NURS 6640 Essay Discussions
WEEK 1:Psychotherapy and Biological Bias
John Bowlby bemoaned the separation between the biological and psychological approaches in psychiatry, and hoped that attachment theory, which brings together psychoanalysis and the science of ethology, would help bridge the rift between them. Recent findings in developmental psychology have delineated features of parent–infant interaction, especially responsiveness, attunement, and modulation of affect, which lead to either secure or insecure attachment. Similar principles can be applied to the relationship between psychotherapist and patient – the provision of a secure base, the emergence of a shared narrative (‘autobiographical competence’), the processing of affect, coping with loss – these are common to most effective psychotherapies and provide the basis for a new interpersonal paradigm within psychotherapy. Attachment theory suggests they rest on a sound ethological and hence biological foundation.
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This paper presents an exclusive discussion of what is known about the biological basis of fear. In presenting this discussion, the paper shall explore the main concepts relating to the biology behind fear in humans with the main ideas being the definition of fear, the evolutionary aspects of fear, as well as the emotional response of the brain in the event of fear or anxiety. The paper shall also present an analysis that seeks to establish fear and anxiety as identical rather than two contrasting concepts as believed by many. In the discussion on the biological basis of fear, the study shall include biological evidence relating to the specific parts of the human brain that respond and react to fear.NURS 6640 Essay Discussions
Introduction
It is interesting how humans respond to fear, especially the bodily changes that take place in the event of an activity or something that triggers fear. Humans respond to fear in different ways, and their bodies react to unexpected situations of fear almost instantly. In response to fear, human bodies exhibit increased arousal, autonomic and neuroendocrinal activation and immediate expectancy among other spontaneous reactions. It is even surprising that fear triggers some emotional reaction in humans based on recent studies by psychologists. An interesting revelation according to empirical studies on emotions under the field of biology point to the fact that emotions are not just feelings as evolutionary studies would want us to believe. Emotions in human beings are accompanied by physiological and behavioral variations (Davidson, 2000). A widely accepted perception of emotions today touches on the fundamental ideology that humans experience emotions in three different but interrelated levels: the behavioral level, the neurophysiological level and the psychological or metal level. Based on inference that emotions have a close relation to fear in terms of the mental or psychological state, it is possible to use such information to build upon the biological basis of fear (Walker, 2002). The consequence of predisposing factors that trigger emotions also tend to instill fear in human beings and this paper shall seek to unravel the biological basis of fear in terms of psychological and behavioral responses relating to biology.
What is fear?
Fear is a motivational state triggered by specific stimuli that result in or escape defensive behavior. Enthologists believe that fear is an unpleasant emotion that comes about as a result of the perception that somebody or something dangerous is likely to happen. This unpleasant emotion triggers a form of defense mechanism that results in escape or counter behaviors. In terms of biology, a couple of neuoroendocrinal activation’s that are usually automatic mostly typify fear. This is essential in explaining the sudden escape of a person at the sight of a scary animal that triggers immediate activation’s in the brain (Strongman, 1996). This effective defense mechanism triggered by a stimulus instills fear. In this context, such instantaneous reactions to fear facilitate coping mechanisms used by the body to respond to cases of fear.
The evolutionary aspects of fear
The evolutionary aspects of fear mainly relate to emotional responses. Fear is a factor of de-escalating tactic interceded by the emotional (paleomammalian) part of the fore brain. As man and other animals evolved millions of years ago, they adapted differently to fear. During the evolutionary period, diverse types of fear characterized the universe and were responded to by animals and humans in dissimilar ways. Scientists conclude that the adaptations developed by humans during this period explain the response and reactions of humans towards fear (Strongman, 1996). However, a couple of fear such as the fear of height is common to all mammals because of the adaptations developed during the Mesozoic era. The fear of snakes and other dangerous reptiles came into existence during the Cenozoic era and is common to all higher primates including humans and apes. However, others such as the fear of insects and mice developed in the Paleolithic and Neolithic periods are unique to humans. During these periods, insects and mice became popular carriers of dangerous infections and diseases, which resulted in different adaptive measures by humans. Such fears are still common today (Iijima, et al., 1996).
The emotional brain
The emotional aspect of the brain occurs at three levels: the behavioural level, the neurophysiological level and the psychological or metal level. Theories of emotion touching on the brain reveal that bodily changes tend to follow directly the perception of existing facts and human feelings of the same changes according to the occurrence of the emotion. In other words, the stimulus that reaches the cerebral cortex part of the brain provokes intuitive changes, which are perceived as emotions. Other studies have advanced that the thalamus is greatly involved in the neuropsychological matter of the brain because such matters are subcortical in nature. A biological explanation on the emotional brain is that a stimulus from the environment triggers the thalamus, which transmits information from to the viscera and cortex, and back again to the cortex to engender an emotional state (Gray & McNaughton, 2000).
Specific parts of the brain that work together to trigger reactions to fear stimuli
Amygdala
The amygdala is part of the brain structure where a majority of neurobiological events related to fear occurs. It is located just behind the pituitary gland and respond in different ways to fear stimuli. Any fear stimulus activates the Amygdala to secrete a series of hormones that immediately influence aggression and fear (Vianna, 2003). As the process of secreting such hormones into the body begins, the Amygdala prompts the body into a state of awareness and alertness, which trigger instant response from other muscles in the legs and hand to get ready for take-off or a fight. As the essential component of the limbic system, the amygdala is critical in preparing the body to respond or react to fear by secreting hormones at the trigger of a fear stimulus (Borod, 2000). It integrates rapid and direct thalamic inputs that transmit a fear stimulus and imitates a cognitive process that prepares the body to respond or react to the threat.
Hippocampus
The hippocampus is touted as the central structure in the brain that engages in processing contextual information necessary to fear conditioning. Situated just next to the amygdala and connected to it by the subiculum and entorhinal cortex, the hippocampus’s main functions is to condition fear into contextual information. The hippocampus conditions fear in circumstances that involve complex polymodal events by receiving impulses from the amygdala and integrating such impulses with prior information to ignite meaningful reactions that respond to fear (Davidson, 2000).
Hypothalamus
The hypothalamus plays a crucial role as far as fear response is concerned. It is responsible for controlling stress reactions and other body processes including emotions and moods. Through the hypothalamic-pituitary-adrenal axis (HTPA axis), the hypothalamus controls the limbic, pituitary, adrenal and genadotropic aspects of the body. A fear stimulus sends LC (locus ceruleus) neurons to the hypothalamus, which activates the HTPA axis that triggers the stress response linked to fear (Lewis & Haviland-Jones, 2000). The connection between the hypothalamus, hippocampus and amygdala act to activate the HTPA axis to respond to a fear stimulus. The hypothalamus receives sensory information from the lateral part of the amygdala, processes the information and relays to the central nucleus, which then projects it to various parts of the brain that respond and react to fear. Fear stimulus impulses relayed by various neurons activate the sympathetic nervous system, as well as the modulating system of the HTPA axis. This triggers a run or attack response, better known as a fight or flight response mechanism (Hyman, et al., 1999).
Sensory cortex
The sensory cortex is an essential component of the fear response mechanism. Immediate sensory data from fear stimulus collects in the thalamus part of the brain. After the collection of the sensory data, the sensory cortex obtains the data from the thalamus, interprets it and organizes the sensory data for dissemination to the amygdala, hippocampus and hypothalamus (Hirsh, 2004).
Thalamus
The thalamus also plays a critical role in fear response. The thalamus basically acts as a collection center, which gathers and collects information from essential sensory organs such as the ears, eyes and mouth. After collecting the sensory information from such organs, the thalamus has the capacity to determine where to send such information for processing. A fear stimulus from the eyes, hands or mouth sends sensory information through neurons to the thalamus, which collects and sends the information to the appropriate response organs for processing (Lewis & Haviland-Jones, 2000).
Fear conditioning explains the behavioural archetype displayed by organisms and their capacity to learn to respond to or predict fearful or threatening events. Fear conditioning explains why some people fear dogs to the extent that they become helpless at the sight of this ‘monster’. It is believed to depend upon the amygdala and the hippocampus in cases of contextual fear conditioning. Fear conditioning also explains the neurobiology of fear because touches on the essential components of the brain including the thalamus, the pituitary gland, the hypothalamus, the amygdala and the sensory cortex (Lewis & Haviland-Jones, 2000). Latest research findings point to the fact that researchers are beginning to develop interest on the neurological processes that trigger fear response mechanisms.
WEEK 2:Delirium Rating Scale
Delirium is a common and a potentially life-threatening neuropsychiatric disorder. Delirium is a disturbance in consciousness with the cardinal and characterized disturbance of reduced ability to direct, focus, sustain, and shift attention. Inattention is accompanied by other cognitive deficits including of orientation, executive ability, language, visuo-spatial ability, learning and memory, as well as abnormalities of sleep-wake cycle, motor activity, affective control, higher level thought and perception. The onset of delirium may be acute or subacute. These symptoms are usually reversible and their severity fluctuates during the course of the day (1). Delirious patients, in particular the elderly, have worse longer-term outcomes following an episode of delirium (2). Recent research has delineated and validated three core domains for delirium symptoms reflecting cognitive, circadian and higher level thinking symptom clusters (3).
Advanced age is the most important factor for delirium risk, attributed to structural and neurodegenerative changes, reduced neurochemical flexibility, and oxidative stress associated with normal and/or abnormal aging. Preexisting cognitive impairment including dementia, comorbid medical conditions (e.g., cardiovascular, infectious, metabolic, major surgery) also increase the risk of delirium occurrence (4). The incidence and prevalence of delirium depends on the population examined and affects 10-30% of hospitalized patients (2,5), and at even higher rates in intensive care settings.NURS 6640 Essay Discussions
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There are several tools used in research and clinical practice to assess delirium severity. The most widely used, well-validated scales are the Mini Mental State Examination (MMSE) (6), Delirium Rating Scale (DRS) (7), Memorial Delirium Assessment Scale (MDAS) (8) and Delirium Rating Scale–Revised 98 (DRS-R-98) (9). The MMSE is a 30-item bedside clinician-administered cognitive test that includes measurement of orientation, memory, comprehension, visuo-construction, and concentration (6). However, it measures only cognition and is not specific to a particular diagnosis (4). The DRS is a 10-item clinician-rated scale developed by Trzepacz et al. (7) in 1988 and was the first rating scale specifically designed to assess delirium phenomenology at a time when cognitive-only tools were used. It was intended for use in conjunction with a cognitive scale and therefore has only one overall cognitive disturbance item. Its items are anchored by descriptions of characteristics intended to differentiate delirium from other neuropsychiatric disorders as well as to quantitate delirium severity. It significantly distinguished delirium from dementia and other neuropsychiatric disorders. The MDAS is a 10-item clinician-rated scale to assess delirium severity with each item rated on a Likert scale but without phenomenological descriptions to anchor ratings (8). It is designed to allow for repeated administration within 24-hour period but not for delirium diagnosis.
The DRS-R-98 is a major overhaul of the DRS in structure and content and has become an essential tool in delirium assessment and research. Timmers et al. (10) claimed that DRS-R-98 is the best overall of delirium rating tool largely because of its range of symptoms and suitability for use by physicians and research assistants after training as do Kean and Ryan (11). The DRS-R-98 is available in a number of languages including Spanish, Japanese, Korean, Portuguese, Greek, Danish, Dutch, German, French, Lithuanian, Norwegian, Italian, Turkish, Hebrew, and both traditional and modern Chinese (4,10,11). The DRS-R-98 has been revalidated in several countries (12-18).
The purpose of this study is to evaluate the reliability and validity of the Turkish version of the DRS-R-98.
WEEK 4: Practicum Experience Time Log
During my first day of clinical practicum in MMW AQH, the register nurse made a medication error and did not report it, she instead she tried to cover it. I would like to reflect on the incident and what I have learned from that situation as a nurse.
Elaborate
This incident happened during- my first clinical day in MMW AQH around 1pm while administering drugs by a register nurse, I was observing her practice in drug administration. She started to prepare the drugs on advance she asked me to collect the drug charts from patient bedside and nursing station .While she was distributing drugs for patient she was attending their needs and answering doctors order by the time goes she become distracted and lost her concentration this situation made me confused and not knowing which patient is next. The nurse had many task to do at the same time. She continued in drug administration but this time with improper way of patient identification, when we reach to the room where incident happen patient requested to take his drugs later as he still having his lunch she kept the drug near to him and left .After we finished three more patient she went back to him as remembered something she was looks stressed and panic, I asked her what happened she did not reply instead she asked the patient to give her back the tablet.
Patient handed the tablet back to her then she gave him another tablet, I realized this was a drug error it was her luck that patient did not take the medicine, she start to explain to him what happen and asked for apology, the patient was so angry yet feeling sorry for her. He questioned her if he had the drug who will take the responsibility? She did not answer. He was not willing to cause a trouble for her so he kept quiet. She proceeded with her work like nothing happen, I was expecting her to report but she did not, when I asked the reason, she reply as long as no harm happen there is no need to report beside that there is no time to report. This left me thinking how many medication errors left un-reported?NURS 6640 Essay Discussions
Analyze
This experience left me disappointed it was hard for me to accept what happen because I have fixed believe that patient safety is first regardless how busy the nurses are. Since then so many question gushed to my head, why this incident happen? What are the causes? Was the staff nurse afraid? Is the nursing negligence acceptable? To answer these questions I have to recall the situation .It was obvious that the circumstances the staff nurse was in made her prone to such incident, her lack of concentration and her unprofessionalism in administering medication made her close to put patient health in danger. However this should not excuse her from responsibility. I can understand that she was in panic and in a stressful situation but she is accountable for her action since she decides to become a nurse and deal with human life. I believe that increased work load made her go for short cuts and malpractice just to finish the care .on the other hand she failed to identify the patient because of distraction. But the main reason why she did not report is maybe she thinks about her colleague’s reaction and she may be punished for that. From what I experienced drug error could be preventable if the staff nurses adhere strictly to hospital polices no matter what.
Revise
There is no exact definition for drug error but, the National Patient Safety Agency and the US National Coordinating Council for Medication Error Reporting and Prevention define it as an any preventable event that may lead or cause inappropriate medication use or patient harm while the medication is in the control of health professional (smith, 2004). According to the latest researches which conducted by Food and drug administration association and the National Patient Safety Agency drug errors always left unreported for many reasons, some of these reasons are related to fear and work overload. These two factors were considered the most dominating factors when it comes to drug errors. Excessive work always leaves the staff fatigued and preoccupied with many task to do and less time to finish it (Mayo, Duncan& Chloe, 2004). Work over load lead the staff to go for the shortest and easiest ways which result in poor nursing practice. Failed patient identification is also another result of work overload, health care professional are not able to counter check and verify patient identity correctly with other staff because of excessive work. On the other hand Fear from consequences and the colleague’s reaction are always the reason why health care professional tend to hide drug errors and not reporting it. Their self esteem will be badly affected in that moment because of that, they will loose the ability to judge and they will comet more vital mistakes. However not reporting drug error is worse and harmful to the patient life. Professionalism is the only way to develop the nursing practice in administering drugs. Right patient identification, Right dose, Right drug, Right time, Right route and Right documentation are the safest bath to follow(Clayton&Stock, 1997).
New approach
Drug errors are a common problem in health care facilities which always associated with serious events so reporting about errors becoming a must to improve the system and patient safety .Most of the international accredited hospitals such as Alwasl Hospitel are now blame free culture, encouraging staffs to report the errors and not to become intimidated by it. Also they deal with reports in confidential manner so the access to such documentation is restricted to authorize person. Their policy stat that all incident report should be written in narrative description which should be comprehensive description of facts containing no personal judgments or opinion and no implication or accusations (AWH. P&P,2004). These hospitals are providing educational session about errors reporting which is important to increase the awareness among the staffs in order to become a positive link in the hospital. These hospitals are maintaining yearly competences in medication management and use for all health care professional. One goal that all health care facilities are trying to achieve is minimizing work load on the health care professional. Most of these hospitals are controlling patient numbers and trying not to go beyond their capacity, they also trying hard to solve the staff shortage in way that will not affect patients and staffs. Other ways in improving medication administration system is by computerize the drug charts for more clarity and using unit dose system. This system helps the health care professional to minimize drug error, it include single unit package with generic and brand name, manufacture, lot number and expiration date. Following this system has many advantages. First it reduces the time spent by nurses in preparing drugs. The pharmacist will have a clear vision about patient situation regarding adverse reaction and contraindication. Patient identification will be easier as each single package has patient name and number so double —check may not needed in emergency cases(Clayton&Stock,1997).NURS 6640 Essay Discussions
WEEK 5 : DSM-5 Diagnosis PTSD
DSM-5 has made a number of important changes to the criteria of post-traumatic stress disorder, the most significant being a more specific definition of the type and nature of the exposure to a threat. Under DSM-5, post-traumatic stress disorder (PTSD) is an anxiety disorder that develops in relation to an event which creates psychological trauma in response to actual or threatened death, serious injury, or sexual violation. The exposure must involve directly experiencing the event, witnessing the event in person, learning of an actual or threatened death of a close family member or friend, or repeated first-hand, extreme exposure to the details of the event. Traumas experienced may involve war, natural disasters, car accidents, sexual abuse and/or domestic violence. A formal diagnosis of PTSD is made when the symptoms cause clinically significant distress or impairment in social and/or occupational dysfunction for a period of at least one month. The symptoms cannot be due to a medical condition, medication, or drugs or alcohol.
PTSD Symptoms
PTSD symptoms may include nightmares, flashbacks, sleep disturbance, mood disorders, suicidal ideation, avoidance, and hyper-arousal in response to trauma-related stimuli. Hyper-arousal may include an increase in blood pressure and heart rate, hyperventilating, mood swings, fatigue, or insomnia when a memory of the event is triggered by some type of internal (cognition) or external (environmental) stimulus. Common symptoms related to PTSD would include insomnia, attention deficit problems, and anhedonia. Common comorbid disorders are depression, anxiety, and substance addiction.
Under DSM-5, for those older than six years of age, PTSD includes four clusters of symptoms (APA, 2013):
Re-experiencing the event — Recurrent memories of the event, traumatic nightmares, dissociative reactions, prolonged psychological distress
Alterations in arousal — Aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance
Avoidance — Distressing memories, thoughts, or reminders of the event.
Negative alterations in cognition and mood — Persistent negative beliefs, distorted blame, or trauma-related emotions; feelings of alienation and diminished interest in life
The duration of these symptoms (which cause clinically significant distress or impairment in social, occupational or other important areas of functioning) must occur for one month or longer. In addition, the disturbance cannot be attributed to a substance or medical condition.
DSM-5 has established two subtypes of PTSD:
1. PTSD Preschool subtype is used in the diagnosis of children younger than 6 years of age. The diagnostic thresholds are lowered for children and adolescents.
2. PTSD Dissociative Subtype is used when the person has prominent dissociative symptoms. These dissociative symptoms include depersonalization, in which the person feels like an outside observer or detached from oneself; and derealisation, in which the world seems unreal, distant or distorted. All other criteria of PTSD must also be met.
Post Traumatic Stress Disorder Treatment and Therapy
Common treatments for post-traumatic stress disorder include: Cognitive Behavior Therapy (CBT), psychotherapy, Exposure Therapy (ET), and eye movement desensitization and reprocessing (EMDR). Pharmacological interventions typically include anti-depressants such as serotonin reuptake inhibitors (SSRIs). In recent years, technology such as computer-aided exposure therapy has significantly improved the experience and effectiveness of exposure therapy (Gerardi, Cukor, Difede, Rizzo, & Rothbaum, 2010). The new age classification under DSM-5 reflects the different thresholds by age (lower for children) and therapeutic requirements.NURS 6640 Essay Discussions
A review of PTSD therapies, based on 14 studies with a total of 758 participants published by the Cochrane Collaboration, ranked CBT as the most effective PTSD therapy. The other therapies which were compared included ET, EMDR, psychodynamic and narrative therapy. All therapies produced improvements in the symptoms of PTSD, anxiety and depression (Gilles, Taylor, Gray, O’Brien, & D’Abrew, 2012). Eye movement desensitization and reprocessing therapy helps the patient analyze and formulate responses to traumatic events by exploring both physiological and neurological changes in relation to traumatic memories.
PTSD is often comorbid with substance abuse and mood disorders such as depression and anxiety, requiring a more complex treatment approach. The traumatic event can be the underlying cause of more serious comorbid conditions such as the inability to speak, or auditory hallucinations. Multicomponent therapies are also being explored. For example, improvements in PTSD and substance abuse symptoms have been shown through the combined use of CBT along with structured writing therapy (van Dam, Ehring, Vedel, & Emmelkamp, 2013) as well as integrated exposure therapy (Mills et al., 2012). Other combined therapies with CBT include emotion regulation training (Bryant et al., 2013) and music and dance therapy.
Virtual reality exposure therapy (VRET) is one of the most promising areas of PTSD therapy. VRET has been used with war veterans from Iraq and Afghanistan (McLay et al., 2011) and all forms of phobias. VRET has a high success rate of coaxing reluctant participants into exposure therapy. One survey of 150 people with phobias showed only a 3% refusal rate to participate in VRET versus 27% for other forms of therapy (Gerardi, Cukor, Difede, Rizzo, & Rothbaum, 2010). VRET places the patient in a computer-generated environment that simulates situations related to the cause of the disorder. Anxiety and fear related to the negative events are reduced over time. As a result of this study, it suggests that computer-aided therapies are proving to be as effective as face-to-face therapies while saving time and providing faster access to care.
Living With PTSD
Post-traumatic stress disorder causes impairments in daily life through the persistent re-experiencing of the negative event via recollections such as intrusive negative thoughts and dreams, flashbacks, and dissociative states. Under DSM-5, emotional reactions to the traumatic event such as fear and helplessness are no longer part of the criteria for PTSD.
The effect of PTSD on daily life and overall prognosis are related to the severity of the exposure. PTSD is associated with “high-risk” professions such as the military, policing, firefighting and emergency medical work. PTSD has significantly limited daily functioning in those exposed to extreme and prolonged trauma such as war veterans. Depression is a common experience of war veterans with PTSD. The comorbidity of PTSD and depression produces lower quality of life scores in physical and mental well-being than those for a single disorder.NURS 6640 Essay Discussions
Substance abuse is more prevalent among individuals who have PTSD, and the severity of symptoms is more pronounced for those with alcohol and other drug problems than for non-users and past users (Wiechelt, Miller, Smyth, & Maguin, 2011). Persons with comorbid addictions also experience significantly more health problems, poorer social functioning, and higher rates of violence and suicide.
WEEK 8: Alcohol Abuse
Alcohol abuse is a serious problem. It is a pattern of drinking too much alcohol too often. It interferes with your daily life. You may be suffering from alcohol abuse if you drink too much alcohol at one time or too often throughout the week. It also is a problem if you can’t stop drinking and it harms your relationships. It can cause you to be unable to function at work and in other areas of your life.
In the United States, alcohol is the most commonly used and misused substance. It can be addictive.1,14
Not everyone who consumes alcohol will become addicted, but there are certain people who may be more susceptible to addiction.2 The effects alcohol has can vary between people, and there are factors that influence those effects, including age, health status, family history, and how much and how often one drinks.2 It should be noted that alcohol addiction and abuse are not the same.
Addiction is a chronic disease that involves uncontrolled, continued substance pursuit and use despite any harmful consequences.3-6 Individuals who suffer from alcohol addiction are often diagnosed with an alcohol use disorder (AUD), and they may also have developed a dependency on alcohol. Dependence is a state where the body requires the presence of a substance such as alcohol just to function normally. Without it, the individual will experience severe, possibly life-threatening, withdrawal symptoms.5,6 Dependence on alcohol is often experienced in tandem with addiction.6
Those who abuse or misuse alcohol are not necessarily addicted to or dependent on alcohol. An individual can misuse alcohol without drinking on a consistent basis. For example, an individual who abuses alcohol may only drink once a week. However, when that individual drinks, they may put themselves in risky situations or drink enough to cause problems, such as alcohol poisoning.2
Signs of alcohol abuse
An alcohol abuse disorder is a serious and progressive condition. But it is treatable. If you think you or someone you care about has a problem with alcohol, learn more about the disease and ask your doctor for help.NURS 6640 Essay Discussions
Early symptoms of an alcohol abuse disorder include drinking more than planned, continuing to drink alcohol despite the concerns of others, and frequent attempts to cut down or quit drinking. As alcohol abuse progresses, the individual develops a tolerance to alcohol. He or she must drink more alcohol to get the desired good feeling or to get intoxicated.
When a person becomes dependent on alcohol, and can’t get a drink, he or she develops withdrawal symptoms such as headache, nausea and vomiting, anxiety, and fatigue.
As alcohol abuse worsens, the person becomes preoccupied with alcohol and can lose control. He or she may have blackouts, which are episodes in which a person completely forgets what occurred when he or she was drunk even though he or she was conscious at the time.
Finally, personality changes occur. Someone suffering from alcohol abuse can become more aggressive and his or her ability to function (hold a job or maintain relationships with friends and family) can seriously deteriorate. Heavy drinkers may experience tremors, panic attacks, confusion, hallucinations, and seizures.
People with alcohol problems often drink alone and say they use alcohol to help them sleep or deal with stress. People who drink excessively may also engage in risky sexual behavior or drive when they should not. They are also at higher risk for dependency on other drugs.
How alcohol abuse affects the body
The effects of too much alcohol on the body are devastating. Health consequences of heavy alcohol use include inflammation of the stomach, inflammation of the liver, bleeding in the stomach and esophagus, impotence, permanent nerve and brain damage (numbness or tingling sensations, imbalance, inability to coordinate movements, forgetfulness, blackouts, or problems with short-term memory), and inflammation of the pancreas. Long-term overuse of alcohol can also increase the risk and severity of pneumonia and tuberculosis; damage the heart, leading to heart failure; and cause cirrhosis of the liver, leading to liver failure.
WEEK 9: Hyperactivity Disorder
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects both children and adults. 1 ADHD develops when the brain and central nervous system suffer impairments related to growth and development. A person with ADHD will show varying degrees of these three behaviors: inattention, impulsivity and hyperactivity. 2
What causes ADHD?
It’s not clear what exactly causes ADHD, though there are factors that may increase the chances of developing the condition. While researchers haven’t identified a specific ADHD gene, lots of studies show a genetic link. It’s quite common for a person diagnosed with ADHD to have at least one close relative with the condition.9, 10 Environmental factors may also play a role. These include exposure to pesticides and lead, a brain injury, being born prematurely or with a low birth weight. 11
“The brain is essentially a huge electrical system that has multiple sub-systems that need to communicate with one another constantly to get anything done,” explains Thomas Brown, Ph.D., director of the Brown Clinic for Attention & Related Disorders in Hamden, CT. Brown is considered a leading global authority on the assessment and treatment of ADHD. In his book A New Understanding of ADHD in Children And Adults: Executive Function Impairments (Taylor and Francis Group, LLC, 2013), he explains why someone with ADHD really struggles with things like listening and completing assignments in a timely manner: The brain communicates messages through neurons in the brain. But at the end of every neuron there is a gap called a synapse. The message needs to jump between the gaps, and does this with the aid of a chemical called a neurotransmitter produced by the body. “Persons with ADHD tend not to release enough of these essential chemicals, or to release and reload them too quickly before an adequate connection has been made.” In effect, messages struggle to get where they need to go to be acted on. Medications, including stimulants and non-stimulants, help make up for these deficits by triggering the release of certain chemicals, which in turn help the neurons to communicate with each other.NURS 6640 Essay Discussions
The most commonly used and recommended test for evaluating a child or adult for ADHD is a standard assessment that is designed to identify behavioral patterns and traits associated with ADHD.14
If your child is between age 4 and 18 and you suspect he or she may have ADHD, the American Academy of Pediatrics recommends that your child’s primary doctor/pediatrician do the initial behavioral screening evaluation. During an office visit, the doctor will meet with your child and you and ask a series of questions to determine if your child shows persistent signs of inattention and/or impulsivity and hyperactivity and whether they occur in more than one situation, such as at home and in school.
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If your child’s pediatrician suspects ADHD, he will likely recommend a formal evaluation by a mental health professional such as neurologist or psychologist who can do neuropsychological testing. This type of testing goes more in-depth than the standard screening. This testing will include screening for auditory and visual processing and sensory development, among other things.15 The idea is that by identifying the contributing factors of ADHD, the doctor can recommend a treatment approach that addresses the underlying cause(s) as well as the ADHD.
If a doctor is having difficulty pinning down the diagnosis, she may recommend neurological imaging. A SPECT (single photon emission computed tomography) scan measures blood flow in the brain. A radioactive dye is injected in the arm, and a series of pictures are taken of the head. These are turned into 3-D images and screened to see where the brain appears more and less active.16 Children diagnosed under age 6 were much more likely to have had neurological imaging compared to those 6 and older (41.8 % versus 25 %).17
WEEK 10: Personality Disorders
Personality disorders are classified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) as mental illnesses and clearly defines them. Difficulty coping with normal stress and trouble forming relationships with family, friends, and coworkers may be indications of a personality disorder. Those who struggle with a personality disorder often don’t enjoy social activities and may not see themselves as contributing to their problems. While each has its own distinctive features, the personality disorders also share some common characteristics.
“All personality disorders involve a pattern of behavior that deviates from the expectations of one’s culture,” says Scott Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York. “There may be a distortion in a person’s cognition, changes in his affect, or difficulties interacting with others and possibly problems with impulse control.”NURS 6640 Essay Discussions
According to Mental Health America, personality disorders fall into three different categories:
Cluster A: Odd or eccentric behavior
Cluster B: Dramatic, emotional or erratic behavior
Cluster C: Anxious fearful behavior
While personality disorders may be responsive to treatment, the challenge is getting the individual with a personality disorder to admit that he has a problem and then agree to treatment. “Many individuals with personality disorders could benefit from individual therapy,” Dr. Krakower says. “But they may choose not to go for treatment or they may go only after a substantial worsening of symptoms in a crisis situation.”
Individuals with personality disorders are prone to comorbid diagnoses like substance abuse disorder, anxiety, and depression, explains Shawna Newman, MD, an adult, child, and adolescent psychiatrist at Lenox Hill Hospital in New York City. “People are genuinely suffering when they have a personality disorder,” she says. “And while their situation can be managed or controlled with treatment, eliminating a personality disorder can be, at best, very difficult and may not be possible.” Psycho social interventions are typically recommended for those with a personality disorder, but there are no FDA-approved medications to treat these disorders, Newman explains.
While you have a moderate level of risk that you will develop a personality disorder if others in your family have one, it’s not a given. “Conditions can run in families just as the risk does for diabetes or heart disease,” says John M. Oldham, MD, interim chief of staff at the Menninger Clinic and Distinguished Emeritus Professor at the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Texas. “But even if you have risk factors, you may develop a personality disorder only if you didn’t have stability during your early years if there was a disconnection or derailment in the attachment process during your development.”
Those with personality disorders don’t have it easy when they are around other people, Dr. Oldham says. “There is a lot of stigma, which also is true for almost any mental disorder,” he says. “However, we are getting a little better about recognizing that these are all illnesses.”NURS 6640 Essay Discussions
Here, an overview of some of the 10 personality disorders listed in the latest Diagnostic and Statistical Manual of Mental Disorders.
1. Borderline personality disorder is defined by “a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity,” says the DSM. Not only do these individuals lack a solid sense of identity, they have difficulty forming and keeping relationships, Dr. Krakower says. However, they may benefit from certain types of therapy such as dialectical behavior therapy (DBT.) DBT is a cognitive behavioral treatment that combines individual psychotherapy with group skills training classes to help individuals learn new skills and strategies for managing their emotions and reducing conflict in their lives.
Medication can calm down the individual, but it’s not as effective as psychotherapy, says Dr Oldham. “If people with personality disorders find the right therapist, and they stick with it, there is a good chance they will get better,” he says.
Those with borderline personality disorder are highly worried that people don’t like them, Dr. Oldham says. “They may imagine this so vividly that they may start arguing with a person when the person wasn’t even thinking of them,” he says. “The person’s relationships get rocky because they’re so insecure.” Individuals with borderline personality disorder tend to be antagonistic and antisocial, and may injure themselves by cutting or burning themselves.
2. Paranoid personality disorder: The individual with this disorder exhibits distrust toward others that typically begins by early adulthood, Dr. Krakower says. “In addition to recurrent suspicions of others, the person reads hidden meanings into benign remarks,” he explains. “The person may suspect that others are deceiving them.” The DSM defines the disorder as “a pattern of distrust and suspiciousness such that other’s motives are interpreted as malevolent.”
The individual suffering from paranoid personality disorder experiences “suspicion without an objective or sufficient basis,” says Dr. Newman. “The individual can read negative meaning into very innocent remarks. They perceive a lot of unintentional insults and may be very unforgiving.”
3. Schizoid personality disorder: This disorder is “a pattern of detachment from social relationships and a restricted range of emotional expression,” says the DSM. “The person may be more of a loner and choose solitary activities,” Dr. Krakower says. While a person with schizoid personality disorder can benefit from social skills groups, unfortunately, these individuals may choose not to seek out treatment.NURS 6640 Essay Discussions
4. Schizotypal personality disorder is marked by a pattern of difficulty with relationships that is accompanied by cognitive and perceptual distortions and eccentric behaviors, says Dr. Krakower. “The individual may be superstitious and have magical beliefs or strange and unusual ideas,” he explains. In this disorder, too, while the person could benefit from social skills groups, they often choose not to seek out treatment. Individuals with this disorder are so highly superstitious they are basically dysfunctional, Dr. Newman says. “They may have odd beliefs that influence their behavior, such as ideas about clairvoyance or telepathy, and those with this personality disorder often have very bizarre thoughts,” she says. Individuals tend to have excessive social anxiety with everyone except first-degree relatives, she says.
5. Antisocial personality disorder: This disorder entails a pattern of behavior that is marked by disregard for and violation of the rights of others. These individuals often fail to conform to social norms, which may result in repetitive arrests and criminal behavior, Dr. Krakower says. “These individuals may wind up in jail,” he adds. Males with antisocial behavior tend to break the law, disregard rules of conduct, and be manipulative and reckless,” says Dr. Oldham. “They show no remorse for the things they do, and they don’t conform to social norms,” he says. “There is not a good treatment for antisocial personality disorder and you should start early in life to try to prevent it because once it’s there, it’s hard to fix.”
6. With a histrionic personality disorder, the person exhibits a pattern of attention-seeking behaviors, which may entail a heightened sense of dramatization and inappropriate sexual or provocative behaviors, Dr. Krakower says. Sometimes, this individual has borderline personality disorder as well. She could benefit from a form of therapy known as DBT.
7. Narcissistic personality disorder involves a pattern of grandiose behaviors with an exaggerated sense of self, Dr. Krakower says. “These individuals are preoccupied with unrealistic images of power and success and may often finds others inferior to them,” he says.
The person tends to believe he or she is special and unique and requires excessive admiration from others, Dr. Oldham says. “These individuals are not very good at having empathy,” he says. “Nor are they interested in trying to understand how other people feel.” A person with a narcissistic personality disorder may concurrently have borderline personality disorder and could benefit from individual therapy, he says, but unfortunately, it’s common for the person to refuse treatment.NURS 6640 Essay Discussions
8. An avoidant personality disorder involves a pattern of behavior with heightened social inhibition, which is often accompanied by a fear of rejection of others, Dr. Krakower says. The person may have feelings of inadequacy and be hypersensitive to negative evaluation, according to the DSM. “With this disorder, in general people may not even realize that the individual has a personality disorder,” says Dr. Oldham. “People with whom they live and are close to will be aware of it.” Psychotherapy is the primary treatment, he says.
9. A person with a dependent personality disorder exhibits a pattern of behavior marked by excessive neediness or clinginess, accompanied by fears of separation, Dr. Krakower says.
10. A person with anankastic (obsessive-compulsive) personality disorder displays a pattern of behavior of excessive orderliness and perfection, Dr. Krakower explains, and he is frequently inflexible and rigid. The individual who has this disorder finds it difficult to discard objects, even if they have little emotional value, he says.
WEEK 11 : Schizotypal Personality Disorder
Schizotypal personality disorder (STPD) is a form of personality disorder that gives people significant distress in social situations and is seen in about 4 percent of the US population. Often, someone with STPD lacks the social skills necessary to participate in regular social activities. A person with STPD has a lot of difficulty establishing close relationships and holding on to them, partially due to a skewed interpretation of social interactions as well as odd social behavior.
Specifics of Schizotypal Personality Disorder
People with schizotypal personality disorder often have misconstrued ideas of reference, or interpretations of daily events and their meanings. They may believe events have paranormal meanings, or they may be abnormally superstitious about everyday occurrences.
It is hard for people with STPD to connect with others because they are often thinking outside of cultural norms. The odd patterns of behavior that characterize a personality disorder may affect the individual’s cognition, emotions, interpersonal relationships, and impulse control.
A person with STPD generally lacks awareness about how their behaviors impact others. They often don’t understand how to form relationships with others and are quick to misinterpret and distrust other people’s motivations for trying to establish a connection. Because of this, people with STPD are often described as loners and quick to take personal offense to otherwise harmless interactions.
To diagnose a person with schizotypal personality disorder, they must demonstrate a consistent and inflexible pattern of odd behaviors and thinking over many years. Symptoms can often be traced back to adolescence or early adulthood. A diagnosis of a personality disorder is rarely made in childhood, as personalities grow, develop, and mature throughout childhood. If a diagnosis is made during childhood, symptoms must have been present for at least one year.NURS 6640 Essay Discussions
While pharmaceutical medications can be useful in alleviating symptoms of STPD, their use must be monitored closely in individuals who also have a history of drug and/or alcohol addiction. Many prescription medications are habit-forming and can be risky for someone in recovery to start using.
When addiction and a mental health disorder are present, treatment for co-occurring disorders is necessary. According to the National Alliance on Mental Illness (NAMI) almost eight million people in the US in 2014 experienced a mental health disorder and a co-occurring substance use disorder. Either disorder can develop first, but both must be treated simultaneously.
Integrated treatment begins detoxification. Being medically supervised throughout this process in an inpatient setting is usually the safest way to detox. Treatment staff may decide to provide medically assisted detox to manage severe withdrawal symptoms, or they may just keep a close watch on your medical condition.
Following detox, rehabilitation in an outpatient or inpatient setting can begin. Comprehensive treatment programs provide individual and group therapy, health education, family services, skill building, and ongoing community support. Toward the end of the program, an aftercare plan will be put into place to support ongoing sobriety, mental health, and relapse prevention.NURS 6640 Essay Discussions
