DSM-5 Child and Adolescent Anxiety Disorders
DSM-5 Child and Adolescent Anxiety Disorders
Walden University
NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Week 5
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Walden University
NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Week 5
Introduction Resources Assignment Making Connections My Progress Tracker
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NRNP 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
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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.
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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 DSM-5 Child and Adolescent Anxiety Disorders
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 DSM-5 Child and Adolescent Anxiety 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.
In the recent past, generalized disorder as turned to be a common illness among children population across the globe. The condition is characterized with severe mental disturbance. Mental health is a vital condition that controls human activities such as thinking, moods, and behaviors (Strijbos & Slors, 2020). Such disorders include depression, eating disorder, depression, antisocial disorder, and histrionic personality disorder, and general anxiety disorder among others. Mostly, majority of the disorders appears during early childhood as well as early and late adulthood. More so, some of the disorder lead to functional issues that alters individuals’ daily activities. In the recent past, mental illnesses cases have increased in numbers thus alarming the health sector as a major concern. This paper covers a generalized anxiety disorder according to case study of an 8-year-old black male brought by his mother to a psychiatric due to various complaint. More so, the paper will underscore probable choices selected and the reason behind choosing such type of a choice.
Decision Pont One: Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder refers to a condition that makes an individual to experience excessive and persistent worries from various numbers of things (Crocq, 2017). Patient with GAD is constantly anticipating for a pending disaster taking place such issues include health, work, family matters. Still, patient with GAD is incapable of controlling their worries by themselves. The condition is triggered by some of the environmental factors that cause a traumatic experience such as illness and divorce. More so, the disorder may be learned from a close family member who previously had noticeable stress matters.DSM-5 Child and Adolescent Anxiety Disorders
According to the case study, Tyrel reveals to meet qualifications of having a GAD. For instance, the mother explains to the psychiatrist that the kid is constantly worrying about washing hands even if they are clean. Still, the child is vulnerable of generalized anxiety disorder since his parents parted and lives differently. As a symptom of the disorder the patient reveals to have a persistent worrying much from cleanliness issue from time to time. Still, the case study reveals that the patient is overthinking about germs and worries about getting sick. The client also perceive situation as posing life threatening whereas it is still okay. More so, the minor has a problem of handling uncertainty. For instance, Tyrel remain stuck to his opinion that hand washing is the only remedy from germs whenever hand washing topic is discussed.
The idea of diagnosing the patient with GAD was to aid in planning the right treatment to give the patient as a way of managing the disorder. This is so, since patient physical assessment and behavior interaction assist in identifying presence of the anticipated illness as well as narrowing the probable infection. The process of elimination and choosing the right disorder was successful and the patient is characterized of having a general anxiety disorder and left other option between obsessive compulsive disorder and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections.
Decision Two: Begin Paxil 10 mg orally daily
My second decision is the patient to begin Paxil 10mg orally daily. This type of drug is the best and most effective drug prescribed to children. Paxil is classified in class of drugs known as antidepressants which can be taken alone or with other type of medicines. The use of this drug can be used to treat various disorders such as generalized anxiety disorder, depression, social phobia obsessive-compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorders (PMDD), and posttraumatic stress disorder (PTSD).
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Paxil is an effective drug that gives positive outcome to a patient suffering from GAD. The reason behind selecting Paxil to treat generalized anxiety disorder is that to an 8 years minor should start taking 10 mg since it is the recommended dosage since it is much effective than over increased amount. The benefits of taking this drug are noticeable after 4 weeks. The drug aid in the restoration of balancing serotonin levels by barring the brain from rapidly absorbing it. Still, paroxetine is also referred to as a selective serotonin reuptake inhibitor (SSRI). This medicine will help the patient to improve their mood, appetite, sleep, and restoration of energy that is used in daily interest activities.
The anticipated outcome includes the subjective and objective adjustments. First, the patient will able to notice positive outcome within the first four weeks. After this duration the patient will start experiencing changes depending with the mode of action of the drug within the brain. Still, the ambiguity characteristic of the drug will be linked to the drug reaction in the body and the patient will have a balance in natural substance within his brain. More so, the patient should be in a position to point out changes in the mode of reasoning about anticipated worries in the brain. The patient will return to the clinic after one month. During this time Tyrel’s mother report changes noticed within the treatment phase as decreased symptoms although not fully.
Decision 3: Increase Paxil to 20 mg orally daily
The start of my second decision in treating the patient will involve an increment of Paxil dosage from 10 mg to 20 mg. this intervention will be done so, since the first though did not optimize the outcome fully even though being positive. The patient will continue taking a higher gram of drug to aid achievement of positive improvement from the disorder. The process of starting a new dosage will be closely followed up to ensure the administered amount is always 20 mg. more so, due to the fact that the patient did not have a complaint of the drug side affects there is the need to add Tyrel’s dosage.
According to Tyrel’s condition after the first phase of treatment the symptoms are declining. For instance, his mother reports that she noticed that the patient was not washing his hand often contrary before starting the dosage. Still, the client starts befriending school reporting although not in full attendance. Now, the patient is in a position to follow a new prescription from a medic since it is recommendable to add dosage since the client has not fully recovered from previous generalized anxiety disorder symptoms.DSM-5 Child and Adolescent Anxiety Disorders
The patient treatment process reveals difference between the actual outcome and expected outcome. For example, after an increase in the amount of dosage level, generalized anxiety symptoms levels will decrease. Such decrease will include full attendance of schools and decline number of time that Tyrel washes hand. These changes will be evident after four weeks and the patient will have a significant symptom decrease. At this time the patient will not experience worries of being around friends as well as daily reporting to school. This will be contrary to the initial anticipated results. Tyrel will continue taking the same amount of dosage for 4 weeks ensuring that the 20 mg level is maintained.
By issuing the patient with an increment with the dosage my hopes were to continue decreasing signs and symptoms of GAD. For instance, the anticipation was the client will start conversing normally with friends as well as fully comply with school schedule. Still, there were hopes that the patient will stop behaviors of washing hands now and then. The medicine will withdraw the patient form fearing getting sick from germs and won’t get much connected to the hand washing topic. Drug increment dosage is important since the initial dosage might be ineffective due to body resistance to a particular drug.
Ethical considerations impacting treatment plan and communication
According to previous research, it is evident patient treatment is tied with ethical considerations. Besides, the recent treatment and diagnosis of such personality disorder such as generalized anxiety disorder is known to have a longstanding history of ethical and social hitches from criticism in regard to the administered medication.
According to the American Nurses Association (2014), PMHNP should uphold patient’s confidentiality as stated in the nursing code of ethics. Still, the health sector gives health laws that govern in the maintenance of private health records. This law is overruled when a patient give consent by issuing authorization of unfolding such personal information to a third party. In addition, this ethical law limits family and friend involvement in a patient’s psychological therapies while assisting the patient with various cognitive functions as well as behavior changes and social support.
Consequently, confidentiality in health matters is a big concern in such Tyrel case. For instance, confidentiality code act as a barrier to friend and family members who would wish to be explained about the condition of the patient (Trivedi et al., 2019). Therefore, talking about Tyrel’s condition with his mother for aid is breach as per this code of ethics and is branded as a nursing malpractice. On the other hand, a nurse will be guided by beneficence code where any action that a nurse choose should be anchored to the patient’s benefit. According to the case at hand, it will be beneficial for a nurse to provide social support to the minor since it is vital for recovery process and hence informing other family members on the significant in his treatment. At this point, this creates a dilemma, hence coming up with a well thought decision will require involvement of a professional consultant as well as engaging previous evidence-based ideas in regard to overcoming generalized anxiety disorder.DSM-5 Child and Adolescent Anxiety Disorders
Voluntary participation is an ethical consideration that permits patient participation evaluation is free from coercion. This rule governs the patient to participate freely in a treatment process without harming their future services a s well as ruining their current program. In this case, Tyrel cannot enjoy this merit since he is a minor the parent has mandate to dictate the treatment process. Also, the child can not withdraw by their choice since they will face pressure from both side of the parent and the nurse.
Informed consent is vital ethical matter in communication and treatment with the family and the client. In this case, it demands medics to provide the patient with the correct information that involve the treatment plan employed in the treatment of GAD. By so doing, this gives te patient the right to choose the treatment or decline while weighing both risk and benefits. Still, this support patient’s autonomy which primarily aim at protecting them from getting harm. Mostly, this creates ethical dilemma in an instance where a patient rejects treatment that only suits their condition thereby narrowing recovery process.
Conclusion
In conclusion, a psychiatric nurse should optimize patient assessment not only when they report to the clinic but also during treatment process. This will enable the nurse to study the patient keenly a plan a rehabilitation phase for check ups for the progress of generalized anxiety disorder. Also, when the patient is undergoing treatment it is vital to offer special attention that will catalyze the healing process of the patient. Although there are different drugs to treat generalized anxiety disorder, professionals should adjust dosage with concern to the patient’s symptom and recovery progress. Still, it is importance to understand the genetical influences of drugs in terms of distribution, absorption, and accretion. In this case, Tyrel will recover from GAD after taking 10 mg and 20 mg dosages as prescribed by a nurse.
References
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
Crocq, M. A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience, 19(2), 107.
Strijbos, D., & Slors, M. (2020). What Kind of” Management” Is Self-Management? A Two-Dimensional Approach to Self-Management in Mental Health Care. Philosophy, Psychiatry, & Psychology, 27(4), 355-370.
Trivedi, R. B., Slightam, C., Nevedal, A., Guetterman, T. C., Fan, V. S., Nelson, K. M., … & Piette, J. D. (2019). Comparing the barriers and facilitators of heart failure management as perceived by patients, caregivers, and clinical providers. Journal of Cardiovascular Nursing, 34(5), 399-409.DSM-5 Child and Adolescent Anxiety Disorders
