Psychotic Disorders: Symptoms and Etiology

• Healthy People 2030 Framework has goals and objectives for improving health and well-being in the US, spanning 2020-2030.
• The framework focuses on critical health issues, emphasizing social determinants of health to foster environments promoting well-being.
• The 2030 Framework places increased emphasis on health equity and social determinants of health, advocating for occupational justice and reducing disparities.
• The US HHS manages the framework, setting specific, data-driven objectives for improving health, reducing disparities, and encouraging healthy behaviors in all life stages.

Social Determinants of Health (SHEEN)

• Economic Stability.

• Education Access and Quality.

• Health Care Access and Quality.

• Neighborhood and Built Environment.

• Social and Community Context.

• The World Health Organization (WHO) is a specialized UN agency responsible for international public health.

• The WHO's main objective is to promote health, keep the world safe, and serve the vulnerable.

• The International Classification of Diseases (ICD) identifies global health trends and statistics.

• The ICD is an international standard for defining, diagnosing, and reporting diseases and health conditions, including disabilities.

• The ICD allows sharing and comparing health information globally using common language.

• The OTPF-4 was informed by the ICD, but is different from it.

• Disability is defined by the CDC as any condition of the body or mind that makes it more difficult for the person to do certain activities and interact with the world around them.

• Disability is located within the individual and impacts their ability to take part in normative actions of society.

• The ADA broadens the scope of disability, noting some disabilities are not visible.

• The physical and social environment can create barriers, magnifying the negative effects of disability on participation and wellbeing.

Models of Disability

• The Medical Model views disability as a problem residing in the individual, caused by disease, trauma, or health conditions requiring medical care. Disability needs to be fixed or cured.

• The Rehabilitation/Functional Model is like the medical model but also considers a person's functional limitations. It emphasizes recovery and a return to a "normal" state.

• The Social Model argues that society creates disability through stigma and by failing to provide accommodations. It focuses on changing society, not "fixing" individuals.

• The Minority Group Model describes people with disabilities as a minority group facing systematic oppression and marginalization, referred to as ableism.

• The Human Rights Model positions disability as a matter of civil rights, emphasizing equal rights and opportunities via legislation and policy changes.

• Disability Studies takes an interdisciplinary approach, exploring the definitions, nature, and impacts of disability.

• It contrasts the social model's emphasis on societal structures and attitudes with the medical model's focus on individual treatment.

• Disability Studies challenges norms and questions societal constructions of normalcy and ability.

• Eye contact is an example of norms which cause distress for individuals with ASD, demonstrating the need for diverse perspectives.

• Occupational Therapy values critical insights to enhance their practices.

• Continuous Improvement states to commit to critically examining and evolving practices to align with disabled communities' priorities.

• Occupational justice requires a focus on achieving occupational justice as a fundamental outcome of OT services by reducing disparities and fighting against stigma and ableism.

• Transform Environments by emphasizing interventions that modify physical and social environments by enhancing accessibility and attempting to "fix" individual impairments.

• Support Community Living Rights by advocating for clients to live in their own communities with necessary accomodations.

• Uphold Self-Determination by ensuring all interventions support clients' autonomy in decision-making about their lives.

Role of OT (Social Model)

• Acknowledge Interdependence via assistive technology and social networks in enabling safe, meaningful participation in occupations.

• Leverage Your Influence through amplifying clients' voices, focusing on advocacy and the rights and needs of those served.

• Engage with Disability Rights Movements and stay informed/involved in contemporary disability rights movements.

• Primary level of healthcare is the first contact between an individual and the health system.

• Most health problems can be satisfactory managed at the primary level of healthcare.

• Secondary level of healthcare requires specialized expertise.

• More complex problems are addressed at a secondary level of care.

• Curative services occur at a secondary level of care.

• The First referral levels are self-referral or physician referral.

• PT, OT, cardiologists and urologists provide secondary healthcare.

• Tertiary level of healthcare requires specialized expertise and equipment.

• May include hospitalization in a tertiary level of healthcare.

• Plastic surgery, cancer, specific cardiac procedures, and neurosurgeries are tertiary healthcare.

• Essential information to understanding a condition includes description/definition, etiology/risk factors, incidence/prevalence, co-occuring conditions, signs/symptoms, diagnosis, precautions/contraindications, course/prognosis, medical/surgical, complementary/alternative medicine, impact on OP, impact of ableism/social stigma, references, resources for clients/professionals, and disability rights organization (perspectives/needs).

• Anxiety disorders differ from developmentally normative fear or anxiety by being excessive or persisting beyond developmentally appropriate periods.

• Anxiety disorders develop in childhood and tend to persist if left untreated.

• Anxiety disorders occur more in females than males, or are more reported in females than males.

• The DSM-5 is an authoritative guide for diagnosing mental disorders with descriptions, symptoms, and criteria.

• The DSM-5 is important for diagnosing and treating mental disorders but also for research, education, and legal matters.

DSM-V: Anxiety Disorders:

• Generalized Anxiety Disorder (GAD): persistent and excessive worry about various topics, events, or activities.
• Worry is difficult to control with physical symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
• Panic Disorder: recurrent, unexpected panic attacks or periods of intense fear/discomfort with physical and cognitive symptoms.
• Palpitations, sweating, trembling, shortness of breath, feelings of impending doom, and fear of losing control or dying include symptoms of Panic Disorder.
• Agoraphobia: intense fear/anxiety related to real/anticipated exposure to situations like public transportation, open/enclosed spaces, crowds, or being outside alone.
• Specific Phobia: marked fear/anxiety about a specific object/situation avoided or endured with intense fear/anxiety.
• Social Anxiety Disorder (Social Phobia): significant anxiety/discomfort about being embarrassed, humiliated, rejected, or looked down on in social interactions, often avoiding social/performance situations.
• Separation Anxiety Disorder: excessive fear/anxiety concerning separation from those attached to, worries about losing, or something separating them from the individual.
• Selective Mutism: complex childhood anxiety, child unable to speak/communicate effectively in select social settings, such as school.
• These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.
• Clinical Anxiety: worry that disrupts function.
• Normal Anxiety: worry that propels one to act.

DSM-V: Obsessive-Compulsive Disorder

• Obsessive-Compulsive Disorder (OCD) leads individuals with unwanted thoughts/fears (obsessions) to do repetitive behaviors (compulsions).

• OCD interferes with daily activities causing distress. People with OCD may try to ignore/stop the obsessions.

• Body dysmorphic disorder is the preoccupation with perceived flaws/defects not apparent, or only slight, to others.

• Hoarding Disorder relates to persistent difficulty discarding with possessions.

• Trichotillomania relates to repetitive pulling out of one's own hair, resulting in hair loss.

• Excoriation disorder is recurrent skin picking resulting in skin lesions.

• The National Institute of Mental Health (NIMH) is part of the U.S. National Institutes of Health (NIH).

• The NIMH is the leading federal agency for research on mental disorders, research in neuroscience, genetics, psychosocial interventions, and mental health services.

• There is a role in educating public and healthcare professionals via mental health disorders.

• The American Occupational Therapy Association (AOTA) provides resources on OT in mental health.

• Every Moment Counts is dedicated to occupational therapists integrating mental health promotion in practice.

• Key Features of the AOTA include multidisciplinary approach and collaboration with educators, parents, and mental health professionals to promote mental health.

• Multi-Tiered Interventions are tools for universal, targeted, and intensive actions, applicable across various settings and populations.

• Model Programs from the AOTA offer programs like "Comfortable Cafeteria" and "Refreshing Recess". These programs are designed to make school conducive to mental health.

• The AOTA offers training materials with workshops, webinars, and training materials for occupational therapists and school personnel.

• Embedded Strategies are practical strategies for embedding mental health promotion into everyday activities at schools and community centers.

• OCD and anxiety are typically treated with medical and non-medical (cognitive behavioral) interventions.

• Occupational therapy, focusing on daily participation, contributes to mental health outcomes across intervention levels.

• OTs working with mental health conditions need to work with caregivers, licensed mental health professionals, and medical professionals.

• Studies in positive psychology supported that engaging in meaningful activities supports resilience, emotional well-being, and mental health.

• Pediatric OT practices showed interventions support social interactions, self-esteem, emotions, while decreasing issues.

• Occupational therapy professionals offer services to those that have various mental conditions influenced by genetic factors or stressors (disabilities, injuries, or trauma).

• Public Health Approach: WHO (2001) encourages a mental health approach to promoting mental health and preventing/treating mental illness.

• The framework illustrates occupational therapy's contributions to mental health via promotion and prevention throughout the lifespan.

Tier 3: Intensive Interventions

• Designed for individuals via mental, emotional, or behavioral disorders impacting functioning, relationships, and emotional well-being.
• Occupational therapy aims for recovery and empowering persons with mental challenges.
• Interventions include:
  • Engagement in occupation
  • Functional assessment
  • Identification and implementation of healthy habits
  • Social skills promotion
  • Community integration
  • Cognitive behavioral self-management strategies.
• The OT works on self-advocacy/goal setting with a client recovering from anxiety.

Tier 2: Targeted Services

• Prevents issues in those at risk via family history/stressors.
• Interventions emphasize preventing/promoting competencies.
• The OT runs a mindfulness-based activity group at an afterschool program in an underserved area with youth.

Tier 1: Universal Services

• Services provided to any individuals.
• The focus is on prevention, encouraging participation in health-promoting occupations, self-regulation and coping strategies; promoting mental health literacy.
• Occupational therapy practitioners develop programs/ embed strategies to promote health in various settings.
• The occupational therapist works with counselor/school and implements a program related to development in children.
• OT is equipped for all tiers.

DSM-5: Complex Trauma

• Adjustment Disorder shows more stress in response to a stressful or unexpected event- sadness/hopelessness/lack of enjoyment/insomnia.

• Symptoms manifest in three months of the event.

• Acute Stress Disorder is shown via anxiety, dissociation, after a month of traumatic stressor.

• Severe anxiety leads to symptoms such as detachment and flashbacks.

• PTSD develops after individual has been exposed.

• Examples:

  • Warfare
  • Sexual assault
  • Natural disaster.

• RAD (Reactive Attachment Disorder) can be seen in children through neglecting caregivers exhibiting: emotionally withdrawn/unresponsive.

• DSED (Disinhibited Social Engagement Disorder) is shown in children with patterns of over-familiar behavior where children actively approach adults.

• Trauma is one "event", harmful or threatening "experiences" via physical/emotional/spiritual well-being. Stress is a state of tension causing anxiety/worry.

• Stressor: stimulus that triggered the stress.

• Trauma: stress occurs when exposed to trauma.

• Resilience is recovering from the face of stress or trauma.

• Protective Factors are the individual's positive qualities and skills (cognitive, social, emotional, environmental, spiritual).

• Supportive relationships via connections gives emotional support during times.

• Positive Coping Strategies includes managing habits contributing to resilience.

• Examples:

  • Mindfulness
  • Exercise
  • Rest.

• Healthy Environments via nurturing settings in communities/schools reduce trauma and stress.

• PTSD (Post-Traumatic Stress Disorder) is caused by terrifying event experiencing and witnessing.

• Flashbacks and anxiety is experienced from uncontrollable thoughts about event when they are in danger.

• ASD (Acute Stress Disorder) is similar but the symptoms occur immediately and last three days to one month.

• Intrusive Memories: distressing memories about the trauma event/nightmares.

• Avoidance: involved with avoids thinking about the trauma.

• Negative Changes in mood/feeling detachment from reality.

• Reactions: being frightened easily.

• Risk Factors contribute to pre-trauma with behavior problems before 6 years.

• Prior trauma occurs.

• Childhood adversity occurs.

• Socioeconomic occur with lack of supports.

• Protective Factors include coping with having supporting relations.

• Resilience includes high quality access/health routines.

• Effects of trauma has short long term effects on mental health of individuals.

• Stress and trauma can impact occupational performance and most notable: work/leisure/school.

• Affect parenting with styles relating to depression.

• Style in emotional is relating to the slave and ancestors through parenting related to war.

• Emerging suggests, modifications/disorders appear in offspring genetics.

• Exposure of therapy helps learn to manage fear to trauma experiencing.

• Restructuring helps makes sense of traumatic events.

• Medications (SSRIS) related to sadness.

OT Role

• Individual sessions focusing on triggers/signs.

• Providing training and adapting strategies.

• Clients increase participation by triggers and support.

• Support determination needs for participation.

• Promote aware and assist by addressing reactions.

• Assist schools by informing policies.

• Trauma cares approach.

• Transparency by operating transparent trust of clients

• Peer support emphasizes sharing of support.

• Collaboration recognizes happening and sharing of power.

• Empowerment environment with strength and voice.

• Gender issues- services by connections.

• Schizophrenia has abnormalities in five domains.

• Domains include delusions, hallucinations, disorganized speech/behavior, and negative symptoms.

• Delusions are false beliefs held with conviction even when there is clear or contradictory evidence.

• Hallucinations involve perceiving things that are not actually present; distortions in perception.

• Hallucinations are perceptual experiences without a real external stimulus, whereas delusions are erroneous beliefs.

• Etiology: Genetics, neurotransmitters, neuroanatomy, stress, environment, social class, prenatal/birth complications, migration, substance use.

• Around 21 million worldwide have schizophrenia which relates to disability, population rises globally.

Signs/Symptoms

• Positivity includes delusions, hallucinations, speech.

• Negativity includes diminished expression with speech brief not able to express in social life.

• Cognition is the deficits.

• Course is related to stages diagnosed during/after 40's.

• Premorbid has before any and signs early social, personality introversion problems.

• Prodromal stage relates to full episode criteria by thoughts functioning the intervention delays to progress on progression.

• Syndrome has diagnostics prominent behavior from aggression points of options.

• Progressive starts, with functioning more where the ability to function.

• Chronic stabilized remission/relapse manage severe.

• Management in medications, with effective treatments.

• Side effects are a result of Atypical antipsychotication.

• Brain stimulation helps treat catatonia.

• Magnetic stimulation relates auditory helps reduce.

• Psychosocial Treatment Cognitive Behavioral Therapy (CBT helps reduce).

• "The disturbance is not attributable to effects of a substance".

• Specify the severity.

• Impairment is not a criteria.

• Less common is disorder with anxiety.

• Schizophrenia has related symptoms that change with disorder.

• Schizoaffective experiences full episodes enough with core diagnostic.

• Personality Disorders: enduring pattern of inner experience and behavior deviating markedly from norms and expectations.

• The pattern has an onset in adolescence/early adulthood, is stable, and leads to distress/impairment.

General Personality Disorder

• An enduring pattern of inner experience and behavior that deviates markedly from norms.
• The pattern is inflexible/pervasive across social pattern leading to distress/impairment.
• Pattern can traced to back to patterns mental.
• Physiological not medical.

Clusters

• Cluster A include awkwardness/withdrawal.
• Cluster B includes impulse/regulation/response.
• Cluster C has high levels of anxiety.
• Function/Functional impairments and suffering related to core is daily life.
• The Cognition is dysfunction.
• Interpersonal is problems.
• Treatment via therapists and medications with intervention.
• Negative affect can lead can discrimmination to conditions. -Affects' individuals judgment.
• Psychological has consequences and symptoms effects.
• Strategies used by promoting needed to enviroment.
• Mental disorders includes an umbrella encompassing experienced in moods.
• Disorders: depression, the elevated, elated energized mood of mania.
• Those with dipolar express both spectrums to substance problem.
• Public health concern.

Depressive Disorders

• Disruptive mood dysregulation major depressive episode (Persistent medication disorder), a disorder as a consequence due to another.
• Common sadness significantly disorders' function varying.
• Major depression needs an interepisode lasting two weeks regulation.
• Bipolar related, induced unspecified- one of mood.
• Type 1 consists of characterized episodes elevated.
• With symptoms of:
  • Self-esteem.
  • Decreased sleep.
  • Speech.
• Type 2 is 1 or more major symptoms.
• Chromic is 2 year or more and is predictable.

Etiology

• Environmental factors:
  • Stress / abuse
• Genetics factor:
  • Hypothalamic
• Cognitive is negative.
• Impacts on occupational performance via cognitive functions.
• Behavioural is a function.
• Social is withdrawal.
• Daily routines is fatigue and interventions.
• Psychological approaches and sensory.
• Role via disorders.
• The Activities that regulate the environment.
• The Routines regulate clients through stimulation.
• The Regulation of support intervention.
• The Therapists through levels functioning.
• Disorders include medication and conditions.
• Impairment relating to obtaining substances.
• Cravings are the desires or paranoia of the criteria and toleration.
• Characterized by recovery and relapse from daily life across life.
• Roles are filled.
• The Patterns behaviour with impaired.
• Addressed during self reports.

Explore symptoms like delusions and hallucinations in psychotic disorders such as schizophrenia. Understand the impact on daily life and societal implications. Learn diagnostic criteria and typical characteristics of affected individuals.