Adult Psychiatric Disorder Adjustment Disorder

An adjustment disorder is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor. (A stressor is anything that causes a great deal of stress in a person's life. Symptoms of Adjustment Disorder: Depressed mood, anxious, regularly acting out of the ordinary. May be experiencing sleep and sexual difficulties. Medication: Medications are generally not appropriate for an adjustment disorder, unless it is complicated by another clinical Axis I diagnosis. Physicians should be especially careful of over-prescribing medications for diagnosis of anxiety or depression, unless the individual better meets the criteria for an Axis I diagnosis. Nursing responsibilities 1. Provide safe environment/protect client from self-harm. 2. Assist client to identify precipitating stressor. 3. Promote development of effective problem-solving techniques. 4. Provide information and support for necessary lifestyle changes. 5. Promote involvement of client/family in therapy process/planning for the future.

Agoraphobia
Is the fear of going out into public places. Agoraphobia can occur with or without panic attacks. Treatment There are a variety of treatments available for agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medications, is considered to be the most effective way to both relieve symptoms and prevent their return. Medication: medical therapy, agoraphobia is usually treated in connection with panic disorder. Commonly, members of the serotonin selective reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups of

medications are used in treatment. Examples of SSRI medications includesertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). Nursing intervention Do not reason out of behavior. Videotaping with review and feedback and role-playing are two therapeutic strategies that can help a person with social phobia. Caring for patients with phobias can involve monitoring medications for effectiveness and adverse reactions, reinforcing concepts presented intherapy, and educating patients and their families on the significance of the phobia as debilitating problem and not just a character flaw to be overcome. Nurses can also teach patients to recognize the signs of increasing anxiety and to select anxiety-reduction measures appropriate for them. One of the most important things for nurses to remember when caring for a patient experiencing phobia is to refrain from confronting or humiliating them. Be sure to carefully screen for suicidal ideation among people with phobias because environmental factors that predispose to phobias also contribute to the risk factors for suicide. When social phobia is identified, especially among young adults, screening for substance abuse and depression is also important.

Antisocial personality
A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years old, as indicated by 3 or more of the following: failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure impulsivity or failure to plan ahead irritability and aggressiveness, as indicated by repeated physical fights or assaults Medications There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. However, several types of psychiatric medications may help with certain conditions sometimes associated with antisocial personality disorder: Antidepressant medications. Antidepressants may help improve depressed mood, anger, impulsivity, irritability or hopelessness. Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression. Anti-anxiety medications. These may help with anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.

Antipsychotic medications. Also called neuroleptics, these may be helpful if symptoms include losing touch with reality (psychosis) or, in some cases, anxiety or anger problems are present. Nursing intervention Client safety should be maintained especially is client is manifesting selfdestructive behaviors. The nurse should allow the client to make his own choice and to be independent as much as possible. Discuss with the client the consequences on his inappropriate behaviors. The nurse should assist the client in dealing with anger. Make a written contract between you and the client to foster adherence to the written agreement. Encourage the client to verbalize his feelings rather than manifesting it physically.

Attention-Deficit Hyperactivity Disorder (ADHD)

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination of both. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development. Treatment Stimulants are the most common treatment for ADHD in children and adolescents. They include methylphenidate -- Ritalin, Metadate, Concerta -or amphetamines, including Dexedrine, Dextrostat, and Adderall. A newer drug, Vyvanse, is a type ofamphetamine thats formulated to last longer and to be less conducive to dependence than other stimulants. Nursing intervention Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated Always remain calm and consistent with the child. Keep all your instructions to the child short and simple. Provide praise and rewards whenever possible. Provide the patient with diversional activities suited to his short attention span. Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span.

Autistic Disorder
Autism is a spectrum disorder, and although it is defined by a certain set of behaviors, children and adults with autism can exhibit any combination of these behaviors in any degree of severity. Two children, both with the same diagnosis, can act completely different from one another and have varying capabilities.

The central features of Autistic Disorder are the presence of markedly abnormal or impaired development in social interaction and communication, and a markedly restricted repertoire of activity and interest. The manifestations of this disorder vary greatly depending on the developmental level and chronological age of the individual. Autistic Disorder is sometimes referred to as Early Infantile Autism, Childhood Autism, or Kanner's Autism. Treatment

Behavior modification Communication therapy Dietary modifications Medication

Nursing intervention
The patient and his family will express reduced levels of anxiety. Anxiety is maintained at a level at which client feels no need for self mutilation Client initiates interactions between self and others, and use eye contact, facial responsiveness, and other nonverbal behavior The patient's family will openly share feelings about the present situation. As much as possible, the patient will demonstrate age-appropriate skills and behaviors. The patient will perform self care activities independently. The patient will develop peer relationships. The patients family will identify and contact available resources as needed. The patient and his family will practice safety measures and take safety precautions in the home. The patient won't engage in self-destructive behaviors.

Delusional disorder
Delusional disorder is characterized by the presence of recurrent, persistent nonbizarre delusions. Treatment Delusional disorder treatment often involves atypical (also called novel or newergeneration ) antipsychotic medications, which can be effective in some patients. Risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa) are all examples of atypical or novel antipsychotic medications. If agitation occurs, a number of different antipsychotics can be used to conclude the outbreak of acute agitation. Agitation, a state of frantic activity experienced concurrently with anger or exaggerated fearfulness, increases the risk that the client will endanger self or others. To decrease anxiety and slow behavior in emergency situations where agitation is a factor, an injection

of haloperidol (Haldol) is often given usually in combination with other medications (often lorazepam , also known as Ativan). Agitation in delusional disorder is a typical response to severe or harsh confrontation when dealing with the existence of the delusions. Nursing intervention 1. promote safe environment, safety of client/others. 2. provide open, honest atmosphere in which client can begin to trust self/others. 3. encourage client/family to focus on defining methods for coping with anxieties and life stressors. 4. promote a sense of self-worth and increased self-esteem.

Cyclothymic Disorder (Cyclothymia)

Cyclothymia is a milder form of bipolar II disorder and can be a precursor to bipolar II disorder. However, it can also occur as extreme moodiness without becoming a major mood disorder. Cyclothymia is characterized by hypomanic and mini-depressive periods that last a few days, follow an irregular course, and are less severe than in bipolar disorder. Treatment Mood stabilizers are the most commonly prescribed medications for cyclothymic disorder. These medications help regulate and stabilize mood so that you don't swing between depression and hypomania. Lithium (Eskalith, Lithobid) has been widely used as a mood stabilizer and is generally the first line of treatment for hypomanic episodes. Anti-seizure medications. The medications, also known as anticonvulsants, are used to prevent mood swings. They include valproic acid (Depakene), divalproex sodium (Depakote) and lamotrigine (Lamictal). Other medications. Certain atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), may help people who don't benefit from anti-seizure medications. Anti-anxiety medications, such as benzodiazepines, may help improve sleep. In addition, one medication, quetiapine (Seroquel), Nursing intervention 1. promote safe environment, safety of client/others. 2. provide open, honest atmosphere in which client can begin to trust self/others

Dysthymia (dysthymic disorder)

usually sets in during early adulthood, and the disorder can last for years or even decades. Later onset is usually associated with bereavement or obvious stress, and often follows on the heels of a more extreme depressive episode. Women

are twice as likely as men to suffer from dysthymia, similar to that seen with major depression. About 3% of the population is affected by dysthymic disorder, with three-quarters of individuals displaying signs of other psychiatric or medical disorders as well. Treatment Tricyclic antidepressants (TCAs) are older and less expensive medications than SSRIs, but they have more severe side effects, including persistent dry mouth, sedation, dizziness, and irregular heartbeat. Because of these, caution is taken when prescribing TCAs to elderly patients. TCAs include amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor). A 10-day supply of TCAs is potentially lethal, so these drugs are questionable treatment options for patients at risk for suicide. Monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) and phenelzine sulfate (Nardil) block the action of monoamine oxidase, a central nervous system enzyme. Patients taking MAOIs must restrict foods high in tyramine (found in red wine, aged cheeses, and meats) from their diet to avoid potentially serious hypertension. Heterocyclics include bupropion (Wellbutrin) and trazodone (Desyrel). Bupropion should not be prescribed for patients with seizure disorder. Side effects of the drug may include agitation, anxiety, confusion, tremor, dry mouth, fast or irregular heartbeat, headache, low blood pressure, and insomnia. Because trazodone has a sedative effect, it is useful in treating depressed patients with insomnia. Nursing intervention Decrease the amount of stimuli in the client's environment (e.g., low noise level, few people, simple decor) Do not reinforce the hallucination. Let client know that you do not share the perception. Maintain reality through reorientation and focus on real situations and people. Provide reassurance of safety if client responds with fear to inaccurate sensory perception. Correct client's description of inaccurate perception, and describe the situation as it exists in reality.

Narcissistic Personality Disorder

usually begins by early adulthood and is marked by disregard for the feelings of others, grandiosity (an exaggerated belief in their own value or importance), obsessive self-interest, and the pursuit of primarily selfish goals. It affects about 1% of the general population and 50-75% of those with NPD are men. Narcissistic Personality Disorder typically occurs in high achievers, although it may also occur in people with few achievements.

Treatment Therapy can be especially difficult because clients are often unwilling to acknowledge the disorder. This difficulty in treatment is often compounded by the fact the insurance companies are focused on short-term treatments that minimize symptoms such as depression and anxiety, but ignore the underlying problems. Cognitive-behavioral therapy is often effective to help individual's change destructive thinking and behavior patterns. The goal of treatment is to alter distorted thoughts and create a more realistic self-image. Psychotropic medications are generally ineffective for long-term change, but are sometimes used to treat symptoms of anxiety or depression. Nursing intervention - Role play alternative behaviors with clients that they can use in stressful and overwhelming situations - Teach the client to problem solve. Have the client define the problem and cause, and list the advantages and disadvantages of the options - Upon discharge, refer for psychiatric home healthcare services for client reassurance and implementation of a therapeutic regimen

Tourette Syndrome
is a neurological disorder characterized by repetitive, involuntary movements or vocalizations called tics. The age of onset is usually between 7-10 years old, although the symptoms may start appearing early in childhood. Men are affected about three to four times more often than women. According to the National Institute of Neurological Disorders and Stroke, 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Treatment

 Watchful

waiting - some cases are mild and are simply tolerated; some cases improve over time and remission can occur after adolescence. Neuroleptic drugs Sedatives Antihypertensive drugs Tranquillizers Nursing intervention

Post-traumatic Stress Disorder

is a severe reaction to an extremely traumatic event. The person can actually experience the event (i.e. be in a plane crash) or be a witness to the event (i.e. rescue worker at a plane crash). Over time and with psychological help, some people learn to cope with the aftermath of the event. However, for others, symptoms such as flashbacks and depression can become worse, lasting a long period of time, and seriously disrupting the person's life. Treatment Explore your thoughts and feelings about the trauma Work through feelings of guilt, self-blame, and mistrust Learn how to cope with and control intrusive memories Address problems PTSD has caused in your life and relationships Types of treatments for post-traumatic stress disorder (PTSD) Trauma-focused cognitive-behavioral therapy. Cognitive-behavioral therapy for PTSD and trauma involves carefully and gradually exposing yourself to thoughts, feelings, and situations that remind you of the trauma. Therapy also involves identifying upsetting thoughts about the traumatic eventparticularly thoughts that are distorted and irrationaland replacing them with more balanced picture. Family therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what youre going through. It can also help everyone in the family communicate better and work through relationship problems. Medication. Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. Antidepressants

such as Prozac and Zoloft are the medications most commonly used for PTSD. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD. EMDR (Eye Movement Desensitization and Reprocessing). EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. Eye movements and other bilateral forms of stimulation are thought to work by unfreezing the brains information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed. Nursing intervention -Encourage the client to express is or her feelings through walking, writing, crying, or other ways in which he client is comfortable. -Encourage the client to talk bout his or her experience(s); Be accepting and non judgemental of the clients accounts and perception