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HIDE AND SEEK_1_ by pptfiles

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									HIDE AND SEEK
LOOKING FOR MEDICAL CONDITIONS THAT MAY MASQUERADE AS BEHAVIORAL PROBLEMS

BEHAVIOR PROBLEM?
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MM is a 24 year old man who has Sturge Weber Syndrome. He has a severe developmental disability, port wine stain, glaucoma, and seizure disorder. He is on a variety of ACMs, eye drops, vitamins and bowel aids. Recently he has been experiencing severe emotional outbursts with damage to property, injury to staff and severe self abuse. He complains of headaches sometimes. Seizures are relatively poorly controlled but this is not new. Recent anticonvulsant levels have been in the therapeutic range. What could be going on here?

BEHAVIOR: THE FINAL COMMON PATHWAY
COMMUNICATION  BIOLOGIC  PSYCHOLOGIC  ENVIRONMENTAL
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COMMUNICATION

NONVERBAL  LIMITED EXPRESSIVE LANGUAGE SKILLS  LIMITED RECEPTIVE LANGUAGE SKILLS  USUALLY HISTORY MUST BE OBTAINED FROM A THIRD PARTY PARENT, GUARDIAN OR DIRECT CARE PROVIDER
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WHY THINK BIOLOGIC?
Behavior is independent of environment.  There are associated vegetative symptom disturbances.  Identified triggers are absent.  Behavior may increase in severity over time as condition progresses.
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BIOLOGIC ISSUES TO CONSIDER
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Specific medical conditions
Medications Drug Allergies

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SPECIFIC MEDICAL CONDITIONS: COMMON DIAGNOSES
GASTROINTESTINAL:

DENTAL PROBLEMS GERD CONSTIPATION ENDOCRINE PROBLEMS: THYROID, DIABETES MELLITUS  SEIZURE DISORDERS

SPECIFIC MEDICAL CONDITIONS: COMMON DIAGNOSES
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PAIN: SINUS, TEETH, EARACHES HEADACHE GLAUCOMA, OTHER EYE PAIN FRACTURES KIDNEY OR GALL STONES GERD

SPECIFIC MEDICAL CONDITIONS: LESS COMMON DIAGNOSES
SLEEP APNEA VITAMIN DEFICIENCIES INCREASED ICP SPINAL CORD PROBLEMS HIDDEN ABSCESSES FOREIGN BODIES

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SPECIFIC SYNDROMES
Down Syndrome  Fragile X Syndrome  Congenital Rubella Syndrome  Sturge Weber Syndrome  Neural Tube Deficits  Fetal Alcohol Syndrome
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MEDICATIONS
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Side Effects
Drug-Drug Interactions Idiosyncratic Reactions and Allergies

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MEDICATIONS: SIDE EFFECTS
Neurologic: paresthesias, seizures, psychiatric, movement disorders, headaches,delirium  Gastrointestinal: dry mouth, heartburn, pain, constipation, diarrhea, anorexia, bleeding  Cardiac: arrhythmias  Genitourinary: retention, incontinence  Bone: osteoporosis
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MEDICATIONS: DRUG-DRUG INTERACTIONS
SSRIs  Anticonvulsants  Neuroleptics  GI drugs: acid blockers, proton pump inhibitors  Antibiotics  Birth Control Agents
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MEDICATIONS: IDIOSYNCRATIC AND ALLERGIC REACTIONS
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BENADRYL can cause hyperactivity PHENOBARBITOL can cause hyperactivity BENZODIAZEPINS can cause disinhibition NEURONTIN can cause disinhibition
ALLERGIES TO DRUGS CAN CAUSE A MULTITUDE OF SYMPTONS FROM RASH TO ANAPHYLAXIS. LATEX GLOVES MAY CAUSE PERINEAL REACTION AND LEAD TO RECTAL DIGGING OR GENITAL MANIPULATION

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EVALUATION PROCESS
History and Physical Examination  Further Diagnostic Workup  Consider Therapeutic Trial  Reevaluation  Consider multidisciplinary consultation
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AGING
Life Expectancy  Individuals with DD are not immune to common chronic medical conditions (cardiac, hypertension, endocrine)  Menopause  Dementia
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BEHAVIOR PROBLEM?
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JG is a 34 year old man who has a severe developmental disability. He is nonverbal but ambulatory and has a seizure disorder. He takes multivitamins and depakote. Recently staff has noted an increase in maladaptive “behaviors” including increased aggression and self injury, disturbed appetite and sleep patterns. His seizures seem to be as well controlled as ever. He has lost about 12#s but was a little obese to begin with and looks good. He seems tired but hasn’t been sleeping well. What could be going on here?

BEHAVIOR PROBLEM?
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LL is a 30 year old man who has a severe developmental disability due to Congenital Rubella Syndrome. He is ambulatory but non-verbal, deaf, blind and about 30#s overweight. Recently he has begun to grab food from his housemates and wet his pants at his day program. Staff are concerned about these behavior problems. What should you be concerned about?

COMING ATTRACTION
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THE FACTS OF LIFE….AND MORE

Sexuality and Developmental Disabilities

A free full day workshop presented by Leslie Walker-Hirsch, M.Ed  Feb.2,2000 8:00am to 4:30pm  Lovelace CME Building  CEUs for nurses, social workers, and counselors


								
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