Substance-Related & Addictive Disorders, Personality Disorders, Eating Disorders & Sleep

Substance-Related & Addictive Disorders Impact Across Age Groups

• Adolescents:
    - Dependency disrupts brain development, especially in the prefrontal cortex, leading to:
      - Lifelong cognitive deficits.
      - Increased risk-taking behavior.

• Adults:
    - Consequences of substance-related disorders include:
      - Occupational failure.
      - Strain in personal relationships.
      - Chronic health issues, notably:
        - Liver disease.
        - Cardiovascular stress.

• Older Adults:
    - Risks associated with substance abuse in older adults include:
      - Higher chance of falls due to impaired coordination.
      - Medication interactions leading to adverse effects.
      - Accelerated cognitive decline due to increased physiological sensitivity.

Substance Profiles: Symptoms & Safety

• Substances & Their Effects:
    - Alcohol:
      - Intoxication Symptoms:
        - Slurred speech.
        - Ataxia (lack of voluntary coordination of muscle movements).
        - Disinhibition (reduced social restraints).
    - Withdrawal Symptoms:
        - Tremors.
        - Seizures.
        - Delirium tremens (DTs).
      - Safety Priorities:
        - Implement seizure precautions.
        - Monitor using CIWA (Clinical Institute Withdrawal Assessment).

  - Opioids:
    - Intoxication Symptoms:
      - Pinpoint pupils.
      - Respiratory depression (slowed or difficult breathing).
      - Bradycardia (slow heart rate).
    - Withdrawal Symptoms:
      - Nausea.
      - Muscle aches.
      - Lacrimation (excessive tear production).
      - Rhinorrhea (runny nose).
    - Safety Priorities:
      - Airway management for respiratory issues.
      - Naloxone deployment in case of overdose.

  - Stimulants:
    - Intoxication Symptoms:
      - Tachycardia (rapid heart rate).
      - Pupillary dilation.
      - Euphoria and paranoia (increased suspicion).
    - Withdrawal Symptoms:
      - “Crashing” (intense fatigue).
      - Depression.
      - Suicidal ideation.
    - Safety Priorities:
      - Monitor for cardiac arrhythmias (irregular heartbeats) and agitation.

  - Cannabis:
    - Intoxication Symptoms:
      - Red eyes.
      - Increased appetite.
      - Slowed reaction time.
    - Withdrawal Symptoms:
      - Irritability.
      - Insomnia.
      - Decreased appetite.
    - Safety Priorities:
      - Provide generally supportive care.

Screening Tools

• CAGE Questionnaire:
    - A 4-question tool designed for alcohol use screening:
      - Cut down: Have you ever felt you should cut down on your drinking?
      - Annoyed: Have people annoyed you by criticizing your drinking?
      - Guilty: Have you ever felt bad or guilty about your drinking?
      - Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves?

• SBIRT (Screening, Brief Intervention, and Referral to Treatment):
    - A comprehensive public health strategy for early intervention in substance use issues.

Personality Disorders

• Cluster Classifications:
    - Personality disorders grouped by descriptive characteristics:
      - Cluster A (Odd/Eccentric): Includes:
        - Paranoid Personality Disorder.
        - Schizoid Personality Disorder.
        - Schizotypal Personality Disorder.
      - Cluster B (Dramatic/Erratic): Includes:
        - Antisocial Personality Disorder.
        - Borderline Personality Disorder (BPD).
        - Histrionic Personality Disorder.
        - Narcissistic Personality Disorder.
      - Cluster C (Anxious/Fearful): Includes:
        - Avoidant Personality Disorder.
        - Dependent Personality Disorder.
        - Obsessive-Compulsive Personality Disorder.

• Focus: Borderline Personality Disorder (BPD):
    - Characteristics:
      - Instability of affect (emotional instability).
      - Instability of identity and interpersonal relationships.
      - Fear of abandonment.
      - Impulsivity.
    - Common Defense Mechanism:
      - Splitting: A cognitive distortion where individuals are viewed as "all good" or "all bad" with no middle ground.

Nursing Communication & Crisis Management

• Setting Boundaries:
    - Essential to prevent manipulation; consistency across all staff involved in the care plan is vital.

• Therapeutic Communication:
    - Utilize clear, matter-of-fact language to avoid misunderstandings.
    - Avoid engaging in power struggles with patients.

• Crisis Safety:
    - Immediate assessment for potential self-harm or suicidal ideation is critical.
    - Use of no-harm contracts is common, but clinical observation remains the primary safety measure.

Eating Disorders & Sleep

Clinical Profiles of Eating Disorders

• Anorexia Nervosa:
    - Characterized by:
      - Intense fear of gaining weight.
      - Distorted body image.
      - Severely restricted intake, leading to low BMI.

• Bulimia Nervosa:
    - Involves:
      - Recurrent binge eating episodes followed by compensatory behaviors, such as:
        - Purging (vomiting).
        - Excessive exercise.

• Binge Eating Disorder:
    - Defined by:
      - Episodes of binge eating without any compensatory purging behaviors.

• Pica/ARFID:
    - Pica: Consumption of non-food items.
    - ARFID (Avoidant/Restrictive Food Intake Disorder): Extreme pickiness not related to body image concerns.

Medical Complications & Care

• Cardiac Risks:
    - Bradycardia and various arrhythmias are frequently observed in cases of severe malnutrition.
   

• Refeeding Syndrome:
    - A life-threatening metabolic complication, characterized by:
      - Hypophosphatemia: A condition caused when nutrition is reintroduced too swiftly following a period of malnourishment.

• Nursing Priority:
    - Stabilize electrolytes and conduct monitoring for one hour after meals to prevent purging behaviors.

Sleep Cycle and Disorders

• Sleep Stages:
    - NREM (Non-Rapid Eye Movement): Comprising stages of light to deep sleep.
    - REM (Rapid Eye Movement): Characterized by:
      - Active dreaming.
      - Muscle atonia (temporary paralysis during sleep).

• Insomnia:
    - Defined as difficulty falling or staying asleep.
    - Treatment options include:
      - Sleep hygiene practices (improving sleep environment and habits).
      - Pharmacological aids (medications designed to assist in sleep).

• Nightmare vs. Sleep Terror:
    - Nightmares:
      - Occur during REM sleep and are recalled by the individual upon waking.
    - Sleep Terrors:
      - Occur during deep NREM sleep; individuals do not recall the event upon waking and appear terrified.