Chapter 27: Adults

Adults begins by distinguishing any mental illness from serious mental illness, detailing how severe conditions like schizophrenia and bipolar disorder lead to significant functional impairment, chronic caregiver burden, and systemic societal issues such as the criminalization of the mentally ill, transinstitutionalization, and the complexities of outpatient commitment. The text emphasizes the shift from traditional rehabilitation paradigms to the empowering recovery model, highlighting therapeutic interventions like Assertive Community Treatment, dialectical behavior therapy, cognitive-behavioral therapy, and peer-support systems to combat common challenges including treatment nonadherence driven by anosognosia, dual diagnosis with substance use, and pervasive social stigmatization. Transitioning to impulse-control disorders, the summary covers the biological and psychological underpinnings of conditions characterized by an irresistible urge to perform harmful or illogical acts, specifically detailing intermittent explosive disorder, kleptomania, pyromania, gambling disorder, and trichotillomania, alongside their respective psychopharmacological and cognitive-behavioral treatments such as habit reversal. The chapter also carefully navigates human sexuality and gender, distinguishing non-pathological gender dysphoria—where individuals experience significant distress due to a mismatch between assigned and identified gender, often seeking gender reassignment, hormonal therapy, and psychosocial support—from paraphilic disorders. It delineates benign paraphilias from harmful paraphilic disorders like pedophilia, exhibitionism, voyeurism, and frotteurism, emphasizing the severe trauma inflicted on victims, the societal necessity for offender management, and therapeutic interventions including hormonal suppression and psychotherapeutic rehabilitation. Furthermore, the text addresses the nuanced presentation of adult attention-deficit/hyperactivity disorder, exploring its neurodevelopmental roots, diagnostic challenges, and management through stimulant medications, environmental structuring, and organizational skills training. Finally, the chapter comprehensively reviews sleep-related disorders, stressing the vital restorative functions of rapid eye movement and non-rapid eye movement sleep regulated by the suprachiasmatic nucleus. It outlines the clinical picture and nursing care for diverse sleep dysfunctions, including insomnia, obstructive sleep apnea, narcolepsy, circadian rhythm disorders, and restless leg syndrome, advocating for strict sleep hygiene practices, cognitive-behavioral therapy for insomnia, and targeted pharmacological or mechanical interventions to prevent the severe physical and cognitive detriments of chronic sleep deprivation.