Flashcards in OTA 110 - Ch. 5, 8, 10, 11 Deck (49)
Changes from DSM-4 to DSM-5
• 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”
20 chapters based on disorder types (neurodevelopmental, psychotic, depressive, anxiety, trauma, substance use, personality, etc.)
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.
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.
(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.
Six major categories of psychotropic drugs:
1) Antipsychotic drugs
2) Antidepressant drugs
3) Antimanic drugs
4) Antianxiety drugs
5) Psychostimulant drugs
6) Antiparkinsonian drugs
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.
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.
Mood stabilizers; reduce intensity of mood swings, mania. (Sometimes anticonvulsants also work). Used with bipolar disorder.
Example: Lithium (toxic, causes fine hand tremor)
To control anxiety in disorders that are not psychotic (anxiety disorder, personality disorder).
Examples: Valium, Xanax (can be very addictive)
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)
Side effect: Nausea
• Have soda/graham crackers or bread
• OTC antacids sometimes recommended by dr., but get their approval in case it interferes with meds
Side effect: Photosensitivity
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
Side effect: Dry mouth
• Allow water whenever thirsty
• Have hard candies available (lemon drops/mints)
• Teach about dehydration effects of caffeine/alcohol
Side effect: Blurred vision
• 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
Side effect: Postural hypotension
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
Side effect: Hand tremors
(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.
Side effect: Akathisia
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.
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
• Preference to street drugs
• Difficulty opening containers/swallowing/memory
Role of OTP re: Medication
1) Observe/report functional level
2) Adherence/other substance issues
3) Management of side effects
4) Driving/safety concerns
5) Med education/management
What does safety as an OTA include?
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
Set of procedures recommended to prevent spread of infection.
Most effective method of disease prevention
Regular and thorough hand washing
“S. E. A.”
Suicide, elopement, assault: the three psychiatric emergencies.
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
Risk factors for suicide
• Major mental disorder
• Past suicide attempts, lethal methods (gun) used
• Adverse childhood experiences
• Sexual abuse
• Substance abuse
• Unemployment/lack of future plans/goals
•**Depressed clients who show increased activity/mood are actually increased risk!**
Signs of suicidal intent
• 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)
Steps in handling assault
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!
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