mental health Flashcards
affect
observable component of emotion
inappropriate affect
inconsistent, incongruent with accompanying idea, thought, speech
restricted/constricted affect
reduced range & intensity
blunted affect
severe lack of affect (does not demonstrate ability to change)
flat affect
lack of signs of affective expression (monotone voice, expressionless face, immobile body)
labile affect
rapid, abrupt changes in affect
anhedonia
unable to experience pleasure
(depression, schizophrenia, some other mental illnesses)
free floating anxiety
pervasive anxiety with no specific focus
fear
anxiety focused on real danger
compulsion
- Repetitive behavior to prevent/relieve anxiety
- Rule bound
- Client feels must be performed to ward off distress
obsession
persistent unwanted thoughts that produce distress
consciousness
responds to external stimuli
disorientation
orientation disturbed to person, place, time, situation (sometimes)
delirium
- acute, REVERSIBLE disorder
- disturbance of consciousness, decreased ability to attend
- short period of time (hrs to days)- tends to fluctuate
- Disoriented with confusion, lability, disturbed behavior (aggression)
- Fear & hallucinations (sometimes)
- causes: brain dysfunction, medication, endocrine disorders, cardiac disorders, fever, liver function disorders
confusion
- inappropriate reactions to environmental stimuli
- Disordered orientation to person, place, time
sundowner syndrome
- late afternoon/night in older people (dementia)
- Drowsiness, confusion, ataxia, falling, agitation, aggression
- sedation/oversedation
- changes in orienting cues (light, familiar people, objects)
defense mechanisms
To safeguard mind against feelings/thoughts that are too difficult for conscious mind to cope with
denial
- best known
- unable to face reality or admit obvious truth
- part of grieving
- may become angry or resistant with feedback
repression
keeping info out of conscious awareness
sublimation
act out unacceptable impulses by converting behaviors into more acceptable forms
EX:
Using kickboxing to vent frustration
projection
taking unacceptable qualities/feelings & ascribing them to other people
intelletualization
reduce anxiety by thinking about events in cold/clinical way
rationalization
explaining unacceptable behavior/feeling in rational or logical manner to avoid true reason for behavior
regression
when confronted by stressful event, people sometimes abandon coping strategies & go back to earlier patterns of behavior
reaction formation
- reduces anxiety by taking up opposite feeling, impulse, formation
EX:
Treating someone you don’t like in excessively friendly manner to hide true feelings
dissociative disorders
- disconnection, lack of continuity between thoughts, memories, surroundings, actions, identity
- Escape from reality in involuntary, unhealthy way
- Reaction to trauma, keep difficult memories at bay
dissociative amnesia
Severe memory loss (more than normal)- (unable to remember info about yourself, events, people in life)
dissociative identity disorder
multiple personality disorder, switching to alternative identities
depersonalization-derealization disorder
- ongoing/episodic detachment (outside self)
- Observing actions, feelings, thoughts, self from a distance (depersonalization)
- Others seem foggy, dreamlike, time feels slow/fast, world seems unreal (derealization)
euthymia
- living without mood disturbances
- mood disorders
- Feeling cheerfulness & tranquility, increased level of stress resilience
euthymia with reactive affect
respond appropriately to subject of a conversation
euthymia with congruent affect
emotions match situation & in agreement with situation
euphoria
- Desirable, natural occurrence when from happy events
- Excessive when not linked to events
- Hypomania, mania, bipolar, side effect of some drugs
apathic mood
- Lack motivation to do things
- Don’t care about what is happening around you
elated mood
- Very happy
- Full of energy
- Self-important
- easily-distractible
agoraphobia
Fear of being outside
psychosis
- Sensory experiences of things that don’t exist, not reality (hallucinations/delusions)
psychotherapy
- talking with a psychiatrist, mental health provider
- Learn about moods, feelings, thoughts, behaviors
hypochondriasis
Preoccupation with/fear of having particular disease rather than focus on individual symptoms
conversion disorder
Unexplained neurological deficit in movement/sensory perception caused by psychological factors
somatization disorder
- Before age 30, lasts for years
- Multiple systems
- Combination of pain, GI distress, neurological problems (numbness), sexual dysfunction
in personality disorders, what does a client have difficulty with?
- interpersonal skills & relationships, negative social interactions
- coping skills
- Deep need for praise/honor
- Very high view of self
- Poor social skills
- little/no concern for others or their feelings
- Aggression
- Entitlement
- Pride
- Inability to build/maintain relationships
- emotional modulation/appropriate affect
Antisocial personality disorder
- Continual antisocial or criminal acts
- Inability to conform to social norms
- No regard for safety or feelings of others, lack remorse
- Precursor is untreated or unresponsive conduct disorder
- Difficulty with authority relationships (interpersonal issue)
avoidant personality disorder
- Extreme sensitivity to rejection
- Socially withdrawn
- desire for companionship but consider themselves unworthy of it
- feeling of uncritical acceptance
- Inferiority complex (feeling inferior to others all the time)
Borderline Personality Disorder
- Extraordinarily unstable affect, mood swings/behavior, relationships, self-image
- Fear of real or imagined abandonment with frantic efforts to avoid it
- Suicidal thoughts
- Alternating extremes of idealization & devaluation (splitting)
- Recurrent self-destructive or self-mutilating behavior
- emptiness feeling
- trauma history
- self-absorption
- difficulty with interpersonal skills: relationships
- communication issues
dependent personality disorder
- others needs before their own
- Need others to take responsibility for major areas in their life
- no self-confidence
- discomfort when alone for a long time
histrionic personality disorder
- Colorful, dramatic, extroverted behavior in excitable, emotional persons
- Unable to maintain deep, long-lasting attachments
- Accompanying flamboyant presentation
narcissistic personality disorder
- Heightened sense of self-importance
- Grandiose feeling that they are special in some way
Obsessive Compulsive personality disorder
(not to be confused with OCD
- Emotional constriction
- Orderliness
- Perseverance
- Stubborn
- Indecisive
- Pervasive pattern of perfection & inflexibility
paranoid personality disorder
- Long standing suspiciousness & mistrust of persons
- Appear hostile, irritable, angry
schizoid personality disorder
- Frequently diagnosed in those with lifelong pattern of social withdrawal
- Eccentric (odd), isolated, lonely
- Discomfort with human interaction
-introverted - bland constricted affect
schizotypal personality disorder
- Odd or strange in thinking/behaviors
- Magical thinking, peculiar ideas, ideas of reference
- Illusion, derealization
in schizophrenia, what does a client have difficulty with?
sensorimotor components
schizophreniform disorder
Symptoms of schizophrenia but lasts 1-6 months instead of lifetime
schizophrenia
- Delusions, hallucinations
- lack of motivation
- disorganized thinking (speech)
- grossly disorganized or abnormal motor behavior (catatonia)
- negative symptoms
- Secondary depression leading to withdrawal
- avoidance – use rewards as motivational strategies (offering a snack as an incentive to attend a group)
- Abnormal social behavior
- Self harm or harm to others
- Extremely volatile, unstable, sometimes dangerous
- Significant cognitive impairment
- Genetic, brain chemistry, environmental roles
AFFECTS:
- cognition: EF, memory, attention, screening of relevant vs irrelevant stimuli
- compromised health/wellness
- recovery hindered by stigma
requirements for schizophrenia dx
- at least 2 symptoms for at least 1 month with ongoing signs for 6 months
- disturbance in 1+ areas of work, interpersonal relations, self care
rule out other dx, medical condition, substance
-
schizophrenia medications & side effects
- traditional antipsychotics: infrequently used, occasionally prescribed
- SIDE EFFECTS: dry mouth, blurry vision, photosensitivity (sun sensitivity), constipation
, orthostatic hypotension (be careful of certain activities which aggravate OH: parachute activity), dystonias (hyperextension or hyperflexion of the wrist & digits), akathisia (restless anxiety provoking need for movement), cardiovascular disorders
Complications:
- Tardive dyskinesia (not safe to operate a vehicle, should explore safer transport means)
- Neuroleptic-induced parkinsonism: muscle stiffness, cog-wheel rigidity, shuffling gait, drooling, stooped posture
- atypical antipsychotics
- SIDE EFFECTS: dry mouth, blurry vision, sedation, dizziness, hypotension, insomnia, confusion
tardive dyskinesia
repetitive muscle movements in face, neck, arms
- should not drive when experiencing this
- complication of medication (antipsychotics for schizophrenia)
shuffling gait
dragging one’s feet along or without lifting the feet fully from the ground
body dysmorphic disorder
- Preoccupied with perceived physical flaws (imagined or slight) that are not significant to others
- Concerns with appearance cause repetitive thoughts/behaviors to conceal/improve “flaws”
- Interrupts social, occupational functions
hoarding disorder
- Perceived need to save items, difficulty discarding possessions regardless of value, need, practicality
- Thought of discarding = distress, justification on why items is needed
- Cramped, cluttered living conditions - impacts safety and cleanliness in home
Trichotillomania
- Hair pulling disorder (scalp, eyelashes, eyebrows)
- Bald, patchy spots
- Impacts social, occupational functioning
Excoriation disorder
- Skin picking repeatedly - results in skin lesions
- Disrupts daily occupations
medications for obsessive disorders
- anxiolytic meds (xanex, valium):
- Side effects: drowsy, ataxia, headache, nausea, depression, dependence - Antidepressants (prozac, zoloft)
- Antiobsessional meds (Luvox)
- Side effects similar to SSRIs - Hypnotic meds to induce sleep
Side effects similar to anxiolytics
open-ended questions
longer, more detailed
(use with major depression)
closed ended questions
- when seeking specific info
- discourage communication
- Appropriate for psych patients who answer questions in unfocused, tangential manners
EX: yes/no questions, one word answers (did you get to work by bus or train? Is the sky blue?)
leading questions
suggest desired response
double questions
ask 2 questions at once to force a choice
Socratic questioning
- explore complex ideas, concepts, and beliefs by asking questions that challenge assumptions, clarify meaning, and reveal underlying principles
- CBT approach to challenge maladaptive thoughts
- What do you mean by that?
- Why do you think that’s true?
- Is that the only way?
- What’s the worst that can happen?
- Are there any counter arguments?
- How did we arrive at that conclusion?
concrete response
literal response
insightful response
includes reasons leading up to event
distractible response
Changes topic or stops in middle of responding
delusional response
Completely off topic
meal prep for person with mental health disorder
always start with cold meal prep then progress to hot meal due to safety concerns
EX: cold pasta salad to instant soup
sequencing issues
- Difficulty planning or enacting the steps of an activity
EX: Drying hands before using soap when washing
INTERVENTION:
Most appropriate INITIAL activity: baking cookies following a recipe
(structure with specific sequence of tasks)
emotional dysregulation
Uncontrolled anger, laughing, crying
lack of self awareness
- not recognize errors or use feedback
- False beliefs about abilities
- surprised/confused when given feedback
EX: What do you mean
social skills group
- interactive Intervention
- empathy development, relationships with others, nonverbal & verbal communication skills, social interactions
aggression
Forceful, angry, destructive speech or behavior
hyperactivity
Restless, sometimes aggressive/destructive activity associated with brain pathology
shifting attention
alternate attention between tasks with different cognitive or motor requirements
selective attention
- avoiding distractions
- pay attention to relevant stimuli
- Dysfunction = random errors in testing (not neglect)
sustained attention
Ability to consistently engage in an activity over time
Ex: playing a simple, repetitive card game in a quiet environment
mental tracking
tracking 2 stimuli in one activity
(EX: looking in car mirror while watching the road)
detecting & reacting
Able to detect & react to gross changes in environment
EX: Phone ringing , name being called
divided attention
two tasks at once
EX: Walking & bouncing a ball simultaneously
distractibility
can’t concentrate without being drawn to irrelevant stimuli
hypervigilence
Excessive attention & alertness that guards against potential danger
amnesia
Not remembering past experiences or personal identity
retrograde amnesia
Not remembering events that occurred PRIOR to trauma
anterograde amnesia
Unable to recall events AFTER trauma
cluster A personality disorders
paranoid PD, schizoid PD, schizotypal PD
- eccentricity (abnormal), distrust, lack of interest in social contact
cluster B personality disorders
antisocial PD, borderline PD, histrionic PD, narcissistic PD
- intense emotions, no empathy, unpredictable behaviors
acute distress disorder
- Similar to PTSD but immediately follows event
- no symptoms after 1 month
cluster C personality disorders
avoidant PD, dependent PD, obsessive compulsive PD
- low social drive, sensitive to criticism
intermediate/short term memory
Recall material within seconds/minutes
recent memory
Remember events of past few days
recent past memory
Able to recall events of past few months
remote memory
- Recall events of distant past
- Long term memory
procedural memory
how to perform tasks/skills
declarative memory
- Recall consciously learned facts
EX: School subjects
semantic memory
Knowing the meaning of words & able to CLASSIFY information
- info about the world
episodic memory
know own personal experiences
working memory
- Temporary
- track info while working on task
- IMMEDIATELY recall info after exposure
- able to focus conscious attention
prospective memory
- Capacity to remember to carry out future actions
-EX: Knowing you have appointments scheduled, turn off the stove, pay bills on time - Important for SAFETY & living independently
echopraxia
meaningless imitation of other person’s movements (in schizophrenia)
catatonia
immobility/rigidity
- strange movements
- uncomfortable positions without moving
- erratic & extreme movements
- echolalia
!! can be emergency if lasting for hours!!
stereotypy
meaningless repetition of words (echolalia)- in ASD, delirium, dementia, tourettes
psychomotor agitation
- Excessive, non productive motor/cognitive activity
- in response to inner tension
psychomotor retardation
decreased/slowed motor & cognitive activity
acting out
Physical expression of thoughts/impulses
akathisia
- State of restlessness
- Urgent need for movement
- Side effect of medication
ataxia
irregular involuntary muscle movements
psychoeducation groups
- CBT
- group with same diagnosis
- teaching info that requires learning capacity that may be impaired with acute illness
NDT groups
Enhances SI in chronic schizophrenia
to be diagnosed with major depression, what are the requirements?
- must have at least 5 symptoms for at least 2 weeks
- 1/5 symptoms must include depressed mood or notable loss of interest/pleasure
major depression
- Irritability
- Anhedonia
- Unintentional weight loss/gain
- insomnia/hypersomnia
- Psychomotor agitation or retardation
- Fatigue/loss of energy
- Feelings of guilt or worthlessness
- Poor concentration
- Continual, long term sadness, emptiness, despair, isolation, hopelessness
- Feeling trapped
- SUICIDAL thoughts or behavior
- irritable, anxious, phobias, obsessive thinking
- difficulties with social, relationships, sexual functioning
- somatic complaints: excessive self focus on physical symptoms
- Can be subtle
- can lead to malnutrition, GI issues, overall decline in physical health
medications for major depression
- Antidepressants that work on neurotransmitters (serotonin, norepinephrine, dopamine) to regulate mood; not for pediatric but for adolescents and up
- SSRIs: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), citalopram (Celexa)
- SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)
- (MAOIs): phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate), selegiline (Emsam)
- electroconvulsive therapy
Side effects: excessive thirst
assessments for major depression
- COPM
- play scale: Knox Preschool Play Scale, Test of Playfulness
- social skills : Social Skills Rating system
- School Function Assessment
- OT Psychosocial Assessment of Learning
- Miller Function & Participation Scales
in mood disorders, what does a client have difficulty with?
ADLs/IADLs
dysthymia/persistent depressive disorder
- “low grade” version of depression
- Less severe depressive symptoms FOR AT LEAST 2 YEARS with periods of no more than 2 months at a time symptom FREE
- May coexist with Axis I (general diagnostic categories) or Axis III (general medical conditions) disorders
Impacts function (may hold job/relationship but loses interest & often appears LETHARGIC)
In Children: school phobia, difficulty sleeping, negative behaviors in school
medications for dysthymia
SSRIs
disruptive mood dysregulation disorder
- Temper outbursts
- Severe & recurrent verbal or behavioral episodes
- Uncharacteristic for expectations of developmental level
- Overreaction to stimuli
- Diagnosed between 6 & 18 years old
premenstrual dysphoric disorder
- Marked affective lability
- Irritability or anger
- Increased interpersonal conflicts
- Depressive symptoms & mood
- Marked anxiety
hypomanic episode
- Symptoms same as manic episode but not severe enough to cause social/occupational impairment
- Last for 4 days rather than 1 week
bipolar disorder
- Fluctuations in mood/behavior
- alternating mania & depression
- genetic, chronic
- Long-term psychotropic medication tx
- low self-esteem and motivation
- Affects family and work roles through mood
- Manic episodes disrupt daily routines
- High work loss rates
- Suicidal thinking/behaviors
- Intense emotional states
bipolar disorder medications
- Mood stabilizers: lithium carbonate
- Anticonvulsants: carbamazepine, gabapentin
- Electroconvulsive therapy: cognitive side effects
bipolar I
1 or more manic episodes combined with hypomanic or major depressive episodes
bipolar II
- one or more major depressive episodes and at least 1 hypomanic episode
- NO MANIC episodes
cyclothymic disorder
- “low grade” version of bipolar disorder
- chronic (at least 2 years) MOOD disturbance, with fluctuating HYPOMANIC & DEPRESSIVE symptoms
- Vocational function impaired with depressed moods
- Social function impaired with unpredictable mood swings - Substance abuse potential problem
manic episode/mania
elevated/irritated mood with AT LEAST 3 OF THE FOLLOWING for at least 1 WEEK:
1. Grandiosity (feeling superior)/impulsive/inflated self-esteem
2. decreased need for sleep
3. Talkativeness/social hyperactivity/pressured speech
4. flight of ideas
5. Distractibility
6. increased activity
7. excessive involvement in pleasurable activities with disregard for consequences
8. Making decisions quickly
9. No sense of risk or danger, risky behaviors
10. Sleeping very little/not at all
11. Feeling of being “high” or “on top of the world” without any rational reason
12. restlessness
13. mood consistently elevated or irritable
14. psychomotor agitation
Can be symptom of manic depressive disorder, bipolar
Need to be watched closely for quick turn from manic to depressed
- First appear in late teens/early 20s, rapid, abrupt onset
- Independent functioning by maintenance treatment (medication)
- tend to be resistant to treatment
- promiscuous, gambling, excessive spending, giving things away, suggestive dress, irritable/assaultive/suicidal behavior
- increased substance abuse risk
manic episode medications
- Mood stabilizing medications (1st line treatment)- Lithium
- Prevent bipolar disorder - antipsychotics
- Anticonvulsants: Depakote, tegretol, lamictal, topamax, neurontin, trileptal
group dynamics
Internal & external factors
group maintenance roles
- members contribute to overall performance of group
1. Harmonizer: manage conflict
2. Compromiser:
3. Follower
4. social-emotional leader: maintenance roles
5. supporter: encourage others
6. tension releaser: funny towards whole group
7. interpreter: manages diversity
8. central negative: argues against ideas
9. monopolizer: makes excessive verbal contributions, preventing others from participating
10. self-confessor: tries to use group as therapy session
11. insecure compliment seeker: seeks validation/recognition
12. joker: pranks, sarcastic
13. blocker: keeps things from getting done
14. withdrawer: mentally/physically removes self from group
15. aggressor: puts others down, attacks others
16. doormat: gives in when challenged
group task roles
- Roles that group individuals assume to accomplish tasks related to overall group objective
1. Information-provider: gives knowledge
2. Information-seeker: asks for more information
3. Energizer: keeps group energy
4. Recorder: takes notes
5. leader/facilitator
6. gatekeeper: manages conversation flow for balance
group norms
- Implicit & explicit rules
- established by group leader or members