Childhood Psychiatric Disorders

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All behavior is meaningfull and attempts to.....

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communicate something

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general treatments for psychiatric disorders

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play for 3-12
group for teen
art and music therapy
mileu-managing the environment
medications used sparingly as poss

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Pervasive Developmental Disorders
Define

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Entire development impaired. with a wide range of manifestations

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Pervasive Developmental Disorders
Predisposing factord

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genetic and biological makeup
chemical imbalances
social problems may increase risk

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symptom clusters
Pervasive Developmental Disorders

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Impairment in social reciprocity: no social skills, impaired communication(no language, poor grammer, tone etc.
Behavior is restrictive, repetitive, routines importatnt.DONT LIKE CHANGE

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Pervasive Developmental Disorders
Two types

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Autism
Aspergers

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Autism
RN assessment

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child has smaller than usual brain at birth then larger than usual after growth spurt
affects more boys than girl
5-10% become functional adults
1:166

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Autism
Affect

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blunt or flat
energies are focused inward.

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Autism
Behavior

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may be Very percoscious. angry, agressive (might be due to not getting needs met) not alot of involvement with people. don't like physcial contact. distracted by other things and become very focused on ie shiny things, disks going round. Attached to inanimate objects

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Autism
Cognative

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may develop words and then lose them. very ritualistic and don't like change. may not be able to speak at all, may only make sounds. this can lead to agression. pay attention to self-care as they have tendencey to hurt self.

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Aspergers

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genetic link from dad
defined in contrast to autism.
no clinical delays can talk and function but have severe impairment with social skill and functioning
they want friends.
routine also importatnt
may not become apparent until later when interaction with other kids happens

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Aspergers
Affect

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flat

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Aspergers
behavior

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can't wait turn
inability to react to normal social cues

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Aspergers
cognition

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less likely to have retardation. very concrete
percocoious and sound like little adults
interest very restricted.
(MOVIE) able to put abstract pieces togeather but unable to put a story into order or understand why they put it in the order they did

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ND for developmental disorders

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G&D delayed
self-care deficits
communication impaired
social isolation

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Goal for Pervasive Developmental disorders

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to decrease disruptive behavior and to help children become more flexible and adaptive

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general RN care for Pervasive Developmental disorders

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meet basic needs-food adls
special education-from school
social skill training done through role playing and cueing
cognitive/behavioral training-done as get older and with pyschologist
family treatment
total team involvement
medications-no specific meds depends on behavior

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Disruptive behavior disorders
two types

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opposition defiant
conduct disorders

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Opposition Defiant
Affect

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angry
lots of outbursts
defiant and irritable

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opposition defiant
behavior

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pattern of disobedience, argumentative, trouble making friends, tests limits

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oppositional defiant
cognition

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not open to negotiation accepts no responsibility for actions

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conduct disorder

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seriously violates social norms. Be worried if see fire starting and injury to animals
occurs in later adolcent-behaviors gets person in trouble with law. after age 18 becomes antisocial disorder.
may see hx of oppositional disorder.
pattern of behavior must exist for 6mo and lcuster of symptoms for 1 year

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conduct disorder
affect

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labile

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conduct disorder
behavior

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no remorse or responsibility. hx of fights at school. acts with anger and gets others angry. restless, figetty, skips school impulsive
disregards rights of others-steal-bully-acts out sexually-uncooperative-loner, not alot of friends

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conduct disorder
cognition

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low achiever
low self esteem

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what must you always be assessing for with conduct disorder and oppostional disorder

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depression

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nursing interventions in general for disruptive behavior disorders

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structured environment-keep safe
time out
behavior modification
encourage verbalizations
actions have consequences-make sure they consequences are appropriate for crime
total team effort
try to increase self-esteem
teach rule of society and norms
problem solve and teach
be specific

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why must you be specific

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you ask specific questions because answers are genrally evasive.

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expected outcomes

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think of behaviors and what would be the opposite
increase acceptance of responsibility for own behavior
decreased conflicts with rules and authority
increased problem solving m/b decreased interpersonal conflicts

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Mental retardation

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ranges from mild to profund with mild having adaptive functioning and profound nn total care for life

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Depression

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deep pervassive and consisten unhappiness. it is the 2nd leading cause of death for adolescents due to suicide

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depression etiology

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stressful environment-living inpoverty or a dysfunctional family
biochemical
genetic
unusual sensitivity
traumatic loss
severe illness

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Depression
Affect

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sad for at least 2 weeks
refer to self as sad.

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depression
behavior

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AGGRESSIVE-different than adult
withdrawn and destructive
sleep changes, apititte changes, aggitation or retardation of movement. adhedonia, excessive guilt feeling, withdrawn and irritable

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depression
cognition

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MORE PREOCCUPIED WITH DEATH
decreased ability to concentrate
somatic complaints-h/s, tummyaches
may complain alot
low energy and self esteem

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why may it be harder to recognize for child

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harder due to limited life experience
the younger the child the harder it is to express their feelings so they manifest them in anger

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depression
nursing diagnoses

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ineffective copin
chronic low self-esteem/situational
self-care deficit

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general interventions
depression

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verbalize feeling
develop a positive self-image-give positive feedback
develop independence-don't create dependence
educate pt and family re med
encourage participation in activities
limit setting is v. important-reasonable expectations and consequences
meds-paxil/bad, prozac good

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expected outcomes
depression

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safety
increased self-esteem
increased problem-solving
return to usual activites and successess
want to see opposite of whatever brought them in