Mental Health: Chapter 23 - Disruptive Behavior Disorders!

Disruptive Behavior Disorders Assessment - Mood and Affect

- quiet and refusing to talk to the hospital an angry Clients may be quiet and reluctant to talk, or they may be openly hostile and angry. Their attitude is likely to be disrespectful toward parents, the nurse, or anyone in a position of authority. Irritability, frustration, and temper outbursts are common. Clients may be unwilling to answer questions or cooperate with the interview; they believe they do not need help or treatment. If a client has legal problems, he or she may express superficial guilt or remorse, but it is unlikely that these emotions are sincere.

A group of nursing students is reviewing information about disruptive behavior disorders. The students demonstrate understanding of the topic when they identify which as an externalizing disorder?

Conduct Disorder! Externalizing Behaviors Lying Cheating at school Swearing Truancy Vandalism Setting fires Bragging Screaming Inappropriate attention-seeking Arguing Threatening Demanding Relentless teasing Anger outbursts

Internalizing Behaviors

Prefers to be alone Withdraws Sulks Won't talk Is secretive Overly shy Stares in lieu of a verbal response Physically underactive Somatic aches and pains Dizziness Nausea, vomiting, stomach problems Fatigue, lethargy Lonely Guilt feelings NervousCrying spells Feels worthless, unloved

Intermittent Explosive Disorder (IED)

Repeated episodes of impulsive, aggressive, violent physical or verbal outbursts. - Onset: IED can occur at any time most common in adolescents and young adults. 4 to 7% of the population. It is more common in males than in females Selective serotonin reuptake inhibitor antidepressants particularly seem to reduce aggressive tendencies because serotonin deficiencies are often linked to causation

IED Medications:

SSRI, lithium, and anticonvulsants valproic acid (Depakote), phenytoin ( Dilantin).

Communication Development:

Speech is the spoken expression of language. The three components of speech are (1) articulation, which refers to the pronunciation of sounds; (2) voice, which refers to the production of sound by the vocal cords; and (3) fluency, which refers to the rhythm of speech. Receptive language function is the ability to hear and understand what others say. Expressive language function is the ability to develop and express one's own thoughts, ideas, and emotions.

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone by the primary health care provider. What would be the most likely reason for the health care provider to prescribe this drug to the client?

The adolescent's behavior poses a danger to others!

Mild:

The child has some conduct problems that cause relatively minor harm to others. Examples include repeated lying, truancy, minor shoplifting, and staying out late without permission.

Cognitive Development:

The cognitive dimension of development relates to working memory capacity, cognitive self-regulation, and the processing and use of information about the environment and objects in the environment. In addition, individuals have an increasing understanding of relationships between self-understanding and information over time. These processes underlie the development of critical thinking skills and executive functioning, which includes learning, forming concepts, understanding, problem solving, reasoning, remembering, and thinking abstractly.

After teaching a group of nursing students about kleptomania, the instructor determines that the education was successful when the students state what?

The disorder is difficult to detect and treat!

Moderate:

The number of conduct problems increases as does the amount of harm to others. Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity.

Decreasing Violence and Increasing Compliance with Treatment:

The nurse must protect others from the manipulative or aggressive behaviors common with these clients. He or she must set limits on unacceptable behavior at the beginning of treatment. Limit setting involves the following three steps: 1.Inform clients of the rule or limit. 2.Explain the consequences if clients exceed the limit. 3.State expected behavior. Providing consistent limit enforcement with no exceptions by all members of the health team, including parents, is essential. For example, the nurse might say,"It is unacceptable to hit another person. If you are angry, tell a staff person about your anger. If you hit someone, you will be restricted from recreation time for 24 hours."

Oppositional Defiant Disorder (ODD)-

The pattern of uncooperative, defiant, disobedient, and hostile behavior. Causes dysfunction in social, academic, and work. consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. A certain level of oppositional behavior is common in children and adolescents; indeed, it is almost expected at some phases such as 2 to 3 years of age and in early adolescence. - Onset- ODD 2%-15% adolescents For ODD parent management training models (reinforce positives, and avoid giving attention to negative behaviors. Individual therapy to the client as needed.

Severe:

The person has many conduct problems that cause considerable harm to others. Examples include forced sex, cruelty to animals, physical fights, cruelty to peers, use of a weapon, burglary, robbery, and violation of previous parole or probation requirements.

A nurse is studying the medical records of a client with conduct disorder. The nurse finds that the client was prescribed lithium. What would be the most likely reason for prescribing this drug for this client?

The presence of aggression! (lithium is a mood stabilizer)

Callous-unemotional traits

They have little empathy for others, do not feel "bad" or guilty or show remorse for their behavior, have shallow or superficial emotions, and are unconcerned about poor performance at school or home. These children have low self-esteem, poor frustration tolerance, and temper outbursts.

Social and emotional development:

includes the development of self-understanding, understanding others, and understanding social interactions. - For example, young preschool children cannot distinguish between their effort and their ability and are likely to overestimate their competence and abilities. Thus caution should be used regarding self-reported ability(ies), and nurses should seek confirmation (e.g., "Johnnie says that he can swallow pills. Have you seen Johnnie take pills before or is Johnnie better able to swallow liquid medicine?").

Disruptive Behavior Disorders Assessment - Sensorium and perception

alert, oriented, intact memory. Intellectually capable but not applied or behavior problem or not attending school.

Disruptive Behavior Disorders Assessment - Judgment and insight

break rules with no regard for consequences. Thrill seekers, risk behavior using substance and do not see the behavior is the cause.

Disruptive Behavior Disorders:

include problems with the person's ability to regulate his or her own emotions or behaviors. They are characterized by persistent patterns of behavior that involve anger, hostility, and/or aggression toward people and property.

Gross Motor Skills:

involve the use of large muscles to move about in the environment. Examples of gross motor development include the sequential skills of sitting, standing, maintaining balance, cruising, walking, running, walking up stairs without assistance, and more complex physical tasks such as playing soccer.

Fine motor Skills:

involve the use of small muscles in an increasingly coordinated and precise manner. Examples of fine motor development include the achievement of the successive skills of batting at an object, reaching and holding an object, transferring an object from hand to hand, holding a pencil in a refined grasp, making marks with a pencil, writing letters, writing words, and the complex skill of creating masterful artwork.

Developmental Milestone:

is an ability or specific skill that most individuals can accomplish in a certain age range.1,10 The categories of age ranges typically include those individuals who are experiencing rapid developmental change, such as infants, toddlers, preschoolers, school-aged children, and adolescents (teens), with emphasis on the growing child.

Kleptomania:

is characterized by impulsive, repetitive theft of items not needed by the person, either for personal use or monetary gain. Tension and anxiety are high prior to the theft, and the person feels relief, exhilaration, or gratification while committing the theft. The item is often discarded after it is stolen. Kleptomania is more common in females and often has negative legal, career, family, and social consequences.

Conduct Disorder (CD)

is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These children and adolescents have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression toward people and animals, destruction of property, deceitfulness, theft, and serious violation of rules. Children with conduct disorder often exhibit callous and unemotional traits, similar to those seen in adults with an antisocial personality disorder. - Onset: CD before the age of 10 with mild, moderate to severe type. 30-50% are diagnosed with antisocial personality disorder in adulthood. 4 to 7% of the population.

Pyromania:

is characterized by repeated, intentional fire-setting. The person is fascinated about fire and feels pleasure or relief of tension while setting and watching the fires. There is neither any monetary gain or revenge or other reason, such as concealing other crimes, nor is it associated with another major mental disorder.

Motoric Development

is frequently separated into two major categories: gross and fine motor.

Disruptive Behavior Disorders Assessment - Self Concept

low self esteem, feeling important if break the law Roles and responsibilities- Poor relationships with others especially those In position of authority. Usually have poor grades, been expelled. Fulfilling Role is being tough, breaking rules and taking advantage of others.

Disruptive Behavior Disorders Assessment - General Appearance & Motor Behavior

normal to extreme appearance (hairstyle, clothing) -Appearance, speech, and motor behavior are typically normal for the age group but may be somewhat extreme (e.g., body piercings, tattoos, hairstyle, clothing). These clients often slouch and are sullen and unwilling to be interviewed. They may use profanity, call the nurse or physician names, and make disparaging remarks about parents, teachers, police, and other authority figures.

Disruptive Behavior Disorders Assessment - History

of disturbed relationships with peer, aggression, disobedience.

Conduct Disorders Medications:

physical aggression (antipsychotics); labile mood (lithium) or other mood stabilizers (tricyclics or anticonvulsants).

Developmental level:

refers to an individual's stage of development (e.g., stage of epiphyseal closure in long bone development, Tanner stage of pubertal development, and stage of cognitive development) or ability to independently achieve an outcome (e.g., perspective-taking and abstract reasoning).

Adaptive Development:

refers to the acquisition of a range of skills that enable independence at home and in the community.

Physical/physiologic development:

refers to the growth and changes in body tissues and organ systems and the resultant changes in body functions and proportions. - Physiologic development includes cellular proliferation, differentiation, and maturation that occurs in each organ and system that allows integrated human functioning necessary for life and health (i.e., infant hematopoietic maturity and secondary sexual characteristic development leading to sexual function)

Disruptive Behavior Disorders Assessment - Roles & relationships

unable to fill their own roles and responsibility

Disruptive Behavior Disorders Assessment - Thought process and content

usually intact, capable of logical rational thinking. Perceive the world aggressive and threatening.