Adult and Geriatrics

Adult and Geriatrics

Dx / Description and Manifestation / Assoc. dx / Key elements of therapeutic approach / Key elements to therapeutic environment / Sample activities / Performance patterns
Anxiety / State of tension and uneasiness that the ego is unable to resolve
Everyone can control their anxiety but some people cannot control / Found in almost every dx
Psychopaths and criminals do not experience anxiety / Allow them to express themselves
Concentrate on productive activities
Help them learn how to express themselves
Listen to their fears
Redirect their attention to a neutral topic
Different responses are needed for different pts. / Calm, comfortable
Decrease amount of people
Schedule of activities
Give a tour of the therapy
Help them feel secure / Yoga
Progressive relaxation
Journaling with structure- helps to see antecedents
Just right challenge
Guide pts. to choose activities
Simple cooking tasks
Response:
Ritualistic: never criticize
Phobic: encourage pts. To talk about fears
Intrusive: reassure you will be available
Depression / Feeling intense sadness, despair, and hopelessness
Occasionally affects most people
Most people recover
Feel hopeless and helpless
Possibly worthless and guilty / Wide range of d/o
Primary sx of affective (mood) d/o
Schizophrenia
Most personality d/o
Normal response to loss, and adjustment / Allow the pt. to talk about themselves
Avoid being overly protective/helpful
Reinforce personal appearance
Avoid too many choices
Do not over plan
Recognize negative feeling
Notify staff of suicidal ideation / Decrease any stimulus
Increase opportunity for decision
Forced choice*
Calming – constant worry
Match tempo- speak slowly, softly and matter of fact
Avoid being overprotective
Show decrease in depressive sx / Thought and behavior chart
Replace harmful thoughts with positive thoughts
Incorporating relaxation or tai chi or yoga
Decrease stress
Painting by numbers- with raised lines
Gross motor activity- improve depression
Sleep hygiene
Like to do things for others
Mania / Disturbance in mood
Excessively happy
Operating at a higher speed / Be cautious on giving criticism
Be firm, consistent
Reinforce limits
Behaviors are caused by dx and/or meds
Be aware of flattery- control they will try to gain control or manipulate you / Work alone
Decrease stimulus / Exercise bike
Gross motor activities
Structured activities
Making a sandwich
Soccer- sport activity
Hallucinations / Sensory experience that doess NOT correspond to external reality
Appear as sight, hear, feel, smell, or tastes things that aren’t there
Arise from a temporary or permanent deficit in the brain function / Wide range of psychiatric d/o
Schizophrenia
Manic and depressive psychoses
Organic mental d/o
Substance abuse d/o / Help understand what is happening
Communicate in calm, clear, firm, natural, rhythmic, soothing, manner
Keep person in reality
Mtn. personal space
“how very interesting, tell me more about it.” / Remove external stimulating environment
Keep alone but not permanently
Move to less overwhelming area / Karaoke
Songs that people should know
Make a pizza- premade dough and put toppings on that they want
Stimulating other sensations
Play Wii
Age involvement with other trusted people
Use bright colors
Delusions / Wrong idea
A belief that is contrary to reality as experienced by others in a cultural group
Belief NOT based in reality
Beliefs: ideas of reference
Ie. The FBI is taking thoughts from you
Inaccurate thought
May give clues to the pt.’s needs / Psychotic d/o
Schizophrenia
Bipolar (depressive or manic)
Eating d/o
Pts. with no other known psychopathology / -  avoid discussing delusions directly
-  avoid looking frustrated
-  meet them at their intellectual level
-  developing and organizing delusions / Stimulating and involve real life activities / Participate in a national weekly trivia game in order to keep up with real life/reality based
Watching and summarizing the movie
Playing cards with friends
Activities should meet the pt.’s intellectual level
Paranoia / description: type of thinking in which persecutory and grandiose ideas predominate.
manifestation: general suspiciousness and very extreme and unbelievable ideas (paranoid ideation), feel suspicious of those around them, constantly alert and concerned about whether others are harassing them, persecuting them, taking advantage, or treating them unfairly. / - paranoid schizophrenia
- psychotic depression
- borderline and narcissistic personality / - look at the world from their point of view
- avoid approaching from behind or suddenly
- do not whisper- they will think you are talking about them
- be clear, concise, directive
- avoid arguing
be truthful and do not make empty promises
- the pt. may try to make a special relationship with staff / - when in a group, let the pt. sit at a separate table but with whomever they wish
- keep the environment as stable as possible
- prepare the pt. for any changes in their environment well in advance
- maintain the same people in a group so they gradually build trust
- don't force socialization / - must be activities that the person can control, meet at intellectual level without getting competitive
-1. cooper tooling: select the design, still level of direction from the leader
- 2. relaxation techniques: guided imagery: person with paranoia writes down what people say on the board
- 3. pasta salad: planning and making: have materials listed and they make it. / - roles: participant, helper, director
- routines: standard, no surprises, know well in advance about changes, need structure
- habits: for a group, make sure set-up is consistent and people put away materials in the same spots
Anger/hostility / Man: through px or verbal violence, stiffening, destruction, sarcasm may be the beginning. Know what the px signs are- prevention is best.
Anger: strong feeling of displeasure
Hostility: unfriendly and threatening attitude directed toward others
Verbally or px abusive: expressing unmet needs / Psychotic d/o
Schizophrenia
Manic-depressive psychosis
Psychotic depression
Organic mental d/o
Some brain d/o / -  tasks sensitive to the pt.
-  get them to talk
-  use your words instead of acting out
-  speak to pt. individually
-  avoid punishing or criticizing
-  tell them how to correct behavior
-  be direct and clear about what is expected
-  / -  stay a few feet away and do not face them directly
-  stay closer to the door
-  keep door open
-  do not be alone
-  remove all weapons or potential weapons
-  stay out of person’s reach
-  no brooms or mops / - journaling
- give a feelings worksheet
- Wii for boxing
- collage
- art
- ripping magazines for pictures
- have a theme for them to follow during art
- destructive activity then constructive activity
Seductive/sexual acting out / Man: touching shoulder, loosing ties, masturbating in public, pt. à pt.
Any behavior that would normally be seen as explicitly sexual or provoking a sexual response / Usually occur in pts. who are psychotic
Assoc. with psychosexual d/o / Approach in calm, non-judgmental way, strict enforcement, explain the rules of therapy. Be clear about limits but mtn. therapeutic relationship,
Last resort: get someone else to work with them
May confuse therapeutic relationship / -  non-crowded environment
-  non judgmental
-  pt. should have personal space
-  protected form sudden touch, smell, warmth of others / -  safe sex is enforced
-  sanding, px exertion
-  no contact sports
-  gross motor activities
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