Mental Health Disorders in Acute Care Setting
Part I
Generally, mental and medical health disorders have significant impacts on individuals’ health care utilization, disability, and attrition from service. Two years ago, mental disorders accounted for more hospitalizations individuals than any other illness and more outpatient care than all illnesses except musculoskeletal injuries and routine medical care. It is also observed that hospitalizations for mental health l disorders were steady in the mid 2000s before increasing by more than 50% in the later years of that decade. This increase in hospitalizations came about as result of increased depression and substance abuse.
For individuals with medical disorders, it is vital that brain damage be considered as a mental health disorder which may at an advanced stage lead to lack of accountability, treatment and to a larger extend result in engagement in illegal activities without literally knowing the acts one is putting across. The individual may present the ability to participate in the legal process but this is based on cognitive functioning and reasoning abilities that may not be present in someone with this kind of disorder (Masotti, Longstaffe, Gammon, Isbister, Maxwell & Hanlon-Dearman, 2015). It is stated that a person with a mental health disorder has trouble paying attention, impulsive, and hyperactive, similar symptoms are witnessed from a person with a medical disorder such as Diabetes Mellitus.
It may be possible to manage the symptoms of ADHD and reduce impulsive behaviors, but for the person with diabetes who also has underlying deficits in reasoning, connecting cause and effect, and anticipating the consequences of their actions managing the ADHD alone is not sufficient to prevent conflict in the legal system. The numbers that are presented in most cases are found to be lower than the diagnoses made for the cases of incarcerated adults. In cases where the general population is being compared, the incarcerated adult males as well as those with diabetes have comparably higher rates of mental health disorders.
Someone who has a severe mental health disorder, such as a severe psychotic disorder, needs special consideration and probable life-long support. It is easy to manage an individual with a mental disorder as, frequent medication as well as supportive therapy can be used to cool down the adversity of the health problem, however, medical disorders lack primary treatments because most of the health problems that are witnessed are permanent or rather create more harm to the brain of the individual. About half of adults with diagnosed diabetes mellitus indicate that they were symptomatic at diagnosis, but the other half report that their diabetes was diagnosed during a routine physical exam, through screening for diabetes, or while being treated for another condition.
An individual with Alzheimer’s can easily be given medical care even during the severity of the disorder. Diabetes mellitus patient can only be managed if prior medical attentions are imposed such as incarceration such as environmental changes, behaviour support as well as proper medical attention. Psychotherapeutic treatment can be more challenging especially for individuals with diabetes due to the fact that they have poor memory as a result, standard therapeutic measures become less ineffective unlike the should be for a person with a normal brain. Consequently, screening for undiagnosed diabetes appears warranted, particularly in persons at high risk for diabetes.
People who have experienced a traumatic brain injury once had a normally functioning brain and have residual function. Although beyond the scope of this review, it is important to mention the emergence, since 1998, of mental health courts. For example, persons with diabetes who have high FPG levels may be at greater risk for developing complications than those who don’t have it. For instance, inmates who have intellectual disabilities are at a high risk of being harmed as a result of their exceptional propensity in their contextual settings to exploitation, abuse, manipulation as well as being misunderstood as to their requirements while in those correctional facilities together with the inability to gain in any way from most existing rehabilitative programs have an impulsive and unpredictably response more so when appearing before legal systems such as courts, correctional facilities, probation, and the community.
Lack of social skills, such as forming friendships and relating to peers, creates increasingly significant problems for children in the primary school years. Hyperactive and impulsive behaviors contribute to unrestrained and overbearing behaviors that make children with ADHD unpopular with their peers, while inattention may mean that children do not pick up subtle and obvious social cues and fail to learn social skills through observation alone (Onnela, Vuokila-Oikkonen, Hurtig & Ebeling, 2014).
Part II
In adolescence self-image is being constructed and diabetes self-care becomes an integral part of daily life. It is the most appropriate time for diabetes education to instill a mastery over everyday care as well as an informed and right attitude towards diabetes. Pre-diabetes is a sign of situation to diabetes in which someone has high blood glucose levels however does not congregate diagnostic criterion for diabetes. Someone in the company of pre-diabetes may contain damaged fasting glucose or harmed glucose tolerance, or has both condition together
The three mainly important risk factors are hyperglycaemia, high blood pressure, and hypercholesterolemia. It has been recommended that enhancements in glycaemia control, blood pressure, and cholesterol level could decrease a person’s hazard for 12 complications. Implementation of suitable diet and exercise behaviors and devotion to medication treatments would consequence in better glycaemia control, alongside with controlled blood pressure and blood lipids, would significantly decrease the risk of diabetes complications. Although blood glucose level monitoring is an integral part of monitoring diabetes but several other complications are associated with the disease which should be ruled out timely and regularly due to the fluctuating glycaemic levels of blood.
The exact causes of diabetes mellitus, the subject of intensive research over the past decades, remain unknown, although it can be accompanied by ketoacidosis, blindness, kidney failure, premature cardiovascular disease, stroke, amputations, and other complications. Extreme cases of diabetes can be witnessed in pregnancy where the mother undergoes physiological stresses due to abnormal glucose tolerance that comes about due to the routine metabolic testing that occurs during pregnancy. The exercise requires repetitive actions of glucose moderation so as to perform a proper diagnosis of diabetes in an asymptomatic patient. For patients with symptoms of diabetes, a single elevated blood glucose value is considered sufficient for confirmation of the diagnosis.
In the cases of general psychiatric and forensic psychiatric assessments, obtaining information proves to be difficult more so when the information needed to make a mental health diagnosis when the patient/client is an adult, because the person’s permission is a necessity for the assessment to rely on information given by other source. In addition, it proves difficult to access collateral information sources because their locations are not easy to come by. Information may be unknown or reported inaccurately, and may be inaccurate in previous reports.
The notable trend has proved that majority of the patients who visit urbanized outpatient centres tend to portray signs of being traumatized mostly in children as well as chronic history for the case of adults together with cases of emotional, sexual and physical assaults. Close to 3 million children suffering from diabetes have been reported to have been neglected in the United States. Self monitoring is vital for patients who are suffering from diabetes to be able to understand their personal glucose level and also be able to apply the proper dosage of glucose required in the body. Physicians recommend that the patients conduct multiple injections of insulin ion their bodies before food intake, exercise and even when close to taking snacks, this is to ensure the problem that comes about as a result of low blood sugar level is tackled (American Diabetes Association, 2014).
From studies, close to 364 children that are abused have signals of anxiety, diabetes and ADHD, it is therefore evident that although clinicians are presented with a wide range of effects for the disorders experienced by these children, majority of the cases have a developmental disturbance on the children as clinical presentations portray. Psychotherapeutic treatment can be more challenging especially for individuals with diabetes due to the fact that they have poor memory as a result, standard therapeutic measures become less ineffective unlike the should be for a person with a normal brain. Consequently, screening for undiagnosed diabetes appears warranted, particularly in persons at high risk for diabetes
Part III
More recently, intensive management has been linked to increased hypoglycemia and increased mortality in a subset of patients including those with a long history of diabetes and cardiovascular disease Clinicians, especially primary care physicians, need to consider that there is more than one form of ADHD and many children may not present with the most obvious symptoms of hyperactivity/impulsivity. The inattentive type may not present until secondary school with increased demands for organization and independent study. Full assessment for possible ADHD requires a comprehensive medical, developmental and psychosocial assessment by the best qualified clinician available. This would usually be a pediatrician or child and adolescent psychiatrist with the training and skills required to assess and treat ADHD. Diagnosis requires evidence of moderate to severe impairment across settings, including home and school.
In this age range, where it is difficult to differentiate ADHD from other common problems, including developmental delays and specific speech and motor disorders, allied health assessments should be considered, especially when developmental difficulties are evident. Assessment of adults with suspected ADHD should be undertaken by the best qualified clinician available. This would usually be an adult psychiatrist or a comprehensive psychiatric service with the training and skills required to assess and treat ADHD (Murray & O’Donnell, 2013). This is due to the high incidence of comorbid psychiatric conditions and the overlap of clinical features of ADHD with other conditions such as bipolar disorder and personality disorders.
In such instances, vocational/intellectual assessments may be useful, not for diagnostic purposes, but to clarify the functional consequences of the diagnosis. Allied health assessment may be helpful in many children and adolescents with suspected ADHD, to identify comorbid speech and language difficulties, motor co-ordination and sensory difficulties that can be targeted with intervention (Ross, Vigod, Wishart, Waese, Spence, Oliver & Shields, 2015). While the DSM-IV diagnosis of ADHD does require impairment, impairment at home, school/work and in social relationships is poorly defined. Careful discussion is needed with the family as to the extent to which problems are specifically related to ADHD symptomatology.
Where functional difficulties persist in the context of ADHD (e.g. learning problems, organizational difficulties), despite initial educational, pharmacological and psychological strategies, neuropsychological assessment can provide information on cognitive strengths and weaknesses. This information can then be used by the person with ADHD and the teacher and/or parent/caregiver to develop compensatory approaches to learning and daily functions. Psychosocial management strategies and, where appropriate, educational interventions should be used in conjunction with medication treatments (Dziegielewski, 2013). The use of medication should only be considered in preschool-aged children when there has been poor response to behavioral or psychosocial therapy and the ADHD symptoms are having a severe impact on the child and their family/careers. It could be trialed in the absence of clinical response to stimulants and ATX
According to a worldwide longitudinal research study, the prevalence of type 1 diabetes is increasing universally at annual rate of 2.8%, demonstrating the significance of addressing the influence of the disease. For normal growth and development, patients with TIDM must maintain a balance between insulin dose, nutritional intake, and physical activity according to self-monitoring results of blood glucose. These targets are not certainly attained or maintained. If anxiety symptoms do not respond to psychosocial interventions, the use of selective serotonin reuptake inhibitors (SSRI) could be considered, either alone or in combination with a medication to treat the ADHD. The RANZCP, RACGP and RACP Clinical Guidance and the Adverse Drug Reactions Advisory Committee (ADRAC) recommendations on the use of antidepressants in children and adolescents must be considered by the physician before prescribing antidepressants.
Reference
American Diabetes Association. Standards of medical care in diabetes – 2014. Diabetes Care 2014; 37:S14-80.
Dziegielewski, S. F. (2013). The changing face of health care social work: Opportunities and challenges for professional practice. New York: Springer Publishing Company
In Peate, I., In Wild, K., & In Nair, M. (2014). Nursing practice: Knowledge and care. Chichester, West Sussex, UK; Malden, MA: John Wiley & Sons Inc.
Murray, B., & O’Donnell, C. (2013). Nursing care in the acute hospital setting: Survivors of torture. Advances In Mental Health, 11(2), 188-196.
Onnela, A. M., Vuokila-Oikkonen, P., Hurtig, T., & Ebeling, H. (2014). Mental health promotion in comprehensive schools. Journal Of Psychiatric & Mental Health Nursing, 21(7), 618-627. doi:10.1111/jpm.12135
Ross, L. E., Vigod, S., Wishart, J., Waese, M., Spence, J. D., Oliver, J., & … Shields, R. (2015). Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study. BMC Family Practice, 161-13
Tuomilehto, J., Lindström, J., Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-50.