A CASE STUDY OF A PATIENT SUFFERING FROM MENTAL AND BEHAVIORAL DISORDER SECONDARY TO MULTIPLE PSYCHOACTIVE SUBSTANCE USE
TABLE OF CONTENT
1. Title page
5. Table of content
2. Literature review
a. Review of past work done by others and general over view i.e incidence
c. Related anatomy and physiology of the brain
d. Etiology or causes
e. Patho physiology
f. Clinical features
g. Management – Medical/ Nursing
h. Prognosis / complications
1. Patient particulars / general data.
2. Family history
3. Personal history
4. History of past illness.
5. History of present illness
6. Nurse’s observation on admission
7. Doctor’s examination- physical / mental
8. Laboratory investigations and other tests
9. Final / provisional diagnosis
10. Pharmacology of drugs prescribed for patient.
1. Medical management given to patients
a. Physical e.g drugs, ECT, surgery and other physical therapies.
b. Psychotherapy, individual, group, family etc
c. Occupational therapy prescribed
d. Recreational therapy prescribed e.g indoor, outdoor.
e. Other therapies e.g hydrotherapy etc.
2. Nursing management according to nursing process.
a. Client identified problem
b. Special observations, reviews and comments.
c. General nursing care based on physical, psychological and social identified needs of clients.
d. Complications developed / prognosis.
e. Nursing care plan of at least six identified problems, care of the client.
3. Conclusion and recommendation.
4. Bibliography and references
In both cities and rural area, young people and adults can be seen who have unsound minds. They wander about, sometimes begging for food or money. As they talk to themselves or to others, it can be noticed that they are mentally ill. In the neighbour hood where they live, those who now them well can trace their problems back to excessive drinking of alcoholic beverages, smoking and or use of drugs such as marijuana.
Unfortunately, in spite of such evidence of the harmful effects of drugs, healthy people still join in taking drugs. Drug abuse is not limited to any one country. All over the world, the control of illegal trafficking in drugs is a hard task for governments. Those who engage in illegal trade in drugs are determined to continue because, they make big profit.
According to Merck Manual of medical information (2003), substance abuse is the use of mind- altering drugs without medical need, in an amount large enough or over a period long enough to threaten the quality of life or health and safety of the user or others.
Substances such as alcohol, cannabis, amphetamines among others are now being taken frequently and in large quantities by our youth. Teenagers and youths between the age of 15 and 30 constitute the high risk groups with females also getting involved. Other groups of abusers are divers, conductors, civil servants and artistes.
The drugs or substances that are being taken can be illicit drugs such as cocaine, heroin or legal substances such a prescription drugs like paracetamol, chloroquine, cough syrup, e.t.c when used in excess or without medical prescription.
According to APA (2000) in DSM IV TR, substance abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances that poses significant hazards to health.
Individuals who abuse substances may experience such harmful consequences of substance use as repeated failure to fulfill roles for which they are responsible, legal difficulties or social and interpersonal problems.
1.1 Literature Review
American Psychiatric Association (2000) defines drug abuse as continual use of psychoactive substance despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused by deliberate use of this substance.
Types of Drugs Commonly Abused In Nigeria
According to NDLEA and NDICP (2014),
· Sedatives, example, barbiturates, mild tranquillizers
· Cannabis, example, marijuana, hashish.
· Hallucinogens, example, Lysergic Acid diethylamide (LSD), dertrover.
· Narcotics, example, heroin, methadone.
· Stimulants, example, cocaine, amphetamine
These are group of drugs used to relax the nervous system and induce sleep. When taken in small doses, they can reduce day time tension and anxiety. Barbiturates are the largest sub-group of sedatives. Some of the barbiturates are short acting and fast starting, while some are low- starting and long acting. These slow- starting and long- acting sedatives are the most abused.
This is a plant that has been grown for thousands of years as a source of fibre and of seeds rich in oil. The leaves and greenish flowers are a source of a powerful nercotic substance. The leaves and flowers are prepared and taken in various forms, they may be eaten, drunk, inhaled or smoked. It’s not used medicinally. The drug is known by various names in different parts of the world such as marijuana and hashish. The strongest form of the drug is obtained from a compound that forms the flowers of the female plants. Often the leaves are simply dried, powered, and mixed with tobacco in cigarette or smoked alone.
These are drugs capable of provoking changes of sensations, thinking, distorted perceptions, self awareness and emotions. They alter the user’s ability to separate fact from fantasy. The degree to which the users suffers from hallucinations depends on the dose of the drug taken.
These are drugs that often blunt the senses. They also make people sleep and relieve pain. Nercotics which usually refer to opium and it’s derivatives in large doses may cause a complete loss of the senses. Nercotics acts as depressants to certain areas of the brain and part of the nervous system. They can also reduce hunger, thirst, sex drive in addition to pain.
These are group of drugs that excite the nervous system. They include caffeine (present in coffee, tea and some soft drinks). The effects of caffeine are mild. Strong stimulants are amphetamine and cocaine.
The illicit use of alcohol and other drugs (substance abuse) is on the increase particularly among adolescents and young adults. This is reflected on the number of admissions recorded at various psychiatric health institutions.
Merck (2003) pointed out that, many drugs, some legal and some not, alter the mind. Some mind- altering drugs affect brain function each time they are used, regardless of how much is used. Other mind – altering drugs affect brain function only if a large amount is used or of it is used continually.
Some individuals such as those with sickle call anaemia, may become addicted to the drug they are being treated with, such as injection pentazocine.
Theories concepts related to substance abuse includes the following:
§ Peer Group Theory:
This theory indicates that, adolescents take substances in order to be accepted by their peers.
§ The Drugs Personality Theory:
This states that, drug risers were nonconformist while those that are conformist do not take drugs. This is based on the longitudinal study.
§ Parental Influence Theory:
This stated that, poor parent – child relationship seems to be contributing to the development of substance use. Drug taking behaviour is learned especially alcohol taking behaviour.
§ Deviance Theory:
Stated that, taking substance is attached to the fact that, because a culture or sub-cultural group is stigmatized or punished, it’s members adopt value to survive in such environment.
Drug: Any chemical substance used in the treatment, cure, prevention or diagnosis of disease or used to other wise enhance physical or mental well being.
Drug Abuse: Illicit use of drugs outside medical prescription that poses danger to the health and interferes with physical, psychological, social and occupational functions.
Drug Dependence: This is a compelling need to continue taking a mind – altering drug to induce pleasure or to relieve anxiety and tension and avoid discomfort.
Tolerance: The need to use progressively larger amounts of the drug to reproduce the effects originally achieved with the starting amount.
Withdrawal Syndrome: This is the collection of symptoms that manifest, following cessation or reduction in the intake of substance.
PATIENT SUFFERING FROM MENTAL AND BEHAVIORAL DISORDER SECONDARY TO MULTIPLE PSYCHOACTIVE SUBSTANCE USE