Psychiatric Nsg Lec

8/9/2019 Psychiatric Nsg Lec

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Core ConceptsPhysiological Foundations of BehaviorPsychological Foundations of BehaviorBehavioral Mal-adaptations

The Test of Tendency

Nursing Interventions to Behavioral Mal-adaptations


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Behavioral Mal-adaptations

Also called as mood disorders, are pervasive alterations in emotions that aremanifested by depression, mania, or both.

Interferes with a persons life, plaguing him or her with drastic and long-termsadness, agitation, or elation accompanied by self-doubt, guilt, and anger alter life activitiesespecially those that self-esteem, occupation, and relationships.

Mood is a personsinternal state of mind thatis exhibited throughfeelings and emotions

Mood Spectrum is the widerange representation of thedifferent state of feelingsand emotions

E uphoriaDysphoria

Affect is the outward expression of theclients emotional state.

ORIGIN ME: from L. depressio(n-), fromdeprimere (see depress).Meaning = severe despondency and dejection,especially when long-lasting.


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General Categories of Mood Disorders

Major Depressive Disorder depressive episodes lasts at least 2 weeks, during which

the person experiences a depressed mood or loss of pleasure in nearly all activities.

There must also be four of the following symptoms;

changes in appetite or weight

sleep

psychomotor activity

decreased energy

feelings of worthlessness or guilt

difficulty thinking or concentrating or making decisions

recurrent thoughts of death or suicidal ideation, plans or attempts.


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Continuation

Dysthemic disorder is characterized by at least 2 years of depressed mood for more daysthan not with some additional less severe symptoms that do not meet the criteria for a majordepressive episode.

Cyclothemic disorder is characterized by 2 years of numerous periods of bothhypomanic symptoms that do not meet the criteria for bipolar disorder.

Subs tance Ind u ced Mood Di sorde r is characterized by a prominent and persistentdisturbance in mood that is judged to be a direct physiological consequence of ingestedsubstance such as alcohol, drugs or toxins.

Mood Disorder Due to a General Medical Condition is characterized by aprominent and persistent disturbance in mood that is judged to be a direct consequence of amedical condition such as degenerative neurologic condition, CVD, metabolic or endocrineconditions, autoimmune and others.


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Continuation

Seasonal Affective Disorder ( SAD) is of two subtypes winter depression SAD andspring-onset SAD.

P ost-P artum Blues is a frequent normal experience after delivery of a babycharacterized by labile mood and affect, sadness, insomnia and anxiety that beginsapproximately 1 day after delivery, usually peaks in 3-7 days , and disappears rapidlywithout medical treatment.

P ost- Pa rt um Dep ressi on meets all the criteria for a major depressive episode with onsetwithin 4 weeks of delivery.

P ost-P artum P sychosis is characterized by a psychotic episode developing within 3weeks of delivery beginning with fatique, sadness, poor memory, and confusion andprogressing to delusions, hallucinations, poor insight and judgement, and loss of contact

with reality.


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Nursing P rocess Applied : Intervention

1. P rovide a safe environment. P hysical safety is a priority.

2. Continually assess the clients potential for suicide.

3. Observe the client closely (medication, change of behavior, mood)

4. Reorient the client to person, place, and time as necessary.

5. Spend time with the client.

6. Initially and when possible, assign same staff members to manage.

7. When approaching the client, use a moderate, level tone of voice.

8. Use silence and active listening when interacting with client.

9. During admission and early residency, use simple, direct sentences.

Avoid complex sentences and directions.


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10. Allow client to cry and verbalize but dont encourage to go intocatharsis.

11. Minimize interaction/interruptions during clients verbalization.

12. Interact with the client on topics comfortable for him or her to discuss.Avoid too much proving.

13. Teach the client about the problem-solving process.14. P rovide positive feedback at each step of the process when progressing.


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P ersonality Is defined as an ingrained, enduring pattern of behaving andrelating to self, others, and the environment; includes perceptions, attitudes, andemotions.

P ersonality Disorders

Are diagnosed when personality traits become inflexible and maladaptive andsignificantly interfere with how a person functions in society or cause the person emotionaldistress.

Diagnosis is made when the person exhibits enduring behavioral patterns that deviate fromcultural expectations in two or more of the following areas:

w ay s of pe rceivi ng & i n te rp reti ng self, othe r pe ople , & eve n t s.

R a ng e , i n te nsit y , la b ilit y , a nd a pp rop ri a te ness of emo ti on a l re sp ons e .

In te rpe rson a l fun cti on i ng.

A b ilit y t o con t ro l i m p u lse s or exp re ss beh a vi or a t the a pp ro p ri a te ti m e/pl a ce .


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Categories of Personality Disorders

Cluster A: Individual whose behavior appears odd or eccentricand includes paranoid , schizoid , and schizotypal

personality disorders.

Cluster B: Includes people appear dramatic, emotional, or erraticand includes antisocial , borderline , histrionic , and

narcissistic personality disorder.Cluster C: Includes people who appear anxious or fearful and

includes avoidant , dependent , and obsessive-compulsive personality disorder.

Adapted from American Psychiatric Association (2000) DSM IV TR: Diagnostic and Statistical Manual of MentalDisorders text revision (4 th edition),Washington DC: APA


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Personality

Disorder

Symptoms Nursing Intervention

P aranoid Mistrust and suspicions of others;guarded, restricted affect.

Serious, straightforward approach; teachclient to validate ideas before taking action;involve client in treatment planning.

Schizoid Detached from social relationships;restricted affect; involved with thingsmore than people

Improve clients functioning in thecommunity; assist client to find case manager.

Antisocial Disregard for rights of others, rules,and laws.

Limit-setting; confrontation; teach client tosolve problems effectively and manageemotions of anger or frustration.

Schizotypal Acute discomfort in relationships;cognitive or perceptual distortions;eccentric behavior.

Develop self-care skills; improve communityfunctioning; social skills training.


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PersonalityDisorder


Borderline Unstable relationships, self-image, andaffect; impulsivity; self-mutilation

P romote safety; help client to cope andcontrol emotions; cognitive restructuringtechniques; structure time; teach socialskills.

Narcissistic Grandiose; lack of empathy; need foradmiration

Matter-of-fact approach; gaincooperation with needed treatment; teach

client any needed self-care skills.

Avoidant Social inhibitions; feelings of inadequacy;hypersensitive to negative evaluation.

Support and reassurance; cognitiverestructuring techniques; promote self-esteem.

Dependent Submissive and clinging behavior;excessive need to be taken care of

Foster clients self-reliance andautonomy; teach problem solving anddecision-making skills; cognitive

restructuring techniques.


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PersonalityDisorder


Borderline Unstable relationships, self-image, andaffect; impulsivity; self-mutilation

P romote safety; help client to cope andcontrol emotions; cognitive restructuringtechniques; structure time; teach socialskills.

Narcissistic Grandiose; lack of empathy; need foradmiration

Matter-of-fact approach; gaincooperation with needed treatment; teach

client any needed self-care skills.Avoidant Social inhibitions; feelings of inadequacy;

hypersensitive to negative evaluation.Support and reassurance; cognitiverestructuring techniques; promote self-esteem.

Dependent Submissive and clinging behavior;excessive need to be taken care of

Foster clients self-reliance andautonomy; teach problem solving anddecision-making skills; cognitive

restructuring techniques.


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PersonalityDisorder


O bsessive-compulsive

P reoccupation with orderliness,perfection, and control

Encourage negotiation with others; assistclient to make timely decisions andcomplete work

Depressive P attern of depressive cognitions andbehaviors in a variety of contexts.

Assess self-harm risk; provide factualfeedback; promote self-esteem; increaseinvolvement in activities.

P assive-Aggressive

P attern of negative attitudes and passiveresistance to demands for adequateperformance in social and occupationalsituations.

Help client to identify feelings andexpress them directly; assist client toexamine own feelings and behaviorrealistically.


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1. Encourage the client to identify the actions that precipitated

hospitalization.2. Give positive feedback for honesty. The client may try to act as

though he or she is sick or helpless or use other techniques toavoid responsibility.

3. Identify behaviors that are unacceptable.

4. Develop specific consequences for the identified unacceptablebehaviors.

5. Avoid any discussion or debate about why the rules or requirementsexit. State the requirements or rules in a matter-of-fact manner.


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12, P rovide immediate positive feedback or reward for acceptablebehavior.

13. Encourage the client to identify sources of frustration, how he orshe dealt with it previously, and any unpleasant consequencesthat resulted.

14. Explore alternative, socially and legally acceptable methods ofdealing with identified frustrations.

15. Include exploration and information on job seeking, work attendance, debt paying, court appearances, and so forth whenworking with the client in anticipation of discharge.


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C auses distorted and bizarre thoughts, perceptions, emotions,movements, and behavior . It cant be defined as a single illness rather adisease process or SYNDROME.

Usually diagnosed in late adolescence or early adulthood and rarelymanifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women. The prevalence is about 1% of thetotal population.

Morel described schizophrenia before as d ementia praecox (precocioussenility);B leuler later coined the term schizophrenia which means split mind (not splitpersonality);95% of clients with schizophrenia have a lifetime disease;It is the most common thought disorder;


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P ositive or Hard Symptoms

Ambivalence H olding seemingly contradictory beliefs or feelings about the same person, event, or situation.

Associative Looseness fragmented or poorly related thoughtsand ideas.

Delusions fixed false beliefs that have no basis in reality.

Echopraxia imitation of movements/gestures of another person whom the client is observing.

Flight of Ideas continuous flow of verbalizationin which the person jumps rapidly from one topic to another.

Hallucinations false sensory perception.

Ideas of Reference false impressions that external events have special meaning for the person.

P erseveration persistent adherence to a single idea or topic.


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Negative or Soft Symptoms

Alogia tendency to speak very little or to convey little substance of meaning.

Anhedonia feeling no joy or pleasure from life or any activities or relationships.

Apathy feelings of indifference toward people, activities, and events.

Blunted affect restricted range of emotional feeling, tone or mood.

Catatonia psychologically induced immobility occasionally marked by periods of agitation or excitement; theclient seems motionless,as if in a trance.

Flat affect absence of any facial expression that would indicate emotions or mood.

Lack of Volition absence of will, ambition, or drive to take action or accomplish tasks.


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Schizophrenia, Undifferentiated Type

Characterized by mixed schizophrenic symptoms (of other types) alongwith disturbances of thought, affect, behavior.

Schizophrenia, Residual Type

Characterized by at least one previous, though not a current episode;social withdrawal, flat affect; and looseness of associations.

Schizophreniform Disorder

The client exhibits the symptoms of schizophrenia but for less than 6months necessary to meet the diagnostic criteria for schizophrenia. Social or occupational functioning may or may not be impaire.


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Schizoaffective Disorder

The client exhibits the symptoms of psychosis and, at te same time, all the

features of a mood disorder, either depression or mania.Delusional Disorder

The client has one or more nonbizarre delusions that is the focus of thedelusion is believable. Psychosocial functioning is not markedly impaired, and

behavior is not obviously odd or bizarre.

Brief P sychotic Disorder

The client experiences the sudden onset of a least one psychotic symptom,such as delusions, hallucinations, or disorganized speech or behavior, which lasts from1 day to 1 month.

Shared P sychotic DisorderTwo people share a similar delusion.


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9. Show empathy regarding clients feelings.

10. Do not be judgemental or to belittle or joke about the clientsbelief.

11. Never convey to the client that you accept the delusions asreality.

12. Directly interject doubt regarding delusions as soon as the clientseems ready to accept this. Again, do not argue.

13. Attempt to discuss the delusional thoughts as a problem in theclients life.


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Eating Disorders ca n b e vie w ed on a con ti nuumw ith clie n t s w ith a nor exi a ea ti ng t oo little or st a rvi ngthe ms elve s, clien t s w ith bu li m i a ea ti ng cha otica lly , a ndclien t s w ith ob e sit y ea ti ng t oo mu ch .

General Classifications of Eating Disorder:A nor exi a N e rvosa - diet , exe rci se , f a sti ng

Bu li m i a N e rvosa b i ng e e a ti ng /p urg i ng


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Bulimia Nervosa i s a n ea ti ng di sorde r cha ra cte rized b y recurr en t epi sode s of bi ng e e a ti ng fo llow ed b y i na pp rop ri a te c om pe nsa t ory b eh a vi ors

t o a voidw

ei ght ga i n such a s p urg i ng, f a sti ng, la xa tive s, di ur etic s, enem a s, orexce ssive exe rci si ng.

Sym pt oms a re a s follow s:F ea r of ga i n i ng w ei ght Self ev a lu a ti on o ve rly i nf lu enced b y bo d y sha pe & w ei ght .

Dep ressive a nd a nxiet y sym pt omsLoss of de n t a l ena m el , chipped ra gg ed , or mo th-e a te nMenst ru a l i rregu la ritie s; depe nde nce on la xa tive sMet a bo lic a lka losi s (vom iti ng); m et a bo lic a cid osi s (di a rrhe a )E lev a ted se rum a m yla se level s w / elect ro lyte i mb a la nce s

Bi ng e e a ti ng w / p urg i ng


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Medical Complications of Eating Disorders(rela ted t o w ei ght l oss)

Body System Symptoms

Musculoskeletal Loss of muscle mass, loss of fat, osteoporosis, and pathologic fracture.

Metabolic Hypothyroidism, hypoglycemia, and decreased insulin sensitivity.

Cardiac Bradycardia, hypotension, loss of cardiac muscle, small heart,arrhythmias, sudden death.

Gastrointestinal Delayed gastric emptying, bloating, constipation, abdominal pain, gas,diarrhea.

Dermatologic Dry, cracking skin due to dehydration, edema, and acrocynosis

Hematologic Leukopenia, anemia, thrombocytopenia, hypercholesterolemia,hypercarotenemia.

Reproductive Amenorrhea and low levels of FSH, LH


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Medical Complications of Eating Disorders(rela ted t o p urg i ng -v om iti ng a nd l a xa tive use )

Body System Symptoms

Metabolic Electrolyte abnormalities, particularly hypokalemia,hypochloremic alkalosis, hypomagnesemia, and elevatedBUN.

Gastrointestinal Salivary gland and pancreas inflammation and enlargementwith an increase in serum amylase, esophageal and gastric

erosion or rupture, dysfunctional bowel, and superiormesenteric artery syndrome.

Dental Erosion of dental enamel (perimyolysis), particularly frontteeth

Neuropsychiatric Seizures (related to large fluid shifts and electrolytedisturbance), mild neuropathies, fatigue, weakness, andmild organic mental symptoms.


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General InterventionsEstablishing nutritional eating patterns

Sit with the client during meals and snacks.

Offer liquid protein supplement if unable to complete meal.

Adhere to treatment programguidelines on nutrition

Weigh client daily in uniform clothing.

Be alert for attempts to hide or discard food or inflate weight.

Helping the client identify emotions and develop non-food-relatedcoping strategies

Ask the client to identify feelings.

Self-monitoring using a journal.

Relaxation techniques.

Distraction.

Assist client to change stereotypical belief.


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General InterventionsHelping client deal with body image issues

Recognize benefits of a more near-normal weight.

Assist to view self in ways not related to body image.Identify personal strengths, interest, talents.

P roviding client and family educationNutrition Emotional Support System General health issues possible professional help and assistance

Emergency conditions.


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Somatoform Disorder ca n b e ch a ra cte rized a s the p resenceof ph ysica l sym pt oms th a t sugg est a m edic a l con diti on w ith ou t ade mos t ra b le org a n ic b a si s t o a ccoun t fu lly for the m. Som atizati on isdefi ned as th e tr a nsference of ment al e xp er ience a nd st a tes into bod ily symptoms .

Gener al Cla ss if ic a t ions of Som a toform Disorder :Som a tiza ti on Di sorde r C on ve rsi on Di sorde r

Pa i n Di sorde r Hyp ocon d ri a si s

Bod y Dysmor phic Di sorde r


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Somatization Disorder i s cha ra cte rized by mu ltiple ph ysica l

sym pt oms. It b eg i ns by 30 y /o, exte nd s ove r seve ra lyea rs, a nd i nclu de s a comb i na ti on of p a i n a ndga st ro i n te sti na l , sexu a l , a nd p sued on euro log icsym pt oms.

Conversion Disorder , someti m es ca lled c on ve rsi on r ea cti on,

i nvolve s unexpl a i ned usu a lly sudde n de f icit s i n sensor y ormo t or fun cti on ( eg. Bli nd ness, p a ra lysi s). The se de f icit ssugg est a neuro log ic di sorde r bu t a re a ssoci a ted w ithp sycholog ica l f a ct ors.


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Pain Disorder ha s the p ri m a ry ph ysica l sym pt om of p a i n, w hichgene ra lly i s unr elieved b y a na lgesics a nd grea tly a ff ected b yp sycholog ica l f a ct ors i n te rms of ons et , seve rit y , exa ce rb a ti on, a ndm a i n te na nce .

H ypochondriasis i s p reoccup a ti on w ith the f ea r th a t on e h a s ase ri ous di sea se (di sea se c on victi on) or w ill get a se ri ousdi sea se (di sea se ph ob i a ). It i s th oug ht th a t clie n t s w ith thi sdi sorde r m i si n te rp ret bo dily sensa ti ons or fun cti on.

Body Dysmorphic Disorder i s p reoccu p a ti on w ith the i m a gi ned orexa gg e ra ted de f ect i n ph ysica l a ppe a ra nce . Self bei ng t ooun a ttt ra ctive .


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Pain Symptoms com pla i ns of he a d a che a nd othe r forms of bo d y p a i n.

Gastrointestinal Symptoms na usea , bloa ti ng, vom iti ng, di a rrhe a .

Sexual Symptoms sexu a l i ndi ff e rence , e rectile or eja cu la t ory d ysfun cti on, i rregu la r m enses,exce ssive m enst ru a l b leedi ng.

Pseudoneurologic Symptoms con ve rsi on sym pt oms su ch a s i m p a i red c oor di na ti on orb a la nce , p a ra lysi s or loca lized w ea kn ess, di ff icu lt y sw a llow i ng or lum p on the th roa t , d oub le vi si on,

de a fness, bli nd ness, seizur es; di ssoci a tive sym pt oms li ke a mn esi a , f a i nti ng

Malingering i s a the i n te n ti on a l p rod ucti on of f a lse or gross ly exa gg e ra ted ph ysica l or p sych olog ica lsym pt oms.


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General InterventionsHealth Teachings

Establish a daily routine.

P romote adequate nutrition and sleep.

Expression of Emotional FeelingsRecognize relationship between stress/coping and physical symptoms.

Keep a journal.

Limit time spent on physical complaints (primary & secondary gains).

Coping StrategiesEmotion-focused coping strategies such as relaxation techniques, deep breathing, guided imagery,

and distraction.

P roblem-focused coping strategies such as problem-solving strategies and role-playing. E motion-focused Coping Strategies help client to relax and reduce feelings of stress.

P roblem-focused Coping Strategies help client to resolve or change clients behavior or manage lifes stressors.


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Cognitive Disorder i s a di srupti on or i m p a i rm ent i n hi ghe r-level fun cti ons of the br a i n b ea ri ng a dev a st a ti ng e ff ect s on the a b ilit y of the a pe rson t o fun cti on i n d a ily li f e . Cogn it ion is t h e br ai n s a b ili ty to process, ret ai n, a nd use inform a t ion (re a son ing, judgment, percept ion, a ttent ion, compre h ens ion, a nd memory).

Gener al Cla ss if ic a t ions of Cogn it iv e Disorder :Deli ri um Di sorde r A mn estic Di sorde r

De m en ti a


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Amnestic Disorder i s cha ra cte rized by a di st urb a nce i n m emor y th a t

result s di rectl y from the ph ysi olog ic e ff ect s of a gene ra l m edic a l con diti onor the pe rsi sti ng e ff ect s of a subs t a nce such a s a lcohol or o the r d rugs.

Etiology:

P hysi olog ic (CVA , he a d i n jur y , etc )

Subs t a nce-i nd u ced (ca rbon mono xide , a lcholi sm)De f iciency (V it a m i n B12 de f iciency )


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Dementia i s a m en t a l di sorde r th a t i nvolve s mu ltiple c ogn itivede f icit s, p ri m a rily m emor y i m p a i rm en t a nd a t le a st on e of thefollow i ng cogn itive di st urb a nce s.

Symptoms:A ph a si a -dete ri ora ti on of la ngu a ge fun cti on (ech ola li a & p a lila li a ).

A p ra xi a -i m p a i red a b ilit y t o exec u te mo t or fun cti on de spite i n t a ct mo t or a b ilitie s.

A gnos i a -i na b ilit y t o rec ogn ize or na m e ob ject s de spite i n t a ct sensor y a b ilitie s.

Di st urb a nce i n E xec u tive F un cti on i ng -i na b ilit y t o thi nk a bst ra ctly a nd t o pl a n, i n iti a te , seq u ence , a nd c om plex b eh a vi or.


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Progressive Stages :

Mild forg et fu lness i s the h a llm a rk of b egi nn i ng.Mode ra te confus i on i s a pp a ren t a long w ith

p rogr essive m emor y loss.

Seve re pe rson a lit y a d e mo ti on a l cha ng es occur.

Pathologic Etiology:A lzhei m e rs Di sea se Va scu la r De m en ti a

P ick s Di sea se C reu tz f eldt-J a kob Di sea se

HIV /A IDS Pa rk i nson s Di sea se

Hun ti ng t on s Di sea se He a d Tra um a


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General Interventions for Dementia

Promoting Safety from Injury

Promote adequate sleep , nutrition , hygiene

Structure environment and routine

Provide emotional support

Promote interaction and involvementPsychotherapy = Reminiscence Therapy family and client

to lament and re-live past experiences .


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Delirium i s a synd rom e th a t i nvolve s a di st urb a nce of consci ousn ess

a ccom p a n ied b y a ch a ng e i n cogn iti on, usu a lly devel op s ove r a shor t pe ri od of ti m e a nd f lu ct u a te s.

Symptoms:

Di ff icu lt y p ay i ng a tte n ti on E a sily Di st ra cted/di sorien ted

Sensor y Di st urb a nce s (illusi ons, ha llu ci na ti ons, m i si n te rp ret a ti ons)

Sleep- w a ke C ycle Di st urb a nce P sych omo t or A ctivit y C ha ng es

May ha ve expe rience s of a nxiet y , f ea r, i rrit a b ilit y , eu ph or i a , a p a th y


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Psychiatric disorders are not diagnosed as easily in children as theyare in adults. Children usually lack the abstract cognitive skills and verbal

skills to describe what is happening. Because of they constantly are changingand developing, children have no sense of a stable, normal self to allowthem to discriminate unusual or unwanted symptoms from normal feelingsand sensations.

General Classifications:

Me n t a l R et a rd a ti on Lea rn i ng Di sorde rs Mot or Sk ills Di sorde rC ommun ica ti on Di s P e rva sive Dev . Di s A DD Beh . Di sorde r

F eedi ng /Ea ti ng Di s Tic Di sorde r E li m i na ti on Di sorde r

O the r Di sorde rs of Inf a ncy , C hildh oo d , a nd A d olesce nce


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Mental Retardation essen ti a l f ea t ur e i s below a ve ra gei n tellect u a l fun cti on i ng ( IQ le ss th a n 70 ) a ccom p a n ied b y

si gn i f ica n t li m it a ti ons i n a rea s of a d a ptive fun cti on i ng su ch a scommun ica ti on, self -c a re , hom e livi ng, so ci a l or i n te rpe rson a l skills,self di recti on, a ca de m ic skills, he a lth a nd sa f et y.

Degrees of Retardation

Mild R et a rd a ti on: IQ 5 0 - 70 Mode ra te R et a rd a ti on: IQ 35-5 0Seve re R et a rd a ti on: IQ 20 -35 P rofoun d R et a rd a ti on: IQ le ss th a n 20


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L earning Disorder i s di a gnos ed w he n a child s a chieve m en t i n rea di ng,m a the m a tics, or w ritte n exp ressi on i s below th a t expected for a ge , forma led u ca ti on, a nd i n telli gence . Low self- estee m a nd p oor so ci a l skills a recommon. A ssi st a nce w ith a ca de m ic a chieve m en t s a re g ive n th roug hspeci a l ed u ca ti on cla sses.

General Types Of L earning DisorderR ea di ng Lea rn i ng Di sorde r

Ma the m a tics Lea rn i ng Di sorde r

Di sorde r of Writte n E xp ressi on


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Motor Skills Disorder a lso kno w n a s Devel op m ent a l C oor di na ti onDi sorde r i s a n i m p a i rm en t of coor di na ti on seve re e noug h t o i n te rf e re

w ith a ca de m ic a chieve m en t or a ctivitie s of d a ily livi ng.It of te n coexi st s w ith c ommun ica ti on di sorde r.

A d a ptive P hysica l Ed u ca ti on P rogr a m

Sensor y In te gr a ti on P rogr a ms

Most c a ses, the sym pt oms pe rsi st un til a d u lth oo d a nd it s di sea se c ours e i sso i nva ri a b le bu t gene ra lly de gene ra tive .


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Communication Disorder i s di a gnos ed w he n a commun ica ti on de f icit i sseve re e noug h t o hi nde r devel op m en t , a ca de m ic a chieve m ent , or A DLs

i nclu di ng so ci a liza ti on.General Types Of Communication Disorder

Expressive L anguage Disorder i nvolve s a n i m p a i red a b ilit y t ocommun ica te th roug h ve rb a l a nd si gn la ngu a ge .

Mixed Receptive- Expressive L anguage Disorder i nclu de s thep rob lems of exp ressive l a ngu a ge a long w ith di ff icu lt y un de rst a ndi ng(receivi ng) a nd dete rm i n i ng the m ea ni ng a nd h ow i s the p rope r resp onse(exp ressi ng).

Phonologic Disorder i nvolve s p rob lems w ith a rticu la ti on (form i ng soun d sth a t a re p a rt of speech a nd spe a k i ng p roce ss). Ex. St u tte ri ng


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Pervasive Developmental Disorder a re ch a ra cte rized by pe rva sive a ndusu a lly seve re i m p a i rm ent of recip ro ca l soci a l i n te ra cti on sk ills,commun ica ti on devi a nce , a nd rest ricted ste reot ypic a l b eh a vi or p a tte rns.

General Types

Autistic Disorder la ck sp on t a ne ous en joym ent , ha ve a pp a ren tly nomoo d s or emo ti on a l a ff ect , ca n t e ng a ge i n pl ay , little i ntelli gence , most common i n bo ys.

Retts Disorder cha ra cte rized by the devel op m en t of mu ltiple de f icit sa f te r a pe ri od of norm a l fun cti on i ng. R a re a nd excl usivel y i n g i rls, a nd pe rsi st sth roug hou t li f e .

Aspergers Disorder cha ra cte rized of sa m e sym pt oms t o a u ti sm bu t w /ola ngu a ge or cogn itive del ay s.


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Attention Deficit and Disruptive Behavior Disorder is characterized byinattentiveness , overactivity , and impulsiveness . (A ttention DeficitH yperactivity Disorder)

Inattentive BehaviorsMisses detailsMakes careless mistakesDifficulty sustaining attentionDoesnt seem to listen

Doesnt follow assigned tasksDifficulty with organization

Avoids task requiring effortsO ften looses thingsEasily distractedForgetful of activities

H yperactive/Impulsive BehaviorsFidgetsO ften leaves seatRuns and climbs excessivelyCant play quietly

Talks excessivelyBlurts out answers

InterruptsCant wait for turnIntrusive with siblings/classmates


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Interventions for ADH DEnsuring the childs safety and others

St op uns a f e b eh a vi orP rovide cl ose supe rvi si on

Give cle a r di recti ons w it little c om p rom i ses.

Improve role performance

Give p

ositive

f eed

ba c

k for meeti

ngexpect a ti

onsMa na ge the e nvi ronm en t

Client and Family Education and Support

Li ste n a nd e ncour a ge ve rb a liza ti on of bo th

Si m pli f y a ctivitie s a nd di recti on


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Feeding and Eating Disorders a re pe rsi ste n t na t ur ed di sorde rs a nd a re no t expl a i ned b y un de rlyi ng m edic a l con diti ons. Most c on diti ons a ff ect ea rly yea r of li f e speci f ica lly i nf a n t s a nd e a rly childh oo d .

General Types

Pica i s pe rsi ste n t i ng esti on of nonnu t ritive subs t a nce s such a s ha i r, cloth , lea ve s,sa nd , etc a nd c ommon s ee n i n m en t a l ret a rd a ti on.

Rumination Disorder i s the repe a ted regurg it a ti on a nd rechew

i ng of foo d .The regurg it a ti on d oes not i nvolve na usea or vom iti ng.

Feeding Disorder i s ch a ra cte rized b y pe rsi ste n t f a ilur e t o ea t a deq u a tel y ort o re fuse e a ti ng w hich result s i n si gn i f ica n t w ei ght l oss or f a ilur e t o ga i n w ei ght .


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Is defined as using drug in a way that is inconsistent with medical or social normsand despite negative consequences .

It denotes problems in social , vocational , or legal areas of the persons life .

Substance Dependence also includes problems associated with addiction such astolerance , withdrawal , and unsuccessful attempts to stop using the substance .

INTOXIC ATION is use of a substance that results in maladaptive behavior .

WITH DRAWA L SYNDRO ME refers to the negative psychological and physicalreactions that occur when use of a substance ceases or dramatically decreases .

DETOXIFIC ATION is the process of safely withdrawing from a substance which have been used for some long time already .


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DSM IV TR lists of 11 Diagnostic Classes

Of Substance Abuse

Alcohol Amphetamines

Caffeine Cannabis

Cocaine HallucinogensInhalants Nicotine

O pioids P hencyclidine

Sedatives Hypnotics/Anxiolytics


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Alcohol is a central nervous system depressant that is absorbedrapidly into the bloodstream. Initially the effects are:- relaxation and loss of inhibitions

- slurred speech- unsteady gait- lack of coordination- impaired attention, concentration, memory and judgment- blackout.

Alcohol withdrawal is usually accomplished with the administration of pharmacological interventions of benzopdiazepines such as lorazepam( A tivan ) and chlordiazepam ( Valium ).

Methodology used = Fixed-schedule Dosing

Symptom-triggered Dosing


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Sedatives, Hypnotics, and Anxiolytics are all considered as C NSdepressants with benzodiazepines and barbiturates as themost frequently abused drugs in this category.

Intoxication symptoms include the following:- slurred speech - impaired attention- lack of coordination - memory lapses- unsteady gait - stupor or coma- labile mood

Tapering is usually accomplished with the administration of pharmacological interventions of benzopdiazepines such as lorazepam( A tivan ) and chlordiazepam ( Valium ).

Methodology used = Fixed-schedule DosingSymptom-triggered Dosing


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Stimulants are drugs that stimulate or excite the C NS . TheDSM IV-TR categorizes amphetamines, cocaine and

other C NS stimulants as having same intoxicationand withdrawal symptoms. Methamphetamine isparticularly dangerous as it is highly addictive andcauses psychotic behavior.

Marked DYSP H ORI A (un ha ppi ness, restle ssness, ma la i se ) i sthe p ri m a ry w ithd ra w a l sym pt om a nd i s a ccom p a n ied by f a ti gu e , vivida nd un ple a sa n t d rea ms, i nsomn i a or hype rsomn i a , i ncrea sed a ppetite ,a nd p sychomo t or ret a rd a ti on or a git a ti on. P sychotic sym pt oms a lso ca ni nclu de suicid a l ide a ti on d u e t o seve re dep ressive expe rience .

h l l d


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Cannabis sativa is a hemp plant that became well-known for itspsychoactive resins the contains more than 60 substances called

cannabinoids, particularly delta-9-tetrahydrocannabinol (THC)responsible for the psychoactive side-effects. Effects includes :- lowered inhibitions - relaxation- euphoria - increased appetite- impaired motor coordination

- inappropriate laughter- impaired judgment- memory and perception loss and distortion

B h i l M l d i


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Hallucinogens are substances that distort the users perception ofreality and produce symptoms similar to psychosis (visualhallucination and depersonalization). Examples L SD (lysergic aciddiethylamide), Ecstacy, even P C P (phencyclidine) an anesthetic.Effects includes :

- increased vital signs - dilated pupils- hyperreflexia - paranoid ideation

- ideas of reference - depression, anxiety- sweating, blurred vision - tremor- unpredictable behavior (belligerence, aggression)

B h i l M l d t ti


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Inhalants are substances including anesthetics, nitrates, andorganic solvents (aliphatics & aromatic hydrocarbons) which are allinhaled for their effects. Effects includes :

- dizziness, nystagmus - slurred speech- unsteady gait - muscle weakness- aggressive behavior - tremor, apathy- unpredictable behavior (belligerence, aggression)

cute to icity causes ano ia, respiratory depression, vagalstimulation and dysrhythmias, bronchospasm, and cardiac arrest.


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Behavioral Mal adaptations


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8. Assist the client to plan weekly or even daily schedules of purposeful

activities: errands, appointments, taking walks, and so forth.9. Writing the schedule on a calendar may be beneficial.

10. Recording a journal of activities, feelings and thoughts may be helpfulto the client.

11. Teach clients social skills.

12. Give positive support to the client for appropriate use of social skills.

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Psychiatric Nsg Lec