CHILD AND ADOLESCENT

Walden University
PRAC 6660: Psychiatric-Mental Health Nurse Practitioner Role I: Child and Adolescent
Week 9
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PRAC 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
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Week 11Photo Credit: Getty Images/iStockphotoPracticum Week 9
This week, you will log all of your Practicum hours in the Meditrek system. You also complete a Decision Tree concerning children with psychotic disorders.
Learning Resources
Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Schizophrenia Spectrum and Other Psychotic Disorders”
McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

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.

Review the following medications:

Schizoaffective disorder Schizophrenia
amisulpride
aripiprazole
asenapine
carbamazepine (adjunct)
chlorpromazine
clozapine
cyamemazine
flupenthixol
haloperidol
iloperidone
lamotrigine (adjunct)
l-methylfolate (adjunct)
loxapine
lurasidone
mesoridazine
molindone
olanzapine
paliperidone
perospirone
perphenazine
pipothiazine
quetiapine
risperidone
sertindole
sulpiride
thioridazine
thiothixene
trifluoperazine
valproate (divalproex) (adjunct)
ziprasidone
zotepine
zuclopenthixol

amisulpride
aripiprazole
asenapine
carbamazepine (adjunct)
chlorpromazine
clozapine
cyamemazine
flupenthixol
haloperidol
iloperidone
lamotrigine (adjunct)
l-methylfolate (adjunct)
loxapine
lurasidone
mesoridazine
molindone
olanzapine
paliperidone
perospirone
perphenazine
pipothiazine
quetiapine
risperidone
sertindole
sulpiride
thioridazine
thiothixene
trifluoperazine
valproate (divalproex) (adjunct)
ziprasidone
zotepine
zuclopenthixol

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
Laureate Education (Producer). (2017b). A young girl with strange behaviors [Multimedia file]. Baltimore, MD: Author.

Assignment: Practicum: Decision Tree (Due in Week 10)
Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.

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 3: 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. 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.

BACKGROUND
Carrie is a 13-year-old Hispanic female who is brought to your oce today by her mother and
father. They report that they were referred to you by their primary care provider after seeking
her advice because Carrie’s behavior has been dicult to manage and they don’t know what to
do.
SUBJECTIVE
Carrie’s parents report that they have concerns about her behavior, which they describe as
sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real.
Her behavior is calm and “passive.” Her parents noted that when she was younger, she was
irritable at times, but have noticed that this has given way to passivity. Her parents state that they
understand that it’s normal for younger children to have “imaginary friends,” but they feel that at
Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has
1/9/2021 Psychopharmacologic Approaches to Treatment of Psychopathology
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html 2/4
friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also
reports that the people on television know when she is home and that they have certain shows
“just for her.”
Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill
of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting
developmental milestones. Initially, when she rst started school, Carrie managed to keep up
with her peers in terms of academic performance, but she was noticed by her teachers to be
isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do
not seem to match what they see in other children her age. Initially the school counselor
suspected that Carrie may have been suering from attention decit hyperactivity disorder
(primarily inattentive type), but now is not certain and has recommended a psychiatric
evaluation. Her grades were “ok” in school up until last year when she left junior high school, and
entered high school, where the academic demands began to increase. Carrie’s teachers had
wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this
did not happen. Now they are describing some regrets over this as Carrie seems “more lost than
ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as
a homework assignment. You attempt to read the assignment, but there does not appear to be
any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.
Carrie’s parents want you to know that although they are concerned about Carrie, they are
opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also
condes that her husband’s grandfather spent “a few years in the nut house.” When you probe
further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”
During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her
about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like
those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states
“no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I
could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to
do is make up my mind that they will be my friend and they would have to.” When you ask Carrie
if she believes that she can control the thoughts of others with her mind, she puts her index
nger up to her mouth and looks toward the door. “My mom gets upset when I talk about these
things. I try not to think about them either because if she is close enough, she could read my
thoughts and they upset her. She may think that I’m into witchcraft or something.”
1/9/2021 Psychopharmacologic Approaches to Treatment of Psychopathology
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html 3/4
When you ask Carrie about the homework assignment that you read, she explains that her
teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”
OBJECTIVE
The client is a 13-year-old Hispanic female client who appears appropriately developed for her
age. She is dressed appropriately for the current weather, and ambulates with a steady upright
gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No
psychomotor agitation/retardation apparent.
MENTAL STATUS EXAM
Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and
spontaneous. Carrie self-reports her mood as “good.” However, her aect does appear somewhat
constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie
seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and
seeing strange “things that I talk to. They don’t scare me; they come to see me from another
world.” No overt paranoia is appreciated. She does report delusions of reference (she believes
that the people on TV play programs “just for her” and at times, television commercials were
designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie
denies any suicidal or homicidal ideation.
At this point, please discuss any additional diagnostic tests you would perform on Carrie.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE
FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE
PRACTITIONER (PMHNP) GIVE TO CARRIE?
In your write-up of this case, be certain to link specic symptoms presented in the case to DSM–5 criteria
to support your diagnosis.
1/9/2021 Psychopharmacologic Approaches to Treatment of Psychopathology
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html 4/4
Early Onset Schizophrenia
(1.html)
Schizoaective Disorder
(2.html)
Schizotypal Personality Disorder

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