Category: Nursing

Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

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Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

PMH: Asthma Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal

Medications: Symbicort 160/4.5mcg

Allergies: NKDA

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal

Assessment:

To prepare:

With regard to the SOAP note case study provided:

consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Analyze the SOAP note case study. Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature. Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal

 

Additional Information to Include in Subjective Data

Onset-The client reported that she noticed bumps I week ago which means that she was not certain for how long they have been present.
I will request the patient to explain the bumps more in terms of its size, pattern, shape, and color. In the past, have you noticed bumps or this is the first time? If you noticed them previously, did you make any efforts to treat them? Recently, have you had any fevers or illnesses? Have you undergone any recent procedures or surgeries that need anesthesia or happened to start a new medication? At the time that you discovered the bumps what were you doing? When you had chlamydia 2 years ago, did you experience similar symptoms? Recently in your house, has anyone had scabies or lice?

Location-patient initially reported external bumps on her genitalia.

Apart from the genitalia, have you noticed bumps elsewhere on your body? If there are any that are internal, can you tell?

Associated Symptoms
– the patient reported that the bumps feel rough and are painless

Currently, before noticing the bumps, did you experience any form of burning or itching? Do the bumps tend to crust over, weep or ulcerate? In the entire period since you noticed them, do the bumps have the same appearance or it happened to change? Do the bumps spread?

Duration- the patient noticed the bumps one week ago but remained uncertain on their exact onset.
Can you tell whether the bumps are always present throughout or if they come and go?

Aggravating factors-
Are you informed of potential factors that tend to aggravate the occurrence of the bumps? Are they irritated by warm water, clothing and tight undergarments? Personally, do you often use douches and fragrant soaps? Recently, have you changed body soaps and detergents that you use?

Relieving factors- Are you aware of anything that tends to reduce/decrease their number, makes them disappear, change its texture or shape?

Alternative treatments-
before seeking medical help, have you tried any topical medications or home remedies? If so, was there any appreciable change or improvement?

Scaling pain- the patient clearly reported that the bumps were painless

Can you please rate the degree to which the bumps bother and affect your life with 10 as the maximum effect?

Past Medical History: Chlamydia and Asthma

Do you have any past medical history of other STIs or Genital Herpes apart from chlamydia?

Underlying skin conditions such as psoriasis and eczema?

Have you either suffered from chicken pox or had its immunization?

Have you previously been admitted to the hospital? If so, how many times and what were the indications?

At what age were you diagnosed with Asthma and are you currently having any complications with it?

What medications were you prescribed previously for chlamydia and who prescribed them?

Past Surgical History

Have you had any major surgical operations or C-section?

Medications: the patient uses Symbicort 160/4.5mcg

Are you taking any birth control meds, medications for acne or other drugs? If yes, when did you start and do you have any issues with it so far?

Since you are asthmatic, do you have a rescue inhaler?

OTC Medications, Supplements, and Herbs

Are you currently taking any work-out supplements, vitamins or OTC medications? If so which ones?

Denies History of?

Do you have a history of Psoriasis, Syphilis, Diabetes, thyroid disease, and a recent candida or step infection and HIV?

Allergies

Do you have any food, drug, and environmental allergies?

Personal Socio-Economic History- The client is a college student, married with children (2 boys and 1 girl). The patient denied the use of tobacco, occasional ETOH.

Do you live in a single home with the children and your spouse? If she lives in a dorm, it is worth knowing how many people they share the bathrooms with. Do you use/abuse any prescription drugs and illicit drugs? What kind of work do you do? What is your husband’s occupation? What are your hobbies? Have you had any recent increase in stressors? What is the client’s cultural history, religion and support system? Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal

Sexual Reproductive History- she is single and sexually active since 18 years of age. She also reports that she had more than 1 partner in the past year. She did a pap smear 3 years ago, which appeared to be normal with no dysplasia. She was diagnosed with Chlamydia 2 years ago and took a complete drug regimen.

It will be necessary to confirm if the client has had any problems since she completed treatment for chlamydia. It will also be necessary to confirm the number of sexual partners that she has had so far and discuss the use of protection. Information on her sexual orientation and how well she prescribes her gender will also be important. Have you ever gotten pregnant? Have you ever had any abortions and miscarriages? Do you know the sexual status of your partners? Do you engage in anal sex? Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal. Do you undertake self-breast exams, if yes, how frequently?

Family History: No previous history of cervical cancer or cervical cancer. Father has a history of Hypertension and mother has a history of GERD and Hypertension.

It will be important to know the age of the client’s parents and if they are deceased or alive. Additional history on both paternal and maternal grandparents and siblings should also be obtained.

Review of Systems

General: 
Have you had any recent weight gain or loss, symptoms of fever and fatigue?

HEENT:
Have you had a recent sore throat, noticed any sores in your oral cavity and throat or white coating on your tongue?

Breasts: 
Do your breasts have any drainage, lumps, tenderness or lumps? Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Respiratory:
Any chest tightness, cough, wheezing or pleurisy?

Cardiovascular/ Peripheral Vascular:         
Any palpitations, chest pain, edema, murmur and arrhythmias?

Gastrointestinal:
Have you experienced symptoms of vomiting, nausea, heartburn, vomiting. Do you experience fresh blood in stool, gray or black stools?

Genitourinary:
What is your last LMP? Do you have any issues with your menstrual cycle? Do you experience urinary symptoms of hesitancy, pain, burning and increased frequency? Do you have any tenderness on the vulval region, dyspareunia, foul odor or vaginal bleeding?

Skin:  
Do you have any histories of eczema, skin cancer, and psoriasis or removal of lesions? Have you experienced any recent or past increased sensitivity to lotions, soaps, and detergents?

Additional Information to Include in Objective Data

Physical Exam:

Vital signs:
Temp 98.6, PR 92, RR 16, BP 120/86, Ht 5’10”, Wt. 169 lbs., BMI = 24.2.

General
: I will describe the patient’s stature, walking gait, grooming, eye contact and affect

HEENT
: I will assess for edema, any drainage, cold sores, tonsils, lesions, oral thrush and look for systemic signs of infection of HSV or other viral infections. Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Neck:
I will assess for nodal tenderness, enlarged nodes at the cervical and clavicular regions, jugular venous distension and bruits.

Chest
: I will assess for labored or non-labored breathing, No breast lumps, nipple discharge, tenderness or nodules. No enlargement of the axillary nodes.

Lungs:
Symmetrical chest wall, CTA. Check for nasal flaring, retractions and wheezing.

Heart & Peripheral Vascular-Rapid Respiratory rate, no murmur, no edema.

Abdomen: Soft, non-tender, normal and active bowel sounds,        no rebound tenderness, negative murphy’s and McBurney’s sign

Genital/Rectal
: Normal distribution of hair, normal hair pattern, no swellings or masses, the urethral meatus has no discharge or erythema and is intact; the perineum is also intact with a healed scar for an episiotomy. The vaginal mucosa is moist, has rugae and is pink in color. The POS is firm, small and round. On the external labia, a painless ulcer is noted.

It is notable that the client has not had a pap smear for 3 years and had a history of chlamydia. Therefore, I will immediately do a pap smear and inspect the cervix for its presentation and motion tenderness in the process. I will check for possible vaginal bleeding, and note any foul discharge or odor. I will palpate to check for enlargement and tenderness of the inguinal lymph nodes. I will check for discharge in the scene and Bartholin glands. I will also note if the ulcer is indurated, whether or not it is the only one and its color. Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Skin: I will examine the skin for dryness, warmth, and pinkness. I will also check other regions for redness, discoloration, scaling, and patches.

Diagnostics

An HSV specimen was obtained for viral culture. To obtain results that are more specific, it will take 1-7 days.

A PH litmus and wet mount KOH should also be considered depending on the PE. Aspects such as clue cells, high PH and a gray discharge should be looked for.

Nontreponemal, PCR, EIA and VDRL tests should be considered for syphilis serology (Gayet-Ageron, et al., 2015).

A small scraping should also be obtained to look for spirochetes

A tzanck smear from the vesicles base should also be done. This test is definite for HSV. The findings that are most likely to be present are multinucleated giant cells but is only if the specimen will be from a herpes lesion that is intact. Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Assessment: Possible Differential Diagnosis

Acute Contact Dermatitis

Syphilis

Herpes Progenitalis(Simplex II)

Syphilis
– This most likely but confirmation with serology is needed. Since the patient has previous STIs history with multiple sexual partners, she is at risk of syphilis. Besides, the place where the lesion is located on the external labia permits easy contact with a direct syphilitic sore (Gayet-Ageron, et al., 2015). Based on the fact that currently, the ulcer is painless, with no itching, burning or pain prior to its eruption, syphilis is a likely diagnosis but previous diagnoses should be ruled out.

Both the objective and subjective data supports a Syphilis diagnosis. However, intensive diagnostics and questioning of the patient should be considered to obtain information that is more precise. For instance, it is important to know about the lesion’s borders, if its base is clear and firmness.

Acute Contact Dermatitis
– this is not likely since the patient has no history of allergens. It should also be noted that the client’s history of her work environment and most recent activities could lead to this diagnosis. If it were contact related, large erythema region could also be expected (Seller& Symons, 2012) Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Herpes Progenitalis (Simplex II)
– The assumption that only a single ulcer exists minimizes the possibility of Herpes Progenitalis, besides, the ulcer that was described was firm. In case of a previous infection, it is usually intensive while the recurrent tend to be localized with patches.  Lesions can even burn and are always painful (Wagenlehner, et al., 2016).

 

References

Dains, J. E., Baumann, L. C., & Scheibel, P., (2016). 
Advanced health assessment and clinical diagnosis in primary care
(5
th
ed.). St. Louis, MO: Elsevier Mosby.

Gayet-Ageron, A., Sednaoui, P., Lautenschlager, S., Ferry, T., Toutous-Trellu, L., Cavassini, M., & Schrenzel, J. (2015). Use of Treponema pallidum PCR in the testing of ulcers for diagnosis of primary syphilis.
Emerging infectious diseases
, 
21
(1), 127.

Seller, R. H., Symons, A.B. (2012). 
Differential Diagnosis of Common Complaints
(6
th
ed). Philadelphia, PA.: Elsevier-Saunders Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

Seidel, H.M., Ball, J. S., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidels’s guide to physical examination
(8
th
ed.).  St. Louis, MO: Elsevier Mosby

Wagenlehner, F. M., Brockmeyer, N. H., Discher, T., Friese, K., & Wichelhaus, T. A. (2016). The presentation, diagnosis, and treatment of sexually transmitted infections. 
Deutsches Ärzteblatt International
, 
113
(1-2), 11 Genitalia Assessment SOAP note case study – Special Examinations—Breast, Genital, Prostate, and Rectal.

NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

Legal and ethical considerations

How legal and ethical considerations for group and family therapy differ from those for individual therapy.

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Therapy is typically dependent on the description of the clients and their expectations. In fact, this difference can be noted for individual and group/family therapies owing to the distinctions of their position level in community structures. All therapies apply professional psychotherapeutic principles to solve existing psychiatric and mental problems. However, unique differences exist with regards to their legal and ethical considerations (Sadock, B., Sadock, V. & Ruiz, 2014). In this respect, differences exist between individual and group/family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

There are three notable ethical differences between the two types of therapies. The first ethical difference is the professional qualifications of therapists who provide their services. On one hand, individual therapy is a general expectation for all therapists. On the other hand, group/family therapy requires that the therapist first undergo training to provide individual therapy before undergoing additional training to provide group and family therapy. This means that the therapists providing services for the two types of therapies are ethical expected to meet the different qualification expectations for practice (Wheeler, 2014). The second ethical difference is that for individual therapy, an informed consent can be expected to express the client’s true sentiments in terms of voluntarily attending the therapy. The same cannot be said for family/group therapy where the realities of social structures create the possibility of some of the members being coerced into attending the therapy. This implies that therapists providing family/group therapy must consider the possibility that some of the members may have been coerced into attending the therapy and would not participate fully or support the therapy exercises. This is particularly an issue of consideration where there are glaring power and authority differences such as children being coerced into attending family therapy by their parents (Whitaker & Cosgrove, 2015). The third ethical difference is that confidentiality would not be much of a concern in individual therapy, but that may not be the case with family/group therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment. That is because the members are not obligated to keep any disclosures made in the therapy sessions confidential. This is an ethical concern that therapists must consider when dealing with group/family therapies since they cannot offer any guarantees that the information that any member discloses will not be exposed outside the group (Cautin, & Lilienfeld, 2015).

In addition to the three ethical concerns that have been discussed, legal difference also exist between the two types of therapies. Firstly, therapists providing psychiatric services must be licensed and certified to provide these services. This would define their scope of practice and geographical area of operation that would typically be defined in terms of states. These licenses and certifications are periodically issued by recognized organizations after ascertaining that the individual is qualified to offer the services (Cautin, & Lilienfeld, 2015). Secondly, therapists are expected to keep all information confidential as indicated by HIPAA legislation. This means that the information can only be used under express permission of the client and for therapy purposes. Therapists who breach the legislation risk facing legal sanctions that could range from their licenses being withdrawn to fines and incarceration (Wheeler, 2014). As a result, therapists should be aware of the legal and ethical considerations when providing their services. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

How the differences might impact your therapeutic approaches for clients in group and family therapy.

The differences noted in the legal and ethical considerations can influence therapeutic approaches for group/family therapies in a number of ways. Firstly, the therapist should meet the licensure and certification requirements to practice, while ensuring that all documentation is current. Secondly, the therapist should consider the possibility that some group/family members could be coerced to attend therapy thus influencing their participation and therapy outcomes. Finally, information security measures should be implemented on how to handle client information in terms of secure storage and use to conform to HIPAA requirements.

References

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

Sadock, B., Sadock, V. & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatr
y (11
th
ed.). Philadelphia, PA: Wolters Kluwer. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Wheeler, K. (Eds.). (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.

Whitaker, R. & Cosgrove, L. (2015).
Psychiatry under the influence: institutional corruption, social injury, and prescriptions for reform
. New York, NY: Palgrave Macmillan.

 

 

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Learning Objectives

Students will:

• Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy

• Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy

• Recommend strategies to address legal and ethical considerations for group and family therapy

To prepare:

• Review this week’s Learning Resources and consider the insights they provide on group and family therapy.

• View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

By Day 3

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

 

The Group Psychologist
|
April 2011

Group Psychotherapy Column

Procedures and guidelines for group therapy

Detailed procedures and rules members of group therapy must adhere to.

By
John Breeskin, PhD, ABPP

Confidentiality

Anything said between any two or more group members at any time is part of the group and is confidential.
I understand that everything said in group is confidential. I agree to keep secret the names of other members of the group and what is said in the group. I agree to keep secret anything which occurs between or among group members. I understand that there is an exception to this confidentiality which applies to the group leader. If the group leader believes that someone is in danger, the leader has a professional obligation to take direct action in order to keep everyone safe.

I agree not to keep secret from the group anything which occurs within the group. Anything which occurs between or among any members is part of the group is kept secret from anyone outside of the group but is not kept secret from the group. This also applies to any individual meetings you may have with a group leader. I understand that if I violate this confidentiality I could be removed from the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Privacy (The Stop Rule)

No group member is ever required to answer any question, to participate in any activity, or to tell anything. If I am asked questions or asked to participate in an activity which makes me feel uncomfortable, I understand that I have the right to pass, that is, the right to refuse. I agree that will never pressure other group members to participate in any discussion or activity after the member has passed or refused. I understand that the group leader is obliged to protect this right. I also understand that I will benefit more from group the more I am able to take risks in sharing and participating.

Dignity

No group member is ever humiliated, hazed, or abused in any way. I agree to avoid this destructive behavior.

Violence or intimidation

Violence or intimidation toward other group members is never tolerated. I understand that I must never be violent or intimidating toward other group members and that if I threaten to harm persons or property I will be asked to leave the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Alcohol and Other Drugs

Group members cannot participate in the group under the influence of alcohol or other mind altering drugs. When under the influence of chemicals, persons do not have access to their emotions and have less control over their behavior. I understand that if the leader believes that I am under the influence of alcohol or other drugs, I will be asked to leave the group.

Exclusive relationships

Dating and other exclusive relationships between or among group members are not a good idea. The relationships can make other group members feel left out. When a couple breaks up, for example, this can be most painful and may make it impossible for these people to continue in the group. Since anything which occurs between or among group members is part of the group, members who are dating or in very exclusive relationships may be embarrassed when their intimate moments are discussed in the group.

Gossip

Gossip and secret grudges can be very destructive in a group. I agree that if I have something to say to another group member, I will try to say it to the member directly rather than talk about him/ her behind his/her back.

Attendance

I agree that I will attend every meeting unless an emergency arises. If an emergency should arise I will notify the group leader prior to the meeting to tell him or her that I will be unable to attend. I understand that the group leader will tell the group what has happened. I understand that if I have three unexcused absences, my continued group membership will be discussed. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Internet Connectivity

I feel very strongly that the members of the group should form and participate in an online group limited to the group members. Of course, the same cautionary notes apply to the internet communications in terms of both confidentiality and inter-group sharing. (I have used this model very successfully, and it significantly enhances a healthy form of interconnection.)

Responsibilities

I understand that it is the group leader’s responsibility to enforce these procedures and guidelines. The group may, when it wishes, propose other procedures and guidelines which will be up to the group to monitor.

Termination

Usually, group members decide, within the group, with the leader, when it is time to leave the group. Sometimes it is necessary for a group member to leave the group unexpectedly. This can cause group members to wonder if they have harmed the leaving member. I promise that if I must leave the group unexpectedly, I will come to a last group meeting and tell the members that I am leaving and say goodbye. I agree to announce this at the beginning of the last meeting so that the group has time to ask questions and say goodbye. If I decide to leave the group the group members may express their concerns but also respect the decision of the person wishing to leave. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

I have read the procedures and guidelines for group and agree to be bound by them while I am a member of the group

_____________________         ____________

Group Member                         Date

I promise to faithfully enforce procedures and guidelines for this group.

____________

Date

JB

Group Leader

 

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Comparison of legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy

In individual therapy, informed consent involves explaining to the client about the treatment and all for the client to decide whether to take part in the therapy or not. On the other hand, in group therapy and family therapy informed consent involves presenting essential information regarding the group treatment to individuals to ensure that they are in a position to rationally decide whether to take part in the group and how to participate (Cooper et al, 2017).  This indicates that informed consent in group/family therapy is relatively different when compared to informed consent in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

In individual therapy confidentiality and privacy are not a major issue because only the client and the therapist are involved. However, in both group and family therapy, confidentiality and privacy issues become a challenge. For example, in group therapy, there is more than one client and during the therapy group members may discuss and reveal their diagnosis, treatment and other issues. The confidentiality and privacy of such information is hence disclosed to all group members (McClanahan, 2014). Similarly, in family therapy, the therapist may be forced to keep quite on some issues, due to the promises the therapist made in good faith. One family member may reveal some vital information, that they may not want the other party to know (Breeskin, 2011). This brings in confidentiality and privacy issues not present in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

The aspect of neutrality and dual relationships is common in family therapy (Laureate Education, 2015). While in individual therapy the therapist is only handling a single client, during a family therapy the therapist handles more than one party and hence the issue of neutrality and dual relationships may arise (Bellesheim, 2016). For example, family members may be having conflicting issues they want addressed. Therapists may hence find themselves in an ethical dilemma regarding their role on conflicting issues of family members.

Impact of the Differences on Therapeutic Approaches

These differences render therapeutic approach more complex and challenging. For example, obtaining an informed consent in group therapy and family therapy is more complex and comprehensive and hence consumes a lot of time (Cooper et al, 2017). In addition, some parties may refuse to take part in the therapy, for instance in family therapy and this leaves the therapist in an uncomfortable situation regarding what to do.  Secondly, confidentiality may be difficult to maintain in family and group therapy because there are more parties involved (Bellesheim, 2016). At times confidentiality and privacy may be breached by one of the group or family member, which eventually impacts the therapeutic approach; for instance, some members may become very affected due to confidentiality breach while some may even terminate treatment. Finally, since maintaining neutrality may be challenging in a family therapy, often the therapist may face a dilemma on the action to take which may slow and even hinder the therapy (Bellesheim, 2016). NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Strategies to address the Legal and Ethical Considerations

Always have the group members read, understand and sign a document detailing procedures and rules for members of group therapy (Breeskin, 2011).

The therapist should always set and maintain group therapy rules

Any client who attempts to or actually breaches the set rules should have an appropriate action taken such as being referred for individual therapy

The group members need to be educated regarding confidentiality and privacy to ensure they are well versed and minimize the risk of breaching confidentiality

Zero tolerance to rule violation NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

The therapist should model the required behaviors, for instance by maintaining the confidentiality of the client’s information (Riva & Erickson, 2018).

References

Bellesheim K. (2016). Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals with Serious Mental Illness.
Ethics & Behavior .
26(7), 607-620.

Breeskin, J. (2011). Procedures and guidelines for group therapy.
The Group Psychologist
. 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Cooper E, Hudson J, Marti K & Lise M. (2017). The Future of Group Therapy: Current and Future Challenges in Group Therapy. International Journal of Group Psychotherapy . 47(1), S219-S239.

Laureate Education. (2015).
Microskills: Family counseling techniques 2 [Video file]
. Baltimore, MD: Laureate Education. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-

Riva, M & Erickson J. (2018).
Ethical Considerations in Group Psychotherapy
. In M. Leach & E. Welfel (Eds.),
The Cambridge Handbook of Applied Psychological Ethics
(Cambridge Handbooks in Psychology, pp. 218-238). Cambridge: Cambridge University NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

Cognitive Versus Rational Emotive Behavioral Theory

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature. Cognitive Versus Rational Emotive Behavioral Theory.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

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Similarities and Differences between CBT and REBT

Introduction

           
In psychotherapy, the term Cognitive Behavioral Therapy (CBT) has almost become a generic term for Rational Emotive Behavioral Therapy (REBT) and Cognitive Therapy (CT). According to Ellis (2003), “it is almost impossible to describe accurately … [as] it has now become much more eclectic and integrative ….” (p. 225). Corey (2017) confirms this inclusive nature of CBT by stating that “One of the most common CBT group approaches is based on REBT principles and techniques” (p. 279). Cognitive Versus Rational Emotive Behavioral Theory For this reason, some authorities seem to use the terms CBT and CT synonymously and interchangeably (Corey, 2017). This paper looks at the similarities and differences between REBT and Cognitive Behavioral Therapy (CBT/CT). The former was independently developed by Albert Ellis in the same period that the latter was being developed by Aaron T. Beck (Corey, 2017).

Similarities between CBT and REBT

CBT and REBT as psychotherapy options share quite a number of similarities. Both are types of behavior therapy that encourage patients to work on their thoughts between therapy sessions, at home. This makes both REBT and CBT use “specific homework assignments” that are given to the patient/ client to go work on and accomplish (Ellis, 2003, p. 229). Both therapies also hold that the way people express their behavior outwardly is the consequence of their own perceptions and beliefs. Furthermore, they also both require the patient or client to identify their problem themselves (Corey, 2017). CBT and REBT both focus on educating the patient and enabling them to work on prevention of presently held negative thoughts influencing future behavior and emotions (Ellis, 2003; Corey, 2017). CBT and REBT also both stress the significance of “irrational or dysfunctional beliefs in the creation of emotional disturbance ….” (Ellis, 1999, p. 5; Iftene et al., 2015). In all, both REBT and CBT advocate for a healthy and “friendly, caring therapist-client relationship” (Ellis, 2003, p. 228). Cognitive Versus Rational Emotive Behavioral Theory.

Three Differences Between CBT and REBT

According to Ellis (2003), CT takes “a collaborative stance” between therapists and clients. REBT, on the other hand, emphasizes more on the therapist teaching the client and the latter absorbing and implementing what they are taught. The major underpinning hypothesis of REBT is that “people contribute to their own psychological problems … [and] specific symptoms” because of what they hold to be true in their own minds (Corey, 2017, p. 271). CBT/ CT on the other hand, is “based on empirical research” and uses evidence-based and tested methods (Corey, 2017, p. 281) Cognitive Versus Rational Emotive Behavioral Theory. The third difference between the two is that on the one hand, REBT aims to make the patient or client identify long-held beliefs and thereafter systematically disabuse them of the same through education. On the other hand, CBT does not consider the client’s negative beliefs as the only cause of symptoms; but also “genetic, neurological, or environmental changes” (Corey, 2017, p. 282). These differences, therefore, may impact my practice as a mental health counsellor in that I’ll have to make an informed choice of behavior therapy to use between the two on a case-by-case basis Cognitive Versus Rational Emotive Behavioral Theory.

Preference for Cognitive Therapy (CT)

Although both psychotherapy modalities are effective and widely accepted, my preference would be CBT. This is because it is based on tested practical evidence that is scientific and can be quantified and replicated (Corey, 2017). Evidence-based therapies (EBT) are currently the gold standard across all levels of medical practice.

Summary

           
REBT and CBT/ CT are alternative forms of behavior therapy that were developed independently at approximately the same time. The former uses philosophical tenets while that latter takes an empirical evidence-based approach. Both are however similar in many ways and significantly impact the practice of the mental health counselor.  

References

Corey, G. (2017).
Theory and practice of counselling and psychotherapy, 10
th
ed
. Boston, MA: Cengage Learning. Cognitive Versus Rational Emotive Behavioral Theory.

Ellis, A. (1999). Rational emotive behavior therapy and cognitive behavior therapy for elderly people.
Journal of Rational-Emotive & Cognitive-Behavior Therapy, 17(1)
, 5-18. DOI: 10.1023/a:1023017013225

Ellis, A. (2003). Similarities and differences between rational emotive behavior therapy and cognitive therapy.
Journal of Cognitive Psychotherapy: An International Quarterly, 17(3)
, 225-240. DOI: 10.1891/jcop.17.3.225.52535

Iftene, F., Predescu, E., Stefan, S., & David, D. (2015). Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth: A randomized clinical trial.
Psychiatry Research, 225
, 687–694. DOI: 10.1016/j.psychres.2014.11.021 Cognitive Versus Rational Emotive Behavioral Theory

Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Introduction

A psychiatric emergency is a disturbance of behaviour, mood, or thought which may lead to harm to the individual or others if untreated (Sadock, Sadock, & Ruiz, 2014).  In both pediatric and adult psychiatric emergencies, the clinician must ensure the safety of everyone involved.  A complete assessment should be performed.  Goals of the psychiatric emergency assessment are to determine whether client poses a risk of harm to self or others, confirm the presence of a psychiatric disorder, and determine factors that may have lead to the issue. It is also essential to determine how the illness has impaired the client’s normal level of functioning, identify the client’s strengths, target the problems for treatment, and determine the level of care the client requires (Carandang, Gray, Marval-Ospino, &MacPhee, 2012). Suicidal behaviours are one of the most common pediatric psychiatric emergencies. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

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Description of Adult Psychiatric Emergency Case

Working and doing my practicum in an acute psychiatric hospital, I have cared for many adults with psychiatric emergencies.  In my last rotation, a 30-year-old Caucasian female with suicidal ideations with a plan to overdose presented to the facility for evaluation.  She reported feeling overwhelmed due to (a) a recent separation from her husband, (b) becoming a single mother, and (c) struggling financially.  The client used a wheelchair due to a motor vehicle accident and felt she was a burden to her family.  A therapist assessed her, and the psychiatrist on call admitted the client with a diagnosis of major depressive disorder. Laboratory testing included a complete blood count, comprehensive metabolic panel, thyroid stimulating hormone level, magnesium level, phosphorous level, urine drug screen, urine pregnancy test, and pharmacogenetic testing for psychiatric medications.  After less than an hour on the adult unit, the client stated she wanted to go home and filled out paperwork requesting release. The client was placed on a 72-hour hold. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.  An initial psychiatric evaluation was performed by the psychiatric mental health nurse practitioner later in the day, and the client was started on an antidepressant.  The client’s level of observation was downgraded to the line of sight after 24 hours then to every 15-minute checks the following day.  She received daily group psychotherapy, weekly individual psychotherapy, and evaluated by either a psychiatric mental health nurse practitioner or a psychiatrist daily.  Appointments for follow-up care were made, and the client was discharged home after 16 days in the facility. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

How a Child or Adolescent Would Be Treated Differently

If a pediatric client were to present with suicidal ideations with a plan, information would be gathered from both the parent or guardian and the child to form the diagnosis.  Laboratory testing would be the same as for the adult client except pregnancy testing; males and females below childbearing age would not require pregnancy testing (Lewandowski et al., 2013).  The psychiatric evaluation would be the same but may require the clinician to use simple words.  Children and adolescents would be asked about bullying at school or on social media and academic difficulties.  The child or adolescent would take part in family therapy sessions as a successful treatment of suicidality in the pediatric population is more likely to involve a family component (Lewandowski et al., 2013).  Selective serotonin reuptake inhibitors are the first-line medication for pediatric clients with moderate to severe depression. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

Ethical Issues

The treatment of children and adolescents requires the consent of their parents or guardians.  Each time a medication is changed, increased, or decreased consent from a parent or guardian must be obtained (Sadock, Sadock, & Ruiz, 2014).  Ethically, the clinician must recognize that children and adolescents must play a part in their treatment and obtain the assent of the minor whenever possible.

References

Carandang, C., Gray, C., Marval-Ospino, H., MacPhee, S. (2012). Child and adolescent psychiatric emergencies. In J. M. Rey (Ed.), 
IACAPAP e-textbook of child and adolescent mental health 
(pp.1-31). Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/J.1-EMERGENCIES-072012.pdf

Lewandowski, R. E., Acri, M. C., Hoagwood, K. E., Olfson, M., Clarke, G., Gardner, W., …& Frank, S. (2013). Evidence for the management of adolescent depression. 
Pediatrics
, 
132
(4), e996-e1009. doi:10.1542/peds.2013-0600

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. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

 

Week 6: Emergency Psychiatric Care in Childhood and Adolescence

”I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work.”

Jessica, age 13

When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients.

Photo Credit: ijubaphoto / iStock / Getty Images Plus

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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.

Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)

Chapter 31, “Child Psychiatry” (pp. 1226–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Bipolar and Related Disorders”

Note: You will access this book from the Walden Library databases.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Reversal of benzodiazepine effects

flumazenil

Aggression

Behavioral problems

Cataplexy syndrome

clozapine

propranolol

zuclopenthixol

aripiprazole

asenapine

chlorpromazine

haloperidol

iloperidone

lurasidone

olanzapine

paliperidone

quetiapine

risperidone

ziprasidone

clomipramine

imipramine

sodium oxybate

Catatonia

Extrapyramidal side effects

Mania

alprazolam

chlordiazepoxide

clonazepam

clorazepate

diazepam

estazolam

flunitrazepam

flurazepam

loflazepate

lorazepam

midazolam

oxazepam

quazepam

temazepam

triazolam

benztropine

diphenhydramine

trihexyphenidyl

alprazolam (adjunct)

aripiprazole

asenapine

carbamazepine

chlorpromazine

clonazepam (adjunct)

iloperidone

lamotrigine

levetiracetam

lithium

lorazepam (adjunct)

lurasidone

olanzapine

quetiapine

risperidone

sertindole

valproate (divalproex)

ziprasidone

zotepine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Optional Resources

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.

Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)

Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)

Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Learning Objectives

Students will:

Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients

Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

Review the Learning Resources concerning emergency psychiatric medicine.

Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.) Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post:

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 in Children Versus Adults Discussion Essay

Case Study: An African American Child Suffering From Depression

Therapy for Pediatric Clients with Mood Disorders

Introduction

Pediatric Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders.    Recent studies have shown a correlation between  affective disorders in children, and depression or anxiety disorders in the adult years. It is suggestive that the onset of adult psychopathologic disorders can be linked to behavioral or emotional symptoms displayed as  a child or adolescent.(Medscape, 2018). Case Study: An African American Child Suffering From Depression.

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Mood disorders in children remain one of the most under diagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.(chop,2018).  Treatments vary depending on the symptoms of the depression. Treatment is aimed at decreasing the signs of the illness. In order to properly treat a patient, there needs to be a complete assessment , past mental health history, psychological therapies and pharmacological interventions should be part of the treatment plan.

The purpose of this assignment is to discuss mood disorders and its effect on children and treatment options available.

Summary of patient

The patient is an 8 year old African American male with chief complaints of feeling “sad, withdrawn, decreased appetite and occasional irritation. Upon assessment the child is alert and oriented x 3, overall mood is sad. He denies visual or auditory hallucinations, however, admits to thinking about himself being dead. The Children’s Depression rating scale is 30, translates to significant depression. The CDRS was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds.(Poznanski,1986). Case Study: An African American Child Suffering From Depression.

Decision 1

Options:  Sertraline 25mg by mouth daily, Paxil 10 mg by mouth daily and Wellbutrin 75mg by mouth 2x/daily

I chose Sertraline 25 mg by mouth daily. Studies have shown that Sertaline is appropriate for treating depression in young children.”(SSRIs) have a relatively good response rate (40-70%)”(p.7). Paxil   is contraindicated for children younger than 18 and Wellbutrin is contraindicated as well. Wellbutrin has other risks for anorexia and seizures (p.16). The initial goal of treatment of mood disorders is a decrease in symptoms. The outcome of treatment was not as I expected , I expected a minimal reduction in symptoms. However, the client reported no change in symptoms.

Decision 2

Options: Prozac 10 mg by mouth daily, Sertraline 37.5 mg by mouth daily, Sertraline 50 mg by mouth daily

I chose to increase the Sertraline to 50 mg  by mouth daily. Sertraline is appropriate for treating children and the dosage can be titrated to up 200 mgs (p.18). The 25 mg dose might not be the right therapeutic dose and  to give it more time to become effective. I did not pick Sertraline 37.5 because it is below the therapeutic  dose suggestion. The reason for not choosing Prozac 10 mg by mouth daily, is to stay with the current medication and titrate up till symptoms decrease and client does not report depression symptoms. The goal of treatment is  to have a reduction in symptoms. The results were some of what I expected, I did not expect a 50% reduction in depressive symptoms. Case Study: An African American Child Suffering From Depression.

Decision 3

Options:  Maintain current dose, change to SNRI, or Increase to Sertraline 75 mg by mouth daily

My choice is to maintain the current dose. Stahl (2013) has mentioned that a 50% reduction in symptoms after treatment with an antidepressant is a “response”. If there is a positive response to a medication it is best to maintain that current treatment. There reason I did not chose the other two options was because the client had a 50% reduction in symptoms without any further symptoms. The goal is for the client to respond positively to medication leading to complete reduction of symptoms. The outcome was as I expected. The goal of titrating a medication that has shown positive results .After a 50% reduction, there should be more reduction after the next 4 weeks, leading to a complete remission of symptoms.

Conclusion with Ethical considerations

Children, including adolescents can display disruptive or irritability as a normal part of this stage in development. But key signs to watch for include irritability and not getting along with other children, stating other children do not like them, the feeling of rejection, these are “bridge symptoms” that can be early signs of risk for a anxiety or affective disorder. Parents, teachers, and care givers need to be aware of what is typical teen behavior and what is atypical to help prevent future mental health disorders.

The ethics and responsibility of prescribing medication falls in the hands of the provider. The provider is responsible for educating the client and the parents in this case of the risk. Children that are younger than 14 are not able to consent to treatment.” They cannot give legal permission for treatment, which must come from their parents. It is the responsibility of the prescribing clinician to inform the parents of the expected benefits and risks of the medication” (Vitiello, 2012, p.12).  The clinician has the responsibility  to monitor the clients  response to medication and compliance . Involving the parents in the plan of care can help monitor the effectiveness of the treatment. Case Study: An African American Child Suffering From Depression.

References

Children’s Hospital of Philadelphia.(2018) Retrieved from https://www.chop.edu/conditions-    diseases/mood-disorders-children-and-adolescents

Laurate Education (2016e).
Case study. An African American Child Suffering From Depression
[Interactive             media file]. Baltimore, MD: Author.

Medscape (2018).  Retrieved from https://www.medscape.com

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical     applications (
4th ed. New York, NY: Cambridge University Press.

Vitiello B. (2012). Principles in using psychotropic medication in children and adolescents. In Rey JM (ed),              IACAPAP
e-Textbook of Child and Adolescent Mental Health. Geneva: International Association       for Child and Adolescent Psychiatry and Allied Professions.
Retrieved from http://iacapap.org/wp-content/uploads/A.7-

 

 

Case Study: An African American Child Suffering From Depression NURS 6630 – Week 2

To prepare for this Assignment:

 

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

 

The Assignment

Examine
 Case Study: An African American Child Suffering From Depression
. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Case Study: An African American Child Suffering From Depression.

 

At each decision point stop to complete the following:

 

Decision #1

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

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. Why were they different? Case Study: An African American Child Suffering From Depression.

 

Decision #3

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. Why were they different?

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

 

Note:
 Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

 

Therapy for Pediatric Clients with Mood Disorders – Case Study: An African American Child Suffering From Depression

Decision #1

Which decision did you select?

Begin Zoloft 25 mg orally daily.

Why did you select this decision?

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that functions by restoring serotonin balance in the brain to improve mood, particularly the client’s depression. Besides that, it is highly effective in treating mood disorders and depression among children. In addition, starting at the lower dose of 25 mg since antidepressants tend to increase anxiety when first used Stahl, 2014) Case Study: An African American Child Suffering From Depression.

What were you hoping to achieve by making this decision?

The prescribed medication was intended to improve the client’s mood and address the depression by restoring the serotonin balance in the brain (Stahl, 2014).

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

The prescription and its dosage was intended to improve the client’s mood and address the depression (Stahl, 2014). But, this objective was not achieved. Instead, the client returned to the clinic after four weeks reporting that she had not experienced any changes to her depressive symptoms. The lack of response is likely the result of the low medication dosage with a higher dose anticipated to further improve the serotonin balance in the brain to alleviate the depressive symptoms (Stahl, 2013). Case Study: An African American Child Suffering From Depression

Decision #2

Increase Zoloft dose to 50 mg orally daily.

Why did you select this decision?

The dosage was increased since the initial dose did not achieve the desired outcome of reducing the depressive symptoms. The increased dose is anticipated to further improve serotonin balance in the brain thereby reducing the depressive symptoms (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to increase the prescribed medication dose was intended to reduce the client’s depressive symptoms by improving serotonin balance in the brain (Stahl, 2014).

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

The expected result from increasing the dosage to 50 mg was to reduce the depressive symptoms. This was achieved since the client visited the clinic four weeks later with the depressive symptoms reduced by 50% and client reporting that he was tolerating well (Stahl, 2014).

Decision #3

Maintain the current dose of Zoloft at 50 mg orally daily.

Why did you select this decision?

The decision to maintain the current dose was made for two reasons. Firstly, the client was responding well to the current dosage with clear symptoms reduction. Secondly, the client had adjusted well to the current dosage to imply that it was an optimum dosage for reducing the symptoms without presenting adverse effects (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to maintain the current dosage was made with the intention of building on the current positive results. The dosage is already working in relieving the depressive symptoms, and maintaining it is expected to continue the current trend of relieving the symptoms (Stahl, 2014) Case Study: An African American Child Suffering From Depression.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

It was expected that additional symptoms reduction would be reported beyond the current 50%. But this was not the case with no further reduction in symptoms reported after four weeks. Given that the 50% reduction in symptoms was not full remission, the client was responding to the medication so that a change in drugs was not warranted, then the next step would be to recommend the use of psychotherapy as an additive therapy to complement the prescription medication. This decision is informed by ethical justifications that the client is already responding to medication whose dosage cannot be increased so that psychotherapy is recommended as a complement that would provide additional benefits (Stahl, 2013; Stahl, 2014). Besides that, the standard safe Zoloft dose for children is 50 mg daily for mood disorders and depression. Increasing the dose beyond 50 mg daily is likely to reduce the symptoms further but also result in client intolerance and adverse side effects that include suicide tendencies (Gordon & Melvin, 2014; Magellan Health, Inc., 2013; Vitiello, 2012).

 

 

References

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal?
Journal of Pediatrics and Child Health
, 50(11), 847-854. doi:10.1111/jpc.12655 Case Study: An African American Child Suffering From Depression

Magellan Health, Inc. (2013).
Appropriate use of psychotropic drugs in children and adolescents: a clinical monograph
. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: neuroscientific basis and practical applications
(4
th
ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014).
The prescriber’s guide
(5
th
ed.). New York, NY: Cambridge University Press.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.),
IACAPAP e-textbook of child and adolescent mental health
. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf Case Study: An African American Child Suffering From Depression

Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Analyzing an Ethical Decision

Article: “Zhang S, Graham M, Brink J & Wang X. (2015). Involuntary admission and treatment of patients with mental disorder.
Neurosci Bull
. 31(1), 99–112”.

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Ethical Issue in the Article

Ethics involving involuntary treatment for people with mental illness revolve about protecting patients and other people and the ethical and legal aspects of balancing the autonomy and rights of the patient with the public rights (Sadock et al, 2014). Sometimes psychiatric patients do not consider themselves to be ill while other times they refuse to undergo treatment and therefore they may end up being forced to undergo treatment against their will (Zhang et al, 2015). Moreover, majority of voluntary psychiatric patients are coerced into accepting treatment maybe by the family, employer, friends or medical personnel. Accordingly, the involuntary treatment of psychiatric people brings in ethical issues in regard to autonomy and informed consent (Zhang et al, 2015). This is because involuntary treatment may be viewed to be violating the autonomy of the patient as well as the principle of informed consent. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Moral and Ethical Dilemmas Surrounding the Issue

The moral and ethical dilemma surrounding the issue of voluntary vs. involuntary treatment occurs when the healthcare provider is forced to honor the autonomy of the patient and seek informed consent, and at the same time ensure that the patient gets the suitable treatment (Opsal et al, 2016). Mental illness can impair the patient’s judgment and their decision-making ability and hence such patients may not be able to make decisions regarding their treatment. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Accordingly, the healthcare provider has to make a decision between respecting the autonomy of the patient and being beneficent by providing treatment to be patient (Hustoft et al, 2018). The line separating the respect for the patient autonomy and beneficent care brings in moral and ethical dilemmas especially when handling individuals with severe mental illness. A healthcare provider should be able to justify and be heedful of any removal of the patient’s right and learn the responsibility of stripping a patient their freedom in order to provide the appropriate care (Hustoft et al, 2018).

Comparison to State Health Laws and Regulations in Missouri

Missouri has civil commitment laws that set out the procedure to determine when involuntary treatment is suitable for people with severe mental illness. Laws of Missouri permit the use of court-ordered treatment which is referred to as assisted outpatient treatment (AOT). For a person to be provided with the court-ordered treatment, the person must demonstrate probability of serious harm to self and other people, and show significant risk of physical harm that may result due to the inability of the individual to make treatment decisions because of the mental impairment (Lebenbaum et al, 2018) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Missouri laws also list the designated facilities acknowledged by the Department of Mental Health to offer involuntary detention services. Similarly, the principle of beneficence supports treatment for the best interests of the patient and if the patient is perceived to pose danger to self or other people, and is unwilling to get treatment (Lebenbaum et al, 2018). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Process of Ethical Decision Making

The first step would be to recognize the ethical dilemma and gather the relevant factors about the dilemma. The second step would be to examine for the right-versus-wrong issues and test for right-versus-right paradigms. Finally, the organization policies regarding ethics and Missouri laws about involuntary treatment would be analyzed in order to make the appropriate ethical decisions (Brayley et al, 2015). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

References

Brayley J, Alston A & Rogers K. (2015). Legal criteria for involuntary mental health admission: clinician performance in recording grounds for decision.
Med J Aust
. 203 (8): 334.

Hustoft K, Larsen K et al. (2018). Voluntary or involuntary acute psychiatric hospitalization in Norway:A 24 h follow up study.
International Journal of Law and Psychiatry
. 56 (2018), 27-34

Lebenbaum M, Chiu M, Vigod S & Paul K. (2018). Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study.
BJPsych Open
. 4(2), 31–38. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Opsal A, Kare J & Clausen T. (2016). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders.
BMC Health Serv Res
. 16(656).

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.

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

•Standard 5D “Prescriptive Authority and Treatment” (page 58)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

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.

•Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)

•Chapter 31, “Child Psychiatry” (pp. 1082–1107)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Introduction”

•“Use of the Manual”

•“Cultural Formulation”

Note: You will access this book from the Walden Library databases.

Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from https://web.archive.org/web/20160416180027/http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf

American Psychological Association. (2017). Code of Ethics. Retrieved from http://www.apa.org/ethics/code/

Document: Child and Adolescent Diagnostic Assessment Worksheet (Word document)

Document: Practicum Journal Template (Word document) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Required Media

Gajbhare, P. (2014, March 8). Mental status examination [Video file]. Retrieved from https://www.youtube.com/watch?v=VjWVYgf2UcU

Note: The approximate length of this media piece is 36 minutes.

YMH Boston. (2013a, May 22). Vignette 1 – Introduction to a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=pQy-jwiu7gM

Note: The approximate length of this media piece is 3 minutes.

YMH Boston. (2013c, May 22). Vignette 4 – Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE

Note: The approximate length of this media piece is 4 minutes. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Optional Resources

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.

•Chapter 1, “Neural Sciences” (pp. 1–92)

•Chapter 31.2, “Assessment, Examination, and Psychological testing” (pp. 1107–1118)

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.

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

•Analyze salient ethical issues in psychiatric mental health practice

•Compare ethical dilemmas with state health laws and regulations

•Analyze ethical decision-making processes Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

To prepare:

•Review literature for moral/ethical issues encountered by a PMHNP.

•Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

•Summarize the moral/ethical issue in the article (no more than 1 paragraph).

•Describe the moral and ethical dilemmas surrounding the issue.

•Analyze the ethical issue and compare them to the state health laws and regulations in your state.

•Outline the process of ethical decision making you would use to address this ethical dilemma. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

Assignment 1: Practicum: Decision Tree

Introduction

The focus of the assignment is on making three decisions regarding the diagnosis and treatment of a client, 8-year-old Caucasian female with school difficulties. The first decision will involve making a differential diagnosis for the client and providing a rationale for selecting the decision. The second decision will involve making a decision about the treatment pan psychotherapy and providing a rationale for the decision. The last decision will be about treatment plan psychopharmacology and justifying the decision. In addition, the co-morbid physical and mental factors that may affect the diagnosis and treatment of the client will be considered. Finally, the paper will discuss the ethical considerations that may influence the treatment plan and communication with the client and her family. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

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Decision #1: Differential Diagnosis

The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This decision was selected because the client meets the criterion for A1 (inattention) for ADHD.  According to American Psychiatric Association (2013) the DSM-5 criteria confirming diagnosis of ADHD inattention include: the person fails to be attentive to details or makes mistakes in work, classwork, and other activities; difficulties in maintaining attention in tasks or play activities; often seems like one is not listening when spoken to directly; fails to follow through on instructions, does not finish classwork, chore or workplace duties; experiences difficulties in tasks and activities organization; normally avoids, does not like or is unwilling to take part in activities or tasks that need sustained mental efforts such as classwork or homework; regularly misplaces things essential for activities or tasks such as pens, books, toys; gets easily diverted and distracted by unnecessary stimuli and is often forgetful in daily activities (Volkmar et al, 2014). The client meets most of the above symptoms as indicated by the scoring of the Conner’s Teacher Rating Scale, subjective data and mental status exam. The Conner’s Teacher Rating Scale indicated that the client is inattentive, gets distracted easily, makes careless mistakes in her classwork, forgetful about the already learned content, poor in arithmetic, spelling and reading, short attention span and has difficulties in peer interactions. Subjective data indicated that the client could not sit still during the interview, was interruptive and reported that her mind wanders during class Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. The mental status exam revealed that the client’s attention and concentration were somehow limited.  Other standardized assessment instruments that might be essential in identifying symptoms of ADHD include
ACTeRS and the Vanderbilt Assessment Scale.
In addition, the
Child Behavior Checklist can be used to further assess the behavior of the client (Sadock et al, 2014).

By selecting this decision, the expectation was that the correct diagnosis for the client would facilitate appropriate prescribing of the treatment regimen for the client.

Decision #2: Treatment Plan for Psychotherapy

The selected decision is to begin Adderall XR 10 mg orally daily. Adderall is a branded combination of (75%) dextroamphetamine along with (25%) levoamphetamine salts. This decision was selected because Adderall is FDA approved for the treatment of ADHD. In addition, evidence shows that Adderall is a stimulant that is effective in improving and balancing neurotransmitters level within the brain. Adderall also has minimal side effects and has fewer rebound symptoms because the medication wears off gradually and it is typically a long-lasting medication (Lakhan & Kirchgessner, 2013). According to Lakhan & Kirchgessner (2013), Adderall is an extended-release formulation that has a duration action of about 10-12 hours. This is a notably longer duration of action when compared to the majority of other methylphenidate formulations whose duration of action is a maximum of 6 hours. In addition, studies show that Adderall is a neuro-enhancement medication that is effective in memory improvement, improving focus and attention span (Lakhan & Kirchgessner, 2013). Accordingly, Adderall would be effective in treating the symptoms and signs of ADHD for the client. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

By choosing this decision, it was expected that symptoms and signs of ADHD for the client would improve since Adderall has been shown to be effective in improving symptoms such as attention span. Specifically, it was hoped that the client’s disruptive behavior would reduce as well as her ability to focus and pay attention. It was also hoped that the medication would improve the client’s episodic memory and hence reduce her forgetfulness. This is because a study conducted by Advokat & Mindy (2013) demonstrated that Adderall is a stimulant that has the ability to improve episodic memory in individuals with ADHD and also has some cognitive benefit.

The result for this decision was that there was an improvement in signs and symptoms of ADHD for the client as manifested by the ability of the client to be more attentive at school and the ability to maintain attention throughout the morning classes. This outcome was consistent with the expected outcome. However, during the afternoon the client would “daydream” which means she was not able to maintain attention in the afternoon. The reason for the client being not able to maintain attention in the afternoon was that the medication dose administered had worn off and therefore the inattentive symptoms would begin manifesting again prior to the administration of the subsequent dose of Adderall (Advokat & Mindy, 2013).  It was also reported that the client started losing appetite after she started taking Adderall. The loss of appetite for the client can be attributed to the medication’s side effects. Appetite loss is a common side effect with this medication because it suppresses appetite (Sallee, 2015).

Decision #3: Treatment Plan for Psychopharmacology

The selected decision for the client’s treatment plan for psychopharmacology is the addition of a small dose of immediate release of Adderall in the early afternoon. This decision was selected because the client has been showing inattentiveness during the afternoon because by afternoon the medication wears off. Therefore, the addition of a small dose of Adderall in the afternoon for the client will ensure that the client will maintain attention in the afternoon as well. In addition, the addition of a small dose of immediate release of Adderall would help the client to maintain attention during early evening and hence she will be able to do any homework given at school (Heal et al, 2013).

The reason why the decision to assure the parents that weight loss is a common side effect with Adderall was not chosen is because this option will not assist the client in maintaining attention in the afternoon classes. Secondly, the option of augmenting the Adderall treatment with family therapy was not selected because the family therapy would not solve the issue of return of the return of inattentive symptoms during the afternoon classes (Heal et al, 2013). Accordingly, this justifies the decision to add a small dose of immediate release of Adderall in the early afternoon in order to enable the client to maintain attention even during the afternoon. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Ethical Considerations in Treatment Plan

It will be important to ensure that the professional legal obligations of ensuring optimal treatment for the client are met. Therefore, it should be ensured that the assessment and treatment of Katie is I accordance with the current professional guidelines (American Nurses Association, 2014). Informed consent should be sought from the parents of Katie while Katie should also be allowed to assent to the treatment. This is because any assessment or treatment without seeking informed consent involves a legal misdemeanor of battery. Accordingly, in this case, it will be important to seek consent from the client’s parents but at the same time try to take into account the views and wishes of Katie (Merman et al, 2017). The treatment process for the client will also involve respect for autonomy by obtaining suitable consent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Moreover, the hyperactivity presents an ethical conflict between justice and beneficence/non‐maleficence. Other ethical aspects include the addictive effects of ADHD treatments and also evidence shows that ADHD treatment may have irreversible effects on the central nervous system. Accordingly, the healthcare practitioner should educate the client’s parents regarding the potential side effects of the proposed treatment to ensure the parents are fully informed before they consent into the treatment (Merman et al, 2017).

Conclusion

The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This is because the client meets the criterion for A1 (inattention) for ADHD as per DSM-5. The selected decision for decision point two is to begin Adderall XR 10 mg orally daily. The rationale for selecting this decision is because Adderall has been shown to be effective in improving signs and symptoms of ADHD by improving and balancing neurotransmitters level within the brain. The selected decision for decision point three is to add a small dose of immediate release of Adderall in the early afternoon. The rationale for selecting this decision is to ensure that the client will be able to maintain attention even during the afternoon.  Finally, it will be important to seek consent from the parents of Katie and also integrate wishes and views of Katie in the treatment plan. It is also important to educate the parents about the possible side effects of the proposed treatment regimen.

 

 

References

Advokat C & Mindy S. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers.
Front Neurosci
. 7(82).

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

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

Heal D, Smith S, Gosden  & Nutt D. (2013). Amphetamine, past and present – a pharmacological and clinical perspective.
J Psychopharmacology
. 27(6), 479–496.

Lakhan S & Kirchgessner A. (2013). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects.
Brain Behav
. 2(5), 661–677.

Merman S, Laura B, Hans G & Frances A. (2017). ADHD: a critical update for educational professionals.
Int J Qual Stud Health Well-being
. 12(1): 1298267.

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

Sallee F. (2015). Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers.
J Child Adolesc Psychopharmacol
. 25(7): 558–565.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder.
Journal of the American Academy of Child & Adolescent Psychiatry
. 53(2), 237–257.

 

Week 3: Autism Spectrum Disorder, ADHD, ODD, and ICD

”I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She does not care about me. She only cares about my little brother and that man that keeps coming around. I don’t care anything about her. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.  That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.

Jacob, age 11”

There are many mental disorders that occur early in the life course. The DSM-5 describes neurodevelopmental disorders such as autism spectrum disorder and ADHD and disruptive, impulse-control, and conduct disorders, such as oppositional defiant disorder and conduct disorder. These disorders are examined together with a particular emphasis on comparing and contrasting presenting features. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Diagnosis of these various conditions can rarely be made in a single office setting and often require a comprehensive approach involving multiple stakeholders, including the child, as well as his or her parents, teachers, and other significant figures in the child’s life and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.

The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

This week, you begin exploring disorders that occur early in the life course by working with your group to develop a Parent Guide. You also examine a case to determine a differential diagnosis and treatment plan that incorporates both psychotherapy and psychopharmacology.

Photo Credit: Cultura/Seb Oliver / Cultura / Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Required Readings

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

•Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

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.

•Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)

•Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253) Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

•“Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Irritability in autism

Attention-deficit/hyperactivity disorder

aripiprazole

risperidone

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine (hyperactivity)

clonidine

guanfacine

haloperidol (hyperactivity)

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Required Media

Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author.

Optional Resources

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.

•Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)

Assignment 1: Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Learning Objectives

Students will:

•Evaluate clients for treatment of mental health disorders

•Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:

Examine Case 1. 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.

At each Decision Point, stop to complete the following:

•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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

•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. 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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

•Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

•Also include how ethical considerations might impact your treatment plan and communication with clients and their families. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Conduct Disorder Parent Guide

Introduction

Conduct disorder is classified among disorders of disruptive behavior which are often comorbid with other defiant disorders. Conduct disorder is characterized by a pattern of behaviors which demonstrate a violation of rights and aggression. It has a complex etiology which is as a result of the interaction of several psychosocial and biological factors. Biologically, a low level of p5-hydroxy indole acetic acid levels in CSF tends to correlate with violence and aggression among children and adolescents Conduct Disorder Parent Guide. A family which lacks structure and supervision with occasional conflicts between parents and siblings results to maladaptive behaviors. This paper discusses the Conduct disorder including its signs and symptoms, pathophysiology, diagnosis, and currently available treatment options.

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Signs and Symptoms

The signs and symptoms of conduct disorder vary with age and are highly dependent on whether the condition is moderate, mild or severe. The first sign is aggressive behavior which may result in physical harm. Aggressive behavior may be in the form of fighting, bullying, forced sexual activity and cruelty to animals or others. Children may also display destructive behavior where they intentionally destroy and vandalize property (Blair, Leibenluft & Pine, 2014). Other children may display deceitful behavior where they repeatedly lie, break into cars or homes to steal or even shoplift. The last sign is that of violating rules such that, a child frequently goes against societal accepted rules or even engage in behaviors which are not appropriate for the child’s age (Blair, Leibenluft & Pine, 2014). Key examples of such behaviors may include sexual activity at a very young age, running away and skipping school Conduct Disorder Parent Guide.

Pathophysiology

 

Behaviors which are a problematic result from a child’s temperamental characteristics and environmental influences that shape the child’s temperament. As young as 2 years, the signs of irritability, inattentiveness, impulsivity, and compliance can result in behavioral patterns which negatively influence conduct in later ages (Sadock, Sadock & Ruiz, 2014). Due to difficulties with a child’s temperament, even parents with good intentions get involved in a negative cycle and can even isolate themselves from communal and family support. As a child advances, those with problems in conduct progressively display aggression and impulsivity with peers since they lack the skills for socializing (Sadock, Sadock & Ruiz, 2014). By the time they reach adolescence, most of them experience anger episodes and resort to being aggressive rather than responses that are verbally mediated.

Diagnosis of Conduct Disorder

Based on the DSM-V criteria for diagnosing mental health disorders, conduct disorder is diagnosed among individuals with a positive history of habitually violating the rights of other people such that, he/she fails to confirm individual behaviors to social norms that are appropriate for age. Besides, an individual ought to have at least four of the signs and symptoms in the categories of being aggressive to animals and people, destroying property, theft and deceit and serious violation of rules (American Psychiatric Association, 2013).   Some of the behaviors may include: using a weapon to harm others, frequent physical confrontations with others, aggressive behavior towards animals or others, destroying property with arson or other means, an incident of forcibly influencing another to engage in sex, engaging in economic crimes and running away from home at least twice(American Psychiatric Association, 2013).  The behaviors should also have significant impairment on the physical, social and mental functioning of the individual who should either be an adolescent or a child.  The child or adolescent may also have limited prosocial emotions such as lack of empathy, guilt or remorse, not concerned about his/her performance and a deficient effect.

Treatment Options

           
Treatment for conduct disorder aims at decreasing or eliminating behavioral problems in the short term while working towards the long-term goal of preventing the behavioral problems of children from worsening with time. Multiple modalities of treatment have proven to be highly effective in treatment especially the combination of psychotherapy with medications. The most effective psychotherapeutic approach is cognitive behavioral therapy (Sadock, Sadock & Ruiz, 2014). In this case, CBT is used in the context that behavioral which are not appropriate can be unlearned and replaced with pro-social ones which are more meaningful.  This is done through a systematic manipulation of consequences and rewards which promote behaviors which are pro-social and discourage those that are antisocial. Majority of the parents with children who have conduct disorder tend to blame themselves for creating a number of problems in a child’s life(Sadock, Sadock & Ruiz, 2014). Therefore, Family therapy can also be used to improve the interactions and communication among family members by addressing family conflict. For instance, parent management training can be used to teach parents how to positively change the behavior of a child at home.

Medications that have proven to be effective in the management of conduct disorder aim at reducing a child’s distressing symptoms such as aggression, impulse and other underlying mental illnesses that may be in existence. Generally, atypical antipsychotics such as risperidone are indicated for the management of mood lability (Pringsheim et al., 2015).  Clonidine, a beta blocker may also be used to control aggression and impulsivity. Anticonvulsants such as lithium have also proven to be effective in managing aggression and symptoms of mood disorders. Fluoxetine, which is a selective serotonin reuptake inhibitor, has proven to benefit patients with rigid, depressive aggressive behaviors (Pringsheim et al., 2015).   Stimulants are also effective in managing aggressiveness and impulsivity but need close parental monitoring due to high street value and a high potential for abuse from peers.

 

 

References

.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Blair, R. J. R., Leibenluft, E., & Pine, D. S. (2014). Conduct disorder and callous-unemotional traits in youth.
New England Journal of Medicine
, 
371
(23), 2207-2216.

Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behavior, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine.
The Canadian Journal of Psychiatry
, 
60
(2), 42-51.

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 Conduct Disorder Parent Guide

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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

•Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

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. Conduct Disorder Parent Guide.

•Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)

•Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

•“Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf Conduct Disorder Parent Guide

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. Conduct Disorder Parent Guide

Review the following medications:

Irritability in autism

Attention-deficit/hyperactivity disorder

aripiprazole

risperidone

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine (hyperactivity)

clonidine

guanfacine

haloperidol (hyperactivity)

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Required Media

Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author. Conduct Disorder Parent Guide

Optional Resources

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.

•Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)

Discussion: Parent Guide

Note: You and your group will use the wiki function to develop three Parent Guides (one in Week 3, one in Week 7, and one in Week 10). A wiki is a site that allows collaborative editing by all users. Each group will have its own place to communicate and collaborate on the assignments. Once your group has completed each assignment, one member should transfer the information to its final format and submit it through the group submission link in the Discussion. Do not delete the assignment from the wiki format, as your Instructor will review this area to determine each member’s participation.

Collaboration is essential to accurate diagnosis of the conditions under consideration in this week. For this week’s Discussion, you practice collaboration by working in a group on developing a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder Conduct Disorder Parent Guide.

It is recommended that you make your project as attractive as possible and consider using the finished product as teaching tools for families that you will work with in your own practices.

Learning Objectives

Students will:

•Analyze signs and symptoms of neurodevelopmental disorders

•Analyze the pathophysiology of neurodevelopmental disorders

•Analyze diagnosis and treatment methods for neurodevelopmental disorders

•Evaluate Parent Guides Conduct Disorder Parent Guide

To Prepare for this Discussion:

•Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.

•Review the resources concerning your assigned disorder.

•Review the Blackboard Help website concerning wikis.

•Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the Accessing Group Discussions instructions below.

Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:

•Signs and symptoms

•Pathophysiology

•How the disorder is diagnosed

•Treatment options

Provide a minimum of three academic references. Conduct Disorder Parent Guide

Working With Children and Adolescents Versus Adults Essay Discussion

Discussion: Working with Children and Adolescents versus Adults

Importance of Developmental Assessments

Developmental assessment in children is used to evaluate different facets of the child’s functioning like behavior, social interaction, cognition, communication, sensory abilities, motor abilities, as well as adaptive skills (Sadock, et al, 2014). Developmental assessment entails conducting accurate evaluations to determine the ability of a child to meet the essential developmental milestones and objectives. Working With Children and Adolescents Versus Adults Essay Discussion. In addition, it examines the performance and the ability of the child to perform common daily activities and tasks. Therefore, developmental assessment can help in identifying potential developmental problems and the need for more diagnostic examination; provides an objective account of the child’s deficits and abilities; and also helps in planning for suitable interventions (Thapar et al, 2015). In children diagnosed with or with suspected autism, all developmental domains should be assessed.

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Assessment Instruments to Evaluate Children and adolescents

The Modified Checklist for Autism in Toddlers (M-CHAT) instrument: This tool is utilized to evaluate children aged 16 months to 2 years and a half to examine their risk for autism. The tool has a set of 23 questions and it can be administered and scored as a component of well-child review and can also be utilized by specialists and other healthcare providers to assess a child’s risk to autism spectrum disorders.  The main aim of this instrument is to make the most of sensitivity and hence identify a high number of children with autism (Kleinman et al, 2013). Children who fail more than three items are supposed to be referred for diagnostic assessment by a specialist. Working With Children and Adolescents Versus Adults Essay Discussion.

Pediatric Symptom Checklist-17 (PSC-17): This is a brief questionnaire that is used to identify and evaluate for any emotional and behavioral changes and problems in children. This tool covers numerous behavioral and psychological problems. It is purposely used to examine the psychosocial functioning of the child. The tool has 35-item parent-reported questions as well as a youth self-report, a graphic version as well as a shorter 17-item version for parents and children (Murphy et al, 2016).

Treatment Options for Children and Adolescents

Floortime: This treatment entails the parent lying on the floor with the child and playing and performing the activities the childlike playing. Therapist and the parents engage the child through the activities preferred and enjoyed by the child and follow the child’s lead while playing. Floortime intervention aims at supporting the child’s emotional and cognitive development by assisting the child to learn emotional and communication skills (Mercer, 2015).

Kapvay: This is a non-stimulant and a long-acting clonidine used to treat AD/HD in children/adolescents aged between 6 to 17 years. The medication is normally prescribed two times a day and it is normally started at 0.1 mg and can be increased up to 0.2 mg two times a day.

The Parents’ Role

Parents play an important role in the assessment and treatment of children. First, parents have the duty of giving consent when children are being assessed and treated because minors are not supposed to give consent to their treatment. Secondly, during assessment parents act as informants and providing important information that may facilitate making an accurate diagnosis. Lastly, parents play a key role in ensuring that their children adhere to the treatment regimen (Sadock, et al, 2014). Working With Children and Adolescents Versus Adults Essay Discussion.

References

Kleinman J, Robins D, Ventola P, Juhi P, Hilarly B, Esser E, Wilson L et al. (2013). The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders.
J Autism Dev Disord
. 38(5), 827–839.

Mercer J. (2015). Examining DIR/Floortime™ as a Treatment for Children With Autism Spectrum Disorders: A Review of Research and Theory.
SAGE Journals
. 27(5), 625-635

Murphy M, Paul B, Chiang C, Sturner R, Howard B, Abel M & Michael J. (2016). The PSC-17: Subscale Scores, Reliability, and Factor Structure in a New National Sample.
Pediatrics
. 138(3), e20160038.

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. Working With Children and Adolescents Versus Adults Essay Discussion.

 

 

Discussion: Working With Children and Adolescents Versus Adults

Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP. Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents.

In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far.

Learning Objectives

Students will:

•Analyze the importance of developmental assessments

•Analyze assessment instruments used for evaluating children and adolescents

•Analyze treatment options used for children and adolescents

•Analyze roles parents play in assessment and treatment

To Prepare for the Discussion

•Review the Learning Resources concerning psychiatric assessments and assessment tools.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post your answers to the following:

•Explain why a developmental assessment of children and adolescents is important.

•Describe two assessment instruments and explain why they are used for children and adolescents but not adults.

•Describe two treatment options for children and adolescents that may not be used when treating adults.

•Explain the role parents play in assessment and treatment. Working With Children and Adolescents Versus Adults Essay Discussion

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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.

•Chapter 2, “Contributions of the Psychosocial Sciences” (pp. 93–130)

•Chapter 6, “Classification in Psychiatry” (pp. 290–299)

•Chapter 31, “Child Psychiatry” (pp. 1107–1152)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

Note: You will access this book from the Walden Library databases.

Resume, Portfolio, and Cover Letter Resources

CoverLetter.us. (2017). Nurse practitioner cover letter sample 1. Retrieved from http://www.coverletter.us/nurse-practitioner-cover-letter/ Working With Children and Adolescents Versus Adults Essay Discussion

Dahring, R. (2013). Cover letter caveats. Retrieved from https://web.archive.org/web/20161117160433/http://nurse-practitioners-and-physician-assistants.advanceweb.com:80/Columns/Career-Coach/Cover-Letter-Caveats.aspx

Porche, D. J., & Danna, D. (2015). Cover letter & resume preparation: Every detail is important when applying for a job. Advance Healthcare Network for NPs & PAs. Retrieved from https://web.archive.org/web/20160818183515/http://nurse-practitioners-and-physician-assistants.advanceweb.com:80/Features/Articles/Cover-Letter-Resume-Preparation.aspx

Walden University Career Services Center. (2017). Resumes & CVs: Home. Retrieved from http://academicguides.waldenu.edu/careerservices/resumesandcvs

Document: Cover Letter, Resume, and Portfolio Assignment Guide (PDF)

Optional Resources

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.

•Chapter 2, “Diagnosis, Diagnostic Formulations, and Classification” (pp. 17–30) Working With Children and Adolescents Versus Adults Essay Discussion

CBT in group and family settings

Post an explanation of how the use of CBT in groups compares to its use in family settings. Provide specific examples from your own practicum experiences. Then, explain at least two challenges counselors might encounter when using CBT in the group setting. Support your response with specific examples from this week’s media.

CBT in Group and Family Settings

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Introduction

Cognitive behavioral therapy (CBT) uses cognitive restructuring to change the maladaptive negative thinking pattern and behavior into a positive thinking pattern. CBT hypothesizes that an individual can be vulnerable to maladaptive thinking pattern of self, surrounding and the world in general. The focus of this discussion on the use of CBT in family and group settings (Thimm & Liss, 2014) CBT in group and family settings.

CBT in a group setting focuses on providing therapy to a number of people undergoing similar problems to change their maladaptive thinking patterns a more adaptive thinking pattern. The therapist focuses on the relationship between him/herself, the group, as well as the individual members of the group. Team members benefit from group therapy by sharing their challenges with other group members who might be having similar challenges (Wheeler, 2014). The group through members are a source of support and morale to each other since all members experience similar problems and challenges. CBT in group and family settings. In addition, by attending numerous individuals at once, the therapist can provide help to more individuals simultaneously (Thimm & Liss, 2014). During the practicum, I handled a group of members who all had a diagnosis of major depressive disorder.

CBT in a family setting hypothesizes that feelings, emotions, and behaviors are mutually influencing among family members. It, therefore, focuses on providing support to the members of the family to alter their thinking into more adaptive thinking and to ensure family members make better decisions and improve the atmosphere of the family setting (Wheeler, 2014). An example is a family where the husband was having an alcohol use disorder and both the wife and husband were involved in the therapy. CBT in group and family settings.

Some challenges counselors encounter while using the group setting include difficulties in restructuring the thinking pattern of people at the same time. Secondly, issues of privacy and confidentiality may present a challenge in a group setting (Ringle et al, 2015). CBT in group and family settings.

References

Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. 
Psychiatric services (Washington, D.C.)
. 
66
(9), 938-45.

Thimm J & Liss A. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice.
BMC Psychiatry
. 14(292).

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to

       guide for evidence-based practice
. New York, NY: Springer. CBT in group and family settings