Psychiatric Nursing

Open access articles and resources on psychiatric nursing
Current
11/23/09

Tic Disorders

Introduction

Tic disorders are characterised by the presence of tics. Tic is an abnormal involuntary movement (AIM) which occurs repetitively, rapidly and is purposeless in nature. Symptoms begin before the age of 18 years and not caused by medical condition.

Types

  1. Motor tic -characterised by repetitive motor movements.
  2. Vocal tic- characterised by repetitive vocalizations.
  3. Tourette's syndrome - combined motor and vocal tics and coprolalia.

Motor Tics

Motor tics are earliest to appear, and begging in the head region progressing downwards. Motor tics can be simple or complex.

  1. Simple motor tics: include eye blinking, grimacing, shrugging of shoulders, tongue protrusion.
  2. Complex motor tics: these include stamping, jumping, hitting self, squatting, echokinesis (repetition of observed acts), copropraxia (obscene acts).

Vocal Tics

Vocal tics can also be simple or complex.

  1. Simple Vocal Tics- include coughing, barking, throat-clearing, sniffing, clicking.
  2. Complex Vocal Tics - include echolalia (repetition of heard phrases), palilalia (repetition of heard words), coprolalia (use of obscene words) and mental coprolalia (thinking of obscene words).

Etiology

  1. leaning difficulties
  2. neurological soft signs
  3. abnormal EEG and ERP findings
  4. Tourette's syndrome may be inherited

Treatment

  • Pharmacotherapy with haloperidol, clonidine or pimozide
  • Treatment of associated depression
  • Behaviour therapy

References

  1. Ahuja N.A short text book of psychiatry. 5th edn. New Delhi. Jaypee brothers medical publishers.2004.
  2. GelderM,Gath D,Mayou R,Cowen P. New oxford text book of psychiatry. 4th edn.Oxford. Oxford university press.2004.
  3. Kaplan HI, Sadok BJ. Synopsis of psychiatry-behavioural science or clinical psychiatry.9th edn. Hong Kong.William and Wilkinsons publications. 1998.
  4. Kapoor B. Text book of psychiatric nursing. Publishers of medical and nursing books; Delhi: 2006.
  5. Fortinash K M, Patricia A and Worret H. Psychiatric mental health nursing (3 rd edn) Mosby publications. 2001.
Current
11/23/09

Elimination Disorders

Enuresis

Enuresis is defined as the involuntary or intentional voiding of urine either during the day or night, at inappropriate places. This condition is common in infancy. Children achieve bladder control by the age of 3 years and still 7% children after 5 years wet their bed.

Types:

  • Primary' type in which the individual has never established urinary continence
  • Secondary' type in which the disturbance develops after a period of established urinary continence, usually at 5-8 years of age.

a. Nocturnal- Episodes occurring only at night are referred to as nocturnal

b. Diurnal- daytime wetting is labelled diurnal.

Etiology

  • Psychological disturbance: Children living in socially disadvantaged situations and experiencing psychosocial stress have a greater frequency of enuresis.
  • Genetic: 75% of enuretics have a first degree relative with h/o enuresis

Treatment

  • Restriction of fluid intake after 8 PM, in nocturnal enuresis.
  • Bladder training during daytime- increasing holding time of the bladder.
  • Interruption of sleep before the expected time of bed wetting
  • Conditioning devices which cause alarm to sound as soon as the voided urine touches the bed sheet.
  • Supportive psychotherapy to child and parents.
  • Pharmacotherapy with imipramine 25-75 mg/day -drug of choice or DZM to reduce stage 4 NREM sleep.

Encopresis

  • Encopresis is an elimination disorder characterised by following features
  • Encopresis is repetitive passage of feces at inappropriate time and/or place, after bowel control is physiologically possible.
  • This is no due to the presence of any organic cause, which is called fecal incontinence.
  • more common (3-4 times) in males
  • 25% have associated enuresis

Types:

  1. Primary type: where toilet training has never been achieved
  2. secondary type: where Encopresis emerges after a period of fecal continance

Etiology

1.    Inadequate, inconsistent toilet training.

2.    Sibling rivalry

3.    maturational lag

4.    underlying hyperkinetic disorder

5.    emotional disturbances

6.    mental retardation

7.    childhood schizophrenia

Treatment

  • Evaluate for organic causes.
  • Family interventions- Warm and understanding family environment.
  • Behaviour therapy- with positive and negative reinforcements.
  • Preventive care- consistent and smooth toilet training.
  • Supportive psychotherapy.
Current
11/23/09

Eating Disorders

Anorexia Nervosa

Definition

Anorexia nervosa is an eating disorder characterised by following features:

  • most often occur in females than males
  • common age of onset in adolescence (13-19 years)
  • intense fear of becoming obese
  • body image disturbance
  • refusal to maintain above a minimum normal body weight for age, sex, height.
  • Significant loss of weight - usually more than 25% of the original body weight or BMI below 17.5.
  • no medical illness
  • absence psychiatric illness
  • primary or secondary amenorrhea
  • strict dietary restrictions
  • poor sexual adjustment and fear of pregnancy(unable to accept the 'female role').

Comorbidity

Depressive symptoms and obsessive compulsive personality traits and about 50% of anorectics have bulimic episodes with binge eating

Differential diagnosis

Medical illness- hypopituitarism, tuberculosis, depressive episodes

Treatment

  • Short-term management - to ensure weight gain and correct nutritional deficiencies
  • Long-term treatment aimed at maintaining a normal weight achieved through a short-term management

Treatment modalities include

  • Behaviour therapy- based on positive reinforcement and sometimes negative reinforcements.
  • Individual psychotherapy
  • Hospitalization - with adequate nursing care
  • Pharmacotherapy with CPZ, FXT, AMT, Clomipramine and Cyproheptadine (8 to 32 mg)
  • Group therapy and family therapy

Prognosis

Prognosis is better in

  • younger age of onset
  • less number of hospitalizations
  • no bulimic episodes

Bulimia Nervosa

Definition

Bulimia nervosa is an eating disorder characterised by following clinical features:

  • Commonly in early teens and adolescents.
  • There is intense fear of becoming obese.
  • Recurrent binge eating large quantities of food
  • Feeling of lack of control over eating during binges.
  • Self-induced purging
  • Vomiting, using laxatives, diuretics, fasting or excessive exercise.
  • Self-evaluation unduly influenced by body shape and weight.
  • Bingeing and purging are not accompanied by anorexia nervosa.

Treatment

  • Behavior therapy
    • based on positive and negative reinforcements
  • Individual psychotherapy
  • Drugs as adjuncts- Imipramine, FXT,
  • Group therapy and Family therapy

Binge Eating Disorder

  • Sometimes called compulsive overeating.
  • This is a common eating disorder.
  • Eating an amount of food much larger than most people would eat in a similar period and accompanied by a sense of lack of control or a feeling that one can't stop eating.
  • Clinical features include:
  • Eating much more rapidly than normal.
  • Eating until uncomfortably full.
  • Eating large amounts of food when not hungry.
  • Eating alone because of embarrassment about how much is eaten.
  • Feeling disgusted with oneself, depressed, or guilty about eating.

NURSING PROCESS

NANDA Diagnosis for Eating disorders

    • Anxiety
    • Disturbed body image
    • Powerlessness
    • Imbalanced Nutrition: Less than Body Requirements
    • Imbalanced Nutrition: More than Body Requirements
    • Chronic low self-esteem

Interventions

    • Nutritional Stabilization
    • Strengthening coping skills
    • Promotion of self-esteem and positive self concept.
    • Cognitive Behavioral Interventions
    • Thought stopping techniques
    • Body Image Interventions
    • Family Involvement
    • Group Therapy
    • Exercise
    • Medications
Current
11/23/09

The International Journal of Psychiatric Nursing Research

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Psychiatric Nursing

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