finalllllll Flashcards
(96 cards)
1
Q
Somatic symptom disorder/anxiety illness disorder
A
Excessive thoughts, feelings, or behaviors related to somatic symptoms including: persistent thoughts about the seriousness of the symptoms, persistent anxiety about the symptoms, excessive time and energy focused on the symptoms.
2
Q
How many months must somatic symptom disorder be present for?
A
at least 6 months
3
Q
Comordities of somatic somatic/anxiety illness
A
depression, anxiety, panic disorder “DAP”
4
Q
Somatic/illness implication for function
A
Mild to moderate in most cases, work deficits with absenteeism, distraction as a result of worry, may be cognitive and emotional regulation deficits, and issue with self identity and self image
5
Q
Conversion disorder
A
one or more symptoms of altered motor function (weakness, paralyzed, slurred speech, swallowing issues) or sensory function (visual, olfactory, auditory)
6
Q
Psychological factors affecting medical conditions
of somatic/illness
A
- presence of a medical symptom or condition other than a mental disorder.
- Psychological or behavioral factors affect the medical condition: affect the course of the medical condition, interfere with treatment of the medical condition, increase health risk for the person, and influence the pathophysiology, cause, exacerbation of the disorder or the need for medical treatment.
- Diagnostic category used for situations where medical condition (cancer) is associated with depression or anxiety.
- Need to address psychological symptoms to improve medical outcomes and quality of life.
7
Q
Somatic/illness lifespan considerations
A
- n children, somatic symptoms may be expression of anxiety
- Children with somatic symptoms are likely to have dysfunctional educational experiences (school absence) and involved in the juvenile justice and welfare systems
- In later life, somatic symptoms often express anxiety or depression
- May present in later life with some degree of cognitive confusion
8
Q
Pica - diagnostic criteria
A
persistently eating non food items
9
Q
to be diagnosed with pica, u have to show symptoms for at least?
A
1 month
10
Q
Pica Comorbitities (Alvina Ingests Socks)
A
autism, intellectual and schizophrenia
11
Q
Pica OT implications
A
Self-care associated with cooking/eating always affected Physical health (malnutrition, intestinal blockage, toxin), cognitive function and processing
12
Q
Ot behavioral intervention
A
Establish strategies with positive direction/ outcome
Focus on providing other occupations, meal preparation
Environmental modifications
13
Q
Anorexia Nervosa DC
A
Restriction of caloric intake leading to significant low body weight
Intense fear of gaining weight or being fat
Disturbance in body image, excessive concern about body weight or shape, or lack of recognition of the seriousness of the current low body weight
14
Q
Comorbidities Anorexia
A
depression and anxiety
15
Q
Anorexia treatment
A
Medical management to address nutritional deficits
Psychodynamic therapy- control issues
CBT
Nontraditional antipsychotic medications- address dopamine dysfunction
Combination probably most effective
16
Q
Anorexia OT implication
A
Occupational engagement
Therapeutic alliance- a cooperative working relationship between client and therapist; goal setting
Focus on acceptable leisure pursuits that de-emphasize food
Social skills training
Stress management; Self-expression opportunity
Support and education for caregivers and families
17
Q
Bulemia DC
A
Repeated episodes of binge eating
Inappropriate mechanisms for compensating for overeating (vomiting, laxatives)
Binging and purging
Self-image is not excessively influenced by bodyweight
18
Q
Bulemia DC how long
A
At least once a week for 3 months
19
Q
DCT (dialetctical behavior therapy) treatment _____ and used in _____
A
focuses on awareness of problems and choices, mood regulation techniques, and coping skills”
Invalidating environment:
bulemia
20
Q
Invalidating enviroment
A
- bulemia
- “its tendency to respond inappropriately to private experiences independent of the validity of the actual behavior”
- The environments create a sense of uncertainty, unpredictability, or hostility
21
Q
Bulemia OT implications
A
Coping skills training focused on mood regulation, managing social situations, and interaction with the environment
Practice avoiding triggering situations
Meaningful occupations that reduce urge to binge (e.g. yoga)
22
Q
Binge Disorder DC
A
Repeated episodes of binge eating: in a limited time, eats an amount much larger than is considered normal; lacks control over eating during each episode
The episodes are associated with: eating too quickly, eating until uncomfortable, eating large amounts when not hungry, eating alone because of guilt or depression, feeling disgusted with oneself, distress about binge eating.
Not associated with anorexia or bulimia
23
Q
Binge Disorder DC Length
A
Average once a week for at least 3 months
24
Q
Binge Disorder treatment
A
Integrative response therapy, a group-based guided self-help treatment focused on affect regulation.
Cognitive behavioral therapy with accompanying medication
Medication
25
Binge Implications for OT
Wellness efforts focused on changing behaviors
Emphasis on healthy occupations that address eating habits
Health promotion/prevention activities with children
26
Eating Disorders lifespan considerations
Pica and rumination disorder occur primarily in children
Anorexia and bulimia most often emerge in adolescence. Consider family therapy
For older adults, physiological regulation of appetite changes
Changes in neurotransmitter production often cause decrease in appetite in older adults which can lead to malnutrition
Anorexia of aging is qualitatively different from that of younger adults because it Is not typically associated with conscious choice
27
Encropese DC
once a month 3 months, 4 years
28
Insomnia DC
Dissatisfaction with quality or amount of sleep:
Difficulty falling asleep
Difficulty maintaining sleep (frequent waking)
Early morning waking
*At least three nights a week For at least three months
In spite of adequate opportunities for sleep
Distress or dysfunction
29
Insomnia Comorbidities
Anxiety, Trauma, Depression
30
Narcolepsy DC
Repeated intense need to sleep, falling asleep, or napping within the same day.
At least three times per week for at least three months
At least one of:
Cataplexy at least a few times per month:
Brief episodes of sudden loss of muscle tone triggered by sudden, strong emotions- laughing/ joking, fear, anger or excitement while remaining conscious [a cat that has low tone]
Spontaneous grimaces or global hypotonia
Hypocretin deficiency- regulate sleep and energy
Rapid eye movement (REM) sleep less than 15 minutes
31
Obstructive Sleep Apnea DC
One of the following:
Polysomnography of at least 5 obstructive apneas or hypopneas per hour of sleep with:
Nighttime breathing disturbances like snoring or breathing pauses during sleep
Daytime sleepiness or fatigue in spite of adequate opportunities for sleep
Or 15 or more episodes of apnea (no breathing @ all) or hypopneas (abnormally slow breaths) per hour of sleep without other symptoms
32
Obstructive Sleep Apnea Etiology
```
Facial structure (shape of jaw, nasal septum) & amount of upper airway soft tissues
Overweight or obesity
```
33
Circadian Rythym Disorder DC
Sleep disruption due to alteration of circadian system or a mismatch between the person’s rhythm and the requirements of the social or work environment
Excessive sleepiness or insomnia or both
Distress or dysfunction
34
Circardian Rythym Disorder Etiology
Degeneration or decreased neuronal activity of suprachiasmatic nucleus neurons (melatonin)
Decreased responsiveness of the body’s internal clock to signals such as light and activity
Decreased exposure to bright light and structured social and physical activity during the day
These may occur as a result of shift work or jet lag
35
Sleep Cycle Stage 1
Entering sleep, light (1-7 minutes)
36
Sleep Cycle Stage 2
Light sleep, heartbeat and breathing starts to slow down, muscles start to relax (10-60 minutes)
37
Sleep Cycle Stage 3
Deep sleep, more slow and relaxed (20-40 minutes)
38
Sleep Cycle Stage 4
REM- Increase brain activity, increase heart rate & BP, dreams, muscles paralyzed (10-60 minutes)
39
Nightmare Disorder
Frequent troubling dreams that are well-remembered
40
Non-rapid eye movement disorder
Sleep walking, sleep terrors
41
Rapid eye movement sleep behavior disorder
Repeated periods of arousal during sleep with vocalization and/or complex motor behaviors, occurring during REM sleep
Ex: Think of it as a next level nightmare disorder. You are legit physically reacting to your nightmare. “Moaning or screaming during nightmare”
42
Restless Leg Syndrome
Frequent urge to move the legs, with uncomfortable or unpleasant sensations during sleep, frequently in REM
43
Sleep Disorders Implication for Function
Performance may be affected in work, leisure, play, education, social participation due to daytime fatigue or excessive sleepiness
Skills affected include cognition (executive function, concentration, attention span), emotional regulation
Self esteem and confidence
44
Sleep Disorders Treatment
Behavioral strategies with focus on *sleep hygiene*
Short or long term medication use
Continuous Positive Airway Pressure (CPAP) machine (only for obstructive sleep apnea)
Surgical options for obstructive sleep apnea
Treat medical conditions
45
Sleep Disorders Implication for OT
FOCUS ON SLEEP HYGIENE
Establishing a calm bedtime routine
Using bed only for sleep and sex
Avoiding naps if possible, one nap only at 30 min
Avoiding vigorous exercise too close to bedtime
Minimize or avoid screen time 1 hour before bed
Make sure bedroom is dark and comfortable temperature for sleep
Minimize liquid in evening
Daily exercise (safely)
Mindfulness meditation
Body positioning for comfort- restless leg
Managing and routinely using CPAP
Work simplification/energy conservation to address fatigue until sleep improves
Childhood narcolepsy- parent education
Family education for safety- sleep walking, acting out dreams
46
Strategies to improve circadian rhythm
Sunlight exposure in morning
| Going to sleep and getting up at the same time
47
AOTA Fact Sheet
*Cognitive or behavioral therapy interventions, or strategies to address sensory avoiding or sensory seeking behaviors
48
Older Adults in Long Term Care Sleep
Daytime activity programs, including exercise, foster socialization and facilitate arousal, engagement, and decreased involuntary daytime napping.
49
Genito-Pelvic Pain/ Penetration Disorder DC
Recurrent difficulties with:
Vaginal penetration during sex
Pain during vaginal intercourse
Anxiety about pelvic pain
Tensing of the pelvic floor in anticipation of pain
**Symptoms persist for at least six months
Symptoms cause distress
50
Genito-Pelvic Pain/ Penetration Disorder Etiology
Psychological: Anxiety (anticipation of pain), stress, and tension
Physical: Abdominal abnormalities
Mixed: Childbirth- inadequate healing following childbirth; anxiety about resuming sexual relations
51
Genito-Pelvic Pain/ Penetration Disorder Treatment
Treatment of any underlying medical conditions
Behavioral interventions
Estrogen for peri- or post-menopausal women
52
Delayed Ejaculation Disorder DC
One or both on most occasions when intercourse is attempted:
Significant delay in ejaculation
Absence of ejaculation
At least six months
Symptoms are distressing to the individual
53
Delayed Ejacualtion Disorder Etiology
Physiological/ physical factors- illness, injury, drug side effects, and lifestyle
Psychological factors- distress, *anxiety, depression* relationship distress
Combined
54
Gender Dysphoria DC
Incongruence between self-perceived gender and assigned gender, for at least six months, with at least two of:
Incongruence between experienced gender and sex characteristics
Desire to be rid of sex characteristics because of this incongruence
Wish to have the sex characteristics of the other gender
Wish to be and to be treated as the other gender
Has romantic and sexual feelings or reactions of the other gender
Symptoms are associated with distress
55
Gender Dysphoria Etiology
Not well understood, but almost certainly biological- complicated genetic and hormonal events.
56
Gender Dysphoria Prognosis
Variable
Depends on the degree of support in his/her social network
Individual must decide what course of action to take, gender reassignment being the most extreme but in some cases, offering the best outcome
57
Gender Dysphoria IFF
Affects most performance areas due to psychological distress, particularly social occupation
Self-esteem, self-identity, role
May affect academic for school-aged individuals
May affect emotional regulation, cognition
58
Gender Dysphoria Treatment
Psychotherapy
| Gender reassignment with accompanying therapy to assist in adaptation to new gender
59
Gender Dysphoria Lifespan Considerations
Cultural differences in gender roles and acceptable sexual expression
Cultural differences in willingness to seek help
Level of acceptance and support network
Gender dysphoria often emerges in childhood or adolescence
Potential for victimization, bullying
Social isolation
60
Gender Dysphoria OT Implications
Address issues of self-concept, self-esteem, social interaction
Identify performance areas that are particular strengths and assist to enact them
Provide opportunities for emotional expression through non-verbal mechanisms (e.g. creative arts)
For paraphilias, redirect to socially acceptable occupations
For gender dysphoria, assist in adjustment to new gender role
None of these is well-documented in the OT literature
Trauma informed approach notes
Experience/trauma of LGBT youth
61
Trauma Informed Approach
systematic approach to ensure youth to prepare to respond to trauma in school organization
62
Oppositional defiant disorder (ODD) DC
A pattern of angry or irritable mood with argumentative, defiant, or vindictive behavior, lasting at least six months, with:
Angry/irritable mood
Often loses temper, is easily annoyed and/or is angry or resentful
Argumentative/defiant behavior
Often argues with authority figures
Defies or refuses to comply with rules or requests
Blames others for his misbehavior
Vindictiveness
Has been spiteful or vindictive at least twice in six months
Persistence and frequency of these behaviors is markedly greater than normal behavior and occurs with others who are not related
Symptoms are associated with distress in the individual or in others
63
ODD differential diagosis and comorbidities: angry demo
ADHD
| Developmental disorders
64
ODD Etiology
Genetic/biological
Reduced cortisol reactivity to stress
Reduced amygdala reactivity to negative stimuli
Altered serotonin and noradrenaline neurotransmission
Abnormalities in the amygdala and frontal cortex
Environmental
Prenatal maternal cigarette smoking, alcohol use, or viral illness
Maternal stress and anxiety
Low birthweight
Early neonatal complications
Parental stress
Dysfunctional parenting (can be the reason, but not in most cases)
Early deprivation or adoption all are implicated in development of the disorder
65
ODD prognosis
Strong predictor of adult *antisocial personality disorder*
Strong predictor of conduct disorder and depression
Worse prognosis if early onset
More severe ODD predicts personality disorder
66
ODD Treatment
nterventions focused on social learning
Psycho therapies including cognitive-behavioral therapy, parent training and family therapy
Collaborative problem solving has shown some modest success
*Develop skills in problem solving, flexibility, frustration tolerance*
67
ODD imlications for OT
Implications for OT
Parent training- understand behavior & social learning
Behavioral interventions emphasizing engagement in meaningful and acceptable forms of activity, with emphasis on improved social awareness and skill
Teach problem solving, decision making; train frustration tolerance and attention
Clear expectations and consequences are essential
Consistent with classroom rules, house rules
68
Conduct Disorder DC
Diagnostic Criteria
Persistent pattern of behavior with serious violation of the rights of others or rules of conduct:
Aggression to people and animals
Bullies, threatens or intimidates others and/or initiates physical fights
Has used a weapon that can cause serious harm
Physical cruelty to people or animals
Destruction of property by fire or in other ways
Deceitfulness or theft
Has broken into someone else’s house or car, has stolen
Lies to obtain something or avoid obligations
Stays out late despite parental rules (younger than 13)
Is often truant from school
Symptoms cause dysfunction
**At least 3 episodes in one year, with symptoms in past six months**
69
Conduct Disorder Comorbidities (SAIL)
Substance use disorders “SAIL”
ADHD
Intellectual disabilities
Learning disabilities
70
Conduct Disorder Etiology
Subtle neurological deficits like poor verbal abilities and inhibitory control
Gray matter volume reductions in the areas that process socioemotional stimuli
Family histories of antisocial behavior and either harsh or inconsistent parenting - controversial
Adolescent form less severe
71
Conduct Disorder Prognosis
*Poor with associated alcohol or substance abuse
*High probability of developing adult antisocial or borderline personality disorders and encountering financial and legal difficulties
Early onset of the behavior predicts a worse outcome, including a high potential for violence and criminal behavior over time
Worst with callous/unemotional traits
72
Conduct Disorder IFF
Negatively affects school, social, and work performance
Difficulty in areas of interpersonal skills, emotional regulation
Difficulty transitioning to adult roles- work & family life
Can contribute to legal difficulties which further affect performance
73
Conduct Disorder IFOT
Channel energy to more appropriate activities
Reinforcement for acceptable behavior
Consistent expectations
Engagement in recreation- provide experience of success
Opportunities for appropriate expression of emotion – movement, music, art, play; build self-concept
Anger management, coping strategies
Parent training for the above
Treatment of ADHD and other co-existing conditio
74
Opioids DC
Problematic pattern of use with significant impairment or distress, with at least two of the following:
Taken in larger amounts or over a longer time than intended
Desire or unsuccessful efforts to control use
Significant time spent obtaining, using, or recovering from use
Craving or urge to use
Recurrent use interferes with major role obligations
Recurrent use leads to social or personal problems
Important activities given up because of use
Use in situations that are physically hazardous (e.g. driving)
Use continues despite knowledge of problem
Tolerance
Withdrawal- hallucinations, anorexia, depression, insomnia, vomiting
75
Opioids Prognosis
*Respiratory suppression with overdose,
| poor outcome as logn as 20 years after diagnosis
76
CAGE
Cut down
Annoyed
Guilty
Eye-opener
77
CELLPS
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Complex Attention
Executive Function
Learning and memory
Langauge
Perceptual motor
social cognition
```
78
Major vs Mild cognitive disorders
Decreased memory may have difficulty with certain IADL’s but no problem with ADLS, trouble with money management, writing a check but no problem taking care of self: MILD
Deficits do not interfere with independence in daily activities, but greater effort, compensatory strategies or accommodations may be required
No basic self care, warm up food, dress themselves, trouble remembering names fam members, etc.: MAJOR
Deficits interfere with independence in daily activities
Alzheimers
79
Alzheimers Etiology
Combination of genetic and environmental factors
Genetic: *apolipoprotein “PAPOU” is the most important genetic risk factor
Excessive amounts of two proteins undergo synaptic dysfunction, oxidative stress, loss of calcium regulation, and inflammation
Sociodemographic factors include educational level and physical fitness also factors
Most significant risk factor identified to date is *aging
80
Alzheimers DC
Evidence of a causative genetic mutation
Evidence of decline in memory and learning
Progressive, graduate decline in cognition
No evidence of other or mixed etiology
Behavioral symptoms: agitation, aggressiveness, sundowning (confusion when sun is going down)
Not a diagnostic criterion, often develop visual processing issues
81
Parkinsons
Motor symptoms: hand-resting tremors, pill-rolling, tremors at wrist, shuffling gait, bradykinesia, hypokinesia, akinesia, kyphotic posture, speech and swallowing problems
Can cause Neurocognitive Disorder although symptoms do not appear in every case
NCD symptoms can include
Mood. sleep and autonomic function changes
Impairments in cognition and perception
82
Parkinsons Etiology
unclear
83
Huntingtons
Autosomal dominant affecting HTT gene
Results in *chorea (jerky and involuntary movements), behavioral disturbances, and dementia/NCD
Diagnostic criteria
Onset is insidious and progression is gradual
Based on family history or genetic testing
HD before age of 40 with a young family
Difficult to manage bc autosomal dominant
50% chance one has a gene if parent is carrier
50% chance of passing to offspring
84
Vascular Disease
Characteristics: lesions affect cortical regions important for memory, cognition and behavior
**Often found in conjunction with alzheimers and other causes of dementia making it difficult to classify
Risk factors: high BP (blood pressure), vascular disease, late-life depression
85
VD Etiology
One or more cerebrovascular events
| Notable deterioration of complex attention and frontal-executive function
86
TBI
Unpredictable because depends on area of cortex
Pre-injury function is important
Inflammation and white matter damage can persist for years even after a single event
87
TBI DC
```
one or more of the following:
Loss of consciousness
Posttraumatic amnesia
Disorientation
Neurological signs
Chronic effect of TBI can possibly lead to other NCDs
```
88
NCD IFOT
*Compensatory strategies - external memory aids
Caregiver support
Occupation-based program to maximize procedural memory
Just-right challenge - activity that is just slightly above what a person is currently able to easily do. It is an activity the person is able to do, but it requires a little bit of a stretch.
Activities tailored to their abilities and interests
Activities that client enjoyed prior to cognitive deficits
89
Cluster A
```
Cluster A: characterized by odd or peculiar behavior
Schizotypal
Mild form schizophrenia
May not hallucinations or delusions
If they do its milder and more insight
Not as frequent/severe
Most severe
self-centered
```
90
CLuster B
flamboyant or dramatic behavior
antisocial, borderline
Characterized by emotional instability, disruptive and erratic interpersonal relationships, restricted affect, and lack of empathy and insight
Thought to be deficient or abusive parenting
Evidence for inherited component
Borderline PD
Unstable interpersonal relationships for at least 3 years at 18
Failure to conform to lawful behavior; deceitfulness
Self-image problems - uncertainty
Inappropriate affect - anger/impulsivity
Efforts to avoid abandonment
suicidal or self-harm
Depression, bipolar, must be ruled out
Comorbidities
91
CLuster B comorbidites
Depression
PTSD
Substance abuse
92
Cluster C
characterized primarily by anxiety or fear
Avoidant, dependent, OCD
Highly correlated with major depressive disorder and anxiety disorders
Theories: attachment difficulties, traumatic life events, psychosocial stress and dysfunction
Prognosis
93
Personality Disorders Etiology
Genetic factors: serotonin system & stress reactions
Deficits in function of prefrontal cortex & structures related to emotion and impulse control
Structural and functional deficits especially in limbic and paralimbic brain areas, and the cognitive-executive brain regions
Parental influences (anhedonia)
Childhood trauma
Exaggerated defense mechanisms
Avoidant, borderline, histrionic, paranoid, schizoid, and schizotypal strongly comorbid depression
94
Personality Disorders Comorbidity
Major depression, anxiety disorder, substance use disorders: worse outcome
95
Personality Disorder OFOT
Underlying issues:
Inaccurate perceptions of self and others
Inadequate social skills
Poorly developed personal values and goals
Poor self-esteem
Participate in team:
Psychotherapy
Group therapy
Behavioral approaches
CBT
Medications - evidence is weak
Group/cooperative activities:
Planning social event: social skills training
Interpreting accurately what other people say
Developing empathy, consistent, clear, non judgemental feedback from therapist and other group members
96
PD IFOT Cluster A, B, C
```
Cluster A
Sensory integrative interventions
Cluster B
Behavioral approach
Occupational engagement
Sports, self-care/meal preparation
Self appraisal, build self-esteem
Behavior modification
Cluster C
Social skills training
```
