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NRNP 6665 PMHNP Care Across the Lifespan I

ByLeon Kiprotich Leon Updated on

NRNP 6665 PMHNP Care Across the Lifespan I

Week 1: Child and Adolescent Assessment

WEEK 1: AT A GLANCE

CHILD AND ADOLESCENT ASSESSMENT

INTRODUCTION

All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.

Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.

LEARNING OBJECTIVES

Students will:

  • Evaluate comprehensive integrated psychiatric assessment techniques for children and adolescents
  • Recommend assessment questions for child and adolescent patients
  • Explain the importance of thorough psychiatric assessment for children and adolescents
  • Identify rating scales that are appropriate for child/adolescent psychiatric assessment
  • Identify psychiatric treatments appropriate for children and adolescents
  • Explain the role of the parent/guardian in child/adolescent psychiatric assessment

Week 1 discussion

Comprehensive Integrated Psychiatric Assessment

Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 andSimulation Scenario-Adolescent Risk Assessment 
  • Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.

BY DAY 3 OF WEEK 1

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

LEARNING RESOURCES

  • Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
    • Chapter 1, “Introduction”
    • Chapter 4, “The 15-Minute Pediatric Diagnostic Interview”
    • Chapter 5, “The 30-Minute Pediatric Diagnostic Interview”
    • Chapter 6, “DSM-5 Pediatric Diagnostic Interview”
    • Chapter 9, “The Mental Status Examination: A Psychiatric Glossary”
    • Chapter 13, “Mental Health Treatment Planning”
  • Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175.
  • 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.). Wiley Blackwell.
    • Chapter 32, “Clinical assessment and diagnostic formulation”

Required Media

Optional Resources

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
    • Chapter 1, “Examination and Diagnosis of the Psychiatric Patient”
      • Section 1.2, “Children and Adolescents” (pp. 74-87)

Example Week 1 Discussion

ES

May 29, 2024 May 29 at 7:40pm

Manage Discussion Entry

The practitioner spoke calmly and softly to the patient to create a soothing atmosphere and make the patient comfortable. She had good body language that was open and facing the patient, conveying an interest in his answers. The practitioner did not ask open-ended questions, which could have gotten more information from the patient about what he was feeling. The practitioner did not have the patient expand on his answers to get more information about what bothers him, such as his anger, school problems, and alcohol use.

 The most significant concern is for the patient’s safety. He has expressed that he has thought of suicide and is not coping well. He also stated that he has been having anger issues which can lead to impulsive actions that could lead to further thoughts of suicide or self-harm. The next question that should be asked would be if the patient has any plan or intent or has thought of how he would hurt himself or others. This questioning would open up the conversation about what safety steps need to be addressed with the patient.

A thorough psychiatric assessment is vital with children and conducted with patience and time for them to answer the questions. The comprehensive evaluation will allow the practitioner to know all the problems the patient faces and determine the priorities that need to be a priority in a treatment plan. A comprehensive assessment will evaluate all aspects of the child or adolescent life, including possible family issues, trauma, abuse, bullying, or conflicts at school. The reason that an assessment is so critical is that pediatricians complete the majority of assessments in their yearly exams.

It is a quick assessment that may not identify actual problems the patient is having. Many children and adolescents get referred for further treatment, precipitating the comprehensive assessment. More than fifty percent of all mental health disorders emerge by the time a patient is fifteen years old (McGorry et al., 2022). Failing to identify mental health needs in childhood and adolescence can affect the further development of the person’s future social, educational, and economic opportunities (McGorry et al., 2022).

Two assessment tools that could be utilized when assessing a child or adolescent are the Adverse Childhood Experiences (ACEs) scale and the NICHQ Vanderbilt Assessment Scale. The ACEs screening identifies adverse childhood experiences that can precipitate or be a component of mental health issues for children(Watson, 2019). The ACEs can help identify exposure to abuse, neglect, family trauma, and other events that can affect a child’s mental health (Centers for Disease Control and Prevention, 2021). The NICHQ can help identify ADHD, Oppositional Defiant Disorder, anxiety, and depression (Kemper et al., 2018). The parent, teacher, and patient can complete the questionnaire, which gives a view from all parties on the symptomology the patient is experiencing.

Two treatments unique to children and adolescents are play therapy and occupational therapy. Play therapy is utilized in individual, group, and educational settings (Zhang et al., 2019). Play therapy gives children/adolescents a comfortable, safe place to play and addresses their issues. Play therapy utilizes games to identify problems, determine strengths, and allow the child to create a therapeutic relationship with the therapist. Game therapy can assist with behavioral, mental health, social interaction, and cognition problems (Zhang et al., 2019). If used in a group setting, it can help build relationships between children and help them learn coping skills, improve concentration, address social anxiety fears, and teach appropriate social skills. Participating in group play can also help alleviate the fear of new situations, new environments, and new interactions with others (Zhang et al., 2019).

Occupational therapy is a treatment that can be utilized to treat many physical and mental health issues. Occupational therapy helps with autistic, ADHD, developmentally delayed, behaviorally challenged, and children with comorbid problems related to other diagnoses. Occupational therapy can address sensory and physical limitations, executive functioning, neuro-developmental issues, and many more challenges (Novak & Honan, 2019). Occupational therapy helps the child acquire skills to become more independent and includes a great deal of parental education to utilize at home. The therapy consists of carrying over the skill implementation at home, school, and other settings where the child would spend much time. The activities that the child and parents are educated on are specific to the child’s needs to help the child adapt and change to become more independent.

The inclusion of the parent or caregiver of a child or adolescent in the assessment is essential because they will provide information that the child may not be able to express or that they see from a different perspective. Including the parent in the assessment allows the parent to give their perspective on what is happening and what they see. Without their view, the practitioner may not get the full story or may get a version of the situation that is inaccurate. Sometimes parents or caregivers may see that a child behaves in a way the child cannot identify. Without that input, the practitioner could not evaluate the whole situation. Having the caregiver or parent involved also creates a connection for the patient that they are invested in helping the child address and treat the issues (Waid & Kelly, 2020).

The sources of reference utilized for this paper are either peer-reviewed journal articles written for the mental health profession or journals prepared for the professionals working in mental health. They include specific language for the profession, are educational, and include further references to support their information.

References

Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy [PDF]. cdc.gov. https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf.

Kemper, A. R., Maslow, G. R., & Hill, S., et al. (2018). Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents [Internet] (Comparative Effectiveness Reviews, No. 203 ed.). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK487766/table/results.t2/.

McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022). Designing and scaling up integrated youth mental health care. World Psychiatry, 21(1), 61–76. https://doi.org/10.1002/wps.20938.

Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273. https://doi.org/10.1111/1440-1630.12573.

Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & Social Care in the Community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947.

Watson, P. (2019). How to screen for aces in an efficient, sensitive, and effective manner. Paediatrics & Child Health, 24(1), 37–38. https://doi.org/10.1093/pch/pxy146.

Zhang, A., Jia, Y., & Wang, J. (2019). Applying play therapy in mental health services at primary school. SHS Web of Conferences, 60, 01008. https://doi.org/10.1051/shsconf/20196001008.

Week 2: Ethical and Legal Foundations of PMHNP Care Across the Lifespan

WEEK 2: AT A GLANCE

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE ACROSS THE LIFESPAN

INTRODUCTION

In your role as a PMHNP, you will regularly encounter situations that 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 evidence-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 background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.

LEARNING OBJECTIVES

Students will:

  • Analyze salient ethical and legal issues in psychiatric-mental health practice
  • Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
  • Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*

Week 2 Discussion – Ethical and Legal Foundations of PMHNP Care

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Select one of the following ethical/legal topics:
    • Autonomy
    • Beneficence
    • Justice
    • Fidelity
    • Veracity
    • Involuntary hospitalization and due process of civil commitment
    • Informed assent/consent and capacity
    • Duty to warn
    • Restraints
    • HIPPA
    • Child and elder abuse reporting
    • Tort law
    • Negligence/malpractice
  • In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

BY DAY 3 OF WEEK 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 2

Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

Week 2 Example Discussion

Ethical and Legal Foundations of PMHNP Care – Autonomy

Autonomy in medical practice is the right of competent adults to make decisions on their own healthcare based on information from medical professionals. The principle of autonomy requires healthcare professionals to acquire consent from the patient before engaging in any investigations or treatments. Typically, a decision is considered autonomous when two conditions are met; the individual must have all relevant mental capacity to make rational decisions and must be unaffected by external constraints (Chapman, Toretsky, & Phoenix, 2019). In the healthcare field, a decision is viewed as autonomous when the patient has sufficient information, the capacity to make a decision and arrives at a decision voluntarily.

According to Chapman, Toretsky and Phoenix (2019), medical practitioners are expected to respect the principle of autonomy by disclosing medical information including the available treatment options to allow patients to make their own decisions. The principle of autonomy is not applicable to people who do not have the capacity or competence to make autonomous decisions such as infants and young children and patients who lack competence due to mental, developmental, or physical disorders (Chapman, Toretsky, & Phoenix, 2019). To make informed consent, there are several requirements; the patient must have the capacity to understand and decide based on the information provided to them, understand the disclosure, and acts voluntarily to give consent.

According to the article by Gómez-Vírseda, De Maeseneer and Gastmans (2020), patients have the legal right to make decisions as long as they are in their right mental status. Patients can decide whether or not to get treatment even if their decisions do not align with the physicians’ recommendations. Legal precedents have advanced the necessary requirements for patient autonomy such that patient autonomy is now the dominant principle instead of the physician’s beneficence.

McGee, Dingle, & Edelsohn, (2016), note that the welfare and health of children are maintained by their guardians. However, children and adolescents should also be involved in the decision-making process on the types of treatment they receive. Medical professionals should explain the medical issues and possible treatment options in a way that both the children/ adolescent patient and the guardian can understand. The child/adolescent should then be allowed to participate in decisions about the care they will receive to the best of their abilities to act rationally and comprehend their options. Children or adolescents have the right to agree or disagree with the treatment options presented to them. The guardians of the children or adolescents have the right of proxy consent where they can make decisions for the minors under their care. In some jurisdictions, the consent of adolescents of a certain age is required.

The psychiatrist of the child/ adolescent is required to obtain the minor’s assent whenever it is reasonable as well as the legal guardian’s consent before any medical actions take place. However, as noted by McGee, Dingle and Edelsohn (2018). There are some provisions for emergencies and in the case of emancipated minors. During emergency medical care, medical professionals are allowed to consider assent and consent as secondary considerations in order to provide urgent medical care to the minor patient. Emancipated minors are legally responsible for their own care and their consent must be obtained before any actions take place. In some jurisdictions, minors involved with sexually-related situations, minors are allowed to make autonomous decisions regarding their care.

Song et al. (2020) argue that there are cases when the decisions of the child or adolescent and the guardians are in conflict. In situations where the guardian consents to treatment while the minor dissents, medical practitioners may opt to treat the minor patient in spite of their dissent. It is up to the minor patient’s psychiatrist to determine the consequences of treating the patient without their consent and encourage the minor and guardians to collaborate to enhance the health of the minor.

Psychiatrists and all medical professionals have the ethical responsibility to maintain their patient’s autonomy through providing the all necessary information and allowing them to make their own decision. In my practice, I will strive to maintain my patient’s autonomy and in cases where my ethical responsibilities conflict with the law or other governing legal authority, I will take the necessary steps to resolve the conflicts using the Ethical Standards of Ethics Code and General Principles. I will also ensure that I never use any conflicts or standards to violate my patients’ right to autonomy.

References

Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing psychiatric mental health nurse practitioner practice: impact of state scope of practice regulations. Journal of Nursing Regulation, 10(1), 35-43. https://doi.org/10.1016/S2155-8256(19)30081-X.

Gómez-Vírseda, C., De Maeseneer, Y., & Gastmans, C. (2020). Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Medical Ethics, 21, 1-14. 

McGee, M. E., Dingle, A. D., & Edelsohn, G. A. (2018). Review of the revised 2014 American  Academy of Child and Adolescent Psychiatry code of ethics. Journal of the American   Academy of Child and Adolescent Psychiatry, 55(4), 257-261.

Song, S. Y., Wang, C., Espelage, D. L., Fenning, P., & Jimerson, S. R. (2020). COVID-19 and school psychology: Adaptations and new directions for the field. School Psychology        Review, 49(4), 431-437.

LEARNING RESOURCES

Required Readings

NRNP 6665 Week 3: Special Considerations Related to Prescribing for Children and Adolescents

INTRODUCTION

There is probably no greater responsibility that the psychiatric-mental health nurse practitioner assumes than the responsibility of prescribing medications. While patients can be harmed by psychotherapy, the level and intensity of the harm generally does not approach the same level of harm that can occur from improper prescribing. PMHNPs must understand their responsibility, both at the state and federal levels, when it comes to prescribing medications.

This week, you will explore the particular clinical considerations associated with prescribing for children and adolescents.

LEARNING OBJECTIVES

Students will:

  • Recommend psychopharmacological interventions for children and adolescents
  • Recommend nonpharmacological interventions for children and adolescents in mental health settings
  • Analyze clinical decision making related to treatment of children and adolescents in mental health settings
  • Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
  • Create a study plan for the nurse practitioner national certification examination

Week 3: Assignment 1: PRESCRIBING FOR CHILDREN AND ADOLESCENTS

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Reference:

Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCE

TO PREPARE

  • Your Instructor will assign a specific disorder for you to research for this Assignment.
  • Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

THE ASSIGNMENT (1–2 PAGES)

  • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
  • Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
  • Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
  • Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

BY DAY 7 OF WEEK 3

Submit your Assignment.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK3Assgn1+last name+first initial.
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Required Readings

  • Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
    • Chapter 14, “Psychosocial Interventions”
    • Chapter 15, “Psychotherapeutic Interventions”
    • Chapter 16, “Psychopharmacological Interventions”Links to an external site.
  • 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.). Wiley Blackwell.
    • Chapter 43, “Pharmacological, Medically-Led and Related Treatments”
  • Walden University. (n.d.). Developing SMART goals.
  • Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
    • Chapter 5, “Psychopharmacology”

Required Media

Week 3: Assignment 2: STUDY PLAN

Based on your practice exam question results from Week 2, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress. You will revisit and update your study plan in NRNP 6675, and you may continue to refine and use it until you take the exam.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.
  • Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?

THE ASSIGNMENT

  • Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
  • Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.
  • Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.

BY DAY 7 OF WEEK 3

Submit your study plan.

Module 2: Assessing, Diagnosing, and Treating Mood, Anxiety, Eating, Sleeping, and Elimination Disorders Across the Lifespan

Week 4: Mood Disorders in Adults

INTRODUCTION

I am finally doing everything right. I stayed up all night studying for my final exams and even managed to clean out my closet and order a whole new bedroom from the internet. I know I will ace all my exams. Nothing can go wrong like they did a few months ago. I was so low and was sleeping all the time. I did not think I would ever be happy again, but now I know I can do anything.

—Jessica, age 22

Patients presenting with mood disorders may find that their moods impact their ability to function or that their moods are not consistent with their circumstances. Bipolar and related disorders are one category of mood disorders. They affect nearly 3% of the U.S. population each year (Depression and Bipolar Support Alliance, n.d.). Although being relatively rare in terms of lifetime prevalence, bipolar disorder is burdensome to the individual and health care system because of its early onset, severity, and chronic nature. The average age of onset is around 25 and it affects men and women equally.

The importance of evidence-based intervention for treatment in persons with mood disorders cannot be underestimated. Unstable moods can result in repeat chronic hospitalizations and profound life disruption. Mood disorders are a leading cause of disability worldwide and can contribute to suicide (World Health Organization, 2020). Practitioners should understand that developing a good rapport and relationship with the patient can make a significant difference in the course, symptom management, and stability of the patient.

This week, you will assess, diagnose, and develop appropriate treatment plans for adults presenting with mood disorders.

LEARNING OBJECTIVES

Students will:

  • Assess adults presenting with mood disorders
  • Develop differential diagnoses for adult patients with mood disorders
  • Develop appropriate treatment plans for adult patients with mood disorders
  • Advocate health promotion and patient education strategies for adult patients with mood disorders

Week 4: Assignment – Assessing, Diagnosing, and Treating Adults with Mood Disorders

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
  • Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
  • Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Consider patient diagnostics missing from the video:

Provider Review outside of interview:

Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

THE ASSIGNMENT

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
  • Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit your Focused SOAP Note.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK1Assgn+last name+first initial.
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Week 4: Learning Resources

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
    • Chapter 6, “Bipolar Disorders”
    • Chapter 2, “Neurodevelopmental Disorders and Other Childhood Disorders”
      • Section 2.9, “Depressive Disorders and Suicide in Children and Adolescents” (pp. 174-180)
      • Section 2.10, “Early-Onset Bipolar Disorder” (pp. 181-184)
    • Chapter 7, “Depressive Disorders”
    • Chapter 21, “Psychopharmacology”
    • Chapter 22, “Other Somatic Therapies”

Required Media

Medication Review

Depression   Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation)
agomelatine
amitriptyline
amoxapine
aripiprazole
(adjunct)
brexpiprazole (adjunct)bupropion
citalopram
clomipramine
cyamemazine
desipramine
desvenlafaxine
dothiepindoxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
iloperidone
imipramine
isocarboxazid
ketamine
lithium (adjunct)
l-methylfolate (adjunct)		 lofepramine
maprotiline
mianserin
milnacipran
mirtazapine
moclobemide
nefazodone
nortriptyline
paroxetine
phenelzine
protriptyline quetiapine (adjunct)
reboxetine
selegiline
sertindole
sertraline
sulpiride
tianeptine
tranylcypromine
trazodone
trimipramine
venlafaxine
vilazodone
vortioxetine		 citalopram
desvenlafaxine
duloxetin
eescitalopram
fluoxetin
eparoxetine
pepexev
sarafe,
sertraline
venlafaxine		 Bupropion HCL extended-release
Bipolar depression Bipolar disorder (mixed Mania/Depression Bipolar maintenance Mania
lithium (used with lurasidone)
lurasidone
olanzapine-fluoxetine combination (symbyax)
quetiapine
valproate (divalproex) (used with lurasidone)		 aripiprazole
asenapine
carbamazepine		 olanzapine
ziprasidone		 aripiprazole

lamotrigine
lithium
olanzapine

 aripiprazole
asenapine
carbamazepine
lithium
olanzapine
quetiapine
risperidone

valproate (divalproex)
ziprasidone

NRBP 6665 Week 5: Mood and Anxiety Disorders in Children and Adolescents

INTRODUCTION

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

LEARNING OBJECTIVES

Students will:

  • Explain signs and symptoms of mood and anxiety disorders in children and adolescents
  • Explain the pathophysiology of mood and anxiety disorders in children and adolescents
  • Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents
  • Develop patient education materials for mood and anxiety disorders in children and adolescents

Week 5: Learning Resources

LEARNING RESOURCES

Required Readings

  • Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
    • Chapter 3, “Common Clinical Concerns”
    • Chapter 7, “A Brief Version of DSM-5″
    • Chapter 8, “A stepwise approach to Differential Diagnosis”
    • Chapter 10, “Selected DSM-5 Assessment Measures”
    • Chapter 11, “Rating Scales and Alternative Diagnostic Systems”Links to an external site.
  • Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality.
  • 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.). Wiley Blackwell.
    • Chapter 60, “Anxiety Disorders”
    • Chapter 61, “Obsessive Compulsive Disorder”
    • Chapter 62, “Bipolar Disorder in Childhood”
    • Chapter 63, “Depressive Disorders in Childhood and Adolescence”

Required Media

Medication  Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17)		 aripiprazole (age 10–17)
asenapine  (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)

olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)
Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)
Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)

Week 5: Assignment – Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.
  • Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

THE ASSIGNMENT

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.

BY DAY 7 OF WEEK 5

Submit your Assignment.

Week 6: Eating, Sleeping, and Elimination Disorders; Midterm Exam

INTRODUCTION

Eating, sleeping, and elimination disorders may come to the attention of providers in a variety of settings. These disorders can be profoundly disturbing to patients’ lives and may have significant comorbidities with other disorders. Eating disorders, such as anorexia and bulimia, are widely known. But it is important to understand and be able to recognize less common disorders, such as pica and rumination disorder. Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep, and they frequently accompany other disorders, especially depression, anxiety, and PTSD. The elimination disorders of enuresis and encopresis are troubling to children and parents and cause significant difficulty in daily functioning.

Obtaining a thorough history is essential to diagnosing eating, sleeping, and elimination disorders; formulating a treatment plan; and monitoring the plan’s effectiveness. This week, you will explore these categories of disorders and complete your midterm exam.

LEARNING OBJECTIVES

Students will:

Apply concepts related to psychopathology, diagnostic reasoning, and treatment planning in advanced practice psychiatric-mental health nursing care

Instructions

Back to Week at a Glance

MIDTERM EXAM

This exam will cover the following topics from Week 1 through Week 6 of the course relevant to assessment, diagnosis, and treatment across the lifespan:
Child and adolescent psychiatric assessment

  • Ethical and legal foundations of PMHNP care
  • Prescribing for children and adolescents
  • Mood disorders
  • Eating, sleeping, and elimination disorders

Prior to starting the exam, you should review all of your materials. There is a 2.5-hour time limit to complete this 100-question, multiple-choice exam. You may only attempt this exam once.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

EXAM ESSENTIALS

Students are strongly encouraged to review the full Exam Essentials located in the syllabus before taking the exam. This is a shortened version of the full Exam Essentials.

Planning for the Exam

  1. Exams are due no later than Day 7 at 10:59pm Central Time. If exams are not completed by due date the grade is a ZERO. Retakes of exams are NOT permitted.
  2. Please see instructions in Canvas for total time allotted to complete the exam.
  3. You must take the exam in one sitting-there is no starting and stopping.
  4. The exam will auto submit once the full allotted time has elapsed.
  5. Do not take the exams on iPads, iPhones, or other portable devices as you may get locked out of the exam.
  6. Please use only the recommended browsers Chrome or Firefox.

Taking the Exam

  1. Close out of all Browser windows on your computer and log in fresh as you prepare to begin the exam. When you are logged in for a long period, the exam will idle or freeze and lock you out.
  2. You should only have ONE browser window open for the exam. Having more than one browser or browser window open will lock the exam. This is a violation of the exam taking policy subject to academic sanctions. 
  3. Exam resets will not be allowed if the exam log indicates you stopped viewing the quiz and viewed a different browser window.
  4. You will only be able to see one question at a time.
  5. Do not use the return/back button to change your answer(s). This will lock you out of the exam.
  6. Save all your answers.
  7. Do not refresh the page. This will cause the page to freeze and lock you out.
  8. Do not copy, screenshot, video, or write down the questions in the exam. This is a violation of the exam taking policy subject to academic sanctions. 

Reporting Difficulties During the Exam

  1. If you have a question, please e-mail faculty the question number and we will review it.  Do not take a picture of the test item.
  2. If you have technology difficulties during the exam, contact our Customer Care team 24/7 via phone at 1-800-WaldenU or from your portal via live chat.
    1. Remember, the Walden Classroom Information Hub – Walden University. is available 24/7 with a range of resources.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

BY DAY 7

Submit your Midterm Exam.

Attempt History

Attempt Time Score
LATEST Attempt 1 100 minutes 89.75 out of 100

Quiz results are protected for this quiz and are not visible to students.

Correct answers are hidden.

Score for this quiz: 89.75 out of 100

Week 6: Learning Resources

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
    • Chapter 13, “Feeding and Eating Disorders”
    • Chapter 2, “Feeding and Eating Disorders of Infancy or Early Childhood”
      • Section 2.7, “Feeding and Eating Disorders of Infancy or Early Childhood” (pp. 162-166)
    • Chapter 15, “Sleep-Wake Disorders”
  • 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.). Wiley Blackwell.
    • Chapter 70, “Sleeping Interventions: A Developmental Perspective”
    • Chapter 71, “Feeding and Eating Disorders”
  • Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
    • Chapter 10, “Sleep Disorders”

Medication  Review

Review the FDA-approved use of the following medicines related to treating eating, sleeping, and elimination disorders.

Bulimia nervosa/binge eating Enuresis
Fluoxetine – bulimia
Lisdexamfetamine – binge eating		 Desmopressin
Tofranil
Excessive sleepiness in narcolepsy, obstructive sleep apnea/hypopnea
syndrome, shift work sleep disorder		 Insomnia Restless leg syndrome
armodafinil
modafinil
pitolisant
sodium oxybate
Solriamfetol		 Doxepin
Eszopiclone
Estazolam
Flurazepam
Lemborexant
Quazepam
Ramelteon
Suvorexant
Temazepam
Triazolam
Zaleplon
Zolpidem		 Ropinirole
Pramipexole
Rotigotine patch
Gabapentin enacarbil

Module 3: Assessing, Diagnosing, and Treating Neurocognitive, Neurodevelopmental, Dissociative, Somatic Symptom-Related, Disruptive, Impulse-Control, and Conduct Disorders

Week 7: Neurocognitive Disorders

INTRODUCTION

My mother used to be a teacher—an elementary school teacher. We were all so proud of her when she completed her PhD when she was 50. Now she is 75 and has begun to have times when she does not know what day it is. We found her wandering around the neighborhood because she could not find her way home. Once, she forgot where she parked her car at the grocery store. She thought someone had stolen it. The manager was so kind to drive her around the parking lot until she recognized her car. We are afraid she might get hurt or lost.

—Gary, age 50, son of Dorothy, age 75

Neurocognitive disorders are unique among the other psychiatric disorders you have studied in that they “are syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined” (DSM-5, 2013). That is, diseases or injuries are to blame for the neurocognitive manifestations. These conditions are acquired and (in contrast to neurodevelopmental disorders) represent a decline from a previous higher level of functioning. Neurocognitive disorders present a diagnostic challenge for the PMHNP in that many of the signs and symptoms overlap.

This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders.

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
    • Chapter 3, “Neurocognitive Disorders”
  • Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
    • Chapter 8, “Delirium and Neurocognitive Disorders”

Required Media

Medication  Review

Review the FDA-approved use of the following medicines related to treating neurocognitive disorders.

Alzheimer’s disease Delirium Parkinson’s disease dementia/psychosis
caprylidene
donepezil
galantamine
memantine
rivastigmine		 There are no FDA-approved medications for the treatment of delirium. nuplazid
rivastigmine
pimavanserin

Week 7: Assignment

  • Due No Due Date
  • Points None

Diagnosing and Treating Patients with Neurocognitive Disorders

Neurocognitive disorders (NCDs) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning in such areas as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring for someone with a neurocognitive disorder is not only challenging for the clinician; it is stressful for the family as well. The PMHNP needs to consider not only the patient but also the “family as patient.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

There is no Assignment due this week. You should review this week’s Learning Resources and consider the insights they provide about assessing, diagnosing, and treating neurocognitive disorders. Use this quiet week to work on your practicum assignment if you are taking both courses concurrently.

Week 8: Neurodevelopmental Disorders

INTRODUCTION

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 doesn’t care about me. She only cares about my little brother and that man that keeps coming around. I don’t care about her. 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-TR described neurodevelopmental disorders such as intellectual disability and delay, autism spectrum disorder, language, speech and communication disorders, ADHD, motor disorders, developmental coordination disorder, stereotypic movement disorder, tic disorder, and specific learning disorders (e.g., dyslexia, difficulty mastering mathematical reasoning) . Diagnosis of these various conditions can rarely be made in a single office visit and often requires a comprehensive approach involving multiple stakeholders, including the child, his or her parents, teachers, other significant figures in the child’s life, and medical 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.

This week, you begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder.

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
  • Summarize legal, ethical, and patient education factors related to neurodevelopmental disorders

Week 8: Learning Resources

LEARNING RESOURCES

Required Readings

  • Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
    • Chapter 12, “Developmental Milestones”Links to an external site.
  • 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.). Wiley Blackwell.
    • Chapter 51, “Autism Spectrum Disorder”
    • Chapter 55, “ADHD and Hyperkinetic Disorder”
  • Utah State University. (n.d.). Creating study guides
  • Walden University. (2020). Success strategies: Self-paced interactive tutorials.
  • Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
    • Chapter 13, “Child/Adolescent Neurodevelopmental Disorders”

Required Media

Medication  Review

Irritability in autism Attention-deficit/hyperactivity disorder
aripiprazole
risperidone		 amphetamine IR, XR, and ER
dextroamphetamine
atomoxetine

clonidine hydrocholoride ER
Dexmethylphenidate IR and XR
guanfacine hydrocholride ER
lisdexamfetamine
methylphenidate
methylphenidate hydrocholoride IR and ER, transdermal

Week 8: Assignment – Study Guide Forum

Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.

For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5-TR.
  • Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

THE ASSIGNMENT

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5-TR but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

  • Signs and symptoms according to the DSM-5-TR
  • Differential diagnoses
  • Incidence
  • Development and course
  • Prognosis
  • Considerations related to culture, gender, age
  • Pharmacological treatments, including any side effects
  • Nonpharmacological treatments
  • Diagnostics and labs
  • Comorbidities
  • Legal and ethical considerations
  • Pertinent patient education considerations

BY DAY 7 OF WEEK 8

You will need to submit your Assignment to two places: the Week 8 Study Guide discussion forum as an attachment and the Week 8 Assignment submission link. Although no responses are required in the discussion forum, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.

Access the Study Guide Forum (or click the Next button).

Week 9: Dissociative Disorders

INTRODUCTION

Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self.

There are three major dissociative disorders defined in the DSM-5-TR: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder. Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations.

LEARNING OBJECTIVES

Students will:

  • Analyze issues related to the diagnosis and treatment of dissociative disorders
  • Analyze legal and ethical considerations related to dissociative disorders

Week 9: Assignment – Controversy Associated with Dissociative Disorders

The DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

  • Review this week’s Learning Resources on dissociative disorders.
  • Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.

THE ASSIGNMENT (2–3 PAGES)

  • Explain the controversy that surrounds dissociative disorders.
  • Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
  • Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
  • Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

BY DAY 7 OF WEEK 9

Submit your Assignment

Week 10: Somatic Symptom-Related Disorder

INTRODUCTION

Patients with somatic symptom-related disorders suffer from disproportionate feelings, thoughts, or behaviors related to physical symptoms. These disorders may manifest as excessive anxiety given the severity of a diagnosis or as pain or symptoms that don’t have a specific physical cause and are then attributed to psychological factors. Although it may be easier for some to understand and accept a physical diagnosis, somatic symptom-related disorders demonstrate the amazing connection between mind and body.

This week, you will explore the relationship between cognitive and physical symptoms in somatic symptom-related disorders.

Week 10: Learning Resources

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
    • Chapter 12, “Somatic Symptom and Related Disorders”
  • 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.). Wiley Blackwell.
    • Chapter 72, “Somatoform and Other Related Disorders”

Required Media

Week 10: Somatic Disorders

Back to Week at a Glance

ASSESSING, DIAGNOSING, AND TREATING PATIENTS WITH SOMATIC SYMPTOM-RELATED DISORDERS

Effectively treating patients with somatic symptom-related disorders begins with comprehensive assessment and understanding of the symptoms and duration of the patient’s complaints. As a practitioner, you will need to listen to your patients and know what questions to ask in order to elicit the information that will allow you to determine the most effective diagnosis. You will have to do this while understanding that there could be more than one disorder contributing to the symptoms that are disrupting their daily lives. When you believe you have established the diagnosis, you must then consider a course of treatment that will work best for a particular patient. For the same disorder, both pharmacological and nonpharmacological treatments may be considered depending on the needs of the patient.

There is no Assignment due this week. You should spend this week reviewing the Learning Resources on somatic symptom-related disorders and preparing for your final exam, which you will take next week.

Week 11: Disruptive, Impulse-Control, and Conduct Disorders; Final Exam

FINAL EXAM

INTRODUCTION

This week you will explore disruptive, impulse-control, and conduct disorder. These disorders have in common the fact that they are rooted in a lack of self-control. Many of these disorders may start in childhood or adolescence and may continue into adulthood. Within this group, you will find disorders such as oppositional defiant disorder, antisocial personality disorder, intermittent explosive disorders, pyromania, and kleptomania. Effective therapy for these disorders often includes cognitive behavior therapy, skill building, and skills management.

This week you will also complete your final exam.

LEARNING OBJECTIVES

Students will:

  • Apply concepts related to psychopathology, diagnostic reasoning, and treatment planning in advanced practice psychiatric-mental health nursing care

LEARNING RESOURCES

Required Readings

  • Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
    • Chapter 2, “Neurodevelopmental Disorders and Other Childhood Disorders”
      • Section 2.11, “Disruptive Mood Dysregulation Disorder” (pp. 185-186)
      • Section 2.12, “Disruptive Behaviors of Childhood” (pp. 186-193)
    • Chapter 18, “Disruptive, Impulse-Control, and Conduct Disorders”
    • Chapter 20, “Other Conditions that May be a Focus of Clinical Attention”
  • 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.). Wiley Blackwell.
    • Chapter 65, “Oppositional and Conduct Disorders”

Required Media

NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Name: P.P                DOB: 1/07/1995 Age: 25 yrs Gender: female 

Subjective:

CC (chief complaint): mood cycles between periods of low energy for about 4 to 5 times in a year, and mostly being high for more than a week in a row.

HPI: the patient came for a mental health assessment, and seeking review of her medications after being treated for previous psychiatric symptoms and being started on medications. She has a history of being treated using medications such as Zoloft, Risperidone, Seroquel (quetiapine), and Clonazepam, then stopping due to side effects. She reports getting episodes of low energy, no motivation, disinterest in activities 4 to 5 times a year. During these low periods, she often skips work, and eats too much, and prefers to sleep mostly up to 12 to 16 hours a day. She reports having periods that she is high for over a week, whereby she sometimes has auditory hallucinations. Excessive talking, insomnia for days, increased goal-orientedness, and heightened sexual behavior. The conversation also revealed she has grandiosity and a heightened sense of importance whereby she envisions everything about her future being with celebrity stars.

Past Psychiatric History: history of several admissions or psychiatric symptoms, she has had no suicidal or homicidal ideation since 2017.

Family Psychiatric History: her mother suffered from a psychiatric illness which she thinks was either bipolar and she tried committing suicide once. Her father went to prison for drugs and thinks her brother probably also has been diagnosed with a psychiatric problem before.

Legal History: she has been arrested once for public disturbance, but thinks this was made up because she cannot remember that scene

Substance Current Use: she smokes one packet of cigarettes daily, and has no recent history of other prescription drugs or substance abuse.

Medical History: he has hypothyroidism and polycystic ovarian syndrome (PCOS)

  •       Current Medications: takes thyroxines for hypothyroidism and oral contraceptive pills for PCOS
  •       Allergies:no known food or drug allergies.
  • Reproductive Hx: heterosexual female but has a heightened sexual life at different times which places her at high risk.

Review of systems (ROS):

  • GENERAL: no fever, night sweats, or vomiting, but amidst to have gained weight when taking some psychotropic medications
  • HEENT: no changes in visual acuity, no diplopia, eye discharge, or photophobia. She has no ear pain, tinnitus, or discharge. No history of nose bleeding, recurrent upper airway infections, she has no denture or teeth problems, and reports of good oral hygiene.
  • SKIN: normal hair texture and pigmentation, no nodules, ulcers, or lesions.
  • CARDIOVASCULAR: she has no paroxysmal nocturnal dyspnea, intermittent claudication, palpitations or chest pain.
  • RESPIRATORY: no exertion or difficulty in breathing, hemoptysis, or coughing.
  • GASTROINTESTINAL: she has a good appetite, no changes in bowel habits, no nausea, vomiting, heartburn, dysphagia, yellowness of eyes, or abdominal pain.
  • GENITOURINARY: no urinary urgency, incontinence, hematuria, frequency, hesitancy, dysuria, color changes, or decreased urine output.
  • NEUROLOGICAL: No changes in memory, convulsions, syncope, lightheadedness, abnormal sensations, or dizziness.
  • MUSCULOSKELETAL: no changes in gait or mobility, no joint aches, swelling, fractures, or history of arthritis or gout.
  • HEMATOLOGIC: no bloody or dark stool, no easy bruising, or nosebleeding.
  • LYMPHATICS: no peripheral edema, or swellings
  • ENDOCRINOLOGIC: she has no polyuria, polydipsia, or constant polyphagia. She, however, reports slowness and a history of current treatment for hypothyroidism.

Objective:

Physical Exam 

General: He was well-groomed, seemed overweight, and normal gait.

Vital signs: BP 123/78; pulse 81 regularly regular, temperature 37.5 ear; RR 21; weight: 142lbs; height 5’2; BMI 26 (overweight).

The rest of the systemic examination was normal. 

Diagnostic results: awaiting results of her lipid profile.

Assessment:

Mental Status Examination: 

Appearance: looked like a young adult, and as she walked in she responded to my greetings and sat with normal posture. She was well dressed, despite having the smell of cigarettes she did not look intoxicated. she had no obvious bruises or body scars on exposed areas.

Level of consciousness and Orientation: she was alert and well orientated to time and place, and person.

Behavior: she was charming, had good rapport and attitude despite getting irritable on few occasions, and being too critical of personal questions. However, she was cooperative on kind assurance, with no abnormal movement or compulsions, and didn’t resist being examined.

Concentration and attention: she maintained normal eye contact, and was attentive throughout the assessment.

Speech: her speech was not pressured, with normal volume and tone, with a short latency of speech. She responded to questions adequately, despite admitting to having a history of excessive talking. Mood: currently has a normal mood she often feels high “keep my moods high, high, high”, but also sometimes gets depressed “I feel like I’m not worth anything”

Affect: neutral Appropriate to content and congruent with the mood.

Thought Process: she expressed herself in a logical and meaningful manner. She had no circumstantiality, tangentiality, or flight of ideas, she had no neologisms or thought blocking.

Thought content: she has ideas of grandeur, and pseudo-delusional conviction of importance, but no poverty of thought, and no suicidal and homicidal ideation. She has no phobias or irrational fears, no obsessions or compulsions.

Perceptual Disturbances: she has auditory hallucinations, no illusions, and no episodes of depersonalization or derealization.

Cognition: her Immediate, short-term, and long-term memory were intact. She had good attention, judgment, abstraction, and level 6 insight.

Diagnostic Impression: Bipolar 1 Disorder. 

The patient was otherwise normal on this visit since the mental status examination only tells about the mental status at that moment, but can change at any time. The presenting complaints and information gathered on a further inquiry made me arrive at a primary diagnosis of bipolar 1 disorder. According to Ganti et al., (2018), Bipolar I disorder is diagnosed when one meets the criteria for a full manic episode with or without episodes of major depression, thus also called manic-depression. Often patients have interspersed euthymia, major depressive episodes, or hypomanic episodes between manic episodes (Perrotta, 2019), of which she presented in a euthymic state on this visit. She is mostly in the manic phase due to undertreatment (López-Muñoz et al., 2018), since the euphoria, heightened energy, and goal-orientedness make her skip her medications.

Differential diagnoses: 

Schizoaffective disorder: patients with this disorder, often meet criteria for either a major depressive or manic episode during which psychotic symptoms such as hallucinations and delusions consistent with schizophrenia are also met. Additionally, mood symptoms present for a majority of the psychotic illnesses since some may have atypical features such as flat or blunted affect, anhedonia, apathy, and lack of interest in socialization (Ganti et al., 2018). As such patients often cycle between having a diagnosis between psychotic and mood disorders, thus are given the second generation. antipsychotics such as risperidone to target both psychotic and mood symptoms.

Organic mood disorder due to hypothyroidism: psychiatric symptoms may also be a manifestation of organic disorders such as endocrine or metabolic disorders. Additionally, patients with bipolar also have a high prevalence of psychiatric and medical comorbidities (Grande et al., 2016), such as thyroid disorders or diabetes. She admits to having comorbid hypothyroidism, which could explain the episodes of depression due to undertreatment since she has a history of skipping other medications.

Seasonal affective disorder: This condition is often described as a subtype of recurrent depressive or bipolar disorder. Often patients have recurrent dysregulated mood and affective episodes of regular onset and remission of similar times annually (Pjrek et al., 2016). This condition has been shown to have a high degree of persistence and only about 20 percent of patients get to complete remission after five to eleven years (Nussbaumer-Streit et al., 2018). This is less probable because she described manic symptoms that lasted more than a week (Ganti et al., 2018), thus meeting the criteria for a manic episode.

Case Formulation: this case involves P.P, who is a 25-year-old female with comorbid hypothyroidism and PCOS. Despite having major depressive episodes, where she has anhedonia, hypersomnia, depressed mood, feelings of worthlessness, slowness, loss of energy, and excessive eating, she also experiences manic episodes consisting of grandiosity, inflated self-esteem, increased goal-orientedness, decreased need for sleep, and talkativeness, and excessive involvement in sexual indiscretions despite its negative consequences.

Treatment Plan: most psychiatric conditions require both pharmacotherapy and psychotherapy to have good outcomes. Bipolar patients benefit from mood stabilizers such as lithium, which has been shown to reduce mania and suicide risk, or carbamazepine, especially if the symptoms are rapidly cycling. Most patients have a faster response when mood stabilizers are combined with atypical antipsychotics such as risperidone and quetiapine. Antidepressants are discouraged as monotherapy due to concerns of activating mania or hypomania. I would start her on carbamazepine, at an Initial dose of 200 mg PO q12hr, since it is easier to monitor and make adjustments unlike lithium (Arcangelo et al., 2017). Additionally, I would recommend her to start on Supportive individual therapy, then later enlist her into group therapy to help prolong remission once the acute manic episode has been controlled. I would encourage her to start thinking of quitting smoking and weight reduction since they negatively affect her health.

Reflection notes:

This patient presented minimal challenges since she had good insight into her psychiatric problem. Otherwise, I think I would have explored more on how the symptom cycle between mania and depression and the periods of these symptoms. Additionally asking more about psychotic symptoms such as illusion and delusions would help make a clearer diagnosis with specifiers. If this patient becomes difficult to follow up I would consider referring her to a psychiatrist, and an addiction and wellness counselor

References

  • Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. (2017). Pharmacotherapeutics for Advanced Practice (Vol. 4). Philadelphia: Wolters Kluwer.
  • Ganti, L. K. (2018). First aid for the psychiatry clerkship. McGraw Hill Professional.
  • Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572. https://doi.org/10.1016/s0140-6736(15)00241-x
  • López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International Journal of Molecular Sciences, 19(7), 2143. https://dx.doi.org/10.3390%2Fijms19072143
  • Nussbaumer-Streit, B., Pjrek, E., Kien, C., Gartlehner, G., Bartova, L., Friedrich, M. E., Kasper, S. & Winkler, D. (2018). Implementing prevention of seasonal affective disorder from patients’ and physicians’ perspectives–a qualitative study. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1951-0
  • Perrotta, G. (2019). Bipolar disorder: definition, differential diagnosis, clinical contexts, and therapeutic approaches. Journal of Neuroscience and Neurological Surgery, 5(1), 1-6. DOI: 10.31579/2578-8868/097
  • Pjrek, E., Baldinger-Melich, P., Spies, M., Papageorgiou, K., Kasper, S., & Winkler, D. (2016). Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. European Psychiatry, 32, 28-33. https://doi.org/10.1016/j.eurpsy.2015.11.001