Management of Psych Mental Health Disorders Discussion
Management of Psych Mental Health Disorders Discussion
Management of Psych Mental Health Disorders : There are two different discussions posted that needs two different responses. Please do not respond to both discussions as one. There needs to be two separate responses and each response needs it own separate references. thanks Management of Psych Mental Health Disorders Discussion
Response to Discussion 1
When dosing medications on seniors, it is important that the nurse is first of all aware of the medical history of the patient as you have stated, and to acknowledge that most likely the individual has limited resources and chances are that they cannot afford huge medical bills. Among children, many factors need to be considered. You mention the issue of informed consent which discloses to their guardians the doses and the factors that were considered. At below 18 years, parents and guardians are responsible for aiding in decision making. In the details of your discussion, you have clearly highlighted the importance of standards in medication for these groups such as the Beers criteria (Shin et al., 2021)Management of Psych Mental Health Disorders Discussion. Perhaps something I could add is that due to the dynamic nature of medical care, these criteria should not be too rigid but rather flexible enough to allow for new findings to be incorporated in the future.
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Reference
Shin, H., Kim, N., Cha, J., Kim, G. J., Kim, J. H., Kim, J. Y., & Lee, S. (2021). Geriatrics on beers criteria medications at risk of adverse drug events using real-world data. International Journal of Medical Informatics, 154, 104542. https://doi.org/10.1016/j.ijmedinf.2021.104542
Response to Discussion 2
Commenting on the diagnosis for JoAnn Smith, the patient demonstrates symptoms of an individual suffering from ADHD. The DSM-5 has explained that an individual suffering from this illness is unable to focus on tasks for a sufficient amount of time. Children with ADHD, have trouble concentrating in class and are often in trouble for failing to follow instructions (Sanders et al., 2019). In agreement with your diagnosis, it is important for additional questions such as the history of medication such as slow-in learning in school. Treatments for ADHD vary depending on severity. Interventions that are gaining increasing attention is therapy to help unearth factors that could be triggering the episodes.
Reference
Sanders, S., Thomas, R., Glasziou, P., & Doust, J. (2019). A review of changes to the attention-deficit/hyperactivity disorder age of onset criterion using the checklist for modifying disease definitions. BMC psychiatry, 19(1), 1-8. Management of Psych Mental Health Disorders Discussion
There are two different discussions posted that needs two different responses. Please do not respond to both discussions as one. There needs to be two separate responses and each response needs it own separate references. Thanks.
Discussion 1
What additional considerations should be given when dosing medications for children and seniors and why?
Prior to dosing medications for seniors a thorough history and physical examination should be carried out by the practitioner to gain insight on any past mental health issues, current medications, and any other medical conditions including liver or hepatic disease (Jacobson, 2014). Also, it is important to have the medication instructions in writing and ask the pharmacy to have larger labels on the medication bottles (Jacobson, 2014). Since many seniors are either retired or not working they are usually on a fixed income. Costs of medications can obviously be very expensive and patients should be educated on the costs (Jacobson, 2014). Educating the patient on the dosage, time, and possible side effects are imperative to discuss with the patients. Jacobson (2014) discussed the changing one medication at a time to alleviate confusion and side effects.
Prior to dosing any medication for a child, a complete history and any past medical records should be reviewed by the provider as well as any documents and evaluations (Dulcan et al., 2017). Medications are mainly dosed on a person’s height and weight and the provider should document their recording during each visit. Also, due to the child being under the age of 18 informed consent needs to be documented and education on the medication, dosage, side effects, and compliance is a priority for parents or guardian of the child (Hirsch, 2018).
What is the Beers Criteria?
The Beers criteria is a set of recommendations for providers when prescribing medication to seniors to prevent adverse effects that can be harmful for this population (Jacobson, 2014). The criteria assists providers in selecting appropriate medications for seniors while providing education to the patient and even their family members (Jacobson, 2014). Also, the Beers criteria have established a list of medications to avoid in patients with certain medical conditions (Jacobson, 2014)
Any differential diagnoses
Oppositional defiant disorder (ODD). The patient in this case does not appear to have hostility nor negativity to demands as a person would with ODD (American Psychiatric Association, 2013). According to Dulcan et al., (2017) a child with ODD presents with being argumentative and having irritable moods in the past six months. The patient can also be vindictive towards other which does not apply to the patient in question (Dulcan et al., 2017).
Autism spectrum disorder (ASD). Attention deficit hyperactivity disorder (ADHD) and ODD both present with symptoms of “inattention, social dysfunction, and inability to manage behaviors” (American Psychiatric Association, 2013 p 64). The patient for this discussion appears to have normal social interaction with friends and there is no mention of speech deficits or below normal intelligence based on his current grades (Dulcan et al., 2017).
Anxiety disorders. The patient may have some anxiety especially due to the divorce of his parents and the shared custody. The patient is reluctant to discuss the father or step-mother perhaps signaling an anxiety disorder because of the rules established by them if the patient is disobedient. The patient does have difficulty with concentration but no mention of extreme anxiety or worry for the past six months (American Psychiatric Association, 2013).
Your diagnosis and reasoning
Attention deficit hyperactivity disorder (ADHD). According to the American Psychiatric Association (2013) the patient meets criteria A 1. a, b, c, d, e, f, 2. b, e, f, g, h, i, B, C, D, and E (American Psychiatric Association, 2013). The patient presents with inattention and hyperactivity symptoms described in the scenario. The patient seems to be lacking the ability to maintain the pace of the schoolwork, interrupts students and the teacher, has been disciplined for excessive talking and inability to sit still in class and at home, and demonstrates lack of focus and concentration. The mother does not believe there is a problem with her son. However, Dulcan et al., (2017) states that school and home environments can influence the severity of ADHD symptoms. The patient may have more severe symptoms at his father’s house and school.
Any additional questions you would have asked
Knowing if there is any psychiatric history in the family could assist in the diagnosis. Neither the mother or father was questioned about their medical history. How old was the mother when she gave birth to the patient? Did the mother smoke cigarettes or drink alcohol during pregnancy? Was the child born premature or was he malnourished during infancy? There is a 75%-80% heritability of ADHD (Dulcan et al., 2017). Asking the child questions pertaining to how he feels when he stays at both homes and determine what makes him happy or sad.
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
Prior to prescribing medication or any treatment consent needs to be signed by the parents. For this patient, Adderall 5 mg po q morning before school. Adderall, a stimulant, is a dopamine, norepinephrine reuptake inhibitor stimulant indicated for ADHD that enhances norepinephrine and dopamine in the prefrontal cortex to improve attention and concentration (Stahl, 2020). As with all stimulants, side effects include increase in heart rate, blood pressure, arrythmias, headache, nervousness, nausea, weight loss, loss of appetite, irritability, and dizziness (Stahl, 2020). The black box warning indicates seizures, cardiac palpitations and arrythmias, suicidal thoughts, and sudden death in people with pre-existing cardiac abnormalities (Stahl, 2020). Notify parents and patient to take the medication as prescribed and provide education on onset of action which may be seen immediately or the medication can take several weeks for full effect (Stahl, 2020). The dose can be titrated by five milligrams each week depending on the effectiveness of the medication.
Any labs and why they may be indicated
Prior to starting a stimulant an electrocardiogram should be ordered to rule out any abnormal cardiac rhythms or disturbances (Stahl, 2020). Blood pressure needs to be taken prior to start of medication and during treatment (Stahl, 2020). Also, it is imperative to measure the patient’s height and weight during treatment. Medications titrations are based on weight of the patient so it is indicative to have accurate measurements. Furthermore, asking the parents if they have any history of cardiac disease is important to assess (Stahl, 2020). Dulcan et al., (2017) states that thyroid and lead levels should be assessed for during the initial examination.
Screener scales or diagnostic tools that may be beneficial
Screening scales such as the NICHQ Vanderbilt Assessment Scale for teachers, parents, or medical professionals to aid in the diagnosis of ADHD by measuring attention and hyperactivity symptoms (Dulcan et al., 2017). The Child Behavior Checklist (CBCL) can be used to monitor a child’s behavior and abilities (Biederman et al., 2021). The CBCL can also monitor changes during treatment. The Teachers Report Form assesses scholastic performance as well as any behavioral problems (Staff et al., 2020).
Additional resources to give (Therapy modalities, support groups, activities, etc.)
With parental consent, the parent or provider can inform the school of the child’s strengths and weaknesses and an Individualized Education Program may be enacted to ensure that the child’s needs are met during school (Dulcan et al., 2017). Also, having teachers regularly report on the child’s behavior and academic performance are crucial for the best results (Dulcan et al., 2017). Cognitive behavioral therapy can be beneficial for the patient to ascertain critical thinking strategies while being able to monitor their achievements (Dulcan et al., 2017). Dulcan et al., (2017) recognizes family therapy as a way to decrease struggles and battles with the child.
DISCUSSION 2
What additional considerations should be given when dosing medications for children and seniors and why?
The brain of children and seniors are both very fragile as the child’s brain is maturing and the seniors’ brain can be deteriorating leading to the need for careful consideration with all medications provided to each age group (Sadock et al., 2014).
What are the Beers Criteria?
(1) potentially inappropriate medications in older adults; (2) potentially inappropriate medications to avoid in older adults with certain conditions; (3) medications to be used with considerable caution in older adults; (4) medication combinations that may lead to harmful interactions; and (5) a list of medications that should be avoided or dosed differently for those with poor renal function (Sadock et al., 2014).
Group 2: JoAnn Smith
Your diagnosis and reasoning: ADHD (Attention Deficit Hyperactivity Disorder) Predominantly inattentive presentation. From the information provided patient meets criteria 1a. making careless mistakes in school work and other activities, 1b. has difficulty keeping attention on tasks or play activities, 1d. does not follow through on instructions, 1e. difficulty organizing tasks, 1h. easily distracted, and 1i. forgetful in everyday tasks (Dulcan et al., 2018).
Any differential diagnoses: Specific learning disorder- the patient could not be interested or becomes too frustrated to do his work or listen/follow directions (American Psychiatric Association, 2013, p. 73). Depressive disorder-patient could be experiencing poor concentration from a depressive episode related to parents’ divorce and situation (American Psychiatric Association, 2013, p. 74).
Any additional questions you would have asked:
Has any testing been completed at school for attention, learning disability, etc?
Does the patient have a 504 plan or an IEP?
I would want to talk to the patient alone and ask about his feelings about school work? Living arrangements? Friends? Activities?
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
The patient is not failing in his grade or is not in danger of being held back at this time. I would want to send screening tools to the patient’s teachers, have each parent fill out a screening tool, and go over the screening tool with the patient to see how he feels about his performance (Reichenberg & Seligman, 2017). Once all the data was collected, I would then make a decision to start medication or not and discuss all options with all the parents.
Any labs and why they may be indicated: Thyroid function test and or lead screening are the only tests recommended and only if warranted by an abnormality in the physical examination (Dulcan et al., 2018).
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Screener scales or diagnostic tools that may be beneficial:
Child Behavior Checklist and Snap-IV for all parties to fill out and return (Dulcan et al., 2018).
Additional resources to give (Therapy modalities, support groups, activities, etc.)
Patient would benefit from behavioral therapy as he has been getting into trouble at school and also can discuss any thoughts/feelings about his parent’s divorce that can be contributing to his behavior (Sadock et al., 2014).