Psychosocial Conditions Final Guide PDF

Somatic symptom related disorders Presence of or worry about somatic-bodily- symptoms that cannot be explained by clear physical etiology. Absence of underlying physical cause does not mean that the individual is not suffering. **Somatic symptom disorder– Patients seeking medical care for physical s...

Somatic symptom related disorders Presence of or worry about somatic-bodily- symptoms that cannot be explained by clear physical etiology. Absence of underlying physical cause does not mean that the individual is not suffering. **Somatic symptom disorder– Patients seeking medical care for physical symptoms in the absence of clear biological exam. Comorbidity - Depression - Anxiety - Panic disorders - Anxiety is key diagnostic criterion Conversion disorder (Functional neurological symptom disorder) - Neurological symptoms (paralysis, blindness, seizures) for which there’s no evidence of actual neurological impairment. - Involve movement and/or senses. - Neurological symptoms do not fit the typical presentation of neurological disorder - Not consciously faking Treatment– - Treatment strategies include CBT & transcranial magnetic stimulation - Medication may help Lifespan considerations– - In children, these conditions are closely related to anxiety - Treatment of anxiety can improve outcome - Very common later on in life especially with comorbidity with depression and anxiety Feeding & eating disorders **PICA: behavior involved in eating nonfood items such as dirt, coins, hair, articles of clothing, etc. Pediatric form associated with developmental disability, autism, or other disorder. In adulthood, associated with pregnancy or iron deficiency. Lasts at least a month Behavior is not culturally or socially normative OT intervention– - Compulsive behavioral intervention can help as can some medications. - OT can address sensory issues, redirect attention to more positive occupations, behavioral and environment modification, if deficiency establishes routine to seek proper source. **Anorexia Nervosa Restriction of caloric intake resulting in significant low BW. Intense fear of gaining weight or being fat. Disturbed body image Excessive concern about BW Lack of recognition of seriousness of low BW. **Treatment & OT interventions–  - treatment= family therapy, behavior modification, neurofeedback - OT emphasize positive occupational engagement, stress management, expressive arts, education **Bulimia nervosa - First binge eating; then repeated use of inappropriate mechanisms to compensate for overeating (vomiting, laxatives) - At least weekly for 3 months or more - Self-image is not excessively affected by behavior treatment & OT interventions– - CBT, psychotherapy, environmental interventions can be helpful. - OT provides practice of coping skills, emotional regulation, & engagement with occupations that require concentration; establishment of healthy lifestyles with focus on body perception and positive meal experience. Binge eating disorder Repeated binge eating is associated with eating too rapidly, eating when not hungry, eating until uncomfortably full, eating. Embarrassment, and feelings of guilt, depression, or distress about binge eating. At least once a week for at least 3 months. treatment & OT intervention– - May benefit from behavioral intervention, bariatric surgery (surgery in stomach to make it smaller and decrease absorption), antidepressant medication - OT intervention not well documented but may emphasize education about food-related occupations; this is not an evidence based recommendation at present Cultural considerations - Some eating disorders have culturally mediated conditions. - Other eating disorders become more frequent as western diet is added - As food insecurity diminishes, eating disorders increase - Prevention & health promotion programs must incorporate cultural beliefs. Ch. 13 Elimination disorders– **Enuresis: repeated involuntary or intentional voiding of urine in bed or on clothing. OT intervention - Occupational therapy supports behavioral intervention, addressing self-concept, and psychosocial developmental delay. - Behavioral training using alarm therapy is highly effective. - Lifestyle changes if nighttime bedwetting. **Encopresis - Repeated defecation. Either voluntary or involuntary - In inappropriate places - In individual who is at least 4 years old - Occurs at least once a month for at least 3 months **Etiology & prognosis– - Unpleasant experience with toilet training - Chronic constipation during infancy  - Low muscle tone & coordination, slow intestinal motility, more common in male. - Poor diet, stress, low physical activity level, & unpredictable daily routine are also implicated. - Prognosis: often with chronic bowel difficulties as a consequence **Occupational therapy– - Understand possible negativity associated with toileting - Help develop positive toileting experience and daily routine through family education & support, offer support for self-esteem. - Suggest to incorporate realistic & fun ways to increase fiber & water intakes Ch. 15– sexual dysfunction & paraphilic disorder **Delayed Ejaculation: significant delay in or absence of ejaculation on most occasions when intercourse is attempted. - Persists for at least 6 months - Causing distress - Results of biological, psychological, and social factors. - Self-limiting & sometimes resolves without treatment * treatment– - Treatment involves behavioral intervention, with partner involved, and medication **Genito-pelvic pain/penetration disorder: difficulty with vaginal penetration during sex. - Pain & fear of pain during intercourse & tensing of the pelvic floor in anticipation of pain - Symptoms must persist for at least 6 months & cause distress - Anxiety, stress, & tension are among the psychological sources - abdominal abnormalities might be a physical source - Mixed cause might be consequences of childbirth - some are treatable, others more intractable treatment– - Underlying medical issues must be treated - Behavioral interventions may be needed - Estrogen replacement therapy may be helpful in some situations OT implication– - Social and sexual occupations need to be assessed. - Education - Address self-esteem issues Ch. 16– gender dysphoria Gender– both sexual identity, person’s identity in terms of sex assignment & sexuality & gender identity, & culturally constructed understanding of one’s gender with accompanying behavioral expectations are social and cultural constructs. **Occupational therapy intervention– - Main focus is self-esteem & self-concept. - Support can be provided in learning to live in preferred gender- new occupation & ADL. - May need work with family and partner to address their issues and ensure support - Advocacy for clients - Teaching safety, medication management, addressing mental health concerns, teaching emotional regulation, & teaching now to manage side effects or symptoms **Cultural considerations– - Some cultures have strong prescriptions and stigmatize these individuals - Everywhere, gender roles are culturally mediated Lifespan considerations– - Gender dysphoria emerges in early adolescence. - Current generation of older adults who are transgender may never have taken the option of gender reassignment & could be dealing with long-standing feelings of persecution & stigma. Trauma-informed approach– systemic approach to ensure entire organizations or schools are equipped to recognize and respond to trauma. 4 R’s in trauma- informed approach– Realizing Recognizing Responding Resisting Ch17– **Oppositional defiant disorder Etiology & prognosis Pattern of angry or irritable mood accompanied by argumentative, defiant, or vindictive behavior. - Lasting at least 6 months **Function, treatment & OT intervention - Affects family, social, play and educational occupations - Defiant of authority and often bully others - Deficits in emotional regulation - Deficits in executive function– poor problem solving and decision making - Psychotherapy is most strongly indicated intervention and may include CBT, parent training, & school-based intervention - Occupational therapy focuses on parent training and designing highly structured environments with clear consequences for behavior, positive & negative. **Intermittent explosive disorder Behavioral outburst shows a failure to manage aggressive impulses through verbal aggression, damage of property, or physical injury to others. - Occurring at least 2x a week over period of 3 months. Conduct disorder **Etiology & prognosis Persistent pattern of behavior that violates the rights of others or rules of conduct, including aggression toward people and animals, destruction of property, and deceitfulness or theft - At least 3 episodes in 1 year - Associated with dysfunction - Subtle neurological deficits as well as genetics implicated - Poor parenting Function, treatment, & **OT intervention - OT focuses on channeling energy to positive occupations  - Parent training - Behavior modification & education of family Ch 18 & 20 Ch. 18– Substance-Related & Addictive Disorders Substance use is the intake of the substance. - **Intoxication describes the immediate effects of substance. - **Tolerance: need to increase the dose as the body accommodates to the substance. - **Withdrawal describes the physiological symptoms that accompany reduced use of substances. Alcohol **Alcohol use disorder– - Problematic pattern of alcohol use, with significant distress or impairment over a 12-month period. - Time spent obtaining the substance - Use increases over time as habituation occurs **Alcohol intoxication– - Behavioral changes includes slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory during immediate use. - High intake → coma & death - Slowing of central nervous system & autonomic function **Alcohol withdrawal– - Physiological symptoms secondary to cessation of use-hand tremor, insomnia, nausea, vomiting, hallucination, anxiety Alcohol use screening tool → CAGE C– has anyone ever felt you should cut down on your drinking? A– have people annoyed you by criticizing your drinking? G– have you ever felt guilty about your drinking? E– have you ever had a drink first thing in the morning (eye opener) to steady your nerves to get rid of a hangover. Opioids– Includes both illicit (heroin) and medically useful medications (morphine, oxycodone, codeine) Opioid use disorder– sustained use of any of the opioids including heroin and pain medications; long-term use results in tolerance and withdrawal symptoms. **opioids Etiology & prognosis– - Often begins with prescribed use for pain - Anxiety or depression increases risk - Tends to be chronic & relapsing - Significant early tolerance effects - Severe withdrawal symptoms & significant craving - Can lead to respiratory suppression - Respiratory rate is decreased **Role of OT substance use - Try to understand & empathize & use communication techniques  - Evaluate whether the client is ready to change & use motivational strategies to encourage the client. - Evaluate the daily occupations of the person in 3 major occupational areas (self-care, productivity, and leisure affected by substance use. - Help people develop more satisfying and meaningful patterns of time use and replace unhealthy activities with healthy and meaningful ones. - Help client set short and long term goals to enable participation in other activities. - Help the client evaluate the risk of relapse & develop a relapse-prevention plan with client Substance use disorders: OT– - Occupation, “Substance use:, needs to be replaced with more positive habits and occupations - Focus on building self-esteem - Encouraging physical activity - Support 12 step program engagement that focus on social and spiritual support **Personality disorders– Descriptions of personality disorders emphasize emotion and behavior instead of etiology. Three clusters of personality disorders grouped according to common symptomatology. - Cluster A disorder characterized by odd or peculiar behavior - Cluster B disorder present with flamboyant or dramatic behavior - Cluster C characterised primarily by anxiety or fear For all the personality disorders, the first criterion is pervasive pattern of behavior Borderline Personality Disorder– - Pervasive pattern of instability in interpersonal relationships, self-image, and affect. - Impulsivity, intense interpersonal relationships characterized by alternating idealization and devaluation - Frequent suicidal or self-mutilating behavior - Poor control of anger - Results from complex interaction of neurological, genetic, and environmental factors - Impaired function in self-care, work, leisure, & social occupations - Somewhat responsive to treatment - Behavioral and psychoeducational treatments most effective Occupational therapy in personality disorders– Increasing self-awareness - Opportunities for self-expression, realistic appraisal of behavior, analysis of strength and weakness OT in borderline personality disorder– - Appraisal of behavior - Educate sleep hygiene & promote positive sleep pattern - Establishment of daily routine - Educate use of sensory strategies as alternative to self-harm behavior - Educate use of physical activities as emotional outlet when anger & anxiety - Adapting social environment Lifespan considerations– childhood trauma is implicated in many personality disorders Ch. 19– Neurocognitive Disorders **Change of cognitive domains in NCD Growing scientific understanding of the complex interaction between physiology & psychology. Defined by changes of cognitive domains in: - Complex attention - Executive function– problem solving, decision making - Learning & memory - Language - Perceptual- motor - Social cognition **Major/Mild Neurocognitive Disorder– Major neurocognitive disorders symptoms includes - Significant cognitive decline from the previous level of performance in 1 or more cognitive domains. - Deficits interfere with independence in daily activities. Mild neurocognitive disorders is characterized by modest cognitive decline from the previous level of performance in one or more cognitive domains - Basic ADL is independent, IADL may be impaired - May not necessarily progress to Major **Alzheimer’s Disease Most common neurocognitive disorder. - Progressive & deteriorating - Deposits of proteins, brain atrophy - No definitive lab test **Vascular disease– 2nd most common neurocognitive disorder - Presence of one or more cerebrovascular accidents (CVA) - Characterized by deficits in executive function, especially cognitive flexibility and inhibitory control. **Parkinson’s Disease– - Movement disorder– affect movement, muscle tone, posture, balance - Decrease dopamine **Huntington’s Disease– Clearly genetic disease - 50% chance - Characteristic motor deficits– clumsiness, involuntary jerking movements of limbs body (Chorea) - Cognitive deficits– difficulty concentration, memory lapses, executive dysfunction - Mental changes– depression, mood swings, personality changes, irritability NCD: Implications for Function - Alzheimers, Parkinson’s – progressive decrements in performance, skills, habits, patterns, roles, ADL, IADL  - AD- early signs relate to confusion about everyday activities accompanies by deficits in short-term memory - PD- early symptoms may be motor rather than neurocognitive in nature. Skill deficits may be more motor focused , & cognitive only. - Individuals with late stage alzheimers are ultimately bed-ridden, unable to move purposely swallow, talk or otherwise function. - TBI and substance medication related conditions not necessarily progressive. - Functional consequences of TBI are dependent on the location of the injury and its severity. - substance/medication related NCD is often characterised by deficits in abstract reasoning, motor planning, and cognitive flexibility - Comorbidity- individual may have several NCD simultaneously - Individuals with NCD in early staged, may become depressed as they recognize their own functional loss - Mild NCD associated with decrements in executive functioning and long/short term memory. - By definition mild NCD are not accompanied by loss of ADL performance, but loss of IADL performance is common - Social performance often well maintained before late stage, although increasingly superficial over time. - Perceptual challenges including potential for falls. NCD treatment– Medication available for - Parkinsons - Vascular No medication for - Alzheimer’s - Huntington’s Parkinsons may improve with deep brain stimulation, exercise, dance, acupuncture. Parkinson’s benefits from multidisciplinary intervention including PT, OT, and Speech. AD,PD,HD: focus on management of symptoms. Environmental modifications to support function, reduce caregiver burden. Vascular NCD: manage conditions that contribute to vascular damage– hypertension, diabetes - Focus on reducing excess disability from comorbid conditions - Emphasize prevention of cognitive decline through: physical activity, exercise, cognitive activity, maintaining healthy BW, BP, lipid levels Implication for OT– Overall goals: - Maintain function - Enhance QOL - Support individual and caregiver Leisure activities can reduce depression thereby enhancing function. Behavioral & environmental strategies. Exercise & physical activity– SAFETY. Management of self-care activities. Computer-based cognitive practice. - Sensory stimulation - ADL & modified IADL training, task oriented training, functional activities, medication management - Cognitive stimulation therapy encourages cognitively challenging activities. - Strength-based intervention & self-directed exploration of activities to enhance pleasure, self-concept & satisfaction. - Realistic framing of goals: maintenance/ prevention of deterioration rather than improvement. - Compensatory strategies– external memory aids. - Caregiver support Occupation-based program to maximize procedural memory– memory for well-established habitual activities. - Emphasis on importance of tailoring activities to the emotional, physical, and cognitive abilities of the client in order to reduce frustration and create “just right” challenge. - Person-centered dementia care - TAP, activities tailored to their abilities and interest; training for caregivers on how to use activities as part of daily care routines. - Draw on activities that client enjoys prior to cognitive deficits Chapter 14– Sleep wake disorders & breathing-related Sleep-wake disorders and breathing-related sleep disorders– associated distress and impairments are the criteria that most clearly warrant a mental disorder diagnosis. - Frequently, but not always, an accompanying medical diagnosis. **Insomnia disorder– dissatisfaction with quantity or quality of sleep. - Difficulty falling asleep, staying asleep, or experiencing early morning waking. - At least 3x a week for at least 3 months in spite of adequate opportunities for sleep. - Negatively affects function or causes distress. - Possibly due to genetics or stress Comorbidites & prognosis– **Comorbidities - Anxiety disorder - Depression - Trauma-related disorders **Narcolepsy– repeated intense need to sleep and falling asleep; or a sudden attack of deep sleep. - It is neurological disorder - At least 3x per week for at least 3 months **Type 1 narcolepsy– Cataplexy - Brief episodes of sudden loss of muscle tone triggered by sudden, strong emotions- laughing/joking, fear, anger or excitement while remaining conscious, at least a few times a month. **Type 2 narcolepsy– No cataplexy  - Sleep paralysis, last for 1 to 2 minutes - Additional criteria includes hypocretin deficiency and rapid eye movement sleep less than 15 minutes. **Obstructive sleep apnea & Hypopnea– - Polysomnography of at least 5 obstructive apneas or hypopneas (blood oxygen levels must drop by at least 3-4%) 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 or hypopneas per hour of sleep without other symptoms. **Etiology/Prognosis– - Strongly associated with neurological disorders; neurocognitive deficits related to high leptin levels; hypertension; and anatomical structure of the face & airway. Etiology– - Facial structure, & amount of upper airway soft tissues - Overweight or obesity - Associated with hypertension; neurocognitive deficits related to leptin(regulation of appetite & fat storage) - Treatment effective (continuous positive airway pressure CPAP most common) but often abandoned because of cumbersome/habit issue **circadian rhythm sleep-wake disorders– Recurrent sleep disruption due to - Alteration of circadian system - Mismatch between the person’s rhythm and the requirements of the social or work environment. - Excessive sleepiness or insomnia or both Distress or dysfunction as a result of these symptoms. **Etiology - Mutations in core clock genes - Disruption in cortisol and melatonin production - Degeneration or decreased neuronal activity or suprachiasmatic nucleus neurons. - Decreased responsiveness of the body’s internal clock to signals such as light and activity - Demands of rotating shift work **Sleep cycle– Stage 1= NREM entering sleep, light Stage 2= NREM light sleep, heartbeat and breathing start to slow down, muscles start to relax Stage 3= NREM deep sleep, more slow and relaxed Stage 4= REM increase brain activity, increase heart rate & BP, dreams, muscles paralyzed **Nonrapid eye movement sleep arousal disorders– Sleepwalking: repeated episodes of getting up from bed during sleep and moving around in an unresponsive individual. Sleep terrors: episodes of terror causing waking from sleep, usually in a panic. Possibly caused by altered brain functional connectivity. **Rapid Eye Movement (REM) Sleep behavior disorder– - Repeated periods of arousal during sleep with vocalization and/or complex motor behaviors, occuring during REM sleep. - Most common in older men and is often associated with neurodegenerative diseases like Lewy body dementia & parkinson’s disease. - Poor prognosis because of associated neurological disorders. **Restless legs syndrome– - Frequent urge to move the legs, with uncomfortable or unpleasant sensations. - Symptoms worsen late in the day or at night - Etiology may be impaired endothelial function, iron deficiency, dopaminergic dysfunction, & genetic factors - Prognosis is good if associated with pregnancy, otherwise unclear **Sleep disorders: implication of 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 & confidence - Productivity - Family relationship **Sleep disorders: treatment– - Behavioral strategies with focus on sleep hygiene - Short or long term medication use - Light therapy - Continuous positive airway pressure machine for obstructive sleep apnea - Surgical options for obstructive sleep apnea - Treat medical conditions Sleep disorders implications for OT– focus on sleep hygiene and physical activities - Establishing a calm bedtime routine - Using the bed only for sleep and sex - Avoiding naps if possible, or one nap not more than 30 mins - Avoiding vigorous exercise too close to bedtime. - Minimize or avoid screen time 1 hour before bedtime - Making sure bedroom is dark and a comfortable temperature for sleep - Minimize liquid in evening; urinate before bedtime - Daily exercise routine - Cognitive behavioral approach for sleep hygiene & exercise routine - Strategies to improve circadian rhythm (sunlight exposure in the AM & going to sleep and getting up at the same time each day) - Mindfulness meditation if related to stress - Body positioning for comfort - Managing and routinely using CPAP - Work satisfaction/energy conservation to address fatigue until sleep improves - Childhood narcolepsy– parent education  - Family education for safety–sleep walking, act out dreams - Driving needs to be assessed based on degree of sleepiness; alternatives **Lifespan considerations– Sleep difficulties occur across lifespan In children → parental issues may be factor Narcolepsy first appears in childhood Sleep difficulties in older adults are very common due to menopause, brain injury, or age related changes. Caution must be used when recommending medication to older adults due to increased sensitivity to medication Topics before midterm Schizophrenia– diagnosed based on presence of 2 or more of the major signs of psychosis lasting MORE THAN 1 MONTH. At least 1 of those symptoms must be DELUSIONS, HALLUCINATIONS, OR DISORGANIZED SPEECH. Unable to differentiate reality & delusions. The second may be another one of those 3 symptoms or disorganized/catatonic behavior, or negative symptoms (diminished emotional expression or avolition) Often has prodromal and residual symptoms between active symptom episodes Schizoaffective disorder– symptoms of schizophrenia along with at least one period during which there’s a major episode of DEPRESSION OR MANIA. Delusions or hallucinations must be present for 2 or more weeks without a major mood episode at some point during illness. Mood episodes must be present for the majority of the duration of illness. Function– Function generally better than schizophrenia Significant cognitive deficits Bipolar I– more severe. Individual may or may not have accompanying depressive episodes. The individual has at least ONE manic episode - Period of abnormal and persistent elevated, expansive, or irritable mood - Abnormal and persistent increased goal-directed behavior Individual shows at least THREE other symptoms of mania - Inflated self-esteem or grandiosity - Decreased need for sleep - Excessive talkativeness or pressure to speak - Distractibility - Increase in goal-directed activity or psychomotor agitation Bipolar II– at least ONE hypomanic episode. Abnormally elevated or irritable mood Abnormally increased activity or energy for several days.  At least 3 signs of mania including GRANDIOSITY, INFLATED SELF-ESTEEM, DECREASED NEED FOR SLEEP, TALKATIVENESS, FLIGHT OF IDEAS, INCREASE GOAL DIRECTED ACTIVITY At least one major depressive episode. Individual has never had a manic episode. OT implication– a. Monitoring impact of medications b. Medication management c. Identifying meaning and important occupations d. Encouraging emotional control through occupational engagement e. Enhancing self-concept f. Addressing self-esteem g. Education for family h. Community integration