NR320: Mental Health: Exam 3 / NR 320 Exam 3 Study Guide: Mental Health

NR320: Mental Health: Exam 3 / NR 320 Exam 3 Study Guide: Mental Health Chapter 32: Eating Disorders • Concept of Eating Disorders:patient experiences severe disruption in normal eating and disturbance in perception of body shape/weight o Co-Morbidities:  Depression  Social phobias  OCD  Mood and anxiety disorders  Substance abuse  Personality disorders  Most common is hx of sexual abuse o Female relatives of individuals with eating disorders have 12 times more likely at risk o Nursing Communication Guidelines for Patients with Eating Disorders:  Long-term tx with individual, group and family therapy  Avoid authoritarianism and assumptions of parental role  Build therapeutic alliance  Frequently acknowledge pts difficulty with goal of gaining weight  Address underlying emotions of anxiety, depression, low self-esteem, and feelings of lack of control o Causes of Eating Disorders:  Family issues  Conflicts among parents  Divorce  Depression  Perfectionist  Low self-esteem: doubts about self-worth, harsh self-judgment based on issue of weight  Misunderstood  Sexual abuse: want to keep childlike body, afraid of sexual maturity  Neglect  Social anxiety  A tendency toward perfectionism  Inflexible thinking – all or nothing thinking  Fear of losing control o Understanding Eating Disorders:  Do not concentrate on food – Eating disorders are EMOTIONAL PROBLEMS  Attempt to control, hide, avoid & forget pain, stress & self-hate  Most prevalent in industrialized societies where thinness is considered the attractive ideal • Anorexia Nervosa: begins around puberty and involves extreme weight loss o Diagnosis is made from:  A refusal to maintain a normal body weight - Dropping below 15% ideal body weight  Absence of menstruation for at least 3 months  Distorted view of body size, shape and weight  Intense fear of gaining weight  Disturbed body image (believing one is fat despite emancipation) o Anorexic Thinking:  Need for control  Food rituals  Preoccupied with weight& shape  Restrict eating  See themselves as fat  Withdrawn socially o Signs & Symptoms: Anorexia Nervosa  Cachectic: muscle wasting  Lanugo: soft hair growth over body (r/t inadequate protein in diet)  Mottled cool skin  Dehydration  Thin, brittle hair  Dry broken out skin that is gray or yellowed  Dental problems and gum disease  Feeling cold much of the time  Depression, isolation, loneliness  Insomnia o Physical Complications: Anorexia Nervosa  Vital sign abnormalities ( BP)  Electrolyte imbalances  Osteoporosis  Abnormal thyroid function  Cardiac abnormalities (irregular HR)  Fatty degeneration of liver, elevated cholesterol  Kidney infection & failure (Hematuria&Proteinuria) o Nursing Process: Anorexia Assessment Guidelines  Determine if medial/psychiatric condition warrants hospitalization (appropriate testing important)  Severe hypothermia, bradycardia, hypotension, hypokalemia, cardiac abnormalities  Weight loss more than 30% over 6 months  Suicidal of self-mutilating behaviors  Severe depression or psychosis  Emotional problems  Chaotic family relationships o Treatment: Anorexia Nervosa  RefeedingSyndrome: emergency status causing cardiac collapse and possible death  Generally treat on an outpatient basis unless a medical emergency occurs  Patient will usually fight the tx because they fear gaining weight and losing control  Can be manipulative and will lie to avoid exposure that they are not eating  Family MUST be a part of the recovery process for support  CBT, group therapy, family therapy and medication for depression • Bulimia Nervosa o Diagnosis is made from:  Assessment and the history of behaviors  Recurrent episodes of binge eating followed by self-induced vomiting, misuse of laxatives or diuretics  Behaviors are designed to prevent weight gain – not necessarily to lose weight  Patient will often be at normal or near normal weight so diagnosis is usually made off of patient history and behaviors o Characteristics: Bulimia Nervosa  Being a “people pleaser”  Low self-esteem  Depression, isolation and loneliness  Preoccupation with food; hoarding, hiding or stealing food o Physical Complications:  Upset stomach  Burning throat (acid reflux)  Worn tooth enamel  Purging removes electrolytes: low electrolytes cause cardiac arrhythmias  Muscle spasms  Dehydration  Parotid gland enlargement: largest salivary gland  Esophageal tears  Russell’s sign: callus on knuckles from self-induced vomiting  Dry skin and hair; hair loss o Treatment for Bulimia:  Medical stabilization is a priority b/c of the altered fluid balance and cardiac functioning  Patient is usually a lot more cooperative with tx due to the shame and humiliation of binging and purging  Family support and education  CBT  Medications to treat depression • Binge Eating Disorder: repeatedly go on large binges, uncontrollably consuming large quantities of food in short periods of time and eating until they are uncomfortably full o Diagnosis is made from:  Eating large amounts of food at first to comfort emotions  Eating when not hungry  Fuels guilt for over eating  Uses guilt about eating to avoid other feelings  Repeated episodes of binge eating even after experiencing significant distress  Compulsive overeating  Usually depression motivated o Treatment: Binge Eating Disorder  CBT to restructure thought processes  Medications for depression o Characteristics: Binge Eating  Lack of control over eating during the episode  Eat rapidly and eating until uncomfortably full  Eating alone - Being ashamed to be seen eating  Eating numbs feelings, relieves tension and other emotional states  Difficult expressing feelings  Low self-esteem o Physical Complications of Binge Eating:  Diabetes (blood sugar problems)  Heart disease, Stroke ( BP,  cholesterol)  Obesity Chapter 34: Personality Disorders Personality: refers to the unique traits, characteristics and behaviors that define an individual from another individual. It refers to the mental aspects of the individual in contrast to the physical. It is the style of how one deals with the world. Personality Disorder: refers to an individual using coping methods in an inappropriate or maladaptive way to everyday occurrences. These maladaptive behaviors are what expose a Personality Disorder. • Personality Disorders o Classified by the DSM-IV-TR as Axis II diagnoses o Some Common Characteristics of Personality Disorders (PD) are:  Patients with a diagnosis of PD usually exhibit odd or eccentric behaviors  Their behaviors are usually inflexible and maladaptive when responding to a stressor  Individuals with PD assume that everyone thinks and functions as they do and do not recognize their odd behaviors as a problem  Because individuals with PD do not recognize their behaviors as a problem it greatly affects how they relate to society and they often cannot maintain relationships or jobs  Have a tendency to “get under the skin” of others which can bring on undesirable results. They blur boundaries of interaction and evoke intense interpersonal conflict  PD often exists as a co-occurring disorder with Axis-I diagnoses. It is often missed or misdiagnosed when occurring by itself  Hereditary, environmental and developmental events are believed to influence the incidence of PDs as well as childhood traumas, abuse and neglect o Careful and comprehensive assessments need to be done with these patients to rule out any medical cause for the erratic behaviors o HC workers need to constantly assess their own feelings when dealing with this population o Individuals with PD are often successful at confusing, frustrating and splitting staff o HC team needs to stay united in tx o Treatment: PDs  No cure, No meds  CBT  Psychodynamic therapy (talk therapy)  Work toward insight development and help patient to recognize faulty thinking • Types & Causes of Personality Disorders (PDs): o Cluster A: odd or eccentric behaviors  Paranoid PD  Based in mistrust  Difficult trusting other people  Concern that people have hidden motives  Always consumed with the idea that they are going to get hurt by another person  Inability to collaborate  Poor self-image  Social isolation  Detachment  hostility  Schizoid PD  Extreme shyness - isolative  Cannot interact with other people  Do not want any attention on them  Does not desire nor enjoy close relationships even with family members  Avoid social activities that involve significant interpersonal contact  Appear aloof and detached  Fixated on personal fantasies and thought  Schizotypal PD  Bizarre, weird, eccentric  Discomfort in social situations  Odd beliefs and fantasies or preoccupations, magical thinking  Odd behaviors or appearance  Odd speech  No close friends  Inappropriate displays of feelings  Excessive or unrelieved social anxiety o Cluster B: dramatic, erratic or emotional behaviors  Histrionic PD  Always needs to be on stage, performing, dramatic  Very animated in speech  Attention seeking PD  Constant seeking of reassurance or approval  Excessive dramatics with exaggerated displays of emotions  Excessive sensitivity to criticism or disapproval  Inappropriately seductive appearance or behavior  Need to be center of attention  Low tolerance for frustration or delayed gratification  Opinions are easily influenced by others but difficult to back up with details  Tendency to believe that relationships are more intimate than they actually are (using words like always or never)  Antisocial PD  Criminal component to this PD – breaks laws repeatedly  Lack of having a conscious  Lies, steals and fights often  Disregards safety of self and others  Take advantage of other people  have no moral compass  Extremely manipulative and adept at flattery  Develop a witt& charm to help them get out of predicaments  Borderline PD  Most common PD  Based in abandonment (divorce, death, abuse)  Learn how to develop love/hate relationships – A need to push away others 1st  Will result in self-injury to snag a person back into the relationship  Frequent displays of inappropriate anger  Recurrent acts of crisis as self-mutilation and over dosing  Feelings of emptiness and boredom  Intolerance of being alone  Impulsiveness with money, substance abuse, sexual relationships, binge eating, shoplifting  Narcissistic PD  Feeling of self-importance  They are the most important people in the world  They are the only one that matters  Reacts with rage, shame or humiliation to criticism  Takes advantage of others to achieve own goals  Has feelings of self-importance  Requires constant attention and admiration  Exaggerates achievements and talents  Preoccupied with fantasies of success, power, beauty, intelligence or ideal love  Has unreasonable expectations of favorable treatment  Lacks empathy o Cluster C: anxious or fearful behaviors  Avoidant PD  Shyness – can be in relationships but cannot initiate anything – Followers  Be easily hurt by criticism and exaggerate potential difficulties  Slow excessive restraint in intimate relationships  Be reluctant to become involved with people  Be shy in social situations out of fear of doing something wrong  Avoid activities or occupations that involve contact with others  Dependent PD  Involved with antisocial PDs  Need attention so bad they are willing to be with someone who abuses them  Need guidance, supervision, clingy  Have difficulties making decisions without reassurance from others  Have problems expressing disagreements with others  Avoid personal responsibility  Avoid being alone  Feel devastated or helpless when relationships end  Be unable to meet ordinary demands of life  Become preoccupied with fear of being abandoned  Be easily hurt by criticism  Obsessive-Compulsive PD  Based in perfectionism  Difficult to enjoy life b/c they are extremely consumed with rules  Money is a very controlled issue  Inflexibility  Preoccupation with details, rules and lists  Reluctance to allow others to do things for them  Excessive devotion to work  Restricted affection of affection  Lack of generosity  Inability to throw things away even when objects have no value Chapter 25: Addictive Disorders • Substance Use Disorders Abuse: use of substance that falls outside of medical necessity, resulting in adverse effects to user and others Dependence (Addiction): occurs when tolerance to drug occurs and amounts need to increase to avoid withdrawal. Continued use despite negative consequences Tolerance: need for increasingly larger or more frequent doses to achieve the desired effects originally produced by a lower dose Intoxication: reversible substance specific syndrome caused by recent ingestion of a substance, characterized by behavior and cognitive changes Withdrawal: development of maladaptive behavior and cognitive changes due to stopping the use of the substance • Factors Contributing to Substance Abuse o Genetics o Biochemical changes in the brain after use of the substances o Addictive personality o Learned Theory or Role Modeling o Conditioning: b/c drug effects are so pleasurable individual wants to keep doing it • Assessment Tools o Self-assessments for the health personnel o B/C substance abusers usually have a skewed idea of how much they use - assessment tools become necessary o Physical observation o Lab testing o Drug History & Assessment o CIWA Scale for Assessment of Alcohol Withdrawal o Michigan Alcoholism Screening Test o The CAGE Questionnaire (self-assessment) • Operational Definition of Addiction: The 3 Cs o Behavior motivated by emotions ranging along lines of Craving to Compulsive spectrum o Continued used despite adverse consequences to health, mental status, relationships, occupation and finances o Loss of Control • How Substances Work in the Brain o Dopamine is a neurotransmitter that plays a major role in addiction  It regulates motivation, emotion, cognition and ability to experience pleasure and pain  Dopamine is released into the synapse, crosses over to the next neuron and binds to that neuron’s dopamine receptor  That binding gives intense feelings of pleasure  As a result of the flood of dopamine the neurons try to regulate the levels of dopamine in the brain by producing less o The reduced amount of dopamine is not enough to stimulate the limbic system so the person has to use more drugs to get the dopamine levels up in order to feel normal • Common Concerns of Addicts o Concerned about being rejected o May be anxious about recovering b/c will no longer use substances they feel they need to survive o Concerned about failure to recover • Defense Mechanisms of Addicts o Denial o Projection (scapegoating another reason) o Rationalization o Passivity o Manipulation (very manipulative, do what they can to get what they want) • Communication Guidelines o Accepting, nonjudgmental approach important for therapeutic relationship o “Intervention” for resistant addict may be used to help patient willingly engage in treatment • Treatment o Focus is always relapse prevention  Psychotherapy  Group therapy  Methadone maintenance  MISA (mentally ill substance abusers) programs  Family/Client Education (PG 497)  Self-help groups for patient and family  AA (alcoholics anonymous)  Al-Anon and Alateen for family members • Book Resources: PG 466: Sedative, Hypnotic & Anxiolytic Drugs PG 469: CNS Stimulants PG 471: Common Sources of Caffeine PG 474: Opioids & Related Substances PG 477: Hallucinogens PG 479: Cannabinoids PG 482-483: Psychoactive Substances Summary PG 484-485: Symptoms Associated with Intoxication and W/D PG 487: Drug History & Assessment PG 487-488: CIWA Scale for Assessment of Alcohol Withdrawal PG 489: Michigan Alcoholism Screening Test PG 489: The CAGE Questionnaire PG 491: Nursing Dx PG 500-501: Twelve Steps for AA PG 502: Addiction Self Help Groups Chapter 30: Somatoform & Dissociative Disorders • Both Somatoform and Dissociative Disorders are anxiety response disorders o They occur when the anxiety becomes overwhelming and the person becomes either cognitively disorganized or their personality becomes disordered • Definitions of Somatoform o Somatoform Disorders: a group of disorders with unexplained physical symptoms that have no organic basis  The symptoms are usually immeasurable and improvable  Individuals do not perceive themselves as having a psychiatric disorder and therefore will not seek or will resist treatment  As a result will “doctor shop” to find the cause b/c they are truly perceiving the discomfort o Examples:  Munchhausen  Munchhausen by Proxy • Predisposing Factors o Genetic o Biochemical: decreased levels of serotonin o Psychodynamic: inconsistent parenting in this phase leads to low self-esteem and adult narcissistic focus on body symptoms o Learning and Socio-Cultural-Symptoms that are reinforced by parental attention recur later and child learns the benefit of the sick role • Somatization Disorder o Diagnosis requires certain number of immeasurable symptoms accompanied by functional impairment o Pain: head, chest, back, abdomen and joints o GI symptoms: dysphagia, nausea, constipation o Cardiovascular symptoms: palpitations, SOB, dizziness • Pain Disorder o Severe and prolonged pain that causes clinically significant distress or impairment in social, occupational or other areas of functioning o Diagnosed when testing rules out organic cause for pain and discomfort o Typical sites for pain: head, lower back, abdomen, and joints o Huge risk for substance abuse o Psychological implications are the patient will experience secondary gains • Hypochondriasis o Unrealistic or inaccurate interpretation of physical symptoms or sensations leading to preoccupation and fear of having a serious disease o Individual cannot be reassured by negative physical findings and seek extensive medical care b/c of their belief o Will not see a psychiatrist b/c they are convinced that there is a medical origin • Conversion Disorder o Symptoms that affect voluntary motor or sensory function suggesting a physical condition o Usually occurs after a situation produces extreme psychological stress o Once the symptoms appear the individual will show a lack of concern “La Belle Indifference” and is usually a clue that this is psychological and not physical o Common symptoms include:  Involuntary movements  Seizures  Paralysis  Abnormal gait  Blindness • Body Dysmorphic Disorder (BDD) o Exaggerated belief that the body is deformed or defective in some specific way o This disorder is often characterized as a delusional disorder o Presence of significant impairment in function o Typical characteristics include:  obsessive thinking and compulsive behavior  mirror checking and camouflaging  feelings of shame  withdrawal from others • Communication Guidelines o True somatoform symptoms are not under the individual’s voluntary control o The patient cannot see the impact of the behaviors and often suffer extreme anguish o Take symptoms seriously o After physical complain investigated, avoid further reinforcement o Shift focus from somatic complaints to feelings o Patients have difficulty articulating feelings so they use somatic complaints to communicate o Use matter of fact approach to patient resistance or anger o Avoid fostering dependence o Teach assertive communication • Dissociative Disorders o Non Pathological Dissociation: mind is not attached to body signals  Examples: daydreaming, driving without remembering o Pathological Dissociation: altered mind-body connections associated with stress and anxiety  Unconscious defense mechanisms to protect the Ego against overwhelming anxiety  Results in alteration in functions of identity, memory and consciousness • Predisposing Factors o Genetics: more common in first degree relatives o Neurobiological:  Limbic system involvement where traumatic memories are processed  Hippocampus smaller than normal o Brain tumors, epilepsy o Psychological trauma: overwhelms the individual’s ability to cope  Learned method for avoidance of stress and anxiety • Types of Dissociative Disorders o There are 4 Types of DDs recognized by DSM-IV:  Dissociative Amnesia  Dissociative Fugue  Dissociative Identity Disorder  Depersonalization Disorder • Dissociative Amnesia (DA) o Inability to recall personal information usually of traumatic or stressful nature often occurring after traumatice event o Types of Amnesia  Generalized: inability to recall entire lifetime  Localized: inability to remember all events in certain periods of time  Selective: some but not all events recalled • Dissociative Fugue o Sudden, unexpected travel away from home and inability to recall one’s identity or information about one’s past o Since individual cannot recall personal information may assume a new identity o Precipitated by traumatic event • Dissociative Identity Disorder (DID) o Presence of two or more distinct personality states that take control of behavior  Alter has its own pattern of thinking, perceiving and relating  Core personality is unaware of others  Can be non-human like animals, robots or aliens o Precipitated by severe sexual, physical, or psychological trauma o Signs of DID:  Finding unfamiliar clothes in closet  Being called an unfamiliar name by strangers  Periods of lost time (most token characteristic) • Depersonalization Disorder o Persistent experiences of feeling detached from the body o Person feels mechanical or in a dream o Can be precipitated by severe acute stress or childhood emotional abuse • Treatment o Most of the time treatment occurs in the outpatient setting unless there is an emergent issue  CBT  Psycho-education  Journaling  Recreational therapy  Group therapy  Psychopharmacology Book Resources PG 672: Diagnostic Criteria for Somatization Disorders PG 673: Diagnostic Criteria for Pain Disorder PG 674: Diagnostic Criteria for Hypochondriasis PG 675: Diagnostic Criteria for Conversion Disorder PG 675: Diagnostic Criteria for Body Dysmorphic Disorder PG 678: Diagnostic Criteria for Dissociative Amnesia PG 679: Diagnostic Criteria for Dissociative Fugue PG 680: Diagnostic Criteria for Dissociative Identity Disorder PG 680: Diagnostic Criteria for Depersonalization Disorder PG 684: Nursing Dx Chapter 39: Grief and Loss • Stages of Grief o Denial o Anger o Bargaining o Depression o Acceptance • Types of Loss o Death, divorce or separation o Removed from the home to foster home o Maturational changes like aging (empty nest syndrome) o Debilitating disease, their future o Parental loss such as going to jail or murder • Concept of Grief and Loss o Grief is mental and emotion anguish that is a response to loss of something significant o Grief is a universal reaction however the way it is expressed is culturally determined  It involves stress, pain, suffering and impairment in functioning that can last days, weeks or months o Normal Reactions:  shock  denial  anger  depressed mood  insomnia  anxiety  poor appetite  guilt  anhedonia  bad dreams  poor concentration • Severity of Grief o Grief process is a subjective experience therefore there are no time guidelines o Many variants on how intense will be such as:  How dependent the individual was on the deceased  Other losses at the same time (natural disasters)  Unexpected or shocking death (car accident)  Lack of support system • Maladaptive Responses to Loss o Delayed or Inhibited: can be potentially dangerous b/c feelings can turn into a depression. As a result can delay the individual from returning to a satisfying life o Distorted (Exaggerated): d/t the grieving experience being exaggerated may cause the individual to become dysfunctional in daily living activities o Chronic/Prolonged: maintaining rituals for the lost one as if they were still there long after the grieving process is over • Concept of Grief and Loss o Disenfranchised Grief  Loss that is not congruent with socially sanctioned and recognized role  People who are unable to openly grieve b/c it is not acceptable in society • Assessment Guidelines o Access for:  Lack of expression of grief: if they are not grieving it can turn into depression or suicidality  Be aware of cultural beliefs, responses and rituals  Support systems • Interventions for Helping People in Acute Grief o Remain fully present; use eye contact, attentive listening, and appropriate touch o Be patient with silence; do not attempt to fill o Encourage support from family and friends o Offer spiritual support and referrals when needed o Be supportive when intense emotions expressed • Communication Guidelines o Listen actively without interrupting o Use prompts like “go on…” o Do not offer banal advice or philosophical statements o Helpful responses include:  “His death will be a terrible loss”  “No one can replace your loved one” • Book Resources PG 946: Normal Grief Reactions vs Depression PG 799: Normal Grief Reactions vs Clinical Depression Chapter 35: Older Adults • Geropsychiatry o Practice specializing in the psychopathology of the elderly o The future will see an increase in mentally ill geriatric population o The role of the geropsych nurse will include case management and advanced nurse practice such as prescribing meds o Assessment Components:  Verbal interview  Mental status  Behavioral responses  Functional abilities  Physiological functioning  Social support • Psychiatric Disorders in Elderly o Dementia o Delirium o Depression o Schizophrenia o Anxiety • Ageism: bias against older people because of their age and represents dislike by the young of the old o Health care personnel not immune to ageism o Older adults receive less information about their health care and less care than younger adults o Communication  Avoid “elderspeak”  Talking to patients as if they were children  Terms of endearment….honey, sweetie  Elderspeak conveys that older adult is incompetent and inferior • Suicide o Older individuals in the US have the highest suicide rate of any age group o The leading cause of suicide is depression o Factors associated with suicide:  Hopelessness  Uselessness  Despair o Viewed as final gesture of control in situations • Depression o Manifest in older adults as:  Changes in sleep pattern (insomnia)  Changes in appetite  Anhedonia (loss of pleasure)  Anergia (loss of energy)  Increased concern with body function (bowel movements) o Factors for Depression  Medical illness  Functional disability  Social isolation  Accumulation of life stressors  Losses  Medications o Treatment  Therapeutic milieu  Cognitive stimulation  Consistent physical layout  Structured routine  Provision of safety  Reminiscence therapy • Book Resources PG 849 Reminiscence Therapy PG 849 Expressive Therapy Chapter 23: Children and Adolescents (0-17) • Emotional Problems vs. Mental Illness o The statistics for mental illness are lower in the children and adolescent population o Mental illness usually shows symptoms in late teens or early adulthood o The children and adolescent population will exhibit more emotional and/or behavioral problems • Mental Health Assessment of Children o Mental Status Assessment  Provides information about problems in thinking, feeling, and behaving o Developmental Assessment  Information about a child’s current maturational level compared with chronological age as well as identifying developmental deficits o Pervasive Developmental Disorder  All encompassing, all enveloping  Severe, impaired social interaction and communication skills, accompanied by stereotyped behavior  3 Types:  Mental Retardation  Autism  Asperger’s Syndrome • Mental Retardation (MR) o Deficits in general intellectual and adaptive functioning o Weak intellectual development impairs:  Learning  Functioning  Communication  Interpersonal skills  Social adjustment o Degree of mental retardation assessed by IQ testing: Mild, Moderate, Severe, Profound o Depending on the degree of severity focus should always be on improving quality of life o There are 5 major pre-disposing factors that may contribute to or cause MR:  Hereditary  Early alterations in embryonic development.  Pregnancy and perinatal factors (infections, malnutrition)  General medical conditions acquired in during infancy (infections, trauma)  Environmental influences (deprivation of nurturance) • Autism o Autism-visually observed before 3 years characterized by a withdrawal of the child into the self and into a fantasy world of his/her own creation o Impairment in communication and imaginative play, lack of responsiveness and interest in others o May show an aversion to affection or not develop attachments to significant adult o Minor changes can precipitate resistance or hysterical responses • Asperger’s Syndrome o Similar to autistic disorder, with later onset and less severe symptoms o Children often have normal intelligence o Inappropriate social skills o Tendency to be concrete in interpretation of language o Tend to be inflexible with ADLs o Can exhibit savant syndrome o Pre-disposing Factors:Asperger’s Syndrome  Genetic  Neurological-several abnormalities in brain structure, neurotransmitters and functions  Perinatal influences-research is supporting that mothers who have asthma during pregnancy have a higher chance at producing a child with autism • ADHD o Characteristics: (must meet all three components)  (1) Inattention: difficulty paying attention to task at hand, easily distracted  (2) Hyperactivity: fidgets, runs, talks excessively  (3) Impulsivity: blurts out answers before question is finished, has difficulty waiting one’s turn, interrupts and intrudes on others conversations or games o Theories:  Genetics  Biochemical/bioanatomical  Prenatal, perinatal, and postnatal influences  Environmental-exposed to high levels of lead, food dyes  ADHD difficult to diagnose before age 4 because behaviors are normal for age group o Meds for ADHD:  Psychostimulants: Ritalin, Daytrana, Concerta  Part of the frontal lobe that is sluggish causing hyperactivity  Stimulants activate that lobe area therefore regulating activity • Mood Disorders o Symptoms:  be self-critical  sadness  pessimism  anhedonia  social withdrawal  irritability  aggressiveness  suicidal ideation  Children more likely to exhibit somatic complaints o Behaviors:  risk taking behaviors  drugs  ETOH  running away  truancy  misuse of sex  dropping out of school  pregnancy • Disruptive Behavior Disorders o Conduct Disorders  Persistent pattern of behavior in which rights of others and age-appropriate societal norms or rules are violate  Aggression towards people and animals, destruction of property, deceitfulness or theft  Lacks feelings of guilt or remorse  If this continues into adulthood will turn into antisocial personality d/o  They don’t see themselves as defiant but instead are responding to unfair conditions therefore projection is a common defense mechanism o Oppositional Defiant Disorder  Persistent stubbornness, argumentativeness, fighting, disobedience, testing of limits, running away, truancy, unwilling to negotiate and refusal to accept blame  Cannot maintain friendships  Recurrent pattern of negativistic and defiant behavior toward authority figures without seriously violating rights of others  They don’t see themselves as oppositional but responding to unreasonable demands • Tourette’s Syndrome o Neurological disorder that causes marked distress and significant impairment in social and occupational functions characterized by motor and verbal tics exacerbated by stress o Age of onset can be as early as 2 years but most often around 6-7 years o Symptoms can diminish as the person ages • Book Resources PG 378 MR Degrees of Severity PG 383 Diagnostic Criteria for Autism PG 389-390 Diagnostic Criteria for ADHD PG 400 Diagnostic Criteria for CD PG 404 Diagnostic Criteria for ODD Chapters 31 & 33: Sexual & Impulse Control Disorders • Concepts o Adults are considered the age group of 18-60 and have many issues regarding their mental illness experience  Barriers to Recovery  Sexual Disorders  Impulse Control Disorders  Adult ADHD o Treatment Options  Mental Health Centers  Partial Hospitalizations  Residential Centers  Psychiatric Home Health Care  Shelters  Self Help Groups  Psychopharmacology  Case Management • Barriers to Recovery o Medications side effects which may cause individual to become non-compliant o Patient feels shame, anger and isolation o Unemployment, poverty, housing instability, victimization o Treatment mandated by the court causing treatment resistance and non-compliance o Stigma, loneliness and perceptions that patients are less than human or dangerous o Anosognosia: because the brain is sick the patient can’t recognize that the brain is sick o Substance abuse • Sexual Disorders o Paraphilias: preoccupation with sexual fantasies and related sexual urges focusing on socially unacceptable “targets”  These behaviors are recurrent over a period of at least 6 months and cause the individual or recipient significant distress or impairment in functioning  Types of Paraphilias:  Exhibitionism: deriving sexual pleasure by exposing genitalia to unsuspecting strangers. They usually have rewarding relationships but are still compelled to do this  Fetishism: use of nonliving objects for sexual gratification. To be without these objects may render individual impotent  Transvestic fetishism: dressing as person of opposite sex  Frotteurism: touching/rubbing against non-consenting person usually in crowded places  Pedophilia: fantasized or actual sexual activity with child  Sexual Masochism/Sadism: satisfaction from receiving/giving abuse  Voyeurism: observing unsuspecting person in sexually arousing situations  Response of the Aggressor  Most individuals with paraphilias deny that they have a problem and seek help only when their behavior has come to the attention of others  Some individuals are so ashamed or humiliated by their “needs” that it may exacerbate into a dangerous situation for the aggressor or victim o Gender Identity Disorder  Gender Identity Disorder or Transsexualism: despite having the anatomical characteristics of a given gender the individual has the self-perception of being the opposite gender  May begin to identify with the opposite sex to include changing their appearance and personality to match what they feel is their true identity  Debate as to whether this is really a mental illness o Sexual Disorders Treatments  Cognitive Behavioral Therapy  Systematic Desensitization  Aversion Therapy • Impulse Control Disorders (ICDs) o Failure to resist an impulse to perform an act that is harmful to themselves or others o They usually experience and increased amount of tension or anxiety prior to the act o Then experience pleasure, gratification or relief of the anxiety after committing the act o Types of ICDs  Intermittent Explosive Disorder: aggressive act is greatly out of proportion to the precipitating event and the individual is usually not an aggressive individual outside of these episodes  Kleptomania: repeated stealing of unneeded items which are then usually thrown away, discarded or quietly returned  Pathological Gambling: persistent, recurrent maladaptive gambling behavior despite negative consequences  Pyromania: repeated fire-setting – purposeful but does not have criminal motive  Trichotillomania: mindless pulling out of one’s hair resulting in noticeable hair loss in order to relieve tension • Adult ADHD o Incidence in adults is not well established due to poor reporting o Contributes to wide variety of interpersonal, social, academic and vocational problems negatively affecting health and socioeconomic achievement o Persistent pattern of inattention, impaired ability to focus and concentrate, hyperactivity, impulsivity that is not age appropriate • Book Resources PG 770: Diagnostic Criteria for IED PG 771: Diagnostic Criteria for Kleptomania PG 772: Diagnostic Criteria for Pathological Gambling PG 773: Diagnostic Criteria for Pyromania PG 774: Diagnostic Criteria for Trichotillomania