Download presentation
Presentation is loading. Please wait.
1
Trisha Economidis Marilee Elias Fall 2014
Dementia & Delirium Eating Disorders Problems of Childhood and Adolescence Personality Disorders Trisha Economidis Marilee Elias Fall 2014
2
Neurocognitive Disorders
Clinically significant cognitive deficits and changes from previous levels of functioning. Can be classed as mild or major based on severity of symptoms Neurocognitive Disorder due to Alzheimer’s Disease (most common) Major Neurocognitive Disorder (previously Dementia)
3
Other Neurocognitive Disorders
Neurocognitive Disorder due to Parkinson’s Disease Neurocognitive Disorder due to HIV Infection Neurocognitive Disorder due to another medical condition
4
Major Neurocognitive D/O & Delirium
Common problems of the Elderly Patient What do we observe? How does it develop? What are the symptoms? What are the etiologies? What are the interventions?
5
Delirium Characterized by “disturbance of consciousness and a change in cognition” (APA) Temporary State of Confusion Develops rapidly Symptoms Cognition Level of Consciousness Psychomotor Activity Emotions
6
Delirium Etiologies: General Medical Conditions Substance-Induced
Substance-Intoxication and/or Withdrawal Multiple Etiologies
7
Delirium Interventions This is an Emergency Aggressive Treatment
Safe Environment Sensory Perceptions Reorient & reorient & reorient
8
Major Neurocognitive Disorder (Previously Dementia)
Not a normal part of Aging Loss of previous levels of cognitive, executive & memory function Usually Progressive & Irreversible Classifications Primary Dementias Secondary Dementias
9
Dementia Signs/Symptoms
Early stages: progressive memory loss, trouble finding the right words Symptoms progress with cognitive decline, increased irritability, loss of sensory & motor function Late Stages: Unable to recognize family, loses ability to communicate, forgets how to eat, requires total care
10
Interventions with Dementia
Orient to reality Clocks, calendars Promote memory/reminiscing Familiar items, Pictures, Music Provide safe, structured environment
11
Feeding and Eating Disorders
Anorexia Nervosa Bulimia Nervosa
12
Anorexia Nervosa Who presents with this disorder? What do they fear?
What’s distorted? What does the patient do about food? Exercise? What about self-worth? Physical Symptoms?
13
Self-worth & Physical Symptoms
The self-worth’s connected to the symptoms.. What’s up with weight? What’s happening with muscles? Is it cold in here? What happens to the cardiac system? Yellow skin, lanugo
14
Bulimia Nervosa What’s Bulimia? What’s binging? What’s purging?
What are the physical symptoms? Weight -Exercising Dentition Check out those hands Cardiac concerns Electrolyte imbalances
15
Binge Eating Disorder Eating portions larger than normal
Lack of control over eating At least 3 of the following: Eating more rapidly Eating until uncomfortably full Eating large amounts when not hungry Embarrassed by amounts eaten Disgusted, depressed, guilty after eating
16
Etiologies for Anorexia/Bulimia/ Binge Eating
Is it in the genes? Neuroendocrine abnormalities Hypothalamic Dysfunction The factors of family dysfunction Overprotective, rigid, controlling, critical parents
17
Treatment Modalities Behavior Modification Individual Therapy
Put the patient in control, promote autonomy Individual Therapy Family Therapy Psychopharmacology No specific meds Treat anxiety, depression, OCD
18
Case Study Meet Lily, 14 year old high school freshman. Her father is Hispanic, and her mother is Caucasian. She identifies with her father’s Hispanic culture and idolizes the popular Latina singers.
19
Case Study Meet Abby, age 29, her husband Tom, and their 5 year old daughter Megan. Tom is a young executive in a business firm, Abby is a stay at home mom. Tom has expectations about how Abby should care for their daughter and their home.
20
Personality Disorders
What are they? What are their characteristics? Often co-exist with? Three clusters of behavior A= Odd, eccentric B= Dramatic, emotional, or erratic C= Fearful, Anxious
22
Personality Disorders
Cluster A Paranoid Schizoid Cluster B Antisocial Borderline Narcisisstic Histrionic Cluster C Passive-aggressive
23
Paranoid Personality Disorder
Cluster A Men> Women Early adult onset Who do they suspect and mistrust? Hypervigilant and READY for ALL threats Why do they seek treatment?
24
Schizoid Personality Disorder
Cluster A Men diagnosed> Women Pattern of social withdrawal They are way too serious Spontaneity? Inability to form personal relationships
25
Antisocial Personality Disorder
Cluster B Men 3X> Women Exploitative, aggressive & manipulative Lacks a lot Where do we find them? Lower SEC > Higher SEC (especially in urban areas)
26
Borderline Personality Disorder
Cluster B Emotionally unstable, intense, impulsive, self-destructive, pervasive anger, depressed The most common personality disorder Women up to 4X > Men What’s splitting got to do with it? It’s all or nothing
27
Narcissistic Personality Disorder
Cluster B Inalienable right to special rights & privileges Too much self-worth Men> Women Exploitive Overly self-centered
28
Histrionic Personality Disorder
Cluster B Colorful, dramatic, extroverted behavior Manipulative, exhibitionist behaviors Self-dramatization Attention seeking Women>Men
29
Passive/Aggressive Personality Disorder
Cluster C Onset by early adulthood Envy and resent others Negative attitudes Passive resistance to social, work situations Procrastinate, or “forget” to resist Crave attention, reassurance Covertly vent anger and resentment
30
A client with borderline personality disorder has had 21 admissions to the mental health unit, each precipitated by a suicide attempt, usually resulting in superficial cuts on the arm. On this admission the client has developed a relationship with a highly supportive nurse. The client has progressed to having a pass to spend an afternoon in a nearby shopping mall. The nurse is shocked when the ED calls to say that the client had just be brought in with multiple self-inflicted lacerations. The nurse asks a peer, “Why? Everything was going well. How could she do this to me?”
31
While the nurse at the personality disorders clinic is interviewing a client, the client constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the client is very sensitive to the nurse’s nonverbal behavior. His responses are often argumentative, sarcastic and hostile. He suggests that he is being hospitalized so “they can exploit me.”
32
Emotional Problems in Children
Behaviors are: Not age appropriate Deviate from cultural norms Cause deficits or impairments in adaptive functioning
33
Childhood and Adolescent Diagnosis categories
Neurodevelopmental Disorders: Intellectual Disabilities (Previously Mental Retardation) Autism Spectrum Disorder (new) ADHD Specific Learning Disorder Motor Disorders (Tourette’s Disorder)
34
Childhood and adolescent diagnosis categories, cont.
Disruptive, Impulse-Control, and Conduct Disorders Conduct Disorder Oppositional Defiant Disorder Intermittent Explosive Disorder Antisocial Personality Disorder Pyromania/Kleptomania
35
Neurodevelopmental Disorders
Group of conditions with onset in the developmental period Typically manifest before child enters grade school Developmental deficits that produce impairments of personal, social, academic, or occupational functioning
36
Intellectual Disability (Intellectual Development Disorder) – Previously Mental Retardation
Must be a current intellectual deficit as well as a deficit in functioning Onset is in the developmental period Less emphasis placed on level of IQ and more on deficits in general mental abilities and functioning May be classed as Mild, Moderate, Severe or Profound based on adaptive functioning level – NOT IQ
37
Intellectual Disability
Etiology? Those genes again! Prenatal factors Pregnancy and perinatal factors General medical conditions in infancy or childhood Environmental influences and other mental disorders
38
Intellectual Disability Classification based on Adaptive Functioning Level
Mild Moderate Severe Profound Additional impairments or deficits: Communication, self-care, self-direction, functional academic skills, work, health, safety and more Adaptive functioning Able to adapt to daily living requirements? Meet expectations of person’s age or cultural group?
39
What are the Interventions?
Individualized Plan The 3-Rs Provide safe, comfortable environment Positive reinforcements Let’s do things in a simple, concrete way It’s always a “family” affair
40
Down’s Syndrome Most common chromosomal disorder with developmental delays Prevalence 1/800 live births in the US ↑ Incidence in women > 35 years old Extra chromosome at #21 = total of 47 Causes changes in both body and brain Mild to moderate mental retardation
42
Autism Spectrum Disorder
Previously individual disorders of Autistic D/O, Asperger’s D/O, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder - now all part of a single spectrum based on clinical presentation and pathological findings.
43
Autism Spectrum Disorder
Determined by impairments in social interaction and communication across multiple contexts, as well as restricted, repetitive patterns of behavior, interests or activities Level of severity is from mild to severe Three levels of severity for both social communication and restricted interests/repetitive behaviors – used to determine required level of support
44
Attention Deficit/Hyperactivity Disorder
A persistent pattern of inattention and/or hyperactivity and impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. ADHD, predominantly inattentive type ADHD, predominantly hyperactive-impulsive type ADHD, combined type
45
ADHD Etiologies Genes (again?) Biochemical Anatomical
Neurotransmitters Anatomical Alterations in the brain Prenatal, perinatal, postnatal factors Environmental factors Psychosocial factors
46
ADHD Interventions Provide a safe environment Positive feedback
Develop trusting relationship with caregivers Help child interact with others at an appropriate level of maturity
47
Psychopharmacological Interventions for ADHD
Stimulants? Why? Paradoxical effects of CNS stimulants ↓ Hyperactivity ↑ Ability to focus, learn and work What drugs? What can we do to address side effects?
48
Tourette’s Syndrome (Motor Disorder)
Essential Features? Onset Before 18 years of age Boys > Girls Etiologies Guess what’s first on the list Biochemical Structural Areas of Brain Dysfunction Environmental
49
Treatment of Tourette’s Syndrome
Psychosocial Therapy Includes the Family Psychopharmacological Therapy Drugs Haloperidol ((Haldol)for Severe Symptoms) Pimozide((Orap) Severe Symptoms after other drug failures) Clonidine (Safe, Few Side Effects) Atypical Antipsychotics Risperidone (Resperdal) (Good reduction of symptoms) Ziprasidone (Geodon) Olanzapine (Zyprexa)
50
Disruptive, Impulse-Control, and Conduct Disorders
Includes conditions involving problems in the self-control of emotions and behaviors Manifested in behaviors that violate the rights of others (aggression, destruction of property) or that bring the individual into conflict with societal norms or authority figures
51
Disruptive, Impulse-Control and Conduct Disorders
Symptoms are severe enough to produce significant impairment: Social Academic Occupational Conduct Disorder Oppositional Defiant Disorder
52
Conduct Disorder What is the pattern of behavior? What’s violated?
What’s common? Behaviors may include aggression to people or animals (bullying, physical fights), destruction of property, deceitfulness or theft, and serious violations of rules (running away, truancy before age 13, staying out at night despite parental prohibitions before age 13)
53
Conduct Disorder Often progresses to Antisocial Personality Disorder as an adult Predisposing factors: Genetics Biochemical Diagnosis of ADHD Poor peer relations during childhood Certain family dynamics: parental rejection, inconsistent or harsh discipline, large family, marital conflict and divorce, alcohol abuse in home
54
Nursing Interventions
Managing Aggressive Behavior Protecting others from Physical Aggression Improving interactions with others Developing age-appropriate, acceptable behaviors Client accepting responsibility for own behavior
55
ODD Oppositional Defiant Disorder
What’s the pattern of behavior? Who is the behavior directed against? Impaired functioning: Social, academic and/or occupational Onset by 8 years of age Pre-puberty Boys> Girls Puberty more equal Male/Female ratios
56
ODD Etiologies Biological influences Family Influences
Possibly Genetic Family Influences Parental Problems A power struggle Biological- Shares characteristics with Conduct Disorder, Poss relationship to genes R/T metabolism of Neurotransmitters Family- Oppositional Behaviors do happen in normal development, BUT if phases are prolonged or overreaction in child’s environment, Power and Control Needs of Parents- may feel behaviors are hostile and/or deliberate by child= Power Struggle, Parental problems with limit setting, structure and discipline, being unavailable, or Impulsive-disordered parent is role model
57
Symptoms of ODD Passive-Aggressive Behaviors What will the child do?
Other Physical Manifestations? Enuresis Encopresis Passive-Aggressive Behaviors- Stubbornness, Procrastination, Disobediance, Carelessness, Testing of Limits, Unwillingness to Compromise, Child may: Run away, Truancy, Academic Underachievement, Temper Tantrums, Fighting, Impaired Interpersonal Relationships Enuresis-Involuntary discharge of Urine, can be R/T Stress Encopresis- Child becomes constipated R/T not defecating, R/T Stress
58
Nursing Interventions for ODD
↑ Compliance with Therapy Developing less negative attitude Client accepts responsibility for behaviors ↑ Self-esteem Client verbalizes positive self-statements Improved interactions with staff and peers
59
Other Disorders of Childhood/Adolescence: Separation Anxiety Disorder
Now officially classed as an anxiety disorder Developmentally inappropriate and excessive anxiety concerning separation from the home or those to whom the person is attached
60
Separation Anxiety Disorder
What’s the essential feature? (think excess) Onset Anytime before 18 years of age As early as preschool age Girls > Boys
61
Separation Anxiety Etiologies You already know the first one
Temperament Environmental Influences Family Influences Stressful Life Events
62
Separation Anxiety Symptoms
Difficult separations from who? Anticipation of separations Refusing to… Specific Phobias Depressed Mood
63
Nursing Interventions
Provide safe, secure environment Assist your client to: Reach manageable level of anxiety Develop adequate coping strategies Spend time away from attachment figure Interact with others
64
Other Disorders of Childhood & Adolescence: Disruptive Mood Dysregulation Disorder
New diagnosis Severe recurrent temper outburst not in proportion to the situation Verbal and/or physical rages to people or property, 3 or more times a week. Consistently irritable or angry, observable by others for 12 or more months; ages 7-18 yr old. DMDD added because of concerns of over- diagnosis of bipolar disorder in children Overlaps with ODD criteria, but more severe
65
What treatment modalities do we use for Children and Adolescents?
Behavior Therapy Family Therapy Group Therapy What kinds? Psychopharmacology Not used as the sole method of treatment
66
Brains Full Yet?
Similar presentations
