Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay
Introduction
A psychiatric emergency is a disturbance of behaviour, mood, or thought which may lead to harm to the individual or others if untreated (Sadock, Sadock, & Ruiz, 2014). In both pediatric and adult psychiatric emergencies, the clinician must ensure the safety of everyone involved. A complete assessment should be performed. Goals of the psychiatric emergency assessment are to determine whether client poses a risk of harm to self or others, confirm the presence of a psychiatric disorder, and determine factors that may have lead to the issue. It is also essential to determine how the illness has impaired the client’s normal level of functioning, identify the client’s strengths, target the problems for treatment, and determine the level of care the client requires (Carandang, Gray, Marval-Ospino, &MacPhee, 2012). Suicidal behaviours are one of the most common pediatric psychiatric emergencies. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.
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Description of Adult Psychiatric Emergency Case
Working and doing my practicum in an acute psychiatric hospital, I have cared for many adults with psychiatric emergencies. In my last rotation, a 30-year-old Caucasian female with suicidal ideations with a plan to overdose presented to the facility for evaluation. She reported feeling overwhelmed due to (a) a recent separation from her husband, (b) becoming a single mother, and (c) struggling financially. The client used a wheelchair due to a motor vehicle accident and felt she was a burden to her family. A therapist assessed her, and the psychiatrist on call admitted the client with a diagnosis of major depressive disorder. Laboratory testing included a complete blood count, comprehensive metabolic panel, thyroid stimulating hormone level, magnesium level, phosphorous level, urine drug screen, urine pregnancy test, and pharmacogenetic testing for psychiatric medications. After less than an hour on the adult unit, the client stated she wanted to go home and filled out paperwork requesting release. The client was placed on a 72-hour hold. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay. An initial psychiatric evaluation was performed by the psychiatric mental health nurse practitioner later in the day, and the client was started on an antidepressant. The client’s level of observation was downgraded to the line of sight after 24 hours then to every 15-minute checks the following day. She received daily group psychotherapy, weekly individual psychotherapy, and evaluated by either a psychiatric mental health nurse practitioner or a psychiatrist daily. Appointments for follow-up care were made, and the client was discharged home after 16 days in the facility. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.
How a Child or Adolescent Would Be Treated Differently
If a pediatric client were to present with suicidal ideations with a plan, information would be gathered from both the parent or guardian and the child to form the diagnosis. Laboratory testing would be the same as for the adult client except pregnancy testing; males and females below childbearing age would not require pregnancy testing (Lewandowski et al., 2013). The psychiatric evaluation would be the same but may require the clinician to use simple words. Children and adolescents would be asked about bullying at school or on social media and academic difficulties. The child or adolescent would take part in family therapy sessions as a successful treatment of suicidality in the pediatric population is more likely to involve a family component (Lewandowski et al., 2013). Selective serotonin reuptake inhibitors are the first-line medication for pediatric clients with moderate to severe depression. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.
Ethical Issues
The treatment of children and adolescents requires the consent of their parents or guardians. Each time a medication is changed, increased, or decreased consent from a parent or guardian must be obtained (Sadock, Sadock, & Ruiz, 2014). Ethically, the clinician must recognize that children and adolescents must play a part in their treatment and obtain the assent of the minor whenever possible.
References
Carandang, C., Gray, C., Marval-Ospino, H., MacPhee, S. (2012). Child and adolescent psychiatric emergencies. In J. M. Rey (Ed.), IACAPAP e-textbook of child and adolescent mental health (pp.1-31). Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/J.1-EMERGENCIES-072012.pdf
Lewandowski, R. E., Acri, M. C., Hoagwood, K. E., Olfson, M., Clarke, G., Gardner, W., …& Frank, S. (2013). Evidence for the management of adolescent depression. Pediatrics, 132(4), e996-e1009. doi:10.1542/peds.2013-0600
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. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.
Week 6: Emergency Psychiatric Care in Childhood and Adolescence
“I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work.”
Jessica, age 13
When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay
This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients.
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Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
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 23, “Emergency Psychiatric Medicine” (pp. 785–790)
Chapter 31, “Child Psychiatry” (pp. 1226–1253)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Bipolar and Related Disorders”
Note: You will access this book from the Walden Library databases.
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay
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:
Reversal of benzodiazepine effects
flumazenil
Aggression
Behavioral problems
Cataplexy syndrome
clozapine
propranolol
zuclopenthixol
aripiprazole
asenapine
chlorpromazine
haloperidol
iloperidone
lurasidone
olanzapine
paliperidone
quetiapine
risperidone
ziprasidone
clomipramine
imipramine
sodium oxybate
Catatonia
Extrapyramidal side effects
Mania
alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
estazolam
flunitrazepam
flurazepam
loflazepate
lorazepam
midazolam
oxazepam
quazepam
temazepam
triazolam
benztropine
diphenhydramine
trihexyphenidyl
alprazolam (adjunct)
aripiprazole
asenapine
carbamazepine
chlorpromazine
clonazepam (adjunct)
iloperidone
lamotrigine
levetiracetam
lithium
lorazepam (adjunct)
lurasidone
olanzapine
quetiapine
risperidone
sertindole
valproate (divalproex)
ziprasidone
zotepine
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.” Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay
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 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)
Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.
In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.
Learning Objectives
Students will:
Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients
Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients
To Prepare:
Review the Learning Resources concerning emergency psychiatric medicine.
Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.) Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post:
Briefly describe the case you selected.
Explain how you would treat the client differently if he or she were a child or adolescent.
Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay