Category: Nursing

“Captain of the Ship” Bipolar Disorders

Recommend psychopharmacologic treatments based on therapeutic end points for clients with bipolar disorders

Recommend psychotherapy based on therapeutic end points for clients with bipolar disorders

Identify medical management needs for clients with bipolar disorders

Identify community support resources for clients with bipolar disorders

Recommend follow-up plans for clients with bipolar disorders

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Select an adult or older adult client with a bipolar disorder that you have seen in your practicum.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic

agent. (This should relate to HPI and clinical impression.).

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client “Captain of the Ship” Bipolar Disorders.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers

 

“Captain of the Ship” Bipolar Disorders

Introduction

Bipolar disorder us a mental disorder characterized by extreme mood swings that encompass mania/hypomania (high moods) and depression (low mood). During hypomania/manic episode, the person is full of energy while during the depressive episode, the person feels sad and loses interest in most activities (McCormick et al, 2016). This paper will analyze a client with bipolar disorder and discuss the appropriate treatment options for the client.

HPI and Clinical Impression for the Client

The client Mr. M a 32-year-old male presented complaining of symptoms such as difficulty in concentrations, loss of appetite, sadness, irritability, sleep disturbances, lack of energy and lack of interest in most activities. The client reported that in spite of taking lamotrigine 100 mg/day and moclobemide 600 mg/day, the symptoms had persisted. The client further reported that sometimes he was full of energy, overly sociable, aggressive, talkative, sleep for only 2 hours at night, and would take risky decisions, which was unlike him “Captain of the Ship” Bipolar Disorders.

From the above data, the client experiences hypomanic episodes and depressive episodes and hence the diagnosis is bipolar II disorder. The DSM-5 criteria stipulate that depressive episodes are characterized by symptoms such as fatigue, sadness, lack of interest, appetite and weight changes, as well as suicidal thoughts. Hypomania episode is characterized by risky behaviors, high energy levels, reduced need to sleep, delusions, and feeling euphoric (Muneer, 2016). The client presented with hypomanic and depressive symptoms and this justifies the diagnosis of bipolar II disorder “Captain of the Ship” Bipolar Disorders.

 

Psychopharmacologic Treatments

Lithium 300 mg 3 times a day: Lithium will be prescribed as the mood stabilizer. Shah et al, (2017) explain that the efficacy of lithium in the treatment and prevention of hypomania and mania episodes. The medication is also effective in improving suicidal thoughts in people with bipolar disorder.

Lurasidone 20 mg PO qDay: Lurasidone will target the bipolar depressive symptoms. The medication is approved by the FDA in treating bipolar depressive symptoms, either as a monotherapy or in combination with lithium (Bawa & Scarff, 2015). Moreover, the medication is associated with few side effects and therefore the client is not likely to experience metabolic symptoms such as weight gain “Captain of the Ship” Bipolar Disorders.

Psychotherapy Choices

Cognitive-behavioral therapy (CBT): CBT is the psychotherapy choice for the client. CBT targets the maladaptive thinking patterns and the dysfunctional beliefs that lead to the hypomanic and depressive symptoms for the client (Geddes & David, 2013). As a result, the negative/maladaptive thinking pattern will be transformed into more a positive thinking pattern and this will help eliminate the negative feeling and improve the symptoms of bipolar and normal functioning for the client (Geddes & David, 2013).

Medical Management Needs

The client and his immediate family members will require education regarding the client’s condition to enable them to understand his condition and handle him better. They will also be educated about the possible triggers for depressive and hypomanic symptoms and how to avoid the triggers. There will also be a need to encourage the client to adhere to the prescribed treatment.  (Kilbourne et al, 2013). Moreover, bipolar is characterized by suicidal thoughts and therefore it will be necessary to monitor the client closely. It will also be important to educate the client about the importance of maintaining regular schedules when it comes to activities of daily living such as sleep. More importantly, one of the prescribed medications (lithium) is associated with toxicity and side effect and therefore the client will be educated about the side effect and possible toxicity. The client will also be monitored and assessed closely to avoid any possible toxicity (Kilbourne et al, 2013) “Captain of the Ship” Bipolar Disorders.

Community Support Resources

The client will be linked to the locally available support groups so that he can meet and socialize with individuals undergoing similar mental health problems. This will motivate the client to cope with his conditions and adhere to the prescribed treatment. The client will also be provided with educative resources such as booklets and magazines about his condition so that he can gain information about how to avoid triggers and manage the symptoms (Culpepper, 2014).

Follow-up Plan

The treatment plan and the client’s progress and response to the prescribed treatment will be reviewed after four weeks. The psychiatrist in collaboration with the PMHNP will assess the client and prescribe treatment according to his progress, tolerance, and response to the treatment. The PMHNP will also educate the client and administer the medications as well (Culpepper, 2014). A social worker will have the role of monitoring the progress of the client while at home.

Conclusion

The diagnosis for this client is bipolar II disorder as per the hypomanic and depressive symptoms. The prescribed medications include lithium as the mood stabilizer and lurasidone to treat the depressive symptoms. The psychotherapy choice for the client is cognitive behavioral therapy in order to change the maladaptive thinking pattern into a more positive thinking pattern. The medical management needs include monitoring the client for suicide and treatment adherence, as well as educating the client about the possible triggers and symptom management. The client will be linked with the local support groups and given reading resources about the condition “Captain of the Ship” Bipolar Disorders.

 

References

Bawa R & Scarff. (2015). Lurasidone: A New Treatment Option for Bipolar Depression—A Review.
Innov Clin Neurosci
, 12(1-2), 21–23.

Culpepper L. (2014). The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care.
Prim Care Companion CNS Disord
, 16(3): PCC.13r01609.

Geddes & David M. (2013). Treatment of bipolar disorder.
Lancet
, 381(9878).

Kilbourne A, David G, Allison N & Miller C. (2013). Integrating Bipolar Disorder Management in Primary Care.
Curr Psychiatry Rep
, 214(6), 687–695 “Captain of the Ship” Bipolar Disorders.

McCormick U, Murray B & McNew B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses.
J Am Assoc Nurse Pract
, 27(9), 530–542.

Muneer A. (2016). The Neurobiology of Bipolar Disorder: An Integrated Approach.
Chonnam Med J
, 52(1), 18–37.

Shah N, Grover S & Rao P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder.
Indian J Psychiatry
, 59(1), S51–S66 “Captain of the Ship” Bipolar Disorders.

Describe each client (without violating HIPAA regulations)

Students will:

Develop effective documentation skills for group therapy sessions *

Develop diagnoses for clients receiving group psychotherapy *

Evaluate the efficacy of cognitive behavioral therapy for groups *

Analyze legal and ethical implications of counseling clients with psychiatric disorders *

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.

Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.

Using the DSM-5, explain and justify your diagnosis for each client.

Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.

Explain any legal and/or ethical implications related to counseling each client.

Support your approach with evidence-based literature Describe each client (without violating HIPAA regulations)

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Psychotherapy with groups and families

Part 1.

The case involved a family that sought psychotherapy for spousal and domestic abuse. The family seeking therapy is comprised of two members. The first member is the mother, Maria, a 24 year old women of Latino descent. She is a housewife with no marketable skills and moved into the country seven years ago upon getting married to her husband. She reports that her husband has been physically and emotionally abusive towards her. He does not allow her to have friends of contact with her family. She further adds that the abuse has escalated to an extent that she feared for her life. Although she is currently separated from her husband after the police intervened after the neighbors made repeated reports to them. She is fearful that she does not have any marketable skills or a social support system in place thus making her vulnerable to manipulation from her husband. She is not on any prescription medication Describe each client (without violating HIPAA regulations).

The second member is the daughter, Angela, a 7 year old child. She is non-communicative and appears fearful in the presence of adult males. She has scars from beatings by her father. She is not on any prescription medication.

Part 2.

Using DSM-5, Maria has been diagnosed as suffering from intimate partner violence. The diagnosis is based on the set criteria that includes being subjected to violence and aggression from an intimate partner who was her husband in this case. She has experienced severe and chronic episodes of spousal violence over the course of her marriage. To be more precise, she meets two out of four conditions for this diagnosis. Besides that, she has been repeatedly subjected to emotional abuse (psychological aggression). These aspects of her relationship support the diagnosis (Sperry, 2016).

Using DSM-5, Angela has been diagnosed as suffering from child physical and psychological abuse. This diagnosis is based on the scars on her body that act as evidence of physical abuse. In addition, her fear of male adults and non-communicative nature are evidence that she has been psychologically abused by her father (Sperry, 2016). Describe each client (without violating HIPAA regulations).

Part 3.

The family therapy should apply cognitive behavioral therapy (CBT) as an appropriate approach. The family are victims of physical and psychological abuse that was targeted at controlling them. This had a negative effect on their behaviors, emotions and thoughts. CBT addresses the negative effects of the abuse through applying a stepwise methodology that identifies the problem, reflects on past abuse, evaluates how the abuse was justified, reflecting on how emotions affected thoughts that ultimately affected behavior, and developing self-talk that changes and challenges the negative emotions to protect the clients (Wheeler, 2014).

Part 4.

Counseling Maria has legal implications over confidentiality and disclosures. The abuse has legal implications and there could be sensational details that the counselor is obligated to report to law enforcement officers. This is particularly the case if the abuse is still ongoing and the police are not aware. This could be challenging since Maria has been assured of confidentiality and that none of the information she discloses will be shared with a third party without her prior informed permission (Cautlin & Lilienfeld, 2015). Describe each client (without violating HIPAA regulations).

Counseling Angela has ethical implications. She is a child and issues of informed consent come into play since she is not consulted on whether or not she wants to attend therapy. In addition, there is an issue of confidentiality since the mother expects to be informed about the case details even if Angela expresses a desire to have all the case details kept confidential and not disclosed to other parties (Cautlin & Lilienfeld, 2015).

References

Cautin, R. & Lilienfeld, S. (2015).
The encyclopedia of clinical psychology, volume II Cli-E
. Hoboken, NJ: John Wiley & Sons.

Sperry, L. (2016).
Handbook of diagnosis and treatment of DSM-5 personality disorders:
assessment, case conceptualization, and treatment
(3
rd
ed.). New York, NY: Routledge.

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: a how-to-guide for evidence-based practice
(2
nd
ed.). New York, NY: Springer Publishing Company, LLC. Describe each client (without violating HIPAA regulations).

 

Students will:

Develop effective documentation skills to examine group therapy sessions with children and adolescents *

Develop diagnoses for child and adolescent clients receiving group psychotherapy *

Analyze legal and ethical implications of counseling child and adolescent clients with psychiatric disorders *

Select two clients you observed or counseled this week during a group therapy session for children and adolescents. Note: The two clients you select must have attended the same group session. If you select the same group you selected for the Week 8 or Week 9 Journal Entries, you must select different clients Describe each client (without violating HIPAA regulations).

Then, address in your Practicum Journal the following:

Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.

Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.

Using the DSM-5, explain and justify your diagnosis for each client.

Explain any legal and/or ethical implications related to counseling each client.

Support your approach with evidence-based literature

Describe each client (without violating HIPAA regulations)

 

Group Therapy Sessions with Children and Adolescents

Description of clients, identifying any pertinent history or medical information

Client A, a seven-year-old girl presented to the hospital psychiatric department with a history of feeling anxious when not together with her mother and sleeping away from home.  This happened when the girl slept at a friend’s or relative’s home or while in a school camp. She expressed her nervousness as a worry that something bad would happen to her mother. Whether the detachment had was anticipated or had occurred, the client and her mother stated that she would experience worry, fear, stomach churning, crying, trembling and sweating.  At the period of consultation, the client was not under any medication and medical history revealed that the client did not have any other clinically significant feature.

Client B, a twelve- year old boy was brought to the pediatrician by his mother who was concerned that the boy is no longer rides bikes or play with toys with other children in the neighborhood. Over the last one month, the boy has been isolating himself and has become more irritable with no recognized trigger, has complained of frequent stomachaches and headaches over the last numerous weeks, and worries that all people in the family will die. Teachers have reported inattentiveness and impulsive behaviors in the class. The boy has also been having random durations of uncontrollable screaming and crying with no trigger Describe each client (without violating HIPAA regulations). There doesn’t exist a history of trauma, psychotic medication, changes in everyday life or recent losses.

An explanation and justification diagnosis for each client using the DSM-5

Client A is suffering from separation anxiety disorder (SAD).  The DMS-5 defines SAD as a developmentally unsuitable and excessive nervousness about separation from home or from those to whom the patient is attached.  According to Cooper-Vince et al (2014), diagnostic criteria describe excessive anxiety associated with separation as demonstrated by the existence of at least three of the specified SAD symptoms. These symptoms include  recurrent extreme distress when separation from  key attachment figures or home is anticipated or occurs, excessive and persistent worry  anxiousness  about losing or on probable harm happening to a key attachment figure,  excessive and persistent nervousness that an untoward incident will result in separation from the key attachment figure and persistent refusal or reluctance to go elsewhere for  fear of being separated. Other symptoms include excessively and persistently reluctant or fearful of not being with key attachment figures or at home and frequent reports of physical symptoms like vomiting, nausea, stomachaches, and headaches when a detachment from key attachment figures is anticipated or occurs. Describe each client (without violating HIPAA regulations).

Client B is suffering from major depressive disorder (MDD).  As Fatemi and Clayton (2016) indicate, according to the DSM-5 diagnostic criteria for MDD include the presence of at least five depressive symptoms for two or more weeks. These symptoms include the existence of irritable/depressed mood or anhedonia, reduced along with other depressive symptoms like reduced capability to have fun, sleep disturbance, impaired social relationships or social withdrawal suicidal ideation or thoughts of death, lack of energy, poor concentration. These symptoms should not be as a result of the effects of medication, drug or alcohol use, or a universal medical illness.

Ethical and legal implications related to counseling clients

A key ethical implication related to counselling both clients is competency.  According to Ziomek-Daigle (2017), it is the ethical responsibility of children and adolescent psychotherapist to ensure that they have the proper treating and competency in child and adolescent psychotherapy. There exist diverse systems, such as school, peers, community and family interacting with the child.  Successful and adolescent psychotherapy needs specialized skills and knowledge in counselling these populating along with a thorough knowledge of the bigger systemic context affect the adolescent’s life and behavior Describe each client (without violating HIPAA regulations).

Confidentiality and informed consent are other major ethical issues when counselling children and adolescents.   it is a legal and ethical responsibility for a counselor to get informed consent from clients utilizing a language they are able to understand.  As Sori and Hecker (2015) allege, children and adolescents who have not reached the legal age of giving consent, the counselor is required to obtain consent from the parent, but the child must agree to take part in counselling. Sori and Hecker (2015) claim that confidentiality issues are intricate in treating children and adolescents because their legal guardians or parents are usually involved in the counselling process and can access their medical records. Therefore, the counselor must maintain a balance amid the ethical responsibility of informing the parents on any treatment performed and the progress of the treatment, and the clients’ right to autonomy and privacy. Describe each client (without violating HIPAA regulations).

 

References

Cooper-Vince, C., Emmert-Arponson, B., Pincus, D., & Comer, J. (2014). The diagnostic utility of separation anxiety disorder symptoms: An item response theory analysis.
Journal of Abnormal Child Psychology
, 42(3): 417-248

Fatemi, S., & Clayton, P. (2016).
The Medical Basis of Psychiatry
.  New York:  Springer.

Sori, C., & Hecker, L. (2015). Ethical and Legal Considerations When Counselling Children and Families. 
Australian and New Zealand Journal of Family Therapy
, 36(4): 450-464.

Ziomek-Daigle, J. (2017). Counselling Children and Adolescents:
Working in School and Clinical Mental Health Settings
. Boca Raton, FL:  Taylor & Francis. Describe each client (without violating HIPAA regulations).

nurs 6660 pediatric bipolar depression disorder debate essay

Evaluate diagnosis of pediatric bipolar depression disorder

Analyze consequences to diagnosing/failing to diagnose pediatric bipolar depression disorder

justify whether or not pediatric bipolar depression disorder should be diagnosed.

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Evaluate the diagnosis of pediatric bipolar depression disorder

The diagnosis of pediatric bipolar depression disorder involves both physical evaluation and medical examination. In the physical evaluation, the psychiatric interviews the child and one parent. The interview allows the healthcare provider to conduct a comprehensive evaluation of all relevant clinical symptoms that are associated with mood disorders in children. Nonetheless, the information that is provided by the interviewees is likely to have some discrepancies. Therefore, the parents should observe the child with bipolar depression disorder closely for it is helpful for two week period before visiting a healthcare facility for the first time (Rizvi, Ong, & Youngstrom, 2014). In particular, child’s caregivers are supposed to monitor energy, mood, sleep, and any unusual behavior portrayed by the child and keep mood charting nurs 6660 pediatric bipolar depression disorder debate essay. Healthcare providers should enquire about the functioning of the child at school, home, and when with peers before ascertaining whether symptom of bipolar depression disorder is present or absent.

Bipolar depression disorder does not have any imaging or lab test. Nonetheless, the psychiatric need to conduct relevant laboratory testing and medical evaluation of any medical conditions or substance abuse that might result to mood symptoms. The laboratory testing or imaging results might be positive even if the patient had a normal physical examination or negative medical history. The clinician would conduct a complete blood count (CBC) and urinalysis during comprehensive evaluation. Additionally, the clinician would conduct differential with hematocrit and blood urea nitrogen (BUN) tests. Other recommended tests are serum electrolytes to test the level of potassium, sodium, chloride, phosphate, and calcium. Finally, the liver function test would be conducted to test aspartate aminotransferase (AST), alkaline phosphatase, alanine aminotransferase (ALT), and bilirubin (Renk et at, 2014).

Analyze consequences to diagnosing/failing to diagnose pediatric bipolar depression disorder

justify whether or not pediatric bipolar depression disorder should be diagnosed nurs 6660 pediatric bipolar depression disorder debate essay.

An argument against Diagnosing Pediatric Bipolar

Diagnosing pediatric bipolar depression disorder is associated with some shortcomings. First, psychiatrists tend to misdiagnose and give the wrong treatment to children with BP. Clinicians were not aware that this condition is likely to affect children. Consequently, they diagnosed and offered treatment for other mood disorders, including depression and anxiety. Additionally, the symptoms of BP are different in adults and children. Secondly, unlike in adults, children with bipolar disorder do not portray and clinical presentation. In cases the symptoms are present they are different from those portrayed by adults with this condition nurs 6660 pediatric bipolar depression disorder debate essay. Therefore, it is challenging for the healthcare provider to rule out whether a child is suffering from bipolar or other mood-related disorders. Furthermore, the drastic increase in the number of children diagnosed with bipolar disorder is due to redefinition of mania, which is among the major aspects considered in BP diagnosis.

Besides, most clinicians are diagnosing children with bipolar disorder rather than with conditions that could have been diagnosed in the past, including ADHD, conduct disorder (CD), oppositional defiant disorder [ODD], pervasive developmental disorders [PDD]), and learning disorder. Also, the diagnosis of children with bipolar disorder is likely to be palatable to individuals who are close to the child, including caregivers, teachers, and friends. Medical officers are likely to confuse the problematic moods and behaviors of a child to those of genetic disorder. The medications that are used in the treatment of bipolar disorder have also raised concern among critics. Some drugs might not reduce the severity of the symptoms of the condition but rather result in harmful side effects. In other words, the risks associated with the medication of bipolar disorder is overlooked. Diagnosing children with bipolar disorder will do them more harm than good.

An argument for Diagnosing Pediatric Bipolar

Diagnosing children with bipolar disorder accrues some benefits to the patients and their families. First, diagnosing this condition will give the clinician the basis of giving the appropriate medication to the patient. This medication will, in turn, reduce the risk associated with untreated cases of bipolar disorder (Axelson, 2016). Children with bipolar are at a high risk of performing poorly in school and being rejected by their peers (Campos et al, 2017). Additionally, these children are likely to cause physical injury, including committing suicide. These behaviors are likely to tear their families apart. Secondly, diagnosing the bipolar disorder is the most effective strategy of helping children with this condition nurs 6660 pediatric bipolar depression disorder debate essay. Clinicians can promote the level of attachment with children after diagnosis thus reducing the level of stress experienced by the patients and their families.

Also, psychiatric diagnoses are considered as the basis of descriptions of clusters of behaviors that are exhibited by individuals in society. Social institutions indicate that the impairment of the functioning of these behaviors is determined by human beings. Therefore, psychiatric diagnosis indicates that the health of human beings determines their behaviors. Diagnosis and appropriate treatment give people suffering from bipolar disorder an opportunity to flourish in life. Furthermore, the diagnosis will enable clinicians to differentiate the cluster of behaviors of bipolar disorder from those of millennia in various cultural practices. Finally, the pharmaceutical industry plays a significant role in shaping the values and interpretations of individuals. Therefore, it is evident that diagnosing children with bipolar disorder accrues benefits to the patients and their families.

References

Rizvi, S. H., Ong, M. L., & Youngstrom, E. A. (2014). Bipolar disorder in children and adolescents: an update on the diagnosis.
Clinical Practice
, 
11
(6), 665.

Renk, K., White, R., Lauer, B. A., McSwiggan, M., Puff, J., & Lowell, A. (2014). Bipolar disorder in children. 
Psychiatry journal
, 
2014 nurs 6660 pediatric bipolar depression disorder debate essay
.

Campos, C. R. F., Oliveira, M. L. C., Mello, T. M. V. F. D., & Dantas, C. D. R. (2017). Academic performance of students who underwent psychiatric treatment at the students’ mental health service of a Brazilian university. 
Sao Paulo Medical Journal
, 
135
(1), 23-28.

Axelson, D. (2016). Pediatric bipolar disorder: Overview of choosing treatment. 
UpToDate. Retrieved October

26
, 2018 nurs 6660 pediatric bipolar depression disorder debate essay.

NURS 6650 Group Processes and Stages of Formation Essay

Introduction

Group process involves how people and members work together to attain a common objective. Groups are essential for human experiences and hence it is important for the PMHNP to understand group processes and stage formation (Crane-Okada, 2012). This paper will provide a critique for “Group therapy: A live demonstration” video and provide an analysis for the group processes, stage formation, and curative factors of groups. Finally, the paper will discuss the effect of curative factors on client’s progress and strategies to manage intragroup conflict.

Group’s Processes and Stages of Formation

The study of group processes involves social and cognitive effects and their impact on…

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In a 2- to 3-page paper, address the following:

Explain the group’s processes and stage of formation.

Explain curative factors that occurred in the group. Include how these factors might impact client progress.

Explain intragroup conflict that occurred and recommend strategies for managing the conflict. Support your recommendations with evidence-based literature NURS 6650 Group Processes and Stages of Formation Essay

This is the video

Psychotherapy.net (Producer). (2011a). Group therapy: A live demonstration. [Video file]. Mill Valley, CA: Author

 

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

 

​The Theory and Practice of Group Psychotherapy, 5th Edition by Yalom, Irvin D. ; Leszcz, Molyn. Copyright 2005 by Hachette Books Group. Reprinted by permission of Hachette Books Group via the Copyright Clearance Center.

 

 

Chapter 5, “The Therapist: Basic Tasks” (pp. 117–140)

 

Chapter 8, “The Selection of Clients” (pp. 231–258)

 

Chapter 9, “The Composition of Therapy Groups” (pp. 259–280)

Crane-Okada, R. (2012). The concept of presence in group psychotherapy: An operational definition. Perspectives in Psychiatric Care, 48(3), 156–164. doi:10.1111/j.1744-6163.2011.00320.x

 

Note: Retrieved from Walden Library databases.

 

Lerner, M. D., McLeod, B. D., & Mikami, A. Y. (2013). Preliminary evaluation of an observational measure of group cohesion for group psychotherapy. Journal of Clinical Psychology, 69(3), 191–208. doi:10.1002/jclp.21933 NURS 6650 Group Processes and Stages of Formation Essay

 

Note: Retrieved from Walden Library databases.

 

Nicholson, R. (2002). The dilemma of psychotherapy notes and HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from
http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4

 

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved March 18, 2017, from
http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/

 

Group Processes and Stages of Formation

Introduction

Group process involves how people and members work together to attain a common objective. Groups are essential for human experiences and hence it is important for the PMHNP to understand group processes and stage formation (Crane-Okada, 2012). This paper will provide a critique for “Group therapy: A live demonstration” video and provide an analysis for the group processes, stage formation, and curative factors of groups. Finally, the paper will discuss the effect of curative factors on client’s progress and strategies to manage intragroup conflict. NURS 6650 Group Processes and Stages of Formation Essay.

Group’s Processes and Stages of Formation

The study of group processes involves social and cognitive effects and their impact on group members. Studies on group process focus on interactions between team members, traits of members, and the effect of such factors on ensuring the efficacy of the group. Group processes consist of essential components like group norms, roles, identity and status of the group, as well as the group social interaction (Crane-Okada, 2012). These components are further influences by qualities such as trust, feedback among group members, and conflict and resolution. Stages of group formation consist of forming, storming, norming, performance stage, as well as adjournment stage (Lerner et al, 2013).

In the “Group Therapy: A live demonstration” video, the group consisted of individuals struggling with social challenges and hence sought treatment to address these challenges. The common goal of the group was identified by the social challenge all members were experiencing and the need to improve their adaptive functionality; this was the forming stage. The storming phase occurs after forming of the group is typified by role assigning and some disagreements NURS 6650 Group Processes and Stages of Formation Essay. The norming stage includes the group members normalizing and getting used to each other (Lerner et al, 2013). This was demonstrated in the group where members could share their experiences freely. The performance group is characterized by trust among group members and this was demonstrated in the group where members were able to solve issues with minimal supervision.  The group in the video is at the performance stage as the members freely share their experiences and interpersonal relationships (Lerner et al, 2013).

Curative Factors in the Group

Curative factors that took place in the group included hope installation; imparting of information; and universality. Hope installation is evident where group members are ready to provide hope to each other (Hauber et al, 2019). The group members also impart information and universality is also evident. An example of hope installation and imparting of information is evident where for example Gill tells about his alcoholism and shares how alcohol addiction has negatively affected his marriage. Phillip shares about his sexual addiction. After sharing these experiences, group members encourage them and thus install hope (Hauber et al, 2019).

Intragroup Conflict that Occurred

An example of an intragroup conflict that occurred in the video is where Philip and Sam sharply differed and argued because of their past encounters.  Three strategies that can be used to manage conflicts in a group include collaborating and compromising (Overton & Lowry, 2013). Collaborating includes negotiating between the members having conflict and ensuring members with the conflict learn from each other, compromising strategy include reaching a compromise to ensure all team members find a middle ground (Overton & Lowry, 2013) NURS 6650 Group Processes and Stages of Formation Essay.

References

Crane-Okada, R. (2012). The concept of presence in group psychotherapy: An operational definition.
Perspectives in Psychiatric Care
, 48(3), 156–164.

Hauber K, Boon A & Robert V. (2019). Therapeutic factors that promote recovery in high-risk adolescents intensive group psychotherapeutic MBT programme.
Child Adolesc Psychiatry Ment Health
.  13(2).

Lerner, M. D., McLeod, B. D., & Mikami, A. Y. (2013). Preliminary evaluation of an observational measure of group cohesion for group psychotherapy.
Journal of Clinical Psychology
. 69(3).

Overton A & Lowry A. (2013). Conflict Management: Difficult Conversations with Difficult People.
Clin Colon Rectal Surg
. 26(4),259–264. NURS 6650 Group Processes and Stages of Formation Essay

 

Introduction

Group process refers to when individuals congregate with a common objective that they seek to achieve.  The fundamental elements which any group must have in order to come into existence from the beginning to the end, such as group norms, trust generation, inter member feedback, resistance, conflicts and resolutions are important in any group (Yalom & Leszcz, 2005). In this case, the congregated individuals reach a consensus that they will remain as part of the group until the objective that led to its formation has been met (Allen & Spitzer, 2015). A group is likely to encounter most if not all of the stages of group formations, commonly referred to as forming, storming, norming, performing, and adjourning (Tuckman, & Jensen, 1977). Research has shown group therapy to be as efficient as individual therapy. In group therapy, members are able to effect change as well as make it easier for one another to interact with the guidance of their peers and that of a counselor.  The therapist therefore must understand group process as well as the stages of group formation in order to help them develop the group and determine an individual’s appropriateness for the group (Tuckman, & Jensen, 1977). NURS 6650 Group Processes and Stages of Formation Essay




Explain the group’s processes and stage of formation.

In the present situation, the group has been formed by individuals who are seeking treatment after recognizing that they have a social problem and require help thereby identifying their common goal. Typically, groups with a greater number of objectives will be more cohesive than those with fewer objectives (Psychotherapy.net, 2011).   This group’s current stage of formation is in the storming stage, this is because the group has not yet completed any tasks since it is still unsettled. This was just formed recently and the members are in the process of adjusting. In fact, the members’ uncertainties before forming the group are now being expressed. There are some aspects of forming stage left, as evidenced by Gill’s avoidance of very important self-disclosure, even when pushed by Bonnie, he tried to change the subject by shifting to Julius’s health problem. Avoidance of self-disclosure is typically seen in forming stage (Tuckman, & Jensen, 1977).  Conflicts between members are common occurrences that can make task completion challenging (Tuckman, & Jensen, 1977) This is particularly seen in the case of Philip and Pam who are engaged in a conflict that could degenerate into one of them leaving the group. Conflicts and competitions are characteristics of storming stage of group formation. In resolving the conflicts between members, the group is likely to become more cohesive and develop a culture of mutual support and compromise that avoids conflicts. At this point, the group should have moved to the norming stage to begin the actual process of developing a solution even as the members’ interactions are harmonized (Smith, 2012). NURS 6650 Group Processes and Stages of Formation Essay.

Explain curative factors that occurred in the group. Include how these factors might impact client progress.

The interactions between the group members showed that some curative factors occurred in the group. The members have expressed some hope that they will find a solution for their problems as expressed by their willingness to be a part of the group. The presence of the group offers the members hope that their problems are not unique and that they can share on their experiences to get a better awareness of these problems while supporting each other to develop solutions. Given the presence of hope, each member is motivated to support the group activities. The group brings to attention the fact that each member is not unique in his or her problems. Rather, these problems are universal and the only difference is in the way each individual approaches them. In sharing their experiences, every member can familiarize with the different aspects of the problems and collectively develop a more effective solution while discussing with others. Being in the group allow the members to understand the different aspects of social interaction, what is acceptable, and what is not when engaging with others. It is important to understand that individual problems typically have a social root, and gaining insight into social interaction can help in providing a solution. Finally, the presence of a facilitator (counselor) is important in guiding group interactions and activities as a mediator. Although the facilitator does not develop the solution, he or she guides the group towards a productive direction that allows them to achieve favorable results with minimal negative effects in the shortest time possible (Allen & Spitzer, 2015). The four curative factors occurred in the group and had an impact on the clients’ progress.

Explain intragroup conflict that occurred and recommend strategies for managing the conflict. Support your recommendations with evidence-based literature.

The group experienced an intragroup conflict whereby members expressed dissatisfaction with each other that threatened to break up the group. This was observed in the interaction between Philip and Pam that showed clear evidence of conflict. The two were dissatisfied with each other and Pam threatened to quit from the group if Philip was not expelled. The conflict polarized the group since Pam’s ultimatum implied that the group must choose between retaining Pam and losing Philip or retaining Philip and losing Pam. Although Philip did not mention an intention to quit if Pam was retained, he felt that Pam was appreciated more within the group than him. This was because the group members made ardent pleas to Pam not to quit the group while ignoring his presence and his need for assurance that the group supported him. In essence, he felt that Pam was supported whereas his presence is unnecessary. Philip summarized his feelings by indicating that he felt less valued than Pam according to how the situation was developing (Psychotherapy.net, 2011). In this respect, an intragroup conflict existed between Pam and Philip NURS 6650 Group Processes and Stages of Formation Essay.

Conflict in a group does not have to mean that the group cannot function. In fact, it may actually help the group function if the conflict is handled well. People can grow and learn from conflict, especially if it can be resolved in a way that makes the group a winner, not in a way that makes one individual the loser (Hadad, & Reed,2007). Ignoring conflicts will only make things worse, so conflicts are better delt with as they arise. Treat issues as problems to be solved, and do not engage in blaming. Be open minded and fair when listening to everyone, and brainstorm to find solutions or compromise (Hadad, & Reed, 2007).

The existence of the intragroup conflict between Pam and Philip is one that threatens to break up the group. While the conflict is a threat, it can also act as an incentive that allows the group to understand its purpose. In comprehending that the exit of either Philip or Pam will cause the group to break up, then it will be incumbent upon the group to resolve the existing conflict without breaking up the group. Should the existing conflict be resolved amicably without losing any members, then the group will learn that each problem has a solution and their individual problems similarly have solutions as well (Smith, 2012). In this respect, the group should approach intrapersonal conflict as an opportunity to affirm the efficacy of the group in developing solutions.

 

References

Allen, K. & Spitzer, W. (2015). Social Work Practice in Healthcare: Advanced approaches and emerging trends. Thousand Oaks, CA: SAGE Publications.

Psychotherapy.net (Producer). (2011). Group therapy: A live demonstration. [Video file]. Mill Valley, CA: Author.

Smith, G. (2012). Psychological Interventions in Mental Health Nursing. Berkshire: Open University Press.

Tuckman, B. & Jensen, M. (1977) Stages of Small Group Development. Group and Organizational Studies, 2, 419-427 [Review]. (n.d.). NURS 6650 Group Processes and Stages of Formation Essay

NURS 6660 Voluntary and Involuntary Commitment Essay

Decision Between Voluntary and Involuntary Psychiatric Commitment in the Case of a Suicidal Fourteen Year-Old

Voluntarily committing a patient to psychiatric care means that they or their family freely give consent for the same. Involuntarily committing them on the other hand implies that they or their family have not freely given their consent for the same. Based on this particular scenario in the case study, therefore, what would be recommended would be that the minor be involuntarily committed. This is because first and foremost the divorced parents cannot agree whether this adolescent suicide attempt patient should be admitted or not. Secondly, suicidality is the most common reason for inpatient psychiatric admission, with up to 75% of child, adolescent, and adult patients getting hospitalized for the reason of wanting to harm self (National Academy of Sciences, 2019) NURS 6660 Voluntary and Involuntary Commitment Essay.

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Based on Indiana laws, this client is eligible for involuntary commitment. According to Indiana code 12-26-1-1 sec. 1, a client who is deemed to be a danger to themselves by virtue of being mentally unstable can be committed to psychiatric care involuntarily (LawServer Online, 2019). This can either be emergency detention for a maximum of 72 hours (IC 12-26-5) or temporary commitment for a maximum of 90 days (IC 12-26-6). In Indiana, the temporary commitment requires that the PMHNP petitions the municipal court to grant this by giving a written statement outlining the results of examination and assessment as well as the professional expert opinion. However, another physician or clinician giving the same reasons must also be produced (Pace, 2017) NURS 6660 Voluntary and Involuntary Commitment Essay. Because this young client wants to kill himself, he is eligible for involuntarily commitment under this statute by virtue of intent to harm self.

The understanding of the Indiana state laws therefore served to confirm the initial PMHNP opinion that this client required involuntary commitment to the psychiatric unit. Statistics show that close to half of completed suicides in the United States are related to an underlying mental disorder. Also, involuntary commitment is known to be tied to many common suicide risk factors (American Academy of Sciences, 2019). This child is dangerous to himself and may attempt to kill himself once again. According to Ng and Kelly (2012), perception of dangerousness is a factor associated with involuntary commitment or admission NURS 6660 Voluntary and Involuntary Commitment Essay.

If this client were not eligible for involuntary commitment, to support the parents in voluntary commitment some of the actions that would be taken would include thorough assessment of the child for future suicide risk. This would be through either or both the Scale for Suicide Ideation (SSI) and/ or the Beck Hopelessness Scale. Also, if the client were not eligible for involuntary commitment, one of the actions that would be taken to start treatment would be to initiate the psychotherapeutic intervention of cognitive behavioral therapy or CBT (National Academy of Sciences, 2019). This is a non-pharmacologic intervention that intends to modify the client’s behavior and positively influence and direct his future actions. Other measures of psychotherapy that would be attempted would include group psychotherapy. In this, the therapeutic factors of universality and altruism would help the client realise that they are not only alone in what they are going through; but also that there are other persons who care about them and their wellbeing NURS 6660 Voluntary and Involuntary Commitment Essay.  Needless to say, the divorced parents would also benefit from some counselling individually in order to know how to cope with their son’s condition.

 

References

LawServer Online, Inc. (2019).
Indiana code 12-26-1-1. Statutes under which mentally ill and either dangerous or gravely disabled may be involuntarily detained or committed
. Retrieved from
https://www.lawserver.com/law/state/indiana/in-code/indiana_code_12-26-1-1

National Academy of Sciences, (2019).
Chapter: 7 medical and psychotherapeutic interventions
. Retrieved from
https://www.nap.edu/read/10398/chapter/9#231

Ng, X.T. & Kelly, B.D. (2012). Voluntary and involuntary care: Three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit.
International Journal of Law and Psychiatry, 35
, 317-326. Doi: 10.1016/j.ijlp.2012.04.008

Pace, T. (2017, July 21). How to have someone committed to a psychiatric facility in Indiana.
Legal Beagle
. Retrieved from
https://legalbeagle.com/8573504-someone-committed-psychiatric-facility-indiana.html

 

 

Review the Learning Resources concerning voluntary and involuntary commitment.

Read the Week 7 Scenario in your Learning Resources.

Research your state’s laws concerning voluntary and involuntary commitment

NURS 6660 Voluntary and Involuntary Commitment Essay

 

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a

“stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your

consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an

apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s

parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not

“live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?

Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.

Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain. NURS 6660 Voluntary and Involuntary Commitment Essay.

If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.

If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client NURS 6660 Voluntary and Involuntary Commitment Essay.

 

…were not eligible for involuntary commitment, to support the parents in voluntary commitment some of the actions that would be taken would include thorough assessment of the child for future suicide risk. This would be through either or both the Scale for Suicide Ideation (SSI) and/ or the Beck Hopelessness Scale. Also, if the client were not eligible for involuntary commitment, one of the actions that would be taken to start treatment would be to initiate the psychotherapeutic intervention of cognitive behavioral therapy or CBT (National Academy of Sciences, 2019). This is a non-pharmacologic intervention that intends to modify the client’s behavior and positively influence and direct his future actions. Other measures of psychotherapy that would be attempted would include group psychotherapy. In this, the therapeutic factors of universality and altruism would help the client realise that they are not only alone in what they are going through; but also that there are other persons who care about them and their wellbeing.  Needless to say, the divorced parents would also benefit from some counselling individually in order to know how to cope with their son’s condition NURS 6660 Voluntary and Involuntary Commitment Essay.

 

References

LawServer Online, Inc. (2019).
Indiana code 12-26-1-1. Statutes under which mentally ill and either dangerous or gravely disabled may be involuntarily detained or committed
. Retrieved from
https://www.lawserver.com/law/state/indiana/in-code/indiana_code_12-26-1-1

National Academy of Sciences, (2019).
Chapter: 7 medical and psychotherapeutic interventions
. Retrieved from
https://www.nap.edu/read/10398/chapter/9#231

Ng, X.T. & Kelly, B.D. (2012). Voluntary and involuntary care: Three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit.
International Journal of Law and Psychiatry, 35
, 317-326. Doi: 10.1016/j.ijlp.2012.04.008

Pace, T. (2017, July 21). How to have someone committed to a psychiatric facility in Indiana.
Legal Beagle
. Retrieved from
https://legalbeagle.com/8573504-someone-committed-psychiatric-facility-indiana.html
 NURS 6660 Voluntary and Involuntary Commitment Essay

Treatment of Psychiatric Emergencies in Children Versus Adults Essay

Consider a case where your adult client had a psychiatric emergency.(make one up)

Briefly describe the case you selected.

Explain how you would treat the client differently if he or she were a child or adolescent.

Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case

Treatment of psychiatric emergencies

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Briefly describe the case you selected.

The case involves Peter (pseudonym), a 27-year-old Caucasian male who was brought into the emergency room following an attempted suicide with a drug overdose Treatment of Psychiatric Emergencies in Children Versus Adults Essay. He was found comatose in his bedroom of the home he shares with two friends. The friends report that he had come in early from work and went into his bedroom. He had been there for 45 minutes when his friends heard commotion in his bedroom and went in to find hum convulsing. A suicide note and an empty bottle of pills were on the bed beside him. His medical records reveals that he lived as a health child and adult, experiencing common ailments such as asthma, pneumonia and chickenpox. Over the last two years, he frequently complained of heartburn and episodes of pharyngitis and rashes, and an episode of venereal warts. In the last six months leading to the suicide attempt, Peter gained significant weight. His housemates indicate that the weight gain may have been caused by pleasure eating since he discovered his fiancée cheating on him, an event that may have precipitated the pleasure eating. There is evidence of substance, suicidal ideation and mental health issues in the client. He was diagnosed with depression and anxiety disorder four months ago. Xanax (anxiolytic) and Celexa (antidepressant) were prescribed to manage the disorder. The friend report that Peter was the ‘life of the party’ and ‘jokester’ prior to breaking up with his fiancée, but had become dull since the breakup Treatment of Psychiatric Emergencies in Children Versus Adults Essay.

Explain how you would treat the client differently if he or she were a child or adolescent.

Treatment for suicide among adults is similar for treatment among children and adolescents. In this case, the treatment would be presented s acute management of the suicidal behavior to include psychopharmacology and psychotherapies. The first step is to establish a relationship with the client and family or friends, while also establishing the importance of treatment Treatment of Psychiatric Emergencies in Children Versus Adults Essay. This is particularly important for children and adolescent clients since they would require consent from a parent or legal guardian for the treatment to proceed. This step is slightly different for adult clients since the client has the legal right to make treatment decisions (Sadock, B., Sadock, V. & Ruiz, 2014). Another significant detail is that for children and adolescent clients, discussion with the family would typically involve the case aspects being discussed with the therapist presenting the treatment options. On the other hand, treatment for adult clients involve the therapist collecting details about the case from the client’s family and friends, and not discussing the case details unless with the express permission from the client (American Nurses Association, 2014).

Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case

There are ethical issues that must be considered when working with a child or an adolescent emergency case. The first issue is the therapeutic boundary with the therapist often challenged to refrain from engaging in actions that could confuse the boundaries. This is especially so when dealing with clients who find it difficult to express their impulses and longings in words. For instance, they could ask questions about how the therapist behaves as a parent. They could also challenge the boundaries by posing embarrassing and challenging questions (Smith, 2012). The second issue is client autonomy with regards to the client contributing to decisions based on objectivity and understanding. Including children and adolescents in decision making about treatment is respectful and strengthens the working alliance Treatment of Psychiatric Emergencies in Children Versus Adults Essay. The third issue is confidentiality, especially when the parents demand to know case details that the client expects to be kept confidential (Allen & Spitzer, 2015). The three ethical issues are common when working with child and adolescent clients.

References

Allen, K. & Spitzer, W. (2015).
Social work practice in healthcare: advanced approaches and emerging trends
. Thousand Oaks, CA: SAGE Publications.

American Nurses Association (2014).
Psychiatric-mental health nursing: scope and standards of practice
(2
nd
ed.). Washington, DC: Author.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan &Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry
(11
th
ed.). Philadelphia, PA: Wolters Kluwer.

Smith, G. (2012).
Psychological interventions in mental health nursing
. Berkshire: Open University Press Treatment of Psychiatric Emergencies in Children Versus Adults Essay.

NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

Assessing and Treating Pediatric Clients

Introduction

The case study is on an 8-year-old boy, manifesting psychiatric symptoms. The mother reported that the client had become very nervous and worried. He also spends most of the time cleaning his hand because he fears his hands could get contaminated and become sick like he previously did. The client has also been avoiding playing with his friend and attending school. Other symptoms include irritability and sleep problems. Accordingly, this assignment involves making decisions about the diagnosis for the client and treatment choices. The paper will conclude by discussing ethical aspects likely to impact the treatment of the client.

Decision Point One

According to the presented symptoms for this client, the decision regarding the diagnosis of the client is that he has…

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You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

 

Case #2

Anxiety disorder, OCD, or something else?

BACKGROUND

Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.

His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

OBJECTIVE

During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

MENTAL STATUS EXAM

Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Generalized Anxiety Disorder (GAD)

Obsessive Compulsive Disorder

Pediatric Autoimmune Neuropsychiatric Disorder
s Associated with Streptococcal Infections (“PANDAS”)

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/index.html

Obsessive Compulsive Disorder was chosen for the diagnosis in Decision 1

Begin Fluvoxamine immediate release 25mg orally at bedtime was chosen for Decision 2

Augment therapy with cognative behavior therapy was chosen for Decision 3 NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay

Decision #1: Differential Diagnosis

Which Decision did you select?

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning

Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision.

Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning

Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning

Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

 

Assessing and Treating Pediatric Clients

Introduction

The case study is on an 8-year-old boy, manifesting psychiatric symptoms. The mother reported that the client had become very nervous and worried. He also spends most of the time cleaning his hand because he fears his hands could get contaminated and become sick like he previously did. The client has also been avoiding playing with his friend and attending school. Other symptoms include irritability and sleep problems. Accordingly, this assignment involves making decisions about the diagnosis for the client and treatment choices. The paper will conclude by discussing ethical aspects likely to impact the treatment of the client. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point One

According to the presented symptoms for this client, the decision regarding the diagnosis of the client is that he has obsessive-compulsive disorder (OCD). The reason why this decision was selected is that he presents symptoms akin to OCD symptoms. According to the DSM-5 criteria, symptoms of OCD include repetitive ritualized behaviors and intrusive obsessions. The symptoms of OCD lead to anxiety and distress to the client (Sachs & Eefurth, 2018). Examples of compulsions in people with OCD consist hand washing, avoidance, routine praying, routinized behaviors, among other behaviors (Sachs & Eefurth, 2018). In this case study, the client manifests anxiety and the ritualistic compulsive behavior include handwashing.

The intrusive obsession presented by this client is his fear of his hand becoming contaminated with germs and as a result, becoming sick (Sachs & Eefurth, 2018). Nonetheless, the client may also be having social phobia as manifested by his school avoidance and avoiding socializing with his friends.

 

Decision Point Two

The second decision for this client is to begin Fluvoxamine immediate release 25 mg orally at bedtime. The reason why this medication was chosen is that it is an SSRI and it is FDA approved for children who are 8-years and above (Pittenger & Bloch, 2014). The medication works by hindering the reuptake of serotonin within the brain. Additionally, evidence has demonstrated the efficacy of Fluvoxamine in treatment of OCD in children by improving the symptoms. In addition, the medication has been shown to be tolerable and safe for pediatric population. Because fluvoxamine has sigma-1 antagonist effects and thus causes sedation, it is supposed to be administered during bedtime (Thamby & Jaisoorya, 2019). NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Selection of this decision hoped that the OCD symptoms in the client would decrease. This can be manifested by reduced handwashing and reduced fear of contamination as well as reduced anxiety. This is because the efficacy of the drug has been demonstrated in treatment of OCD in children (Pittenger & Bloch, 2014). Secondly, it was hoped that the client would tolerate the drug and thus not have any adverse side effect.

The result of this decision was just as it was expected because there was a decrease in the symptoms in the client in the client as the handwashing reduced and anxiety as well. The sociability of the client also improved as he began interacting with his friend. The symptom improvement in this client is attributable to the efficacy of fluvoxamine in improving symptoms of OCD (Thamby & Jaisoorya, 2019). In addition, the client did not report any side effects from the medication. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Decision Point Three

The chosen third decision was for the client to augment the treatment using cognitive behavior therapy. The reason for this choice is because CBT has been demonstrated to be effective when treating OCD and the therapy does not carry any side effects or risks (Wu et al, 2016). When treating OCD, cognitive behavior therapy uses exposure and response prevention (ERP) and cognitive therapy to alter the thoughts and behavior of an individual. During the step of exposure-response prevention (ERP), the person with OCD is kept in a situation likely to expose him/her to the obsessions and the client is advised not to conduct compulsions that they normally perform to ease the anxiety and distress (Tundo et al, 2016). In this case the client would be exposed to a contaminated area and requested not to perform hand-washing NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay. After this, cognitive therapy is then applied where the therapist helps the client to alter the negative thinking pattern associated with the obsession and compulsive behavior (Tundo et al, 2016). The client is helped to identify the patterns that cause distress and negative behavior such as the compulsions and adopt a more adaptive thinking pattern and hence reduce the anxiety, distress, as well as the negative behavior associated with performing the compulsive acts (Wu et al, 2016).

Ethical Considerations

The ethical considerations that could affect the client’s treatment plan include informed consent. Since medications such as Fluvoxamine is associated with specific side effects, it would be important to inform the parents of the client about the possible side effects as well as provide full information about all available treatment options to enable them to make an informed treatment choice (Pittenger & Bloch, 2014) NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

Conclusion

The client’s diagnosis is OCD because the client is obsessing with his hands becoming contaminated and performs compulsive behavior of ritualistic handwashing. The second decision is for the client to start client fluvoxamine immediate release 25 mg due to the medication’s efficacy in the treatment of OCD in children.  the last decision is to augment the treatment with CBT due to its efficacy in lowering OCD symptoms. Lastly, the ethical consideration applicable for this client is informed consent to allow the parents make an informed treatment choice. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

 

References

Pittenger C & Bloch M. (2014). Pharmacological treatment of obsessive-compulsive disorder.
Psychiatr
Clin North Am
. 37(3), 375–391.

Sachs G & Eefurth A. (2018). Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment.
Int J Neuropsychopharmacology
. 21(1), 59–62.

Thamby A & Jaisoorya T. (2019). Antipsychotic augmentation in the treatment of obsessive-compulsive disorder.
Indian J Psychiatry
. 61(Suppl 1), S51–S57.

Tundo A & Necci R. (2016). Cognitive-behavioral therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence.
World J Psychiatry
.  6(4), 449–455.

Wu Y, Lang Z & Zhang H. (2016). Efficacy of Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis.
Med Sci Monit
. 1(22), 1646–1653. NURS 6660 week 5 decision tree assignment – obsessive-compulsive disorder (OCD) Essay.

NURS 6650 Clinical Supervision – anxiety disorder Essay

consider a client whom you do not think is adequately progressing according to expected clinical outcomes.

Reflect on a child or adolescent client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with an anxiety disorder.

Describe the client. Note: Do not use the client’s actual name.

Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.

Identify any additional information about this client that may potentially impact expected outcomes.

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J.T is a 16 year old Caucasian male patient. He presents to the clinic with the claim that he experienced increased anxiety. He has been experiencing anxiety attacks for the last six months which have increased intensely for the last two weeks. He has been on anxiety medication during the last one week and reports minimal positive progression.  He reports increased insomnia and shakiness since the beginning of his treatment plan and considers the drugs ‘futile and more sickening’. NURS 6650 Clinical Supervision – anxiety disorder Essay The symptoms are currently affecting his daily activities. He is often tensed and has difficulties paying attention in class and finishing his assignments.

On examination, J.T. feels stressed all the time and worries about failing his examinations constantly. He is also afraid of making presentations in class which increases tension since one of his teachers expects the class members to participate in public speaking from time to time. He exhibits normal speech volume, rate and coherent articulation. He appears tensed but with intact language skills. The general demeanor and facial expressions demonstrate a stressed mood. The affect is appropriate, congruent and affluent with no delusion and hallucination signs. He does not abuse drugs but he is under pressure to try by his peers. Cognitive functioning and memory are age appropriate and intact. NURS 6650 Clinical Supervision – anxiety disorder Essay.

Therapeutic Approach

The patient will be treated using thee cognitive behavioral therapy which is considered to the most effective approach towards anxiety disorder management. This will be combined with the exposure therapy which was not included in the previous treatment plan. The objective of these combined techniques will be to overcome the clients fear, calm their mind and reduce their levels of anxiety. Exposure therapy will involve exposing the client to his fearful situations to relieve the tension that triggers anxiety (Topper et al., 2017). The client will be requested to think of the scary situations and direct exposure through systematic desensitization. Relaxation techniques will be applied to confront the trigger in this case NURS 6650 Clinical Supervision – anxiety disorder Essay.

Cognitive behavior therapy addresses negative distortions and behaviors thus changing our perception of the selves and the world (Hofmann & Otto, 2017). This in turn develops positive behaviors that help in the adaptation to the reality and reduction of fears that trigger anxiety. This will modify the client’s thoughts and behaviors as well as his cognitions to determine the anxiety triggers. Moreover, it will address the reactions and behaviors towards different situations particularly public speaking, socialization and examination situations which are identified as the key triggers to his anxiety. This will be followed by the process of cognitive restructuring or thought challenging which will entail the identification of the client’s thoughts, challenging the negative ones through evaluation of the provoking thoughts, questioning evidence, analyzing beliefs and evaluating the reality of negative predictions (Stein & Sareen, 2015). Consequently, the negative thoughts will be replaced by the realistic thoughts.

Additional information

The history of the client’s sickness will be an added advantage to accurate diagnosis and treatment. This will help learn the previous mental conditions experience before and the type of treatment that were effective in the management of the condition. Moreover the family history will facilitate the identification of probable disorders that might run in the family and hence improve clinical decision-making. Additionally, information regarding their allergies will help determine the cause of minimal progress of the treatment plan that involved the use of medication (Lader, 2015). This is because; allergies could worsen the client’s symptoms rather than improve them and hence risk the patient’s safety NURS 6650 Clinical Supervision – anxiety disorder Essay.

References

Hofmann, S. G., & Otto, M. W. (2017). 
Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques
. Routledge.

Lader, M. (2015). Generalized anxiety disorder. 
Encyclopedia of psychopharmacology
, 699-702.

Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. 
New England Journal of Medicine
, 
373
(21), 2059-2068.

Topper, M., Emmelkamp, P. M., Watkins, E., & Ehring, T. (2017). Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. 
Behaviour research and therapy
, 
90
, 123-136 NURS 6650 Clinical Supervision – anxiety disorder Essay.

NURS 6650 – Treating Childhood Abuse Essay

What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.

How might exposure to the media and/or social media affect the patient?

What type of mandatory reporting (if any) is required in this case? Why?

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Child abuse is a global concern that affects the mental and physical stability of the victim. According to Thapar et al. (2015), there were 3.4 million referrals of child neglect and abuse cases in 2012. Many of the cases are caused by close relatives which makes reporting difficult due to fear and shame considering that children are still dependent on the abusers for provision. This paper explores abuse through the study of Morgan, a 19-year-old male’s, case with the aim of determining the assessment strategies foe abused patients, media and social media exposure and the mandatory reporting types for abuse cases NURS 6650 – Treating Childhood Abuse Essay.

Assessment Strategies

Physical examination is an effective strategy in assessing the signs of abuse. It identifies scars, deformities and other marks that suggest previous case of physical abuse. Inspection, palpation, percussion, and auscultation techniques are used to identify any deviations from the normal and also identify long-term effects of physical abuse on the patient (Sadock, Sadock, & Ruiz, 2014). On the other hand, psychological assessment screens for the mental status of the patient following the abuse incidences. For instance, the patient reports to have a depressed mood and panic attacked from the return of their abuser and this suggests that the event affects his mental wellbeing. This examination will involve the evaluation of the patient’s behavior, learning and thinking through psychological testing, observation, interviews and consultation (American Psychiatric Nurses Association, 2017) NURS 6650 – Treating Childhood Abuse Essay. These assessment strategies will inform accurate diagnosis as well as the formulation of the appropriate treatment plan.

Effects of exposure to the media and/or social media

The media and social media present increased exposure of persons to the outside world. Exposing patients to these platforms can have both positive and negative repercussions. For instance, exposure to the media and social media can help the client in getting psychological help from professionals. Additionally, he might be able to meet and interact with other individuals who have had familiar experiences and get to learn how to cope with the return of his abuser. On the other hand, exposure can result to bullying of the patient which could result to depression and social withdrawal among other mental problems. The patient might be ridiculed by the public subjecting them into significant distress which would eventually turn the patient into an abuser in the future. The exposure also breaches the privacy rights of the patients. on the contrary, it can also result in acceptance of the victim by the society as the media creates awareness of social crimes through his case NURS 6650 – Treating Childhood Abuse Essay. He might as well be used as the ambassador of the abused to share his experiences in the future and help others in their recovery.

Mandatory reporting required in this case

Mandatory reporting of abuse is a legal requirement in the United States for cases observed or suspected. Mandated reporters are responsible for reporting and in this case, the healthcare provider is expected to report to the child protective services (CPS). The report will be classified in the sexual abuse category since the patient was molested by their cousin during his childhood. The report will be filed with the child protection authorities as required by the Child Protection Act 1999 (Pfefferbaum & Shaw, 2013). Mandatory reporting will therefore be done to allow protection of the patient against future molestation and provide counselling on how to improve his quality of life even with the cousin currently out of prison NURS 6650 – Treating Childhood Abuse Essay.

 

References

American Psychiatric Nurses Association. (2017). Childhood and adolescent trauma. Retrieved from
http://www.apna.org/i4a/pages/index.cfm?pageID=4545

Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness.
Journal of the American Academy of Child & Adolescent Psychiatry
, 52(11), 1224–1238. Retrieved from
http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015).
Rutter’s child and adolescent psychiatry
(6th ed.). Hoboken, NJ: Wiley Blackwell. NURS 6650 – Treating Childhood Abuse Essay.

Intellectual Developmental Disorder Treatment options Essay

Intellectual development disorder is associated with deficits an individual’s intellect characterized by experiential learning, academic learning, abstract thinking, planning, judgment and reasoning (Zheng & Chen, 2016). The treatment of this disorder involves the alleviation of symptoms and multiple options are available for the management of this disease. Each treatment intervention is uniquely tailored for specific individual to meet their personal needs.

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Behavioral Intervention is effective in the treatment of intellectual developmental disorder. It involves the use of techniques and behavioral changes. Behavioral interventions seek to teach the functional alternative behaviors and reduce the associated symptoms. The techniques used include modelling, fading, prompting and reinforcements. Another intervention is applied behavior analysis (ABA) that utilizes the learning theory principles to bring about positive and meaningful change of behavior in the patient (Schuengel et al., 2019). These changes develop self-control, social, communication and self-monitoring skills. They are also applicable in the daily and structured settings as well as group and individual instruction Intellectual Developmental Disorder Treatment options Essay. Peer-Mediated treatment also engages children with disabilities in activities that boost their competency in communication.

Notably, pharmacological therapy is also effective in treating intellectual developmental disorder. It entails the use of medication to treat children for early developmental delays. Psychological therapy involving psychiatrists, geneticist, special education therapist, physical therapist or occupational and speech therapist is also necessary in treatment. Environmental arrangement organizes the surrounding to promote communication. The aim is to set the communication occasion and increase the environmental interest. The patient comments and expresses desires to understand and enquire about the environment thus improving the communication and learning skills. Moreover, Functional communication training (FCT) replaces challenging behavior with the appropriate communication and behavioral alternatives that improve their cognitive levels. On the other hand, Incidental teaching teaches elaborate communication attempts and interesting opportunities using prompt questions Intellectual Developmental Disorder Treatment options Essay.

References

Schuengel, C., van Rest, M. M., Stanford, C. E., & Hastings, R. P. (2019). Impact of Research About the Early Development of Children With Intellectual Disability: A Science Mapping Analysis. In 
Frontiers in Education
 (Vol. 4, p. 41). Frontiers.

Zheng, X. F., & Chen, J. J. (2016). Evaluation of intellectual development level of 300 children with language disorder. 
Zhongguo dang dai er ke za zhi= Chinese journal of contemporary pediatrics
, 
18
(11), 1115-1118 Intellectual Developmental Disorder Treatment options Essay.