NRNP 6635 Week 5: Disruptive, Impulse-Control, and Conduct Disorders; Dissociative and Somatic Symptom-Related Disorders

NRNP 6635 Week 5: Disruptive, Impulse-Control, and Conduct Disorders; Dissociative and Somatic Symptom-Related Disorders

NRNP 6635 Week 5: Disruptive, Impulse-Control, and Conduct Disorders; Dissociative and Somatic Symptom-Related Disorders

Consider the following two scenarios:

Tim is a 6-year-old boy who was brought to the family medicine clinic for the first time. When the doctor entered the examination room, he noticed Tim spinning in circles on the stool while his mother pleaded, “If I have to tell you one more time to sit down…” Tim was not allowed to start first grade until his immunizations were up to date. Tim’s mother explained that he had gone to several doctors for immunizations but was so disruptive that the doctors and nurses would always give up. Tim might comply now that he had a new doctor, she hoped. The mother described her son’s aggressive and destructive behavior over a period of several years, as well as four school suspensions during kindergarten. He is frequently “uncontrollable” at home, resulting in broken dishes and furniture. Tim started a small fire last year while playing with the gas stove. Tim is fond of dragging the family dog around by its tail. Tim’s older sisters used to watch him but no longer do so after he threw a can of soup at one of them. Tim’s father is a long-distance truck driver who sees him every three to four weeks (Searight et al., 2001).

Wallace, a 55-year-old man who recently retired, is the primary caregiver for his wife, who is currently undergoing chemotherapy for breast cancer. Wallace became increasingly concerned about his own ability to care for his wife and his sense of agency in the situation as his wife became weaker as a result of the treatment. Wallace’s symptoms worsened after his wife was hospitalized due to a serious infection. He stopped eating and lost 25 pounds in just a few weeks. Wallace had to ask for directions back to the house where he had lived for 15 years while on a trip to the grocery store to buy food for the family. This exacerbated his depression and anxiety, and he became afraid to leave the house, often sitting in the same chair for hours without moving.

This week, you will investigate three distinct groups of disorders. Patients with the first—disruptive, impulse-control, and conduct disorders—have problems controlling their emotions or acting out in ways that involve aggression, destruction/violation of others’ rights, defiance, or breaking societal norms. Second, dissociative disorders involve a disconnect from aspects of one’s life, such as one’s sense of identity, memories, environment, or time perception. Finally, somatic symptom-related disorders are characterized by excessive thoughts, feelings, or behaviors related to physical symptoms (e.g., pain, gastrointestinal issues) that are not fully explained by diagnosed medical conditions.

Also Check Out: Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD NRNP 6635

_{Conduct Disorder: Diagnosis and Treatment in Primary Care by Searight, H. R., Rottnek, F., Abby, S. L., in American Family Physician, Vol. 63/ Issue 8. Copyright 2001 by American Academy of Family Physicians. Reprinted by permission of American Academy of Family Physicians via the Copyright Clearance Center.}

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Learning Resources

Required Readings

American Psychiatric Association. (2013). Dissociative disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm08

American Psychiatric Association. (2013). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

• Chapter 12, Dissociative Disorders
• Chapter 13, Psychosomatic Medicine
• Chapter 19, Disruptive, Impulse-Control, and Conduct Disorders
• Chapter 31, Child Psychiatry (Sections 31.13 and 31.14 only)

Required Media

Classroom Productions. (Producer). (2015). Dissociative disorders [Video]. Walden University.

Classroom Productions. (Producer). (2016). Impulse and conduct disorders [Video]. Walden University.

Classroom Productions. (Producer). (2016). Somatic symptoms and related disorders [Video]. Walden University.

MedEasy. (2017). Somatic symptoms and factitious disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=n-NN8fHB_a4

Assessing and Diagnosing Patients With Disruptive, Impulse-Control, Conduct, Dissociative, and Somatic Symptom-Related Disorders

Assessing patients with symptoms related to the disorders you are exploring this week pose some particular challenges for which the PMHNP should be prepared. Disruptive, impulse-control, and conduct disorders may involve aggressive outbursts, anger, deceitfulness, and unpredictability. Eliciting the needed interview and history data requires special care, self-control, and deliberateness on the part of the clinician. Several structured or semi-structured clinical interview tools exist for patients and, in the case of minors, for parents as well.

There is no Assignment due this week. Use this quiet week to work on your practicum Comprehensive Psychiatric Evaluation and Case Presentation if you are taking the two courses concurrently.

What’s Coming Up in Week 6?

In Week 6, you explore eating, sleeping, and elimination disorders through your Learning Resources. You also complete a midterm exam on the topics covered in the course thus far.