Features of caring for people with mental disabilities

Neuropsychological signs of mental disorders in children

Doctors have identified a number of syndromes - mental characteristics of children, most often found at different ages. The syndrome of functional deficiency of subcortical formations of the brain develops in the prenatal period. It is characterized by:

• Emotional instability, expressed in frequent mood swings;
• Increased fatigue and associated low work capacity;
• Pathological stubbornness and laziness;
• Sensitivity, capriciousness and uncontrollability in behavior;
• Long-term enuresis (often up to 10-12 years);
• Underdevelopment of fine motor skills;
• Manifestations of psoriasis or allergies;
• Appetite and sleep disorders;
• Slow development of graphic activities (drawing, handwriting);
• Tics, grimacing, screaming, uncontrollable laughter.

The syndrome is quite difficult to correct, since due to the fact that the frontal regions are not formed, most often deviations in the child’s mental development are accompanied by intellectual disability.

Dysgenetic syndrome associated with functional deficiency of brain stem formations can manifest itself in children up to 1.5 years of age. Its main features are:

• Disharmonious mental development with displacement of stages;
• Facial asymmetries, irregular teeth growth and imbalance of the body formula;
• Difficulty falling asleep;
• An abundance of age spots and moles;
• Distortion of motor development;
• Diathesis, allergies and disorders of the endocrine system;
• Problems in developing neatness skills;
• Encopresis or enuresis;
• Distorted pain threshold;
• Violations of phonemic analysis, school maladjustment;
• Selectivity of memory.

The mental characteristics of children with this syndrome are difficult to correct. Teachers and parents must ensure the child’s neurological health and the development of his vestibular-motor coordination. It should also be taken into account that emotional disorders intensify against the background of fatigue and exhaustion.

The syndrome, associated with the functional immaturity of the right hemisphere of the brain, can appear from 1.5 to 7-8 years. Deviations in the mental development of a child manifest themselves as:

• Mosaic perception;
• Impaired differentiation of emotions;
• Confabulation (fantasizing, fiction);
• Color vision disorders;
• Errors in estimating angles, distances and proportions;
• Distortion of memories;
• Feeling of multiple limbs;
• Violations of stress placement.

To correct the syndrome and reduce the severity of mental disorders in children, it is necessary to ensure the child’s neurological health and pay special attention to the development of visual-figurative and visual-effective thinking, spatial representation, visual perception and memory.

There are also a number of syndromes that develop from 7 to 15 years due to:

• Birth injury of the cervical spinal cord;
• General anesthesia;
• Concussions;
• Emotional stress;
• Intracranial pressure.

To correct deviations in a child’s mental development, a set of measures is required aimed at developing interhemispheric interaction and ensuring the child’s neurological health.

Nursing process in caring for patients with mental disorders

The role of the nurse in organizing the treatment process and care for mental patients is difficult to overestimate, since it includes a wide range of issues, without which it would be impossible to implement a therapeutic approach to patients and, ultimately, register remission states or recovery. This is not the mechanical implementation of medical prescriptions and recommendations, but the solution of everyday issues, which include the direct implementation of treatment processes (dispensing medications, parenteral administration of drugs, carrying out a number of procedures), which should be carried out taking into account and knowledge of possible side effects and complications. Ultimately, this means taking responsibility for carrying out a number of activities. Preparing a patient for a particular procedure or event sometimes requires a lot of strength, skill, knowledge of the patient’s psychology and the nature of existing psychotic disorders from the nurse. Convincing a patient of the need to take medicine and undergo a particular procedure is often difficult because of its painful effects, when, due to ideological and delusional motives of hallucinatory experiences or emotional disorders, he sometimes resists all therapeutic measures. In this case, knowledge of the clinical picture of the disease helps to correctly solve the therapeutic problem, making a positive treatment solution possible. To this day, the care and supervision of mentally ill people carried out by a nurse remains relevant. It includes feeding the sick, changing linen, carrying out sanitary and hygienic measures, and so on. Monitoring the entire contingent of patients is especially important. This applies to depressed patients, patients with catatonic symptoms, patients with acute psychotic disorders and behavioral disorders. Care and supervision are undoubtedly important links in the overall treatment plan for patients, since it would be impossible to carry out therapeutic activities without these important hospital factors. Information about patients, the dynamics of their diseases, changes in the treatment process, and so on is invaluable during the complex treatment process that is carried out by mental patients in psychiatric hospitals. Only a nurse can detect the appearance of a number of delirious symptoms in the evening, prevent the implementation of suicidal tendencies, establish daily mood swings in patients based on indirect, objective characteristics, and predict their socially dangerous impulses. Sometimes, in order to reassure the patient, the nurse promises him another meeting with his family, a conversation on the phone, but then does not fulfill the promise, i.e. deceives the patient. This is completely unacceptable, as the patient loses confidence in the medical staff. If it is impossible to directly and specifically answer a particular question, you should move the conversation to another topic and distract the patient. It is also not recommended to fraudulently place a patient in a hospital. This makes it difficult to contact him in the future; he becomes distrustful for a long time, does not say anything about himself, about his experiences, and sometimes becomes embittered. You should not be afraid of the sick, but you should not flaunt excessive courage, as this can lead to serious consequences.

Nursing process in schizophrenia and affective disorders.

Schizophrenia (F20-29) is a chronic progressive (malignant) mental illness with an unclear etiology, leading to a change in the patient’s personality, sometimes subtle, but gradually worsening in the future.

Defect (from Latin defectus - flaw, deficiency) means mental, primarily personal, loss that occurred due to psychosis.

The main characteristic of the defect and its main difference from dementia is that, firstly, it is associated with remission and, secondly, it is dynamic.

The dynamics of the defect consists either in its increase (progression) or in its weakening (the formation of remission itself), up to compensation and reversibility.

Affective disorders (F30-F39) are disorders in which the main disorder is a change in emotions and mood towards depression (with or without anxiety) or towards elation. Changes in mood are usually accompanied by changes in overall activity level.

The nursing process for schizophrenia and affective mood disorders now includes four components:

1.gathering information (survey),

2) planning,

3) interventions,

4) assessing the effectiveness of interventions.

Before considering each of these stages, let us dwell on the problems of communicating with patients suffering from schizophrenia.

Features of communication with patients and their loved ones.

It should, firstly, be borne in mind that patients suffering from schizophrenia and affective mood disorders are often immersed in their experiences, fenced off from the outside world, and attempts to collect information, much less penetrate into their inner world, can cause them resistance and even aggression. This is especially possible in patients with paranoid schizophrenia.

Therefore, the duration of conversations with patients, even in a state of incomplete remission, not to mention periods of acute manifestations of the disease, should be short. It is recommended to have several short conversations during the day, separated by intervals.

In conversations with patients, general expressions and abstract constructions should be avoided in every possible way: facts and judgments communicated to the patient must be extremely specific. Otherwise, due to thinking disorders and delusional constructs, the meaning of the conversation in the patient’s mind may be distorted.

Because when communicating with patients suffering from schizophrenia and affective mood disorders. aggression on their part, although infrequently, does occur; here is an abbreviated diagram from a textbook for care professionals (USA):

“PUT IT INTO PRACTICE – FAST MANAGEMENT OF AGGRESSION AND ANGER”

1. Persuade the client, transfer his actions to a different plane.

2. Enlist the support of colleagues to remove other patients, but keep one near you.

3. Ask specific, non-disturbing questions in a calm, modulated voice.

4. Do not try to find out the cause of aggression, but point out its consequences (interference with work, inattention to other patients, etc.).

Collection of information.

The autism of patients suffering from schizophrenia and affective mood disorders, inaccessibility and resistance to communication require the collection of information not only from patients, but also from their relatives and loved ones. At the same time, one should take into account the fact that among the relatives of patients with schizophrenia there are many strange people, with personality deviations, with whom meaningful contact may also not be realized. Therefore, if possible, it is advisable to ask several people about the patient’s problems.

Manifestations and consequences of the disease that need to be identified when collecting information, their presence or absence noted:

1. The presence of changes in sensory perception (hallucinations, illusions, senestopathies and other manifestations; the presence of depersonalization and derealization is also indicated here).

2. The presence of changes in cognitive processes (delusions, autistic thinking structures and other manifestations).

3. The presence of changes in communication - formality of communication, reluctance to communicate, complete lack of communication, etc.

4. Changes in the motor sphere - necessary tests and postures, mannerisms, agitation, stupor.

5. Changes in affect - unusually low or high mood, anger, apathy.

6. Increased risk of suicide.

7. Increased risk of committing violent acts.

8. Changes in family relationships: separation from the family, family breakdown, lack of understanding by the family of the patient’s condition, rejection of the patient.

9. Problems with employment, decline and loss of productivity, misunderstanding by colleagues, threat of loss of employment.

10. The presence of a deficit in self-care (sloppiness, untidiness, reluctance to take care of oneself, etc.).

11. The presence of undesirable (side) reactions to prescribed psychotropic drugs - tremor, slowing of movements, reactions to external stimuli, etc.

12. Sleep state (partial, complete insomnia).

Based on the information collected, the patients' problems are identified, and hence the necessary interventions.

Typical problems of patients arise from the clinical manifestations of various forms of schizophrenia and affective mood disorders described above. Here there are hallucinatory-delusional manifestations, a lack of communication, and frequent, especially at the onset of the disease or its relapse, psychomotor agitation, manifested in various forms. It should be noted that in modern conditions, with the widespread use of psychotropic drugs, the risk of violent acts on the part of the mentally ill is largely a common misconception; it is less than the risk of violence in the general population (“healthy”). But the risk of suicide among patients suffering from schizophrenia and affective mood disorders is very high, and antipsychotic therapy does not prevent this. You should also remember about the possibility of developing post-schizophrenic depression.

Family problems of patients suffering from schizophrenia and affective mood disorders are very significant. Family and relatives may not understand the patient and consider the symptoms of his illness to be manifestations of a bad character. On the other hand, in some cases the family stubbornly insists that the patient is healthy and seeks all sorts of excuses for his painful behavioral manifestations.

It is especially undesirable and dangerous when the family does not understand the patient’s condition upon his discharge from the hospital, and he appears to her, for example, as completely recovered or as hopeless and unhappy. Then family members show constant and inappropriate compassion towards the patient, or family and loved ones continue to maintain tense, hostile relationships; Often the family experiences fear and confusion in front of the patient.

Patients suffering from schizophrenia often lose their jobs.

Neglect of patients can be a particularly serious problem - this can be corrected when it comes to such manifestations as their sloppiness and untidiness, but much more serious when it comes to the loneliness of patients (especially men) as a result of serious illness or their homelessness (for example, deprivation of housing as a result of fraud or family departure).

Planning of nursing interventions and their evaluation.

They stem in part from those provisions that are set out in the sections relating to rehabilitation: patients and psychotherapy. It is necessary to recall once again that in foreign countries where the nursing process is developed, the nurse is the organizing center of the so-called “treatment team”, where doctors - a psychiatrist and a psychologist - perform a predominantly advisory role.

Interventions must be planned and priorities must be identified first.

Typical nursing interventions are provided to patients suffering from schizophrenia and affective mood disorders in acute stages and in transition to remission.

1. Carry out and monitor the implementation of medicinal and other medical prescriptions, note the effectiveness and side effects of medications and draw the doctor’s attention to this.

2. Try to identify stress factors that enhance the patient’s hallucinatory and other experiences. Provide him with a calm, peaceful environment to reduce impulsiveness, anxiety and other manifestations.

3. As hallucinatory-delusional and other experiences subside, first distract the patient from them, making them less relevant; point out to the patient the consequences rather than discussing delusional and other experiences. Only in the future should the patient be brought to a critical assessment of his judgments and behavior.

Help the patient with personal hygiene: dressing, washing, etc. until he (she) learns to do it independently. Establish and indicate for the patient the exact time of self-care.

5. Attract and encourage patients to participate in group activities (communication with other patients; participation in psychotherapeutic groups, occupational therapy, etc.).

6. Encourage the patient as he or she returns to normal judgment, normal behavior, and increased activity. Assess and increase the patient’s self-esteem; thus preventing post-schizophrenic depression.

7. Conduct conversations with the patient regarding his correct behavior at home and ways to prevent relapse of the disease. Teach to recognize the first signs of relapse and the need to urgently seek medical help.

8. Carefully document and save everything received during interaction with the patient.

9. Actively work with the patient’s family. Lead them to understand his painful symptoms and problems, especially after his discharge from the hospital.

As can be seen from the above, interventions numbered 1 and 2 refer to the acute period of the disease, and the rest to the period of subsidence of the process and stabilization of remission. Care professionals also often have to deal with the patient's employers to provide the patient with the conditions necessary for rehabilitation, as well as deal with things that may seem small on the surface but are stressful for the patient (abandoned animals, unkempt plants, undelivered or unreceived letters, etc.).

Evaluation of the effectiveness of interventions is carried out at different times and depends entirely on their content: for example, when determining the effectiveness of treatment or side effects of drugs - daily; with assistance in self-care or encouraging the patient to be active - weekly. In general, the recovery of normal behavior in schizophrenia and mood disorders is quite slow, and care experts in the United States figuratively compare it to “earning income in extremely small increments.”

All interventions in patients suffering from schizophrenia and affective mood disorders are carried out while maintaining the basic rules of communication with them: a short conversation, especially at the beginning of communication, specificity and certainty of statements.

Causes

Childhood mental illnesses don't appear out of nowhere - there are factors that can greatly contribute to their occurrence.

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Individual diseases have their own causes, but the presented area is more characterized by mixed specific disorders. It is necessary to consider all probable causes, without dividing by the disorders they cause.

Genetic predisposition . In this case, the disease is caused from the very beginning by the pathological functioning of the nervous system, and disorders at the gene level, as is known, cannot be treated - medicine can only reduce the symptoms.

If there have been cases of serious mental disorders among close relatives of future parents, it is possible (but not guaranteed) that they will be passed on to the child. Such pathologies can reveal themselves even in preschool childhood.

Limited mental abilities . This factor, which also manifests itself as a mental disorder, can negatively affect the subsequent formation of the body and cause the most severe illnesses.

Brain damage . Another extremely common reason, which (like disorders at the gene level) interferes with normal brain activity, but not at the gene level, but at the level visible through an ordinary microscope. This includes head injuries that were received in the first years of life, but in certain cases the child’s brain can be injured before birth or during a difficult birth.

Bad habits of parents . The mother’s harmful addictions are especially dangerous in this regard, but if the father also had problems with alcohol, was addicted to drugs, or was a heavy smoker, this can also have an impact on the child’s health.

Constant conflicts . If an adult does not provide a psychologically healthy atmosphere, then for a child who does not yet have a formed nervous system or a correct perception of the world around him, this can be a significant blow.

Prevention of mental development disorders

A comprehensive system of preventive measures is of particular importance in preventing the development of mental disorders. Prevention of mental disorders must begin with regular examinations and consultations with a pediatrician, as well as checking the child’s psychomotor reactions.

The state of mental development should be determined by a speech therapist, child psychologist, pediatrician and defectologist. The exact diagnosis of the child and the type of mental development disorders can be determined using a diagnostic examination.

Prevention of mental development disorders is based on the use of special medical, pedagogical, psychological and social methods of testing the child. To create the right environment for mental development, a favorable correctional space is used, in which the child develops cognitive function, logical thinking and acquires learning skills.

An important factor in prevention is safety, as well as medical and pedagogical consultations from the first months of pregnancy.

After the birth of a child and during the first year of his life, the first signs of mental disorders can be identified. Lack of reactions to sound and light may be the first signs of such disorders.

In preschool children, mental development disorders often manifest themselves in the form of problems with speech and writing, delayed motor development and poor memory.

To effectively prevent mental development disorders, it is necessary to eliminate conflicts in the family, avoid physical and psychological trauma during pregnancy, and also create a favorable environment for the development of the child.

Types of mental development disorders

Mental development disorders are classified into several types.

The main types of mental development disorders include:

• dysontogenesis, including damaged, delayed and distorted development;
• irreversible mental underdevelopment;
• disharmonious mental development;
• degenerative mental development associated with epilepsy and other diseases;
• pathological mental development caused by mental and somatic pathologies.

They also distinguish types of mental development disorders according to the schizophrenic process: asynchrony, retardation and mental retardation.

In some cases, clinical forms of disorders appear, including acceleration, infantilism, autism and somatopathy.

Separately in medicine, mental development disorders associated with the type of oligophrenia are distinguished - uncomplicated, neurodynamic, analytical and psychopathic forms.

Symptoms and causes of mental development disorders

Mental development disorders manifest themselves most often in infancy and childhood. These psychological disorders are associated with various factors, traumas and pathologies.

The main causes of mental development disorders are:

• hereditary brain pathologies;
• chromosomal diseases;
• brain defects;
• epileptic syndrome;
• lesions and pathologies of the central nervous system;
• brain tumors;
• hydrocephalus;
• severe diseases of the nervous system and neurocutaneous syndromes;
• hereditary endocrine diseases;
• somatic pathologies;
• disorders and diseases of the sensory organs;
• lack of education and pedagogical neglect.

Mental development disorders in children manifest themselves in the form of underdevelopment, damage to personal development and lack of self-determination, impossibility of mental development and problems with cognition, psychopathy and distortions (autism).

The most serious causes of mental development disorders are hereditary, biological, social and psychogenic factors.

Disorders of mental development in children are expressed in a significant lag in development from peers, slower mental development, inconsistency in behavior and perception with age norms. These disorders begin to appear early in life and are often associated with brain dysfunction.

When determining the causes of mental development disorders, it is necessary to take into account the child’s temperament, the presence of somatic and cerebral pathologies, emotional state and deprivation.

Biological causes of disorders include pathologies during pregnancy, prematurity, birth and postpartum injuries, somatic diseases and brain injuries.

Mental development disorders can be caused by social factors, including lack of attention and separation from the mother, social isolation, deficits in upbringing, training and development, unfavorable conditions in the family and society.