Mental Health Nursing Applications in Childhood and Eating Disorders

Flashcards covering essential vocabulary and concepts related to mental health nursing, specifically in the context of childhood disorders and eating disorders.

etiology of childhood mental illness

• biological

  • direct genetic link, but also factors in terms of brain development

• psychological

  • temperament - behavioural adaptation

  • resilience - success in facing challenges

• environmental

  • family dysfunction, deviant parental behaviours/mental illness → learned behaviour

• cultural

  • conflict between expectations, lack of role modeling, views on mental illness

erikson’s stages of development

• childhood / adolescence is industry vs inferiority, which is the main stage we look at here

• 6-12 y.o.

assessments

• history of the present illness → how long has this been going on? how long since parents noticed symptoms? have you sought treatment? what impact is this having on school and social life? what is the effect on family? are siblings treating the kid differently?

• developmental history and assessment → has the family moved a lot, what kind of play does the child like, are they eating and sleeping at a relatively normal rate of progression? language development? energy level, motivation, independence vs attached

• neurological assessment → more of an observation on clinician’s part, rather than report from parents

• medical and family history → education of parents, what do they do for work, is the family social, is the family home a lot, do they move often

• mental status assessment

• suicide risk assessment

methods of assessment

• semi-structured interviews

• play therapy

• functional assessment of abilities during activities

• screening

• testing

• observing/interacting w/ child

• make sure parents are not participating in assessment unless asked - they shouldn’t answer questions on behalf of the child

group therapy for children

• play for younger children

• playing and talking for grade-school children

• talking for older children

behavioural and cognitive behavioural therapy

• using rewards and limit setting - not punitive

• point system leading to rewards

disruptive behaviour management for kids

• should interrupt disruptive behaviour early to avoid chaos and prevent contagion to other kids

• ignoring

• signals and reminders

• redirection

• humour

• closeness or touch

• restructured activity

milieu management for kids

• can you manipulate the environment to better meet the needs of the child

• seclusion and restraint / time out / quiet room

• should be used w caution - seclusion and restraint should follow provincial and facility-specific policies

• seclusion and restraint are last-resort interventions

play therapy

• bibliotherapy - using literature

• therapeutic drawing

• therapeutic games

• music therapy

intellectual disabilities

• occurs on a continuum

• include deficits in

  • problem solving

  • reasoning and judgement

  • communciation

  • self-care

  • social participation

communication disorders

• can be in expressive and receptive ability

• may need to alter the way you give instructions

• impacts engagement w others

specific learning disorders

• dyslexia - reading

• dysgraphia - writing

• dyscalculia - arithmetic

motor disorders

• stereotypic movement disorder - things like hand flapping, spinning in circles

• tourette’s

  • CBT can be used to increase an individual’s awareness of what’s happening

autism spectrum disorder

• appears during first 3 years, characterized by:

  • impairment in communication and imagination

  • impairment in social interactions

  • restricted, stereotyped patterns of behaviour, interest, and activities

  • can be misdiagnosed and explained by things like covid that would delay development

• most often recognized by speech delay w/in 18 months

• asperger’s no longer exists and falls within the spectrum, is most often missed early on because there is no speech delay

• spectrum goes from level 1 to level 3, with level 1 meaning the child requires some support and level 3 meaning they require extensive support

ADHD

• diagnosis must occur across two or more settings - like at home and at school, at home and at work, etc.

• inappropriate degrees of:

  • inattention - during tasks or play (even if enjoyable), listening, easily distracted, forgetful, loses things, disregards social cues

  • impulsiveness - fidgets, climbs, constantly in motion, excessive talking

  • hyperactivity - interrupts a lot, is impatient and intrusive

• three types - impulsive, inattentive, and combined. combined is the most common

• assessments based on level of physical activity, attention span, talkativeness, social skills, and comorbidity

psychological interventions for ADHD

• behaviour modification

  • reward system

  • consistent expectations and rules

  • strengths-based approach

• family counseling for education and sometimes for coping

• play therapy for younger children

• recreation or art therapy for older children

• cognitive behavioural therapy, depending on age of child

pharmacological interventions for ADHD

• psychostimulants - CNS stimulants

  • increase attention and task-directed behaviour

  • reduce impulsivity, restlessness, distractibility

• there is a risk for abuse of these meds

• side effect of insomnia, appetite suppression, possible growth retardation

• it is recommended that kids take breaks from stimulants on days they don’t need to be dialed in or super focused

• ridolin, concerta - inhibit dopamine and norepinephrine reuptake, so higher availability

• methamphetamine based adderall and vivanz promote release of dopamine and norepinephrine and inhibit their reuptake

• non-stimulant SNRIs can be used when stimulants don’t work

oppositional defiant disorder

• more of an attitude presentation than conduct disorder, which is behaviour

• angry, irritable mood

• defiant and vindictive behaviour

• social and academic difficulty

• conflict w authority figures

• can be misdiagnosed when attitude is sparked by changes or difficulties in their life, when it is not actually ODD

conduct disorder

• more of a behavioural presentation than oppositional defiant disorder

• early intervention is key in preventing escalation to adult antisocial personality disorder

• abnormally aggressive behaviour

• violates others’ rights

• disregard for societal norms

• academic failure, suspension, dropout

• juvenile delinquency - pyromania and/or kleptomania

• drug and alcohol abuse

• socialized vs unsocialized - socialized is when they still maintain good social relationships. unsocialized is usually more concerning - behaviours performed in isolation

mental health disorders in children - general

• anxiety → separation and general anxiety disorders. GAD to do with pressure and performance expectations. somatic symptoms.

• depression is still common.

• depression and anxiety can have more behavioural manifestations than they do in adults because children may not know how to express themselves

• bipolar is rare and often misdiagnosed because children are expected to be more emotionally labile

• PTSD even from big life changes like divorce

• feeding / eating disorders

  • pica

  • rumination disorder → swallow the food and regurgitating, chewing it and eating again

  • avoidant/restrictive food intake disorder

definition of eating disorder

• persistent disturbance of eating or eating-related behaviour that results in the altered consumption of absorption of food, significantly impairing physical health or psychosocial functioning

Anorexia Nervosa

• A serious mental illness characterized by self-starvation and excessive weight loss

• there is a binge-eating and purging type of anorexia, separate from binge eating disorder. includes recurrent binge eating and purging, self-induced vomiting, use of laxatives, diuretics, enemas

• restricting type is primarily dieting, fasting, and excessive exercise

Bulimia Nervosa

An eating disorder characterized by binge eating followed by purging.

Binge Eating Disorder

Recurrent episodes of eating large quantities of food, often quickly and to the point of discomfort.

Avoidant/Restrictive Food Intake Disorder (ARFID)

• lack of interest in food, avoiding food, concern about adverse consequences of eating

• can be a texture component here

• does not involve body image disturbance

pregorexia

• fear of normal expected weight gain in pregnancy, so they decrease diet and increase exercise

• not officially recognized in DSM5

orthorexia

• obsession with healthy eating, to the point of excluding all food other than what the person deems to be healthy

• can result in deficiencies like if the person refuses to eat all fats, they would become deficient in vitamins ADEK

female athletic triad (FAT)

• low energy availability

• low bone density

• irregular menstrual cycles

• all as result of obsessive eating

comprehensive approaches to obesity management

• behavioural interventions like CBT, motivational interviewing (to focus on the positives like what someone likes about their body, finding out what it is about food that brings them satisfaction), and self-monitoring and goal setting

• nutritional support - individualized, non-restrictive meal plans and collaboration with registered dieticians

• physical activity - gradual, ability-based movement and an emphasis on health rather than just weight loss

• pharmacologic options like orlistat, liraglutide, and semaglutide

• surgical interventions in extreme cases like bariatric surgery

risk factors for eating disorders

• gender

• age

  • AN onset between 13-19

  • BN onset between 17-18

• personality

  • AN - sensitive, perfectionist, self-critical

  • BN - impuslive, moody, dramatic features

• family history of obesity, eating disorders, depressive disorders

• age of onset of non-disordered dieting behaviour

• interest groups like dancers, wrestlers, actors, models

• critical events like teasing or bullying

• predisposing psychiatric conditions

• predisposing medical conditions like diabetes and celiac disease

warning signs and symptoms of eating disorders

• yellowish, dry skin

• lanugo development - body has zero insulation so it develops that fine hair

• skipping or avoiding meals, eating alone

• going to bathroom after meals

DSM-5 criteria for anorexia / bulimia

• both anorexia and bulimia have levels of severity - for anorexia it’s a BMI scale and for bulimia it is based on episodes per week

thoughts and behaviours associated w anorexia

• fear of weight gain

• preoccupation w food

• food-handling rituals

• rigorous exercise

• use of laxatives or diuretics

• judging self-worth by weight

clinical presentation of anorexia

• weight loss and peripheral edema

• cold extremities

• lanugo and yellow skin

• cardiovascular issues like hypotension, bradycardia, heart failure, related to hypokalemia and hypophosphatemia

• impaired renal function

• muscle weakness

thoughts and behaviours associated w bulimia

• binge-eating behaviour

• self-induced purging

• anxiety and compulsivity

• possible chemical dependcy

• depression or mood disorder

• difficulty w relationships, self-concept, impulsivity

clinical presentation of bulimia

• normal or slightly low weight

• dental decay or erosion

• swollen parotid glands

• peripheral edema

• calluses on hands or fingers

• muscle weakness

• cardiovascular abnormalities or heart failure related to hypokalemia and hyponatremia

hospitalization criteria for anorexia or bulimia

• physical criteria

  • hypothermia

  • extreme hypotension

  • BMI < 15 or rapid weight loss of over 1kg/week

  • arrhythmia or ECG abnormality

  • metabolic alkalosis or acidosis

  • hypokalemia

  • low glucose

  • severe dehydration

  • evidence of hepatic, renal, cardiovascular damage that requires intervention

• psychiatric criteria

  • suicide risk

  • inability to maintain treatment agreements

  • family dysfunction or crisis

  • severe depression

refeeding syndrome

• potentially fatal shift in electrolytes

• when someone was so malnourished and you’re starting to replace those nutrients, so the body resets too fast

anorexia treatment outcomes

• less than half fully recover

• 33% show improvement but 20% remain chronic

• 50% will develop bulimic symptoms

• 25-70% of adolescents have positive long-term outcomes

bulimia treatment outcomes

• 50% will fully recover

• 33% will relapse

• poor outcome indicators

  • longer duration of illness

  • history of unsuccessful treatment attempts

  • comorbid substance abuse

  • cluster B personality disorder

nursing role in eating disorder treatment

• take their concerns seriously

• validate

• refer to physician for vital sign and labs monitoring

• differentiate between counseling and therapy

• assess for psychiatric risk

• reinforce message that food is medicine

• educate yourself about medical complications

• use evidence-based interventions

• teach emotional regulation skills

• normalize ambivalence and difficulty of recovery

• help families see that it’s not their fault

• understand what enables illness vs supports recovery

• set boundaries while supporting the person

• encourage communication between family members

• assist parents in accessing treatment for their kids

things not to do r/t eating disorder recovery

• do not assume that appearance reflects severity of illness

• don’t give them nutritional advice other than consulting w a professional who specializes in eating disorders

• don’t talk about their appearance positively or negatively

• don’t focus on the why of the disorder

• don’t adopt a “change or die” position

• don’t make it all about motivation

• don’t argue, bargain, or reason

• don’t minimize the difficulty of recovery