Assessment of Mental Disorder

• Psychological tests
• Intelligence tests
• Mental status exam & interview
• Personality assessment
• Neuropsychological assessment
• Behavioral assessment
• symptom assessment & application of diagnostic critera

Schizophrenia spectrum

• Psychosis: "loss of contact with reality"
• Positive symtoms: delusions & hallucination, disorganized speech, grossly disorganized behavior
• Negative symptoms: social withdrawel, etc.
• No longer has subtypes

Delusions

&

Hallucinations

• Disturbance in a belief system, irrational beliefs and ideas that are most likely not going to change despite conflicting evidence
• Disturbance in perception without external stimuli, can occur in all 5 senses but most common is auditory

Bipolar disorder

Manic episodes

• distinct period where there is abnormally, persistently, elevated, expansive or irritable mood
• persistent increase in activity/energy that is present for most of the day, nearly every day, for at least 1 week

Bipolar Disorder

Hypomanic episode

• A manic episode of lesser duration

Bipolar disorder

Major depressive episode

• 5 or more depressive symptoms present during the same 2-week period
• represent a change from previous funtioning
• At least one symptom is 1) depressed mood or 2) loss of interest or pleasure (anhedonia)

• 5 or more depressive symptoms present during the same 2-week period
• Represent a change from previous functioning
• At least one is present: 1)depressed mood or 2) anedonia

• Significant weight change
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue
• feelings of unworthiness or inappropriate guilt
• diminished ability to concentrate
• recurrent thoughts of death or suicide

• Fear = emotional response to a real or imminent threat wheras anxiety= anticipation of future threat
• most disorders contain an element of fear, panic, doom or nervousness
• everyday experiences are sources of terror
• Phobias can be related to a specific situation, persons or objects
• PTSD and OCD removed from category
  

Obsessive Compulsive Disorder (OCD)

&

Related Disorders

• Obsession: recurrent & persistent thoughts, urges, or images that are experienced as intrusive & unwanted
• Compulsion: repetitive behaviors or mental acts that an individual reels driven to perform in response to an obsession according to rules that must be applied rigidly
• Common symptoms include: cleaning, taboo thoughts, harm
• ex: OCD, body dysmorphic disorder, hoarding, trichotillomania
  

• Resulting from exposure to a traumatic or stressful event
• Anhedonia, aggressive or externalized anger, or dissociative symptoms
• May result in persisten recollection of the event, flashbacks, exaggerated startled response, sleep difficulties, emotional numbing, avoidance behavior
• examples: PTSD, adjustment disorder, acute stress disorder

• disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control & behavior
• frequently found in the aftermath of trauma
• can be detatchment from self, memory, or personality/identity
• examples: dissociative identity disorder, dissociative amnesia

• Problems in the self-control of emotions and behaviors
• violate the rights of others and/or bring the individual in conflit with societal norms or authority
• more prevelant in males & earlier onset
• examples: Oppositional defiant disorder, conduct disorder, antisocial personality disorder, pyromania

• an enduring pattern of inner experience and behavior that:
• deviates markedly from the expectations of the individual's culture
• is pervasive and inflexible
• has an onset in adolescence or early adulthood
• stable over time
• leads to distress and impairment

Personality Disorders

Cluster A

• Odd or Eccentric
• Paranoid
• Schizoid
  Schizotypal

Personality Disorders

Cluster B

• dramatic, emotional, erratic
• antisocial
• borderline
• histrionic
• narcissitic

Personality Disorders

Cluster C

• anxious or fearful
• avoidant
• dependent
• obsessive compulsive

• Psychiatric Rehab (recovery, community integration, improved quality of life, community based, client centered, empowerment oriented)
• Community support programs
• clubhouses
• advocacy groups
• assertive community treatment
• Pharmocological treatment (antipsychotic, antidepressants, mood stabilizers, anti-anxiety)

• acceptance of self (self-prejudice)
• side effects of medications
• social withdrawal
• adherence w/ treatment
• co-occurring substance abuse disorder
• living in community but not integrated
• fear and anxiety present barrier
• other health conditions

• Unemployment & underemployment, despite potentially high intellect & achievement premorbid
• Need to take time off at work for therapy
• Ability to cope with stress & endure
• limited coping & social skills
• features of the work enviroment may exacerbate symptoms

Blood

Red blood cells

• Contains hemoglobin
• carries oxygen throughout the body

Blood

White blood cells

• Immunity

Blood

Platelets

• Clotting function

Blood

Plasma

• Liquid form of blood

Blood

Functions

• move oxygen & other nutrients throughout body
• distributes hormones for endocrine system
• removes waste
• protects body from outside stuff
• regulates temperature

Blood pressure

Cystolic

Blood pressure

Diastolic

Words associated with heart

Engine that pumps blood to body

Pulmonary circulation

• Deoxiginated blood enters the heart through the vena cava
• travels through right atrium down to the right ventricle then to pulmonary artery to lungs

• Oxiginated blood goes to veins to left atrium, left ventricles, and out to body through aorta

• Cardiologist
• Radiologist
• Hematologist- blood doctor
• Technicians

• soundwaves
• graphic representation of heart

• Cardiac stress test (controlled forced exertion)
• Angiography (invasive, catheter through veins & arteries with dyes)
• Cardiac catheterization

• causing obstruction or diminished supply of blood in artery- walls become thickened & less elastic
• Plaque build up
• hyperlipidemia (high cholesterol)
• thrombus (emoblism, blood clot broke off & is moving)

• Sustained high blood pressure
• strain on heart

• Dialation (ballooning out) of the artery wall
• can cause sudden death

• Narrowing of the coronary arteries-stenosis
• ischemia-loss of bloodflow
• hypoxia- lack of oxygen (temporarily)

Angina pectoris

(mini heart attack)

• decreased blood flow to heart beacuse oxygen needed isn't being supplied
• pain
• lifestyle changes & cardiologist

• no oxygen or blood flow
• rapid death of heart muscle
• cannot regenerate heart muscle
• immediate medical attention
• irradic heart beat, heart failure, bypass (possible results)
• modifications of activities, diet, life long medications

• weakening in verticles causes pooling of blood
• congestion build up
• less oxygen
• pool of blood in lungs
• fatigue, cognitive issues, breathing issues, swelling in body

• Tachycardia: fast heart beat
• Bradycardia: slow heart beat
• Dysrhythmia: irregular heart beat, palputations, shortness of breath, diziness, fatigue, fainting

• results in backward flow from ventricles to atria
• narrowing of valves-obstruction

• pain
• flu-like symptoms
• normally bacterial infection related

• tissue damage wherever blood is not going to
• blood pools
• poor healing
• necrosis (tissue death)

• results from vessels spasming and constricting blood flow in fingers and toes
• turns white
• reaction to cold or emotion

• inflammation in vein caused by limited activity
• loss in sensation
• can cause blood clots

• distention of veins
• blood not flowing effectively through it
• pain, fatigue

• lifestyle management, diet, exercise, no alcohol & smoking
• medication (antithrombolitic, cardiotonic, nitrogymcerin,antihypertension)
• surgical treatment
• transplantation
• cardiac rehab (education, counseling, how to safely return to activities)

• Lack of healthy red blood cells
• less oxygen
• can be from vitamin deficiency, diet induced (vegetarian), hereditary sometimes

• mutation in hemoglobin, crescent shaped, not as many red blood cells
• African Americans
• fatigue
• pain
• difficulty breathing
• necrosis, tissue/organ damage
• crisis where blood isn't going to
• osteonecrosis- bone breaking down
• Complications- retina damage
  

• manage and prevent complications
• learn triggers

• unable to clot
• men affected

• enviromental restrictions- extreme cold or heat
• employer attitudes- liability issues
• job modifications- returning to work may be difficult or impossible
• limitation on isometric activities
• pacemakers & interference- machinery or equipment can cause malfunction

Conditions of the respiratory system

Terminology

• Pneumo
• Pulm

Conditions of the respiratory system

Functions

• supply O2 to the circulatory system
• Inspiration: take breath in
• Ventilation & respiration: movement of gases into lungs (exchanging O2 & CO2)
• Expiration: expelling air from lungs

Epiglottis

vs.

Uvula

• epiglottis- flap
• uvula- punching bag

more alveoli = more surface area in lung to exchange gases

so damage=

Professionals & Diagnostic procedures

respiratory system

• pulmonologist- specializes in respiratory conditions
• x-rays
• bronchoscopy & laryngoscopy
• pulmonary angiography- inject dye
• pulmonary function test- volume of air in lungs
• lung scan

• pharyngitis- sore throat
• laryngitis- swelling of vocal chords

• Bacterial infection
• from contact with someone who has it
• weight loss, fever, cough
• presciption

• Lungs can't keep up
• contraction and restriction of airways
• coughing
• tightness in chest
• dust,smoke,allergies,cold air, stress

• exposed to chemicals or irritants
• mesothelioma, aspestosis
• changes structure of lungs

• Chronic obstructive pulmonary disease
• emphasema, chronic bronchitis
• Criteria: air flow limitations, progressive, associated with exposures to noxious particles/gases (smokers)
• symptoms: coughing, limited air flow, chronic inflammation in lungs, alveoli destroyed
• classifications: 0-4
• management: pulmonary rehab, controlled exercise, medications, drainage, learning breathing techniques

• genetic
• difficulty with water and salt intake
• thick mucus build up in lungs

• lifestyle management: staying healthy and active
• medication
• supplemental oxygen & breathing apparatuses
• surgical treatment & transplantation
• pulmonary rehabilitation

• psychological issues: fear & anxiety, depression
• expectations of others/ misunderstanding
• lifestyle issues: limitations on activities, stress, exercise & diet, hydration, sexual activity
• avoiding enviromental irritants

• enviromental restrictions: irritants, temperature extremes, commuting, upper body activity (extended exertion)
• employer attitude
• job & work schedule modifications
• litigation
• hazard of oxygen (open flames)

• underlying change in brain function
• caffeine not included

Substance-induced disorders

substance intoxication

• syndrome that is reversible due to recently ingesting substance
• clinically significant problematic or psychological changes
• presence of specific symptoms related to that substance
• symptoms experienced are not related to another disorder
• no nicotine or tobacco
  

substance-induced disorders

substance withdrawal

• syndrome changes as a result from using substance less
• symptoms develop shortly after lessening use
• causes distress and impairment in functional area of life
• not due to another condition
• no hallucinagens or inhalents

Substance use disorders critera

Impaired control

• criterion 1-4

1. longer or more than you originally expected
2. persistent desire to cut down, regulate, or cease use of substance
3. preoccupied with drug use, obtaining or recovering from
4. craving impulse

Substance use disorders criteria

Social Impairement

• criterion 5-7
• 5. results in failure to fullfill life rolls due to use
• 6. continue use despite the fact that they have reccurent problems related to using
• 7. given up or reduced activities they previously enjoyed

substance use disorder criteria

Risky use

• critera 8 & 9
• 8. recurrent use in physically dangerous situations
• 9. continuation despite problems

substance use disorders criteria

Pharmacological criteria

• criteria 10 & 11
• 10. tolerance- increase dose to reach same level
• 11. withdrawal- levels decrease causes symptoms

Initial treatment for substance use & abuse

detoxification

• managing acute intoxification

Initial treatment for substance use & abuse

Withdrawal

• based on substance and time used, also gender and weight
• 1) physical- 24-48 hrs after last use, can last up to 2 weeks
• ex: shaking, vomiting, seizures, sweating, rapid heard beat
• 2) psychological- cravings, drug dreams, hallucinations, sleep disturbances, depression, anxiety, DTs

Initial treatment for substance use & abuse

medical concerns

• malnutrition
• poor dental care
• diseases
• etc.

Initial treatment options

Medically managed inpatient treatment

• decreasing physical symptoms
• short time period

Initial treatment options

community detoxification

• not hospital based, detox center
• social, counseling based

Initial treatment options

Inpatient rehabilitation

• beyond detox and withdrawal
• removed from enviroment
• longer amount of time
• peer oriented, counseling, holistic health

Initial treatment options

Maintenance/outpatient treatment

• remove self from substance with medication
• sometimes after hours or weekends to fit schedule of person

Initial treatment options

self-help meetings

• AA, NA, etc.
• confidential support groups
• steps

Professionals involved

(substance use disorder)

• medical staff- psychiatrist, doctors
• counselors- not at self-help level, run groups, lead therapy, aftercare planning
• nutritionists- reverse inbalances and bad habits
• peer specialists

• assessing client readiness- make sure grouped with similar people
• engaging and motivating clients- lifestyle changes, use supports
• utilizing a holistic approach
• wrapping around services

• general- inhibits central nervous system
• alcohol-related illness: nervous, cardiovascular, respiratory, gastrointestinal, reproductive systems
• eye disturbances, increased heart rate, short term memory loss

Substances

1-5

• Alcohol- slurred speech, passing out, attention, memory
• caffeine- stimulant, insomnia, flushed skin, function of medicines
• cannabis- mood change, increase brain function, hyperconcentration, memory
• hallucinogens- long lasting psych issues, altered percetion
• inhalants- single use can cause brain fry

substances

6-10

• opiods- quick increase tolerance, euphoria (ex: heroine)
• sedatives- depress central nervous system (slows down), hallucinations, convulsions
• stimulants- increase central nervous system, paranoia, increase alertness, metabolism (ex: cocaine)
• tobacco- heart disease, cancer, lung
• other/unkown

Diagnostic procedures

(sustance use disorders)

• screening instruments
• drug tests: breathalizer, hair, blood, urine, etc.
• medical evaluation
• behavioral and psychological screening

General management of conditions

(substance use disorders)

• acknowledgment- admitting you have a problem, having family admit it
• inital treatment
• the "process" of recovery (possibility of relapse)
• ongoing treatment
• treatment for medical complications

factors related to positive outcomes

(substance use disorders)

• client characteristics
• program characteristics (peer counseling, discharge plans, etc.)
• system characteristics ( comprehensive, longer services, etc.)
• men seek treatment more, women are more successful
• single people less successful

• low self-esteem and self-confidence
• denial
• guilt
• violence and aggression
• loss of social relationships
• legal issues

• work interfering with use
• decreased performance, increased absenteeism
• accidents
• job stress
• problems with criminal history, poor work history
• stigma

Orthopedic and Rheumatic Conditions

Structures & Functions

Bones

• 216
• provides structure
• absorb minerals
• blood cells developed in bones
• remodeling

Orthopedic and Rheumatic Conditions

Structures & Functions

Connective tissue

• ligaments- connect bones @ the joint
• tendons- connect muscles to bone
• cartilage- causes form
• bersa sacks- area of cushion

Orthopedic and Rheumatic Conditions

Structures & Functions

Joints

• where 2 or more bone join together
• articulation point 
• ex: wrist
• fiberous joints- bone to bone, fixed, no movement
• cartilagelous joints- some movement ex: pubic bone
• synovial- regular joints (most common)
• Ball & Socket ex: shoulder
• hinge- ex: elbow
• gliding- ex: vertebrae
• pivotal-head, neck

Orthopedic and Rheumatic Conditions

Structures & Functions

muscles

• involuntary ex:heart & intestines
• voluntary ex: skeletal
• have a sheeth (protective layer)
• every muscle attatched at 2 pts - origin and insertion

Orthopedic and Rheumatic Conditions

Diagnostic procedures

• radiography
• bone scan
• MRI
• CAT scan
• Blood tests

Orthopedic and Rheumatic Conditions

Low Incidence conditions

Trauma

• to musculoskeletal system
• contusions- soft tissue injury
• fractures- breaking bone
• strain- muscles/tendens
• sprain-ligaments
• dislocation
• bersitis
• tendonitis
• tenosynovitis- lining/sheethh on tendon is inflamed

Orthopedic and Rheumatic Conditions

Low Incidence conditions

Carpal tunnel syndrome

• numbness, tingling, pain
• tear injuries
• itis syndromes

Orthopedic and Rheumatic Conditions

Low Incidence conditions

Degenerative conditions

Osteoarthritis

• unremitting
• localized joint condition
• wear and tear conditions
• weight bearing joints
• exacerbated by cold/damp
• treatment- assistive tech. ex: cane, weight loss, medications, replacement of joints, exercises to keep moving

Orthopedic and Rheumatic Conditions

Low Incidence conditions

Degenerative conditions

Ankylosing spondylitis

• inflammatory joint disease
• impacts bone @ base of spine that attach to pelvis
• causes fusing of joints and change of posture, humpback

Orthopedic and Rheumatic Conditions

Back Pain (chronic - beyond 6 months)

TYPES

• static- sitting, sleeping, not moving
• kinetic- movement, better when sitting still
• syadic pain- radiating from lower back, down leg

Orthopedic and Rheumatic Conditions

Back Pain

Causes

• trauma
• poor mechanics and posture
• slipping of vertebrae
• gradual breakdown of vertebrae
• arthritis
• osteoperosis
• infections
• tumors
• sever indigestion
• scoliosis

Orthopedic and Rheumatic Conditions

Back pain

Testing and diagnosis

• EMG, MRI, CT scans

Orthopedic and Rheumatic Conditions

Back pain

treatment & pain management

• exercise/rest
• biofeedback
• stress management
• medications
• muscle conditioning
• stretching
• braces

Orthopedic and Rheumatic Conditions

Back Pain

Limitations & implications

• rest
• change positions more frequently
• illiminating lifting & bending or learning to do so properly
• decreasing vibrations

Orthopedic and Rheumatic Conditions

Low Incidence conditions

Trauma

Orthopedic and Rheumatic Conditions

Chronic Pain

Types

• acute- abrupt, onset, short duration
• chronic:
• nociceptive- injury to musculoskeletal or organ tissue
• neuropathic- injury to nerve tissue

Threshold

&

Tolerance

• perception of pain starts 

•  changes over time, woman have a higher pain tolerance

Orthopedic and Rheumatic Conditions

Chronic pain

Causes

• trauma
• degenerative condition
• psychological
• also no organic cause sometimes

Orthopedic and Rheumatic Conditions

Chronic pain

treatment and pain management

• medications
• PT
• TENS (electric pads)
• relaxation therapy
• hydrotherapy
• nerve block
• neurosurgeries

Orthopedic and Rheumatic Conditions

chronic pain

limitations and implications

• distressed and irritable
• depression
• helplessness

Amputation

causes

• traumatic
• necrosis
• infection
• tumors
• thermal
• elective

Amputation

treatment and management

• control infection before amputation
• surgical reimplantation
• prosthetics

Amputation

Complications

• swelling
• ulceration
• contractures (stiffening)
• bone spurs
• scoliosis
• neuromas
• pain (phanton and physical)

Amputation

Limitations and implications

• depends on:
• how much function is lost
• severity
•  circumstances

• changes in body image

Autoimmune conditions

Rheumatoid arthritis

• progressive, systemic, chronic
• synovial joints
• symmetrical (not one knee, both)
• extra synovial fluid
• symptoms: red, swollen joints, pain, immobility, fatigue, weight loss, weakness, deformation, build up of scar tissue
• limitations & implications: life roles, unpredictable, episodic (flare-ups), learned helplessness, body image, loss of function bc of deformity
  

Autoimmune conditions

Systemic Lupus

• inflammation & structural changes in many organs/systems
• onset- could be rapid or slow
• symptoms: rash,weight loss, pain, sensititivity to sunlight, inflammation, rogan function, cognitive disfunction, fatigue, depression
• treatment & management: monitor & maintain organ function, medications to slow disease
• limitations & implications: fear of unkown, loss, rest & avoid sunlight/cold/damp
  

Autoimmune conditions

Fibromyalgia

• always sore and tired
• diffuse pain syndrome
• musculoskeletal pain
• sleep disturbances
• pain and stiffness
• testing & diagnosis: none
• cause: unkown
• limitations & implications: depression, anxiety, widespread, misunderstood disease

• dependence
• chronic pain
• psychological issues
• limitations to activities and participation

• restrictions
• resistance to modifying
• reistance to using assistive devices
• need to change or modify job/career