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Intermittent explosive disorder with older person suffering from mental Health-NURSING TUTOR

05 Jul 2021 32 Views Sarah
Topic: Intermittent explosive disorder with older person suffering from mental Heath
Introduction:
The paper is aiming to analyse and present vast literature review and critiquing the present data and research studies about the intermittent explosive disorder amongst old age people suffering from mental health issues. The key focus of this literature review is to present varied management and therapeutic methods for this disorder. Intermittent Explosive Disorder (IED) is a state that makes an individual flare up with anger and displays aggressive behaviour consisting of violence (Medeiros et al., 2019, pp 303). Generally, it is not rare to see people losing temper, however, a person suffering from IED display it repeatedly. People suffering from IED might become very dangerous, and attack other people. They can be aggressive physically and verbally as well (McCloskey & Drabick, 2018, pp. 391). IED can exist in many forms and some of the symptoms of IED are yelling, shouting, road rage, threatening, throwing tantrums, showing aggressive behaviour by breaking glass, punching walls, or breaking plates, and get into arguments. IED-affected individuals get involved in brawls and fights, domestic violence, and become extremely angry even for minuscule issues (Coccaro & Ridder, 2019, pp. 145).
IED-affected events and attacks happen without any warning and they are very short in duration lasting only for about half an hour. Apart from the internal rage, the people suffering from IED may show other physical signs as well such as tremors, tightening of chest, head pressure or headache, adrenaline rush, and heart palpitations, etc (Coccaro & Ridder, 2019, pp. 146). IED affected individuals display loss of control, anger, and being irritated during the episode or before the episode. Seeing them having the experience of emotional detachment is not rare. Once the event is over, they might experience being relieved (McCloskey & Drabick, 2018, pp. 392). Some show tiredness and report being feeling guilty or remorseful towards the happened episode. IED-affected people can experience these kinds of events regularly or for some people, this kind of events happen after months or weeks and in between these events, they show non-violent behaviour. However, the occurrence of a verbal flare-up is not rare between these non-violent durations (Medeiros et al., 2019, pp 305).
Background:
Diagnostic And Statistical Manual (DSM-5) describes a newly researched approach to diagnose IED in the people in its new edition. It has categorized 2 behaviour patterns and differentiated them (Fanning et al., 2019, pp. 54). First is, more recurring events of people displaying verbal aggressive behaviour, however, without harming any person or property and secondly, less happening events of being hostile and causing destruction while being seriously harmful towards the property and the people. DSM has reported a disorder where an individual shows behaviour patterns being aggressive and crazy in all of its editions, however the name of IED appeared only in the third edition (Coccaro, 2018, pp. 118)). efore the third edition, this kind of behaviour was considered being a rare issue among people. With the advancement in diagnostic techniques and research, now it is considered a more common phenomenon. The treatment of the IED is done through various methods (Fanning et al., 2019, pp. 56). Generally, the treatment consists of medication and talk therapy or psychotherapy. Several psychotherapeutic approaches to anger management have been published in the literature. However, they tend to be general strategies; i.e., there is an important gap on research specifically focusing on the management of IED (Coccaro & Ridder, 2019, pp. 147).
Critique:
Medeiros et al. (2019, pp 306) suggested that developing skills in the people suffering from IED via group therapy or individual session is really helpful. One common therapy used to treat IED symptoms is called CBT (Cognitive Behavioural Therapy) that helps people to recover from it. CBT recognises a special behaviour or situation that works as a catalyst to invoke IED behaviour in people. It helps the individual by training them to control unwanted responses and anger with the help of techniques to relax their minds, alter thought processes to see the situation differently, use cognitive restructuring and problem solving and communication skills.
Several types of medicines are used for managing and treating IED. This medication list may include uses of antidepressants particularly SSRI (Selective Serotonin Reuptake Inhibitors), anticonvulsant mood balancers and other medicines if required (Coccaro & Grant, 2019, pp. 267).
Extreme anger issues have been linked to several types of diagnosis. Some of these are antisocial personality disorder, bipolar disorder, borderline personality disorder, depressive disorder, and anxiety disorder. Problematic aggression can be linked with each of these. Biological and clinical overlapping of some common aspects cannot be denied as well (McCloskey & Drabick, 2018, pp. 394). However, some of the particular symptoms of IED to look upon are-a) thought procedures linked with perceived injustice, b) elevated levels of hostility, c) very high level of impatience, and d) recurrent, unplanned and brief aggression episodes. Treatment linked with maladaptive anger needs to be a customisable one. Psychotherapy treatment potency can be increased via customizable interventions (Fisher, 2017, pp. 150).
McCloskey et al. (2008, pp. 876) conducted 12 weeks randomised control trial of psychotherapy for IED, which is the only trial that has been published. It was delivered in individual and group format where results showed that it was effective to decrease hostile behaviour. Group Therapy is particularly helpful in curing IED since it provides the opportunity for participants to enhance their social skills, which is considered a big issue in IED. It is also cheaper than individual sessions, certainly in developing nations like Brazil.
The Intermittent explosive disorder (IED) is a lifelong illness which might prevail for years, though the state of being severe outbursts can lessen with age. This particular disorder may start in infancy, after 6years of age, or during adolescence years. Younger adults are more likely to get it than older adults (Coccaro, 2018, pp. 120). The precise cause of the condition is unclear, although a combination of environmental and biological factors are likely to be involved. The majority of individuals who suffer from this condition grew up in homes where explosive behaviour and oral and physical violence were normal. Being subject to this form of aggression at a young age increases the likelihood that these children will have the same characteristics as adults (Coccaro, 2018, pp. 121). This was environmentally influenced. It is possible that the disease is passed on from parents to children due to a genetic factor. In patients with intermittent explosive disorder, there might be some variations in the anatomy, chemistry, and function of the mind relative to the individuals who do not have the illness. Thus, there are differences in the way brain actually functions (Fisher, 2017, pp. 155).
Intermittent explosive behaviour is largely treated with an amalgamation of medications and cognitive behavioural therapy (which includes relaxation training cognitive restructuring, and coping skills training) (Coccaro & Ridder, 2019, pp. 145). Especially, fluoxetine is the treatment that has been studied the most for the stated disorder. Phenytoin, carbamazepine and oxcarbazepine are some of the other medications that have been tested for the disorder or that have been prescribed if fluoxetine fails in any case. Antidepressants, mood regulators, anticonvulsants, and antianxiety are some of the drugs that should be tried in general (Coccaro & Grant, 2019, pp. 271).
There have been a number of psychotherapeutic approaches to conflict and anger control published in the last decade’s literature. Nevertheless, they are typically broad strategies; thus, there is a significant gap in research directly focused on IED management. Severe anxiety disorders, antisocial personality disorder, major depressive disorder, bipolar disorder, and borderline personality disorders have also been linked to this excessive rage and anger (Costa et al., 2018, pp. 318).
The aim of this study conducted by Fahlgren et al. (2019, pp. 545) was to see how effective a group therapy grounded on cognitive-behavioural interferences aimed at intermittent explosive disorder was (IED). The tentative findings of a clinical trial measuring pre- and post- intervention scores in various anger dimensions are presented in this article. There were no gaps or differences in demographic profile or pre-treatment status between those who finished treatment (n=59) and those who dropped out (n=25). Pre- and post-treatment ratings on the State-Trait Anger Expression Scale (STAXI) revealed statistically essential improvements in both rage measures and sub-scales of the respective inquiry form. This early study adds to the limited clinical evidence currently available. Our results add to the body of evidence that formal and structured cognitive-behavioural group therapy, with an emphasis on conflict control and cognitive coping, is a promising recovery option for IED. In the group environment, Cognitive Behavioural Therapy can be more successful. This therapy is also necessary as it makes the person learn how to communicate with others. Observing others' actions and sensing peer pressure can help people better control their emotions (Fahlgren et al., 2019, pp. 549).
Fisher, 2017 (pp. 153) suggests that for managing IED patients, it is necessary o learn to unlearn problematic actions and behaviours and this can be best attained with family involvement and support. Anger management is a skill that can be mastered. Run-through the approaches you've been educated in therapy in order to support you understand what causes your outbreaks and how to react in habits that benefit you rather than hurt you. The ED patients have to establish a course of action with a psychiatrist or a mental health specialist on anytime you find yourself being frustrated. If you're worried about losing control, for example, try to get out of the situation. The patients should try to relax, go for a stroll or call a close friend. The patient must be educated and trained in improving self-care. It is focused on getting enough sleep, exercise, and to apply overall stress control on a daily basis and this will all help the patient increase your anger and frustration tolerance. The patients must refrain from consuming alcohol or using recreational or illicit substances. These drugs will make patient angrier and boost the chances of having an explosive outburst (Coccaro, 2018, pp. 123).
Mauck & Moore (2014, pp. 501) suggested alternative therapies and dietary modifications for IED to be applied effectively. Nonetheless, there are approaches in good number that are unlikely to be harmful. These are eating a well-balanced diet, having adequate sleep, maintaining a healthy level of physical activity, abstaining from beer, tobacco, and smoking, finding an interval for enjoyable events such as music being played and enjoyed, eliminating and handling causes of tension, meditating or using other mindfulness methods, and experimenting with complementary treatments including massage, acupressure, and acupuncture.
McCloskey (2019, pp. 235) conducted a particular case study involving time-series research for a young adult man suffering from a dysthymic disorder (double depression) and major depressive disorder in addition to intermittent explosive disorder. Long-term psychodynamic psychotherapy (LTPP) was used to treat the patient, with a focus on promoting and fostering autonomy and emotional expression. The patient completed regular interventions specific to his presenting complaint, such as general anxiety as well as rage episodes, over the course of 13 months of therapy. Simulation Modelling Analysis for time-series data was used to look for clinically relevant changes between the baseline and two treatment stages. Overall rage and distressing episodes improved as a result of the study. In addition to regular assessments, the patient performed a monthly assessment of general psychological functioning during recovery period. Its findings indicated no discernible improvement or alteration. The effectiveness of LTPP in the action of the two disorders mentioned as above (DD and IED) were discovered and analysed with complicating variables and treatment consequences (McCloskey, 2019, pp. 240).
Chan et al. (2019, pp. e782) conducted a research over the psychosocial treatments for IED only in their early stages of growth. While cognitive-behavioural therapy (CBT) (or any psychosocial intervention) has been shown to be successful in managing aggression and anger, no study has been done on the effectiveness of CBT (or any other psychotropic intervention) in the management of severe level of anger dysregulation and violent behaviour that is typical of IED. Though methodologically constrained, the few published research that have looked at CBT for IED have all shown that it can mitigate frustration and violent impulses while still increasing anger regulation. This progress tends to be greater than wait-list/self-monitoring controls, and preliminary evidence shows that CBT outperforms more client-centred and nondirective treatment. Nonetheless, more of the well-controlled studies have been the need inclusive of studies that made use of more intense and rigorous comparison conditions and other therapeutic modalities’ based investigations separately and completely in combination with CBT as reported by Chan et al. (2019, pp. e790).
Recommendations:
Problem-solving therapy is a new and approaching management therapy for IED as it gives the patients with effective tools for identifying and solving problems arising due to life stressors and making them violent and aggressive (Pardo et al., 2020). The aim is to enhance the overall quality of life and decrease the negative effect of physical and psychological illness. This therapy is highly used in treating depression and for other personality disorders and behavioural disorders. This can be combined with other therapies also. The coping ability of the patient is improved with this therapy (Pardo et al., 2020).
Meditation as well as mind-body therapies has been proposed to help ageing people prevent or improve their cognitive loss. Their usefulness, though, is also debatable. The efficacy of meditation and mind-body activities in improving memory of elderly people aged 60 and up was investigated in this research (Xia et al., 2019, pp. 2075). Variables that double as moderators were also investigated. The meta-analysis comprised 41 research studies for a total of 3,551 participants. Mind-body exercises and meditation enhance memory and cognition in the elderly in general, but then again the form of exercise has a different impact on improving cognition (Xia et al., 2019, pp. 2075). Furthermore, cognitive function improves only after the intervention lasts longer than 12 weeks, the recommended physical workout frequency is 3-7 times weekly with each session lasting 45-60 minutes. This research shows that mind-body exercises like yoga, tai-chi and meditation can help older adults aged 60 and up strengthen their memory, and that exercise requirements should be included when designing interventions (Xia et al., 2019, pp. 2075).
Dialectical Behavioural therapy (DBT) is a form of cognitive behavioural therapy that focuses on assisting individuals with borderline personality problems and disorders. It has a prominent distinction to be made amid CBT and DBT. DBT helps people to recognise destructive feelings and also equips them with the tools they need to control them. Among these some of the skills are emotional parameter; meditation; distress tolerance; and interpersonal connections as reported in the work of Pardo et al. (2020).
Conclusion:
It is quite evident from the critical literature review that IED has been