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

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

Flashcards in OTA 110 - Ch. 5, 8, 10, 11 Deck (49)
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1

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”

2

DSM-5 structure

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

3

MAOI

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.

4

Tyramine reaction

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.

5

Tardive dyskinesia

(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.

6

Six major categories of psychotropic drugs:

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

7

Antipsychotic 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.

8

Antidepressant drugs

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.

9

Antimanic drugs

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

Example: Lithium (toxic, causes fine hand tremor)

10

Antianxiety drugs

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

Examples: Valium, Xanax (can be very addictive)

11

Psychostimulant drugs

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)

12

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

13

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

14

Side effect: Dry mouth

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

15

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

16

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

17

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.

18

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.

19

Nonadherence

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

20

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

21

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

22

Universal precautions

Set of procedures recommended to prevent spread of infection.

23

Most effective method of disease prevention

Regular and thorough hand washing

24

“S. E. A.”

Suicide, elopement, assault: the three psychiatric emergencies.

25

Suicide

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

Risk factors for suicide

• 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

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)

28

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!

29

Elopement

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

Independent Living Safety Topics

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