BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSHYCHIATRIC-MENTAL HEALTH

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1 BAPTIST HEALTH SCHOOL OF NURSING NSG 3036A: PSHYCHIATRIC-MENTAL HEALTH THERAPEUTIC INTERVENTION FOR PEOPLE WITH ADJUSTMENT AND IMPULSE CONTROL DISORDERS LECTURE OBJECTIVES: 1. Describe various types of adjustment and impulse control disorders and identify symptomology associated with each. 2. Identify predisposing factors in the development of adjustment and impulse control disorders. 3. Formulate nursing diagnosis and goals of care for clients with adjustment and impulse control disorders. 4. Describe appropriate nursing interventions for clients and families affected by adjustment and impulse control disorders. 5. Evaluate nursing care of clients with adjustments and impulse control disorders. 6. Discuss various treatment modalities relevant to treatment of adjustment and impulse control disorders. READING ASSIGNMENT: Townsend Chapter 35 LECTURE OUTLINE I. Introduction A. Adjustment and impulse control disorders are two separate diagnostic categories. Usually caused by psychosocial stress. B. Adjustment disorders are common. Impulse control disorders are rare. C. Behaviors 1. Impairment in an individual s usual social and occupational functioning 2. Compulsive acts that may be harmful to the person or others II. Historical and Epidemiological Factors A. Adjustment disorders are more common in women

2 B. Impulse control disorders-five categories include: intermittent explosive disorder, pathological gambling, and pyromania (all common in men). Kleptomania and trichotillomania (more common in women) III. Adjustment Disorders A. Background assessment data: an adjustment disorder is characterized by a maladaptive Reaction to an identifiable psychosocial stressor that occurs within 3 months after onset of the stressor and persists for no longer than 6 months after onset of the stressor. B. Categories are distinguished by the predominant features of the maladaptive response. 1. Adjustment disorder with anxiety 2. Adjustment disorder with depressed mood 3. Adjustment disorder with disturbance of conduct 4. Adjustment disorder with mixed disturbance of emotions and conduct 5. Adjustment disorder unspecified C. Predisposing factors 1. Biological theory 2. Psychological theory a. A maladaptive response to stress caused by early childhood trauma, increased dependency, and retarded ego development b. A lack of developmental maturity, available support systems, or adequate coping strategies. c. Dysfunctional grieving process. 3. Transactional model of stress adaptation: The way in which certain individuals respond to various types of stressors depends on the type of stressor, the situational context in which the stressor occurs, and intrapersonal factors. Model takes into consideration the interaction between the individual and his or her internal and external environment. D. Diagnosis/Outcome 1. Dysfunctional grieving and impaired adjustment. 2. Outcome criterion are identified for measuring the effectiveness of nursing care

3 E. Planning/implementation 1. Aimed at assisting the individual to progress toward resolution of grief that has been generated in response to real or perceived loss. 2. If the adjustment disorder is in response to a change in health status, the nurse assists the client to accept the change and make required lifestyle modifications to function as independently as possible. F. Evaluation: Conducted to determine if the nursing actions have been successful in achieving the objectives of the care IV. Impulse Control Disorders (five categories) A. Essential Features 1. Failure to resist an impulse, drive, or temptation to perform some act that is harmful to the person or others. 2. An increasing sense or arousal or attention before committing the act 3. An experience of pleasure, gratification, or relief at the time of committing the Act. B. Intermittent Explosive Disorder- discrete episodes of failure to resist aggressive impulses resulting in serious assaultive acts or destruction of property. C. Kleptomania- recurrent failure to resist impulses to steal items not needed for personal use or their monetary value. D. Pathological gambling- a chronic and progressive failure to resist impulses to gamble, and gambling behavior that compromises, disrupts, or damages personal, family, or vocational pursuits

4 E. Pyromania- the inability to resist impulse to set fires. F. Trichotillomania- the recurrent pulling out of one s own hair that results in noticeable hair loss G. Diagnosis/Outcome 1. Ineffective individual coping 2. Risk for other directed violence H. Planning/Implementation 1. Aimed at protection of the client and others from harm associated with aggressive impulses and assaultive behavior 2. Assist the client to learn to delay gratification and to develop more adaptive strategies for coping with stress. I. Evaluation V. Treatment Modalities A. Adjustment Disorders 1. Goals of therapy a. To relieve symptoms associated with a stressor b. To enhance coping with stressors that cannot be reduced or removed c. To establish support systems that maximize adaptation 2. Types of therapy

5 a. Individual psychotherapy b. Family therapy c. Behavioral therapy d. Self-help groups e. Crisis intervention f. Psychopharmacology B. Impulse Control Disorders 1. Intermittent explosive disorder a. Group/family therapy b. Psychopharmacology 2. Kleptomania a. Insight-oriented psychodynamic psychotherapy b. Behavior therapy c. Psychopharmacology 3. Pathological gambling a. Behavior therapy b. Psychopharmacology c. Gamblers Anonymous 4. Pyromania a. Aversive therapy b. Behavior psychotherapy c. Psychopharmacology