Practicum Case Study

Practicum Week 5
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.”

Case Study:
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/index.html

Discussion: Clinical Supervision
Clinical Supervision is an essential component of your development as a psychiatric mental health nurse practitioner. It provides an opportunity for professional collaboration as you share experiences with and gain insights from colleagues. For this Clinical Supervision, consider a client whom you do not think is adequately progressing according to expected clinical outcomes.
Learning Objectives
Students will:
• Analyze clients presenting for treatment of anxiety disorders
• Evaluate effectiveness of therapeutic approaches for clients diagnosed with an anxiety disorder
To Prepare:
• Review this week’s Learning Resources concerning treating patients with anxiety disorders.
• Reflect on a child or adolescent client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with an anxiety disorder.
In a 1 – 2 page paper
• Describe the client.
• Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.
• Identify any additional information about this client that may potentially impact expected outcomes.

BUY A PLAGIARISM-FREE PAPER HERE

Practicum Case Study
Description of the Client
The client is an 8-year-old boy called Tyrel, who presented with numerous psychiatry complaints. The mother reported that the client manifested symptoms such as nervousness, worrying, and spending so much time cleaning his hand to get rid of germs and avoid becoming sick again. Tyrel has also withdrawn from his best friend and has been avoiding school. Other symptoms include irritability and sleep disturbances. The objective assessment indicated that his cautious around people and he emphasizes that handwashing is the only mechanism to prevent sickness. He constantly thinks about dirty hands and is scared of when to wash the hands again. The hands are dry. MSE indicates that he is alert and oriented to all aspects. He reports having anxiety and his affect is consistent. He denies hallucinations, suicidal ideation, or a paranoid/delusional thought process. The diagnosis for this client is obsessive-compulsive disorder (OCD). OCD is normally characterized by anxiety, distress, and “intrusive obsessions and repetitive ritualistic behaviors” (Hirschtrit et al., 2017). Handwashing and avoidance are among the most common ritualistic behaviors in compulsions.
Therapeutic Approach
The therapeutic approaches for this patient include the pharmacological approach and the psychotherapy approach. The pharmacological approach is Fluvoxamine immediate release 25 mg orally at bedtime. Fluvoxamine is an SSRI that is safe, well-tolerated, and its efficacy in treating OCD in the pediatric population has been shown (Kotapati et al., 2019). Fluvoxamine has been approved by the FDA to treat OCD in the pediatric population aged 8 years and above. The medication has sedative properties and hence it should be administered at bedtime. The psychotherapy choice is the use of cognitive-behavioral therapy (CBT). CBT will focus on teaching the client techniques he can use to help him understand and explore alternative thinking patterns and behavior. This is because CBT focuses on changing the maladaptive/negative thinking pattern into a more positive/adaptive thinking pattern, in order to facilitate positive behavior change (Foa, 2015). Therefore, CBT will help Tyrel to reduce his obsessiveness with dirt and germs, explore and use alternative behaviors to respond to the obsessive thoughts about dirt/germs, instead of frequent handwashing.
Additional Information
The additional information that may affect the expected outcomes for the client includes unwanted side effects from the medications and adherence to treatment (Wehry et al.,2015). Therefore, it will be necessary to educate the client about the potential side effects and inform him of the importance of adhering to the treatment regimen. The mother will also be encouraged to ensure that Tyrel is always supervised when taking medications to ensure effective adherence.

References
Foa E. (2015). Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder. Dialogues Clin Neurosci, 12(2): 199–207.
Hirschtritt M, Bloch M & Mathews C. (2017). Obsessive-Compulsive DisorderAdvances in Diagnosis and Treatment. JAMA, 1(2).
Kotapati, V. P., Khan, A. M., Dar, S., Begum, G., Bachu, R., Adnan, M., Zubair, A., & Ahmed, R. A. (2019). The Effectiveness of Selective Serotonin Reuptake Inhibitors for Treatment of Obsessive-Compulsive Disorder in Adolescents and Children: A Systematic Review and Meta-Analysis. Frontiers in psychiatry, 10, 523. https://doi.org/10.3389/fpsyt.2019.00523
Wehry A, Katia B, Hennelly M, Connolly S & Strwan J. (2015). Assessment and Treatment of Anxiety Disorders in Children and Adolescents. Curr Psychiatry Rep, 17(7): 591.