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Chapter 24
Adults
Severe and persistent mental
illness
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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
Issues facing those with severe
and persistent mental illness
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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 affecting the society and the
individual
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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
Application of the nursing process
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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
Impulse control disorders
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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
Application of the nursing process
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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
Sexual disorders
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Definition
 Disorders
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affecting sexual function and identity
Types
 Gender
identity disorder (transsexualism)
 Paraphilias- preoccupation with sexual fantasies and
related sexual urges
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Theory
 Biological
: cause unknown, sexual hormone
abnormality
 Psychological; failure to develop attachments in early
childhood
Sexual disorders
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Clinical picture: persistent discomfort with ones present
gender assignment and role and strong/persistent desire to
assume characteristics of opposite or desired gender
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Most paraphilias are male
Exhibitionism
Fetishism
Frotteurism
Pedophilia
Sexual masochism and sexual sadism
Transvestism/ fetishism/ voyeurism
Paraphilias NOS
Effect on individuals, families & society
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Recidivism; repeating a previous offense
Application of the nursing process
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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
Adult attention deficit and
hyperactivity disorder
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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
Application of the nursing process
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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
Application of the nursing process
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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