Tag: Clinical-Nursing

Treatment of Psychiatric Emergencies in Children Versus Adults Essay

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

Briefly describe the case you selected.

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

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

Treatment of psychiatric emergencies

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Briefly describe the case you selected.

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

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

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

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

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

References

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

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

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

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

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

Assessing and Treating Pediatric Clients

Introduction

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

Decision Point One

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

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

 

Case #2

Anxiety disorder, OCD, or something else?

BACKGROUND

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

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

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

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

OBJECTIVE

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

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

MENTAL STATUS EXAM

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

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

Decision Point One

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

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

Generalized Anxiety Disorder (GAD)

Obsessive Compulsive Disorder

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

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

Obsessive Compulsive Disorder was chosen for the diagnosis in Decision 1

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

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

Decision #1: Differential Diagnosis

Which Decision did you select?

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

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

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

Why were they different?

Decision #2: Treatment Plan for Psychotherapy

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

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

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

Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

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

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

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

Why were they different?

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

 

Assessing and Treating Pediatric Clients

Introduction

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

Decision Point One

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

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

 

Decision Point Two

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

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

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

Decision Point Three

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

Ethical Considerations

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

Conclusion

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

 

References

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

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

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

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

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

NURS 6650 Clinical Supervision – anxiety disorder Essay

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

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

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

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

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

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

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

Therapeutic Approach

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

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

Additional information

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

References

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

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

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

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

NURS 6650 – Treating Childhood Abuse Essay

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

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

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

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

Assessment Strategies

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

Effects of exposure to the media and/or social media

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

Mandatory reporting required in this case

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

 

References

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

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

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

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

Intellectual Developmental Disorder Treatment options Essay

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

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

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

References

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

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

Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

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.

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https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/03/mm/decision_tree/index.html

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. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

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. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

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.

Review of Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Introduction

           
Katie is a female 8 year-old Caucasian child who is brought to the clinic by her parents. She has a previous provisional diagnosis of attention deficit hyperactivity disorder or ADHD. Katie is having difficulties in school with concentration and performance. She is also not socializing well with her peers and likes to keep to herself. Her attention span is also short. Katie was born to mature parents (47 and 49 years old respectively) and had notable low wellness scores at birth. The parents bring with them the Connor’s Teacher Rating Scale form which had been filled by her teacher at school. This is helpful in assessing her condition and arriving at the correct diagnosis.

Decision Point Number 1

In using the available assessment tools and based on what the parents and the teacher had reported, the diagnosis of ADHD with predominantly inattentive presentation was made as stated above. According to the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
, inattention such as Katie’s must meet criterion A. 1 (a)-(i) for this diagnosis to be reached (APA, 2013). This was met by Katie because her Conner’s Teacher Rating Scale shows that she is easily distracted at school and has the habit of only paying attention to what she has interest in. She is also quite forgetful of what she has been taught in school, attributable too to her inattention. The hope in arriving at this diagnosis was that Katie would be started on ADHD treatment at the right time; a fact that would place her in a better position to be free of her symptoms in the shortest time possible (Wender & Tomb, 2017). However, on close assessment during the revisit session, subjective evidence showed clearly that Katie was also evidently hyperactive as she could not stay in one place during the interview with the psychiatric-mental health nurse practitioner or PMHNP. Apart from the fact that her answers were short, it was also revealed that she also wonders in thought while in class Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie. Her mental status examination was however largely unremarkable.  She was oriented in all aspects and was dressed appropriately for both the time of the day and the weather. The only thing that stood out was that she had an imaginary friend by the name “Audrey.” Because of these findings, the presentation of the diagnosis had to be reviewed from predominantly inattentive to combined presentation (APA, 2013; Wender & Tomb, 2017). This is because her symptoms largely agreed also with criterion A. 2 (a)-(i) on hyperactivity and impulsivity. Moreover, she also fitted in with the rest f the criteria B, C, D, and E (APA, 2013). Thus the summary of her definitive diagnosis is ADHD with inattention, hyperactivity, and impulsivity. There wasn’t much difference in the initial decision and the revised one in terms of the results as the diagnosis itself has not changed but only the presentation. The fact that she had not started to show any significant response to treatment is to be expected because ADHD response to pharmacologic treatment typically takes weeks (Stahl, 2014; Katzung, 2018).

Decision Point Number 2

           
On the return visit the girl was put on wellbutrin (bupropion) 75 mg daily to be taken by mouth. This decision was taken because this s a major norepinephrine dopamine reuptake inhibitor or NDRI approved by the Food and Drug Administration (FDA) for the treatment of ADHD (Stahl, 2014; Katzung, 2018; Nursingworld.org, n.d.). The other reason for choosing wellbutrin is that it continues to work for several years later and in the process deters the recurrence of symptoms (Stahl, 2014). This long term remission is what was intended to be achieved by this choice. Wellbutrin is one of the best pharmacotherapeutic agents available for treating ADHD. However, its effects are normally not felt immediately and its full therapeutic action may be evident from up to four weeks later (Stahl, 2014). The results of this decision to start wellbutrin and what was expected are not significantly different for two reasons. First is that as stated it takes weeks for the full impact of the drug to be felt (this patient returned after four weeks). Two is that the questions that Katie is asking are not part of the known side effects of the drug (Stahl, 2014). Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Case #1

A young girl with difficulties in school

BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

Child Behavior Check List

Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” 
(Available at: https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 )
. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.” Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

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

 
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

 
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

 
314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

Decision Point Number 3

As stated above, wellbutrin (bupropion) does not cause the patient to ask the type of questions that Katie is asking as a side effect (Stahl, 2014). Therefore, the decision taken in this instance is to reassure the patients that those questions she is asking are just part of her normal developmental progress given her age. They have got nothing to do with the treatment which is evidence-based. As at now, there is no evidence to suggest that the drug may cause such behavior. Therefore, because the overall response is so far promising (the teacher says the girl has started being more attentive and is doing her academic work), the dose of bupropion will be doubled to 150 mg daily. By making this decision, the hope is to augment the noted effect of the drug and ensure long-lasting remission. One consideration though is that the questions about death by Katie may persist. This would mean she is having some sort of suicidal ideation which may be caused by the wellbutrin (Stahl, 2014; Wender & Tomb, 2017). If this occurs, it would mean the results of the intervention and the expectations would be different, due to the fact that antidepressants generally may at times cause suicidal ideation. In that case, the drug would be changed from wellbutrin to concerta 18 mg
mane
per day. this would also be supported by psychotherapy in terms of training in social skills to improve her engagement with her peers and take her mind away from suicidal thoughts (Corey, 2017). In doing all this, the ethical principle of nonmaleficence (not causing harm) has to be remembered as continuing a drug that may result in her committing suicide will be immoral. Also the decision of the parents on treatment options has to be respected – ethical principle of autonomy (Haswell, 2019).

References

American Psychiatric Association [APA] (2013).
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
5
th
ed. Arlington, VA: APA.

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

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179. Doi: 10.12968/joan.2019.8.4.177 Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Katzung, B.G. (Ed) (2018).
Basic and clinical pharmacology, 14
th
ed
. New York, NY: McGraw-Hill Education.

Nursingworld.org (n.d.).
Pharmacological Principles
. Retrieved 14 June 2019 from
https://www.nursingworld.org/~4ae124/globalassets/catalog/sample-chapters/pmhnpsamplechapter.pdf

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

Wender, P.H. & Tomb, D.A. (2017). ADHD:
A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults
, 5
th
ed. New York, NY: Oxford University Press. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay

Post an explanation of how the use of CBT in families compares to CBT in individual settings. Provide specific examples from your own practicum experiences. Then, explain challenges counselors might encounter when using CBT in the family setting. Support your position with specific examples from this week’s media. (references need to be since 2013 and from creditable resources)

Walden University NURS 6650 Week 5: Group and Family Psychotherapy

Introduction

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Cognitive behavioral therapy (CBT) trains individuals to recognize their maladaptive thinking patents and to be aware of the situations, thoughts, and feelings that induce negative automatic thoughts. After this step, CBT focuses on confirming if the individual would want to change their current problems (David et al, 2018). CBT is based on the premise that a person can be susceptible to negative thinking regarding self, future and generally the world. According to David et al (2018) thinking is reinforced by attitudes that are based on childhood experiences and other life events and this can lead to negative thinking. Therefore, CBT aims to change the negative thinking perspective into a positive thinking perspective through cognitive restructuring (Mohamadian et al, 2018). This discussion will focus on how the use of CBT in a family setting compared to CBT within individual settings NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

Individual CBT has a generally well-defined framework that emphasizes on reducing harm, especially with individuals who have substance abuse disorders or anxiety disorders (Wheeler, 2014). Individual CBT is a collaborative process that occurs between the therapist and the client; the process integrates physiology and schemas when developing the treatment plan (Wheeler, 2014).

On the other hand, CBT for the family is solution-focused and also brief. The focus of family CBT is on providing support to the family members to ensure they think and act in a more adaptive way, and learn to make better decisions and develop a more friendly and calmer family atmosphere. In family CBT therapy, feelings, cognitions, and behaviors are perceived as mutually influencing all individuals involved (Patterson, 2014).

An example of a client I experienced during practicum is a 32-year-old male client named B.G who participated in individual CBT once weekly and family CBT once weekly. The client had an alcohol abuse disorder NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

The client presented to the individual CBT after his employer along with the spouse complained that he was not able to manage his alcoholism. The client reported that he took alcohol almost every day of the week but he was trying to cut down the intake. During the individual CBT, open-ended questions were used to help to obtain situational and cognitive information from the client. The client would get angry and upset; this implied that he was not being honest about his alcohol intake. The client would give different information every time he was questioned. The client attended three individual CBT sessions and a recommendation was made to start family CBT with his wife (EB) because “the house was full of stress”.

During the family CBT therapy, the client was open about his alcohol use. However, the wife would interrupt him. The wife insisted that the client was not making efforts to cut down alcohol intake. However, during the session, B.G kept contradicting himself and while EB gave a seeming reliable account. This informed the therapist that BG was not making noticeable efforts to reduce alcohol intake. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

According to B.G thinking, his alcohol intake did not in any way present a problem to his marriage, life or career. CBT views substance use disorder as a situation where individuals use such substances to reinforce the behavior. With time, such negative and positive reinforcing agent becomes a part of everyday activities. CBT attempts to reduce such effects by improving incidents allied to abstinence or by developing skills to help in reducing substance use (Wheeler, 2014). NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

During the family therapy, it became clear that B.G would give a different account when alone but when the wife was present, he tried to give an accurate account. Accordingly, the therapist proposed to the client to continue with the individual therapy and also attend family CBT once weekly.

Evidence shows that when individuals with substance use disorder try to maintain sobriety or lower substance use, there is a likelihood of relapse (Ringle et al, 2015). As a result, ready for change meeting were proposed for the client. This was based on this week’s media that indicated that clients are positively influenced to change when they encounter other individuals experiencing similar situations.

The example of this client shows some of the challenges encountered during psychotherapy and that in some situations it would be necessary to have clients undergo both family and individual therapies to ensure the therapy goals are met. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

Some of the challenges that a therapist may encounter when using CBT in a family setting is trying to restructure the thinking pattern of different people at the same time. In addition, the therapist may be unsure if the structure of the session was appropriate for diverse family members and if the CBT techniques were effective for every individual (Ringle et al, 2015).

 

References

David D, Cristea J & Hofmann S. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy.
Front Psychiatry
. 9(4).

Mohamadian F, Bagheri M, Sadat M & sani H. (2018). The Effects of Cognitive Behavioral Therapy on Depression and Anxiety among Patients with Thalassemia: a Randomized Controlled Trial.
J Caring Sci
. 7(4),219–224.

Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. 
Journal of Family Psychotherapy
, 
25
(2), 132–144.

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.

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

       guide for evidence-based practice
. New York, NY: Springer. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay

NURS 6650 Working With Children and Adolescents Versus Adults Essay

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

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Importance Of Developmental Assessments Of Children And Adolescents

Developmental assessments of pediatric clients form a vital part of holistic care which is a major goal of psychiatric nursing. When conducting psychiatric evaluations, developmental assessments are used to gauge the likelihood of any deviations from normal development physically, psycho-sexually, socially or emotionally (American Psychiatric Association, 2013).  Based on the outcomes of an assessment, mental health practitioners can institute early interventions for any deviations noted. Developmental assessments are also essential since some adolescents and children can present in clinical settings with behaviors consistent with disabilities in development (American Psychiatric Association, 2013). By using these assessments, mental health practitioners can determine whether such disability is as a result of trauma, environmental factors or genetics. When identified early, the right referrals can be made to promote a child’s development and well-being NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Assessment Instruments For Adolescents and Children

           
The use of assessments instruments in adult and pediatric populations is vital in ensuring that the criterion for a specific diagnosis has been met. Generally, the most commonly used instruments for diagnoses are questionnaires and interviews (Sadock, Sadock & Ruiz, 2014). However, there exists a huge difference between the assessment instruments used for adults and pediatric clients. This is attributed to the fact that the details captured in pediatric assessments are obtained from additional sources such as caregivers, parents, and teachers other than just the pediatric client. Assessment instruments used for pediatric clients should be simple, brief, specific and sensitive. Assessment instruments that are specifically used for pediatric clients and cannot be used for adult patients are the National Institute of Mental Health Interview Schedule for Children Version IV and Dominic-R (Hargrave & Arthur, 2015). The former can be used in clinical settings with children between 6-17 years in either a parent or child format. The child format is suitable for children aged 9-17 years of age which the parental format can be used for pediatric clients aged 6-17 years old(Sadock, Sadock & Ruiz, 2014). On the other hand, the Dominic-R assessment instrument uses the images of a child named Dominic to depict several symptoms and can be used for children aged 6-11 years. Even though the behavioral and emotional content it illustrates is based on DSM-III-R, these details can be incorporated with the clinical details of the DSM-IV NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Treatment Options For Adolescents and Children

           
Play therapy has proven to be a highly effective and successful treatment option among pediatric patients with ADHD, depression, and PTSD. This form of therapy utilizes a play model that is nondirective to promote an environment that is safe and enhances the growth of a child (Blanco et al., 2015). The other treatment option used for children and adolescents is trauma-focused cognitive behavioral therapy. According to de Arellano, et al., (2014), trauma-focused CBT is a preferred empiric treatment model for pediatric clients who have undergone some form of trauma. NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Parent’s Role In Assessment and Treatment

           
Adolescents and children are heavily reliant on the participation of direct caregivers and parents in care for more successful health outcomes. Parents are relied on by clinicians to obtain exact information on the symptoms that a child presents with, past medical, surgical, psychosocial and family history (American Psychiatric Association, 2013). It is also worth mentioning that, rarely do children or adolescents initiate psychiatric evaluations. Therefore, to comprehensively understand the reasons for evaluation, clinicians can only collect information through interviews with caregivers or parent. However, information shared by children or adolescents should not be ignored since they tend to understand their concerns, thoughts, and feelings better.

 

References

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

Blanco, P. J., Muro, J. H., Holliman, R., Stickley, V. K., & Carter, K. (2015). Effect of child-centered play therapy on performance anxiety and academic achievement.
Journal of Child and Adolescent Counseling
,
1
(2), 66-80.

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60-72 NURS 6650 Working With Children and Adolescents Versus Adults Essay.

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.

de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence.
Psychiatric Services
,
65
(5), 591-602. NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Psychiatric Mental Health Practices Ethics and Dilemmas

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

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.

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Psychiatric Mental Health Practices Ethics and Dilemmas

A summary of an ethical issue in the article

“Hem, M., Molewijk, B., Gjerberg, E., Lillemoen, L., & Pedersen, R. (2018). The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.
BMC Medical Ethics
, 19 (1):54”.

Coercive treatment is a prominent ethical issue that professions in psychiatric mental health practices face. Over the past years, the utilization of coercion in psychiatric services has gained increasing attention and raised some of the utmost hard ethical issues. The usage of coercion threatens the autonomy of the patient. It can cause both physical and psychological harm and it as well threatens the perception of healthcare professionals of what entails good treatment and care. Generally, coercion is used to assist the patient. Nevertheless, it might also be utilized to safeguard others or be misapplied by healthcare professionals. Thus, the usage of coercion is an intricate ethical enterprise Psychiatric Mental Health Practices Ethics and Dilemmas.

Ethical and moral issues surrounding the use of coercion

There are several different ethical challenges connected to the usage of coercion.  As Norvoll et al (2018) indicate, coercion entails professionals overriding apparent autonomy of patients, with resultant ethical implications. The serious impacts of coercion on a patient’s liberty and autonomy make coercion an innately value-laden action.  The most significant justification for coercion is that it is aimed at promoting the well-being and best interest of the patient. As Hem et al (2018) allege, the usual argument is that coercive care and treatment might improve the health of the patient or that failure of not doing what is viewed as safe or good can cause impairment. Psychiatric Mental Health Practices Ethics and Dilemmas. This line of thinking presumes that a patient’s best inters is thoroughly evaluated and carefully considered when applying coercion.

How to balance between nonmaleficence and beneficence when using coercion is a major ethical dilemma because it entails balancing between inflicting harm(nonmaleficence) and promoting good. For instance, restraints lessen the risk of physical harm to the patient but they have an adverse effect resulting in humiliation, fear, anger, embarrassment, and powerlessness. Practitioners are also faced with the ethical dilemma of balancing between the patient’s best interest and the safety of hospital staff and other patients (Hem et al, 2018). According to Steinert (2017), if practices that restrict liberty, like involuntary detention and inpatient treatment or seclusion becomes essential due to dangerous behavior, there is a likelihood of severe deterioration of psychosocial health. Averting such an outcome may be regarded as acting in the best interest of the patient’s well-being. Therefore, treating a patient against her or his will is justifiable as being beneficent to the patient if the aim is to avert long-term constraint of his freedom and if this restriction isn’t merely a hypothetical possibility Psychiatric Mental Health Practices Ethics and Dilemmas.

An analysis of the ethical issue and its comparison to Indiana state laws and regulations

Legislation exists in the majority of states to allow for coercion and involuntary treatment of individuals who are considered to be ill and at danger. The civil commitment laws are a mechanism to coerce a person to undergo outpatient treatment of psychiatric hospitalization. AS Cautin and Lilienfeld (2015) assert, civil commitment might transpire only after a court determines that a person is suffering from a statutorily needed level of mental condition and probably associated conditions.  Typically, a court orders civil commitment when the involved person is unable to voluntarily consent to treatment. Psychiatric Mental Health Practices Ethics and Dilemmas. Like other states, Indiana has civil commitment laws that determine the criterion establishing when involuntary care or treatment is suitable severely mentally ill patients who cannot voluntarily seek care. Indiana state laws permit for inpatient treatment and assisted outpatient treatment.

Ethical decision process

As a PMHNP, I might address the ethical dilemma of the use of coercion by evaluating the patient’s decisional capacity and the best interest of the patient. If the capacity of the patient to make rational choices is hindered, I may respect the autonomy of the patient by involving his relatives to make decisions on behalf of the patient or offer any pertinent information that they possess about the possible preferences of the patient. As Baruth and Lapid (2017) allege, discussions with healthcare team and family are key in making a determination of patient values that apprise medical decision making. Information from other healthcare professionals and family are useful in supporting conclusions when establishing capacity, and can also be valuable to a proxy or surrogate decisionmaker when the patient is considered to not to have decisional capacity. Psychiatric Mental Health Practices Ethics and Dilemmas.

 

References

Baruth, J., & Lapid, N. (2017) Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal.
AMA Journal of Ethics,
19(5): 416-425.

Cautin, R., & Lilienfeld, S.  (2015). The Encyclopedia of Clinical Psychology, 5Volume Set. New York:  John Wiley &  Sons

Hem, M., Gjerberg, E., Husum, T., & Pedersen, R. (2018). Ethical Challenges when using coercion in mental healthcare: a systematic literature review.
Nursing Ethics
, 25(1): 92-110.

Norvoll, R., & Hem, M., Pedersen, R. (2016). The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.
HEC Forum
, 29(1): 59-74.

Steinert, T.  (2017). Ethics of Coercive Treatment and Misuse of Psychiatry.
Psychiatric Services,
68(3): 291-294. Psychiatric Mental Health Practices Ethics and Dilemmas.

Comprehensive Integrated Psychiatric Assessment of a child or adolescent

Evaluate comprehensive integrated psychiatric assessment techniques

Recommend assessment questions

Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.

Watch the Mental Status Examination video.

Watch the two YMH Bostonvideos

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Child and Adolescent Diagnostic Assessment Worksheet

IDENTIFYING INFORMATION: (age, gender, and ethnicity of client; parents)

COLLATORAL INFORMANTS
:

CHIEF COMPLAINT: (in the client’s own words
)

Other informants:

HISTORY OF PRESENT ILLNESS
:
(this should create the timeline and details of the child/adolescent symptoms so that it leads to the clinical assessment and formulation)
­­­­­­­­­­­­

 

PAST PSYCHIATRIC HISTORY/PREVIOUS PSYCHIATRIC VISITS/HOSPITALIZATIONS:­­­­­­­­­­

 

PAST MEDICAL HISTORY
:

 

PAST SURGICAL HISTORY
:

 

CURRENT MEDICATIONS (INCLUDING COMPLIANCE):

 

ALLERGIES
:

 

PSYCHOSOCIAL

HISTORY: (who the child lives with, relevant cultural information, school, grade, teacher, friends)

 

Sexual Orientation/Gender Identity (if unknown, evidence of gender dysphoria):

 

­­­­­­­­­­­­­­­­­­(NOTE: If LGBT, elicit “out” status, family dynamics): _________________________________

History of physical/emotional/sexual abuse: __________ History of bullying: _________Religion: ________

FAMILY HISTORY OF PSYCHIATRIC ILLNESS:

 

History of Family Suicide Attempts/Completed Suicides:

SUBSTANCE ABUSE HISTORY:

Smoker: _____History of alcohol, marijuana, meth use/abuse:  ____________________________________

 

REVIEW OF SYMPTOMS:

 

 

 

GENERAL WELL BEING:

(Example:

-Child/parent reports that (she/he) is sleeping (well, poorly, fair). States that (she/he) has trouble (falling asleep, staying asleep, or waking up feeling as if she/he had not slept at all).

 

-Further, reports (low, fair, good) energy throughout the day. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

 

-Child/parent acknowledges (poor, fair, good) appetite (if fair/poor, indicate how long this has persisted for). Any significant weight loss/gain.

 

 

MENTAL STATUS EXAMINATION
:
(see
Kaplan & Sadock’s Synopsis of Psychiatry: Behavior Sciences/Clinical Psychiatry
for Child MSE)

 

=============================================================================

 

CLINICAL FORMULATION: (Discuss diagnostic reasoning here.) ­­­­­­­­­­­­­­­­­­­­­­

 

 

 

DIAGNOSIS USING DSM-5:

 

(Begin with psychiatric diagnosis that the patient is being treated for; then, in order of relevance/importance/significance to the overall clinical picture, list the diagnoses.
DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses. Other conditions that are a focus of the current visit or help to explain the need for a treatment or test may also be coded.)

 

DIAGNOSIS:

 

 

PLAN OF TREATMENT:

 

Comprehensive Integrated Psychiatric Assessment

Introduction

The Vignette 4 video describes a 16-year-old teenage client who presented for a mental health assessment. The client was referred by the mother and he claimed that he was not aware why he was referred for a mental health assessment. The video indicates that the client is not interested in the assessment and the therapist utilizes various techniques, where some are helpful while other techniques are not helpful. This will be discussed in this post. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

What the Practitioner did Well

Before the session starts, the practitioner informs the client regarding confidentiality. According to Sadock et al (2014), confidentiality is the foundation of effective therapeutic relationships and effective treatment (Wheeler, 2014).  Secondly, the practitioner actively engaged the client and asked him regarding his opinion which indicates that the practitioner believes about independency of the client’s feelings and thoughts. The client responds positively and both his eye contact and verbal interactions improve. As per Sadock et al (2014), engaging adolescents leads to a better rapport because they feel they are being given a chance to have their side of the story heard.  In addition, the practitioner asked regarding other individuals in the life of the client which informs him that the client ha better relationships with his coach and girlfriend.  The client is very comfortable talking about these relationships which can inform the practitioner.

Areas the Practitioner need to Improve

The practitioner can improve in a few areas. For example, the provider tries to air his own opinion regarding what he thinks of the client’s mother. This is evident where the client reports that the mother feels he has an “anger management” issue and the practitioner tells him that the mother has his won reasons for stating so. At this point, the practitioner uses facial expression and a voice tone that indicates that he completely disagrees with the client’s perspective. Such an approach can make the client feel alienated. This is clear, where the client withdraws and looks down. According to Sukhodolsky et al (2016) the ability of a practitioner to read the body language of clients is an important skill. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

Compelling Concerns

Some of the concerns include that the practitioner fails to come up with strategies that the client and the mother can adopt for effective communication. The client claims that the mother is nagging. This can be perceived as a family issue or a developmental issue since teenage boys are not likely to disclose their personal feelings to their mothers (Bista et al, 2016). It is also important for the practitioner to acknowledge the client’s feelings about the whole issue. At this point, the practitioner reflects and normalizes the aversion of the client talking to his mother through humor. This resonates with the client and assists in improving the connection between the client and the therapist.

The Next Question and the Reason

The therapist did not address the client’s possible risky behavior. Therefore, I would assess if the client has any issues to do with substance or alcohol abuse. The first question would be “have you ever been in a CAR driven by a person (including yourself) who was intoxicated or had been using drugs or alcohol?” This question is derived from the CRAFFT screening tool. According to Sadock et al (2014), substance abuse or alcohol abuse can significantly affect psychiatric symptoms as well as the treatment. Comprehensive Integrated Psychiatric Assessment of a child or adolescent.

 

 

References

Bista B, Thapa P, Sapkota D, Suman S & Paras P. (2016). Psychosocial Problems among Adolescent Students: An Exploratory Study in the Central Region of Nepal.
Front Public Health
. 4(158).

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.

Sukhodolsky D, Smith S, Spencer M, Karim I & Piasecka J. (2016). Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents.
J Child Adolesc Psychopharmacol.
26(1), 58–64.

Wheeler, K. (Eds.). (2014).
 Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.)
. New York, NY: Springer Publishing Company Comprehensive Integrated Psychiatric Assessment of a child or adolescent.