mental disorders – Best Essay Writers

Alzheimer’s disease Research Paper

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Alzheimer’s disease

Since patient wandering and confusion are common for the patient with moderate-to-severe Alzheimer’s disease, what would the RN teach the family about maintaining a safe environment? Provide three examples.

The RN should teach the family that patients diagnosed with Alzheimer can comfortably live in their homes, provided the safety measures are put in place. The family members must be educated on ways Alzheimer disease causes changes in the patient’s brain and body functions. This affects the patient reasoning, judgement, physical ability, behaviour, cognitive functions and sense of time (Bridenbaugh, Monsch & Kressig, 2012).

The family should be taught on ways to identify the possible dangers. The hazardous areas should be locked. Drugs and other chemical substances should be stored out of reach, in lockable cupboards. The family must be ready for emergencies. This implies that they should keep emergency phone numbers such as fire departments and local police helplines. The family members should ensure that the safety devices are working.

These include smoke detectors and carbon monoxide detectors and fire extinguishers. Walkways should be well lit to prevent falls. All weapons such as guns or other types of weapons must be removed. Basically, the home must be well lit, ventilated and free from hazards. The home should not be too restrictive, but one that encourage social interaction and independence (Schneider, 2011).

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To prevent the patient from wandering, the patient’s relatives and care givers should be taught the following strategies. To start with, they should create a daily activity plan. This helps identify the times of the day that wandering occurred. The patient must be reassured whenever they feel lost, disoriented or abandoned. The care giver must refrain from using correcting the patient using harsh voice.

All patients’ basic need must be met. They should not allow the patient to go places that trigger confusion and disorientation such as grocery stalls, malls or other venues that are busy. The doors must remain locked, and keys including car keys put out of sight. The patient must never be left alone i.e. they should always be under supervision. If the main issue is night wandering, devices that signal motions should be used (Lacey, Jones, Trigg & Niecko, 2012).

How would the RN adjust the teaching based on the family’s educational level, socioeconomic status or culture? Provide two examples

Despite the increase emphasis on patient centred care, when it comes to coping strategies for Alzheimer, the healthcare provider should focus on family centred care. In this case, the RN must conduct a family assessment to understand patient structure as well as style. This helps RN formulate effective teaching plan (Skoog, 2011).

To begin with, the RN should evaluate the barriers that would hinder the family ability to deliver health care. This includes the ages, sex and health status of the family member. The family socioeconomic status influences the teaching strategy. People from high socioeconomic status are most likely to be educated, thus basic healthcare can be used during the teaching process.

However, those from low income households tend to have low level of education which determines people’s attitudes and perceptions of care. Additionally, some family members lack basic knowledge of the disease. Cultural backgrounds could make some patients to believe in folk medicine. These factors must be addressed when teaching the patient’s family members (Trigg, Jones, Lacey & Niecko, 2012).

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What are common symptoms of caregiver role strain?

The demands of giving care to Alzheimer patients are very taxing which can lead to care givers strain and burnout. These are manifested through stress, anxiety, exhaustion, and sleep disturbances. Other common symptoms of care giver role strains include changes in appetite, depression, withdrawal and mood swings (Trigg, Jones, Lacey & Niecko, 2012).

Provide one nursing diagnosis statement (statement must include an actual nursing diagnosis, related factor and as evidenced by) that may be appropriate for a patient with moderate-to-severe Alzheimer’s disease.

Anxiety related to stress and situational crisis as evidenced by insomnia, restlessness, memory loss, and cognitive functions deficits.

References

Bridenbaugh, S., Monsch, A., & Kressig, R. (2012). How does gait change as cognitive decline progresses in the elderly?. Alzheimer’s & Dementia, 8(4), P131-P132. http://dx.doi.org/10.1016/j.jalz.2012.05.349

Lacey, L., Jones, R., Trigg, R., & Niecko, T. (2012). Caregiver burden as illness progresses in Alzheimer’s disease (AD): Association with patient dependence on others and other factorsâ€”Results from the Dependence in Alzheimer’s Disease in England (DADE) study. Alzheimer’s & Dementia, 8(4), P248-P249. http://dx.doi.org/10.1016/j.jalz.2012.05.660

Schneider, L. (2011). Agitation and Alzheimer’s disease. Alzheimer’s & Dementia, 7(4), S92. http://dx.doi.org/10.1016/j.jalz.2011.05.223

Skoog, I. (2011). Vascular Disease Risk Factors and Alzheimer’s Disease. Alzheimer’s & Dementia, 7(4), S284. http://dx.doi.org/10.1016/j.jalz.2011.05.822

Trigg, R., Jones, R., Lacey, L., & Niecko, T. (2012). Relationship between patient self-assessed and proxy-assessed quality of life (QoL) and patient dependence on others as illness progresses in Alzheimer’s disease: Results from the Dependence in Alzheimer’s Disease in England (DADE) study. Alzheimer’s & Dementia, 8(4), P250-P251. http://dx.doi.org/10.1016/j.jalz.2012.05.667

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Mental Illness and social stigma

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Mental Illness and social stigma

Angermeyer, M. C., Holzinger, A., Carta, M. G. & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. The British Journal of Psychiatry, 199 (5); 367-372.

Aim; investigating if mental illness’ biogenetic causal attributions were linked to more tolerant attitudes in the general public, and if such attributions were connected to lower responsibility and guilt perceptions. There was also an exploration of the extent to which responsibility notions were linked to rejection of the mentally ill people. Finally, evaluating how prevalent responsibility notions were in the general public in relation to various mental disorders.

Research design; systematic review of population studies that were representative. There was an examination of the attitudes towards the mentally ill as well as the beliefs about the disorders.

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Key research findings/ recommendations; biogenetic causal models should cease being used to reduce rejection of the mentally ill. biogenetic causal attributions are not linked to attitudes that are more tolerant but are connected to stronger rejection (schizophrenia). The self-responsibility stereotype was not connected to rejection. Mental disorder’s public images are more dominated by dangerousness and unpredictability stereotypes. Responsibility is minimally relevant.

Strengths and weaknesses; there was use of an adequate number of studies. However, there is no mention of what can be used instead of the biogenetic causal models.

Deacon, B. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33, 846-861.
Aim; the study aimed at exploring the biopsychosocial model that is often neglected in studying mental disorders.

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Research design; a scientific approach was used to investigate the speculations.

Key research findings/ recommendations; in America, the healthcare system has been dominated by the biologically-focused strategy to practice, policy, and science for over three decades. Within this period, there has been a rise in the psychiatric medications use. Moreover, mental conditions have been more commonly seen as brain diseases that result from chemical imbalances which can be corrected using disease-specific drugs.

Regardless of the widespread hope in the neuroscience’s potential of revolutionizing mental health practice, evidence shows that the biomedical model broadly lacked clinical innovation. It was also characterized by mental health impacts that were very poor. The biomedical paradigm profoundly has affected clinical psychology through drug trial methodology adoption in psychotherapy research.

Regardless of the fact that that this approach has brought about the development of psychological treatments that are empirically supported for different mental diseases, it ignores the treatment process inhibits dissemination and treatment innovation, and resulted to the classification of this field along practitioner and scientist lines.

Strengths and weaknesses; noteworthy, the researchers recommend the biopsychosocial mode as the appealing biomedical approach’s alternative. In addition, there is advice on the need for a public and honest dialogue regarding the utility and validity of the common biomedical paradigm.

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Haslam, N. & Kvaale, E.P. (2015). Biogenetic Explanations of Mental Disorder: The Mixed-Blessings Model. Current Directions in Psychological Science, 24(5), 399-404
Aim; exploring how the mentally ill people are perceived in relation to biogenetic explanations from the perspectives of clinicians, the affected, and public.

Research design; systematic review.

Key research findings/ recommendations; regardless of the fact that biogenetic explanations might soften public stigma through diminishing blame, they escalate it through inducing avoidance, pessimism as well as the belief that those affected are unpredictable and dangerous. Such explanations might also induce helplessness and pessimism among the affected people and minimizes the empathy the treating clinicians often feel for them.

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Strengths and weaknesses; it is recommendable for the authors to mention that they interpreted the findings in the light of the social psychology research in relation to mechanistic and essentialist thinking. However, a lot more studies need to be conducted so as to explain many aspects that this study does not touch on.

Pattyn, E., Verhaeghe, M., Sercu, C., & Bracke, P. (2013). Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study. Soc Psychiatr Psychiatr Epidimiol, 48, 1637-1645.

Aim; the aim of this study was contrasting mental illness’ medicalized conceptualization with the psychologizing mental illness. It also examined the consequences of sticking to one model as opposed to the other for stigma and help seeking.

Research design

There was used of survey research approach. Face-to-face interviews were conducted in a representative sample that consisted of a general population from Belgium. The vignette technique was essential for depecting schizophrenia. Te disease view, labeling processes, and causal attributions were addressed. Data analysis was through linear and logistic regression models using SPSS Statistics 19.

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Key research findings/ recommendations; mental illness’ medicalization requires a package deal, that is, the disease view’s application to promote medical treatment recommendations, and biopsychosocial causal attributions. Labeling triggers stigmatizing attitudes. General medical care is recommended by those who prefer the biopsychosocial approach while specialized medical care is recommended by those who use the disease view.

In relation to informal help, those that use the biopsychosocial model rarely recommend consulting friends compared to those who prefer the psychosocial model. Those who use the medical label barely recommend self care. Those who use the medical model are likely to exclude others socially, especially those that have undergone through psychiatric treatment.

Strengths and weaknesses

There is a clear comparison between different model but the results are limited to the Belgians.

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Delirium Diagnosis in Geriatric Patient Case Study

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Delirium Diagnosis in Geriatric Patient

Case study 1

Delirium, dementia and depression are serious health complication common among geriatric population. The clinical manifestation of these healthcare complications is mainly impaired cognitive function, which makes it difficult to differentiate. This is usually a challenge because most of geriatric patients often present with multiple medical comorbidities which contribute to the affective and cognitive changes. Advanced nurse practitioners are expected to understand the key differences between these diseases as it is the first step to effective treatment (Holt, Young & Heseltine, 2013).

In this case study, the list of differential diagnosis would include dementia, depression and delirium. However, the fact that the patient is very confused, agitated, mental status fluctuates and rambles in an incoherent and disorganized manner, then, the most likely definitive diagnosis is the patient is derelict. Delirium is differentiated from the other two mental disorders by a) onset, b) Attention, c) and d) fluctuation of the symptoms.

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The onset of delirium in geriatric population occurs rapidly as compared to other two diseases where symptoms onset is mainly gradual and worsens progressively. In patients that are derelict, the patient is unable to remain focused. In early stages of dementia and depression, the patient is generally able to remain alert. In delirium patients, the signs and symptoms fluctuation is predominant throughout the day (Flaherty & Resnick, 2011).

To further confirm the diagnosis, the cognitive assessment should be done using comprehensive geriatric assessment tool. The physical exams, neurological exam, blood test and urine test should be conducted to check indicators of underlying health complications. I would not request from brain imaging test unless the aforementioned diagnostic tests fails to confirm delirium or underlying health complications (Featherstone, Hopton & Siddiqi, 2010).

The first step in treatment of the patient is to address underlying triggers. This includes terminating medication identified as underlying cause. With regard to pharmacological management of delirium, the patient should be give antipsychotics of choice, administered at lowest dosage.

Therefore, the patient should be administered Haloperidol and benzodiazepines. The healthcare provider must ensure that the patient gets an individualized care plan to treat and prevent further complications. This includes devising environmental interventions to address the disorientation and cognitive impairments (Holroyd-Leduc & Reddy, 2012).

Reference

Featherstone, I., Hopton, A., & Siddiqi, N. (2010). An intervention to reduce delirium in care homes. Nursing Older People, 22(4), 16-21. http://dx.doi.org/10.7748/nop2010.05.22.4.16.c7732

Flaherty, E., & Resnick, B. (2011). GNRS. New York, NY: American Geriatrics Society.

Holroyd-Leduc, J., & Reddy, M. (2012). Evidence-based geriatric medicine. Chichester, West Sussex, UK: Blackwell Pub.

Holt, R., Young, J., & Heseltine, D. (2013). Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age and Ageing, 42(6), 721-727. http://dx.doi.org/10.1093/ageing/aft120

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Mental Health Consumer Care

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Mental Health Consumer Care

“How would you feel when almost every individual within the society treats you differently by avoiding any form of interaction? Well, no one prefers to be treated that way. Mental health consumers are more often marginalized because of their mental state. This aspect can worsen their entire being and situation, which can propel them to neglect the self. By definition, a mental health consumer refers to persons who use mental health services in order to empower their mental health status while obtaining support or treatment.

Evidently, suffering from mental illness can be devastating to a patient and that situation can affect various aspects of their lives ranging from their physical status to their emotional being. On the other hand, self-neglect refers to the behavioral situation in which a person neglects or fails to attend to their personal basic needs such as feeding, appropriate clothing, tending appropriately to medical conditions, feeding or personal hygiene. Nonetheless, in extreme cases of self-neglect, the situation can be inferred to as Diogenes syndrome (Townsend, 2013).

Despite the severity of self-neglect in a mental health consumer, nursing professionals need to care for them in an attempt to improve their mental health issues. This presentation focuses on the relevance of nursing care of mental healthcare consumers who self-neglect to modern mental health nursing as well as to recognize the appropriate linkages with other mental health care providers.

In order to appropriately identify patients suffering from mental health problems, it is ideal to identify the various aspects that help in identifying them or the factors that assist in characterizing them. Most cases involving self-neglect are often recognized as a result of numerous complaints received from several sources such as community organizations, neighbors, GPs and healthcare professionals (Naik, Lai, Kunik & Dyer, 2008).

The process of managing and identifying cases is very complex and difficult, which requires a multi-disciplinary and multi-agency approach. Based on several studies, individuals with mental health problems are often poor and indulge in smoking habits, lack exercise, consume alcohol, have poor diets and consumer other drugs (Middleton, 2008; Richardson, 2007). The deteriorating state of their daily lives often affects their energy levels, organization skills, attention, physical abilities or motivation.

The effect on the patient can cause them to neglect the self. Studies also indicate that the side effects of certain psychiatric medications can cause a decrease in the motivation levels among mental patients (Townsend, 2008; Gunstone, 2003). Therefore, self-neglect among mental patients can be caused by illness alone. With the help of medical practitioners including nursing care cases of self neglect among mentally ill patients re likely to reduce.

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Notably, nurses constitute the largest population of health care professionals, thus, they have a key role in the management and identification of self-neglect among mentally ill patients. The relevance of nursing care to mental healthcare consumers in the modern nursing practice can be identified through the assessment, diagnosis, outcome identification, planning, and implementation and evaluation steps (Peate, Wild, & Nair, 2014).

In the initial process, nurses establish a database in which the database relates to the client using assessment tools such as KELS, geriatric depression scale and nutrition assessment (Pickens et al., 2007). The next process involves identifying the patients’ health care needs as well as the specific goals for care. The third process involves establishment of the specific criteria that measures the achievement of anticipated outcomes while the forth process involves designing the most appropriate strategy that facilitates the achievement of the desired goals.

The implementation process involves initiating and finishing actions that are necessary in accomplishing goals as the final process involves determination of the degree to which the objectives and goals of the implemented care have been achieved (Boyd, 2010). Through this sequential step, a nursing practitioner is capable of analyzing personal achievements in relation to providing care to patients, especially those with mental illness and having self-neglect. The outcomes of this process help both the nursing specialists and other medical professionals to identify the various steps that in deed help in solving the problem of self-neglect among mentally ill patients, for future referencing.

Currently, the nursing profession is working towards providing holistic care to patient. This means that other than assisting patients within hospitals, nurses also help patients outside the hospitals such as acceptance within the society. With reference to mentally ill patients, they are among the mostly segregated groups of people within the society. The nursing education helps in providing additional knowledge to nurses and it is disseminated to the public by informing them that mentally ill patients are just like other people with slight differences in their ways of thinking and making decisions.

Some of the interventions include adult protection services, drug misuse rehabilitation, housing services, budgeting services and neurological assessment among many others (Lauder, Anderson & Barclay, 2005). These shape the current approach in providing care to patients by integrating friendly approaches towards the patients. By dealing with cases of self neglect, nurses are capable of reducing the stigma that mental patients receive, which in turn promotes their general well-being.

In conclusion, within the modern nursing field, practitioners are more propelled towards the identification and management of self-neglect cases among mentally ill patients as a means of preventing the reoccurrence of the phenomenon. Since nurses constitute the largest portion of individuals within the health care sector, they play a chief role in ensuring the provision of proper care to patients.

In the nursing profession, taking care of mentally ill patients helps in identifying the most appropriate ways of providing care. Treating mentally ill patients with self-neglect issues helps in improving the health of the patients in general.”

References

Boyd, M. (2010). Psychiatric nursing: Contemporary practice. Philadelphia: Lippincott Williams & Wilkins. https://books.google.co.ke/books?id=a-GcGVtBnqQC&pg=PA893&lpg=PA893&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=H7F7RnZ_WT&sig=hFRFTS4lxe5tl53BEFM-1drGcpA&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Gunstone, S. (2003). Risk assessment and management of patients whom self-neglect: a ‘grey area’ for mental health workers. Journal of Psychiatric and Mental Health Nursing, 10, 3, 287-296. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2850.2003.00568.x/abstract

Lauder, W., Anderson, I., & Barclay, A. (2005). A framework for good practice in interagency interventions with cases of self-neglect. Journal of Psychiatric and Mental Health Nursing, 12, 2, 192-198. http://www.ncbi.nlm.nih.gov/pubmed/15788037

Middleton, J (20 June, 2008). Self-neglect 2: nursing assessment and management. Nursing Times. Retrieved from http://www.nursingtimes.net/roles/older-people-nurses/self-neglect-2-nursing-assessment-and-management/1584631.fullarticle

Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Geriatrics, 63, 2, 24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847362/

Peate, I., Wild, K., & Nair, M. (2014). Nursing Practice: Knowledge and Care. Hoboken: Wiley. https://books.google.co.ke/books?id=xqXCBwAAQBAJ&pg=PA250&lpg=PA250&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=a6pjAEpAMS&sig=XBJXGriVDaILTkHpVefKU3FG_2o&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Pickens, S., Naik, A. D., Burnett, J., Kelly, P. A., Gleason, M., & Dyer, C. B. (2007). The utility of the Kohlman evaluation of living skills test is associated with substantiated cases of elder self-neglect. Journal of the American Academy of Nurse Practitioners, 19, 3, 137-142. http://www.ncbi.nlm.nih.gov/pubmed/17341281

Richardson, B. K. (2007). Psychiatric nursing. Clifton Park, NY: Thomson Delmar Learning. https://books.google.co.ke/books?id=yw2HAQAACAAJ&dq=psychiatric+nursing+by+richardson&hl=en&sa=X&redir_esc=y

Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Philadelphia: F.A. Davis Co. http://www.sbmu.ac.ir/uploads/townsend2011.pdf

Townsend, M. C. (2013). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia: F.A. Davis Co. https://books.google.co.ke/books?id=cxdengEACAAJ&dq=Essentials+of+psychiatric+mental+health+nursing:+Concepts+of+care+in+evidence-based+practice.&hl=en&sa=X&redir_esc=y

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Dementia PICO Analysis Method

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Dementia PICO Analysis Method

Part I: PICO analysis of research topic

Step 1: Frame clinical question using PICO method

P: the patients include people with dementia and psychosis

I: the anticipated intervention is to utilize typical antipsychotic drugs

C: the current standard or comparison group is atypical antipsychotics

O: the desired outcome is to have less mortality rates for elderly people with dementia and psychosis

The PICO question basically stands for patient, intervention, comparison and outcome (Elkins, 2014).

Part II: Search strategy

The PICO question is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O).

Step 1: Resources utilized to find articles

A number of scholarly articles relating to the identified issue are identified. The resources that were used in finding the articles that relate to the topic include the following: handbooks, electronic databases research, encyclopaedias, relevant books, and reputable journals.

Step 2: Search terms and criteria

With regard to search terms and criteria that were utilized, the search terms include the following: dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics. The inclusion criteria was as follows: scholarly peer-reviewed journal articles only, articles not older than 5 years, articles that are published in the English language, articles that focus on dementia and psychosis among the elderly population, and article that reports on primary research.

Step 3: Boolean search strings

With regard to the exclusion criteria, the articles that would be excluded are as follows: articles that are older than 5 years, articles not published in English, and articles that do not focus on the elderly patients with dementia. Using different Boolean search strings, keywords would be combined with operators like OR, NOT as well as AND in order to generate additional results that are relevant. For this research, the Boolean search strings that would be utilized include the following: atypical antipsychotics and psychosis, atypical antipsychotics and dementia, typical antipsychotics and dementia, typical antipsychotics and psychosis. Therefore, the search results would be limited only to the two keywords.

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Part III: Analysis of literature

Step 1: Summary of five articles

The following 5 articles in the table below were selected from the research effort.

Table 1: Summary of analyzed articles

Citation	Conceptual framework / theory	Main finding	Research Method	Strengths of study	Weaknesses of study	Level of evidence
Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43	Not specified	Atypical antipsychotics medications provide modest benefits up to twelve weeks /short term treatment of psychosis and dementia. Nonetheless, these benefits should be balanced against the risk of major adverse events such as increased death. With longer term prescribing, there are clear benefits, but the risk of death also increase.	Review of existing studies. The authors provide a summary of the evidence that pertain to safety and efficacy from short-term randomized controlled trials, as well as main findings from case register studies	Study is thorough. Presents both benefits and shortcomings of atypical antipsychotic drugs. The review provides an up-to-date and balanced overview of the safety concerns and effectiveness that relate to atypical antipsychotics in elderly patients with dementia, giving a full overview of mortality risk	The study only focuses on atypical antipsychotic drugs and does not also look into the safety concerns and efficacy of typical antipsychotics.	High level
Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936	Not specified	Broad statements that compare the comparative risk of specific adverse effects between conventional and atypical antipsychotics are mainly insignificant. Instead, comparisons need to be made between particular typical and particular atypical antipsychotic drugs.	The authors reviewed various studies including post marketing, surveillance studies, and observational studies and randomized controlled trials.	The study is comprehensive, thorough and up-to-date	A small number of studies were reviewed	High level
Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40	Not specified	Using atypical antipsychotics to treat dementia amongst older adults is linked to a higher rate of mortality.	A cohort study was conducted that comprised 696 elderly patients with Alzheimer	The study recommends new approaches for managing dementia to replace the use of atypical antipsychotic drugs which have potential risks of mortality	A small sample size was used and the study was carried out within a single hospital. This affects the generalizability of the findings	Medium level
Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal Of The American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061	Not specified	Shortly after initiating oral atypical antipsychotic drug, the likelihood of developing a major event in elderly people with dementia was high.	This was a population-based, retrospective cohort study.	A large sample size was used that comprised 21,526 elderly men and women with dementia	The study had more women that. Women were 13,760 while the number of men was 7,766.	High level
Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943		Atypical antipsychotic medicines might be linked to a slight increased likelihood for death in comparison to placebo where typical antipsychotic drugs were used.	The authors assessed the evidence for high death rates from atypical antipsychotic medications for patients who have dementia. The data sources were obtained from Cochrane Controlled Trials Register, MEDLINE, and meetings and presentations.	A large sample size is used hence the findings could be generalized. There a total of 5,101 participants	Some very old data materials from the 1960s were used which may not be relevant for use today	High level

Step 2: History and purpose of research question

Every antipsychotic drug has warnings of increased mortality for elderly patients (Schneider, Dagerman & Insel, 2012). Antipsychotic medications are broadly utilized in managing psychological and behavioural symptoms in dementia in spite of concerns as regards their safety (Ballard et al., 2011; Piersanti et al., 2014). Compared to typical or conventional antipsychotic drugs, atypical antipsychotic drugs are linked to a statistically significant rise in the likelihood of mortality for older men and women who have dementia (Haddad & Sharma, 2012).

The purpose of the research question is to find out whether the use of typical antipsychotic medication, which is the intervention, results in less mortality rates than atypical antipsychotic medication, which is the comparison group, in elderly patients who have dementia and psychosis.

Step 3: Strengths and weaknesses of existing literature

The strengths of the existing literature is that there are studies which focus mainly on the atypical antipsychotics and others that focus mainly in typical/conventional antipsychotics and their correlation with mortality. The weakness of the existing literature is that there are no studies that compare typical antipsychotics and atypical antipsychotics on the rates of mortality on elderly patients with dementia and psychosis (Rochon et al., 2013).

Step 4: Gap in current literature

At the moment, the gap in current literature is that there are no studies which have focused specifically on the association of atypical and typical antipsychotic medications on the rates of mortality among the older adults who have dementia.

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Conclusion

In conclusion, the PICO question for the research study is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O). The purpose of the research question is to find out whether the use of typical antipsychotic medication results in less mortality rates than atypical antipsychotic medication in elderly patients who have dementia and psychosis. The resources used to find articles included electronic databases research, relevant books, and reputable journals. The search terms that were utilized include dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics.

References

Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43

Elkins, M. Y. (2010). Using PICO and the brief report to answer clinical questions. Nursing, 40(4), 59-60. Retrieved from the Walden Library databases.

Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936

Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40.

Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal of the American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061

Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943

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The Nursing Care of Mental Health Consumers Who Self – Neglect

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The Nursing Care of Mental Health Consumers Who Self – Neglect

Despite the severity of self-neglect in mental health consumers, nursing professionals need to care for them in an attempt to improve their mental health issues. This presentation focuses on the relevance of nursing care of mental healthcare consumers who self-neglect to modern mental health nursing as well as to recognize the appropriate linkages with other mental health care providers.

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Notably, nurses constitute the largest population of health care professionals, thus, they have a key role in the management and identification of self-neglect among mentally ill patients. The relevance of nursing care to mental health consumers in the modern nursing practice can be identified through the assessment, diagnosis, outcome identification, planning, and implementation and evaluation steps (Peate, Wild, & Nair, 2014).

References

Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Geriatrics, 63, 2, 24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847362/

Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Philadelphia: F.A. Davis Co. http://www.sbmu.ac.ir/uploads/townsend2011.pdf

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The diagnosis and management of depression

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The diagnosis and management of depression within the American population

Identifying a Problem

The diagnosis and management of depression within the American population remains one of the health factors affecting the health sector. Sources determine that the prevalence of depression within the American population is ascertained to stand at 8.5%, a factor that has seen less people seek medical attention (Wagner, Müller, Helmreich, Huss, & Tadić, 2015). Thus paper therefore seeks to develop a PICOT question in determine the aspect of depression and its effects within this population.

PICOT Question

It is essential to consider that the PICOT P, Population: I Intervention C, Comparison, O, Outcome and T Time is developed in guiding this study. In the American population between the ages of 30-35 of the working class (P), is there a need of developing a tool that will analyze depression (I), compared with the other approaches of care (C) that ensures appropriate procedures are developed in order to detect depression (O) within a specified time (T)? The aim of the PICOT question is developed to determine enough evidences that justify the element of depression among the American population through the use of effective tools.

Selecting Sources of Literature

In considering the results of this paper, it is essential to search through multiple databases that include EBSCOhost, Google Scholar, PsycINFO and the Cochrane and other sources from Health Care research centers. In getting the results of this study, there are key search words that need to be considered (Wagner, et.al.2015). These words include: screening, depression, depressive disorders, BECK or BDI-ii and the population. The use of both the published and the unpublished materials in searching the literatures was incorporated with the materials reviewed dating back between 2005-2010.

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Selecting Sources of Literature

According to Wagner et.al.2015, a metal-analysis was conducted to determine the effects of depression on the American population. The findings of the study identifies that a majority of the population presented traumatic symptoms. This material determines that depressive disorders among the younger generation may lead to suicidal and homicidal thoughts and attempts (Jackson, Dianne & Garnefski, 2015).

Some of the symptoms that are presented by this author include chest pains, headaches, painful urination, dizziness an excessive sweating. This source intrinsically supports the specified area of study since it provides evidence to some of the effects of depression among the American population.

Jackson et.al.2015 in his literature consequently revealed that the screening of depressive disorders among the American population undergoes a process of identification, assessment, and initiation of approaches aimed at managing this disease within the American population (pp.197). This author details a quantitative randomized study within this population and establishes that the abuse of substances is as a result of depression, a factor that explains the reasons why several Americans engage in risky sexual behaviors.

On the other hand, the population is also likely to engage in drugs and substance abuse as a result of depression. The author determines that there is a need of developing a concurrent treatment method that uses psychotropic drugs and other stable stimulants in the management of depression. The inclusion of psychotherapeutic method is also essential in the management of depression.

The author also mentions that depression within this population needs to be effectively managed since discoveries have been made that establish individuals in this state engage in unprotected sex and the inclusion of multiple sexual partners, a factor that would result into a health concern within a nation.

References

Wagner, S., Müller, C., Helmreich, I., Huss, M., & Tadić, A. (2015). A meta-analysis of cognitive functions in children, adults and adolescents with major depressive disorder. European Child & Adolescent Psychiatry, 24(1), 5-19. doi:10.1007/s00787-014-0559

Jackson, E. M, Dianne S, & Garnefski, N. (2015). Depressive Symptomatology and Child Abuse in Adolescents with Behavioral Problems. Child & Adolescent Social Work Journal, 20(3), 197-210.Retrived From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=10067979&site=ehost-live

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Intellectual Disability: Research Paper

About 1 percent of the entire population has intellectual disability, which is a considerable disorder in adaptive as well as intellectual function in the early stages of development (Aveyard 2014). Individuals with the intellectual disabilities rate of developing mental illness are greater in comparison to the whole population, however, challenges in communication, access to services, literacy means that mental issues in persons with intellectual disability are inadequately recorded.

Moreover, the majority of persons with intellectual disability exhibit challenging behaviors, meaning characters of intensity, duration, and frequency that endangers their physical safety or those around them or even restricts accessing community services.

For a long period, there have been concerns that psychotropic medicine especially, antipsychotics are overused as such prescribed for problem behavior instead of diagnosing mental sickness, regardless of insufficient proof on their effectiveness. Nonetheless, getting an accurate amount of psychotropic in persons with learning disabilities is intricate, while present literature is limited due to varying descriptions.

In spite of inadequate proof from policy context, there is no detailed assessment of psychotropic in adults with learning disability in United Kingdom primary care conducted, while results from other nations cannot be generalised due to variations in health care provisions as well as practices (Guerzoni & Zuleeg 2011).

Proof demonstrates that psychotropic use in entire population has been increasing tremendously for the past years, however, few studies have investigated that the patterns used to prescribe psychotropic among persons with intellectual disability. Regarding deinstitutionalization, creating warrens of psychotropic use, adverse effects and efforts to minimise its use to individuals with learning disability through the implementation of prescription standards are not clear. Furthermore, with the large as well as representative sample size, it is apparent that there are increased rates of mental illness, challenging behavior and psychotropic medicine among people with intellectual disability.

Research Question

Do challenging behaviors among persons with learning disabilities result from mental impairments?
Are social workers faced with challenges caring for persons with learning disabilities?

Research Objectives

To establish whether or not challenging behaviors among persons with learning disabilities result from mental impairments
To understand some of the challenges that come with caring for persons with learning disabilities

Hypothesis

H₀: Challenging behaviors among persons with learning disabilities do not result from mental impairments
H₁: Challenging behaviors among persons with learning disabilities do not result from mental impairments
H₀: Social workers caring for persons with learning disabilities do not undergo challenges that wear them down
H₁: Social workers caring for persons with learning disabilities undergo challenges that wear them down

What is challenging behavior?

An individual’s conduct may be regarded as challenging if it threatens their safety or those around, particularly care or even contributes poor life quality. In addition, such behaviors can influence their capacity to participate in routine activities. Challenging behaviors consist of self-harm, destructiveness and aggression among others. Communication determines the way in which people express their needs.

In the event that communication is problematic, it may extremely discourage individuals leading to challenging behavior. If such behavior contributes to desire results, it may be repeated over and over. Challenging behaviors are common in persons with problems that impact communication and the brain including learning disability, and dementia (Economist Intelligence Unit 2011).

Challenging behavior or behaviors that challenge are culturally anomalous behaviors of frequency or duration that endangers their safety or others. In most cases, an individual must display trends that are a threat to services for a significant timeframe. Seriously challenging behaviors are not transient occurrences. According to the National Institute for Health and Care Excellence (NICE), challenging behavior is a concept that is associated with aggression, stereotype, and agitation or self-harm, withdrawal, and sexual misconduct (NICE 2016).

Additionally, challenging behavior involves persons whose conduct present considerable challenges to services. This comprises of behaviors that are associated with mental health issues. Challenging behaviors are widely used among persons with learning or intellectual disability, in addition to those with autism. Nonetheless, there are other groups that can be regarded to have challenging behaviors such as those with dementia and serious mental issues.

Impact of challenging behavior

Challenging behavior is described as ‘socially unacceptable behavior’, ‘bad behavior’ (Craver 2015). The term also reflects a challenge to those concerned. It indicates that something is not working well, and it needs to be rectified and stopped. Behavior is challenging if it causes harm to another individual, or prevents them from fulfilling certain things in their lives. Challenging behaviors are detrimental to the lives of the affected persons and those around them. Hence, dealing with challenging behaviors requires careful handling in a way that supports the safety and well-being of people and others

Aggression and assault

In a study conducted by 76 social care workers in institutions that provide intellectual disability services, three-quarter of respondents had faced aggression, self-harm, and disruptive behavior. Recent studies of employees working with persons with dementia discovered that roughly three-quarter of workers faced fearful events during their work (Springer et al. 2013). The most common reported cause was physical assault. Among the respondents sampled, a fifth said they had been injured, a quarter experienced fears during interaction, and half of the interviewees stated that they adopted a more personal centered style while others learned to be more vigilant.

This study gives indications of nature and level challenging behavior experienced by staff in care homes for people with dementia. Recent studies of perception of severe behavior and fear of assault showed that the degree of fear was greater when staff was exposed to challenging behavior. Researchers, however, found unclear evidence for the relationship between the quantity of challenging behavior and the level of fear of assault.

References

Emerson, E. 2011, Challenging behaviors. Available from http://www.amazon.co.uk/Challenging-Behaviour-Eric-Emerson/dp/0521728932/280-1066416-6180644?ie=UTF8&camp=1634&creative=19450&creativeASIN=0521728932&l inkCode=as2&redirect=true&ref_=as_li_ss_tl&tag=mentalhealt08 [25^th May 2016].

Guerzoni B. and Zuleeg F. 2011, Working away at the cost of aging. Brussels: European Policy Centre. Available from:http://www.epc.eu/documents/uploads/pub_1265_working_away_at_the_cost_of_ageing. pdf ,[25th May 2016].

Hayes, S. A., & Watson, S. L. 2013. The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of autism and developmental disorders, 43(3), 629-642.

Mental health center 2016, Oppositional defiant disorder. Available from http://www.webmd.com/mental-health/oppositional-defiant-disorder?page=222 [25^th May 2016].

National Center for Learning Disabilities. 2012, What are learning disabilities? Available from http://www.ncld.org/types-learning-disabilities/what-is-ld/what-are-learning-disabilities [25^th May 2016].

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