mental health first exam
DSM V characteristics
A careful clinical history and summary of the social, psychological & biological factors needs to occur to determine a diagnosis. 1. Allows for multiple diagnoses - principal diagnosis is listed first; condition chiefly responsible for signs & symptoms that are of clinical concern at the time of admission 2. Provisional diagnosis - given when there is diagnostic uncertainty (example: inadequate history; duration of illness not yet met) 3. Each disorder is followed by a diagnostic code used for data collection and billing purposes
EI and therapeutic use of self?
EI is established as a CORE COMPETNECY for health care clinicians Associated as needed for cultural sensitivity in healthcare practice Also identified as a significant leadership attribute among businesses. More research needed to 1)measure EI constructs in persons (clinicians) and 2) effect of EI on patient care
secure attachment leads to the following traits...
Emotional flexibility Social functioning Cognitive abilities Sense of resiliency in times of trouble
insecure attachment leads to the following traits....
Emotional rigidity Difficulty in social relationships Impairments in reasoning Difficulty in understanding the mind of others Psychological vulnerability - a risk factor in the face of stressful situations
social awareness
Empathy, respect for others, and perspective taking.
universal implementation of SEL examples "call to action"
School & Community Risk & Needs Assessments Consultation with School Personnel to explore, adopt, implement Champion- Take Leadership Initiatives in Schools, Family, Community Contexts Develop policies & practices to enhance SEL- impact organizational development Be a liaison/coordinator & integrate school-family-community SEL efforts Re-evaluate existing programs to ensure maintenance & sustainability Conduct research - quality of SEL programs, evaluate formatively
Goleman's Emotional Intelligence 5 domains/quadrants
Self Awareness Self Regulation Motivation Empathy Social Skills.... zins elias model is CASELs adaptation of this
mary ainsworth's forms of insecure attachment
The insecure-avoidant child, having experienced brusque or aggressive parenting, tends to avoid close contact with people and lingers near caregivers rather than approaching them directly when faced with a threat. The insecure-ambivalent child finds exploratory play difficult, even in the absence of danger, and clings to his or her inconsistent parents. Insecure-disorganized children have parents who are emotionally absent with a parental history of abuse in their childhood. These children tend to behave in bizarre ways when threatened. According to Ainsworth, disorganization is a severe form of insecure attachment and a possible precursor of severe personality disorder and dissociative phenomena in adolescence and early adulthood. Ainswoths' stranger situation protocol - 7 steps
developmental cascades
The process by which a child's previous experiences and interactions may spread across other systems and alter his or her course of development....A phenomenon that represents the interactive effect of problems & competencies over time just like a waterfall...implications on adaptive behaviors
bowlby's prototype of anxiety
a childs sense of distress during separation is perceived and experienced as anxiety
basic features of the DSM V
descriptive approach (RARELY attempts to account for how disturbances come about, focuses on manifestations of the disorders), diagnostic criteria, systematic description - in terms of its associated features: specific age-, culture-, and gender-related features; prevalence, incidence, and risk; course; complications; predisposing factors; familial pattern; and differential diagnosis.
emotional intelligence was initially
developed by mayer and salovey in 1990; possibly a 4 quadrant model - self awareness, social awareness, self-managment, relationship skills/management/social skills
secure attachment is a process that leads to...
development of emotional competence, well being, and interpersonal skills in adulthood
Health promotion programs and services may target individuals, communities, and populations as well as policymakers. The focus of these programs is to....
enhance mental health, resiliency, and quality of life ! promotion - helping individuals to increase their control over their health , creating conditions and possibilities thru which health can be achieved
Mental Health Promotion for C&Y
enhancing abilities/skills/capacities in youth that will promote future health and well-being.
integration of DSM and ICD
fifth edition rlly tries to integrate both: is designed to correspond with the organizational arrangement of disorders planned for ICD-11. For the first time, the DSM is combined with ICD to promote a) collection of national statistics, b) design of clinical trials aimed at developing new treatments, and c) consideration of global applicability of the results by international regulatory agencies.
Barhtolomew and Horowitz working models
proposed that working models of attachment (anxiety) are comprised of 2 parts - thoughts about the self; and thoughts about others
intensive individualized services
provided for children and youth with identified mental, emotional, or behavioral disorders that LIMIT participation in needed and desired everyday activties
internalizing disorders
psychosocial problems that are manifested in a turning of the symptoms inward, as in depression or anxiety *disorders with prominent anxiety, depressive & somatic symptoms. Studies will focus on developing new therapy approaches while identifying biological markers
externalizing disorders
psychosocial problems that are manifested in a turning of the symptoms outward, as in aggression or delinquency * disorders with prominent impulsive, disruptive conduct & substance use Studies will focus on the sharing of genetic and environmental risk factors
settings to look at for MH promotion in schools
recess, cafeteria, postive behavior in school hallways, classrooms, restrooms, bus.. collab with teachers, nurses, aids,
Mental Health Prevention for C&Y
reducing risks within a person (internal) and within one's environment (external) to minimize lasting negative effects
examples of universal based promotion efforts
school wide bullying prevention, positve behavioral intervention and supports , SEL
4 styles of attachment in adults
secure anxious-preoccupied dismissive-avoidant fearful-avoidant
Sexual Abuse
sexual behavior b/t child & adult or 2 children when one is significantly older or uses coercion.
DSM IV Features
5 axes 17 classifications over 300 specific disorders (297 about)
DSM V organization
NO AXES 2 general clusters/categories - internalizing and externalizing groups - organized on a developmental and lifespan continuum beginning with early childhood to later life disorders
is it always too late to develop attachment?
NO; Studies show that security of attachment can change as relationships change so it is never too late to begin to offer children these basic elements of secure attachment.
OT distinct value in SEL
OTs are ideally trained to become advocates of SEL movement among school psychologists, counselors & educators
tier 2 MH
- targeted services - Children & youth who are at risk of having learning, emotional, or life circumstances that may lead to problem behaviors, and/or development of mental disorders. - Service provision includes both promotion (promote competencies to offset early symptoms like relaxation strategies) & prevention (reduce risk factors)!!! - OT conducts a functional behavioral assessment to determine a child's needs - Interventions include teaching healthy substitutes for problem behaviors to promote well-being and/or modifying one's environment as a preventive measure.
4 dimensions of health according to SAMHSA
(1) health (well-being and symptom management), (2) home (maintenance of a safe and stable place to live), (3) purpose (meaningful daily activities), and (4) community (relationships and social networks)
contingent communication
- A parent who notices a child's signals - A parent who makes sense of the child's signals in terms of what they mean to the child - A parent who offers a timely & effective response - Contingency is a form of joining, of communion, connecting child & parent. Leads to emotional well-being & positive sense of self
Assumptions of Attachment Theory
- An individual's interactions with their primary caregiver(s) leads to a sense of security. - An internalized secure base leads to healthy positive development of the SELF as capable and worthy of love and attention from others. - Rosenberg and McCullough (1981) assert that humans have an innate need to feel that they matter to others. This need is a powerful motivator of human behavior.
repair
- An interactive process that involves an acknowledgement of a disconnection & an attempt to reconnect: - Break in responsiveness - when child needs connection & it does not occur - Break in responsiveness - can occur when parents are distracted, tired, sick, preoccupied, setting limits, etc - Break in responsiveness - A missed opportunity for connection
reflective dialogue
- Parents who elaborate on deeper layer of child's subjective experience - Focusing on the mental processes such as thoughts, feeling, sensations, perceptions, memories, attitudes, beliefs, & intentions - Offers child the opportunity to develop "mindsight"- ability to perceive the subjective experience of others & of themselves - cornerstone of compassion
mental health is represented by a... (4)
- Positive affective or emotional state (subjective) - Positive psychological & social functioning (self acceptance, self control, self identity and fulfilling relationships, social roles) - Productive activities - Resilience in face of adversity AND ability to cope with life stressors
coherent narratives
- Story telling becomes a vital form of interpersonal communication & internal understanding -Narratives help us to "make sense" of our lives & of other people *Studies have shown that parents who have come to make sense of their own early life relationships have the highest likelihood of having children who are securely attached to them. They offer contingent communication to their children.
similarity between reactive attachment disorder and disinhibited social engagement disorders
- both result from disrupted development of normal attachment behavior/maltreatment or physical abuse - etiology is directly linked to caregiving deprivation - can also result in failure to thrive - May be a result of frequent changes in foster care - Have associated symptoms such as increased risk to gain weight as neonates, feeding difficulty & poor impulse control. - Result in higher risks of multiple psychiatric disorders, lower intelligence & more behavioral problems.
ingredients of secure attachment
- contingent communication - reflective dialogue - repair - emotional communication - coherent narratives
expanded role of mental health with childreen and youth
- mental health care now takes place in school settings more often than outpatient or hospitals - - - school setting as de facto mentla health system for children - national movement to expand services
5 areas of social emotional learning
- self awarenss - self managment - social awareness - relationship skills - responsible decision making
Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice PAPER; salient points
- throughout the lifespan - mental health as a state of well-being in which a person realizes his/her abilities, copes with the challenges of life, and is able to work and contribute to the community (however way) - OT roots in mental health/psychiatry: moral treatment movement - sought to replace the brutality and idleness of earlier treatment of disorders of the mind with attention to establishment of healthy routines and participation in meaningful occupation - Meyer and habits with psych hospitals to reconstruction hospitals - ot bridging the gap between different service models - ot skilled at analyzing the many variables that effect behavior - illuminated alternative strategies for behavioral activation and skill development - group process, therapeutic use of self - practitioners and clients collaborate to identify factors that may be barriers or supports to healthy participation in desired and necessary daily occupations - partner with peer specialists to enable recovery services and supports that build on individual strengths to enable the 4 dimensions of health identified by the SAMHSA (substance abuse and mental health services admin)
tier 1 MH
- universal system wide promotion efforts to all - systematic EBP reviews suggest a positive impact on development from the following interventions: Social Skills training to improve social-emotional functioning Play, recreation, or leisure programs to increase social skills & peer interactions Health promotion initiatives and educational programs such as stress management & health literacy (mental health literacy, yoga, mindfulness, exercise) - creating supportive social and physical environments that enjoyable and successful for all individuals
SEL is most effective when...
-taught as part of a system wide, collaborative effort -when it begins in preschool and continues thru high school - when infused and linked with academics and school curriculum - goal is infusing it in everyday activities and learning
incidence of maltreatment
1 in 5 children in USA is a victim of maltreatment according to CDC *Identification, management & tx require COLLABORATIVE efforts among practitioners, ER staff, law enforcement, attorneys, social service & MH professionals
mental health once OT was born
1917 adolf meyer: psychiatrist who introduced bio-psycho-social model to mental illness; moral tx; philosophy of OT holistic! willam rush dunton: (father of OT) medical doctor specializing in psychiatry states that occupation is as necessary to human life as food and drink eleanor clarke slagle: (mother of OT) dr meyer appointed her as the director of the first OT department and she developed her own OT intervention called "habit training" - a method of re-educating patients by substituting healthful habits for bad habits Mental hygiene movement - focused on how "idleness contributes to morbid introspection", an observed symptom of mental illness
History of mental health B4 ot
1st asylum-safe havens with gardens, staff cottages & residences on ground for persons with mental illness - pennsylvania hospital, mental hygiene, moral treatment (1800s) - FAILED bc: Lack of trained professionals, over-crowding, "questionable practices" including electroshock, lobotomies, cold sheet packs, & insulin shock therapy
list of categories of mental disorders DSM V
22 Neurodevelopmental disorders Schizophrenia Spectrum & other Psychotic Disorders Bipolar & Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive & Related Disorders Trauma & Stressor-Related Disorders Dissociative Disorders Somatic Symptom & Related Disorders Feeding & Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse-Control & Conduct Disorders Substance-Related & Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilic disorders Other Mental Disorders Medication-Induced Movement Disorders & Other Adverse Effects of Medication Other Conditions that may be a Focus of Clinical Attention
how many categories in the DSM V
22 categories of mental disorders - comprimising more than 150 discrete illnesses (reduced from DSM IV)
positive developmental experiences include
3 1. proximity seeking - need for physical closeness 2. seeking a safe haven - turning to caregivers for comfort when upset 3. formulating a secure base - following repeated experiences, children internalize the sense of security that can be used when apart from caregivers
emotional communication includes
A. Sharing & amplifying of positive emotions such as joy & excitement B. Sharing of emotion that allows a child to learn that emotions are tolerable internally & can lead to a rewarding sense of closeness interpersonally. - Negative emotions are an important opportunity to deepen a child's capacity for self-regulation & self-understanding - Leads to development of empathy & compassion
DSM IV AXES
AXIS I - all clinical disorders (Table 9-1, p 289) AXIS II - personality disorders & mental retardation (table 9-2, p,289) AXIS III - physical disorder or general medical conditions (table 9-3, p.289) AXIS IV - psychosocial & environmental stressors (table 9-4, p.290) AXIS V - GAF scale (table 9-5, p.290) global assessment of functioning - rate subjectively the social, occupational, and psychological functioning of an individual, e.g., how well one is meeting various problems-in-living.
emotional intelligence
Ability to understand feelings within oneself & others, using these feelings to guide thought & action - Mayer and salovey 1990
relationship skills
Cooperation, help seeking and providing, and communication, social skills
what is the DSM
Diagnostic and Statistical Manual of Mental Disorders - medical classification of these disorders; developed by the APA in 1844/1869....first DSM officially released in 1952
responsible decision making
Evaluation and reflection, and personal and ethical responsibility - ability to evaluate and reflect on ones behaviors
two of the first researchers to explore Bowlby's ideas.
Hazan and SHaver (1987) - Noted that the relationship between infants and caregivers and the relationship between adult romantic partners share similar features. - Example: feeling safe when the other is near; sharing close, intimate contact; feeling insecure when the other is missing; mutual fascination with the other... - argued that adult romantic relationships are like attachments just like infant and caregiver - Romantic love is a result of the attachment behavioral system, as well as the motivational systems that give rise to caregiving and sexuality.
self awareness
Identification and recognition of one's own emotions, recognition of strengths in self and others, sense of self-efficacy, and self-confidence.
self-management
Impulse control, stress management, persistence, goal setting, and motivation.
theory of attachment was originally developed by
John Bowlby (1907-1990) British psychoanalyst Attempted to understand the intense distress experienced by infants who had been separated from their parents. Mary Ainsworth (1913 - 1999) systematically studied infant-parent separations
severity of mental disorder according to DSM V
Mild - few symptoms Moderate - "in the middle" between mild & severe Severe - symptoms exceed those required to make the diagnosis In partial remission - full criteria was previously met & only some of the symptoms remain for a minimum of 6 months Full remission - no signs or symptoms are evident but it is still clinically relevant to note the disorder
AOTA's new model for mental health
PUBLIC HEALTH MODEL that considers the promotional and preventive aspects of children and youths mental health,, strengths based & systems approach (home, school, community, neighborhood)
PBIS
Positive Behavioral Interventions and Supports - broadened to promote positive behavior by considering the combined influence of multiple systems - person, classroom, school, family, community
the new paradigm in ot practice for C & Y
a strengths based, systems approach
definition of a mental disorder
a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning - associated with significant distress or disability in social, occupational, or other important activities. -An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one is NOT a mental disorder. -Socially deviant behavior (political, religious or sexual) and conflicts that are primarily between the individual and society are NOt mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
EI traits
ability to motivate oneself; persist in face of frustration, regulate one's moods, emotions, & behaviors; empathy; ability to maintain an above average level of social skills
SEL competence is highly correlated with...
academic achievement, health, & citizenship
development includes...
age related specific competencies across cognitvie, emotional, behavioral aspects
effective client therapist relationships
benefit health outcomes: healthy lifestles, behaviors, well being; results in better patient satisfaction, compliance and adherence
risk factors examples
child abuse or neglect, low income, lack of resources -- increases likelihood that mental health development will be disrupted
public health model for mental health
considers the promotional and preventive aspects of the mental health of children and youth - approaches: MH prevention, promotion, and individual intervention - services in tiers: 1 - universal promotion and prevention efforts for whole populations (can include those at risk or not); tier 2: targeted intervention - prevention and early intervention for children at risk for developing mental health challenges; tier 3 - Intensive individualized interventions (for children already identified with MH challenges or illness) diff than medical model which focuses on medical approaches that are deficit-driven - enusre the conditions in which ppl can be healthy
saying about the persistence of attachment theory?
from cradle to grave, from womb to tomb
who expanded concept of emotional intelligence?
goleman in 1995 expanded notion of EI as a multi-dimensional construct & publicized this exposure: Emotional Intelligence: Why it can matter more than IQ? EI traits: ability to motivate oneself; persist in face of frustration, regulate one's moods, emotions, & behaviors; empathy; ability to maintain an above average level of social skills
secure adults relationships are characterized by
greater longevity, trust, commitment, and interdependence; and they are more likely to use romantic partners as a secure base from which to explore the world
Neglect
hard to evaluate bc its an omission of care - what isnt seen - what isnt happening most prevalent form of abuse; failure to provide adequate care & protection
protective factors examples
healthy attachment, supportive caregivers, therapeutic services and accessibilty
psychoeducation strategy (bazyk)
helps to demystify therapy, empower the child and family, and instill hope for a positive outcome: educate child and family about the disorder including typical symptoms (thoughts and bodily reactions) causes, course of treatment, and major intervention strategies; role of therapist as "coach"; importance of "homework" to practice between session
SEL article zins and elias
i. -SEL def'n- ability to recognize and manage emotions, solve problems effectively and establish positive relationships with others ii. came from research on prevention and resilience iii. children in present day are uncertain about their daily lives and are exposed to unhealthy behaviors iv. 5 components of SEL: self awareness, social awareness, responsible decision making, self-management, relationship skills - Wang et al. found that 8 of the 11 most influential categories involved social and emotional factors (e.g., student-teacher social interactions, classroom climate, and peer groups - the FOCUS of most SEL programs is universal prevention and promotion: preventing behavior problems/maladaptiv behaviors and habits from forming by promoting social emotional competence - rather than direct intervention - charged and divided social climate inciting anxiety and fear and even hate -SEL has positive effects on academic performance, benefits physical health, improves citizenship, is demanded by employers, is essential for lifelong success, and reduces the risk of maladjustment, failed relationships, interpersonal violence, substance abuse, and unhappiness - risk and resilience perspective - 1990s after golemans emotional intelligence - The goal is to infuse SEL into ongoing activities and program delivery systems in schools and communities to make the intervention sustainable -behaviors cognition and emotion skills - sparked by emotional intelligence
emotional abuse
includes verbal assaults, exposing to domestic violence, over-pressuring in advanced expectations, encouraging or instructing a child to engage in antisocial activities
tier 3 MH
individualized intensive services -Persons have identifiable symptoms and/or disorders that directly lead to occupational disruptions - Interventions/Services target person variables (internal), Occupations (task analyses) & the Environment (modifications, adaptations) - Examples: Person - self concept; self esteem; self confidence Occupations - skill based training that increases success Environment - modifying a context; adaptive equipment recovery model focusing on enabling persons with mental health challenges through a client-centered process to live a meaningful life in the community and reach their potential
level 3 MH interventions
intensive, clinical interventions that can benefit mental problems/disorders (specific to disorder & origins of illness; includes preventing & promoting as well)
ICD
international classification of diseases - designed by WHO, official coding system in the US, ICD 10 CM came out OCT. 2014 (first in 1990s)
mental illness refers to....
intevahngeable with mental disorder - subset of the mental health continuum - refers to diagnosable psych conditions that disrupt a person's functioning - DSM V USA taxonomy of illnesses - symptoms can range from severe to mild
bart and horowitz further explained
model of anxiety self and other: like a punnet square positive positive on upper left corner, negative negative on lower left secure: high self worth, believes that others are responsive, comfortable with autonomy and in forming close relationships with others preoccupied: sense of self worth is DEPENDENT on gaining the approval and acceptance of others dismissing: overt (inflated) self view, denies feelings of self-distress, and dismisses the importance of close relationships fearful: negative self view, lakc of trust in others, subsequent apprehension about close relationships with others, high levels of distress
for SEL implementation....
need to eval schools readiness; ownership, personnel training, what instructional standards need to be established to teach SEL 2003 childrens mental health act in illinois
is mental health discrete?
no it exists on a continuum from wellbeing (flourishing) to mental illness
physical abuse
non accidental injury
what is OT's distinct value in mental health?
occupations are protective factors!!! -Meaningful and purposeful engagement in occupations is a protective factor in the prevention of mental ill health. -knowledge of the psychosocial factors impacting performance is a mainstay, core feature of ALL practice areas - the use of evidence-based meaningful activities to promote participation in everyday life. - no health without mental health - WHO - The actual "doing" of occupations is believed to be transformative, promoting adaptation, creating personal and social identities, connecting people to their communities, and enabling ongoing personal growth and development - meaningful participation in activities that result in positive emotions reslult in resilience and well being, postive self esteem, reduction in behavior probs, imporvement in social interaction
each of AOTAs mental health info sheets provide:
overview of the topic, implications for occupational therapy, and strategies for MH promotion, prevention, and intervention in a variety of settings. Each sheet also provides important references and Internet resources for further reading and resource allocation
definition of psychosis
state in which a persons mental capacity to recognize reality and communicate and relate to others is impaired, thus interfering with the persons capacity to deal with life's demands • Severe impairment of social & personal functioning • Ego regression • Grossly impaired in reality testing • Presence of delusions and/or hallucinations without insight Does not apply to minor distortions re:judgment
MH promotion
strategies for optimizing mental health; enhancing competence in valued roles and activities, building strengths and resources, enhancing skills, abilities, and capacities to promote future health and well being, improving the social, physical, and economic environments that determine the mental health of individuals and populations
MH intervention
strategies to diminish or end the effects of an identified mental health problem after the problem has been identified - also critical to promote and optimize positive mental health!
competencies =
successful completion of developmental tasks buildign a psitive foundation for facing future challenges
level 2 MH interventions
targeted interventions that can benefit at risk children/youth (prevention driven)
the emphasis with attachment theory is on
the CONTEXT - applies to all around early development and the impact of attachment of the infant - how you develop relating to yourself and to other people
social emotional learning according to CASEL
the process through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions - regulate behavior based on thoughtful decision making (thinking about their feelings, how one should act) - emotional and social skills must be developed to prevent feelings from hijacking thoughts and actions
MH prevention
traditionally focused on reducing the incidence and seriousness of problem behaviors and mental health disorders - now reducing risk factors (strategies to reduce mental health problems before identification of a specific mental health problem ), minimizing mental health problems by enhancing protective factors as well (social and emotional competencies, clear standards for bheavior)
level 1 MH interventions
universal approaches that can benefit the whole population (promotion driven)
definition of neurosis
• Chronic & recurrent nonpsychotic disorder • Characterized mainly by anxiety • Appears as a symptom • Expressed thru defense mechanisms • Ego dystonic • Relatively enduring or recurrent without treatment • Intact reality testing & personality organization • Can impact or impair life & functioning level • Of no organic etiology • Examples: anxiety disorders, dysthymia, cyclothymia, somatoform disorders
purpose of the DSM
• Set criteria that can distinguish one psychiatric diagnosis from another • Give a common language among practitioners • Reliable diagnoses are essential for guiding intervention, prevalence statistics, clinical research and documenting public health information • Criteria is concise & explicit to facilitate objective assessment of symptoms in a variety of settings (inpt, outpt, partial hospital, primary care, private practice, community)
