Chapter 40. PSYCHOPATHOLOGY

8/13/2019 Chapter 40. PSYCHOPATHOLOGY

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Psychiatric-Mental Health Nurses Association

of the Philippines, Inc. (PMHNAP)

Chapter 40

Child and Adolescent

Psychiatric Nursing


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Keltners Psychiatric Nursing Philippine edition

Learning Objectives

Describe major categories of child and adolescent

psychiatric disorders.

Describe frequency of serious psychiatric disorders

in children and adolescents. Identify genetic and environmental factors

associated with developing psychiatric disorders.

Describe the symptoms of selected child and

adolescent psychiatric disorders.

Identify principles of nursing intervention with child

and adolescent psychiatric patients.


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Depression

Approximately 9.5% of youth have experienced

some form of depression by age 16, with girls

experiencing higher rates of depression (12%) than

boys (7%) by mid-adolescence (Costello et al.,2003).

Feelings of helplessness, hopelessness, decreased

energy, and social withdrawal.

Depression is expressed via somatic complaints. Suicidethird leading cause of death among

adolescents in the United States.


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Bipolar Disorder

Irritability is a more prominent symptom.

Manifestations:

Mood instability

Temper tantrums Impulsivity

Subtle depressive symptoms


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Anxiety Disorders

Anxiety disorders in children occur at the rate of

about 10% by age 16.


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Pediatric Obsessive-Compulsive

Disorder

Recurring thoughts (obsessions)

Repetitive ritualistic behaviors (compulsions)

Often associated with disruptive behavioral

disorders such as conduct disorder and oppositional

defiant disorder


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PTSD in Children

Can be caused by a single traumatic event or from

long-term sexual and physical abuse.

Symptoms of PTSD in children are similar to many

of the same symptoms as adults:o Nightmares

o Intrusive memories

o Hypervigilance


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Other Anxiety Disorders in Children

Separation anxiety

Social anxiety disorder

Panic disorder


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Attention Deficit

Hyperactivity Disorder

A complex brain disorder that involves subtle

abnormalities in central nervous system functioning

(Kieling et al., 2008).

Diagnosis of ADHD must last at least 6 months. Symptoms appear before age 7.

The best treatment plan includes management and

understanding from parents and teacher.


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Proclamation 472

National Attention Deficit Hyperactivity Disorder

Awareness Week third week of October, every

year.

Proclaimed September 18, 2003 through PresidentGloria Macapagal-Arroyo.

It states that ADHD is a chronic brain disorder with

social, academic, and emotional impacts that can

affect an estimated 4 millions Filipinos nationwide.


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Used to describethe pervasive

developmentaldisorder

classification of theDSM-IV-TR

This categorydenotes sustained,

behaviorallydefined braindisorders and

includes (in orderof frequency):

Autistic disorder

Pervasive developmentaldisorder not otherwise specified

Aspergers disorder

Retts disorder

Childhood disintegrativedisorder

Autism Spectrum Disorders


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Three Major Commonalities in

Autism Spectrum Disorders

Arrested socialskills

Impaired verbaland nonverbalcommunication

Restricted,

repetitive, andstereotypical

behavior,interests, and

activities


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Usually entails a

systematic abuse of

power involving

repetition, harm, andunequal power

(Nansel and Overpeck,

2003).

Repeated negative

actions of one or

more students toward

a victim(Olweus, 2001).

Bullying

Crucial Elements of Bullying

Intentionally cruel

Unprovoked


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Types of Bullying

Is the most frequent type of bullying, with name calling and derogatory remarksbeing most common.

Verbal bullying

Involves shunning and ignoring the victim.

Relational bullying

Can range from slight shoving to burns and broken bones.

Physical bullying

May take the form of private text messages or e-mails, pictures being postedwithout permission and rumors being spread via e-mails, text messages, orsocial networking Web sites.

Cyberbullying


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Nurse-Patient Relationship

for Families

Family members can be powerful allies in

attempting to overcome the mental disorder but can

also be powerful roadblocks to success.

Families can be very instrumental in recordingsymptoms and in tracking symptom frequency,

intensity, number, and duration.


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Psychopharmacology

Depression

Tricyclicantidepressants

(TCA)

Selective serotoninreuptake inhibitors(SSRI)

Anxietydisorders

Nonbenzodiazepinebuspirone (Buspar)

TCA and SSRI

Bipolardisorder

Age 1017:Risperidone

Age 12 or more:lithium

Age 1117:Aripiprazole

Dosages are weight based.


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Psychopharmacology

ADHD

Methylphenidate (Ritalin)

Extended-acting methylphenidate (Concerta)

Dextroamphetamine with amino acid lysineattached (Vyvanse)

Plain dextroamphetamine (Dexedrine)

Amphetamine mixture (Adderall)

Other stimulant formulations such aspemoline (Cylert)

Autism spectrumdisorders

Aripiprazole (Abilify)

Risperidone (Risperdal)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Ziprasidone (Geodon)

Dosages are weight based.


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Milieu Management

Physical safety such as protecting the patient fromaggressive peers, harmful objects, and incompetent

medication administration Psychological harm (e.g., ridicule, verbal abuse, or

harassment)

Safety

Layout of the physical environment

Organization of the treatment plan

Structure


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Milieu Management

Nonviolence, cleanliness, participation in chores, and participationin therapeutic activities

Norms

Putting limits on acting-out behavior, self-destructive conduct,aggressiveness toward others, and inappropriate sexual actions

Use of phones and texting, choice of visitors or friends, andseclusive behaviors

Limit setting

Appropriate independence

Balance

Chapter 40. PSYCHOPATHOLOGY

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