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Chapter 24 Adults Severe and persistent mental illness 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 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 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 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 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 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 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 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 Adult attention deficit and hyperactivity disorder 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 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 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