2nd Response. Week 11 Discussion
Hello Ronald and thank you for your interesting and informative post on adoption. As
you mentioned in your post, over half of adopted children in the United States are adopted from
the child welfare (foster) system. According to Allen, Timmer & Urquiza (2014), children
adopted from foster cares could have history of child abuse and neglect in their original home or
the foster homes. History of child abuse and neglect is noted by many professionals to require
that these children undergo attachment therapy in order to address their emotional and behavioral
needs. Allen, Timmer & Urquiza notes that Parent-Child Interaction Therapy (PCIT) is one of
the evidence-based treatment options that conforms to expectations and requirements prescribed
by attachment theory research. PCIT is noted by Allen, Timmer & Urquiza to demonstrate
significant improvements in positive parenting techniques, reduction of parenting stress, and
reduction in externalizing and internalizing concerns among the adopted children (Allen, Timmer
& Urquiza, 2014, Ferow, 2019).
As noted in my post in reply to another student, Ferow (2019) notes that it is also
important for providers to note that children adopted from foster cares may be experiencing grief
and loss from either death, divorce, parental incarceration, or similar situations. The children
may be challenged in recovery due to lack of necessary life experience, coping skills, and lack of
appropriate support networks to work through their grief. It is therefore important for those
providing care to the children to recognize these risk factors associated with complicated or
unresolved grief. Some therapy techniques that have been found helpful in helping children in
adoption from foster care services include motivational interviewing, group therapy, and grief
support groups. Ferow notes that it is also helpful for the adults involved in the child’s care to
develop open and honest lines of communication with the child. Sadock, Sadock & Ruiz (2014)
notes that there is a need for cultural sensitivity, respect, and capacity to facilitate a foster child’s
cultural development and identity. This can be achieved by training providers, foster care service
providers and parents of adopted children to acknowledge the importance of cultural sensitivity
when dealing with children in foster or adopted homes (Allen, Timmer & Urquiza, 2014, Ferow,
2019, Sadock, Sadock & Ruiz, 2014).
References
Allen, B., Timmer, S. G., & Urquiza, A. J. (2014). Parent–Child Interaction Therapy as an
attachment-based intervention: Theoretical rationale and pilot data with adopted
children.8Children and Youth Services Review,847(Part 3), 334–341. https://doi-
org.ezp.waldenulibrary.org/10.1016/j.childyouth.2014.10.009
Ferow, A. (2019). Childhood Grief and Loss.8European Journal of Educational Sciences, 1–13.
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
1st Response. Week 11
Hello Kathleen and thank you for your interesting and informative post on foster care. Ferow
(2019) notes that children in foster care or adoption experience grief and loss from either death,
divorce, parental incarceration, and similar situations. The children may be challenged in
recovery due to lack of necessary life experience, coping skills, and lack of appropriate support
networks to work through their grief. It is therefore important for those providing care to the
children to recognize the risk factors associated with complicated or unresolved grief. Some
therapy techniques that have been found helpful in helping children in foster care include
motivational interviewing, group therapy, and grief support groups. Ferow notes that it is also
helpful for the adults involved in the child’s care to develop open and honest lines of
communication with the child. Sadock, Sadock & Ruiz (2014) notes that there is a need for
cultural sensitivity, respect, and capacity to facilitate a foster child’s cultural development and
identity. This can be achieved by training providers and foster care services to acknowledge the
importance of cultural sensitivity when dealing with children in foster or adopted homes
(Sadock, Sadock & Ruiz, 2014, Ferow, 2019).
References
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Ferow, A. (2019). Childhood Grief and Loss.8European Journal of Educational Sciences, 1–13.
Initial Post. Week 11 Discussion
Gender Dysphoria
The selected topic that I choose to address in this discussion is gender dysphoria (GD).
According to the American Psychiatric Association [APA] (2013), gender dysphoria refers to the
distress that may accompany an individuals incongruence between their experienced/expressed
gender and their assigned gender based. Karia et al. (2016) notes that GD is characterized by
persistent unhappiness with one’s own sex, and a desire to be of the opposite sex. The term
transgender is also used for individuals with GD. Children with GD have an insistence that they
are of the other gender, different from their assigned gender, and have a strong dislike of their
sexual anatomy. Some of the psychological issues that may result from GD include elevated
levels of emotional and behavioral problems such as anxiety, disruptive and impulsive-control,
and depressive disorders (AACAP, 2012c, APA, 2013, Sadock, Sadock, & Ruiz, 2014).
Assessment Measure and Treatment Options
As an assessment and diagnosis for GD is made, it is important to note that according to
the DSM-5 diagnostic criteria, a diagnosis of GD can only be made after at least 6 of the listed
symptoms are met. The condition must also be associated with clinically significant distress or
impairment in social, school, or other important areas of functioning. One of the assessment tools
that can be used in assessing for GD include the Minnesota Multiphasic Personality Inventory-2
(MMPI-2). The reason for choosing the MMPI-2 in this discussion is that MMPI-2 is noted by
Karia et al. (2016) as an important tool in assessing comorbid psychopathology, anxiety, lack of
parental and family support and extreme psychological distress that are related to GD. The
MMPI-2 is a self-administered questionnaire consisting of 567 items that aims to assess both the
psychopathology and the main structural characteristics of the personality of participants. This
tool is particularly important in assessing for whether GD in individuals with schizophrenia is
due to delusionally changed gender identity, or if GD is regardless of the psychotic process.
Distinguishing between GD that is due to delusionally changed identity or that is not related to
psychosis is important as it affects the therapeutic decisions that a psychiatric mental health
practitioner (PMHNP) can make. According to Sadock, Sadock, & Ruiz, (2014), some of the
treatment options available for people with GD include individual, family and group therapy that
can guide the children in exploring their gendered interests and identities. Culture could play a
major role and influence treatment decisions by families. Some families, based on culture may
choose providers who practice reparative, or conversion therapy which attempts to change a
person’s gender identity or sexual orientation. Sadock, Sadock, & Ruiz notes that such therapy is
contrary to position statements by the APA and practice guidelines of the American Academy of
Child and Adolescent Psychiatry [AACAP] (AACAP, 2012c, APA, 2013, Sadock, Sadock, &
Ruiz, 2014, Vitelli & Riccardi, 2011, Stusinki & Lew-Starowicz, 2018).
References
American Academy of Child & Adolescent Psychiatry (AACAP). (2012c). Practice parameter on
gay, lesbian, or bisexual orientation, gender nonconformity, and gender discordance in
children and adolescents. Journal of the American Academy of Child & Adolescent
Psychiatry, 51(9), 957-974. Retrieved from http:??www.jaacap.com/article/S0890-
8567(12)00500-X/pdf
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.) [DSM-5]. Washington, DC: Author.
Human Rights Campaign. (n.d.). Growing up LGBT in America. Retrieved from
http://assets.hrc.org//files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf?
_ga=1.83582870.1279387255.1493224749
Karia, S., Jamsandekar, S., Alure, A., De Sousa, A., & Shah, N. (2016). Minnesota Multiphasic
Personality Inventory-2 Profiles of Patients with Gender Identity Disorder Requesting
Sex Reassignment Surgery.8Indian Journal of Psychological Medicine,838(5), 443–446.
https://doi-org.ezp.waldenulibrary.org/10.4103/0253-7176.191378
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Stusiński, J., & Lew-Starowicz, M. (2018). Gender dysphoria symptoms in
schizophrenia.8Psychiatria Polska,852(6), 1053–1062. https://doi-
org.ezp.waldenulibrary.org/10.12740/PP/80013
Vitelli, R., & Riccardi, E. (2011). Gender identity disorder and attachment theory: The influence
of the patient’s internal working models on psychotherapeutic engagement and objective
A study undertaken using the Adult Attachment Interview.8International Journal of
Transgenderism,812(4), 241–253.
https://doi-org.ezp.waldenulibrary.org/10.1080/15532739.2010.551485
2nd Response Week 10 discussion
Hello group D and thanks for your interesting and informative post on
avoidant/restrictive food intake disorder (ARFID). I liked your easy to read parent guide and its
attractive design and pictures. I also liked the evidence-based details you provided about ARFID.
An additional point to add on this topic would be that according to Yasar et al. (2019), traumatic
life events such as choking that led to temporary inability to breath are among etiological factors
that may trigger eating disorders such as ARFID. Yasar notes that eye movement desensitization
and reprocessing (EMDR) therapy combined with cognitive behavioral therapy (CBT) are noted
by studies to be effective in significantly reducing ARFID symptoms (Yasar et al. (2019).
References
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Yaşar, A. B., Abamor, A. E., Usta, F. D., Taycan, S. E., & Kaya, B. (2019). Two cases with
avoidant/restrictive food intake disorder (ARFID): Effectiveness of EMDR and CBT
combination on eating disorders (ED).8Klinik Psikiyatri Dergisi,822(4), 493–500.
https://doi-org.ezp.waldenulibrary.org/10.5505/kpd.2019.04127
1st Response Week 10 discussion
Hello group C and thanks for your informative and interesting post. I liked the evidence-
based details you provided about encopresis. I also liked the design of your parent guide which
was easy to read and understand. Of course it would be good to know who developed the
pamphlet (group members). According to Sadock, Sadock & Ruiz (2014), most children with
encopresis and become constipated, for retaining feces either voluntarily or secondary to painful
defecation. This leads to chronic rectal distention from the hard, large fecal masses which cause
loss of tone in the rectal wall. Oral administration of laxatives such as polyethylene glycol (PEG)
at 1 g/kg per day, surgical disimpaction and cognitive-behavioral therapy are some interventions
to that can help in managing encopresis (Sadock, Sadock & Ruiz, 2014).
References
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
2nd Response. Week 8 Discussion
Hello Ronald. You wrote a very interesting post. You raised and elaborated on a few
points that raise serious questions on why children may need psychiatric diagnosis or
psychopharmacological treatment. The American Nurses Association [ANA] (2001) provision
number 3.5 notes that if a nurse is aware of inappropriate or questionable practice in the
provision or denial of healthcare, concern should be expressed to the person carrying out the
questionable practice, and attention should be called to the possible detrimental effect upon the
patient’s well-being, or the best interests as well as integrity of the nursing practice. However, it
is important to note that although pharmacological companies do financially benefit from sale of
the medications used for treatment of children, the psychiatric mental health nurse practitioner’s
(PMHNP) role in treating children should be focused on the importance of managing the serious
conditions afflicting their clients such as pediatric bipolar disorder (PBD). Fristad & MacPherson
(2014), Sadock, Sadock & Ruiz (2014), Isaia et al. (2018), and Radu et al. (2014) all note that
PBD is a serious condition that is associated with morbidity and mortality in children. Same
writers listed above point out that multiple research studies on treatment for PBD note that
although pharmacotherapy for pediatric PBD is an option, growing literature suggests that
psychosocial interventions are also important in providing families with an understanding of
symptoms, course, and treatment options for PBD (ANA, 2001, Fristad & MacPherson, 2014,
Sadock, Sadock & Ruiz, 2014, Isaia et al., 2018, Radu et al., 2014).
References
American Nurses Association [ANA]. (2001). Code of Ethics for Nurses with Interpretive
Statements. Silver Spring. MD. Nursesbooks.org.
Fristad, A. M., & MacPherson, A. H. (2014). Evidence-Based Psychosocial Treatments for Child
and Adolescent Bipolar Spectrum Disorders.8Journal of Clinical Child & Adolescent
Psychology,843(3), 339–355.
https://doi-org.ezp.waldenulibrary.org/10.1080/15374416.2013.822309
Isaia, A. R., Weinstein, S. M., Shankman, S. A., & West, A. E. (2018). Predictors of Dropout in
Family-Based Psychosocial Treatment for Pediatric Bipolar Disorder: An Exploratory
Study.8Journal of Child & Family Studies,827(9), 2901–2917. https://doi-
org.ezp.waldenulibrary.org/10.1007/s10826-018-1126-0
Radu, D. A., Chirita, R., Untu, I., Sacuiu, I., Lupu, V. V., Ciubara, A., & Burlea, L. S. (2014).
Bipolar Disorder in Children: The Diagnostical Challenge.8Romanian Journal of
Rheumatology,823(2), 120–123.
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
1st Response. Week 8 Discussion
Hello Diana. Thank you for your very informative post. You explained your position
against diagnosing bipolar depression disorder in children very well and with evidence that there
is potential for error in making the diagnosis and that it could lead to harm to the child. As you
mentioned, and as noted by Sadock, Sadock & Ruiz (2014) and8Radu et al. (2014), one of the
main challenges of differential diagnosis for pediatric bipolar disorder (PBD) is with attention-
deficit/hyperactivity disorder (ADHD), conduct disorder, and also disruptive mood dysregulation
disorder (DMDD). The challenge is because sometimes it’s very difficult to differentiate the
manic/hypomanic symptoms (logorrhea in PBD/the excessive talking in ADHD, psychomotor
agitation in PBD/Hyperkinesis of ADHD, and distractibility that is present in both disorders).
Sadock, Sadock & Ruiz notes that according to the Diagnostic and statistical manual of mental
disorders (5th ed.) [DSM-5], the diagnostic criteria for manic episodes in children and adolescents
and in adults are the same. Sadock, Sadock & Ruiz also notes the importance of treating PBD,
and notes that treatment of PBD should incorporate multimodal interventions including
pharmacotherapy, psychoeducation, psychosocial intervention with the family and the child, as
well as school interventions to optimize the child’s school adjustment and achievement (Sadock,
Sadock & Ruiz, 2014, Radu et al., 2014).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.) [DSM-5]. Washington, DC: Author.
Isaia, A. R., Weinstein, S. M., Shankman, S. A., & West, A. E. (2018). Predictors of Dropout in
Family-Based Psychosocial Treatment for Pediatric Bipolar Disorder: An Exploratory
Study.8Journal of Child & Family Studies,827(9), 2901–2917. https://doi-
org.ezp.waldenulibrary.org/10.1007/s10826-018-1126-0
Radu, D. A., Chirita, R., Untu, I., Sacuiu, I., Lupu, V. V., Ciubara, A., & Burlea, L. S. (2014).
Bipolar Disorder in Children: The Diagnostical Challenge.8Romanian Journal of
Rheumatology,823(2), 120–123.
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Initial Post. Week 8 Discussion
“For” Pediatric Bipolar Depression Diagnosis
Although bipolar disorder (BD) has been regarded as a rare pathology in children and
adolescents, Radu et al. (2014) notes that there has been a significant increase in pediatric bipolar
disorder (PBD), noting that recent studies shows that it occurs in 1.8% of children and
adolescents (p. 120). PBD is noted by Radu et al. and Isaia et al. (2018) as a serious mental
illness that is characterized by significant mood lability and psychosocial impairments across a
variety of domains, including at school, at home, and with peers. Some of the mania/hypomania
symptoms of PBD include elevated mood that is associated with elements of grandiosity,
logorrhea, insomnia, hypersexuality, psychotic symptoms, irritability, self-harm and suicidal
behavior, involvement in dangerous activities, poor judgement, and flight of ideas. Some of the
PBD depressive symptoms are characterized by sadness, episodes of unjustified crying,
hypersomnia or insomnia, agitation, irritability, withdrawal from normally enjoyable activities,
and apathy leading to suicidal ideations. Radu notes that children with PBD commonly have
ADHD as a comorbidity, noting that 91% of children and 57% of adolescents with PBD have
ADHD (p. 121). Some of the tools that can be used for assessing the clinical symptoms of PBD
include the FIND scale which targets the four coordinates of PBD namely – Frequency
(symptoms present more days per week), Intensity (severity of symptoms), Number (3-4 times
per day), and Duration (symptoms lasting more than 4 hours per day). Another tool used is the
Young Mania Rating Scale [YMRS] (Isaia et al., 2018, Sadock, Sadock & Ruiz, 2014, Radu et
al., 2014 ).
Diagnosing PBD is important as it allows for appropriate pharmacological and
psychotherapeutic interventions to be used in managing the disorder. Diagnosing and treating
PBD would allow the psychiatric mental health nurse practitioner (PMHNP) to address the many
functional impairments that affects the daily lives of these youths and their families. Isaia et al.
(2018) notes that in an effort to improve the prognosis for youths with PBD, evidence-based
psychosocial treatments in conjunction with pharmacological treatments have been developed
and found to improve symptoms and functions among the youth with PBD (Isaia et al., 2018,
Sadock, Sadock & Ruiz, 2014, Radu et al., 2014 ).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Isaia, A. R., Weinstein, S. M., Shankman, S. A., & West, A. E. (2018). Predictors of Dropout in
Family-Based Psychosocial Treatment for Pediatric Bipolar Disorder: An Exploratory
Study.8Journal of Child & Family Studies,827(9), 2901–2917. https://doi-
org.ezp.waldenulibrary.org/10.1007/s10826-018-1126-0
Radu, D. A., Chirita, R., Untu, I., Sacuiu, I., Lupu, V. V., Ciubara, A., & Burlea, L. S. (2014).
Bipolar Disorder in Children: The Diagnostical Challenge.8Romanian Journal of
Rheumatology,823(2), 120–123.
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
2nd Response. Week 7 Discussion
Thank you group C for the great parental guide that you designed. I like the way you
organized the information in the guide. I also like the way the information in the chart is clearly
explained to the parents in a way that they can clearly understand. One way that I think would
have improved the parental guide is use of bigger fonts as that may help those who cant read
very fine/small fonts. I however understand that that would have pushed your guide to probably
2 pages. Another thing to add is that according to the National Institute of Neurological
Disorders and Stroke [NINDS] (2017), researchers through genetic analysis have determined that
deletions in the NRXN1 gene or duplications in the CNTN6 gene were each associated with an
increased risk of Tourette syndrome. As researchers understand more about the genes involved in
Tourette syndrome, it moves them closer to the ultimate goal of developing treatment to help
children affected by the disease (NINDS, 2017).
References
National Institute of Neurological Disorders and Stroke. (2017). Researchers uncover genetic
gains and losses in Tourette syndrome. Retrieved from https://www.ninds.nih.gov/News-
Events/News-and-Press-Releases/Press-Releases/Researchers-uncover-genetic-gains-and-losses
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
1st response. Week 7 Discussion
Thank you group D for a very interesting and informative parent guide on Stereotypic
Movement Disorder (SMD). Rad & Furlanello (2016) notes that SMD is characterized by
stereotypical motor movements (SMM). Rad & Furlanello also notes that the prevalence of SMD
as a comorbidity in people with Autism Spectrum disorder (ASD) is very high, and that it
interferes with learning and social interaction. Rad & Furlanello notes that real-time detection of
SMM would be advantageous for caregivers, families, and therapists. Real-time detection would
allow those involved in caring for individuals with SMD to evaluate and mitigate the onset of
meltdowns that are anticipated by the atypical behaviors associated with SMD. The early
evaluation and mitigation gradually alleviates the duration and severity of the abnormal
movements (Rad & Furlanello, 2016).
References
Rad, N. M., & Furlanello, C. (2016). Applying Deep Learning to Stereotypical Motor Movement
Detection in Autism Spectrum Disorders.82016 IEEE 16th International Conference on
Data Mining Workshops (ICDMW), Data Mining Workshops (ICDMW), 2016 IEEE 16th
International Conference on, ICDMW, 1235–1242. https://doi-
org.ezp.waldenulibrary.org/10.1109/ICDMW.2016.0178
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
2nd Response. Week 6 Discussion
Hello Lorraine and thank you for your interesting and informative post on psychiatric
emergencies. You raised a very important point about dealing with aggressive children in a
hospital setting. Margret & Hilt (2018) notes providers should evaluate any aggression by
patients and ensure safety. Providers should note that children with autism spectrum disorder
(ASD) and neurodevelopmental disorders typically respond poorly to transitions and chaotic
environments such as the emergency department (ED). This may aggravate aggression and
worsen their mental state if staff lack clear understanding and training to deal with such
situations. Margret & Hilt therefore recommends that a specialized ASD guideline of care within
the ED to support evaluation for ASD and related disabilities should be in place in areas that deal
with children psychiatric emergencies. The guideline should include individualized ASD care
screen that lists communicative methods, sensitivities, and self-soothing strategies as per their
care-givers. The guidelines should also include assignment of low-stimulation rooms that limits
staff and extraneous sounds and contains sensory tools for self-soothing (Margret & Hilt, 2018).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Margret, C. P., & Hilt, R. (2018). Evaluation and management of psychiatric emergencies in
children.#Pediatric Annals,#47(8), 328-333.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Texas Department of Family and Protective Services. (n.d.). Reporting Suspected Abuse or
Neglect of a Child in Texas: Reporting Basics. Retrieved from
https://www.dfps.state.tx.us/Training/Reporting/documents/Reporting_Basics.pdf
1st Response. Week 6 Discussion
Hello Shamell and thank you for your very interesting and informative post. You raised
very important points to note. One other point to note is that according to Margret & Hilt (2018),
mental illnesses among children and adolescents in the United States of America (USA) affects 1
in 5 children (p. 328). There are concerns that despite the need for services for children and
adolescents, mental health services for them is fragmented due to a scarcity of specialized care
personnel, and limited inpatient and outpatient services due to closures of facilities because of
increasing cost. This has lead to overflow of mental health visits by children and adolescents to
the emergency department (ED). The fragmented mental health services for children and
adolescents has led to the use of the ED for subacute or less emergent mental health problems
that could otherwise be handled in community-based mental health centers if they were
accessible (Margret & Hilt, 2018).
References
Margret, C. P., & Hilt, R. (2018). Evaluation and management of psychiatric emergencies in
children.#Pediatric Annals,#47(8), 328-333.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01
Initial Post. Week 6 Discussion
Adult Client
The adult client psychiatric emergency that I am reviewing involved a 28-year old female
with a diagnosis of Borderline personality disorder 301.83 (F60.3), and unconfirmed history of
sexual abuse as a child. She was recently admitted to the psychiatric/behavioral/mental health in-
patient unit that I work in after a suicide attempt by stabbing herself in the upper left quadrant of
her abdomen. The client required surgery and admission to the ICU after the suicide attempt.
This was her forth suicide attempt in the last two years. Initially, the client presented as angry,
easily irritable, violent, combative and at times required restraining as she attempted to reopen
her surgical wounds by removing the staples and sticking her fingers into her surgical wounds.
She was placed on one-on-one level of observation as she continued to endorse suicidal ideations
and chronic feelings of emptiness. She claimed that she was tired of living under so much
emotional pain, and that she hoped she would eventually find a way to complete suicide.
What if the Client was a Child/Adolescent
Margret & Hilt (2018) notes that in the Unites States of America (USA), suicide is a
leading cause of death for children aged 10 to 14 years, and that unfortunately, this rate has
continued to rise by as much as 24% since 1999 (p. 330). If the above described client was a
child or an adolescent, the psychiatric mental health nurse practitioner (PMHNP) treating the
child/adolescent would have to assess the child/adolescent for underlying stressors such as
physical or sexual abuse. Sadock, Sadock & Ruiz (2014) notes that one way to make the
assessment would be to interview the child/adolescent and individual family members, both
alone and together. If possible, it would be important to obtain the child’s/adolescent’s history
from informants outside the family such as noncustodial parents, therapists, and teachers. Such
informants could provide valuable information about the child’s/adolescent’s daily functioning.
With such a serious suicide attempt, it would be important for the PMHNP to assesses and
determine the circumstances of the suicide ideations and attempt. It would also be important to
evaluate whether the child lives in a safe environment. It would also be important to assesses
whether the family or the guardians are able to provide the appropriate supervision after
discharge. The child would still require in-patient hospitalization as she continues to endorse
suicidal ideations. Psychotherapy and psychopharmacological treatment would need to be
initiated or continued for the child/adolescent (Margret & Hilt, 2018, Sadock, Sadock & Ruiz,
2014).
Legal or Ethical Issues
Legal or ethical issues to consider when working with a child or an adolescent emergency
case includes the parent’s role in treatment of the minor child, and the potential that the
emergency could have been caused by underlying stressors such as physical or sexual abuse by
the parent(s) or guardian(s). The Texas Department of Family and Protective Services [DFPS]
(n.d.) notes that Texas State laws requires anyone who suspects child abuse or neglect to report
those suspicions to the DFPS or to the local law enforcement agency. A person who suspects but
fails to report it can be charged with a misdemeanor or state jail felony (DFPS, n.d.).
References
Margret, C. P., & Hilt, R. (2018). Evaluation and management of psychiatric emergencies in
children.#Pediatric Annals,#47(8), 328-333.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Texas Department of Family and Protective Services. (n.d.). Reporting Suspected Abuse or
Neglect of a Child in Texas: Reporting Basics. Retrieved from
https://www.dfps.state.tx.us/Training/Reporting/documents/Reporting_Basics.pdf
2nd response. Week 5 Discussion
Hello Ritu for the interesting and informative post. I agree with you on the diagnosis of your
client of Generalized anxiety disorder (GAD). Stahl (2013) notes that anxiety/fear and excessive
worry are some of the core symptoms of anxiety disorders. Imran, Haider & Azeem (2017) notes
that most guidelines, including the National Institute of Clinical Excellence guidelines
recommends psychotherapy as the first-line treatment for children and adolescents with anxiety
disorders. As you mentioned in your post, and as noted by Imran, Haider & Azeem, cognitive
behavioral therapy (CBT) is noted in several randomized controlled trials (RCTs) as highly
effective in treatment of anxiety disorders in children. However, CBT in combination with a
selective serotonin reuptake inhibitor (SSRI) such as Sertraline is noted as a more effective form
of treatment for GAD than an SSRI or CBT alone (Imran, Haider & Azeem, 2017, Stahl, 2013,
Stahl, 2014b).
References
Imran, N., Haider, I. I., & Azeem, M. W. (2017). Generalized anxiety disorder in children and
adolescents: An update.#Psychiatric Annals,#47(10), 497-501.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/00485713-20170913-01
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University
Press
1st reply to Carolyn. Week 5 Discussion.
Thank you for your very interesting and informative post. Stahl (2013). I agree with your choice
of selective serotonin reuptake inhibitors (SSRI) such as Sertraline for treatment of generalized
anxiety disorder (GAD), and also on the need for psychotherapy. I had a very interesting case
and conversation with my preceptor a few weeks ago when we saw a client who presented with
symptoms of unspecified anxiety. My preceptor decided that we start the client on Buspar 5 mg
twice a day for the unspecified anxiety. After the client left, I voiced my opinion to her, that
based on Stahl (2013) and Stahl (2014b), the recommended first-line psychopharmacological
treatment for anxiety should be an SSRI such as Sertraline. She stated that out of experience, she
had noted that Buspar worked better with children with unspecified anxiety, and that Sertraline
worked better with GAD for the same population. I was looking forward to meeting the client
when she returned for follow-up after 4 weeks. I apparently won’t be able to do that due to the
ongoing Covid-19 (Sadock, Sadock & Ruiz, 2014, Stahl, 2013, Stahl 2014b).
References
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry#(11th8ed.). Philadelphia, PA: Wolters Kluwer.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University
Press
nitial Post. Week 4 Discussion
Strategies for assessing the patient for abuse
88888888888 According to Hershkowitz & Lamb (2020), protocols and recommendations for assessing
children for abuse should emphasize the importance of intensive rapport building and provision
for emotional support for children by their providers. Intensive rapport building and emotional
support are noted as important strategies in assessing children and adolescents for abuse as they
enhance children’s cooperation and performance. Rapport building and emotional support
strategy is also noted to enhance children’s willingness and facilitates communication. Rapport
building and emotional support encourages children to affirm and describe their traumatic
experiences, and is noted to help children cope better with anxiety. It also helps to empower
them and increase their level of trust and engagement and thereby motivate them to discuss their
experiences of abuse and to make credible abuse allegations. Hershkowitz & Lamb also notes
that rapport building and emotional support elicits more accurate free-recall information from
preschoolers and helps reduce suggestibility. Open-ended questions and avoidance of leading or
suggestive questioning is another strategy to use when assessing patients for abuse. Hershkowitz
& Lamb notes that use of the above strategies in assessing patients for abuse is noted with more
statements being deemed credible and sufficient in abuse cases. This helps many vulnerable
patients from being left unprotected and exposed to further abuse (American Psychiatric Nurses
Association, 2017, Hershkowitz & Lamb, 2020).
Effect of exposure of patient to the media/social media
88888888888 According to Pantic (2014), the National Institute of Health (NIH) notes that the
relationship between the media and/or social media and mental health problems remains
controversial. While several studies have indicated that prolonged use of social networking sites
such as Facebook may be related to signs and symptoms of depression, other studies have
presented opposite results and shown positive impact of social networking sites on self-esteem.
In a study conducted by Oshri et al. (2015) on childhood physical and sexual abuse and social
network patterns on social media, their research findings supported a differential impact on
victims’ relational patterns online. The study also noted that young women with sexual abuse
history are more withdrawn and anxious to engage in tightly connected networks. This point is
also considered controversial as social isolation is also considered harmful even though it has
potential to protect those with history of abuse from networks with high rates of unhealthy
behavior (Oshri et al., 2015, Pantic, 2014).
Mandatory Reporting Required
88888888888 According to the Texas Department of Family and Protective Services [DFPS] (n.d.),
Texas has both civil and criminal laws to protect children from abuse and neglect. The law as
noted in the Texas Family Code Section 261.101 (a) requires anyone who witnesses abuse or
neglect to report it. This week’s case study on a 19-year old adolescent male (Morgan) who is
noted to have a history of molestation qualifies to be reported to DFPS. Although the cousin who
molested Morgan was sent to jail in the past, Morgan now reports hoe traumatized he feels and
that his cousin’s release from jail gives him the creeps. DFPS needs to be informed, especially if
Morgan lives in the same home with the cousin who previously molested him (DFPS, n.d.,
Walden University, n.d.).
References
American Psychiatric Association. (2013).8Diagnostic and statistical manual of mental
disorders(5th8ed.). Washington, DC: Author.
American Psychiatric Nurses Association. (2017).8Childhood and adolescent
trauma.8Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545
Clarke, A. J., & Sheikh, A. P. A. (2018). A perspective on “cure” for Rett
syndrome.8ORPHANET JOURNAL OF RARE DISEASES,813. https://doi-
org.ezp.waldenulibrary.org/10.1186/s13023-018-0786-6
Hershkowitz, I., & Lamb, M. E. (2020). Allegation rates and credibility assessment in
forensic interviews of alleged child abuse victims: Comparing the revised and
standard NICHD protocols.8Psychology, Public Policy, and Law. https://doi-
org.ezp.waldenulibrary.org/10.1037/law0000230
Oshri, A., Himelboim, I., Kwon, J. A., Sutton, T. E., & Mackillop, J. (2015). Childhood
Physical and Sexual Abuse and Social Network Patterns on Social Media:
Associations With Alcohol Use and Problems Among Young Adult Women.8Journal
of studies on alcohol and drugs,76(6), 845–851.
https://doi.org/10.15288/jsad.2015.76.845
Pantic I. (2014). Online social networking and mental health.8Cyberpsychology, behavior and
social networking,17(10), 652–657. https://doi.org/10.1089/cyber.2014.0070
Sadock, B. J., Sadock V. A., & Ruiz, P. (2014).8Kaplan & Sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry(11th8ed.). Philadelphia, PA:
Wolters Kluwer.
Texas Department of family and Protective Services (n.d.).88When and How to Report
Child Abuse. Retrieved
from8https://www.dfps.state.tx.us/Child_Protection/Child_Safety/report_abuse.
asp
Walden University (n.d.). Childhood Abuse Case Study (PDF). Retrieved
from8https://class.content.laureate.net/c2d25a50e4f76a67640daef9661a07f1
.pdf
Worsley, J. D., McIntyre, J. C., Bentall, R. P., & Corcoran, R. (2018). Childhood
maltreatment and problematic social media use: The role of attachment and
depression.8Psychiatry Research,267, 88–93. https://doi-
org.ezp.waldenulibrary.org/10.1016/j.psychres.2018.05.023
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Thread:
Initial post Week 4 Discussion
Post:
Response to Dr. Fletcher
Author:
Symonpeter Ndungu
Posted Date:
March 18, 2020 2:02 PM
Status:
Published
Response to Dr. Fletcher
88888888888 Dr. Fletcher, thank you for your question. There are parental control apps that are now
available to use for monitoring children. YouTube Kids is one of the apps that now gives parents
ability to select trusted channels and topics that their children can access. The app also gives
parents an option to restrict video recommendations to channels that have not been verified by
YouTube kids and thereby avoiding the broader content that the App pulls from the main
YouTube site through algorithms. Google has also introduced a Family Link app that gives
parents a set of powerful tools to monitor which applications their children are installing and
using. The Google Family Link app also gives parents ability to monitor the amount of time
spent by children on certain applications, and ability to restrict or block certain applications
(Maheshwani, 2018, FRPT, 2017, Sanders, Parent & Forehand, 2018).
8References
FRPT. (2017). Parents can set digital ground rules for children with Google’s new Family
Link app.8FRPT- Software Snapshot, 4–5.Retrieved fromhttps://eds-b-
ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?
vid=4&sid=7cd29be8-13bd-4d4c-9ae5-038c28d68cd7%40pdc-v-sessmgr03
Maheshwari, S. (2018). YouTube Kids Giving Parents Greater Control Over Content.8New
York Times,167(57944), B9.
Sanders, W., Parent, J., & Forehand, R. (2018). Parenting to Reduce Child Screen Time: A
Feasibility Pilot Study.8Journal of developmental and behavioral pediatrics : JDBP,39(1),
46–54. https://doi.org/10.1097/DBP.0000000000000501
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Post:
RE: Initial Post
Author:
Symonpeter Ndungu
Posted Date:
March 20, 2020 6:49 PM
Status:
Published
1st8Response. Week 1 discussion
Hello Carolyn and thank you for your interesting and informative post. As you
mentioned, the media/social media can have negative and significant ramifications on mental
health especially through victimization and shaming of abuse victims (Berryman, Ferguson &
Negy, 2018). However, Oshri et al. (2015) notes that childhood physical and sexual abuse can be
associated with to both positive and negative effects of media/social media. The positive includes
the potential utility of media/social media as a platform for targeted preventive interventions
while the negative aspects could be related to the online social network patterns associated with
alcohol use (Berryman, Ferguson & Negy, 2018, Oshri et al., 2015).
References
Berryman, C., Ferguson, C. J., &8Negy, C. (2018). Social media use and mental health
among young adults.8The Psychiatric Quarterly,89(2), 307–314. https://doi-
org.ezp.waldenulibrary.org/10.1007/s11126-017-9535-6
Oshri, A., Himelboim, I., Kwon, J. A., Sutton, T. E., & Mackillop, J. (2015). Childhood
Physical and Sexual Abuse and Social Network Patterns on Social Media:
Associations With Alcohol Use and Problems Among Young Adult
Women.8Journal of studies on alcohol and drugs,876(6), 845–851.
https://doi.org/10.15288/jsad.2015.76.845
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Week 4 Initial Post
Post:
RE: Week 4 Initial Post
Author:
Symonpeter Ndungu
Posted Date:
March 21, 2020 11:11 PM
Status:
Published
2nd8Response. Week 4 discussion
88888888888 Hello Yetunde and thank you for your interesting and informative post. As you
mentioned, many children may grow into adulthood with symptoms of undiagnosed PTSD due to
lack of awareness. The Texas Department of family and protective services [DFPS] (n.d.) notes
that the thousands of children who suffer from abuse and neglect are too young, terrified, or
simply confused to tell anyone about it. Psychiatric mental health nurse practitioners (PMHNP)
therefore need to recognize their silent cries for help even when they don’t cry or ask for help
when needed. In Texas where I live, failure to report suspected child abuse and neglect is a
criminal offense under Texas Family Code, Section 261.109 (DFPS, n.d.,8Pantic, 2014).
References
Pantic I. (2014). Online social networking and mental health.8Cyberpsychology, behavior
and social networking,817(10), 652–657. https://doi.org/10.1089/cyber.2014.0070
Texas Department of family and Protective Services (n.d.).88When and How to Report
Child Abuse. Retrieved
from8https://www.dfps.state.tx.us/Child_Protection/Child_Safety/report_abuse.asp
