Research Articles Base: Mental Illness

Bipolar Disorder

Bipolar Disorder   Introduction Bipolar disorder causes shifts in a person’s mood, energy, and ability to function. The symptoms of this disorder have the potential to damage relationships. This paper analyzes the case of Scott, a patient diagnosed with bipolar disorder. This paper presents an intensive investigation of bipolar disorder, its phases, signs and symptoms, diagnosis, treatments and medications.   Bipolar Disorder Bipolar disorder is also known as manic-depressive disorder. This disorder is frequently marked by periods of inconsolable sadness and despair (major depression) alternating or intermixed with periods of extreme cheerfulness, energy, extravagance, and talkativeness that may suddenly turn into rage and hostility (mania). Usually the presence of one of the moods is followed by a period of the opposite mood ( 2000). Bipolar disorder, also commonly known as manic depression, is a brain disorder that causes shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder can result in damaged relationships, difficulty in working or going to school, and even suicide. Bipolar disorder can cause dramatic mood swings – from high and feeling on top of the world, or uncomfortably irritable, to sad and hopeless, often with periods of normal moods in between. The periods of highs and lows are called episodes of mania and depression.   Signs and Symptoms Mania (Manic Episode) <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Increased energy, activity, and restlessness</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Excessive ‘high’, overly good, euphoric mood</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Extreme irritability</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Racing thought and talking very fast, jumping from one idea to another</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Distractibility</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Little sleep needed</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Unrealistic beliefs in one’s abilities and powers</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Poor judgment</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Spending sprees</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> A lasting period of behavior that is different from usual</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Increased sexual drive</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Abuse of drugs</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Provocative, intrusive, or aggressive behavior ( 2007)</li> </ul> Depression (Depressive Episode) <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Lasting sad, anxious, or empty mood</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Feelings of hopelessness or pessimism</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Feelings of guilt, worthlessness, or helplessness</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Loss of interest or pleasure in activities once enjoyed, including sex</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Decreased energy, a feeling of fatigue or of being ‘slowed down’</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Difficulty concentrating, remembering, making decisions</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Restlessness or irritability</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Sleeping too much, or lack of sleep</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Change in appetite and/or unintended weight loss or gain</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Thought of death or suicide, or suicide attempts (National Institute of Mental Health, 2007)</li> </ul>   Bipolar Disorder I Bipolar disorder I is characterized by at least one manic episode, with or without major depressions (). People with bipolar episode type I experience at least one episode of mania – that is, an episode during which their mood ranges unpredictably from euphoric to irritable and is accompanied by hyperactivity, lack of need for sleep, impulsiveness, rapid thoughts and speech, poor follow through in tasks, poor judgment in business and personal arenas, poor insight (self-awareness of changes in attitude and behavior), delusions of wealth or power or victimization by conspiracies, and often, but not always, auditory hallucinations (2000). Patients with bipolar I disorder have had at least one episode of mania. Some patients have had previous depressive episodes, and most patients will have subsequent episodes that can be either manic or depressive. Hypomanic and mixed episodes can occur, as well as significant subthreshold mood lability between episodes ()   Bipolar Disorder II and Hypomania Bipolar disorder II is characterized by at least one episode of hypomania and at least one episode of major depression (). People with bipolar II disorder show a similar pattern of a recurrent depression punctuated by occasional mood elevations, except that the mood elevation is milder and is described as hypomania. Individuals with hypomania tend to experience episodically expansive but controllable ‘highs’ and increased productivity while retaining reasonable insight and judgment. These ‘little highs’ may last only a few hours before a mood swing occurs and increasingly severe depressive symptoms set in (2000). Patients meeting criteria for bipolar II disorder have a history of major depressive episodes and hypomanic episodes only (). Hypomania is a mild to moderate level of mania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression (2007).       Cyclothymic Bipolar Disorder Cyclothymic disorder may be diagnosed in those patients who have never experienced a manic, mixed, or major depressive episode but who experience numerous periods of depressive symptoms and numerous periods of hypomanic symptoms for at least 2 years, with no symptom-free period greater than 2 months (). While cyclothymic disorder is not as severe as either bipolar disorder II or I, the condition is more chronic. Hypomanic symptoms tend toward irritability as compared to the euphoric symptoms of bipolar II. The disorder lasts at least two years, with single episodes persisting for more than two months.   Scott’s Case Scott is a 26-year old patient diagnosed with Bipolar Disorder – predominantly having manic phases 2 years ago. He is a plumber by trade and has been working full time for the last six months. He was admitted in the last 24 hours to an acute mental health inpatient unit. He reported that signs and symptoms such as little sleep, lack of appetite, and weight loss. In addition, he also exhibits grandiose or unrealistic beliefs on his abilities. His friend reveals that Scott has a tendency to be distracted owing to the fact that he was unable to complete a single job in two weeks despite commencing many. Other symptoms that Scott present are rapid speech and flight of ideas. Scott refuses to be hospitalized therefore he has a great tendency run away from the unit. Studying the signs and symptoms that Scott exhibits, his medical records, and the supporting evidence/statements presented by his family and friends reveal that Scott’s condition is Bipolar I Disorder characterized by manic episode accompanied by lack of need for sleep, rapid thoughts and speech, poor follow through in tasks, poor judgment, grandiose and denial. These symptoms of mania are accompanied by Hypomania. With Hypomania the symptoms of mania are milder and of shorter duration (but they last at least four days). They do not affect social or work life as dramatically.   Goals of Scott’s Care and Treatment Bipolar disorder is a recurrent disease. However, its course is unpredictable. The major goals of treatment are the following: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> To treat and reduce the severity of acute episodes of mania when they occur.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> To reduce the frequency of episodes.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> To avoid cycling from phase to another.</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> To help the patient function as effectively as possible between episodes.</li> </ul>   Scott’s case calls for a treatment that will control his acute manic episodes and a long-term maintenance treatment to reduce the frequency of episodes. The primary focused of Scott’s treatment is symptom control to allow a return to normal levels of psychosocial functioning.   Hospitalization Many patients with bipolar I disorder are hospitalized at some point in the course of their illness. Because acute mania affects insight and judgment, individuals with mania are often hospitalized over their objections, which can be upsetting for both patients and their loved ones. However, most individuals with mania are grateful for the help they receive during the acute episode, even if it was given against their will at the time. Hospitalization should be considered under the following circumstances: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> When safety is in question due to suicidal, homicidal, or aggressive impulses or actions</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> When severe distress or dysfunction requires round-the-clock care and support</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> Where there is ongoing substance abuse, to prevent access to drugs</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> When the patient has an unstable medical condition</li> <li class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%"> When close observation of the patient’s reaction to medication is required (www.psychguides.com)</li> </ul> At present, Scott is experiencing an acute manic episode, requiring hospitalization and close attention. However, long-term hospitalization is not necessary.   Therapeutic Interventions Psychotherapy Psychotherapy for bipolar disorder helps a person cope with life problems, come to terms with changes in self-image and life-goals, and understand the effects of the illness on significant relationships. As a treatment to relieve symptoms during acute episode, psychotherapy is much more likely to help with depression than with mania – during manic episode; patients may find it hard to listen to a therapist. Long-term psychotherapy may help prevent both mania and depression by reducing the stresses that trigger episodes and by increasing patients’ acceptance of the need for medication ().   Specific Psychotherapies for Bipolar Disorder 1. Psychoeducation The purpose of psychoeducation is to educate patients about the illness and its treatment including types of treatment (especially pharmacology) and side effects in order to enhance understanding and compliance (2000). Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs ().       2. Family Therapy The purpose of family therapy is to improve communication among family members, reducing interpersonal crisis and noncompliance ( 2000). Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person’s symptoms (). 3. Cognitive Behavioral Therapy (CBT) CBT helps patients understand and change depressed negative cognitions (2000). CBT helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness (). 4. Interpersonal and Social Rhythm Therapy Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes (National Institute of Mental Health).   Pharmacological Interventions Mood stabilizing drugs are the mainstay for patients with bipolar. They are defined as drugs that are effective for acute episodes of mania and depression that can be used for maintenance. The currently available first-line mood stabilizers are lithium and valproate. Both drugs stimulate the release of the neurotransmitter glutamate, although they appear to work through different mechanisms. Other drugs may also be used.  Lithium has been used for years for bipolar disorder. It remains the best drug for people with pure mania characterized by euphoria and pure depression. Valporoate is an anti-seizure agent that is effective for many patients with mania, rapid cycling, and mixed states, as well as for patients who are also substance abusers. Carbamazepine is usually the second anti-seizure medication of choice. Atypical Antipsychotics have mood stabilizing properties ().   Ethical Considerations The ethical consideration in drug therapy is that drugs remove responsibility for the patient. They put all the power into the hands of doctors and psychiatrists. Pharmacological drugs have serious and dangerous side effects. The biological model of mental disorders removes responsibility from the patient and places it on faulty functioning of the body. With respect to ethics, this means that no blame is attached to the individual, but on the negative side. It means that the patient is not empowered to help him/herself. All responsibility is taken away and placed in the hands of the health professional.     Conclusion Bipolar disorder poses a great challenge to patients, their families and loved ones and to the health professionals as well. Bipolar disorder affects one’s life and can damage relationships. Bipolar disorder can be controlled. Patients together with their families need to work hand in hand with health professional in order to manage the disorder effectively. There are different drugs available that effectively control the symptoms of bipolar disorder. The key to successfully managing the disorder and effective patient function is early detection and treatment.     Credit:ivythesis.typepad.com

Bipolar Disorder

Bipolar Disorder Introduction Bipolar disorder causes shifts in a person’s mood, energy, and ability to function. The symptoms of th...

Bipolar Disorder I (focus on adolesence)

Bipolar Disorder 1: Focus on Adolescence               One of the most prevalent psychological disorders in adolescence includes mood disorders, which are characterized by a disturbance in the regulation of mood, behavior, and affect. Such mood disorders are subdivided into depressive disorders, bipolar disorders, and depression in association with medical illness or alcohol and substance abuse. The focus of this paper is the bipolar disorders, which is known as manic-depressive disorder and involves episodes of alternate serious mania and depression, where mood swings from high elation and irritability to extreme sadness and hopelessness (, 2007). Because researches have found out that the onset of this type of psychological disorder is first evident on the pubescent period, this paper aims to examine and discuss the Bipolar Disorder 1 on the perspective of adolescence. Discussion and examination of the psychological disorder includes its description, features, prevalence, and manifestations with respect to DSM-IV TR, or the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. In addition, the possible methods of treatment and the implications of the disorder to the individual and the community would be given emphasis.   Bipolar Disorder 1: Manic-Depressive Disorder             Bipolar Disorder 1 or commonly called as the Manic-Depressive Disorder is said to be one of the most severe forms of mental illness, which is characterized by recurrent episodes of mania and depression, and is a condition that has a high rate of recurrence, thus, if left untreated, it leads to a high risk of suicide (, 2005). Emotional states of manic-depressives differ in magnitude and severity, and their mood swings from profound feelings of elation or mania to hypomania or feelings in between, to desperate feelings of hopelessness and helplessness or depression (, 2006). Although “normal” moments of a manic-depressive can be identified, such normal moments are considered transitions from one mood swing to another.             This neurological disorder is characterized by unpredictable mood swings from mania or hypomania to depression. Some clients suffer only from recurrent attacks of mania, which in its pure form is associated with increased psychomotor activity. In addition, excessive social extroversion, decreased need for sleep, impulsivity, impairment in judgment, and expansive, grandiose, and sometimes irritable mood can be observed. In clients with severe mania, they may experience delusions and paranoid thinking indistinguishable from that associated with schizophrenia. On the other hand, depressive states of clients may be characterized by depressed mood and loss of interest in pleasurable activities, and includes disturbances in appetite, sleep, and energy level and concentration (, 1988). Clients having depressive episodes may also be so fatigued that they sleep all day and night or cannot go to work or do household chores because of intense sadness and lethargy. They often feel worthless, shoulder excessive guilt, and are preoccupied with thoughts of suicide and death. More recent data show that approximately half of the patients with this type of disorder have sustained difficulties in work performance and psychosocial functioning. It has been reported that most frequent age of onset for bipolar disorder is between 20 and 30 years of age, but many individuals report premorbid symptoms in late childhood or early adolescence. The prevalence is similar for men and women, who are likely to have more depressive episodes and men who are more likely to experience more manic episodes over a lifetime. Its worldwide prevalence is 3-5% of the population, with no significant differences among racial groups (, 2005).             The causes or etiology of manic-depression is unknown, but a number of factors are said to determine its incidence, namely, genetics, biological, and psychosocial factors. It has been reported that the evidence for the heritability of bipolar disorder is stronger than that for unipolar disorder, thus, it has been found out that 50% of bipolar clients have at least one parent with a mood disorder. If one parent has bipolar disorder, there is a 7% chance that any child will have a mood disorder, and if both parents have bipolar disorder, then there is a 50-70% chance that a child will have a mood disorder. Twin studies have also shown that a concordance rate of 0.67 for bipolar disorder in monozygotic twins and 0.20 for bipolar disorder in dizygotic twins (, 1988). In regard of biological causes, it has been supposed that norepinephrine and serotonin are the two neurotransmitters most implicated in the pathophysiology of bipolar disorder. A decrease in serotonin levels affects the depressive state of the client, while increase in dopaminergic activity is increased in mania (, 1988). The last factor considered and crucial to cause bipolar disorder is the psychosocial factors, including the psychological and environmental events that affect the client. Life events and environmental stress serves to be strong causes of bipolar disorders and other psychological disorders. This involves a significant loss on the part of the client, which generates depression and severe emotional distress. Thus, in this regard, it can be perceived that the onset of bipolar disorder is multifactorial in nature.   Bipolar Disorder in Adolescence              (2002) reports that the criteria for diagnosing bipolar disorder in adolescence are the same as those for adults, and defined in DSM-IV TR, having several variations and combinations of mood strength and frequency of mood shift. As similarly and previously discussed, in Bipolar Disorder 1, the individual experiences one or more manic episodes, or mixed episodes and possibly one or more major depressive episodes. There can also be periods of relative or complete wellness between the episodes. Adolescents may initially exhibit either mania or depressive episodes, and a loss or other traumatic event may trigger the episode of depression or mania in adolescents. Additional episodes may occur independently or may be precipitated by stress. The onset of puberty is often thought to trigger the disorder. Symptoms in females may vary with their monthly menstrual cycle. In addition, adolescents may consumer illegal drugs in an attempt to control their mood swings and insomnia. Sudden development of the disorder following puberty often results in addiction to drugs and alcohol in these vulnerable adolescents. It then becomes necessary to treat both the bipolar disorder and the substance abuse. In children and younger adolescents, bipolar disorder is more continuous, with a cycle between depression and mania as few as several times per year, while several times throughout the day. This mixed state can cause them to feel full of energy, restless, worthless, and self-destructive simultaneously ( ., 2002).             Moreover, it has been reported that adolescent bipolar disorder showed significant continuity across developmental periods and was associated with adverse outcomes during young adulthood. Due to high rates of comorbidity with other psychological disorders, definitive conclusions regarding the specific clinical significance of bipolar disorder must await studies and researches with large numbers of cases. This leads to recent surveys that the lifetime prevalence of manic-depression in adolescents was estimated to be approximately 0.5%, and as of now, no national or international epidemiological study of manic-depression in children is available (, 2005). In this regard, it can be seen that causes of bipolar disorder among adolescents are may be due to the changing and ranging hormones and traumatic events both in the society and in the family. With such causes and symptoms observed among adolescents with bipolar symptoms, it would be essential to know how to administer treatment and assistance to both the individual experiencing the psychological disorder and his or her family and community.   Treatment of Bipolar Disorder in Adolescents             Based on such symptoms, the treatment of the client can be administered. Possible treatment of the bipolar adolescent includes the combination of both psychosocial and pharmacological treatments. Pharmacological treatments include administering anti-depressant drugs. Because the cause of depression is the deficiency in neurotransmitters norepinephrine and serotonin, and possible dopamine, administering anti-depressants, such as Selective Serotonin Reuptake Inhibitors or SSRIs, tricyclics, and Monoamine Oxidase Inhibitors or MAOIs, is based on the restoration of normal levels of these neurotransmitters. In addition, Lithium Carbonate remains the mainstay of treatment of bipolar disorder, although sodium valproate or valproic acid is equally effective. Carbamazepine is also efficacious. Serious side effects from lithium administration are rare, but minor complaints, including gastrointestinal discomfort, nausea, diarrhea, polyuria, weight gain, skin eruptions, and edema are common. In the end, urine-concentrating ability may be decreased, but changes in function are not significant. In addition, valproic acid is an alternative for clients who cannot tolerate lithium or respond poorly to it. Valproic acid may be better than lithium for clients who have a rapid-recycling course. Its most serious side effect is hepatotoxicity, which may be fatal. However, such cases are rare, but regular monitoring of liver enzymes of the client must be indicated. Carbamazepine, although not formally approved by the Food and Drug Administration, has clinical efficacy in the treatment of acute mania. It may be initiated 400 to 600 mg/d in divided doses, and increased to achieve a blood level of 4 to 12 mg/L. The recurrent nature of manic-depression necessitates maintenance treatment, and as such, anti-depressant medications may be required. However, the use of anti-depressants must be generally avoided during maintenance treatment because of possible risk of precipitating mania or accelerating the cycle frequency. As such, an alternative agent or combination therapy usually restores the therapeutic benefit (, 1994). Herbal or natural supplements can also be used, as there is evidence that St. John’s wort can reduce depression, but little is still known about its effect on bipolar disorder. Such forms of medications can be provided for by the family of the bipolar adolescent, but must be under the supervision, guidance, and prescription of a psychiatrist. In this regard, over dosages would be avoided that would contribute to further adverse complications.                Aside from pharmacology, the treatment of a bipolar adolescent can be hastened using psychosocial interventions. Psychosocial interventions involve activities and education of the bipolar adolescent, his or her family, and the whole community, thus, providing overall and wholesome assistance and care for the individual with bipolar disorder. One of the psychosocial interventions that can be provided is the Cognitive-Behavioral Therapy, which would help bipolar adolescents by learning how to change inappropriate or negative thought patterns and behaviors associated with the disorder. Methods involved in this type of therapy include modifying the environmental contingencies that surround the problem, weakening previous conditioned associations that have resulted in maladaptive emotional reactions, offering clients more effective models of problem-solving and interpersonal behavior, seeking to change ways in which stimuli are recognized and interpreted, and offering an objectively superior basis for the therapeutic, counseling or casework roles of the psychologist or psychiatrist (, 1995). Another form of psychosocial intervention is Psychoeducation, which involves teaching clients with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown bipolar episode occurs. It may also be helpful for family members. Equally helpful is the use of family therapy, a form of psychotherapy, which uses strategies to reduce the level of distress within the family that may either contribute to or result from the adolescent’s symptoms. Family therapy also helps families or members of the family to understand and improve on how family members interact with each other and resolve conflicts (“, 2007). The last type of psychosocial intervention that can be used is the Interpersonal and Social Rhythm Therapy, which aims to help people with manic-depression both to improve interpersonal relationships and to regularize their daily routines, on the basis that regular daily routines and sleep schedules may help protect against manic episodes. In addition, because biological rhythms are affected by disruptions in social rhythms, this type of therapy aims to correct or alter daily rhythms, including the wake-sleep cycle and times of eating, working, socializing and other daily activities that are unique to each individual (, 2004).   Implications of Bipolar Disorder in Adolescents             Because an adolescent experiencing manic-depression exhibits a number of alternating and opposing symptoms, it can be perceived that a number of implications can be identified. Such implications affect not only the individual suffering from manic-depression, but affect his or her family and community as well. It has been reported that adolescents exhibit irritability and outbursts of destructive rage that are violent and often result in exhaustion. Such rages are frequently precipitated by a requirement to follow a rule or by a denial of a request (., 2002). As such, destruction of property and of self can be observed, thus, making the bipolar adolescent socially destructive and deviant, not only in terms of properties and objects, but in terms of the emotional and psychological aspects of the people around him or her. This is also supported by the feature of bipolar adolescents, as being oppositional and tyrannical. They defy authority and dictate to their parents how they should relate to and discipline their siblings, and display an outburst of rage and anger when told that he or she cannot engage in a requested activity, and often becomes verbally abusive (., 2002). This contributes to the self-destructive behavior of the bipolar adolescent, and the emotional and psychological trauma of the people around him or her, most especially his or her family and friends. Because they tend to defy authority, further implications include more violations in school and the state, thus, may lead to imprisonment and sentences. Manic-depression is also characterized by akathesia, which is restless inner tension, and contributes to the sleep disturbance of bipolar adolescents. It has been observed that bipolar adolescent’s cycle through periods of hyperactivity that is oddly magnified at night, and because of this, they usually sneak out at night after everyone is asleep or driving at night streets without a license (., 2002). Sleep disturbance or lack of sleep has adverse effects on the biological functioning of an individual, most especially on the biological functioning of adolescents, which is in its crucial development at this time.  (2006) reports that sleep is needed to regenerate certain parts of the body, especially the brain. During extended wakefulness or reduced sleep, as being exhibited by bipolar adolescents, neurons may begin to malfunction, visibly affecting a person’s behavior (, 2006). This explanation further supports that the lack of sleep of bipolar adolescents may have been one of the factors that changes their moods and behavior toward situations and other individuals. In addition, because they engage in risky activities at nighttime, they also cause sleep disturbance to other individuals in the neighborhood and to their family, most especially if they engage in noisy, dangerous, and destructive activities. In summation, it can be perceived that the sleep disturbance of the bipolar adolescent also leads to the lack of sleep of his or her family members and the people in the neighborhood. Another trait of bipolar adolescents, which presents adverse implications, is their impulsivity. They act impulsively to energize themselves when depressed (., 2002), thus making them decide on things without using their right and good judgments. Such leads to more serious problems, including premarital sex, teenage pregnancy, single-parenthood, murder, rape, and other crimes and violations of the law that may risk the safety and integrity of the adolescent and his or her family. The lack of proper cognitive functioning of the bipolar adolescent causes him or her to have lack of self-control and to have lack of concentration. This leads the adolescent to quit school, thus, may become socially withdrawn due to extreme depression, and make him or her to think of committing suicide. This presents complications and other problems to be experienced by his or her family, thus, making them make decisions that would worsen the condition of the bipolar adolescent. Such decisions may include abandonment or desertion, reprimanding at all times, isolation, and having the perception that the adolescent is socially deviant or having behavioral problems. In this regard, it can be perceived that such actions can be the effects or the implications of the lack of understanding of the family and community of the bipolar adolescent. Due to ignorance, lack of proper and relevant information, and education, the condition of the bipolar adolescent may worsen and become a full-blown manic-depression. The worst implication of this psychological disorder is to become a full-blown manic-depression and later on lead to psychosis on the later part of the life of the individual. In this regard, the individual would become non-functional in all aspects, such as psychologically, emotionally, rationally, and socially. As such, the end-result of the process would be taking the individual to mental institutions for confinement and to undergo more significant psychological and mental treatments. In this sense, it can be seen that bipolar disorder or manic-depression must not be taken lightly, although its manifestations in the adolescents may seem hard to determine. However, in this regard, the saying, “an ounce of prevention is worth a pound of cure”, is the most relevant saying in addressing problems in bipolar disorder because proper care of the adolescents starts from the family and the community. Preventive measures must be observed in order not to contribute to full-blown manic-depression or other psychotic disorders. Works Cited   Credit:ivythesis.typepad.com

Bipolar Disorder I (focus on adolesence)

Bipolar Disorder 1: Focus on Adolescence One of the most prevalent psychological disorders in adolescence includes mood di...

MENTAL HEALTH DISORDERS IN YOUNG CHILDREN

Mental Heath Disorders in Young Children   INTRODUCTION             Mental Health disorders in children are, more often than not, ignored. Other times, it is just completely, not talked about openly. Because of the rapid changes in the world today, many young children develop mental illnesses because they find it difficult to cope up with the fast pace the world is taking.   I. Most Common Mental Illnesses during Childhood According to , the following are the top 5 disorders children develop: “1. Anxiety disorders. When the child has experienced severe trauma or sudden and extreme change, the child may exhibit symptoms of anxiety disorders as a result of these changes. Also, stressful events, feelings of fear, hatred, and inadequacy may also trigger this disorder. Phobias may accompany this disorder. If the child has been keeping to himself and has not associated with others, or has been having difficulties keeping up at school, it may be tell-tale signs of this disorder. If so, the child must be attended to immediately. Psychological and sociological treatment is available for this disorder, as well as prescribed medication. 2. Attention-deficit disorder. ADHD or ADD is easily becoming one of the most common disorders in childhood today. Its distinguishing characteristics are constant “hyper-activeness” and inability to concentrate. The child may have difficulty keeping to him when he has this disorder. Most often, the child may have a surge of energy that may make it difficult for him to stay in one place. Another is that the child could lack retention span and have difficulty in concentrating. These are the most common symptoms of ADHD and are proven to disrupt school and family life. Because of this, parents are encouraged to seek help from professionals who can help with the treatment of the child. Medication may also be taken to lessen the effects of this disorder. 3. Autism and development disorders. Autism is often characterized by difficulty in normal functioning and development. The child may exhibit difficulty in reading, writing, speaking and may even have impaired social abilities. The child may also have obsessive and impulsive behaviors such as constant banging of the head on the wall. The child does not have the ability to stop this. Another symptom the child may exhibit is to refuse to be touched; they may even refuse to look at the speaker in the eye. Due to these symptoms, the child may choose to keep to himself and refuse to interact with other people. Psychosocial and behavioral treatments as well as medication are available for these symptoms. 4. Mood Disorders. The child may have difficulty expressing his feelings normally. In result, the child may only choose to exhibit these feelings through destructive and may even choose not to show these feelings at all. In result, the child may be aloof towards society. This disorder is said to be caused by sudden changes wherein the child did not have enough time to comprehend the things that happened. And because of the child’s constant change in mood, he may have difficulty keeping up with school and even function normally at home. medication as well as counseling are available to treat this disorder. 5. Depression disorder. It is in a way similar to mood disorders but is often associated with feelings of grief and depression. Tragedies and disasters may cause this disorder. When a child does not have enough ability to cope up with these events, he may chose to keep to himself and withdraw from society. Performance in school and at home and other social settings may suffer due to this recoil instinct of the child. Treatments such as counseling may be able to remedy the damage.  (Source-) I.A. Conceptualization, Diagnosis and Treatment             In forming Diagnosing and treating a certain mental disorder, one must first go through the process of conceptualizing the illness. Let us take for example ADHD and autism.             What is ADHD?? ADHD a disorder in which a child has the incapability to concentrate on a task. Lack of the ability of retention and hyper-activity are also key identifying symptoms of this illness.             According to , M.D., “Diagnosing ADHD is not easy. There is no single test that reveals the presence of the disorder. A physician will perform a complete physical examination and compile a thorough medical history. The physician may use questionnaires or interviews with parents, teachers, babysitters, coaches and others who may describe behaviors typically associated with ADHD. Teachers in particular may be asked to record their observations on standard evaluation forms called behavior rating scales. These forms take advantage of a teacher’s experience working with various children by asking the teacher to compare the child’s behavior to others of the same age group. The physician will look for behaviors that have a long history, and will note when they occur. Questions that may be asked by the physician include: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> At what age did the child first begin displaying symptoms of potential ADHD?</li> <li class="MsoNormal" style="line-height: 200%"> Do problems tend to appear periodically or are they chronic?</li> <li class="MsoNormal" style="line-height: 200%"> Does the child struggle academically?</li> <li class="MsoNormal" style="line-height: 200%"> Does the child have trouble maintaining relationships?</li> <li class="MsoNormal" style="line-height: 200%"> Are there other problems or symptoms that may be apparent? </li> </ul> Standardized testing also may be used to evaluate a child’s mental health status, intelligence level, learning abilities and social adjustment. Before diagnosing ADHD, the physician will rule out other potential causes of symptoms. Sleep disorders such as sleep apnea (temporary cessation of breathing during sleep) are frequently the cause of inattention in children. Other disorders that cause symptoms similar to ADHD include hyperthyroidism (excessive production of thyroid hormone), seizure disorders, and vision or hearing problems. Sudden life changes (such as the death of a loved one) can also cause emotional disruption in children that may appear similar to ADHD. A diagnosis of ADHD is often made in concert with other health professionals such as psychiatrists, developmental and behavioral pediatricians, and behavioral neurologists. Patients should exhibit six or more symptoms in at least one of two categories that persist for more than 6 months and which are not consistent or in line with the patient’s level of development. Regarding inattention, the symptoms include: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> Has trouble in mincing small details or makes mistakes in other activities due to carelessness. </li> <li class="MsoNormal" style="line-height: 200%"> Cannot remain focused on activities like playing.</li> <li class="MsoNormal" style="line-height: 200%"> Doesn’t seem to be listening when addressed directly..</li> <li class="MsoNormal" style="line-height: 200%"> Has difficulty in accomplishing tasks assigned like schoolwork, home duties and other such tasks.</li> <li class="MsoNormal" style="line-height: 200%"> This cannot be the result of oppositional behavior or a failure to understand directions.</li> <li class="MsoNormal" style="line-height: 200%"> Finds the organization of tasks difficult.</li> <li class="MsoNormal" style="line-height: 200%"> Tries, as much as possible, to evade tasks that need great mental concentration.</li> <li class="MsoNormal" style="line-height: 200%"> Often times lose necessary items to complete a task such as pencils or toys.</li> <li class="MsoNormal" style="line-height: 200%"> Attention is easily diverted to external Stimuli.</li> <li class="MsoNormal" style="line-height: 200%"> Is often oblivious to activities of daily basis.</li> </ul> Regarding hyperactivity and impulsivity, the symptoms include: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> Cannot stay put when seated.</li> <li class="MsoNormal" style="line-height: 200%"> Moves from his seat when told to remain seated.</li> <li class="MsoNormal" style="line-height: 200%"> Runs or climbs excessively when the situation is uncalled for.</li> <li class="MsoNormal" style="line-height: 200%"> Cannot seem to do activities such as playing silently.</li> <li class="MsoNormal" style="line-height: 200%"> Likely on the verge of moving about, due to the surge of energy.</li> <li class="MsoNormal" style="line-height: 200%"> Most likely is very chatty.</li> <li class="MsoNormal" style="line-height: 200%"> Utters the answer when the question is finished.</li> <li class="MsoNormal" style="line-height: 200%"> Has difficulty waiting turn.</li> <li class="MsoNormal" style="line-height: 200%"> Invades others privacy.</li> </ul> These symptoms should be found before the child reaches the age of 7, and the impairment should be found in two or more settings. “ (Source-)             According to , treatments for ADHD include a whole range of fields such as the social and psychological aspects. They often are treatments which deal with the patient, in other times with the parents or other adults who interact with the child. Treatments may provide information and guides on how to handle the child with the disorder. Food that triggers the child’s hyperactivity, as observed by parents, is suppressed through dieting. Medication One of the few effective treatments to help lessen the effects of ADHD is medication but only when adopted as part of a “comprehensive treatment plan”. A ‘comprehensive treatment plan’ includes psychological, educational and social measures. This may also solicit the help of parents and teachers who are expected to help and support the child. Psychological treatment may also take part but isn’t really needed.” (Source-) Now let’s take into perspective autism. Autism is a disorder in which a patient’s social and developmental abilities are impaired. More often than not, autistic children have difficulty communicating and interacting with people around them. (source- ) They also have this behaviour that they cannot stop doing something when they are thoroughly fixated by it. Take for example Laura (not real name). She has difficulty washing the dishes. Why? When she starts soaping the dishes, she gets fixated on the rainbow colors the bubbles reflect. And she cannot stop doing that unless all the bubbles have been popped. She just stays there and stares at the bubbles.                 How is Autism diagnosed? According to , from the page of About: Autism Spectrum Disorders, “Autism Spectrum Disorders (ASDs) should be diagnosed by a medical professional with support from physical, occupational and speech therapists. To qualify for a diagnosis, a person must have a total of six or more items from (1), (2), and (3), with at least two from (1) and one each from (2) and (3): 1. Qualitative impairment in social interaction, manifest by at least two of the following: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> A. Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures and gestures, to regulate social interaction </li> <li class="MsoNormal" style="line-height: 200%"> B. Failure to develop peer relationships appropriate to developmental level </li> <li class="MsoNormal" style="line-height: 200%"> C. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest) </li> <li class="MsoNormal" style="line-height: 200%"> D. Lack of social or emotional reciprocity</li> </ul> Qualitative impairment in communication, as manifest by at least one of the following: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> A. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) </li> <li class="MsoNormal" style="line-height: 200%"> B. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others </li> <li class="MsoNormal" style="line-height: 200%"> C. Stereotyped and repetitive use of language, or idiosyncratic language </li> <li class="MsoNormal" style="line-height: 200%"> D. Lack of varied, spontaneous make-believe, or social imitative play appropriate to developmental level</li> </ul> 3. Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one of the following: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> A. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus </li> <li class="MsoNormal" style="line-height: 200%"> B. Apparently inflexible adherence to specific nonfunctional routines or rituals </li> <li class="MsoNormal" style="line-height: 200%"> C. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) </li> <li class="MsoNormal" style="line-height: 200%"> D. Persistent preoccupation with parts of objects.</li> </ul> Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="line-height: 200%"> 1. Social interaction </li> <li class="MsoNormal" style="line-height: 200%"> 2. Language as used in social communication </li> <li class="MsoNormal" style="line-height: 200%"> 3. Symbolic or imaginative play” (Sources-)</li> </ul> Treatment of Autism. According to , MD, Autism cannot be cured. The treatment applied can only bring about improvement but not totally cure the person. The treatment plan for the patient should hit the core symptoms of autism: problems with communication and interaction with other people. (Source-) II. Childhood Disorder’s Effect on Normal Communication             As in the facts and examples presented above, one can conclude that, yes, mental health disorders in childhood do affect normal communication. Children who have such disorders tend to turn away from society or even do not have the capability to connect with society. Children with autism choose not come in contact with other people. They tend to stay with themselves and not socialize with other people. They hardly communicate. Because of that, they tend to shun away school life and other social life, thus, retarding their chances of developing properly. III. Literature Review             In the literature that I have read, I do not think pathology was ever insinuated. It all focused on the retarded development of children with mental disorders and the treatments that are recommended. It also made mention of the treatments that included psychological, psychosocial, and behavioral aspects that may greatly help in the suppression of the symptoms present.                       Reference: Credit:ivythesis.typepad.com

MENTAL HEALTH DISORDERS IN YOUNG CHILDREN

Mental Heath Disorders in Young Children INTRODUCTION Mental Health disorders in children are, more often than not, ignor...

MENTAL DISORDER

MENTAL DISORDER Introduction Mental Health is the capability of a person, the group and the environment to communicate with each other in manners that enhance self-esteem, the holistic progress and utilization of cognitive capabilities (2005). The definition of mental health reflects a number of themes, including psychological and social harmony and integration, quality of life and general well- being, self-actualization and growth, effective personal adaptation, and the mutual influences of the individual, the group, and the environment. Furthermore, it emphasizes the social context of mental health by explicitly indicating the importance of social justice and equality to mental well-being. The definition also recognizes that all individuals possess a capacity for mental health, whether or not they have a mental disorder.             With the emergence of different mental health problems, psychiatric nursing tries to handle and control the problems brought by mental illness and mental disorder towards their societies.        A.   Brief Biography   Mary Browning is 54 year old part-time teaching assistant in a local primary school. She lives at home with her husband John and two cats. She is premenopausal and consults her doctor about feeling tired recently. Clinically the doctor suspected that Mary is a little anemic and arranged some blood tests. Physical examination of  revealed nutritional deficiencies and excesses in addition to weight changes that led to her depressive disorder. Pre-menopausal women are at risk of developing late-life depressive disorder. B. Symptoms of the Disorder Mary Browning experienced more physical illness than younger individuals. She attributed her depressive symptoms to concurrent medical problems: the demoralization and fatigue that accompany her physical illness or the effect of prescribed medications (2002). Persons over the age of 65 represent only 12-13% of the population but receive approximately one-third of medications prescribed. Mary Browning cited that she bore a disproportionate burden of life’s vicissitudes: loss, and conflict, physical illness, and disability. C. Diagnosis Late-life depression is not a necessary consequence of normal aging. It is a widespread and serious medical disorder. Significant depressive symptoms affect over 5 million of the 35 million people over the age of 65 years in the United States (:2005). The consequences of this are substantial: impaired compliance with medical treatment, over utilization of health care resources, diminished quality of life, and premature mortality. Nevertheless, depression is frequently under diagnosed; when properly diagnosed, it is often under-treated. The purpose of this chapter is to illustrate the magnitude of the problem in order to lay the groundwork for discussion of diagnosis and treatment of this condition and its related variants. For all of these reasons, the prevalence of late-life depression on her may be routinely underestimated. Unrecognized depression in a medical setting can prolong the length of hospital stay, increase the use of other health resources, and add to the cost of care (2005). Depression may decrease motivation to care adequately for an existing medical condition. For instance, patients with diabetes and comorbid depression comply poorly with medications and diet and subsequently have more difficulty achieving D. Recommendations The individual healthcare worker’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring that the best is given to patients, specifically for those who have underwent surgical operations.  But professional competence is only part of the picture. The role of the nurse in the treatment or intervention of major depressive disorder among elderly is an essential part of the professional healthcare team through collaborative practice must always give priority through caring its patient and giving all the possible assistance in order to alleviate their sufferings from pain. The provision of holistic care for other people as well as the utilization of various complementary healing modalities is the foundation of nursing. According to  (2005), provision of care is what a nurse does and happens to be the earliest characterization of nursing, which was actually based from the Greek word “therpeia”, meaning therapy. In (1980), a therapist refers to a person that has undergone training on various methods of treatment and rehabilitation aside from the use of drugs or surgery. A therapeutic is then someone who is capable of applying these methods of treatment to cure diseases. Provision of care is a vital aspect of nursing and the fundamental role of nurses (2003). Based from the statement of Reverby (1987), the role of the nurses basically evolves from the historical depiction of women as care providers of vulnerable individuals within the community. Initially, caring is an imposed role among women, especially during the period of mass epidemics and wars. During this time, the nurses were then a paid workforce. In  own words, nurses were “ordered to care in a society that refuses to value caring” (1987, p.1). The provision of sufficient attention to the comfort as well as the support of health and treatment of patients is also part of the nurses’ role. In the traditional perspective however, caring does not require any specific knowledge or skill. Caring appears to be something that naturally comes out of women, especially when they are adequately directed by medicine and administration. Nurses, as expert caregivers, must be aware of themselves in order to participate fully in a therapeutic relationship. This implies that the development of nurses is centrally founded on their ability to integrate feelings with knowledge and experience (2004). Nurses must process their own subjective experience of self with the caring relationship in a way that they are able to remain focused on the patients’ needs (2004). One might think that the integrated awareness of self, other and environment gives the nurses a comprehension and openness required to authentically and fully participate with the caring-healing intention of therapeutic relationship.   Humanistic nursing is described as embracing more than a benevolent technically competent subject-object one-way relationship guided by a nurse on behalf of another. Rather, humanistic nursing is defined as dictating that nursing is a “responsible searching, transactional relationship whose meaningfulness demands conceptualization founded on a nurse’s existential awareness of self and the other” (  1988). Nursing is an experience lived between human beings. All therapeutic action initiated by the nurse in the care of another human being occurs through a self in action, but this is not necessarily through the therapeutic use of self or the art of nursing. (1996) points out that for some nurses, the therapeutic use of one’s self may be simply the implementation of a nursing technique such as the administration of oxygen and not the giving of one’s self. This kind of nursing is described as the “lending” rather than “giving” of one’s self (2002). The difficulty with this “lending” perspective is that although the nurse may be technically competent, she or he remains aloof and the deeper existential needs of the patient remain unaddressed. While possibly providing increased personal comfort to the nurse, the avoidance of the risk of deeper emotional engagement also risks losing the opportunity for personal growth and fulfillment when the nurse does not fully participate in life experiences. There are many kinds of nurses according to their specialty, and one of which is the psychiatric nurse. In this manner, psychiatric nurses practice with autonomy and independence, and are accountable for caring patients with neurological problems or those diagnosed with aneurysms, brain tumours, cerebrovascular disease, degenerative spine disease and epilepsy. It is noted that caring for individuals with neurological dilemma and disabilities needs a special skills and knowledge to sustain the quality of life, functional level and patient outcomes. In addition, illnesses and injuries that cover the nervous system often have extensive effects on different aspects including physical, cognitive, personality and patients’ behaviour. In this manner, nurses who are assigned to assist psychiatric patients must have the ability to combine theories and practice efficiently, since caring for these patients is considered as multidisciplinary (2002). Primarily, the main goal of this paper is to critically analyse a certain nursing practice whose field in to assist patients with major depressive disorder.  In addition, this paper will attempt to provide an in-depth knowledge and understanding of a current area of practice in relation to the clinical management of the psychiatric patients.   Nurses may assume a special role with very ill patients in which direct and continuous support of physiological, emotional, social, and spiritual functions is provided. Nurses may use a wide variety of skills and techniques to take care of patients. A problem-solving or nursing process approach is generally accepted by professional and educational groups; practice, licensing, and ac- crediting bodies; and the institutions where nursing is practiced as an appropriate framework for nursing practice and activities (1990; 1993). This approach includes assessing and diagnosing patient problems, planning and goal setting for individual patient needs, intervening for each problem, and evaluating results. Pain and anxiety are examples of patient problems for which nurses might intervene. In hospitals, nurses might be involved in direct care of patients, management, teaching, research, or consultation regarding patient care. Nursing roles in hospitals may also encompass coordinating the multiple services involved in patient care (1993). The direct care nursing role in critical care settings, specifically those patients experiencing neurological problems and diseases involves assessing the complex interplay of illness or dysfunction of the individual as a physiologic and psychologic whole. Herein, the psychiatric nurse may be considered an extension of the functions of a patient unable to care for her-himself. The patient crisis may be elective surgery, overwhelming infection, trauma, angina, or multiple system failure and coma. The nurse provides physical care and monitors vital functions including heart rate; blood pressure; skin integrity; bowel and bladder functions; nutritional, fluid, electrolyte, and mobility status; and mentation. In addition, the psychiatric nurse assesses for abnormalities and takes action to help the patient return to normal function (1987). Conversely, in the field of nursing, there can be seen different models in which the psychiatric nurses can use in order to promote quality care among patients as well as provides respect on their autonomy. According to (1992), advocacy model can be used to let the psychiatric nurse put into practice the skills and the knowledge that they have learned.  Advocacy model is the model for nursing practice which was developed as nursing developed its own sense of professional identity, separate from duties to physicians and institutions.  Under this model, the primary role of the psychiatric nurses is to protect or safeguard the rights and interest of its patients.  Here, the psychiatric nurses must be able to recognize the rights of the patients undermined by their institutional practices and unequal power structures.  Moreover, the psychiatric nurses must be able to do its duty to empower patients, both directly by supporting and respecting patient autonomy or independence and indirectly by working to changes of practice to disempowering the patients.  The psychiatric nurses have a duty to respect the patient’s rights to self-determination and confidentiality which is under the patient autonomy.  The principle of patient’s autonomy expresses that nurses have a job to treat the patient according to the patient’s desire, within the limits of accepted treatment and to protect the patient’s confidentiality and privacy. Under which, the nurses has the core responsibility to let the patients be involved in treatment decisions in a meaningful way with due consideration being given to the patients’ demands, desire and abilities and safeguarding their private life (Bernal. 1994). One of the considered topics attached to nursing practice in relation to patient autonomy is how they do documentations and record keeping, for it is very important not only for the record of the hospitals but most especially to the patient. This means that the cognitive knowledge that psychiatric nurse have learned for many years in doing record keeping and filing must be applied and put into practice effectively. For example, generating documentation of very sensitive and personal matters in a patient’s medical records creates a corresponding responsibility for the nurse and their job is to protect that patient’s constitutional right to privacy. On the other hand, there exist some instances where public policy concerns override or at least limit the patient’s right to privacy.  In these cases, concern over public health, or to prevent abusive or criminal conduct, commands that the nurse make reports to the appropriate health or law enforcement agency. One thing is very apparent; the patient has an absolute right to their own medical records.  Even then, our technological advancements make transmission of records more risky.  Any time documents are sent in the mail or electronically, there should be a clear provision set out at the beginning of the document stating that these matters are the personal, confidential medical records and the sole property of the patient and hospital. Moreover, nursing practice dictates that any discussion or other transmission of sensitive patient information should be conducted with the utmost care and discretion.  The psychiatric nurse should be aware that the health service delivery environment is fear-provoking, intimidating, and alien to most people. Further, inconsiderate regard for privacy and confidentiality can greatly diminish the patient’s experience in that environment. Thus, issues about documentation and record-keeping of patients suffering from neurological problems and illnesses should be given enough focus by the one who are authorized to do it, i.e. psychiatric nurses.   Credit:ivythesis.typepad.com

MENTAL DISORDER

MENTAL DISORDER Introduction Mental Health is the capability of a person, the group and the environment to communicate with ea...

ETIOLOGY DISORDERS

Etiology Disorders             Over the past years, a number of researches regarding the etiology of mental disorders have been undertaken. And according to -, ,  and  (2005) the neurobiological factors is a relevant aspect in the study of etiology of mental disorders. The knowledge on the causes and origins of mental disorders helps social workers and practitioners study and develop interventions.             Over the past 25 years some of the findings regarding mental illnesses have suggested that the environment and the influence of the family members are contributory factors in various mental disorders ( and , 1995). Moreover, in the study of Johnson et al (2000) pointed out that recent literature have suggested that neurobiological factors could also influence the etiology f mental disorders, and the researchers have described this new knowledge as neuropsychiatric revolution.             This paper examines the etiology of schizophrenia, conduct disorder, antisocial personality disorder, paranoid personality disorder, borderline personality disorder, pedophilia and hebephilia. Precursor behaviors, as well as, subsequent behaviors using the internal and external determinism theories will also be discussed. Moreover, the analysis of the current behaviors using the theories of determinism with regards to crime will also be discussed in this paper. Etiology of Schizophrenia             Schizophrenia is a mental disorder characterized by the impairments regarding the expression of reality, and is often coupled with hallucinations, paranoia and unorganized thinking and speech.  There are various causes of schizophrenia and the following are the main contributory factors to the etiology of the mental illness: Genetic- it is regarded by a number of researchers as one of the main causes of schizophrenia. According to , , and  (2005) schizophrenia is due to the complex inheritance of an individual and there is a possibility that numerous genes interact to obtain a greater risk for schizophrenia. Environmental- , ,  and  (2005) pointed out that an individual that lives in an urban environment has greater risl of acquiring schizophrenia. Furthermore, , , and  (2007) pointed out that being a first and second generation immigrant could also be a risk factor in obtaining schizophrenia due to racial discrimination, unemployment, social adversity and poor conditions in housing. Aside from, the physical environment, the experiences of an individual during his or her childhood such as abuse could also contribute to the development of schizophrenia (, ,  and  (2005).  (2006) discussed that a number of literature have shown evidences that the exposure of the mother to infections during pregnancy could increase the possibility of having schizophrenia. Substance abuse- although a number of studies have pointed out that drug use could be a contributory factor in developing schizophrenia the connection between these two has been difficult to set apart due to the complex nature of both the mental illness and the substances. , ,  (1996) discussed that amphetamines could be responsible for a number of symptoms of schizophrenia. Aside from amphetamines, stimulant drugs could also trigger schizophrenia (, , , 1990).  Etiology of Conduct Disorder             The causes of conduct disorder constitute of various factors such as genetics, social and constitutional familial factors. ,  and  (1990) discussed that children exhibiting conduct disorders may inherit reduced activity in the baseline autonomic nervous system from their parents, for this reason these children may need greater stimulation to attain optimal arousal. Moreover, the  (1997) pointed out that the high level of sensation-seeking activity that is related to conduct disorder may be accounted to hereditary factors. Other risk factors of conduct disorders include substance abuse by the parents of the children, marital conflict, child abuse, mental illness and neglect by the people around him or her. Another risk factor is the antisocial behavior of the caregivers or the parents (, 1997). Aside from the risk factors that may contribute to the development of conduct disorder in an individual, , ,  and  (2000) discussed that conduct disorder has been associated with failure in school or work, genetic vulnerability, life experiences that is traumatic, and physical and sexual abuse. In addition, , ,   (1995) discussed that young children exhibiting attention deficit hyperactivity disorder or ADHD have the greater chances of developing Conduct Disorder later in life. Lastly,  and  (1996) stated that family factors particularly individuals that live in the low socioeconomic status, and have parents that have poor parenting skills could contribute to the development of conduct disorder. Etiology of Antisocial personality disorder             Antisocial personality disorder is a psychiatric disorder wherein the individual having this mental illness violates the rights of other people and the norms of the society repeatedly. And individuals that exhibit this disorder are often in the court rooms, welfare and prisons. According to the  (2007) individuals that have antisocial personality disorder usually lie, fight and steal. Moreover, these people have difficulties dealing with the authorities.             The  also discussed that the factors in the environment, as well as, the genetics could also contribute to the development of antisocial personality disorder. Moreover, the main factor in the environment that could aid in the development of the disorder is the deprivation of a stable relationship with another individual. In the genetic factors, having a parent that is a sociopath could be a strong predictor in developing antisocial personality disorder.             In addition,  (2007) discussed that the personality of an individual is the totality of the way a person feels, thinks and behaves and when an individual behaves in an appropriate manner there is a possibility that the person is suffering from personality disorder. Furthermore,  discussed that the history of the family such as having one parent with antisocial behavior could increase the possibility of their offspring in developing the condition. Another is if the environment and homes often times inflict pain and punish children it could a strong factor in having an antisocial personality disorder. Etiology of Paranoid Personality Disorder               Paranoid Personality Disorder is a mental illness wherein an individual has the possibility to interpret the actions of other people as threatening to them. Usually, the disorder surfaces in the early adulthood and is characterized by the presence of distrust and suspicion that leads to misinterpretation of the actions. Moreover, individuals that have paranoid personality disorder are not able to acknowledge their own feelings of negativity, distrust and suspicion to other people. On the other hand, these people usually do not lose the touch of reality. However, these people do not confide to other individuals because of the fear of being betrayed. According to  (2006) the specific causes of paranoid personality disorder is still unknown but the prevalence of the disorder appears in families that have a member that is schizophrenic. In addition, paranoid personality disorder is the result of a negative childhood especially those individuals that have experienced abuse during childhood which could cultivate deep insecurities in a child. Etiology of Borderline Personality Disorder             Borderline personality disorder is a mental illness which is characterized by a repetitive pattern of instability and disorganization in their mood, behavior, relationships and self-image. According to  (1999) borderline personality disorder is a disorder that affects 1% to 2% of the population. Over the past years, studies have identified several factors that could contribute to the development of borderline personality disorder which includes abuse during childhood, unstable environment within the family, and history of mental illness in the family. And according to ,  and  (2005) a number of studies has consistently associate abuse such as physical and sexual and borderline personality disorder. Furthermore, in the study of  (1999) the emotional, physical and sexual abuse that a child experienced increased the likelihood of developing borderline personality disorder. Moreover, in the study of  (2001) identified that children that experience sexual abuse are most likely to develop BPD than those who did not.             Another probable reason that causes confusion in the significance of etiology and abuse in BPD is that the factors of heredity could be confused with the effects of the family environment. According to  (2003) BPD is associated in a number of heritable traits such as neuroticism and impulsivity. In addition, according to  (2007) the causes of BPD is still being studied and the possible causes are: Genetics- in researches regarding families it revealed that personality disorders may be inherited. Environmental Factors- individuals that have borderline personality disorder have a history of abuse during childhood and separation from loved ones. Brain abnormalities- in studies some parts of the brain that is involved in the regulation of emotion, aggression and impulsivity. Etiology of Pedophilia             Pedophilia is one of the subcategories in the larger group of sexual disorders. According to  (2007) pedophilia is defined as intense, recurrent and aphrodisiac fantasies that involve sexual activities with prepubescent children. The acts of pedophiles constitute simple voyeurism, sexual fondling, performing oral sex on children and masturbation and in most cases they do not require penetration. However, most of the pedophiles persuade and befriended children.             The psychological profile of pedophiles is really complex due to the fact that these people constitute a heterogeneous group. On the other hand, the common characteristics of perpetrators are male which could be heterosexual or homosexual, and most of them do not have gender preference. Moreover, usually pedophiles are a relative, neighbor or friend of the family.             The cause of people engaging in sexual activities with children are deviant among pedophiles however one theme appears repeatedly which is the perpetrator usually justifies his or her actions. Usually the pedophiles tell the authorities that the child was the one that solicited for the sexual activity and claims that the child also experience sexual pleasure from the act. Often times, pedophiles indicate that their behavior is not harmful to the child.             The pedophilic personality of the perpetrators do not manifest in the early life but usually surfaces during adolescence. And the disorder is usually more common to individuals that have experience sexual abuse during their childhood days. For this reason, the pedophiles usually select victims in congruence to the age wherein they were sexually abused. Personality tests of perpetrators suggest that they are usually shy, depressed, sensitive and introverted, as well as, emotionally immature and the fear of not functioning appropriately in the adult sexual relationships. Etiology of Hebephilia             Hebephilia also known s Ephebophilia is also one of the subcategories of sexual disorders. In Ephebophilia the sexual predator is usually attracted to children that are in puberty. And just like pedophiles the causes of hebephilia is still unknown and are usually vague. Some offenders could be solely attracted to the child while some can also be attracted to adults. Offenders could be sexually attracted to children of the same gender. Theories of Determinism             The behaviors of sexual offenders or even criminals could not be put in just one category. The extent and reason behind their actions are too profound and extensive. There are two types of determinism, the external and internal. External determinism- two categories are divided under this theory. First is the environmental determinism and in this theory the fate or destiny of an individual plays a central role which is shaped by the society. In the case of sexual offenders and criminals the individuals around them and the society influence their beliefs as they grow up. As mentioned earlier sexual offenders are usually abused as a child, therefore the environment around them has shaped the individual in becoming a criminal or an offender. However, not all individuals that experience sexual abuse as a child may become sexual offenders in the future; however it could still be a risk factor. Our world is not a perfect place; therefore there is always the possibility that a child will be abused. Although, the society cannot completely eradicate the incidence, reducing or preventing it from happening will be the next best step and this can be done, if the society, as well as, the government will become more aware of the possible causes. Example, social workers must focus on children living in environments that are abusive and not conducive in honing a better a productive member of the society, and create interventions that will make them less prone to abuse by adults within their environment.   Orchestration is the determinism created by the spiritual guides, it is not important for an average individual, however for people that are on their spiritual quest or journey it plays an important role in the way their lives are shaped. The main purpose of orchestration is to develop and understand the character of an individual and develop the ability to handle issues and problems. For criminals and sexual offenders most of them have already lost their connection to a higher form of individual because of what they have experienced while growing up. Most of them lived in households wherein abuse is very common and unstable relationships with people around them occur. If a child could not develop a stable and good relationship with a physical human being what more with spirits. Internal Determinism- and just like external determinism, it is also divided into two groups and these are childhood determinism and abreactive determinism. In childhood determinism, the quality of the relationship between a child and an adult is very important particularly in terms of authority and sexuality. Childhood determinism centers the two needs of the child which are the approval of the society and inferiority complex. Most sexual offenders did not get over their inferiority complex due to physical and sexual abuse that they experience. For offenders the idea that children submits to the authority of an adult makes it easier for them to abuse children.             In the abreactive determinism stimulated the learning of an individual regarding relationships. Moreover, this form of determinism promotes self-awareness to an individual. It also involves understanding the meaning of life rather than acquiring knowledge in order to see the good and bad side of life. Usually the sexual offenders, as well as, criminals justify their actions therefore most of them do not understand the real meaning of life and cannot differentiate the right and wrongful acts, and even if they know the good and the bad most of them are still in denial. Conclusion             Mental disorders are very complicated, the causes and reasons behind its development to an individual is still under investigation. Most individuals that have mental disorders often times commit crimes just like the pedophiles. There are a number of reasons why it occurs and a number of studies have pointed out genetics and environment. The environment wherein a person is surrounded shapes his or her personality which is the way an individual behaves and thinks. If a child is brought up in an abusive home, there is a probability that in the near future they will become one. Therefore, the environment such as home and the society wherein the person lives plays an important role in shaping them to become offenders in the near future or become productive citizens in our society.     References: Credit:ivythesis.typepad.com

ETIOLOGY DISORDERS

Etiology Disorders Over the past years, a number of researches regarding the etiology of mental disorders have been undertake...