Psychiatric Mental Health Nurse Practitioner Role
Walden University
NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Week 5
IntroductionResourcesAssignmentMaking ConnectionsMy Progress Tracker
☰
Menu
Walden University
NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Week 5
IntroductionResourcesAssignmentMaking ConnectionsMy Progress Tracker
☰
Menu
×
NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Back to Course Home
Course Calendar
Syllabus
Course Information
Resource List
Support, Guidelines, and Policies
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Photo Credit: Getty Images/Monkey Business
Week 5: Anxiety Disorders in Childhood and Adolescence
\”I don’t know why everyone is worried that I don’t want to go out with my friends anymore. I just like to stay home. There is nothing wrong with that. I go to school and get good grades, but I don’t know what to say to those other girls in my class. They ask why I can’t go to the mall with them on the weekend and I get all embarrassed. They don’t understand that I don’t know what to say to them. When I do say something, it is always wrong, or they laugh. I can just stay home and read my books.\”
Emma, age 15
Anxiety disorders that plague many individuals in adulthood often have their origins in childhood and adolescence. By identifying those children and adolescents with anxiety disorders, the PMHNP can intervene and teach skills that the client can use to control anxiety throughout his or her life.
This week, you analyze case studies to determine the diagnosis and treatment of anxiety disorders.
Learning Resources
Required Readings
American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
Standard 8 “Education” (pages 69-70)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Anxiety Disorders”
McClelland, M., Crombez, M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Healthcare, 29(5), 442-452. doi:10.1016/j.pedhc.2015.03.005
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 31, “Child Psychiatry” (pp. 1253–1268)
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:
Generalized anxiety disorder Social anxiety disorder
alprazolam
citalopram
desvenlafaxine
duloxetine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
paroxetine
pregabalin
sertraline
tiagabine (adjunct)
venlafaxine
citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
moclobemide
paroxetine
phenelzine
pregabalin
sertraline
tranylcypromine
venlafaxine
Obsessive-compulsive disorder Panic disorder
citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
alprazolam
citalopram
clonazepam
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
lorazepam
mirtazapine
nefazodone
paroxetine
phenelzine
pregabalin
reboxetine
sertraline
tranylcypromine
venlafaxine
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). (2017c). Anxiety disorder, ODC, or something else? [Multimedia file]. Baltimore, MD: Author.
YMH Boston. (2013b, May 22). Vignette 3 – Asking about depression in a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=TO8aITpMG5E
Note: The approximate length of this media piece is 3 minutes.
YMH Boston. (2013d, May 22). Vignette 5 – Assessing for depression in a mental health appointment [Video file]. Retrieved from https://www.youtube.com/watch?v=Gm3FLGxb2ZU
Note: The approximate length of this media piece is 3 minutes.
Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
Chapter 60, “Anxiety Disorders” (pp. 822–840)
Chapter 61, “Obsessive Compulsive Disorder” (pp. 841–857)
Assignment: Decision Tree (Due in Week 7)
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
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 2: 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.
Anxiety disorder, OCD, or something else?
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric
complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and
“nervousness” over the past 2 months. She states that she notices that he has been quite “keyed
up” and spends a great deal of time worrying about “germs.” She states that he is constantly
washing his hands because he feels as though he is going to get sick like he did a few weeks ago,
which kept him both out of school and o the playground. He was also not able to see his father
for two weekends because of being sick. Shaquana explains that although she and her exhusband Desmond divorced about 2 years ago, their divorce was amicable and they both
endeavor to see that Tyrel is well cared for.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which
she reports as “trouble staying asleep”). She reports that he has been more and more dicult to
get to school as he has become nervous around his classmates. He has missed about 8 days over
12/27/2020 Psychopharmacologic Approaches to Treatment of Psychopathology
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/index.html 2/3
the course of the last 3 weeks. He has also stopped playing with his best friend from across the
street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after
he was sick with strep throat a few weeks ago, she encouraged him to be more careful about
washing his hands after playing with other children, handling things that did not belong to him,
and especially before eating. She continues by saying “maybe if I didn’t make such a big deal
about it, he would not be obsessed with germs.”
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental
milestones on time. He has had an uneventful medical history and is current on all
immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you
discuss school, his friends at school, and what he likes to do. He admits that he has been feeling
“nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to
keep from getting sick.” When you question him how many times a day he washes his hands, he
again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your
assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter
how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that
he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself
feel better is to wash his hands. He reports that it does work for a while and that he feels “better”
after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands
well enough? What if I missed an area?” He reports that he can feel himself getting more and
more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He
reports his mood as “good,” admits to anxiety. Aect consistent to self-reported mood. He denies
visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent.
He denies suicidal ideation.
12/27/2020 Psychopharmacologic Approaches to Treatment of Psychopathology
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/index.html 3/3
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters.
An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer
was shown to be above normal parameters.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE
FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
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.
Generalized Anxiety Disorder (GAD)
(1.html)
Obsessive Compulsive Disorder
(2.html)
Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococcal Infections (“PANDAS”)
[checkout]
