Exam 1 Study Guide

Ancient Egypt History of Mental Illness

- Treatment of mentally ill begins to change
- Mental hospitals
- Hysteria
- Methods to cure mentally ill (opium for visions, rituals, sleep therapy)
- Health of the soul -> mental healthcare is a priority for 1st time

Middle Ages History of Mental Illness

- Inhumane era
- Mentally ill people are possessed by demons
- Mental illness -> witchcraft

Sterilization Programs and Continued Reform

- Eugenic compulsory sterilization programs
- Mental illness -> a defect, due to hereditary

Radical Medicine

- Electroconvulsive therapy
- Insulin shock therapy
- Frontal lobotomy

Practical Domain of IDD

- Self-Management (personal care)
- Job Responsibilities
- Money Management
- Recreation
- Organizing School and Work Tasks

Role of an Individual's IQ Score in IDD Diagnosis

IQ score of 70 or below diagnoses IDD

Mild Level of IDD

Can live independently with minimum levels of supports

Example of Beck's Cognitive Therapy

Distressing or unrealistic thoughts -> negative interpretations and feelings -> negative actions or behaviors

Behavioral Techniques for Cognitive Behavioral Therapy

- Graded Task Assignments
- Activity Scheduling
- Behavioral Experiments
- Modeling
- Behavioral Rehearsal (Role Playing)
- Coaching
- Scripting
- Brief techniques (thought-stopping techniques)
- Breathing Exercises
- Cognitive Homework

Diagnostic Criteria for IDD from DSM-5

- Deficits in intellectual functions
- Deficits in adaptive functioning
- Onset of intellectual and adaptive deficits during the developmental period

Prehistoric History of Mental Illness

- Mental illness stems from magical beings that messed with your mind
- Tribes have spells/rituals to try and cure mental illness (exorcisms, trepanation)

Renaissance History of Mental Illness

- Insane Asylums (poor treatment)
- Torture entertainment; people could come watch treatment
- Patients are "lunatics"
- Mental Illness is a disease

Moral Reform (1942-1947)

- Abuse in psychiatric hospitals is exposed
- Eleanor Roosevelt became sponsor for National Mental Health -> helped advance to humane treatment of patients

Influence of Medicine & Concept of Remedicalization

- Psychopharmacology begins
- Chloropromazine: first psychiatric medication available
- Antidepressants & muscle relaxants for ECT to treat depression and more

Institutionalization

- Lots of people being admitted to mental hospitals -> overcrowded
- Mental illness treated in inpatient settings
- Overcrowded institutions
- Community mental health movement (1960)
- Forced isolation of people with disabilities
- Deinstitutionalization -> patients being released
- Increased homeless due to less low-income housing options (80s)

How were "severely disturbed" individuals being treated during 1920-1950s?

Institutionalized in psychiatric hospitals

Recovery Model

Conceptual model of psychiatric illness that focuses on individuals improving their health and wellness, living a self-directed life, and striving to reach their full potention

Major Dimensions That Support A Life In Recovery

Health
Home
Purpose
Community

Health Dimension of Recovery Model

Overcoming and managing one's disease and symptoms

Home Dimension of Recovery Model

Stable/safe place to live

Purpose Dimension of Recovery Model

Meaningful daily activities and the independence, income, and resources to participate in society

Community Dimension of Recovery Model

Relationships and social networks that provide support, friendship, love, and hope

Wellness Recovery Action Plan

Individualized, self-designed and self-help system used by individuals with mental illness to promote self-recovery

Model of Human Occupation

This model views occupation as a dynamic and systemic process influenced by the person's volition, habituation, performance capacity, and the environment.

Person-Environment-Occupation-Performance (PEOP)

Helps therapists analyze occupational performance through the lens of the person, their environment, and the occupations they engage in, focusing on the interaction of these factors to optimize performance.

Canadian Model of Occupational Performance and Engagement

This model emphasizes the dynamic interaction between the person, occupation, and environment. It highlights spirituality and engagement in occupation as a core element of health and well-being.

Kawa Model

Focuses on understanding the individual’s life context within their social and environmental conditions and working collaboratively to restore or enhance flow.

Purpose of DSM-5

Guides the diagnoses of mental health disorders

DSM-5

Diagnostic and Statistical Manual of Mental Disorders

DSM-5 Major Changes

- Modifications of spectrum disorders
- Replacing terminology (mental retardation -> intellectual disability)
- Improvement methods of assessments
- Disorders on a spectrum (ASD, SA)

Categories of Mood Disorders

- Depressive
- Bipolar and Related Disorders

Bipolar Disorder I

Manic-depressive disorder that can exist both with and without psychotic features

Criteria for Bipolar Disorder I

- At least one manic or mixed episode
- No need for a prior depressive episode
- Can't be better explained by a schizophrenia spectrum disorder
- More severe, easier to diagnose

Bipolar II Disorder

Depressive and manic episodes which alternate, are typically less severe, and do not inhibit function

Criteria for Bipolar II Disorder

- At least one hypomanic episode
-At least one previous major depressive episode
- Can't be better explained by a schizophrenia spectrum disorder
- Less severe; more difficult to diagnose

Brain Stimulation Techniques to Treat Mood Disorders

- Transcranial Magnetic Stimulation
- Electroconvulsive Therapy
- Deep Brain Stimulation

Transcranial Magnetic Stimulation

Non-invasive magnetic stimulation to the scalp

Electroconvulsive Therapy

- Under anesthesia
- Low-voltage currents administered to one side of the brian via electrodes are activated and create a permanent lesion
- FDA approved for Parkinson's Disease

Symptoms of Manic episode

- Elevated/irritable mood for at least 1 week for most of the day
- 3 or more of the following:
Grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas, racing thoughts
Distractibility
Increased goal-direct activity
Excessive involvement in pleasurable activities with high risk

Symptoms of Major Depressive Episode

5 or more symptoms in the same 2 week period:
- Insomnia/Hypersomnia
- Interest (Anhedonia)
- Guilt
- Energy
- Concentration
- Appetite
- Psychomotor
- Suicide

OT Role in Treatment of Mood Disorders

- Observation, interview, and history taking to determine intensity, severity and duration of symptoms
- Life events inventory
- Occupational Profile
- CBT techniques
- Interpersonal Therapy
- Identify areas of occupational performance important to client and set goals
- Assess routines and work with client to reach balance between sleep, self-care, work, and leisure

Interpersonal Therapy

- OT guides client to develop improved communication skills and accurate expression of affect to improve interpersonal relationships
- Builds support for coping with symptoms and life stressors

Three categories of anxiety disorders

- Anxiety Disorders
- Obsessive Compulsive Disorders
- Trauma and Stressor Related Disorders

Diagnostic Criteria for Generalized Anxiety Disorder

At least 3 physical or emotional symptoms:
- Restlessness
- Increased fatigue
- Impaired concentration
- Irritability
- Increased muscle aches
- Difficulty sleeping
Chronic, exaggerated worrying about everyday life that occurs most of the time for at least 6 months

Obsessions

Unwanted, and intrusive thoughts, images, or urges that trigger intensely distressing feeligns

Example of Obsessions

Germ exposure, perfectionism, superstitions

Compulsions

Behaviors an individual engages in to attempt to get rid of obsessions or decrease distress; can be repetitive behaviors

Example of Compulsions

- Showering
- Checking/Re-checking
- Arranging items
- Counting

Repetitive Behaviors

- Can be positive and doesn't interfere with daily life
- Ex: Religious practices, learning a new swkill

Core symptoms of PTSD

Diagnosis requires an adult to have one of each symptoms for at least 1 month"
- Re-experiencing the trauma psychologically (flashbacks, bad dreams)
- Avoiding reminders of the trauma
- Hyperarousal or hypervigilance (easily startled or anger)
- Cognition and mood symptoms

OT Role in Treatment of Anxiety Disorders

- Identify the areas of occupational deficits
- Evaluate (client's routine, environment)
- Relaxation training (breathing, progressive muscle relaxation)
- Expressive activities (journaling)
- Sensory modulation interventions
- Education (time management, lifestyle)
- Complementary Approaches (yoga, animal assisted therapy)

Cluster A Personality Disorders

Social awkwardness, social withdrawal, distorted thinking

Cluster B Personality Disorders

Impulse control and emotional regulation, with a tendency toward dramatic and erratic behavior

Cluster C Personality Disorders

Anxiety and fearfulness

Borderline Personality disorder

Pattern of instability in personal relationships, poor self-image, unstable intense emotions, absolute thinking patterns, prone to angry outbursts, unhealthy coping tools

Positive symptoms of Schizophrenia

- Delusions and hallucinations
- Disorganized speech and behavior

Negative symptoms of Schizophrenia

- Flat affect
- Allogia
- Avolition
- Anhedonia or hypohedonia

Alogia

Poverty of speech

Avolition

Poor initiation of activities and/or inability to sustain goal-directed activities

Anhedonia

Inability to experience pleausre

Hypohedonia

Decreased ability to experience pleasure

Cognitive symptoms of Schizophrenia

- Disorganized speech, thought, and/or attention
- Difficulty with emotional regulation and social cognition

Diagnostic Criteria for Schizophrenia

Characteristic symptoms: 2 or more of the following, each present for a significant portion of time during a month:
- Delusions
- Hallucinations
- Disorganized speech (frequent derailment or incoherence)
- Grossly disorganized or catatonic behavior
- Negative symptoms (affective flattening, alogia, or avolition)
Social/Occupational Dysfunction: for a significant portion of the time since the onset of the disturbance
Some signs of the disorder must be continuously present for at least 6 months

Common Differential Diagnoses for Schizophrenia

- Bipolar Disorder
- Borderline Personality Disorder
- Drug Intoxication and Drug-Induced Psychosis
- Delusional Disorders
- Avoidant Personality Disorder
- Schizotypal Personality Disorder
- Metabolic Disturbance or Systemic Infection
- Syphilis or HIV Infection
- Dissociative Identity Disorder

Borderline Personality Disorder

Emotional instability, fear of abandonment, and strained relationships, often causing intense social difficulties.

Drug Intoxication and Drug-Induced Psychosis

Altered thinking and behavior due to drug use, leading to social withdrawal and impaired interactions.

Delusional Disorders

Strong false beliefs affecting relationships and causing social isolation or distrust.

Avoidant Personality Disorder

Fear of rejection and social inhibition, leading to isolation and difficulty forming relationships.

Schizotypal Personality Disorder

Eccentric behavior and discomfort in social situations, making relationships difficult.

Metabolic Disturbance or Systemic Infection

Physical conditions that cause mental changes, leading to social withdrawal and cognitive issues.

Syphilis or HIV Infection

Illnesses causing cognitive symptoms and stigma, often leading to isolation and emotional strain.

Dissociative Identity Disorder

Shifts in personality causing confusion and relationship challenges.

OT Role in Treatment for Schizophrenia

- Use OTPF to guide eval process and determine how individual's occupations, roles, and routines are impacted
- COPM: guides the interview process and provides observation of client's behaviors while performing occupations
- Cognitive Disability Model Approach
- Assessment of Occupational Performance
- Psychoeducation, Cognitive Remediation, and CBT to support occupational performance.

Conceptual Domain of IDD

- Language
- Reading
- Writing
- Math
- Reasoning
- Knowledge
- Memory

Social Domain of IDD

- Empathy
- Social Judgement
- Interpersonal Communication Skills
- Ability to make and retain friendships

Moderate Level of IDD

Independent living may be achieved with moderate levels of supports (ex: group homes)

Severe Level of IDD

Requires daily assistance with self-care activities and safety supervision

Profound Level of IDD

Requires 24-hour care

Ellis' Rational Emotive Behavior Therapy

- Irrational beliefs lead to emotional distress
- Change irrational beliefs into rational beliefs, leading to healthier emotions and adaptive behaviors

Beck's Cognitive Therapy

States that an individual's thoughts, or personal view of the world, affects how situations are perceived. Occupational functioning is affect when this becomes a pattern

Cognitive Techniques for Cognitive Behavioral Therapy

- Guided Discovery
- Targeting Dysfunctional Assumptions
- Double Standard Dispute
- Catastrophe Scale
- Reverse Role-Playing
- Reframing

Guided Discovery

Socratic Questioning, with a focus on clarification and probing assumptions, evidence, viewpoints, perspectives, implications and consequences

Targeting Dysfunctional Assumptions

Client is asked to provide evidence that supports or does not support personal assumptions

Double-Standard Dispute

Therapist asks the client if they would hold another person they know to the same standard.

Catastrophe Scale

Client is asked to rate something that has been anxiety-provoking or has been the focus of negative energy for the individual.

Reverse Role-Playing

Provides method for the client to argue against the negative assumption or belief that the client possesses. The therapist plays the role of the client and the client becomes the therapist.

Reframing

Technique whereby the therapist works with the client to consider all aspects of a situation

Behavioral Rehearsal

Works well in situations where the client is struggling with verbal interaction (ex: being assertive with someone). Practicing what to say and how to say it can be helpful and can break down negative assumptions regarding personal ability

Cognitive Homework

Client engages in experiential activities and practicing skills at home

Subtypes of Cognitive Behavioral Therapy

- Dialectical Behavior Therapy
- Acceptance and Commitment Therapy
- Mindfulness Based Cognitive Therapy

Dialectical Behavior Therapy

Combines CBT with mindful awareness and distress tolerance practice

Acceptance and Commitment Therapy

- Goal is to increase psychological flexibility (ability to accept your reactions and be present, to choose a valued direction, and take action
- Emphasizes the relationship we have with our thoughts rather than changing (controlling) the content of one's thoughts

Mindfulness Based Cognitive Therapy

- Used as a relapse-prevention treatment for people with depression
- Combination of CBT and mindfulness meditation practice

Thinking in Shades of Gray

Instead of thinking about our problem or predicament in an either-or polarity, evaluate things on a scale of 0-100. When a plan or goal is not fully realized, think about and evaluate the experience as a partial success, again, on a scale 0-100.

Examples of Cognitive Behavior Therapy Tools

- Journaling
- Breathing
- Progressive muscle relaxation
- Challenging though distortions
- Mindfulness
- Positive distraction
- Activity scheduling/ Time management
- Goal setting