Management of common psychiatric problems

Management of common psychiatric problems Mrs.Sharin Neetal D'souza

Management of common psychiatric problems Prepared by: Mrs.SharinNeetalD’souza Lecturer Dept.Child health nursing Yenepoya nursing college Reviewed by: Prof.Umarani J Dr.PriyaReshmaAranha Mrs.Sharin Neetal D'souza

Learningobjectives At the end of the class students will be able to • define common psychiatric problems • list the causes • identify the signs and symptoms • explain the management Mrs.Sharin Neetal D'souza

AUTISM Mrs.Sharin Neetal D'souza

LEO CORNEL 1943 described • Develop before age of 30 months • But it develop later 1 year Mrs.Sharin Neetal D'souza

The child has markedly impaired development in social interaction, communication and restricted activity & interest. It is characterized by withdrawal of the child into self and into fantasy world of her or his own creation. Mrs.Sharin Neetal D'souza

INCIDENCE • Females are affected • More in males • 1 in 100 children Mrs.Sharin Neetal D'souza

ETIOLOGY • Biological factors • Neurological factors • Social environment Mrs.Sharin Neetal D'souza

SIGNS AND SYMPTOMS • Typical autistic aloofness • Disorders of speech and language • Abnormal behavioural characteristics • Ritualistic & compulsive behaviour • Resistance to slight change in environment • Attachment of inanimate object • Majority will have OCD Mrs.Sharin Neetal D'souza

DIAGNOSIS • history collection • Physical examination • EEG • CT scan • Based on behaviour • Blood serotonin • Neurological examination Mrs.Sharin Neetal D'souza

TREATMENT • Behavioural therapy • Psychotherapy • Pharmacotherapy Mrs.Sharin Neetal D'souza

NURSING MANAGEMENT • Meeting the nutritional needs and hydration • Self care needs • Elimination needs • Communication and social needs • Reducing autistic behaviour • Education to parents • Parental counselling Mrs.Sharin Neetal D'souza

Mood Disorders Mrs.Sharin Neetal D'souza

Mood disorders • Mood disorders are among the most common mental health problems experienced by children and adolescents. • They include all types of depression as well as Bipolar Disorders (formerly called Manic-Depression) and are sometimes referred to as “affective disorders.” • Children with mood disorders often are either depressed, manic (unrealistically “up” or hyper), or alternating between the two. Mrs.Sharin Neetal D'souza

Causes • Mood disorders are generally caused by chemical imbalances in the brain but also can be triggered by environmental causes, as with Seasonal Affective Disorder; • a prolonged or severe medical illness; or biological influences, such as Postpartum Depression • It can be triggered by a sad or painful event like a death in the family. It can develop in children who observe constant fighting between their parents. It can also result from the child experiencing parental neglect or abuse. Mrs.Sharin Neetal D'souza

How common are they? • At any one time, depression in any of its forms can be found in about 3.5% of children and teenagers between the ages of 5 and 17, and the rate increases with age. • In the teen years, many more girls report symptoms of depression than do boys. In childhood, there are no such differences between boys and girls. Mrs.Sharin Neetal D'souza

TYPES OF MOOD PROBLEMS • 1. Major Depression • 2. Dysthymia • 3. Bipolar Disorder Major Depression: • Major depression can be a long-lasting and disabling condition that affects most aspects of a person's life. It has distinct emotional, mental, and physical symptoms, like feeling sad, hopeless or guilty for more than two weeks, or having problems sleeping or eating. Mrs.Sharin Neetal D'souza

Dysthymia: • Dysthymia is a chronic low level depression lasting for at least two years that reduces a person's ability to enjoy life, or feel enthusiastic or ambitious. • Bipolar Disorder: • Bipolar disorder is a condition which in adults is characterized by switching between depression and over excitement (the so-called "manic" phase). • In children and teens, the primary symptoms are often irritability and feeling very important and able to do anything (grandiosity). Mrs.Sharin Neetal D'souza

Signs of Mood Disorders • Symptoms of a mood disorder occur or reoccur over an extended period of time and do interfere with normal activities and relationships. • In Preschool Children: • Somber, almost ill appearance. • Frequent complaints of physical problems for which no medical difficulties can be found. • Lack of bounce and enthusiasm • Tearfulness for no little or no identifiable reason. • Spontaneous irritability. • Frequent negative self-statements. • Self-injurious or self-destructive behaviors at times. • Anhedonia (i.e., experiencing little pleasure from things which most peers enjoy). Mrs.Sharin Neetal D'souza

In Elementary School-Aged Children and Adolescents: • Disruptive behavior. • Academic difficulties or declining school performance. • Frequent problems with peers. • Increased irritability and aggression compared to peers and to their own non-depressed state. • Suicidal threats. • Anhedonia (i.e., experiencing little pleasure from things which most peers enjoy). • Sleeping too much. Mrs.Sharin Neetal D'souza

Rapid, unpredictable emotional changes. • Racing thoughts and flight of ideas. • Increased strength and energy along with decreased sleep. • Increased interest in problematic activities such as overspending and drug use. • Grandiosity and inflated self-esteem. • Greatly increased or decreased sexual drive. • Uncharacteristically poor judgment. Mrs.Sharin Neetal D'souza

Treatment • Medications such as anti-depressants and mood stabilizers, especially when combined with psychotherapy, have been shown to be very effective in the treatment of depression. • A newer class of antidepressant drugs called SSRIs (selective serotonin reuptake inhibitors) is now being widely used to treat more severe cases of major depression. • Psychotherapy, such as cognitive-behavioral and/or interpersonal therapy focused on helping the person change distorted views of themselves and the environment around them; Mrs.Sharin Neetal D'souza

helping them to improve their interpersonal relationship skills; and identifying stressors in the environment, how to avoid them, and how to cope effectively with those which cannot be avoided. • Family therapy — families play a vital, supportive role in any treatment process. • Bipolar disorder is treated with a number of different drugs, as well as family and individual therapy. Mrs.Sharin Neetal D'souza

Learning disability Mrs.Sharin Neetal D'souza

LEARNING DISABILITIES • Learning disabilities, or learning disorders, are an umbrella term for a wide variety of learning problems. A learning disability is not a problem with intelligence or motivation. • Children with learning disabilities see, hear, and understand things differently. This can lead to trouble with learning new information and skills, and putting them to use. The most common types of learning disabilities involve problems with reading, writing, maths, reasoning, listening, and speaking. Mrs.Sharin Neetal D'souza

Preschool signs and symptoms of learning disabilities • Problems pronouncing words • Trouble finding the right word • Difficulty rhyming • Trouble learning the alphabet, numbers, colors, shapes, days of the week • Difficulty following directions or learning routines • Difficulty controlling crayons, pencils, and scissors or coloring within the lines • Trouble with buttons, zippers, snaps, learning to tie shoes Mrs.Sharin Neetal D'souza

Age 1-5 years signs and symptoms of learning disabilities • Trouble learning the connection between letters and sounds • Unable to blend sounds to make words • Confuses basic words when reading • Consistently misspells words and makes frequent reading errors • Trouble learning basic math concepts • Difficulty telling time and remembering sequences • Slow to learn new skills Mrs.Sharin Neetal D'souza

Age 10-13years signs and symptoms of learning disabilities • Difficulty with reading comprehension or math skills • Trouble with open-ended test questions and word problems • Dislikes reading and writing; avoids reading aloud • Spells the same word differently in a single document • Poor organizational skills (bedroom, homework, desk is messy and disorganized) • Trouble following classroom discussions and expressing thoughts aloud • Poor handwriting Mrs.Sharin Neetal D'souza

Dyslexia: • There are two types of learning disabilities in reading. • Basic reading problems occur when there is difficulty understanding the relationship between sounds, letters and words. • Reading comprehension problems occur when there is an inability to grasp the meaning of words, phrases, and paragraphs. Mrs.Sharin Neetal D'souza

Signs of reading difficulty include problems with: • letter and word recognition • understanding words and ideas • reading speed and fluency • general vocabulary skills Mrs.Sharin Neetal D'souza

dyscalculia Learning disability with mathematics • A child’s ability to do maths will be affected differently by a language learning disability, or a visual disorder or a difficulty with sequencing, memory or organization. • A child with a maths–based learning disorder may struggle with memorization and organization of numbers, operation signs, and number “facts” (like 5+5=10 or 5x5=25). Children with maths learning disorders might also have trouble with counting principles (such as counting by 2s or counting by 5s) or have difficulty telling time. Mrs.Sharin Neetal D'souza

dysgraphia Learning disability with writing : • Learning disabilities in writing can involve the physical act of writing or the mental activity of comprehending and synthesizing information. • Basic writing disorder refers to physical difficulty forming words and letters. • Expressive writing disability indicates a struggle to organize thoughts on paper. Mrs.Sharin Neetal D'souza

Symptoms include problems with: • neatness and consistency of writing • accurately copying letters and words • spelling consistency • Writing organization and coherence. Mrs.Sharin Neetal D'souza

dyspraxia • Learning disability in motor skill • Motor difficulty refers to problems with movement and coordination whether it is with fine motor skills or gross motor skills. • In order to run, jump, write or cut something, the brain must be able to communicate with the necessary limbs to complete the action. • Signs that your child might have a motor coordination disability include problems with physical abilities that require hand-eye coordination, like holding a pencil or buttoning a shirt. Mrs.Sharin Neetal D'souza

aphasia and dysphasia • Learning disability in language • Language is also considered an output activity because it requires organizing thoughts in the brain and calling upon the right words to verbally explain something or communicate with someone else. • Signs of a language-based learning disorder involve problems with verbal language skills, such as the ability to retell a story and the fluency of speech, as well as the ability to understand the meaning of words, parts of speech, directions, etc. Mrs.Sharin Neetal D'souza

Auditory processing and visual processing disorder: Auditory processing disorder – Professionals may refer to the ability to hear well as “auditory processing skills” or “receptive language.” The ability to hear things correctly greatly impacts the ability to read, write and spell. An inability to distinguish subtle differences in sound, or hearing sounds at the wrong speed make it difficult to sound out words and understand the basic concepts of reading and writing. Mrs.Sharin Neetal D'souza

Visual processing disorder – Problems in visual perception include missing subtle differences in shapes, reversing letters or numbers, skipping words, skipping lines, misperceiving depth or distance, or having problems with eye–hand coordination. Professionals may refer to the work of the eyes as “visual processing.” Visual perception can affect gross and fine motor skills, reading comprehension, and maths. Mrs.Sharin Neetal D'souza

Common Types of Learning Disabilities Dyslexia • Difficulty reading • Problems reading, writing, spelling, speaking Dyscalculia • Difficulty with math • Problems doing math problems, understanding time, using money Dysgraphia • Difficulty with writing • Problems with handwriting, spelling, organizing ideas Mrs.Sharin Neetal D'souza

Dyspraxia (Sensory Integration Disorder) • Difficulty with fine motor skills • Problems with hand–eye coordination, balance, manual dexterity Dysphasia/Aphasia • Difficulty with language • Problems understanding spoken language, poor reading comprehension Auditory Processing Disorder • Difficulty hearing differences between sounds • Problems with reading, comprehension, language Visual Processing Disorder • Difficulty interpreting visual information • Problems with reading, math, maps, charts, symbols, pictures Mrs.Sharin Neetal D'souza

OTHER DISORDER THAT MAKES THE LEARNING DISABILITY: ADHD: • Children with ADHD often have problems sitting still, staying focused, following instructions, staying organized, and completing homework. Autism: • Difficulty mastering certain academic skills can stem from pervasive developmental disorders such as autism and Asperger’s syndrome. Children with autism spectrum disorders may have trouble communicating, reading body language, learning basic skills, making friends, and making eye contact. Mrs.Sharin Neetal D'souza

Diagnosis and testing process of learning disability: • History taking, and observation by a trained specialist. Types of specialists : • Clinical psychologists • School psychologists • Child psychiatrists • Educational psychologists • Developmental psychologists • Neuropsychologist • Psychometrist • Occupational therapist (tests sensory disorders that can lead to learning problems) • Speech and language therapist Mrs.Sharin Neetal D'souza

Preventive measures: • Paying attention to normal developmental milestones for toddlers and preschoolers • Early detection of developmental differences Learn the specifics about your child’s learning disability. • Research treatments, services, and new theories. • Pursue treatment and services at home. • Nurture your child’s strengths • Social and emotion skill • Finding support while helping with learning disabilities Mrs.Sharin Neetal D'souza

Evaluation • Dyspraxia indicates------------------ • Autism commonly seen in the age group of----------------------- • List 2 types of mood disorders Mrs.Sharin Neetal D'souza

Refernces • Wong’s essentials of pediatric nursing; 17th edition • Marlow. Text book of paediatric nursing, 6th edition • Rimplesharma. Text book of paediatric nursing • ParulDatta. Text book of child health nursing Mrs.Sharin Neetal D'souza

Mrs.Sharin Neetal D'souza

Management of common psychiatric problems