Psychiatric Diagnosis and Management: Child

Psychiatric Diagnosis and Management: Child

 

Response to Rajene

Hello Rajene, your post is quite informative. ADHD (Attention-deficit/hyperactivity disorder) is a condition registered in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), a guide in print by the APA (American Psychiatric Association) to diagnose mental illnesses. ADHD is a chronic disorder that impacts numerous kids and frequently lasts into adulthood. ADHD comprises a mixture of persistent challenges like impulsive behavior, difficulties in sustaining attention, and hyperactivity. On the other hand, adjustment disorders with anxiety are frequently diagnosed in adolescents and kids but can also be interpreted in adults. Stressors trigger both conditions. Stressors are negative occurrences that threaten a person’s capacity to self-regulate emotions, behavior, and cognition and achieve desired goals (Perse, 2012). Kids with ADHD may tussle with self-esteem, inferior academic performance, and troubled interactions. Symptoms slightly lessen with age, and treatments usually include behavioral interventions and medications. ADHD diagnosis was formulated to assist individuals and help kids access fundamental health care amenities and actual treatment.

Notably, an adjustment disorder is a behavioral or emotional response to a traumatic occurrence or an alteration in an individual’s life. According to Yalom (2017), a medical visit for psychological disorders like hypertension or ADHD might be routine to a mental professional. Still, patients might fear the implications of the doctor’s evaluation for the length of their life or changes in their lifestyle. The treatments encompass family therapy, peer group therapy, or individual psychotherapy. Dulcan, Ballard, Jha, and Sadhu (2018) assert that the number of empirically supported treatments and the body of clinical research has expanded, assessment practices have been advanced, and there is an increase in emotional and behavioral challenges in youth has increased. Overall, kids and adolescents suffering from ADHD and adjustment disorder with anxiety require psychological and medical support.

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References

Dulcan, M., Ballard, R., Jha, P., Sadhu, J. (2018). A concise guide to child & adolescent psychiatry 5th ed). American Psychiatric Association Publishing.

Perese, E. F. (2012). Psychiatric Advanced Practice Nursing: A Biopsychosocial Foundation for Practice. FA Davis.

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

2 days ago

Rajene Fox 

Module 04 Cast Study

COLLAPSE 

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Module 04 Case Study

Differential Diagnoses/Rational:

1. Attention Deficit/Hyperactivity Disorder.  Patient is unable to sit still, outbursts in school.  He experiences inattention, impulsivity and hyperactivity (Perese, 2012) which can be categorized as ADHD-Hyperactivity Disorder.   He meets DSM-5 criteria for this diagnosis: six or more symptoms persisting for at least 6 months that negatively impacts social and academic activities:  careless mistakes in schoolwork, does not seem to listen when spoken to, does not follow through on instructions/fails to finish schoolwork/chores, dislikes schoolwork, easily distracted, fidgets or squires in seat, bluts out answer/difficulty waiting his turn, interrupts (APA, 2013)
2. Adjustment Disorder with Anxiety.  Common in parental divorce, symptoms remit when stressor removed (Dulcan et al, 2018)).  Most frequent identified stressor includes parental separation or divorce (Perese, 2012)  DSM-5 criteria include stressors accompanying going to his father’s home, nervousness, separation anxiety (APA, 2013) .
3. Autism Spectrum Disorder.  Mild ASD can present in middle school or adolescence.  Poor eye contact, difficulty developing, maintaining and understanding relationships (Dulcan et al., 2018)  According to DSM-5 he does not meet criteria for this diagnosis.
4. Bipolar Disorder
5. Conduct Disorder
6. Anxiety Disorder

Final Diagnoses:

1. Attention Deficit/Hyperactivity Disorder
2. Adjustment Disorder with Anxiety

Treatment:

• Attention Deficit/Hyperactivity disorder:
  • Interview and Mental Status Exam (Dulcan, 2022)
  • Physical exam to include screening for sleep disorders/abnormal awakenings (tonsil enlargement), family history of cardiac disease/sudden death (Dulcan, 2022).  Signs of physical anomalies, thyroid disorder, baseline height and weight, labs if indicated including TSH, EKG if high cardiac risk (Dulcan et al 2018)
  • Rating scale options: Parent & Teacher rating scales, Teacher Report Form , Child Symptom Inventory, Snap IV, ADHD Raiting Scare-5, Vanderbilt ADHD Diagnostic Teacher Rating Scale (Dulcan et al, 2018)
  • Psychological testing and observations during test, CAP Rating Score (Dulcan et al, 2018)
  • Atomoxetine (Strattera) can be useful if anxiety is present:  0.5-1.2 mg/kg/day-may titrate to with a maximum dose of 1.4 mg/kg per day or 100mg/day whichever is less (Stahl, 2017).  Otherwise stimulants are first line: methylphenidate or amphetamine (Dulcan, 2022)
    • Educate patient and parent/guardian possible side effects:  fatigue/sedation, decreased appetite, rare priapism, increased heart rate/blood pressure, insomnia, dizziness, anxiety, agitation, aggression, irritability, dry mouth, constipation, nausea, vomiting, abdominal pain, dyspepsia, urinary hesitancy or retention, weight gain.  Life threatening side effects:  increased  heart rate/hypertension, orthostatic hypotension, liver damage, hypomania/mania, suicidal ideation. (Stahl, 2017)
    • Continuous monitoring
  • Behavioral Parental Training, CBT (Dulcan et al, 2018)
  • Education about disorder, appropriate school and class placement = IEP, academic mediation if necessary. (Dulcan et al, 2018)
  • Possible dietary treatments:  supplementation of Omega 3, fish oil, PUFA, melatonin for sleep, elimination of additives/food dyes and preservatives may be helpful but these all have minimal evidence (Dulcan et al, 2018)
• Adjustment Disorder with Anxiety
  • CBT (Dulcan et al, 2018)
  • Support and promote coparenting quality and efficacy, reduce parenting stress , enhance relationship skills (Karberg & Cabrera, 2020)
  • Atomoxetine that is utilized for ADHD can be beneficial for anxiety symptoms (Dulcan et al, 2018)

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th ed). American Psychiatric Association Publishing, Inc.

Dulcan, M. (2022).  Dulcan’s textbook of child and adolescent psychiatry (3^rd ed).  American Psychiatric Association Publishing.

Dulcan, M., Ballard, R., Jha, P., Sadhu, J. (2018). Concise guide to child & adolescent psychiatry 5^th ed). American Psychiatric Association Publushing.

Karberg, E., Cabrera, N. (2020) Children’s adjustment to parents’ breakup: the mediational effects of parenting and coparenting.  Journal of Family Issues, 41(10): 1810-1833.                                                   DOI: 10.1177/0192513X19894347.

Perese, E. (2012). Psychiatric advance practice nursing: A biopsychosocial foundation for practice. F.A. Davis Company.

Stahl, S.M. (2017) Prescriber’s guide: Stahl’s essential psychopharmacology (6^th ed.) Cambridge University Press.

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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.

 

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Required text book

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