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Chapter 24

Chapter 24. Adults. Severe and persistent mental illness. 3 Categories Broad based mental illness Serious mental illness Biologically based mental illness Affects 2.6% of all adults Individuals have difficulties in performing activities, cooking, ADL, social interaction, etc

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Chapter 24

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  1. Chapter 24 Adults

  2. Severe and persistent mental illness • 3 Categories • Broad based mental illness • Serious mental illness • Biologically based mental illness • Affects 2.6% of all adults • Individuals have difficulties in performing activities, cooking, ADL, social interaction, etc • Extent of Problem • Effect on Individual • Effect on Families, Caregiver & Significant Others • Effect on Society

  3. Issues facing those with severe and persistent mental illness Successful treatment can still leave patient with residual symptoms (milder symptoms) Medication side effects: typical antipsychotics Relapse, chronicity and loss Depression and suicide Co-occurring medical illness Unemployment and poverty Housing instability Stigma Anosognosia Social isolation and loneliness/ Victimization

  4. Issues affecting the society and the individual • Involuntary treatment • Treatment mandated by court order and delivered without patients consent • Outpatient commitment: designed to provide mandatory treatment in less restrictive setting • Criminal offenses and incarceration • Transinstitutionalization: shifting of person or population from one form of institution to another

  5. Application of the nursing process • Assessment • Signs of risk to self or others, depression, hopelessness, relapse, impulsivity, psychosis • Diagnosis • Impaired adjustment, ineffective coping • Outcomes identification • See examples pg 479 • Implementation • Adaptive responses, side effects, pt goals, referrals, psycho-education • Pharmacological/Biological/Integrative • Rehab vs Recovery • Evidence Based Treatment Approaches & Services (PACT, CBT, family support, social skills training, psychotherapy, vocational rehab, advance directives, peer support, technology

  6. Impulse control disorders • Definition: Decreased ability to resist an impulse (or a drive), to perform certain acts that harmful to self or others • Theory • Biological: exact causes not clearly established, abnormalities of brain seem to reduces ones ability to resist impulses • Genetic: gene associated with impulse violence • Psychological: impaired ability to manage anxiety • Clinical Picture • Intermittent explosive behavior • Kleptomania/ Pyromania • Pathological Gambling • Trichotillomania/ Impulse Control Disorders NOS • Effect on individuals, families and society

  7. Application of the nursing process • Impulse Control Disorders • Assessment; presence is often withheld or concealed • Diagnosis; Impaired Adjustment, Anxiety • Outcomes Identification; Outcomes vary, reduce the problem acts and substitute adaptive means • Implementation; treatment strategies focus on combination of psychotherapy and medications • Psychopharmacology (medications) • SSRI, Wellbutrin, Naltrexone • Nonpharmacology • Hypotherapy, CBT, Group therapy

  8. Sexual disorders • Definition • Disorders affecting sexual function and identity • Types • Gender identity disorder (transsexualism) • Paraphilias- preoccupation with sexual fantasies and related sexual urges • Theory • Biological : cause unknown, sexual hormone abnormality • Psychological; failure to develop attachments in early childhood

  9. Sexual disorders • Clinical picture: persistent discomfort with ones present gender assignment and role and strong/persistent desire to assume characteristics of opposite or desired gender • Most paraphilias are male • Exhibitionism • Fetishism • Frotteurism • Pedophilia • Sexual masochism and sexual sadism • Transvestism/ fetishism/ voyeurism • Paraphilias NOS • Effect on individuals, families & society • Recidivism; repeating a previous offense

  10. Application of the nursing process • Sexual Disorders • Assessment • Self assessment is essential because the nurses beliefs and attitudes about these abhorrent behaviors may compromise objectivity • Written assessment questionnaires • Diagnosis; Impaired adjustment, Anxiety • Outcomes Identifications; reduce problematic acts and substituting adaptive means • Implementation • Pharmacological/Biological/Integrative • Psychotherapeutic Treatments

  11. Adult attention deficit and hyperactivity disorder • Prevalence and Comorbidity • ADHD involves persistent pattern of inattention, impaired ability to focus & concentrate or hyperactivity & impulsivity that are more noticeable & severe than at given developmental level/ • peaks age 5-10 yrs, usually diagnosed in children & adolescents • Psychiatric comorbidity; 80% child ADHD have psych dx • Theory • Genetic; strong genetic and familial component • Biological; alterations in neurotransmitters implicated • Psychological; interfamilial conflict & distress are causative for ADHD

  12. Application of the nursing process • Clinical Picture • Underappreciated and underdiagnosed in adults • ADHD specialist for diagnosis is recommended • Effect on Individuals, families and societies • Adults tend to have lower socioeconomic status, less yrs school, smoke, abuse alcohol & drugs

  13. Application of the nursing process • ADHD • Assessment; based on nursing reports, nursing observation, reports employers, family members • Diagnosis; Impaired social interaction, defensive coping • Outcomes Identification; completing tasks • Implementation • Pharmacological/Biological/Integrative • Medications; stimulants are the most widely used medication for ADHD (Ritalin and Adderall) • Psychotherapy; CBT, psychoeducation & support groups

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