Psychiatric Diagnosis and Management: Child

Psychiatric Diagnosis and Management: Child

 

Response to Mari Rearley

Hello Mari,

Your post is quite informative. Bipolar disorder is a psychological health condition that triggers excessive mood swings that encompass emotional highs and lows (hypomania and depression, respectively) (McIntyre et al., 2020). The patient can manage her mood swings by following a treatment plan with psychotherapy and medications. The patient also suffers from postpartum depression, a severe mood disorder experienced by new mothers. Depression may affect a mother’s capacity to take care of the newborn and complete household tasks. The patient might also experience extreme mood swings, challenges bonding with the child, withdrawal from family and friends, tend to eat excessively or too little, have feelings of hopelessness, and cries a lot. The two conditions are likely to trigger insomnia, intense anger or irritability, feelings of inadequacy, guilt or shame, restlessness, fear of not being a virtuous or worthy mom, inability to think, make decisions or concentrate, and suicidal thoughts. As a result, the patient needs more love and support from her partner, healthcare providers, family and friends, and therapy.

A woman’s body and mind experience many variations during and after pregnancy. If a woman feels emotionless, empty, or sad frequently for an extended period after pregnancy, she should seek help. Women susceptible to developing postpartum depression necessitate identification before giving birth to receive proper care services. A holistic nursing care approach and cognitive behavior therapy are essential in helping the patient. Holistic care offers a profound understanding of patients and their countless needs for care (Frisch & Rabinowitsch, 2019). Such care will assist the patient in accepting and assuming self-responsibility. Cognitive-behavioral therapy will help the patient exercise resilience, relaxation, assertiveness, and stress management. Seeking treatment from mental health providers and getting moral support from family members and friends can help alleviate and manage bipolar and depressive symptoms.

References

Frisch, N., & Rabinowitsch, D. (2019). What’s in a definition? Holistic nursing, integrative health care, and integrative nursing: Report of an integrated literature review. Journal of Holistic Nursing, 37(3), 260–272. https://doi.org/10.1177/0898010119860685

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H. & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856. https://doi.org/10.1016/S0140-6736(20)31544-0

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Mari Rearley 

RE: Discussion Question #3 – Prompt

COLLAPSE

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Discussion Response #3

There are several different problems that can be identified within this scenario.  The patient has been diagnosed with bipolar disorder and having a recent episode of depression.  She is a first-time mother and still grieving the recent loss of her mother.  She is having physical symptoms of feeling sore, tired, and overwhelmed, and she and her partner have not been getting along well.  Each of these problems can be treated using a holistic style of nursing care.  Holistic nursing includes philosophies of holism and humanism; recognizes the person as a whole; considers contexts of the environment; includes the mind-body-spirit; uses different methods to deliver care and restore power and responsibility to the patient; supports self-care; openness, equality, and mutuality encompass the provider/patient relationship; and understands the importance of care and support of the provider that is equally important as for the patient (Frisch & Rabinowitsch, 2019).

Bipolar disorder can disrupt every aspect of a person’s life.  Additional stressors such as childbirth and grief can be triggers for manic or depressive states of bipolar disorder (Perese, 2012).  Interpersonal and social rhythm therapy can help regulate mood states, social rhythms, and emotions, along with manage grandiosity, levels of stimulation, and comorbid substance abuse if present (Wheeler, 2014).  Addressing social rhythms allows the patient to function in interpersonal relationships in a less threatening manner and helps them feel more secure within themselves and with others (Wheeler, 2014).  Discovering ways to enhance support with this disorder will improve the patient’s overall quality of life.

Pregnancy and childbirth are major life changing events for a woman and her family.  As a woman, it touches every aspect of your existence; body, mind, and spirit.  Adjusting to a newborn causes a tremendous amount of stress and often creates discord among couples.  Men often struggle with how to provide support, especially if the mother chooses to breastfeed.  Social support given to the mother during pregnancy, birth, and postpartum can positively impact relationships with family members, increase sensitivity to her baby, and adapt to the role of motherhood more quickly and smoothly (Aytac & Yazici, 2020).  Support can be provided by family members, spouse, church members, and medical staff.  Family members can help cook and upkeep the home to allow the spouse to work and the mother to bond and attend to the needs of the baby.  Church members and friends can organize a dinner drop off so that the couple has a warm meal for several weeks following the birth of the child.  The mother needs to have plenty of rest and nutrition.  If the mother does not have adequate support, the practitioner should be made aware to ensure the mother and baby’s needs are met.

This patient is also still grieving the loss of her mother.  Even though it has been a year since the passing of her mother, she longs for sharing the experience of motherhood with her which has complicated the grieving process.  Complicated grief is grief that lasts longer than six months, involves a sense of disbelief that the individual has died, feelings of anger and bitterness over the death, preoccupation with thinking of the loved one, and intrusive thoughts about the death (Perese, 2012).  Without more information it is unknown if the patient meets diagnostic criteria, but there are some things a psychiatric and mental health nurse practitioner can do to treat symptoms of grief.  They can assist in helping the patient with needed time off work, identify financial resources, encourage contact with support groups outside of family, and recommend bibliotherapy to help understand the grieving process (Perese, 2012).  Cognitive behavior therapy with exposure therapy has also been shown to improve symptoms for complicated grief (Perese, 2012).

It is paramount that the mother and father try their best to work out their differences.  Even if it turns that the romantic relationship end, they still need to learn to work together for the sake of their child.  It takes learning new skills and practice to learn to be in a healthy and committed relationship.  Intimate relationships require empathy and vulnerability to achieve high levels of relationship satisfaction.  Imago relationship therapy (IRT) is applied to couples in committed relationships that integrates psychodynamic approaches, like ego psychology and attachment theory, along with cognitive behavior therapy, that theorizes that unconscious factors strongly influence partner selection (Schmidt & Gelhert, 2016).  IRT teaches couples to apply specific empathy-building skills though explicit exercises like couple’s dialogue and caring behaviors, essentially making empathy the central task of relationship work (Schmidt & Gelhert, 2016).  This couple could greatly benefit from practicing this style of therapy.  Any effort to strengthen their relationship is energy well spent.

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References

Aytac, S. H., & Yazici, S. (2020). The effects of social support on pregnancy and postpartum depression. International Journal of Caring Sciences, 13(1), 746–758. http://www.internationaljournalofcaringsciences.org/

Frisch, N., & Rabinowitsch, D. (2019). What’s in a definition? holistic nursing, integrative health care, and integrative nursing: Report of an integrated literature review. Journal of Holistic Nursing, 37(3), 260–272. https://doi.org/10.1177/0898010119860685

Perese, E. (2012). Psychiatric advanced practice nursing: A biopsychosocial foundation for practice (1st ed.). F. A. Davis Company.

Schmidt, C. D., & Gelhert, N. C. (2016). Couples therapy and empathy. The Family Journal, 25(1), 23–30. https://doi.org/10.1177/1066480716678621

Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse (2nd ed.). Springer Publishing Company.

 

 

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Appendix C1 & C2: Discussion Question Response #1 and #2 15 points per response

 

Assignment Description

Each student submits a response to the Discussion Board question. This is done in the appropriate module discussion board in Blackboard (Course Objectives 1-8).

 

Assignment Objectives

The student will:

1. Synthesize the evidence-based literature for the week (learning opportunities, other identified resources);
2. Apply synthesized knowledge to understand the posted question;
3. Demonstrate understanding by developing a written response to the question; and
4. Demonstrate appropriate application of technology for communication and learning.

 

Assignment Steps

To complete this assignment:

1. Read the posted question.
2. Use the assigned readings and other resources to develop a written response to the question.
3. Post the developed response to the appropriate week discussion board in Blackboard by the date assigned in the course calendar.

 

Assignment Evaluation

Each Discussion Board Response will be evaluated according the to the following rubric:

 

Criterion	Possible
Relevance	4	Response addresses the prompt.
Evidence Based	4	Response identifies and synthesizes the evidence in the literature, including DSM 5.
Critical Thinking	5	Review demonstrates critical thinking.
Mechanics	2	Writing is logical, APA 7th used; no errors in spelling, grammar, citations or references.

 

Required text book

Yalom, I. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.