Bipolar: Cognitive issues, behavior issues, symptom/med effects

Depressive: ADL/IADL deficiencies, impaired function with school/work, interpersonal relationships

Anxiety: High stress, stimulus-specific fears

Obsessive-Compulsive Related: Body dysmorphia, hoarding, trichotillomania/excoriation

Trauma/Stressor Related: Sensory processing issues, emotional triggers, substance abuse

Feeding/Eating Disorders: Self esteem/assertiveness issues, food issues

Substance Abuse/Addictions: Need to fill new leisure time, cognitive/perceptual issues, social skills, need for new roles/occupations

Neurocognitive: Declining function, need for roles/routines, memory, judgment, social/emotional skills

Personality: Need for psychoeducation, social skills, societal role, aggressiveness

44
Q

Enabling

A

A codependent behavior; removing the natural consequences to the addict of his behavior. Making excuses for them, giving them money, etc.

45
Q

Denial

A

Defense mechanism used by addict. Not admitting there is a problem; refusal to admit truth or reality.

46
Q

Rationalization

A

Defence mechanism used by addicts. Making excuses/justifications for behavior. Blaming it on something/someone else. “I did it because….”

47
Q

Projection

A

Transferring one’s own unacceptable feelings onto others. Addicts use this as defense mechanism.

48
Q

Co-dependency

A

Unhealthy involvement of non-substance abuser such as a spouse. A codependent person is someone who sacrifices their own needs in order to meet needs of other (addict).

49
Q

Important to address in Substance Abuse interventions:

A

Evaluation/intervention focus on:
• Performance patterns (bad habits?)
• Use of time (filling it, especially leisure)
• Relapse prevention
• Cognitive and perceptual functions/skill development
• Social interaction, social skills, self-expression
• Daily living skills (ADLs may be affected)
• Acquisition, development, maintenance of valued occupational and social roles (ie: work?)

OTA 110 - Mental Health (9 decks)

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