Chapter 24

Adults

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

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

Issues facing those with severe and persistent mental illness

Involuntary treatmentTreatment mandated by court order and

delivered without patients consentOutpatient commitment: designed to provide

mandatory treatment in less restrictive settingCriminal offenses and incarcerationTransinstitutionalization: shifting of person or

population from one form of institution to another

Issues affecting the society and the individual

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

Application of the nursing process

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

Impulse control disorders

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

Application of the nursing process

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

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

Sexual disorders

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

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

Adult attention deficit and hyperactivity disorder

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

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/IntegrativeMedications; stimulants are the most widely used

medication for ADHD (Ritalin and Adderall)Psychotherapy; CBT, psychoeducation & support

groups

Application of the nursing process