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The role of Nutrition in treating Patients with mental illness

The role of Nutrition in treating Patients with mental illness. BY bRIAN LEAL February 13,2012 nEW yORK hOSPITAL qUEENS. epidemiology. Outline. The Brain. Brain Anatomy/Physiology. Brain Anatomy/Physiology. Main component of the Central Nervous System along with the spinal cord

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The role of Nutrition in treating Patients with mental illness

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  1. The role of Nutrition in treating Patients with mental illness BY bRIAN LEAL February 13,2012 nEWyORKhOSPITALqUEENS

  2. epidemiology

  3. Outline

  4. The Brain

  5. Brain Anatomy/Physiology

  6. Brain Anatomy/Physiology • Main component of the Central Nervous System along with the spinal cord • Weighs 3 lbs • Composed of gray and white matter- folded sheets of neural tissue • Gray matter- Rich in neuronal cell bodies and their dendrites, axons, and glial cells • White matter- Large axon tracts in the brain and spinal cords

  7. Central Nervous System • Neurons transmit electrical chemical signals to other cells • The electrical properties of neurons are controlled by interactions between neurotransmitters and receptors at the synapses • Neurotransmitters are chemicals that are released at synapses when an action potential activates them Dopamine Flow of information Serotonin Mood and behavior

  8. Nerve Physiology

  9. Mental Illness

  10. What is Mental Illness? Main Types of Mental Illnesses

  11. Reason for Mental Illness

  12. Sign & Symptoms- Schizophrenia

  13. Sign & Symptoms- Depression

  14. Sign & Symptoms- Bipolar Disorder

  15. Treatments

  16. Medications

  17. Medical Nutrition Therapy

  18. How to Treat These Diseases with Nutrition

  19. Assessment • Anthropometric • Physical Assessment • Diet History • Labs

  20. Intervention

  21. Special Nutrition Interest

  22. Special Nutrition Interest

  23. Special Nutritional Interest

  24. Recommendations

  25. Goals • Adequate Nutrition • Drug Side Effects • Self- Efficacy

  26. Monitoring/ Evaluating • Weights • Supplement • Food intake

  27. Presentation of Patient: C.S.

  28. Assessment • 26 year old Male with a history of schizophrenia • Tied and bound to a chair for over a week • AKA to right leg due to advanced state of ischemia • Seen for poor oral intake

  29. History • Institutionalized in previous years but no known previous hospitalization • History of ETOH abuse and drug abuse • Stayed home alone while the sister and her husband work • Previously took Clozapine but stopped recently- time unknown to patient and family

  30. Labs

  31. Analysis of Labs • Labs during first two weeks were taken when ever possible • Abnormal labs values during first week reflective of C.S mental status and refusal for any PO • Labs improved as C.S oral intake improved

  32. Medication Bibliography

  33. Medical Course • 10/12- Admitted to NYHQ with AMS, right leg infection, schizophrenia • - Surgical Consult- Immediate right AKA • - Transferred to the SICU • 10/13- Uncooperative, • - Refused medical care including wound dressing

  34. Medical Course • 10/14- 25% meal completion • - Reported hearing voices, continuously bite his lips to the point of laceration • - Psychiatric consult • - Administered antipsychotic medications, hydration

  35. Medical Course • 10/15- Decreased appetite, 0% meal completion • Withdrawn, continued to refuse care • 10/16- Initial Nutritional Assessment

  36. Initial Assessment- 10/16

  37. Initial Assessment For C.S. • Patient at high nutritional risk due to poor PO intake, right AKA, admission to SICU • Anthropometry: • Ht- 68in • Wt- 135 lbs prior to AKA • BMI- 20.5 • Current diet: Regular, Ensure BID • Past Medical History: Schizophrenia

  38. Assessment of Nutritional Needs • Calorie needs: Based on Mifflin St.Jeor X 1.1 Activity X 1.4 Stress factor (Amputation Adjustment)- 2080- 2280 kcal/day • Protein needs: Based on 1.2-1.3g/kg (Amputation Adjustment)- 69-75g/day • Fluid needs: Based on 1ml per kcal- 2080-2280 ml/day

  39. Patient Interview • Withdrawn • Reported no appetite, refused PO, oral supplement • Poor PO intake x 4 days. • Does not follow any therapeutic diet or dietary restrictions at home

  40. PES Statement

  41. Plan • Continue current diet and oral supplementation • Encourage PO intake as tolerated • Provide education on current diet and importance of oral intake for wound healing

  42. Goals • More than 50% meal completion • Prevent weight loss • Promote wound healing

  43. Monitor • Weights daily • PO intake • Skin integrity • Pertinent labs

  44. Follow Up- 10/24 • Assessment: • Stated improved appetite, 75% meal completion, compliance to Ensure • Lab values improved as well • Plan: • Continue current diet • Provide oral supplements • Labs value WNL • Day 11 on Clozapine

  45. Medical Course • 10/29- Patient discharged to Rehabilitation site in Connecticut • - Day 16 on Clozapine

  46. Critical Comments

  47. Summary • C.S prognosis- Transferred to Rehabilitation Center • Further mental illness patients • Bipolar • Depression

  48. Thank You !!!! • I would like to thank: Gayanne and Christina • My fellow Interns • Nutrition Care team at NYHQ

  49. QUESTIONS

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