anxiety

pp. 286

SELF

ENVIRONMENT

ACTIVITY

Symptoms of Anxiety

pp. 290

worry aloud, fidget, express fears, bite their nails, pull hair, pace the halls

ritualistic, compulsive, phobic, fearful, intrusive, demanding

List appropriate response variables for

ANXIETY.

SELF: encourage pt. to talk and express feelings

ENVIRONMENT: calm, comfortable, familiar, help feel more secure and in control

GOOD ACTIVITY:projects that can work on for a while, get up, move about, and come back to later; single-motor sequence that repeats to calm and control their own pace; GM act. such as aerobic exercises, stretching, Yoga, meditation; small woodworking kits with small no.ofpieces (3) or with many identical pieces and a finished model provided; simple cooking tasks-cookies- can move around while cleaning up or waiting for a batch to be done

Symptoms of Depression

pp. 291

depressed mood, crying, irrability, lose interest, feelings of hoplessness, helplessness, worthlessnes, guilt, easily frustrated, physical isolation, thereatening, hostile

vegetative signs: sleeping too much, insomnia, losing appetite, overeating, neglect of hygiene and grooming, diminished energy, psychomotor retardation (movements and speech are slowed) or psychomotor agitation (movements/speech speeded up), trouble concentrating, slow to respond or make decisions, easily distracted, unable to pay attention

often with schizophrenia, personality disorders, and substance abusers

List appropriate response variables for

DEPRESSION.

SELF: focus on exactly how they feel and why; never agree that the situation seems hopeless; set realistic STG and activities; reinforce good hygiene/grooming; match tempo to that of pt.; avoid too many choices; know risks of suicide; do not change subject or try to cheer up when pt. talks about bad feelings

ENVIRONMENT: safe and subdued, less stimulation, reudcce lighting/noise level, work 1:1

ACTIVITY: simple, structured, short-term, familiar activities (housework, organizing papers or books, folding laundry, simple cooking, sanding, clerical tasks, sewing); craft activities = highly structured, graded down - mosaics, copper tooling, leatherwork, woodworking, GM activities - aerobics, dance, yoga, running, swimming, ball games, walking outdoors; all increase intake of O2, release tension, and increase blood flow to brain; account for ALL tools and supplies....suicide

pressured speech

flight of ideas

grandiosity

eccentric style of dress

frivolous spending

unaware/indifferent to consequences of actions

lots of energy

manipulative: flattery towards others, gives gifts, "splitting" therapists, "upping the ante"

 often assoc. w. substance abuse, paranoid schizophrenia, personality disorders

List appropriate response variables for

MANIA.

SELF: beware of flattery; cautious in giving praise or approval; be calm, matter-of-fact, firm, consistent, set and enforce limits, constant alertness and patience; redirect over and over; do not get emotionally involved; sense of humor and perspective good

ENVIRONMENT: watch around electrical equipment; REDUCE DISTRACTION; face a blank wall at times

ACTIVITY: let them choose activity, but only 2-3 choices; activites that allow get up and move around, short term, portable, 3 or less steps (copper tooling, stringing beads, sanding, finishing prefabricated wooden projects, small leather projects e.g. wristbands, coin purses). No unfocused/creative/decision-making activities like oil painting; if semi-structured, reduce choices- e.g. making a collage; No fine coordination or attention to detail. No floppy or unpredictable material like clay; activities than can be graded for attention span; GM exercises good for excess energy- dance, volleyball, exercises; time/stress/$$ management

hearing voices, seeing animals/people/lights, feeling burning or crawlling on skin, auditory most common

often assoc. with schizophrenia, organic mental disorders, substance-abuse, manic/depression

List appropriate response variables for

HALLUCINATIONS

SELF: be reassuring; help them understand; talk in calm, firm, natural, rhythmic, soothing manner; avoid sarcasm; avoid arguing; redirect

ENVIRONMENT: reduce stimulation; calm, quiet, nondistracting; encourage conversing w.others

ACTIVITIES: simple, highly structured- coloring "stained-glass" pictures, preparing lunch, wood kits, laundry, housework, music, dance, watching films, TV, cooking, eating

x NO attention to detail, fire coordination

Symptoms of Delusions

[DElusion is a wrong iDEa]

belief not based on reality;

ideas of reference

thought withdrawal/insertion

delusions of persecution

megalomania or delusions of grandeur

erotomania

somatic delusions

 delusions of misidentification

 often assoc. w. schizophrenia, bipolar, personality/eating/organic mental disorders

List appropriate response variables for

DELUSIONS

SELF: avoid discussion of delusions; redirect

ENVIRONMENT: relatively stimulating; real-life activities

ACTIVITIES: better than average verbal/cognitive skills= board games, crossword puzzles, word games, chess, computer games, dancing, writing poetry

persecutory and grandiose ideas

paranoid ideation

paranoid delusions

often assoc. w. schizophrenia

List appropriate response variable for

PARANOIA

SELF: look at world from their POV- everything is dangerous; be clear, consistent, directive, unambiguous, no arguing=they'll win, be truthful (they have extraordinatry memories); make feel more important; threatened by competition; don't let them run the show; compromise

ENVIRONMENT: stable, reliable, enoucrage to join others, watch for violence

ACTIVITIES: give controllable materials-leatherwork, wood, mental; challenge- make complex; can follow diagrams and written directions; activities must be ones the person can control; puzzles, high-level clerical tasks

anger- strong feelings of displeasure

hostility- unfriendly, threatening attitude

aggression- verbal or physical attack on person/object

often assoc. w. psychotic disorders

List appropriate response variable for

ANGER HOSTILITY AGGRESSION

SELF: be sensitive; be alert to signs- body language-tense; threatening gestures; destruction of objects; get them to talk about feelings; avoid punishment/criticism;be direct and clear; watch- may test your limits

ENVIRONMENT: may have to isolate; stand 4-5 ft away/to side; don't be alone; position yourself to the door with door open; do not touch; remove sharp objects

ACTIVITIES: large forceful motions- wedging clay, sanding a large wood project; repetitive motions- peeling potatoes; GM- dance, avoid frustration tolerance and attention to detail; no sharp tools or small, heavy, throwable objects

List appropriate response variables for

SEDUCTIVE BEHAVIOR AND SEXUAL ACTING OUT

SELF: calm, nonjudgmental, avoid physical contact

ENVIRONMENT: crowded situations is not a good idea

ACTIVITIES: GM- exercises, running, wedging clay, woodworking, volleyball, basketball, touch football, dance, swimming, cycling, weight training, aerobics, yoga

Symptoms of Cognitive Deficits:

Confusion and Impaired Memory

deficits in: orientation, alertness, concentration, attention span (distractibility, inattention), memory, comprehension, judgment, problem solving

confabulation- "making up stories" to cover up STM deficits

labile emotions- rapidly shifting from being calm and comfortable to crying or laughing uncontrollably

dressing apraxia- trouble carrying out the proper sequence of actions to get dressed

List appropriate response variable for

COGNITIVE DEFICITS

SELF: remind where they are and who you are/name tag; warm and accepting attitude; give directions; 5 Cs: calm clear concise concrete consistent

ENVIRONMENT: maximize safety; use it to cue desired beh.; need consistent and well-designed environment; large print; signs, pictographs; external memory aids; cuing devices, STRUCTURE AND ROUTINE, keep same day to day; focus on ADLs, iADLs, short walks or shopping excursions

ACTIVITIES: keep prognosis in mind; simple, structured, short-term, finished in 1day, clear and doable; no unfamiliar or complex activities

List appropriate response variables for

ATTENTION DEFICITS AND DISORGANIZATION

SELF: say name loudly; touch shoulder/arm firmly; watch gestures and grunts for pain/interest; be mater of fact, avoid making pt. feel incompetent; help them feel comfortable

ENVIRONMENT: reduce distractions, blank wall; limit the tools and supplies; classical music

ACTIVITIES: simple, well-delineated activities w. definite sequence of very few steps- mosaic tile trivets, leather coin purses, plastic-dip flowers, sewing kits, copper tooling; modify difficult steps; no creative/flexible crafts