![Page 1: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/1.jpg)
Pharmacologic Supports of Brain
Activities in Persons with I/DD
ASSESSING ABNORMAL BEHAVIORS CHRIS HEIMERL, MSSW
5-27-11
![Page 2: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/2.jpg)
OVERVIEW
•Contextual factors
•Importance of observations
•Choice of determining abnormal-ness
•Impact of labeling or naming
•Activities and observations
•Identification of where the problem lies
![Page 3: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/3.jpg)
CONTEXT ! •Quality of Life
•Wellness
•Relationships
![Page 4: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/4.jpg)
Context… •Coping
•Symptom Management
![Page 5: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/5.jpg)
Observe – what do you see?
•Systematic method
• There are many ways to do this.
•Observer bias
•Are you expecting a “problem”?
•Avoid: always and never…
•Counter-transference
![Page 6: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/6.jpg)
AB-normal?... •Normal for whom?
•Cultural context
•Adaptation
•Impairment of function
•Dangerousness
![Page 7: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/7.jpg)
Labels •What is the purpose?
•Is there connection with the individual?
•We all have human behavior.
![Page 8: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/8.jpg)
J: problem-solving awareness of danger decision making care of self/setting O: hallucinations sense of self delusions M2: short/long term obsessive about past forgetful A2: nervousness emotional response handle stress/stimulation change leisure/recreation C: attention span, learning capacity/style-cues, prompts C: communication-nature, content, quantity S: Sleep-awake, snore/apnea nightmares eating-preferences, routines, weight
J
O
M
M
A
A
C
C
S
![Page 9: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/9.jpg)
Whose problem… • Safety concerns • Noise and disruption •– standards within the current living context
• Uncovering bias in caregivers and providers • Challenging the habit of learned behavior •– individual with I/DD and provider.
![Page 10: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/10.jpg)
Mind
Wellness Body
Spirit
Relationships Personal
Professional Quality of Life
Coping Triggers
Repertoire
Symptom Management Medication
Unique Intervention
Mental Health Concerns
![Page 11: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/11.jpg)
Principles of Behavioral Monitoring
•Shared decision making •Defined target symptoms •Objective measurement procedures
• Frequency counts
• Time samples
• Rating scales
•Other clinical indicators • Staff responses
• Performance information
• Increased attention
• Increased concentration
•Defined outcome criteria •Multi-setting data collection Sovner and Hurley
![Page 12: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/12.jpg)
Saboteurs of Effective
Monitoring
•Monitoring is seen as a burden
•Crisis response and band aids
•Monitoring system is too complicated
•Data is not organized or analyzed
![Page 13: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/13.jpg)
Let’s explore further…
![Page 14: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/14.jpg)
Principles of Psychopharmacology Alya Reeve, MD, MPH
5-27-11
GOOD & BAD USES OF
PRESCRIBED MEDICATIONS
![Page 15: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/15.jpg)
OVERVIEW
•Valid uses of medications
•Poor use of medications
•Link symptoms and medication
•Classes of psychotropic medications
•Side effects
•Uncomfortable
•Potentially lethal
![Page 16: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/16.jpg)
Reasonable use of meds •Safety
•Improved functioning
•Ameliorate symptoms
•Treat a specific disorder
•Prevent decline in functioning
•Adjunctive therapy
•Prior to specific procedures
![Page 17: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/17.jpg)
Poor Choices to Use Meds •Convenience
•Whose definition of convenience
•Restraint
•Issues of respect, choice
•Safety documentation
•Lack of review •The need for medication should be documented
•Adding on blindly
![Page 18: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/18.jpg)
General Considerations
•All medications have intended and unintended effects.
•Everyone reacts uniquely to medication.
•There are general responses to expect ~
• The more medication an individual takes, the more likely interactions will occur.
• Concurrent medical conditions will affect medication effects.
![Page 19: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/19.jpg)
General Considerations
•Factors affecting efficacy:
•Potency,
•Bioavailability,
•Compliance,
•Onset of action,
•Duration of action.
![Page 20: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/20.jpg)
Physician/Professional Evaluation Steps
• Establish and maintain safety and trust
• Identify reliable, available, varied sources of information
• Clarify purpose-presenting questions and problems
• Extent of distress, discomfort
• Learn specific behavioral/symptom changes
• Direct contact and observation
• rhythms of movement -- communication
• personal space -- emotional expression
• desire for intimacy -- trust and comfort
![Page 21: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/21.jpg)
Link Sx Meds •Accuracy of assessment
•Determine competence
•Off-label uses of medications
![Page 22: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/22.jpg)
Bioavailability
•Pharmacokinetics –
what the body does with the drug.
•Absorption
•Distribution
•Metabolism
•Elimination
•Pharmacodynamics - what the drug does in/to the body.
•Mechanism of action
•Individual response
•Onset
•Therapeutic vs. toxic
![Page 23: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/23.jpg)
Indications to Use Psychotropic Medications
Diagnosti
c
indication
Neuroleptic
(Anti-
psychotic)
Anti-
depressant
Mood
Stabilizer
Anti-
anxiety
Stimulant Anti-
Parkinson'
s
Primary Psychosis,
Schizoaffective
Disorder,
Delusional
Disorder,
Atypical
psychosis
Diagnostic
indication
Neuroleptic
(Anti-
psychotic)
Anti-
depressant
Mood
Stabilizer
Anti-
anxiety
Stimulant Anti-
Parkinson's
Primary Psychosis,
Schizoaffective
Disorder,
Delusional
Disorder,
Atypical
psychosis
Depressive
Disorders,
Anxiety
disorders
Bipolar
Disorder,
Depression,
Schizoaffective
disorder
Anxiety
Disorders,
(OCD,
PTSD,
Panic,
Generalized)
Attention
Disorders
Extrapyramidal
effects
Other: Conditions and
symptoms…
…may not be …FDA
approved…
…but may… …be
clinically…
…warranted.
![Page 24: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/24.jpg)
Medication Classes • Anxiolytic: cut through anxiety…
• Benzodiazepine
• Buspirone
• Tricyclics
• Beta-blockers
• SSRI’
• SNRI
![Page 25: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/25.jpg)
Antidepressants
•Tricyclics (three-ring compounds)
•SSRI (selective serotonin reuptake inhibitor)
•SNRI (serotonin norepinephrine reuptake inhibitor)
•MAOI (monoamine oxidase inhibitor)
![Page 26: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/26.jpg)
Antipsychotics • Typical
•“neuroleptic”
•Based on animal model of motor stiffness
• Atypical • ? Lower risk of involuntary movements
•Metabolic syndrome
![Page 27: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/27.jpg)
Mood Stabilizers •Lithium: the gold standard
•Anti-Epileptic Drugs
•Tegretol (carbamazepine)
•Lamictal (lamotrigine)
•Depakote (valproic acid)
•Neurontin (gabapentin) – less effective
•Calcium-channel blocker
•Calan (verapamil)
![Page 28: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/28.jpg)
Sedative-Hypnotics • Sleep aides
•Restoril; Lunesta; Ambien
•{Benzodiazepines}
•{Trazodone}
• Antihistamine
•Benadryl
•Atarax
![Page 29: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/29.jpg)
Pain-relief •Non-pharmacologic
•Gabapentin
•Lyrica
•Ibuprofen
![Page 30: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/30.jpg)
Symptoms of MEDICALLY DANGEROUS Effects
•Acute Renal Failure
•Anaphylaxis
•Grand Mal Seizures (or Convulsions)
•Status epilepticus
•Neuroleptic Malignant Syndrome
•Pancreatitis
•QT Prolongation
•Rhabdomyolysis
•Serotonin Syndrome
•Thrombocytopenia
![Page 31: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/31.jpg)
Side Effects •Polypharmacy
•Drug-drug interactions
•Masked toxicity
•Enhanced or slowed metabolism
•Acute dystonia
•Sustained; painful; interferes with function
•May involve any muscle group
•Tx: BZD quickly; benadryl
![Page 32: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/32.jpg)
Side Effects •Akasthisia
•Internal restlessness.
•Acute or delayed onset (Tardive Akasthisa).
•May be interpreted as agitation.
•Generally reversible:
stop the medication,
supportive measures,
BZDs.
![Page 33: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/33.jpg)
Side Effects
•NMS (neuroleptic malignant syndrome)
•Dehydration
•Confusion/delerium
•Increased temperature
•Muscle breakdown
• Potentially fatal !!!
![Page 34: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/34.jpg)
Side Effects •Tardive Dyskinesia
•Slow onset
•Involuntary movement; should fall asleep
•Fast contraction followed by relaxation
•Repeated rating scale(s)
•AIMS
•DISCUS
•SIMAS
![Page 35: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/35.jpg)
Almost time for a break…
•Questions?
•Comments?
![Page 36: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/36.jpg)
You mean there’s more?!?!?
![Page 37: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/37.jpg)
Cases •Stepwise diagnostic determination.
•Simply relying on “behavior” is a great way to get into trouble!
![Page 38: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/38.jpg)
Symptoms of MENTAL AND EMOTIONAL Effects
• Dreaming (Abnormal)
• Emotional Lability
• Excitability
• Feeling Unreal
• Forgetfulness
• Insomnia
• Irritability
• Jitteriness
• Lethargy
• Libido changes
• Panic Reaction
• Somnolence
• Thoughts and actions related to self harm
• Tremulousness
• Yawning
• Food cravings
![Page 39: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/39.jpg)
Symptoms of MENTAL AND EMOTIONAL Effects
• Aggravated Nervousness
• Agitation
• Amnesia
• Anxiety Attack
• Apathy
• Decreased Appetite
• Increased Appetite
• Auditory Hallucination
• Bruxism
• Carbohydrate Craving
• Concentration Impaired
• Confusion
• Crying (abnormal)
• Depersonalization
• Depressive mood
• Disorientation
![Page 40: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/40.jpg)
Symptoms of CARDIOVASCULAR Effects
•Palpitation
•Hypertension
•Bradycardia
•Tachycardia
•ECG Abnormal Flushing
•Varicose Veins
![Page 41: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/41.jpg)
Symptoms of GASTROINTESTINAL Effects
• Abdominal Cramp/Pain • Belching • Bloating • Constipation. • Diarrhea • Dyspepsia/Indigestion • Flatulence • Gagging • Gastritis • Gastroenteritis • Gastrointestinal
Hemorrhage
• Gastro Esophageal Reflux - GERD
• Heartburn • Hemorrhoids • Increased Stool Frequency • Indigestion • Nausea • Swallowing Difficulty • Vomiting
![Page 42: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/42.jpg)
Symptoms of Eyes, Ears, and Mouth Effects
•Conjunctivitis
•Dry Eyes
•Abnormal Vision
•Blurred Vision
•Eye Irritation
•Pupils Dilated
•Toothache
•Bruxism
•Taste Alteration
•Metallic taste
•Tinnitus
•Earache
![Page 43: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/43.jpg)
Symptoms of SKIN Effects
•Acne
•Alopecia
•Angioedema
•Dermatitis
•Dry Lips
•Dry Skin
•Folliculitis
•Furunculosis
•Pruritus
•Rash
•Epidermal Necrolysis
![Page 44: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/44.jpg)
Symptoms of GENERAL BODY Effects
• Dry Mouth
• Sweating Increased
• Allergy
• Asthenia
• Chest Pains
• Chills
• Edema of Extremities
• Falls
• Fatigue
• Fever
• Hot Flashes
• Influenza (Flu)-like Symptoms
• Leg Pain
• Malaise
• Pain in Limb
• Syncope
• Tightness of Chest
![Page 45: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/45.jpg)
Symptoms of UROGENITAL Effects
•Blood in Urine (hematuria)
•Pain on urination (dysuria)
•Urinary Frequency
•Urinary Tract Infection
•Urinary Urgency
•Anorgasmia
(male and female)
•Ejaculation Disorder
•Menstrual Disorder
•Kidney Stone (nephrolithiasis)
![Page 46: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/46.jpg)
Symptoms of UROGENITAL Effects (Women)
•Menorrhagia
•Menstrual Cramps
•Menstrual Disorder
•Pelvic Inflammation
•Premenstrual Syndrome
•Spotting Between Menses
•Pregnancy
![Page 47: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/47.jpg)
Symptoms of RESPIRATORY SYSTEM Effects
•Asthma
•Shortness of breath
•Coughing
•Laryngitis
•Nasal Congestion
•Rhinitis
•Sinus Congestion
•Sinus Headache
![Page 48: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/48.jpg)
Symptoms of NERVOUS SYSTEM Effects
•Coordination Abnormal
•Dizziness
•Vertigo
•Disequilibrium
•Headache
•Migraine
•Paresthesia
•Sluggishness
• Involuntary muscle Contractions
• Increased muscular tone
•Restlessness
•Tics
•Tremor/shaking
•Twitching
![Page 49: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/49.jpg)
Symptoms of HEMATOPOEITIC Effects
•Anemia (RBCs)
•Granulocytopenia (WBCs)
•Thrombocytopenia (platelets)
•Bruises
•Nosebleeds
![Page 50: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/50.jpg)
Symptoms of METABOLIC & NUTRITIONAL Effects
•Arthralgia •Arthropathy •Arthritis •Back Discomfort •Gout •Hepatic Enzymes
Increased •Bilirubin Increased •Hypercholesterolemia
• Increased Weight
•Decreased Weight
•Muscle Cramp
•Muscle Stiffness
•Muscle Weakness
•Myalgia (ache)
•Thirst
•Thyroid changes
•Hyperglycemia
![Page 51: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/51.jpg)
Symptoms of SKELETAL Effects
•Torticollis
•Osteopenia
•Dystonia
•Jaw pain
•Jaw stiffness
•Joint stiffness
![Page 52: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/52.jpg)
INTEGRATION OF MEDICATIONS,
BEHAVIOR, AND ENVIRONMENT(S)
![Page 53: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/53.jpg)
Integration
• Holistic • Whole person; whole environment
• Multiple etiologies in same person • Agitation: medication, worry, vulnerability,
shortness of breath, dementia (some examples)
• Emotional triggers • Anxiety; anticipation
![Page 54: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/54.jpg)
• Personal information
• Reason for seeking consultation
• - presenting problem(s)
• Concise history
• social
• family
• Medical status
- diagnostic history
• Medication history and response
• Behavior, symptom baselines
• - data based!
Information Before Health Consult
![Page 55: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/55.jpg)
Are target signs and symptoms consistent
with diagnosis?
What is the rationale for selected
medication/treatment intervention?
What are the expected benefits?
What are the potential consequences
-with and without use of this treatment?
When should the effect of the
medication/treatment intervention
become apparent?
Does the physician suggest
complementary support/treatment?
How often does the physician want
updates or to see person?
Questions During Health Consult
![Page 56: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/56.jpg)
Obstacles to Effective Treatment
• Intellectual ability and self reporting
•Baseline exaggeration
•Paradoxical changes
•Complex, multi-determinate nature of
behavior
•Physician attitudes and assumptions
Sovner and Hurley
![Page 57: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/57.jpg)
The Four Questions + Michael Smull
•What have we tried?
•What have we learned?
•What are we pleased with?
•What are we concerned with?
The fifth question and its questions:
•Now what? • -what will we continue to do?
• -what will we do less of or stop doing?
• -what will we begin or return to doing?
![Page 58: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/58.jpg)
Differentiating Mental Illness from Behavioral Issues
•Medications and psychotherapy (attentive intention) change brain physiology and neuronal patterns
•All mind-brain experiences are expressed through behavior and communication
![Page 59: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/59.jpg)
Overall: Strive for BEST Outcomes
•Is quality of life •Improved?
•Sustained?
•Are there other “things” that could be done? •Activities
•Attitudes
•Opportunities
![Page 60: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/60.jpg)
“…it takes a community”
![Page 61: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/61.jpg)
Thank you for your
attention and
participation
![Page 62: ASSESSING ABNORMAL BEHAVIORS · •Identify reliable, available, varied sources of information •Clarify purpose-presenting questions and problems •Extent of distress, discomfort](https://reader036.vdocuments.net/reader036/viewer/2022062414/5f05f7b17e708231d415a00b/html5/thumbnails/62.jpg)
Evaluations
•Please fill out your
evaluations …
for CEUs and to provide
feedback