1. Trisha Economidis Marilee Elias Fall 2010
Dementia & Delirium Eating Disorders Disorders Common in Children & Adolescents Personality Disorders
Trisha Economidis
Marilee Elias
Fall 2010

2. Dementia & 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?

3. 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

4. Delirium Etiologies: General Medical Conditions Substance-Induced
Substance-Intoxication and/or Withdrawal
Multiple Etiologies

5. Delirium Interventions This is an Emergency Aggressive Treatment
Safe Environment
Sensory Perceptions
Reorient & reorient & reorient

6. Dementia Not a normal part of Aging
Loss of previous levels of cognitive, executive & memory function
Usually Progressive & Irreversible
Classifications
Primary Dementias
Secondary Dementias
Temporary Dementia

7. The Many Stages of DAT Stage 1: No apparent symptoms
Stage 2: Forgetfulness
Stage 3: Mild cognitive decline
Stage 4: Mild-moderate cognitive decline, Confusion
Stage 5: Moderate cognitive decline,
Early Dementia
Stage 6: Mod-severe cognitive decline, Middle Dementia
Stage 7: Severe cognitive decline, Late Dementia

8. Interventions with Dementia
Orient to reality
Clocks, calendars
Promote memory/reminiscing
Familiar items, Pictures, Music
Provide safe, structured environment

9. Eating Disorders
Anorexia Nervosa
Bulimia Nervosa

10. 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?

11. 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

12. Bulimia Nervosa What’s Bulimia? What’s binging? What’s purging?
What are the physical symptoms?
Weight
Dentition
Check out those hands
Cardiac concerns
Electrolyte imbalances

13. Etiologies for Anorexia/Bulimia
Is it in the genes?
Neuroendocrine abnormalities
The factors of family dysfunction
What’s up with your parents?

14. 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

15. Personality Disorders
Cluster A
Paranoid, Schizoid
Cluster B
Antisocial
Borderline
Narcisisstic
Cluster C
Passive-aggressive

16. 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?

17. Schizoid Personality Disorder
Cluster A
Men diagnosed> Women
Pattern of social withdrawal
They are way too serious
Spontaneity?
Inability to form personal relationships
Prevalence in general population?

18. Antisocial Personality Disorder
Cluster B
Men 3X> Women
Exploitative, aggressive & manipulative
Lacks a lot
Where do we find them?
Lower SEC > Higher SEC

19. Borderline Personality Disorder
Cluster B
Emotionally unstable, intense, impulsive, self-destructive
The most common personality disorder
Women up to 4X > Men
What’s splitting got to do with it?
It’s all or nothing

20. Narcissistic Personality Disorder
Cluster B
Inalienable right to special rights & privileges
Too much self-worth
Men> Women
Exploitive
Overly self-centered

21. 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

22. Disorders Common in Children and Adolescents
Mental Retardation
Autistic Disorder
Attention-deficit/Hyperactive Disorder
Conduct Disorder
Oppositional Defiant Disorder
Tourette’s Syndrome
Separation Anxiety Disorder

23. Emotional Problems in Children
Behaviors are:
Not age appropriate
Deviate from cultural norms
Cause deficits or impairments in adaptive functioning

24. Mental Retardation Etiology? Those genes again! Prenatal factors
Pregnancy and perinatal factors
General medical conditions in infancy or childhood
Environmental influences and other mental disorders

25. Mental Retardation IQ Tests What is the DSM-IV-TR criteria?
Measure deficits in general intellectual functioning
What is the DSM-IV-TR criteria?
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?

26. Mental Retardation Characteristics by Degree of Severity
Mild
Moderate
Severe
Profound
Townsend, table 22-1, p. 527

27. 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

28. 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

29. What do we find with Down’s Syndrome?
Mental retardation with developmental delays of varying degrees
Physical characteristics?
Head, face, neck
Muscles
Hands
Abdomen
Genitalia

30. Pervasive Developmental Disorders
What are the characteristics?
Impaired areas of development
Social Interaction Skills
Interpersonal Communication
This Category includes:
Autistic Disorder
Asperger’s Disorder

31. Autistic Disorder Prevalence 1/150 children in the US
Boys 4-5 X> girls
Onset before 3 years of age
Etiologies include:
Neurological
Genes again
Perinatal Influences

32. Symptoms of Autism Impaired social interactions Impaired communication
Impaired imagination
Rigid routines
Activities and Interests
Impaired Diet

33. Asperger’s Disorder High functioning autism Later onset of symptoms
No significant delays in language, cognitive development, self-help skills
Severe, sustained social interaction impairment
Problems with empathy

34. ADHD Etiologies Genes (again?) Biochemical Anatomical
Neurotransmitters
Anatomical
Alterations in the brain
Prenatal, perinatal, postnatal factors
Environmental factors
Psychosocial factors

35. ADHD Interventions Provide a safe environment Positive feedback
Develop trusting relationship with caregivers
Help child interact with others at an appropriate level of maturity

36. 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?

37. Disruptive Behavior Disorders
Severe enough to produce significant impairment:
Social
Academic
Occupational
Conduct Disorder
Oppositional Defiant Disorder

38. Conduct Disorder What is the pattern of behavior? What’s violated?
What’s common?
DSM-IV-TR Subtypes
Childhood Onset
Usually boys, physical aggression
Adolescent Onset
Lower ratio boys to girls, physical aggression less likely

39. Does Conduct Disorder progress?
Childhood onset subtype
Possible ODD early
Conduct disorder by puberty
Antisocial personality disorder as Adults

40. Conduct Disorder Etiologies Genes (again and again)
Difficult Temperament
Biochemical
Diagnosis of ADHD
Psychosocial Factors
Family Dynamics
Peer Relationships

41. 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

42. 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

43. ODD Etiologies Biological influences Family Influences
Possibly Genetic
Family Influences
Parental Problems
A power struggle

44. Symptoms of ODD Passive-Aggressive Behaviors What will the child do?
Other Physical Manifestations?
Enuresis
Encopresis

45. 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

46. Tourette’s Syndrome Essential Features? Onset Etiologies Structural
Before 18 years of age
Boys > Girls
Etiologies
Guess what’s first on the list
Biochemical
Structural
Areas of Brain Dysfunction
Environmental

47. Treatment of Tourette’s Syndrome
Psychosocial Therapy
Includes the Family
Psychopharmacological Therapy
Drugs
Haloperidol (for Severe Symptoms)
Pimozidine (Severe Symptoms after other drug failures)
Clonidine (Safe, Few Side Effects)
Atypical Antipsychotics
Risperidone (Good reduction of symptoms)
Ziprasidone
Olanzopine

48. Separation Anxiety Disorder
What’s the essential feature? (think excess)
Onset
Anytime before 18 years of age
As early as preschool age
Girls > Boys

49. Separation Anxiety Etiologies You already know the first one
Temperament
Environmental Influences
Family Influences
Stressful Life Events

50. Separation Anxiety Symptoms
Difficult separations from who?
Anticipation of separations
Refusing to…
Specific Phobias
Depressed Mood

51. 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

52. 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

53. Brains Full Yet?