1. MENTAL HEALTH ADDITIONAL INFORMATION

2. VIOLENCE INCIDENCE: Greater in those with ETOH abuse and drug abuse Usually have impulse control and impaired judgment More people react to stress with anxiety instead of violence

3. VIOLENCE/MURDER The extreme manifestations of anger which are usually a reaction to frustration are : violence and murder

4. Types of angry individuals Overcontrolled individual Undercontrolled individual

5. OVERCONTROLLED INDIVIDUAL They quietly tolerate a chronically frustrating situation and harbor resentment while rage builds up inside

6. UNDERCONTROLLED INDIVIDUAL Behavior begins at a early age, has a short fuse. Feels the world is against them. Best defense is the 1 st offense

7. ANGER Anger always has an object Usually the frustrating situation does not occur without a warning sign (body language, verbalization) Anger may be minimal to life threatening SAFETY: Bring violent behavior under control with hospitalization or medication

8. TEACHING OPPORTUNITY Use the violent episode as a teaching opportunity. This is very important as a nurse. GOAL: Help the person find other ways of expressing their fear and anger and to increase their impulse control. This is treatment for violent offenders

9. NEGLECT AND/OR ABUSE OF A CHILD EXAMPLES OF ABUSE: Sexual- 1 in every 3-4 girls will be assaulted by age 18 Physical- 2-4000 deaths a year Psychological- Increase risk for psychological disturbance Neglect

10. ETIOLOGY OF ABUSE Previous abuse (parents) Long term pain No support systems Substance abuse Excessive crying Mental retardation Physical handicap Inappropriate expectations: treat child as older adults

11. Diagnosis NEGLECTED CHILDREN: Child abuse must always be considered when a child presents with bruises or injuries than cannot be adequately explained or that is not compatible with the hx presented by the parent.

12. NEGLECTED CHILDREN May show overt failure to thrive at < 1 yr. old Hunger Poor hygiene Chronic infections Affectionate to even strangers Runaways Aggressive behavior

13. ABUSED CHILDREN Sexual abuse is usually perpetrated by someone known to the child such as father, uncle, mother, brother etc. Most abusers are in a position of authority and are highly trusted Have wide access to the child

14. NURSES MUST REPORT CHILD ABUSE TO CPS* Symmetrical bruises/marks Cigarette burns Immersion burns (looks like socks/gloves) Itching/bruising genital area Difficulty in walking Low self esteem Aggressive behavior

15. ELDER ABUSE AND NEGLECT EXAMPLES OF ABUSE AND NEGLECT: Lack of dentures, glasses, food Withholding of medications Bruises Sexual Exploitation of finances Poor hygiene

16. NURSES ARE MANDATED TO REPORT ELDER ABUSE TO APS The elder is usually frail Often live with their assailants Abusers usually are financially dependent on victim Both the abuser and the victim tend to minimize the situation.

17. DOMESTIC VIOLENCE AND RAPE Male dependence is most common trait Usually a male abuser Usually from an abusive home, ETOH abuse or drug abuse Person may be immature with feelings of inadequacy

18. SPOUSE ABUSE May be male or female Male rape may occur if there are with younger women or if they are frail and elderly Usually occurs when one feels threatened or frustrated The rapist fears being ridiculed if exposed Women who leave the abusers have a 75% risk of being killed

19. RAPE Is an act of violence and humiliation Used to express power or anger Rapist aroused when pain is afflicted DATE RAPES: Rapes in which the rapist is know to the victim

20. MALE RAPE Rapists usually always threatens victim with fists, gun, knife and often harms in non sexual ways

21. Rape : age range Earliest recorded age = 8 Days to 90 years plus INTERVENTIONS: Immediate support Enc. to ventilate rage and fears Provide rape hotlines and centers No longer have to prove that the victims fought against the rapist

22. ANABOLIC STEROIDS EFFECTS OF STEROIDS Natural = Testosterone Synthetic = Anawar, Dianabol Subject to same regulatory requirements for dispensing as narcotics It has a psychological and physical dependence About ½ of steroid users start before the age of 16

23. STEROIDS PHYSICAL EFFECTS Muscle bulk Acne Premature balding Gynomastia Liver neoplasm Psychological/Physical dependence Violent crimes Hostility, depression, suicide

24. Steroid Abuse ?

25. STEROID TREATMENT Detoxification/ Withdrawal Abstinence Psychological support In patient treatment

26. ATTENTION DEFICIT HYPERACTIVITY DISORDER ADHD Characteristics must appear before age 7 Goes hand in hand with bi- polar disorder, anxiety and depression.

27. ADHD Characteristics : Developmentally inappropriate, Inattentiveness, Impulsiveness, hyperactivity.

28. ADHD TYPES INATTENTIVE - have diff. with concentrating, forgetful, makes careless mistakes, loses things. Signs and symptoms intensify with boredom HYPERACTIVE-impulsive, act before they think, interrupt others, difficulty waiting their turn, always in motion, talks excessively. Can progress to conduct disorder

29. ADHD DIAGNOSIS Neuro and psychological exams Speech/Lang. evals Behavior must create a real handicap in at least 2 areas of the child’s life (school, home or social setting)

30. ADHD TREATMENT Stimulating or non stimulating drugs (Ritalin, Cylert, Concerta) : increase neurotransmitter in cerebral cortex and regulate the brain to more normal levels. Individualized care plan Safe calm environment Frequent breaks Provide positive feedback