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 treatment  Treatment mandated by court order and delivered without patients consent  Outpatient commitment: designed to provide mandatory treatment in less restrictive setting  Criminal offenses and incarceration  Transinstitutionalization: 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/Integrative  Medications; stimulants are the most widely used medication for ADHD (Ritalin and Adderall)  Psychotherapy; CBT, psychoeducation & support groups Application of the nursing process