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DEALING WITH DYSREGULATION !!!!!!

DEALING WITH DYSREGULATION !!!!!!. DDMI-TUG 2-13-12. DYSREGULATION. Descriptive term: ups, downs, impulsivity, anger, poor modulation of affect… PTSD Psychotic illness Schizophrenia, depression, bipolar Intoxications Alcohol; Meth; mixtures; prescribed medications

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DEALING WITH DYSREGULATION !!!!!!

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  1. DEALING WITH DYSREGULATION !!!!!! DDMI-TUG 2-13-12

  2. DYSREGULATION • Descriptive term: ups, downs, impulsivity, anger, poor modulation of affect… • PTSD • Psychotic illness • Schizophrenia, depression, bipolar • Intoxications • Alcohol; Meth; mixtures; prescribed medications • High levels and withdrawal • Personality disorders • Borderline Personality Disorder • Medical illnesses • thyroid • tumors

  3. INTERMITTENT EXPLOSIVE DISORDER • 312.34 • Characterized by discrete episodes of failure to resist aggressive impulses  serious assaults or property destruction. • Degree of aggression is out of proportion to provocation or precipitating psychosocial stressor. • Other causes of aggression (including Axis II) have been excluded. • Aggressive episodes are NOT due to physiologic effect of substance or general medical condition (brain injury; Alzheimer dementia, etc.).

  4. IMPULSE CONTROL DISORDER, NOS • 312.30 • Category for disorders of impulse control not met by other descriptors. • Generally non-specific, often reflecting poor inhibition across multiple settings.

  5. POLICE SUPPORT • Call for protection. • Need clear communication of events. • Have a non-medical framework of response – be clear about situation and anything helpful about the individuals involved. • Community Intensive Training (CIT). • Specific training in mental health and DD issues. • Aware of inability of people to respond. • Experience and background are varied.

  6. SHOULD CHARGES BE PRESSED? • People who understand consequences of their actions. • Social rules and expectations. • Dementia and delirium are absolute exceptions. • Risk of jail time and increased vulnerability in population with cognitive impairment; risk of lack of access to maintenance medications.

  7. RESTRAINTS • Physical • Mandt, other training techniques • Handcuffs, 5-point restraints; seatbelts and waist belts. • Chemical • PRN medications; antipsychotic and benzodiazepines. • Monitor respirations and allergic reactions. • Boundaries • Practice of establishing safe interactions, respect for individual space. • Psychotherapeutic treatment philosophy. • Safety • Patient; staff; immediate environments.

  8. WHAT ARE OUR GOALS? • Diffuse situation? • Restrain an individual? • Establish trust? • Elicit cooperation? • Support or Control ????

  9. ARE THERE DIFFERING STRATEGIES IN COMMUNITIES AROUND NEW MEXICO? • Population density • Support opportunities; space; expectations • Cultural differences • Separation by mountains; frontier attitudes • Indian country – services, taboos, jobs • Institutional supports • Employment; services; accessibility

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