This document discusses various mental health issues including categories like developmental, behavioral, and clinical disorders. It provides an overview of autism spectrum disorder including diagnostic criteria and treatments. Nursing interventions are outlined for several disorders including establishing trust and communication. Etiology, symptoms, diagnosis and treatment approaches are summarized for conditions such as ADHD, oppositional defiant disorder, depression, and suicide risk.

1. Renee Franquiz RN, MSN

2.  Catergories of Mental Health Issues
 Growth &Developmental - Stages and Norms
▪ Aspergers, Autism, MR
 Behavioral Disorders
▪ ADHD, Opposition/Defiance, Conduct, Separation Anxiety
 Clinical Disorders
▪ BiPolar, Depression, Suicide
 Diagnosis
 Ability to communicate; Wide range of “normal”
 Pathologic
 Not age Appropriate
 Deviates from Cultural Norms
 Impairs Adaptive Functioning

3.  Overview  Dx - Autism Spectrum DSM-IV Criteria
 Effects 2:10,000 with higher  Two of the following
incidence in males (4:1 ▪ Impaired Non Verbal Communication
ratio) ▪ Failure to develop peer relationships
 Autism Spectrum – No
▪ Lack interests in other people
cognitive or language
▪ Lack of social/emotional reciprocity
impairment
 One of the following
 Suspicions in pre-school
years ▪ Preoccupation with a restricted interest
 Socially “awkward” to an that is abnormal in intensity
extreme ▪ Inflexible adherence to routines or
 Difficulty continues into rituals
adulthood ▪ Repetitive motor mannerisms
 Etiology – unknown; ▪ Persistent preoccupation with parts of
genetic d/t familial an object
tendency

4. MEDICAL MANAGEMENT NURSING INTERVENTIONS
 Social Skills Training  Collaborative Care
 role play social situations  Team member role as a nurse
 Cognitive/Behavior w/medical management
Therapy
 Talk Therapy  Independent Nursing Care
 Medications  Where else and how else
 Co-morbidities might you come in contact
with these children and their
 Physical Therapy families?
 Family Coping
 Support groups

5.  Developmental disorder of brain function which effects:
 Communication – language delay, echolacia
 Social Interaction- lack of reciprocity, responsiveness,
relationships
 Repetitive Behaviors – head banging, clapping, rocking, rituals
and routines
 Manifests b/t 24-48 mos age; 6:1000 with 4x males
 Cause is unknown; evidence supports multiple causes
 Biologic – Abnormal brain structure, Brain Hypoplasia,
Seratonin
 Genetic – Twins, familial
 Environment – Thimerosal; intranatal exposures; Food
Additives/Dyes

6.  DSM-IV Criteria page 382 in Textbook
 Impaired Verbal Communication
 Establishment of trust
 Able to communicate needs and desires
 Impaired Social Interaction
 Establishment of trust
 Engagement in social interaction
 Risk for Harm to Self
 No Harm to self
 Engage in alternate behaviors

7.  Est’b of therapeutic relationship – trust
 Limit Number of caretakers/Decrease stimuli
 Provide w/familiar or security objects
 Maintain a routine/Avoid abrupt changes
 Anticipate Needs
 Positive praise and reinforcement for desired behavior
 Protect from Self-Harm
 Distract
 Devices
 Ongoing Behavior Management Therapy
 Social Training
 Verbal Skills
 Parent Support
 Autism Society of America

8.  Definition
 Deficit in general intellectual functioning as measured
by IQ
 DSM-IV Criteria on page 377 in Textbook
 Etiology (Biologic and or Social)
 Hereditary– Genetic, Chromosomal, Metabolic D/O
 Perinatal Exposure– Infections, Ingestions
 Acquired– Infection, Safety/TBI, Child Abuse, Sx,
Social deprivation/neglect

9.  Mild - IQ 50 – 75
 Slower to talk and perform adls; mental age of 8-
12 year old; likely to achieve skills for self-
maintenance with support
 Moderate – IQ 36 -49
 Noticable delays, simple speech, mental age of
3-7 years; simple tasks with supervision; not
capable of self-maintenance
 Severe – IQ 20 – 35
 Marked delay, limited communication; mental
age of a 1-3 years; requires continuous
supervision
 Profound – IQ below 20
 Minimal purposeful actions; infantile

10.  Risk for Injury
 No physical harm
 Self Care Deficit
 Self Care needs fulfilled
 Impaired Communication
 Means of communication established
 Impaired Social Interaction
 Interacts with others
 Impaired Growth and Development
 Maximize developmental capacity

11.  Physical Needs
 Provide for ADLs
 Encourage Self-Care
 Safety
 Create a safe environment
 Protect from self harm – devices
 Establish means/ method for communication
 Early intervention/special education programs to
maximize potential
 Support families and help in setting realistic goals
 Counsel adolescent/family on sexual maturity and
responsibility, marriage, childbearing and vocation

12. OVERVIEW ETIOLOGY
 Key Symptoms  Biologic
 Inattentiveness  Genetic – familial
 Hyperactive-Impulsive  Biochemical – alterations in
 Difficult to Dx before age 4 dopamine, serotonin, norepi
 Issues emerge with school  Anatomical variations – lobe size
 More common in boys  Intrauterine exposure – Substances
 Majority persist as adults  CNS disorders – sz, infection
 Subtypes
 Combined  Environmental
 Inattentive type  Lead
 Hyperactive-Impulsive type  Food Additives , dyes, sugars

13.  DSM-IV Criteria on page 387 in textbook
 Inattentive
 Unable to listen; Inattentive; forgetful
 Disorganized; Poor follow through
 Procrastinates; Loses things
 Hyperactive
 Restless; Excessive motor actvitiy
 Difficulty with quiet activities
 Talks excessively
 Impulsive
 Interrupts
 Blurts out
 Difficulty waiting turns

14.  Risk For Injury
 No physical harm
 Impaired Social Interaction
 Interacts with others
 Low self-esteem
 Positive self regard
 Noncompliance
 Participates in therapeutic activities

15.  Protect from injury/provide safe environments for
physical activity
 Set boundaries; identify unacceptable behaviors
and consequences
 Provide structure and routines – feenback
systems
 Convey acceptance and provide opportunities for
success
 Limit distractions in the environment
 Empower child to manage own behavior
 Medication Therapy

16.  Dextramphetamin - Dexedrine
 Methamphetamine - Desoxyn
 Combo – Adderall
 Methylphenidate – Ritalin
 Dexmethylphenidate – Focalin
 Anorexia, Insomnia, Weight Loss, Decreased Growth
 Atomoxetine – Strattera
 Same as above, increase BP/Pulse, sexual Dysfunction
 Bupropion – Wellbutrin
 CNS stimulation, anorexia, weight loss

17.  Administer after meal(s); monitor growth and
weight
 Administer in AM, or 6 hours before bedtime
 Use cautiously in clients with CV D/O
 Monitor LFTs
 Monitor for new psychotic D/O
 Monitor OTC that may contain similar
components
 Medication “holiday” to assess behaviors off
therapy

18. OVERVIEW ETIOLOGY
 Patterns of behavior that  Biologic
violate the rights of others  Genetics
 Physical Aggression if  Biochemical – Serotonin, Nor-
Common epi, Testosterone – inconclusive
 Most common reason for  Temperament – “difficult”
psychiatric referral Strong willed
 Higher Incidence Males  Psychosocial
 Child Onset – less than 10 y,  Peer socialization
aggression, disturbed  Family
relationships
▪ Marital discord, changing parent
 Adolescent Onset – After figures, absent fathers
10y, less aggressive, better ▪ Harsh discipline, permissiveness
relationships ▪ Parenteral rejection; Parent MH
D/O, early institutionalization

19.  DSM-IV Criteria on page 395 in textbook
 Physical Aggression - “Tough Guy”
 People and Animals
 Initiates; Weapons
 Rape
 Destruction of Property
 Fire Setting
 Lying/Stealing – Lacks Remorse
 Rules Violations
 Curfew Issues
 Runaway
 School Truancy – ability exceeds achievement

20.  Risk for other directed violence
 No harm to others
 Impaired Social Interactions
 Interacts in socially appropriate ways
 Defensive Coping
 Accepts feedback and responsibility
 Low Self-Esteem
 Positive self regard; discontinuation of
exploitation

21.  Highly Resistant to Treatment – Requires intensive , persistent , long
term services
 Family Therapy
 Parenting Skills Training
 Communication
 Behavior Therapy
 Improved Decision Making/Problem Solving
 Anger Management
 Impulse Control
 Relationship Building
 Substance Use/Abuse
 Medications – manage behaviors (Sedation agents; Impulsiveness; Mood
Stabilizers)
 Prognosis - refractory

22. OVERVIEW ETIOLOGY
 Negative, disobedient,  Biologic
defiance towards authority  Genetics
 Stubborn, argumentative,  Biochemical – Serotonin, Nor-
temper epi, Testosterone –
 Interferes with social, inconclusive
school, and work  Temperament – “difficult”
 Do not violate rights of Strong willed
others
 Family
 Parenting Limitations
 Behaviors emerges in
 Impulsed Disordered Parent –
childhood
Serves as a Role Model
 Higher incidence in males
 Absent Parent

23.  DSM-IV Criteria on page 398 in Textbook
 Passive Aggressive – Negative, stubborn,
disobedient, testing, uncooperative,
argumentative
 Attitude directed toward parent(s)
 Project blame on others
 Poor relationships (limited friends), school
performance

24.  Impaired Social Interactions
 Interacts is socially appropriate ways
 Defensive Coping
 Verbalize responsibilities for behaviors
 Demonstrate effective Coping
 Low Self Esteem
 Positive self regard
 Noncompliance
 Participation in Therapeutic Activities

25.  Family Therapy
 Parenting Skills Training
▪ Avoid Power Struggles
▪ Set reasonable expectations - Structure
▪ Impose limits
▪ Follow Through – Consequences - Rewards
 Behavior Therapy
 Improved Decision Making/Problem Solving
 Anger Management
 Social Skills Building

26. OVERVIEW ETIOLOGY
 Excessive anxiety when  Biologic
separating or anticipating  Genetics
separation from home or  Temperament – Shy, cautious
parents  Environment
 May be triggered by a  Traumatic Event
trauma event; Most  Maternal Over Attachment
common on starting school  Overprotective Family
 Higher incidence in  Parent Role Model Fears
females
 May progress to panic D/O

27.  Separation reluctance
 Tantrums, crying, screaming, clinging
 Reluctance to attend school
 Follow parent around the house
 Inability to sleep away from home
 Worry, nightmares – during separation harm
will come to self or parent
 Phobias – fear of dark, ghosts, dogs

28.  DSM-IV Criteria on page 405 in textbook
 Anxiety
 Uses adaptive activity to manage anxiety
 Feels safe
 Demonstrates trust
 Ineffective Coping
 Demonstrate adaptive coping
 Impaired Social Interaction
 Spend time with others

29.  Establish calm atmosphere
 Reassure client of safety
 Explore fears and worries
 Establish gradual separation goals – desensitize
 Identify alternative adaptive coping
 Alternate parenting techniques
 Anti-anxiety medications – severe cases

30.  Suicide Overview
 Rates rise during adolescence
 3rd leading cause death 15-24 years old
 Greater risk due to impulsive behaviors;Risk
Taking
 Most common methods is firearm (49%)
 Trigger more often relationship issues

31.  Assessment
 Similar tools, methods and findings
 Desire to hurt self with a plan and the means
 Report – minors who seek health care for mental health
are considered emancipated
 Dx
 Risk For Suicide
 Hoplessness
 Interventions
 Physical Safety/Treat Co-Morbidities
 Suicide Precautions
 Therapy/Support

32.  Overview
 Approximately 4%-5% of children experience depression
 Etiology – usually a feeling of loss
▪ Genetic Predisposition
▪ Relationship Difficulties, Family Distruption, school Changes
 Behaviors
 May vary or similar to adults
 Morbid Thoughts; Excessive Worry, Sadness
 Changes in School Performance and Relationships
 Sleeping and Eating Disturbances
 Self Harm - slashing
 Management
 Similar to adults
 +/- Hospitalization
 AntiDepressants and Psychotherapy