Assignment 1: Practicum: Decision Tree Essay

Posted: November 9th, 2022

Assignment 1: Practicum: Decision Tree Essay

Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. Standard 8 “Education” (pages 69-70) Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 31, “Child Psychiatry” (pp. 1253–1268) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. “Anxiety Disorders” Note: You will access this book from the Walden Library databases. American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Assignment 1: Practicum: Decision Tree Essay. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Health Care, 29(5), 442–452. doi:10.1016/j.pedhc.2015.03.005 Note: You will access this article from the Walden Library databases. Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. Assignment 1: Practicum: Decision Tree Essay. Review the following medications: Generalized anxiety disorder Social anxiety disorder alprazolam citalopram desvenlafaxine duloxetine escitalopram fluoxetine fluvoxamine mirtazapine paroxetine pregabalin sertraline tiagabine (adjunct) venlafaxine citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid moclobemide paroxetine phenelzine pregabalin sertraline tranylcypromine venlafaxine Obsessive-compulsive disorder Panic disorder citalopram clomipramine escitalopram fluoxetine fluvoxamine paroxetine sertraline venlafaxine vilazodone alprazolam citalopram clonazepam desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid lorazepam mirtazapine nefazodone paroxetine phenelzine pregabalin reboxetine sertraline tranylcypromine venlafaxine Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Required Media YMH Boston. (2013b, May 22). Vignette 3 – Asking about depression in a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=TO8aITpMG5E Note: The approximate length of this media piece is 3 minutes. YMH Boston. (2013b, May 22). Assignment 1: Practicum: Decision Tree Essay. Vignette 5 – Assessing for depression in a mental health appointment [Video file]. Retrieved from https://www.youtube.com/watch?v=Gm3FLGxb2ZU Note: The approximate length of this media piece is 3 minutes. Laureate Education (Producer). (2017c). Anxiety disorder, ODC, or something else? [Multimedia file]. Baltimore, MD: Author. Optional Resources Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. Chapter 60, “Anxiety Disorders” (pp. 822–840) Chapter 61, “Obsessive Compulsive Disorder” (pp. 841–857) Assignment 1: Practicum: Decision Tree For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder. Learning Objectives Students will: Evaluate clients for treatment of mental health disorders Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders The Assignment: Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. At each Decision Point, stop to complete the following: Decision #1: Differential Diagnosis Which Decision did you select? Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Assignment 1: Practicum: Decision Tree Essay. Why were they different? Decision #2: Treatment Plan for Psychotherapy Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? Decision #3: Treatment Plan for Psychopharmacology Why did you select this Decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their families. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Assignment 1: Practicum: Decision Tree Essay

Introduction

The focus of this assignment is on an 8-year old boy client called Tyrel presented to the health facility accompanied by the mother with various psychiatric complaints. The mother reported that the client has become increasingly nervous and worried over the past two months. For example, the client spends a lot of time cleaning his hands because he fears that germs might contaminate his hands and he falls ill once again. He is very worried about dirt. The client has also been avoiding school and playing with his best friend. He has become irritable and sometimes experiences sleep disturbances. Accordingly, this assignment will involve making three decisions about the client’s diagnosis and his treatment as well. The first decision will be on the differential diagnosis where the client’s diagnosis will be made. The second and third decision be will regarding treatment options for the client. All the co-morbid factors likely to impact the diagnosis and the treatment of the client will be considered when making decisions about the treatment. The paper will also discuss any ethical issues regarding the treatment plan for this client. Assignment 1: Practicum: Decision Tree Essay

Decision 1

The diagnosis for this client isobsessive-compulsive disorder (OCD). This is because the client manifests numerous symptoms of OCD. According to the (American Psychiatric Association, 2013), some of OCD symptoms are: obsessions/compulsions typified by insistent thoughts and urges, as well as repetitive behaviors; the individual spends a lot of time on the compulsions and obsessions such that the individual’s functioning is impaired. In addition, people with OCD are anxious, distressed and manifest repetitive ritualistic behaviors (Krebs &Heyman, 2015). The most common forms of compulsions and obsessions consist of repetitive checking, praying and religious rituals, avoidance, routinized behavior, and repetitive washing. The case study indicates that the client is manifesting majority of OCD symptoms. First, the client has an obsession on hand-washing as he fears that he that his hands might become contaminated with germs and he might become sick again. His obsession with hand-washing has led to impairment of his normal functioning as he is no longer able to attend school, go to the playground or play with his friends (Thapar et al, 2015). The act of hand-washing relieves the client the anxiety and fear that he might become sick pointing out that the client has OCD because as Sadock et al (2014) indicates, the impractical mental act like repetitive hand-washing prevents and decreases anxiety and distress for people with OCD. Nonetheless, Tyrel is avoiding school and socializing with his friends which points out to social anxiety and therefore additional assessment for the client is necessary to confirm or rule out any social anxiety disorder. Assignment 1: Practicum: Decision Tree Essay

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The reason for not selecting GAD andPANDAS diagnosisis because the client does not exhibit any symptom that can be linked to GAD or PANDAS.

With this decision, it was hoped that the correct diagnosis would lead to appropriate treatment for the client and therefore ensure that the symptoms that client is manifesting improve significantly and he eventually achieves remission (Thapar et al, 2015).

Decision 2

The second decision is for the client to be prescribed Fluvoxamine. The medication should be administered at bedtime. This decision was chosen because selective serotonin reuptake inhibitor (SSRI) that works by helping to restore the balance of serotonin within the brain; serotonin is a chemical in the brain that is responsible for mood regulation (Garland et al, 2016). Fluvoxamine has been shown to be effective in reducing persistent/unwanted thoughts (obsessions) and urges to do repetitive compulsions and obsessions like checking or hand-washing. Fluvoxamine is an FDA approved drug to treat OCD in children.Moreover, the medication has few side effects. The rationale for the medication being administered at bedtime is because Fluvoxamine has sedative effects because of the medication’s sigma-1 antagonist properties(Stahl, 2014). Assignment 1: Practicum: Decision Tree Essay

The reason for not selecting the decision to start Zoloft 50 mg orally daily is because the medication has numerous side effects when compared to Fluvoxamine. The reason why the decision to start Fluvoxamine controlled release 100 mg orally in the morning was not selected is that fluvoxamine has sedative properties and therefore the medication is best administered during bedtime (Garland et al, 2016).

With this decision, the expectation was that the symptoms of OCD in the client would significantly reduce. This will be evident through notable reduction of the client’s obsession and compulsion with hand washing and the frequency of the hand-washing as well as decreased anxiety and fear of the hands getting contaminated with germs. Another expectation is that the client will resume his school activities, start playing with his friend once again and start going to the playground.  These expectations are based on the fact that fluvoxamine has been shown in reducing OCD symptoms (Pittenger & Bloch, 2014). Assignment 1: Practicum: Decision Tree Essay

There is no notable difference between the actual outcome of the decision that was chosen and the expected results. This is because when the client returned to the clinic, the mother reported that the OCD symptoms had reduced and the hand-washing had reduced as well. Moreover, the anxiety had reduced as the client was a bit relaxed.In addition, the mother reported that even though the client has not fully embraced going back to school, his school attendance had improved. Moreover, the client had gone to play with his friend, something had not done for some time.

Decision 3

The third decision will be to augment the current treatment withcognitive behavioral therapy (CBT). This reason for selecting this decision is because CBT changes the maladaptive thoughts, feelings as well as behaviors and also equips individuals with OCD with the necessary skills to cope with different situations (Wu et al, 2016). Assignment 1: Practicum: Decision Tree Essay

The decision to increase fluvoxamine to 50 mg orally at bedtime was not selected because the client is already showing significant improvement with the current dose of fluvoxamine and hence there is no need to increase the dose. On the other hand, the decision to augment with an atypical antipsychotic such as Abilify was not selected because antipsychotics are not used in treating OCD because OCD patients such as Tyrel do not manifest psychotic symptoms.

By augmenting the treatment with CBT, it is hoped that the client will continue improving since evidence shows that CBT improves symptomsof OCD. The second expectation is that the client’s anxiety levels would reduce. CBT will change Tyrel’s maladaptive thoughts and feelings regarding anxiety and hence lead to his attitude and behavior change (Wu et al, 2016).

The outcome that was hoped for and the actual outcome are comparable because the symptoms of OCD in the client continued improving since Tyrel was able to attend school more and began socializing and playing with his friend. Assignment 1: Practicum: Decision Tree Essay

Ethics

The ethics applicable during the treatment of Tyrel areinformed consent, confidentiality, and autonomy/decision-making(Ford&Hecke, 2015). First,Tyrel is 8-years-old and therefore a minor who cannot consent or decide regarding his treatment. Therefore, his parents are the ones to give consent for his treatment and also make his treatment choices. In addition, the issue of confidentiality should be respected. Therefore, no information regarding the client and his treatment should be revealed to anyone without the consent of the client or his parents (Ford &Hecke, 2015).

References

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

Ford C &Hecke L. (2015). Ethical and Legal Considerations When Counseling Children and Families.Journal of Family Therapy.36(4).

Garland J, Stan K, Virani A & Dean E. (2016). Update on the Use of SSRIs and SNRIs with Children and Adolescents in Clinical Practice. J Can Acad Child Adolescent Psychiatry. 25(1), 4–10.

Krebs G &Heyman I. (2015). Obsessive-compulsive disorder in children and adolescents.Arch     Dis Child. 100(5): 495–499.

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

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

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

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

Wu Y, Lang Z & Zhang H. (2016).Efficacy of Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis. Med SciMonit. 1( 22), 1646–1653. Assignment 1: Practicum: Decision Tree Essay