TO PREPARE

5

Study Guide

NRNP 6665: PMHNP Care Across the Lifespan I

October 23, 2022

Study Guide

· Signs and symptoms according to the  DSM-5-TR

· Behavioral: excitability, impulsivity, aggression, irritability, fidgeting.

· Cognitive: hard time focusing, issues with paying attention, absent-mindedness, forgetfulness.

· Mood: anxiety, anger, boredom, mood swings (Sayal et al., 2018).

· Differential diagnoses

· Anxiety disorder

· Oppositional defiant disorder

· Conduct disorder

· Obsessive-compulsive disorder

· Adjustment disorder

· Post-traumatic stress disorder

· Substance use disorder (Reale et al., 2017).

· Incidence

· Incidence according to gender; Males (13%) Females (6%)

· Incidence according to race and ethnicity (Sayal et al., 2018).

· Development and course

· Early onset in childhood

· Persistence into adult life

· Risk factors such as family history with the illness and environmental toxins.

· Prognosis

· Substantial relief with treatment using medication.

· Effective use of counseling, behavior therapy and education services reduces signs and symptoms (Danielson et al., 2018).

· Considerations related to culture, gender, age

· Generally affects children but the development varies with age.

· Males more affected than females.

· White children more likely to be diagnosed with ADHD.

· Culture, race and ethnicity influence course of treatment (Danielson et al., 2018).

· Pharmacological treatments, including any side effects

· Stimulants (methylphenidate and amphetamines)

· Nonstimulants (Guanfacine and atomoxetine)

· Side effects: difficulty sleeping, loss of appetite, irritability, moodiness, high blood pressure and heart rate (Hauck et al., 2017).

· Nonpharmacological treatments

· Cognitive behavioral therapy

· Child/parent training

· Cognitive training

· Neurofeedback

· Focus on diets (Hauck et al., 2017).

· Diagnostics and labs

· Clinical evaluation

· Reliance on interviews, observation, psychological tests and questionnaires.

· No lab tests available for ADHD (Danielson et al., 2018).

· Comorbidities

· Depression

· Anxiety

· Obsessive-compulsive disorder (Reale et al., 2017).

· Legal and ethical considerations

· Four key principles (Beneficence, justice, non-maleficence and autonomy)

· Confidentiality and consent

· Prescription medication for children (Reale et al., 2017).

· Pertinent patient education considerations

· Regular communication with teachers/parents

· Provision of essential instructions

· Limitation of distractions (Sayal et al., 2018).

References

Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents, 2016.  Journal of Clinical Child & Adolescent Psychology,  47(2), 199-212. https://doi.org/10.1080/15374416.2017.1417860

Hauck, T. S., Lau, C., Wing, L. L. F., Kurdyak, P., & Tu, K. (2017). ADHD treatment in primary care: demographic factors, medication trends, and treatment predictors.  The Canadian Journal of Psychiatry,  62(6), 393-402. https://doi.org/10.1177/0706743716689055

Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., ... & Bonati, M. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD.  European child & adolescent psychiatry,  26(12), 1443-1457. https://doi.org/10.1007/s00787-017-1005-z

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision.  The Lancet Psychiatry,  5(2), 175-186. https://doi.org/10.1016/S2215-0366(17)30167-0