NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
The Psychiatric and Mental Health Nurse Practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders, or substance abuse problems. They are licensed to provide emergency psychiatric services, conduct psychosocial and physical assessment of their patients, develop and manage treatment plans, and provide ongoing manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on making a psychiatric diagnosis, differentiates between medical disorders with psychiatric symptoms, and orders appropriate medications to treat various psychiatric disorders. A PMHNP can often practice autonomously, depending on state licensure laws. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
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NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Course Readings
After clicking on a citation below, enter your myWalden user name and password at the prompt.
Please Ask a Librarian if you have any questions about the links.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20-22.
Crocker, A. G., Prokić, A., Morin, D., & Reyes, A. (2014). Intellectual disability and co-occurring mental health and physical disorders in aggressive behaviour. Journal of Intellectual Disability Research, 58(11), 1032-1044.
Erickson, S. C., Le, L., Zakharyan, A., Stockl, K. M., Harada, A. M., Borson, S., & … Curtis, B. (2012). New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder. Journal of the American Geriatrics Society, 60(3), 474-479. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21-24.
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24.
Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology, 30(3), 164-172.
Malhotra, A. K., Zhang, J., & Lencz, T. (2012). Pharmacogenetics in psychiatry: Translating research into clinical practice. Molecular Psychiatry, 17(8), 760-769.
Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Please use the link provided directly in your classroom for all content from this resource.
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents w
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Case Study 5 week 7
Type of document Case Study
5 Pages Double Spaced (approx 275 words per page)
Subject area Pharmacology
Academic Level Master
Style APA
Number of sources/references 4
Order description:
I will upload the case study and make sure to answer all questions and bullet points please and use resources and references that are less than 5 years old. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
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NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
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A man appears to be tossing and turning, unable to sleep.
Week 7: Therapy for Clients With Pain and Sleep/Wake Disorders
From negative changes in mood to problems concentrating, pain and sleep/wake disorders can have a tremendous impact on clients’ lives. When clients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat pain and sleep/wake disorders may be addictive, making thorough client assessments and close follow-up care essential. To prescribe appropriate therapies with client safety in mind, you must understand not only the pathophysiology of these disorders, but also the pharmacologic agents used to treat them. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
This week, as you study therapies for individuals with pain and sleep/wake disorders, you examine the assessment and treatment of clients with these disorders. You also explore ethical and legal implications of these therapies.
Photo Credit: [riskms]/[iStock / Getty Images Plus]/Getty Images
Discussion: Sleep/Wake Disorders
It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Learning Objectives
Students will:
Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders
Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy
Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders
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
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
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:
For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine
clonazepam
desipramine
diazepam
doxepin
flunitrazepam
flurazepam
hydroxyzine
imipramine
lorazepam
nortriptyline
ramelteon
temazepam
trazodone
triazolam
trimipramine
zaleplon
zolpidem
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.
Case 1: Volume 2, Case #16: The woman who liked late-night TV
Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Review the posttest for the case study.
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 on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post a response to the following:
Provide the case number in the subject line of the Discussion.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Resources
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
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
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. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Review the following medications:
For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine
clonazepam
desipramine
diazepam
doxepin
flunitrazepam
flurazepam
hydroxyzine
imipramine
lorazepam
nortriptyline
ramelteon
temazepam
trazodone
triazolam
trimipramine
zaleplon
zolpidem
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
The Psychiatric and Mental Health Nurse Practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders, or substance abuse problems. They are licensed to provide emergency psychiatric services, conduct psychosocial and physical assessment of their patients, develop and manage treatment plans, and provide ongoing manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on making a psychiatric diagnosis, differentiates between medical disorders with psychiatric symptoms, and orders appropriate medications to treat various psychiatric disorders. A PMHNP can often practice autonomously, depending on state licensure laws. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
At times, psychotherapy is not enough to alleviate the emotional difficulties that some patients face. To that end, psychopharmacologic approaches are needed. Psychiatric mental health nurse practitioners (PMHNPs) must have a strong basis in psychopharmacology, extending from a prior education in pharmacology, to make appropriate medication choices for their patients. Learners in this course consider psychopharmacologic approaches to major mental health disorders including but not limited to major depressive disorders, bipolar disorder, anxiety disorders, as well as psychotic disorders. Learners explore key considerations associated with medication selection, monitoring of efficacy, and long-term management. NURS – 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology
Course Prerequisites
PMHNP Program Core Coures & NURS-6521
Course Outcomes
By the end of this course, students will:
- Evaluate foundational neuroscience as it relates to caring for clients with psychiatric disorders across the lifespan
- Assess mechanisms of action of medications used to treat a variety of psychiatric conditions
- Compare evidence-based practices to select appropriate psychopharmacologic agents
- Synthesize pathophysiology and health assessment concepts in the psychopharmacologic treatment of psychiatric mental health disorders
- Evaluate ethical and legal implications of prescribing psychotropic medications across the lifespan
- Evaluate the efficacy and adverse reactions of psychotropic medications
- Recommend strategies to become a social change agent for individuals with psychiatric mental health issues. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Developmental psychopathology is a complex approach to studying childhood problems and atypical development, in the context of human development. There are many issues in defining and classifying abnormality, such as different levels of intensity of the problem. It is possible the child could outgrow the symptoms, this could be a phase the child is going through, for example being in a new environment as this can affect children more than it may affect adults. Another problem with defining and classifying abnormality is the parental views of the behaviour, it needs to be established if the child’s parents and parents of other children with similar behaviour have the same views of the behaviour. It needs to be considered if treatment could prevent the child growing up to be abnormal and reduce the likelihood of problems later on in life. The affects of being labelled as abnormal for the child can affect children differently. To overcome these problems a model was required, which considered biological, psychological and social factors. The developmental psychopathology approach is a multidisciplinary, and therefore fulfilling the criteria. Developmental psychopathology uses the dimensional approach, which focuses on a range of behaviours rather than a diagnostic classification. Whether the behaviour is a problem is dependant upon the age of the child, as it is necessary to take into account the age related changes children go through. This is needed to consider what is normal and adaptive, as some behaviour can be normal at one age but may be seen as a problem at another (Hudziak et al., 2007). However some children may develop certain skills later than other children of the same age, what is important is the child develops the skills properly rather than when they are developed. The perception of the child’s level of cognitive development will need to be taken into consideration because it will lead to how the behaviour is perceived, interpreted and labelled by adults. It must be known what is normal development and the stages of development before atypical development can be diagnosed. Atypical development can occur at any stage of development with different problems at different ages. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Another factor the developmental psychopathology approach takes into account is stability. A child’s behaviour can depend on stability, as their behaviour is more responsive to environmental changes. This can include which adults are present in the child’s environment, because it can impact upon their behaviour. Clinician’s have to decide whether the child has a problem or whether the issue is part of an intolerance, ignorance, or misconception on behalf of the adult (Campbell, 1983). NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Psychometric tests uses sample behaviour, which are usually scores on a test, to generalise and allow comparisons of an individual to a norm of their sample population. An example of a psychometric test is the Wechsler Intelligence Scale for Children uses a variety of different task to generate an IQ, without using reading or writing ability. This can be used to diagnose different problems, such as learning difficulties and attention deficit hyperactive disorder (ADHD). However there is no specific pattern of scores for ADHD, therefore it would be difficult to diagnose a child using this test. Although it can be useful to show discrepancies in attention and emotional difficulties it should not be used as a diagnostic tool. Tests, such as the Wechsler Intelligence Scale for Children, are then used in conjunction with other relevant tests, such as measure of achievement and observations, to assess the effects of the context and give a diagnosis. From this clinicians can recommend intervention or treatments that are best for the child, and the interventions can be assessed throughout time using these testing methods. However the tests used need to be valid and reliable because the tests will be used for diagnosis and classification of individuals. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
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The childhood condition to be discussed is Attention Deficit Hyperactivity Disorder (ADHD), a disruptive behaviour. ADHD was first described by Still (1902, as cited in Barkley, 2003) with symptoms including aggressiveness, defiant, overly emotional and cruelty towards others. In the 1950’s it was labelled as “Hyperactive Child Syndrome”, with researchers, such as Chess (1960), empathising the hyperactivity as the defining feature. The disorder was first recognised by the DSM II (American Psychiatric Association, 1968), as Hyperkinetic Reaction of Childhood disorder. This was changed to empathise the importance of inattention and impulsivity in ADHD in the DSM III-TR (American Psychiatric Association, 1987) by labelling the disorder as Attention Deficit Disorder with/without hyperactivity. According to the DSM IV-TR, (American Psychiatric Association, 2000) the essential features of ADHD are the patterns of inattention and/or hyperactivity and impulsivity. As more research has taken place, from first being described the definition of ADHD has changed greatly. This report will focus on how ADHD is diagnosed, treatment and the factors that may affect children with ADHD in social and academic contexts. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
ADHD
ADHD is a condition that develops in some children during early childhood, and may continue into adulthood. ADHD effects 3-5% of all school aged children, leading to it being the most commonly diagnosed behavioural disorder in children. There are three subtypes of ADHD, which are
ADHD predominantly inattention
ADHD predominantly hyperactivity and impulsivity
ADHD combined inattention, hyperactivity and impulsivity
Inattention refers to trouble orienting to stimuli, or even a failure to detect stimuli. It can be seen in responding to the wrong aspects of a stimulus or to an entirely inappropriate stimulus. As well as a failure to sustain attention to task-relevant stimuli, they also show that they are easily distracted or have a short attention span. Impulsivity includes the failure to inhibit responding, or quick responding with numerous errors made in the response. A failure to fully appreciate all aspects of instructions given is a feature of impulsivity. Children with ADHD with symptoms of impulsivity do not stop to think about consequences of their actions, this can sometimes place themselves in dangerous and risky situations. They often do not consider the impact of their actions or statements on others. These children are more likely to respond aggressively, this could be verbally or physically, when frustrated or emotionally hurt by others. Hyperactivity is often a problem when the child is in a restrictive environment where concentration is required. It has been noted that hyperactive behaviours can be evoked by novel or unfamiliar situations (Barkley, 1981). NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
For ADHD to be diagnosed six or more symptoms of inattention must be present for at least 6 months, the symptoms must be disruptive and inappropriate for developmental level.
A few inattention symptoms are listed:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions). NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Often has trouble organizing activities.
For ADHD to be diagnosed six or more symptoms of impulsivity and hyperactivity must be present for at least 6 months, the symptoms must be disruptive and inappropriate for developmental level
A few hyperactivity symptoms are listed:
Often fidgets with hands or feet or squirms in seat.
Often gets up from seat when remaining in seat is expected.
Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
A few impulsivity symptoms are listed:
Often blurts out answers before questions have been finished.
Often has trouble waiting one’s turn.
Often interrupts or intrudes on others. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
DSM IV-TR (American Psychiatric Association, 2000).
Some of the symptoms must have been present before the age of 7 years, as well as being present in two or more setting, such as at home and school. For ADHD to be diagnosed the symptoms must make a significant impairment in the child’s social or academic functioning. The disorder must be diagnosed separate of other conditions, such as mood disorder, or a personality disorder. ADHD is associated with other disorders, for example 20-25% of children with ADHD have learning disabilities. Other associated disorders are anxiety disorder, oppositional defiant disorder, conduct disorder, Tourette Syndrome, depression, sleep problems, and epilepsy.
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There are a variety of different ideas on the possible causes of ADHD. These include environmental factors, such as food additives and refined sugars. Psychosocial factors suggest ADHD being a result of poor parenting skills with inconsistent rules, an over-reliance on punishment and excessive commands. According to Barkley (1981) hyperactive children can be found to be noncompliant, attention seeking and aggressive. These children need supervision. It was also found their mothers were overly directive negative as well as being less responsive to the child in general. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Biological factors may include pre-frontal cortex abnormalities, neurotransmitter abnormalities, and neurological immaturity.
Diagnosis is made through medical and family history; this starts with a physical exam, and interviews with the parents, child and teachers (as the symptoms must be present in at least two settings). The parents and teachers also completed behaviour rating scales. Professionals carry out observations of the child’s behaviours. Finally psychological tests, such as social and emotional adjustment tests, are completed to see if the potential ADHD symptoms may be better labelled as another disorder.
Children with ADHD are commonly prescribed Ritalin, an amphetamine (methylphenidate hydrochloride) that increases dopamine levels that are deficient in those with ADHD. Ritalin has side effects, which include irritability, anxiousness, sleep problems, loss of appetite, dizziness, stomachache, headaches, and marked crying. The use of medication can be helped with behavioural therapy. A multisystemic approach, including psychoeducation, family intervention, school intervention, self-regulation skills training, would be appropriate. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Individual Differences
There are many factors that may influence individual differences that can affect ADHD, for example the severity of ADHD. The severity may be the amount of symptoms that the individual has as they need a minimum of six symptoms per category, therefore some children may have more symptoms than others. The children with combined inattention, hyperactivity and impulsivity may have a severer ADHD because they will have more symptoms and a larger range of symptoms. The type of symptoms that the individual has may affect the severity of ADHD, as some symptoms may be more problematic than others, for example in inattention having trouble organising is not as much of a problem as having issues with listening when being spoken to directly.
Risk and Protective Factors
Risk factors are any characteristic, condition, or circumstance that may increase the likelihood of developmental difficulty or disorder, in a direct or indirect way. For example, the gender of the individual can increase the likelihood of developing ADHD, as it is more prevalent in males than females, with ratios from 4:1 to 9:1. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
According to Sykes (1997) ADHD is due to early physiological problems; however this may be associated with other factors, such as maternal factors. A maternal circumstance may be the heavy use of alcohol during pregnancy that can lead to attention problems (Linnet et al., 2003). Also there has been found to be a significant association between smoking during pregnancy and ADHD (Thapar, et al., 2003). Pregnancy and birth complications, especially maternal bleeding, can lead to ADHD (Milberger, 1997). Childhood illnesses that involve high fevers have been shown to relate to ADHD (Dale, 2003). An important factor is the individual’s social environment; adults in the individual’s life (such as parents and teachers) do not always appreciate the distractions that children with ADHD can cause other children, as well as struggling to keep the individuals attention. Individuals who have ADHD combined with other disorders, such as learning difficulties and Tourette Syndrome, can be more socially isolated. Protective factors are characteristics, events or processes that seem to protect the child from developing psychological problems. Ritalin can help to reduce the symptoms of ADHD, along with behavioural therapy. Children with ADHD can be taught strategies and techniques for coping with stressful situations. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Family Contexts
Bowlby (1982) believed that the parent-child relationship during infancy is a central causal factor in the child’s personality. This can be an upsetting theory for mothers whose children have ADHD, as they begin to feel responsible for their child’s disorder. The parents of children with ADHD may suffer from chronic sorrow, this is a term used to describe that the feelings of grief and sorrow that do not fully resolve when raising a child with developmental difficulties (Olshansky, 1962). Families may feel guilt about their possible genetic contribution to their child’s condition, or feel guilty for bad parenting of ‘naughty’ children. Parents may feel physically exhausted by some of the child’s behaviours, especially with children that are overly active and don’t concentrate very well. This makes it difficult to find things that will interest and keep the individual busy. Parents may become upset by thoughts of their child being stigmatised or socially isolated at school because of the behavioural characteristics of ADHD. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Social Contexts
From Bronfenbrenner’s (1982) ecological systems perspective, culture plays a role in how childhood disorders are diagnosed and interpreted within the social context. For example, Jacobson (2002) found that teachers in both the United States and the United Kingdom identify ADHD characteristic behaviours; however they differed significantly in what they believed to be appropriate behaviour for the classroom. This shows that cultural differences are seen in the interpretation of behaviours, and whether the behaviour is seen as being disordered. A cultural difference can be seen between the criteria of ADHD for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR, 2000), which says essential features of ADHD are the patterns of inattention and/or hyperactivity and impulsivity, and the ICD-10 (World Health Organization, 1993), which says attention, hyperactivity and impulsivity symptoms must all be present for ADHD to be diagnosed. This makes comparisons across cultures difficult as it depends on the criterion that was used to make the diagnosis. However the prevalence rates of males to females having ADHD is consistent across all cultures (Cantwell, 1996). ADHD Working Group, consisting of clinicians and researchers from different countries, stated that ADHD is found in both developed and developing cultures, however in many countries it is under diagnosed (Remschmidt, 2004). Researchers, such as Timimi (2004), believe that the construction and higher rates of ADHD has emerged over recent years due to the stresses of modern Western culture, for example loss of extended family support. There has not been any large scale comparative cross-cultural studies conducted, which would be needed to establish whether ADHD is a universally experienced disorder. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
A supportive environment both at home and at school is important for the individual’s development, for example support at school will help the child with their academic learning and their social skills with peers and teachers. Therefore whether the individual has a supportive environment will have an effect on how they develop with ADHD. As well as support for the child, the family may benefit from having good social support; parents with children with ADHD may find comfort, and even guidance, talking to other parents in the same position. It may also be beneficial for the parents of children with ADHD to have a close extended family, as well as a good friend’s network, because taking time out from looking after the child for an hour may prevent the parent from becoming physically exhausted. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Genetic
A large debate surrounding ADHD is whether it is caused by genetics. ADHD is a failure in the brain circuitry occurring in development, which underlies inhibition and self-control (Barkley, 1998). According to Barkley (1998) the children with ADHD whose brains have portions that are smaller than in normal children is due to genetics. Tannock (1998) suggested that ADHD was the result of a brain dysfunction, which may be of genetic origin. A delayed or abnormal development of the nervous system, specifically the frontal lobe and executive functions may be a cause of ADHD. The neuro-developmental model suggests a biochemical imbalance, which is caused by the dopaminergic pathways from the brainstem to the basal ganglia in the frontal cortex. However disorders can run in families because of either environmental or genetic factors (Faraone, Tsuang, & Tsuang, 1999). It can be argued that environmental factors affect the course and outcome, but are not the cause. There have been no genes isolated, and no neuro-anatomical abnormalities have been found. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Conclusion
Children may not know they have problems and need help; this means the responsibility to identify these issues is that of the adults. This can be difficult, especially for adults who are not the parent of the child, as it can be seen as intruding into the life of a child and their family. The effect of diagnosing a child with ADHD can have a profound impact on a child. The affects of stigmatism, prejudice and discrimination can exaggerate the severity of ADHD. It needs to be considered if the labelling of ADHD will help or be a hindrance for each individual child. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
The developmental psychopathology approach uses multiple perspectives, therefore giving a more eclectic diagnosis than using just one perspective. It takes into account the interplay of a range of influences, leading to a range of outcomes that gives a better diagnosis. It uses a great breadth of theory, methodology and possible mechanisms of development to give an accurate diagnosis of symptoms. It also considers maladaption as an outcome of development, not a disease. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay
Diagnostic classification systems are not very reliable for children and adolescents, bringing the debate of whether these systems should be used for diagnosing children. The systems may be unreliable due to a lack of developmental sensitivity, as they are not based on a firm knowledge of developmental norms. The cultural validity of diagnostic classification systems needs to be examined, as it has been found that there are cultural differences in the interpretation of behaviours (Jacobson, 2002). The cultural background and experience of the clinician involved can influence how they interpret the behaviours of the children. Therefore this can affect the diagnosis. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay