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Learn about Attention Deficit Hyperactivity, Behavioral Disorders, Elder Abuse, and Alzheimer's Disease in older adults. Explore causes, symptoms, and treatments for these mental health issues affecting children and the elderly.
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MENTAL HEALTH UNIT III
CHILDHOOD MENTAL HEALTH PROBLEMS • Attention deficit hyperactivity • Needs structured environment with consistent limits • Family education • Special education in school • Drug therapy • Ritalin • Concerta • Adderall
CHILDHOOD MENTAL HEALTH PROBLEMS • Behavioral or conduct disorders: persistent pattern of unacceptable behaviors • Defiant of authority • Aggressive • Refuse to follow society’s rules or norms • Focus on stable environment & consistent enforced limitations
CHILDHOOD MENTAL HEALTH PROBLEMS • Oppositional defiant disorder: recurring pattern of disobedient, hostile behavior toward authority figures • Lose tempers with adults • Argue with adults • Deliberately annoy adults • Refuse to compromise • Blame others & test limits • Family therapy with limit setting & consistency
NORMAL MENTAL CHANGES IN OLDER ADULTS • See page 180, Table 16-1
LATE ADULTHOOD PROBLEMS RELATED TO MENTAL HEALTH • Vulnerability, abuse, memory loss, dementia, & Alzheimer’s Disease (AD) • Physical or biochemical disorders • Loneliness & social isolation
ELDER ABUSE Any action that takes advantage of an older person, their emotional well-being, or property • Domestic • Institutional • Self-abuse
DEPRESSION • Common mental health disorder of late adulthood • Retirement, lifestyle changes, losses per death • Mask dementia • Medications • Effective therapies • Individual & group therapy • Reminiscing • Antidepressants (SSRI’s)
Sundown syndrome: group of behaviors characterized by confusion, agitation & disruptive actions • Unknown cause • Visual cues & social interactions decrease with the onset of nighttime = confused, irritable, agitated
ALZHEIMER’S DISEASE • Progressive, degenerative disorder affecting brain cells = impaired memory, thinking, & behavior • Diagnosis; rule out all other possibilities • Incidence increases with age • Can progresses slowly • Cognitive abilities lose • Can’t recall recent events or process new information
ALZHEIMER’S DISEASE • Increasingly forgetful; personality changes • Aphasia: loss of language • Apraxia: loss of the ability to perform everyday activities • Visual agnosia: loss of recognition of previously known or familiar people & objects
ALZHEIMER’S DISEASE • Affective losses: loss of their personality • Stress & anger ↑ fatigue levels • Minor anxieties become full catastrophic reactions = ↑ confusion, agitation, & fear • Wander, Noisy, act compulsively or behave violently
ALZHEIMER’S DISEASE • Low stimuli environment • Eliminate stress provoking situations • Physical & emotional support • Medications to slow the disease (pg 197 Table 17-3) (pg 199, common cholinesterase inhibitors)
ALZHEIMER’S DISEASE • Goals to therapeutic care • Provide safety & well-being • Manage behaviors therapeutically • Provide support for family, relatives, & caregivers • Tables 17-1, 17-2 • Boxes 17- 4, 5, 6, 7 • Table 17-4, 17-5
PSYCHOTHERAPEUTIC MEDICATION EFFECT • Interrupts chemical messenger pathways in the brain • Act in/around the synapse - alters flow of neurotransmitters
ANXIETY • Uneasiness, uncertainty, & helplessness • State of tension sometimes associated with feeling of dread or doom • Normal emotional response to a threat or stressor • Part of survival & growth
ANXIETY PURPOSES • Warning • Increase learning – help with concentration & focus • Motivate
ANXIETY DISORDERS • Anxiety expressed ineffectively, coping mechanisms do not relieve the stress • 6 categories per DSM-IV-TR
GENERALIZED ANXIETY • Broad, long-lasting, excessive • Disturbance in emotional area of functioning eventually affects every aspect • Worried, anxious more times than not • Fret about numerous things • Difficult to control worries • Cannot complete simple tasks & responses way off base in relationship to actual situation
PANIC DISORDER • Brief period of intense fear or discomfort • Usually last 1 – 15 minutes with peak after 10 minutes • 2 types • Those associated with agoraphobia: anxiety about possible situations in which a panic attack may occur (public situations) • Those not associated with agoraphobia
PHOBIC DISORDER • Unnatural, obsessive fear • Dwell on object of fear almost to point of fascination • Immobilizes
OBSESSIVE-COMPULSIVE DISORDER (OCD) • OBSESSION: Distressing, persistent, recurring, inappropriate thought • COMPULSION: specific behaviors that must be performed to reduce anxiety
OBSESSIVE – COMPULSIVE DISORDER • Cleanliness, dirt & germs; aggression & sexual impulses; health concerns; safety concerns, order & symmetry • Thoughts, doubts, fears, images or impulses • Defense mechanism of repression • Focus anxieties into compulsive actions & engage in undoing behaviors to relieve stress • Know behaviors are maladaptive but cannot stop • Treated with behavioral therapy & antidepressants
BEHAVIORAL ADDICTIONS • Obsessive-compulsive activities taking on certain forms of addictive behaviors • Gambling, shopping, working, excessive sexual activity • Destruct personal & professional lives
POSTTRAUMATIC STRESS DISORDER (PTSD) • Reliving of traumatic event or situation • Traumatic experience resulted in intense fear, horror, or helplessness • Flashbacks • Assure safety & reorientation • Meds, psychological therapy & emotional support
ANXIETY INTERVENTIONS • Prevent • Detect & treat early • Antianxiety agents • Systematic desensitization – learn to cope with 1 anxiety situation at a time • Flooding– rapidly or repeatedly exposing client to the feared object or situation; phobias • Rational-emotive therapy – learn how their illogical thinking leads to maladaptive behaviors • Relaxation – deep breathing
ANTIANXIETY MEDS Reduce psychic tension of stress • Benzodiazepines (drug of choice) - Decrease anxiety but also can provide sedation, induce sleep, prevent seizures, prepare clients for general anesthesia - Act by ↑ GABA neurotransmitter level - Onset 1 hr. & duration of 4 – 6 hrs. - Side effects are fatigue, sedation, dizziness & orthostatic hypotension; may experience diarrhea during withdrawal - Dependence can result = limited use; prn basis See page 214 Table 18-3 for nursing actions • Nonbenzodiazepines - Antihistamines - Barbiturates
DEPRESSION • Whole body illness • Last few days or several years; several levels • MILD: short lived, triggered by life events or situations; usually self limiting • MODERATE: persists over time;interfere with ADL’s • Fatigue, eating & sleeping difficulties • Anhedonia: inability to enjoy life • Impaired judgment & decision making • Higher risk of suicide
DEPRESSION • MAJOR DEPRESSIVE EPISODE: severe depression lasting ≥ 2 weeks (familial) - Feelings of worthlessness, guilt, despair - Suicidal thoughts begin - When episodes routinely repeat itself for ≥ 2 yrs. = MAJOR DEPRESSIVE DISORDER • DYSTHYMIC DISORDER: daily moderate depression lasting ≥ 2 yrs - Chronically sad, self critical - See self as incapable & uninteresting - See world from a negative point of view - Can carry out ADL’s but unable to enjoy them
BIPOLAR DISORDERS • Sudden, dramatic shift in emotional responses • Time intervals vary • Behaviors build in intensity during mania • If untreated, manic stage can lasts 3 months when depressive stage steps in
BIPOLAR DISORDERS • BIPOLAR I • Episodes of depression alternating with mania episodes • More severe & incapacitating • Delusions & hallucinations occur during mania • BIPOLAR II • 1-2 weeks of severe lethargy, withdrawal followed by days of elevated/irritable mood, constant activity & risky decision making • May not be as severe as Bipolar I but still devastating
Bipolar Disorder • Cyclothymic disorder: repeated mood swings alternating between hypomania & depression • No periods of “normal” functioning • Usually leads into full blown bipolar disorders
MOOD DISORDERS TREATMENT • Acute: 6-12 wks • Reduce symptoms & inappropriate behaviors • Inpatient hospitalization may be required • Medications • Continuation: 4-9 months • Outpatient basis • Medication management • Psychotherapy • Maintenance • Preventing recurrences • Maintenance meds & psychotherapy • Current standard treatments…
MEDICATION CLASSES & CATEGORIES • ANTIDEPRESSANTS • Seritonin Specific Reuptake Inhibitors (SSRI) • Tricyclic Antidepressants (TCA) • Monoamine Oxidase Inhibitors (MAOI’s) • ANTIMANICS • Antimanics • Anticonvulsants • ANTIPSYCHOTICS • Phenothiazines • Nonphenothiazines
ANTIDEPRESSANTS • ↑ certain neurotransmitter activities • 1-2 weeks before symptom relief • Side effects may be noticed soon after starting • Monitor closely for ↑ energy when suicidal
ANTIMANICS • Lithium – natural occurring salt Drug of choice for treatment bipolar disorder • Pre lithium workup • Educate • Monitor side effects & toxic reactions • Minimal difference therapeutic & toxic levels • too low = mania returns • too high (≥ 1.5mEq/L) = uncomfortable & life threatening side effects may occur • Positive effects may take 3 weeks
ANTIPSYCHOTICS • Referred to as major tranquilizers or neuroleptics • Most treat symptoms of major mental disorders • Numerous & troublesome side effects & adverse reactions
EXTRAPYRAMIDAL SIDE EFFECTS • CNS side effects of abnormal movements produced by imbalance of neurotransmitters in brain • PNS side effects: dry mouth, blurred vision, & photophobia • 1st few weeks orthostatic hypotension possible
Known as somatoform disorders – stress related physical problems • DSM-IV-TR = 6 types • Meet 3 criteria: 1. No medical condition • Level of functioning significantly disrupted or impaired • Unaware of or unable to express emotional distress
SOMATIZATION DISORDER • S/S of illness - no traceable physical cause • Long history vague complaints, colorful terms but few facts • Multiple physicians • Signs of anxiety, depression, with impulsive, antisocial & suicidal behaviors • 3 features • Multisystem involvement • Early onset, chronic condition with no physical changes • Absence of any lab values indicating physical involvement *******Deny psychiatric problem*******
HYPOCHONDRIASIS • Intense fear of or preoccupation with having serious disease or medical condition based on misinterpretation of body s/s • Constant fear • Minor abnormalities of body functions, vague physical sensations • Dr. shop; challenge to treat • Poor insight & little concern in finding source of problem • Treatment • Antianxiety & antidepressants
SOMATOFORM PAIN DISORDER • Pain / discomfort major focus of distress • No other cause of pain identified • Treatment: Pain clinic
BODY DYSMORPHIC DISORDER • Preoccupation with perceived physical difference or defect in one’s body • Describe distress as tormenting, devastating, or intensely painful • Describe self as ugly, unacceptable & often avoid work, social or public gathering
FACTITIOUS & MALINGERING • Symptoms intentionally produced • Factitious = to assume the sick role • Malingering = to meet a goal • Factitious disorder by proxy= deliberate production of s/s in another person; usually mother to child (Munchausen's syndrome) • Rarely diagnosed, move Dr. to Dr. • Identify & treat underlying cause
DISSOCIATIVE DISORDERS Dissociation:interruption of fundamental aspect of waking consciousness • Normal common experience (daydreaming) • Coping mechanism to protect from trauma • Children dissociate more easily than adults & if used as defense mechanism can grow into dissociative disorder • Disturbance in the normally interacting functions of consciousness • Identity, Memory, Perception • Most anxiety producing aspect of self walled off from rest of personality in attempt to cope • DSM-IV-TR = 4 types
DEPERSONALIZATION • Feeling detached or unconnected to self • Response to severe anxiety associated with blocking of awareness & a fading of reality • Defense mechanism but not relieve the cause of stress = maladaptive behavior = attempt to escape distress & anxiety; lose identity