DEFINITION EPIDEMIOLOGY ETIOLOGY BMS PATHOPHYSIO S/SX C&P DSM LAB & MED

DISSOC. IDENTITY DO - 2 or more personality 1%,underdiagnosed - trauma, e.g. - hippocampus - coping - memory - chronic and -2 or more distinct -EEG – r/o seizure
state or identities abuse or (memory) mechanism to lapses disabling identities, recurrent DO cause memory
-accompanied by memory -MC w/ history of neglect compartmentalize - changes in - OT memory gaps, gaps
gaps trauma disrupting - amygdala trauma affect goal:integrate significant distress,
identity (emotional - black outs identities not attributable to Med: SSRI –
integration processing) - inconsistent substances or other fluoxetine
w/ usual medical conditions To manage cc
personality depression or
anxiety, does not
treat DID directly

DISSOC. AMNESIA -inability to recall - 2-6% -psych - hippocampus - defense - memory gaps - resolved when -inability to recall -MRI – r/o brain
autobiographical info. -associated w/ response to (memory) mechanism to avoid - confusion e person is autobiographical structures causing
Typically related to trauma traumatic experiences trauma leading stress by - occasionally removed from e info. Related to memory issues
to selective - amygdala repressing wandering trauma trauma, significant
memory (emotional traumatic memories (fugue) distress or fx -benzodiazepines
blocking processing) impairment, not d/t e.g. lorazepam –
substance or other assists in recalling
medical conditions. memories

DEPERSONALIZATION -detachment from -1-2% - linked to -sensory - defense to reduce -unreality -episodic or -persistent or -EEG – r/o seizure
DEREALIZATION oneself / environment with - associated w/ high trauma and perception emotional distress -detachment chronic current experiences DO or temporal
intact reality testing stress situations or stress areas of e brain by feelings of from oneself -can be lifelong of lobe epilepsy
trauma - triggered by -prefrontal detachment -dream-like depersonalization,
substance cortex (self- surroundings derealization, or -SSRI – sertraline
abuse awareness) both, w/ distress or for assoc.
fx impairment depression and
anxiety

DISSOC. FUGUE -unexpected travel away -rare -triggered by Memory - defense -wandering -short-lived, may - specifiers involving -Toxicology –
-inability to recall one’s -associated w/ acute stress or processing mechanism by -confusion recover memory travel and identity screening to r/o
past extreme stress trauma areas of e brain escaping from -inability to eventually confusion drug-induced
- identity confusion distressing recall personal states
situations through details
amnesia -assumes new -no treatment,
identity psychotherapy is
preferred

- incongruence between W= .002% -.003% -genetic - brain structure -brain structure -desire to live -improved - 6 months -Hormonal Level
one’s M= .004 %- .014% -hormonal -hormonal -hormonal as another outcomes in Assessment - for
experienced/expressed - psychosocial influences influences gender supportive those seeking
gender and assigned factors -discomfort w/ environment hormonal therapy
gender w/significant one’s own body -sx may persist
GENDER DYSPHORIA distress -social distress or resolve -hormones e.g.
testosterone and
estrogen; risk =
mood changes
and cardiovascular
issues

-distressing somatic sx w/ -4-6 % -cognitive -amplification of -resistant to -often chronic -persistent somatic Basic Diagnostic
excessive thoughts or distortions sensations reassurance but treatable in sx for over 6 months Tests e.g. CBC –
behaviors focused on sx -heightened -maladaptive -physical therapy w/ excessive to r/o med
SOMATIC SYMPTOMS DO bodily thought patterns complaints thought/beh related conditions
awareness involving to these sx SSRI – fluoxetine
-psychological multiple body For anxiety/ depr.
factors systems
 DEFINITION EPIDEMIOLOGY ETIOLOGY BMS PATHOPHYSIO S/SX C&P DSM LAB & MED
BIPOLAR I Characterized by manic- - trauma, e.g. Neurotransmitters NE – decreased, -P prognosis Medications:
depressive episodes abuse or correlated with than MDD -Depressive
neglect depression -40-50% may Disorders or
disrupting have 2nd manic depressive
identity Serotonin – low episode within episodes
integration levels in CSF and the 2 years after
reuptake sites on the first episode = SSRI (first line)
platelet -high changes of
suicide =NE Reuptake
Dopamine – -chronic, social Inhibitors
reduced in decline
depression, =Dopamine
BIPOLAR II Characterized by atleast -psych increased in mania - stable since Reuptake
one episode of major response to there is a high Inhibitors
depressive disorder and trauma leading chance that the
at least one episode of to selective px will get the _______________
hypomania memory same diagnosis Manic and
blocking for the next 5 Hypomanic
years
= atypical
antipsychotics (2nd
generation
CYCLOTHYMIA - 3-5% of the general -related to BPD -sensitive, antipsychotics:
population -biological and hyperactive, and clozapine,
-co-exist with BPD generic data moody during risperidone,
-families with SUD related with childhood olanzapine, and
-ages between 15-25 Mood DO -sx in teens quetiapine)
Emergence of sx _______________
affects school Mood Stabilizers
and socpar
-G = coping strat = Lithium,
Valproic Acid,
MAJOR DEPRESSIVE 5 or more depressive -highest lifetime -triggered by represent a Chronic and Carbamazepine,
DISORDER symptoms during 2-week prevalence with 5- acute stress or change from tends to relapse. Clonazepam
period 17% trauma previous 50% chance of
functioning at recovering after
least one of the the first year.
symptoms
either Persists =
- depressed dysthymic
mood
- loss of
interest or
ppleasure
-Milder form of MDD W= .MC, less than 64 -biological -depressed Before 25 years
-More Chronic -Unmarried, low - psychosocial mood old in 50% of the
-With at least 2 years of income factors -insomnia px
duration -5-6% of the general -poor appetite
population -low energy – Prognosis varies
DYSTHMIA/ fatigue
PERSISTENT -hopelessness 25% do not
DEPRESSIVE DISORDER recover

-4-6 % -cognitive -resistant to -often chronic

distortions reassurance but treatable in
-heightened -physical therapy
MINOR DEPRESSIVE bodily complaints
DISORDER awareness involving
-psychological multiple body
factors systems
 REVIEW OF RELATED LITERATURES  Occupational History

I. INTRODUCTION II. MEDICAL LITERATURE OBJECTIVE

 Cx initials  Definition  LEVELS OF ASSISTANCE
 Age and Address  Epidemiology and Etiology INDEPENENT Without any A from caregiver
 Diagnosis and OT impression  Clinical Manifestations SET-UP Only set-up or Clean-up
 Medical Course and Prognosis SUPERVISION Present in same room, ready for verbal cues, but no
 Diagnostic Procedures phys. A
 Differential Diagnosis
SBA Caregiver right next to e cx, potential need for phys. A
 Medication and Possible Surgeries
and other safety concerns
and Outcomes
CGA Full phys. Effort, w/ gait belt or steadying A
 Precautions
o Lethality History Min. A 75% or more, more than just steadying A
Mod. A 50% - 74%
o Self-Injury behaviors
Max. A 25% - 49%
OT LITERATURE DEPENDENT Below 25% or 2 or more caregivers to provide A
 Possible OT Problems
 Approaches/ FOR/ Models
 EBP
 Evaluation ASSESSMENT
 Intervention
 Interpretation of Assessment Tools
 Strengths and Weaknesses
INITIAL EVALUATION  OT impression
Format:
 Narrative Client has difficulty in (occupations) as evidenced by (skills) secondary to (client
 Transference vs. Countertransference factors) associated with (diagnosis/ OT impression)
 Closing Interview: 5-10 mins  PPL
 Prognosis
 Potential
SUBJECTIVE
PLAN
 Chief Complaint
 Reasons for Referral OCCUPATIONAL PERFORMANCE The ability to carry out tasks in daily life
 Goals in OT PREVENTION Actions taken to reduce risks of developing health
 HIP issues
o Psychiatric Reviews of Systems HEALTH AND WELLNESS The promotion of overall well-being and QOL
QOL The satisfaction with life
MOOD PARTICIPATION Involvement in desired activities
 DEPRESSION ROLE COMPETENCE The ability to fulfill roles effectively
Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor WELL-BEING Contentment and life satisfaction
agitation or slowing, Suicidality OCCUPATIONAL JUSTICE Ensuring access to meaningful activities and
 MANIA addressing inequalities
Impulsivity, Grandiosity, Recklessness, Increased Energy, Need for  Outcomes
Sleep, Talkativeness, Hypersexuality, Excessive Spending, Mental
ANXIETY  Approach
 GENERALIZED ANXIETY – WH questions  Models/ FOR
 PANIC DO – somatic sx  Goals
 OBSESSIVE – COMPULSIVE – rituals, irrational belief o RUMBA Relevant, Understandable, Measurable, Behavioral, Achievable
 PTSD – nightmares, startle response
o COAST Client, Occupation, Assist Level, Specific conditions, Timeline
 SOCIAL ANXIETY – tachycardia
 SIMPLE PHOBIAS – phobias o SMART Specific, Measurable, Attainable, Realistic, Time-bound
PSYCHOSIS o TICKS Time frame, Individual, Change expected, Key issues, Supports
 HALLUCINATIONS – sensory experience that does not correspond to ext. reality  Plan of Action
 PARANOIA – type of thinking where grandiosity and persecutory ideas dominate o TUS
 DELUSIONS – false belief of external reality o TUG
 PATIENT’S PERCEPTION – reality testing o TUA
OTHER o BMT
 ADHD o EMT
 EATING DO o LFT

o Past Psychiatric History

o Substance Use, abuse, and addictions
 Family History
PSYCHOSOCIAL ASSESSMENT FORM
o Lethality History
 Sit in a 90-degree angle
 General Appearance  Passive Participation – norm awareness experimental, expectations,
o Appearance, Posture, Eye Contact, Grooming, Hygiene cautious
 Attitude and behavior o Higher Levels
 Motoric behavior  Imitative Participation - following the rules and copying others
o Normal, slowed, agitated  Active Participation – taking an existing idea and making your own
 Schizophrenia – fixed post, minimal eye contact, odd behavior o Competitive Participation – innovating and creating
 Cocaine abuse and Mania - hyperactive  Attention
 Depression – psychomotor retardation o Sustained
 Side effects of Lithium - tremors o Divided
 Paranoia – paranoid state o Shifting
 Speech  Memory
o Fluency or Full command of language o Remote - childhood
o Amount o Recent Past – past few months
o Tone and Volume o Recent Memory – past few days
o Rate or speed o Immediate Retention and Recall – seconds to hours
 Manic – pressured speech
 Depression - paucity o Procedural – automatic sequence
 Cognitive DO – uneven or slurred speech o Semantic – knowledge of the world
 Mood o Episodic - experiences
 Affect o Declarative – conscious learned facts
o Flat – severe absence
o Blunted – a less severe o Anterograde amnesia – after taking benzodiazepines
o Constricted – a mild reduction o Retrograde amnesia – after head trauma
o Labile – rapid and unpredictable  Experience of Self and Time
 Thought process o Body Image – perception of own body
o Circumstantiality – overinclusion of trivia, but comes back o Body Scheme – neurological representation of body, proprioception
o Tangentiality – overinclusion, does not come back o Self-Confidence – belief in one’s own ability
o Loose thoughts – no connections in content o Self-esteem – overall sense of self-worth and value
o Preservation – focus on the same topic  Judgement
o Thought Blocking – unable to complete a thought o Test – standardized tests
o Neologism – new word condensed, word does not exist o Social – observations
o Word Salad – repetitions of language with no apparent meaning  Abstract Thinking
o Clang Association – rhyming sounds o Let the cx explain proverbs
 Thought content  Insight
o Persecution – out to harm o Not an indicator of the severity of an illness
o Grandeur – they are more important and powerful o Impaired in delirium, dementia, frontal lobe syndrome, psychosis, borderline
o Reference – special meaning intellectual fx.
o Thought control – thoughts controlled by ext. force
o Thought insertion – thoughts are inserted by an ext. force o CDU Grading
o Thought withdrawal – thoughts are taken away by ext. force 0. Complete Denial of Illness
o Thought Broadcasting – belief that thoughts are being broadcasts, that others 1. Slightly aware
can hear it 2. Aware, blames others
 Perceptual Disturbances 3. Aware, d/t something unknown
o Hallucinations 4. Intellectual insight, does not apply to future
o Illusion 5. True emotional Insight open, emotional awareness, changes in personality
o Delusion  Psychomotor Functions
o Sensory processing deficits o Catatonia – rigid or immobile
o Depersonalization o Stereotype – repetition of senseless actions
o Derealization o Tics – muscle spasms or twitching
 Sensorium Grapefruit and alcohol should be avoided as they can affect the drug’s metabolism and increase the risk of
o Somnolence – can be aroused side effects like drowsiness and dizziness.
o Stupor – unresponsive to most stimuli, only aroused w/ vigorous stimulation
o Lethargy – has difficulty staying awake Psychopharmacology
o Fugue state – a dissociative DO where cx wanders
o Coma – state of unconsciousness
 Motivation
Self Determination Theory (SDT)
o Lower Levels:
 Tone – undirected, impulsive
 Self-differentiation – destructive, may lead to unintended positive
outcomes
o Intermediate Levels
 Self-presentation - constructive exploration, intentionally engages