NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

• Select one of the following ethical/legal topics:
  • Autonomy
  • Beneficence
  • Justice
  • Fidelity
  • Veracity
  • Involuntary hospitalization and due process of civil commitment
  • Informed assent/consent and capacity
  • Duty to warn
  • Restraints
  • HIPPA
  • Child and elder abuse reporting
  • Tort law
  • Negligence/malpractice
• In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

BY DAY 3 OF WEEK 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 2

Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply! 

 

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

Week 2 Discussion

Ethical and Legal consideration of constraints

Restraints is a clinical treatment method used in hospitals for many reasons, such as protecting manic patients from harming themselves or others and preventing demented patients from pulling out their tubes. There are three types of restraints: physical restraints, chemical restraints, and environmental restraints. It is usually the last resort for healthcare providers after all other interventions such as verbal de-escalation failed.

Ethical Consideration of Restraints for Adult Patients

Restraints usually happen in emergencies, healthcare providers will apply them against the patient’s will, which caused considerable ethical dilemmas in clinical. Considering the patient’s safety and autonomy, providers have to weigh the outcome of its use against the outcomes of not using it. Healthcare providers have to receive professional training about the protocols of restraints, familiar with evidence-based guidelines, and legal problems associated with restraints. When restraints are used, they should only limit the movements that may cause harm to the patients or others. Restraints should never be used for the caregiver’s convenience or threatening. If all other less restrictive treatments are failed, restraints are inevitable, providers will make sure that the patients still have their rights during the restraints. Also, the further need for restraints should be assessed continually by healthcare authorities, so, the restraints can be discontinued as soon as possible (Salehi, & others, 2019).

BUY ESSAY HERE

Legal Consideration for Restraints for Adult Patients

Restraint should be used as a last choice and only be imposed when necessary to protect the patient from harming themselves or others. Patients’ rights should be always protected and promoted during the restraint period. Such as privacy, safety, and the right to be free from all forms of abuse or harassment. The attending physician must be consulted as soon as possible. Providers should debrief with the patient and family to discuss the previous interventions and alternatives to restraints. Each restraint order may only be renewed 4 hours later for adults, and it will expire within 24 hours. The restraint order must be discontinued at the earliest possible time (Public Health, 2018). The Code of Regulation also listed many other legal considerations related to restraints and seclusions.

Ethical Consideration of Restraints on Children/Adolescents

Physical restraint used for children and adolescents in mental health facilities requires particular ethical and legal consideration, it is often used as a reactive behavior management strategy for aggressive behaviors. We all realize that restraints limit the patient’s physical movement, and may cause some physical injuries if it is not used appropriately, but we can’t ignore that they could cause severe and long-term psychological consequences for children or adolescents who experienced restraints and seclusions (Nielson, 2021) ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE.

Providers need to understand the consequences of physical restraint on a child’s physical and mental well-being. Children and adolescents are mentally immature, they may feel defended, and they will experience anger, fear, anxiety, and many other negative emotions. According to some patients’ retrospect reviews, being physically restrained is a severely traumatic experience, it caused physical injury as well as psychological damage. Also, reports suggested that the use of restraint within mental health facilities can damage the therapeutic relationship between patients and healthcare providers.

Legal Consideration to Restraints on Children/Adolescents

Due to the tension between the patient’s right to freedom and the healthcare provider’s duty, healthcare providers may face potential claims of improperly detaining patients, false imprisonment, or harming children when restraints are applied. The use of restraints is among the most controversial practices in mental health care, especially for children and adolescents. Children and adolescents are considered the most vulnerable population among mental health patients. Federal and state law shared a desire to provide minor patients with the greatest protections regarding the usage of restraints and seclusion. Providers are mandated to notify the parents and legal guardians of the use of restraints as soon as possible, they will supply a copy of the restraint policy and obtain a written acknowledgment of the policy from the parents. (Neiman, Pelkey, & Holloway, 2016).

References

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of child health care: for professionals working with children in the hospital and community, 25(3), 342–367. https://doi.org/10.1177/1367493520937152

Neiman, E., Pelkey, E., & Holloway, M. (2016). An Analysis of Legal Issues-Child and Adolescent Behavioral Health, Part III: Patient Safety- Identifying and Addressing Legal Issues Involved When Treating Pediatric Patients with Behavioral Health Needs Teaching Hospitals and In-House Counsel Practice Groups, AUTHORS. https://lewisbrisbois.com/assets/uploads/email-files/Child_and_Adolescent_Behavioral_Health%2C_Part_III_-_Patient_Safety.pdf

Public Health. (2018, October 1). Code of Federal Regulations. Www.govinfo.gov. https://www.govinfo.gov/content/pkg/CFR-2018-title42-vol5/xml/CFR-2018-title42-vol5-sec482-13.xml

Salehi, Z., Najafi Ghezeljeh, T., Hajibabaee, F., & Joolaee, S. (2019). Factors behind ethical dilemmas regarding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598–608. https://doi.org/10.1177/0969733019858711

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE RESPONSE 1

Your discussion piece on Restraints was informative. It got me thinking about recent and emerging trends in restraint use and isolation. I know that in my hospital there is a plan to move from restraining patients in a chair to using a bed. We are yet to see this change. This notwithstanding, studies have shown that seclusion and restraint use can be traumatic to patients (Chieze et al., 2019). The comprehensive systematic review by Chieze et. al. (2019) highlighted the negative physical and psychological impact of restraints on this patient population, especially those with a history of trauma. I remember working with a patient who was very disruptive and was pulling out all devices attached to him including extubating himself. He was subsequently physically restrained and placed in an enclosure bed. However, when the family was informed per protocol, they noted that the patient was a prisoner of war, and we were only traumatizing him further. This important part of the patient’s history should have been reflected in his plan of care and the use of physical restraints should have been contraindicated in this patient. As noted by this review, seclusion and restraint were associated with negative effects and they noted problems with arriving at any benefits. The study suggests a more robust patient-staff interaction and relationship which also makes me think of staffing ratios – are healthcare facilities adequately staffed to provide adequate patient-staff interaction to ameliorate or decrease the use of restraints? Meanwhile, I have observed that in my facility, the use of physical restraints is short (about two to four) as they are combined with chemical restraints (e-meds). The ideal for practice is non-malfeasance (do no harm).

Thanks for provoking my thoughts with your discussion piece.

Reference

Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in Psychiatry, 10(491). https://doi.org/10.3389/fpsyt.2019.00491

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE POST 2

WEEK 2 DISCUSSIONS – Initial Post

JUSTICE

After reading Just Mercy, I understood the meaning of justice as not being limited to the judiciary system and all the attending laws but the hope that the system can and will work equally for everyone (Stevenson, 2014), age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status (“Ethical Principles of Psychologists and Code of Conduct,” n.d.) notwithstanding. This is the essence of the Ethical Principles of Psychologists and Code of Conduct (Principle D). The principle of Justice, as noted by the Code of Conduct, is geared towards ensuring fairness and equitable access to competent psychiatric care for all. The other principles (Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, and Respect for People’s Rights and Dignity) make sense in a paradigm where fairness and access is available to ensure that no harm is done, and patients are able to trust their providers (therapeutic alliance) to provide confidential and culturally sensitive evidence-supported care.

Ethical Considerations for Adults

While factors like income security, comorbid health conditions, the need for long-term care, nutrition, housing, abuse, neglect, and age discrimination are some of the ethical issues impacting care for the elderly, the issue of ethical considerations has loomed large in the area of consenting for genetic testing for this population. Lawrie et al. (2019) noted that early detection has not been linked to greater efficacy of treatment. However, they also note that the ethical considerations here are confidentiality, communicating, and sharing of research findings. On the issue of communication, they note that stigma associated with mental illness is a barrier to both delivering the result to the patient/family and disseminating pertinent significant research findings to the provider community. These considerations also apply to children and adolescents as parental consent are required – sometimes by adolescent patients deferring to parents and/or legal guardians, in most cases, to carry out research.

Ethical Considerations for children/adolescents

Adolescence is a period rife with gender issues and emerging gender identity. Kimberly et al. (2018) noted a disparity in the treatment outcomes of cisgender youths and youths with gender dysphoria. The authors urge for a more cautious approach to ensure access and equitable care for this population. Specifically, they advocate for ethical considerations for this population to be gender-affirming and tailored to achieve optimal treatment outcomes (beneficence), with minimal harm (nonmaleficence). The ethical considerations should have a focused treatment plan that supports autonomy for even children during times of rapid development with an emphasis on justice to provide that hope for the future with assured access to care.

Legal Considerations for Adults

As noted above, income security, health care decisions, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination are some of the factors that come with adulthood and become even more significant with age. Bipeta (2019) cautions that the mentally ill have the same right as everyone else and must be treated with respect to the principles enshrined in the Code of Ethics ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE. He warns of the need to treat each patient as a legal entity by understanding the unique aspects of each individual patient. He also recommends patience and learning over time for the practitioner to ensure that no harm comes to the patient in the process of care delivery to a mentally impaired patient.

Legal Considerations for Children/Adolescents

The issue of informed consent also looms large in caring for minors. Levin et al. (2022) note barriers to these include erroneous and biased professional assumptions, and inadequate initial assessments, which may lead to a paucity of information shared with the patients and their parents. They note that this is especially so with the gender dysphoric patient. At work, I noted that some children/adolescents have consented to treatment but have not shared their preferred gender identity with their parents/legal guardians. This limits the provider’s ability to share with the parents. According to Levin et al. (2019), this disagreement or disconnection from parents is a legal barrier to care. They also note that the presence of mental health problems may impair cognition and creates doubt about the minor’s ability to understand and be informed enough to consent to care.

Application to Clinical Practice in Colorado

It is important to practice within the Nurse Practitioner Scope of practice in Colorado. While the NP has full practice rights, it is important to have in mind the ethical and legal considerations noted above as they impact care. The age of consent for minors in CO has been lowered to 12 by the passing of Bill # HB17-1320. Even children as young as 10 can obtain psychotherapy treatment without parental consent. While the provider of care is protected by law, it is pertinent to have the Code of Conduct in mind to ensure that the principles of Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, and Respect for People’s Rights and Dignity, and of course Justice are not compromised in the delivery of care to minors or the cognitively impaired mental patient ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE.

References

Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19Links to an external site.

Ethical principles of psychologists and code of conduct. (n.d.). Https://Www.apa.org. https://www.apa.org/ethics/code/?item=3Links to an external site.

Kimberly, L. L., Folkers, K. M., Friesen, P., Sultan, D., Quinn, G. P., Bateman-House, A., Parent, B., Konnoth, C., Janssen, A., Shah, L. D., Bluebond-Langner, R., & Salas-Humara, C. (2018). Ethical Issues in Gender-Affirming Care for Youth. Pediatrics, 142(6), e20181537. https://doi.org/10.1542/peds.2018-1537Links to an external site.

Lawrie, S. M., Fletcher-Watson, S., Whalley, H. C., & McIntosh, A. M. (2019). Predicting major mental illness: ethical and practical considerations. BJPsych Open, 5(2). https://doi.org/10.1192/bjo.2019.11Links to an external site.

Levine, S. B., Abbruzzese, E., & Mason, J. M. (2022). Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults. Journal of Sex & Marital Therapy, 1–22. https://doi.org/10.1080/0092623x.2022.2046221Links to an external site.

Stevenson, B. (2014). Just Mercy. Delacorte Press.

‌ Wiesen, K. (2022). Nurse Practitioner Scope Of Practice By State – 2021. Www.nursingprocess.org. https://www.nursingprocess.org/nurse-practitioner-scope-of-practice-by-state.html

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE SAMPLE 2

This discussion aims to discuss the ethical and legal considerations of involuntary hospitalization, the due process of civil commitment in adolescents and adults, and explain how this topic concerns psychiatric-mental health practice for children, adolescents, and adults.

Involuntary hospitalization and due process of civil commitment

In the United States, involuntary hospitalization, also known as civil commitment, is a legal intervention where individuals who pose a danger to themselves or others or are gravely disabled (unable to provide basic needs for food, clothing, or shelter) due to a psychiatric illness or substance abuse can be detained in a psychiatric hospital or receive supervised outpatient treatment for some length time (Gi Lee & et al., 2021).

Under California law, short-term emergency detention often referred to as a “5150”, is when a person is held in legal custody for 72 hours. Only designated personnel, such as deputy officers, members of a mobile team, or mental health workers for psychiatric evaluation, can place a person on a 5150 legal hold.  After the 72-hour legal hold, a psychiatrist will evaluate the individual, after which the individual may be placed on a 14-day ‘5250’ involuntary hold or can agree to be admitted or discharged. The subsequent step is expected to continue if a court or psychiatrist orders a commitment extension for up to 14 days, subject to legal review (Gi Lee & et al., 2021).  Within four days after the patient is placed on a 14-day involuntary hold, there must be a certification evaluation hearing, also called a probable cause hearing.  The hospital/facility must present a substantiation as to why the patient necessitates further psychiatric management.  The patient is aided by a patient’s rights advocate who can rationalize why there is no need for an additional hospital stay.  A hearing deputy will decide whether or not there is probable cause to hold the patient in the hospital/facility against their will for a period not exceeding 14 days.

Suppose the hearing officer decides there is probable cause, and the patient disagrees with the decision. In that case, the patient has the right to request a Writ of Habeas Corpus and have a hearing in the Superior court of the county where the patient is being held. The hospital may keep a patient for 180 days after the 5250 legal hold if they are still a danger to themselves or others.  In tremendous cases, when an adult has an extensive history of mental illness and non-adherence, family members or professional personnel may request an LPS (mental health) conservatorship; this gives an adult legal authority to make choices for a seriously mentally ill individual who cannot care for themselves.

The purpose of commitment is to guarantee treatment for individuals who need treatment to alleviate the symptoms of psychiatric disorders that contribute drastically to an individual’s higher risk of harm to self or others (Nussbaum, 2020). A psychiatric patient with involuntary hospitalization often has overlapping vulnerabilities of language, sexual orientation, religion, and disrupted education. These vulnerabilities may either withhold vital services or deliver services coercively (Nussbaum, 2020).  Mental illness affects a person’s ability to make rational decisions and live a normal life. Sometimes, a patient’s capability to make choices is so incapacitated by a psychiatric illness that practitioners manage them against their will to restore their ability to make reasonable choices (Nussbaum, 2020).

Applications to clinical practice and the specific implications for practice within California

Practitioners are profoundly challenged to be ethical when a patient is involuntarily hospitalized due to civil commitment. When patients are held against their will, they are also intensely vulnerable to illness and social structure.  These situations obligate our profession to provide evidence-based patient care and advocate for better care of people with psychiatric disorders.  Civil commitment has obtained punitive legal criticism. The hearing process is criticized for being a “charade” for lacking a specific, meaningful chance for vulnerable individuals to dispute the liberty restriction they face (SAMSHA, 2020).

In California, under the Lanterman-Petris Short Act (LPS), patients admitted under 5150 retain all their rights when hospitalized or receiving services, except for freely leaving the facility where they are admitted (SAMSHA, 2020).  Patients have all rights given to a voluntarily admitted patient.

BUY ESSAY HERE

The practitioners define the decision to commit a patient as resolving the pressure between the ethical principle of nonmaleficence and autonomy (Evans & et al., 2020).  They are obliged to predict the occurrence of a patient causing harm to themselves or others, consider when to intervene to avoid harm, and protect and warn those who may be harmed by the patient’s behavior.  As practitioners, we are guided to respect a patient’s ability to make choices and to neither unduly influence nor coerce a patient we are treating simultaneously. We should also act in ways not to cause harm to patients (SAMSHA, 2020).

Ethical and legal issues concerning psychiatric-mental health practice for children/adolescents and adults

In an article explored by Rice, Xing Tan & Li.  2021, adolescents navigated their treatment from admission to discharge.  Adolescents brought to the hospital by law enforcement officials after being placed under involuntary psychiatric hold because of the danger to themselves have a sense of shame that leads to tagging themselves negatively. The patient’s perceptions of their psychiatric mental health were too severe to be managed within standard community-based settings. Consequently, they were transferred to a locked psychiatric hospital for treatment.  The legal concern is that the patient has the right to privacy, human care, and dignity and cannot be denied this right as a situation of admission or as part of a treatment strategy.  In this study, it was established that practitioners should advocate an appropriate treatment intervention to meet the adolescent’s needs and revealed significant insight into ways of engaging and explaining the treatment to avoid rehospitalizations.

In another article researched by Jones & et al., 2021 adolescents who experience involuntary hospitalizations positively and negatively impact their mental health treatment.  In this study, the participants describe the negative impact of involuntary hospitalization.  The participants reported distrust and inability to disclose their suicidal feelings as the environment was more punitive than therapeutic. Others suggested examination and evaluation be constantly incorporated into the clinical practice and addressed the need to evaluate interventions intended to promote patient-centered practices in hospitals (Jones & et al., 2021). Any time a right is denied under a “good cause,” it must be acknowledged in the patient’s medical record and clarified to the patient ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE.

In an article by Gather & et al., 2019 an adult patient who is actively psychotic and dangerous to themself and others is no longer considered competent to evaluate their need for psychiatric health services. The article substantiates that a commitment promotes the ethical obligation of the practitioner to encourage beneficence to the patient.  Involuntary hospitalization during this course becomes essential to treating the adult patient and initiating preventive services to promote patient and public safety (Gather & et al., 2019).

According to the article “Incidences of Involuntary Psychiatric Detentions in 25 U.S. States,” involuntary hospitalization in adults improves the patient’s clinical condition and overall well-being and protects their safety and others while valuing their rights (Gi Lee & et al., 2021).

It is imperative to balance the significance of self-determination and the social responsibility to care for a person with a lessened capacity to act in their best interest (Gi Lee & et al., 2021).

References

Evans, E. A., Harrington, C., Roose, R., Lemere, S., & Buchanan, D. (2020).  Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder. The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics, 48(4), 718–734.  https://doi.org/10.1177/1073110520979382Links to an external site.

Gather, J., Kalagi, J., Otte, I., & Juckel, G. (2019). Interviewing a Person with Bipolar Disorder Under Involuntary Commitment: A Case Report. Journal of Empirical Research on Human Research Ethics: JERHRE, 14(5), 472–474.  https://doi.org/10.1177/1556264619847322Links to an external site.

Gi Lee, M. S. W., & David Cohen, M. (2021).  Incidences of Involuntary Psychiatric Detentions in 25 U.S. States. Psychiatric Services, 72(1), 61–68.  https://doi.org/10.1176/appi.ps.201900477Links to an external site.

Jones, N., Gius, B. K., Shields, M., Collings, S., Rosen, C., & Munson, M. (2021).  Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Social Psychiatry and Psychiatric Epidemiology, 56(11), 2017–2027.  https://doi.org/10.1007/s00127-021-02048-2

Nussbaum, A. M. (2020). Held Against Our Wills: Reimagining Involuntary Commitment. Health Affairs (Project Hope), 39(5), 898–901.  https://doi.org/10.1377/hlthaff.2019.00765Links to an external site.

Rice, J. L., Tan, T. X., & Li, Y. (2021).  In their voices: Experiences of adolescents during involuntary psychiatric hospitalization. Children and Youth Services Review, 126.  https://doi.org/10.1016/j.childyouth.2021.106045Links to an external site.

SAMSHA.  (2021).  Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice.  https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdfLinks to an external site.

D2.In their voices_ Experiences of adolescents during involuntary psychiatric hospitalization _ Elsevier Enhanced Reader.pdf Download D2.In their voices_ Experiences of adolescents during involuntary psychiatric hospitalization _ Elsevier Enhanced Reader.pdf

D2.Held_Against_Our_Wills_Reimag.pdf Download D2.Held_Against_Our_Wills_Reimag.pdf

D2.Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care.pdfDownload D2.Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care.pdf

D2.Incidences of Involuntary Psychiatric Detentions in25 U.S. States.pdf Download D2.Incidences of Involuntary Psychiatric Detentions in25 U.S. States.pdf

D2.Interviewing.pdf Download D2.Interviewing.pdf ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD)

NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD)

Introduction

ADHD is an incurable mental health issue. Regardless, some standard treatments and interventions involve using medications purposely to relieve symptoms and education approaches to better the patients’ livelihoods and, more so, growth. According to Titheradge et al. (2022), the use of medication among children and adolescents with ADHD is received with controversies as, to some extent, the medications are not used. Some of the reasons for this stand include the challenges of balancing the benefits, perceived risks, and side effects of these medications (Titheradge et al., 2022). Due to the need for pharmacological interventions, off-label drug use (OLDU) is considered an alternative medication for the treatment of ADHD.

Recommended Treatments

One of the recommended on-label drugs in the treatment of ADHD among children is methylphenidate (Nanda et al., 2023). However, the drug is widely discouraged by children due to the extent of its side effects, which include sleep disorders and loss of appetite; significant reasons why off-label treatments and other non-pharmacological approaches are considered. For the off-label interventions, one of the critical drugs that can be used is Bupropion. This is a norepinephrine-dopamine reuptake inhibitor sold under the brand name Wellbutrin. From a different dimension, Bupropion is used in the cessation of smoking but can also act as an antidepressant, hence preferred for the treatment of ADHD (Clark et al., 2023). For non-pharmacological approaches, research guidelines by the US Department of Health and Human Services support increased exercise for at least one hour daily, as this helps improve cognitive functionality and overall wellness (Shrestha et al., 2020). Also, it is usually advised to use a form of behavioral therapy, or CBT, in addition to ADHD drugs. Children and adolescents can benefit from this type of treatment by way of making the shift from tight monitoring to more operational autonomy. Psychoeducational therapies that focus on improving abilities such as preparing, arranging, and restructuring the mind make up most of it. In sessions pertaining to communicating, managing irritation, and changing the kid’s conduct, parents and other relatives may also participate.

ORDER PLAGIARISM-FREE WORK HERE

Risk Assessment

There are several elements considered when comparing the use of off-label and on-label medications, especially among children. First and foremost is the nature and extent of side effects. According to Nanda et al. (2023), methylphenidate is a highly effective medication that is known to increase brain activity controlling behavior, hence effective in treating ADHD. Regardless of this effectiveness and efficiency, the side effects are mainly intolerable among children as it is associated with sleep disorders and poor appetite, which, when taken for the long term, may predispose the child to risks of malnutrition and deficiencies and, consequently, growth issues. On the other hand, the off-line medication bupropion is considered not only an effective medication but also generally tolerable among children and adolescents. This means some of its side effects, including weight loss and constipation, insomnia, and nausea, are lesser than methylphenidate and hence highly preferable (Lee et al., 2022).

ADHD Clinical Practice Guidelines

According to the American Academy of Family Physicians (AAFP), the treatment guidelines for ADHD among children require that children between 4 and 6 years be treated with parent training and behavioral management and behavioral classroom education programs, if available, as the first line of treatment (AAFP, 2020). However, if the approaches fail to work, then guidelines require that the medical practitioners prescribe methylphenidate. For children above six years and adolescents, requirements entail prescribing medication only upon the patient’s approval, depending on their tolerance of the drug’s side effects (AAFP, 2020). In other words, the guideline recommends the consideration of the drugs with the least and, at the same time, highly tolerable side effects. In this evaluation, the off-line drugs and, in this case, Bupropion is one of these drugs with ascertained effectiveness and tolerable side effects. For this reason, researchers highly support the use of effective, efficient, and safe drugs in the treatment of diseases such as DHD, regardless of whether it is off-label or on-label NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD).

Conclusion

The use of OLDU in treating various diseases is a joint event, as ascertained by researchers. Though effective, some of these drugs have yet to be approved by the FDA for several logical and valid reasons, including the time-consuming process required to ascertain and approve the drugs, cost issues, and the complex process of filing for supplemental drug application. Meaning that not all off-label drugs are unsafe for disease management. For this case, for instance, the use of off-line medication, Bupropion, in the treatment of ADHD among children and adolescents is ascertained to be an effective and safer option compared to the on-label approach to the same using methylphenidate. In a nutshell, the choice of a drug for prescription in a medical and clinical setting is evaluated with consideration to not only effectiveness and efficiency but, more so, safety aspects and tolerability of the drug’s side effects.

References

AAFP. (2020). clinical practice guideline: ADHD in children and adolescents. aafp.org. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/ADHD.html

Clark, A., Tate, B., Urban, B., Schroeder, R., Gennuso, S., Ahmadzadeh, S., … & Kaye, A. D. (2023). Bupropion Mediated Effects on Depression, Attention Deficit Hyperactivity Disorder, and Smoking Cessation. Health Psychology Research, 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317506/

Lee, S. Y., Wang, L. J., Yang, Y. H., & Hsu, C. W. (2022). The comparative effectiveness of antidepressants for youths with major depressive disorder: a nationwide population-based study in Taiwan. Therapeutic Advances in Chronic Disease, 13, 20406223221098114. https://journals.sagepub.com/doi/10.1177/20406223221098114?icid=int.sj-abstract.similar-articles.1

Nanda, A., Janga, L. S. N., Sambe, H. G., Yasir, M., Man, R. K., Gogikar, A., & Mohammed, L. (2023). Adverse Effects of Stimulant Interventions for Attention Deficit Hyperactivity Disorder (ADHD): A Comprehensive Systematic Review. Cureus, 15(9). doi: 10.7759/cureus.45995

Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Translational pediatrics, 9(Suppl 1), S114. https://tp.amegroups.org/article/view/32479/html#:~:text=Physiological%20interventions%20are%20regular%20physical,activity%20every%20day%20(43).

Titheradge, D., Godfrey, J., Eke, H., Price, A., Ford, T., & Janssens, A. (2022). Why young people stop taking their attention deficit hyperactivity disorder medication: a thematic analysis of interviews with young people. Child: Care, Health and Development, 48(5), 724-735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545018/  NRNP 6665 Week 3: Assignment 1 – Off-label prescribing – Attention deficit hyperactivity disorder (ADHD)

Off-label prescribing – Major Depressive Disorder (MDD)

Off-label prescribing – Major Depressive Disorder (MDD)

FDA-Approved Treatment for Major Depressive Disorder

Management of underlying mood disorders such as major depressive disorder (MDD) among children requires the implementation of strategies and mechanisms for enhancing efficient mood disorder and achieving the desired outcomes. Fluoxetine is an FDA treatment used for the management of depressive disorder by improving the mood, enhancing coping mechanisms, and ensuring that the pediatric client receives the most effective treatment plan. The FDA-approved treatment is commonly used as the first-line therapy for managing the disorder and enhancing the quality of life of the affected persons (Pettitt et al., 2022). Some of the potential adverse effects that may occur with the treatment include sleep disturbances, gastrointestinal disturbances, and suicidal ideations. Therefore, the patient may require close monitoring and support to help cope with this condition and help mitigate the expected side effects. For instance, the client should be encouraged to take the medication in the morning with food to reduce insomnia and gastrointestinal disturbance manifestations.

Off-label Treatment

Off-label medications can also be used to manage the condition. Sertraline is another SSRI medication that is commonly used in the management of MDD in children and adolescents. The treatment offers various measures and outcomes, such as mood stabilization and reduction of symptoms. However, the medication is used as an off-label agent because it lacks formal evidence for use in the management of pediatric conditions and complications. Pediatric patients taking sertraline may experience conditions and side effects such as nausea, insomnia, and increased risk for suicidal ideation. The healthcare team using these treatment approaches to manage the condition must balance the risks and benefits and consider the medication when the benefits outweigh the risks (Dauchot et al., 2024). Therefore, it is necessary to provide detailed education and explanation to allow informed consent from the legal guardian or the parent to promote safe and effective management.

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Non-pharmacological Interventions: Cognitive Behavioral Therapy

Managing major depressive disorder also requires the implementation of non-pharmacological measures and interventions to enhance the coping mechanisms of the affected child. The provider may use the treatment either solely or in combination with pharmacological therapies to enhance coping, promote emotional regulation, and reduce the frequency and severity of depressive symptoms and the overall quality of life. This non-pharmacological intervention provides optimal opportunities for managing the condition and empowering the patient and the family to manage the condition effectively and achieve the desired outcomes (Korczak et al., 2023). Implementing the non-pharmacological treatment requires a structured approach with regular sessions that empower the patient and the family to manage the desired outcomes collaboratively.

Risk Assessment and Clinical Practice Guidelines

Most assessment criteria are related to the risk assessment to evaluate the severity of MDD, patient history, side effects of a particular medication, and family preferences. Periodical-like clinical practice guidelines have been developed for children and adolescents. According to AACAP guidelines, the first-line pharmacologic treatment in this population is fluoxetine, which has demonstrated a favorable safety and efficacy profile in children and adolescents. Thus, safe practice recommendations for off-label uses of sertraline include its use only when first informed by patients and with monitoring of the beneficiaries (Korczak et al., 2023). CBT is considered first-line treatment therapy and, indeed, often used in the second line because it is evidenced and has a very low risk of adverse reaction. Therefore, the nurse practitioner should initiate strategies and mechanisms for managing the disorder and attaining the best outcomes.

References

Dauchot, D., Rettey, S., Melton, B. L., & Moeller, K. E. (2024). Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns. The Mental Health Clinician, 14(1), 10–16. https://doi.org/10.9740/mhc.2024.02.010

Korczak, D. J., Westwell-Roper, C., & Sassi, R. (2023). Diagnosis and management of depression in adolescents. CMAJ, 195(21), 739–746. https://doi.org/10.1503/cmaj.220966

Pettitt, R. M., Brown, E. A., Delashmitt, J. C., & Pizzo, M. N. (2022). The management of anxiety and depression in pediatrics. Cureus, 14(10). https://doi.org/10.7759/cureus.30231

Tourette syndrome off label treatment

Off-label prescription is when doctors prescribe drugs approved by the FDA to treat some other diseases and treat another disease. This practice is more common when treating children and adolescents with neural health disorders because many drugs belonging to psychotropic have not received FDA approval for use in the pediatric population (Chen et al., 2021). In performing the role of a Psychiatric-Mental Health Nurse Practitioner (PMHNP), evidence-based treatment is essential to ensure proper drug’s effectiveness and safety. This discussion will focus on FDA approved and off-label medication in treating Tourette syndrome.

Case Study: Tourette syndrome

FDA-Approved Medication: Aripiprazole (Abilify)

Aripiprazole (Abilify) is an FDA-approved medication used to manage Tourette syndrome in children and adolescent up to the age of 18 years. Advantages of Aripiprazole include enhancement of focus neural functions and control of muscle excitation (Johnson et al., 2023). The clinical trials have depicted a substantial reduction in Tourette syndrome symptoms when utilized correctly. However, it has side effects like insomnia, blurring of vision and increased constipation.

Off-label medication: Clonidine (Catapres)

Clonidine (Catapres) is an alpha-2A adrenergic receptor agonist approved for hypertension treatment, though it is used in Tourette syndrome management. Catapres has an extended-release form making it better and easily tolerated for treating for Tourette syndrome despite being initially an off-label medicine. The advantages of Clonidine are increased attention, decreased impulsivity, and muscles hyperactivity (Ueda& Black, 2021). Possible side effects of Clonidine include drowsiness, fatigue, and low blood pressure. The risk assessment has to consider these possible unfavorable outcomes, especially among children with existing cardiac disorders.

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Non-pharmacological Intervention Behavioral Therapy

Behavioral therapy is one of the critical approaches in Tourette syndrome treatment in early childhood. It aims to alter behavior by implementing reinforcement techniques and training the parents. Behavioral treatment effectively affects a child’s Tourette syndrome management and enhances social interaction and academic accomplishment due to increased adaptation to social stigma (Van & Tripp, 2020). The first advantage is that behavioral therapy is free from pharmacological side effects. Nonetheless, the effectiveness of behavior therapy relies on commitment and implementation processes.

A risk assessment identifies the treatment plans possible based on the child’s background, symptoms, and the family’s wishes. Aripiprazole provides substantial improvement of symptoms but with adverse gastrointestinal effects. Secondly, clonidine is helpful in children’s medication, but it should be used under careful supervision because of its hypotensive action. Although it has been clear that behavioral therapy does not have significant side effects, most require the families’ commitment (Van & Tripp, 2020). Behavioral treatment is not very effective applied alone for moderate to severe forms of Tourette syndrome.

The American Academy of Pediatrics (AAP) guidelines encourage pharmacotherapy and behavior therapy for Tourette syndrome. These guidelines promote the pharmacological treatment and lift FDA-approved stimulants as first-line treatment while recommending Clonidine for children who cannot tolerate aripiprazole (Chen et al., 2021). Finally, cognitive-behavioral therapy is highly preferred, along with drugs.

Conclusion

Adherence to the principles and standards of evidence-based medicine entails the knowledge and use of various medications mentioned by the FDA, off-label drugs, and non-pharmacological therapies to treat Tourette syndrome in children and adolescents. For instance, both aripiprazole and clonidine are commonly used to help control the symptoms of Tourette syndrome, while there is also a role for behavioral therapy. The risk assessment always considers the benefits against the costs during the treatment process. However, medication guidelines must be upheld during all times of the medication process. Consequently, illustrating and analyzing these factors assist PMHNPs in reaching the best decision when attending to children with Tourette syndrome.

References

Chen, S., Barner, J. C., & Cho, E. (2021). Trends in off-label use of antipsychotic medications among Texas Medicaid children and adolescents from 2013 to 2016. Journal of Managed Care & Specialty Pharmacy, 27(8), 1035-1045.

Johnson, K. A., Worbe, Y., Foote, K. D., Butson, C. R., Gunduz, A., & Okun, M. S. (2023). Tourette syndrome: clinical features, pathophysiology, and treatment. The Lancet Neurology, 22(2), 147-158.

Ueda, K., & Black, K. J. (2021). Recent progress on Tourette syndrome. Faculty Reviews, 10.

Van der Oord, S., & Tripp, G. (2020). How to improve behavioral parent and teacher training for children with ADHD: Integrating empirical research on learning and motivation into treatment. Clinical child and family psychology review, 23(4), 577-604.

Childhood-Onset Schizophrenia Spectrum Disorders off label prescription

Childhood-Onset Schizophrenia Spectrum Disorders off label prescription

Childhood-Onset Schizophrenia Spectrum Disorders

Childhood-Onset Schizophrenia Spectrum Disorders (COS) is a rare and severe form of schizophrenia appearing before the age of 13, necessitating tailored treatment approaches (Driver et al., 2020). The purpose of this assignment is to recommend an FDA-approved medication, an off-label drug, and a nonpharmacological intervention to effectively manage COS in children and adolescents, ensuring a comprehensive treatment plan that addresses both symptoms and overall functioning.

FDA-Approved Medication

When treating Childhood-Onset Schizophrenia Spectrum Disorders in children and adolescents, an effective approach includes a combination of pharmacological and non- pharmacological interventions. Risperidone, an FDA-approved atypical antipsychotic, is commonly used due to its efficacy in reducing both positive and negative symptoms of schizophrenia (Corell et al., 2021). Additionally, aripiprazole, an atypical antipsychotic used off-label, provides an alternative treatment option with a different side effect profile. Complementing these medications, Cognitive Behavioural Therapy (CBT) is a valuable nonpharmacological intervention.

Risk Assessment

Risk assessment for treating Childhood-Onset Schizophrenia involves evaluating both the benefits and potential side effects of medications. For Risperidone, the FDA-approved drug, benefits include significant reduction in psychotic symptoms and improvement in daily functioning (Wu et al., 2022). Risks involve weight gain, sedation, increased appetite, and the possibility of extrapyramidal symptoms (EPS) and metabolic changes. Aripiprazole, the off-label drug, offers benefits such as symptom reduction and a lower risk of weight gain. However, it carries risks including nausea, vomiting, insomnia, and akathisia. Balancing these factors is crucial, considering individual patient profiles and monitoring closely for adverse effects.

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Clinical Practice Guidelines

Clinical practice guidelines for Childhood-Onset Schizophrenia Spectrum Disorders are limited but do exist, mainly derived from adult schizophrenia guidelines adapted for paediatric use. The American Academy of Child and Adolescent Psychiatry (AACAP) recommends atypical antipsychotics like risperidone as first-line treatment due to their efficacy and safety profile. Aripiprazole, while off-label, is supported by evidence for its effectiveness in children (Preda et al., 2020). Guidelines emphasize the importance of combining pharmacotherapy with nonpharmacological interventions, such as CBT, to address comprehensive treatment needs. When guidelines are absent, clinicians must consider evidence-based research, individual patient history, and close monitoring of treatment responses.

Conclusion.

When managing patients with childhood onset schizophrenia, it is important to combine both pharmacological and non-pharmacological interventions as these two have been shown to have better outcomes. Before settling on a pharmacological agent, the healthcare provider should do a thorough risk assessment to ensure that the patient is started on a regimen treatment with minimal side effects.

References

Correll, C. U., Kim, E., Sliwa, J. K., Hamm, W., Gopal, S., Mathews, M., Venkatasubramanian, R., & Saklad, S. R. (2021). Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview. CNS drugs, 35(1), 39–59. https://doi.org/10.1007/s40263-020-00779-5

Driver, D. I., Thomas, S., Gogtay, N., & Rapoport, J. L. (2020). Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders: An Update. Child and adolescent psychiatric clinics of North America, 29(1), 71–90. https://doi.org/10.1016/j.chc.2019.08.017

Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert opinion on drug safety, 19(12), 1529–1538. https://doi.org/10.1080/14740338.2020.1832990

Wu, H., Siafis, S., Hamza, T., Schneider-Thoma, J., Davis, J. M., Salanti, G., & Leucht, S. (2022). Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Schizophrenia bulletin, 48(3), 643–654. https://doi.org/10.1093/schbul/sbac001

 

Childhood-Onset Schizophrenia Spectrum Disorders off label prescription

PRESCRIBING FOR CHILDREN AND ADOLESCENTS

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

_Reference:

_{Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlLinks to an external site.}

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCE

TO PREPARE

• Your Instructor will assign a specific disorder for you to research for this Assignment.
• Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

THE ASSIGNMENT (1–2 PAGES)

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

BY DAY 7 OF WEEK 3

Submit your Assignment.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

1. To submit your completed assignment, save your Assignment as WK3Assgn1+last name+first initial.
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

NRNP-6665 Week 3: Assignment 1 – off label medications for bipolar disorder essay

NRNP-6665 Week 3: Assignment 1 – off label medications for bipolar disorder essay

Management of Bipolar Disorders in Children and Adolescents

Management of bipolar disorders in children is critical for ensuring that the underlying mood disorders are adequately and effectively addressed to enhance effective coping, maintain interpersonal relationships, work towards achieving the targeted academic growth, attain independence, and improve collaboration and coordination in the healthcare environment (American Psychiatric Association, 2013). Lithium is an FDA-approved agent for managing bipolar disorders in children. The drug is preferred because it is effective in stabilizing the mood by reducing the frequency and severity of manic episodes and depression. However, when using this agent, the child is at risk of developing problems such as impaired kidney and thyroid functions and resulting electrolyte disturbances such as sodium and lithium disturbances (Janiri et al., 2023). Therefore, monitoring the kidney, thyroid, and electrolyte functions is critical to achieving the targeted therapeutic functions.

On the other hand, Lamotrigine is commonly used as an off-label option for the management of bipolar disorders among children and adolescents. Research by Liu et al. (2022) indicates that lamotrigine is a non-FDA-approved agent for managing these disorders among children and adolescents. The drug is associated with the targeted therapeutic effects by enhancing the decreased frequency of depressive and manic episodes. Evaluation of the risks from lamotrigine should consider severe adverse and allergic effects such as Stevens-Johnson syndrome. Also, a higher risk for toxic epidermal necrolysis is seen in pediatric patients. Therefore, they need monitoring in the early phase of treatment to improve safety and for timely identification of the risks and problems involved. However, the patients also face some risks, and they include increased incidence of weight gain compared with other drugs. Hence, the nurse practitioner should compare the potential benefits against the possible risks to choose the right approach to include.

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Non-pharmacological Interventions

These conditions and mood stability may also be treated using non-pharmacological treatments such as psychotherapy. Such interventions may include psychoeducation or providing the child with more information about coping mechanisms and family-focused therapy to enhance the child’s ability to handle stressful mood dysfunctions (Gautam et al., 2019). The nurse practitioner has to ensure that the child’s caregivers, including the family members and teachers, acquaint themselves with the signals and preliminary actions to help the child learn coping strategies, which must be included in the care plan. Hence, there is a need to augment communication with the child and engage the family and the educational systems to support the implementation of care plans concerning the child. If so, the psychoeducation sessions may be designed at this frequency to facilitate the child’s developing better adaptation and coping with the issues and needs.

The Clinical Practice Guidelines

The Clinical Practice Guidelines (CPG), particularly for bipolar disorders and other mood conditions, are from the American Academy of Child and Adolescent Psychiatry, AACAP. The following guidelines require the PCP to undertake a Clinical assessment and evaluate the severity of the condition and the underlying needs to develop an individualized and effective management plan. The roles and responsibilities of the nurse practitioner include diagnosis and treatment through psychotherapy, administering medication, and psychotherapy because it is a prerequisite for the core and above-needed amount to be addressed (American Academy of Child and Adolescent Psychiatry, 2019). The nurse practitioner should also apply suitable personnel indicating relevant best practices and evaluate the origination of the child and family in a well-coordinated and timely management process.

The ethical and legal considerations of decision-making processes proposed by the nurse practitioner should consider the protection of pediatric patients, and their management for safety must be practical and sufficient. The nurse practitioner must involve the child’s family to ensure they obtain informed consent from the child. There is a need to take precautions by avoiding drug interaction with other diseases that may be affecting the child. Involving pediatric patients and thinking of how patients’ preferences can be incorporated into improving the quality of their care is also critical. This process needs proper and inevitably efficient cooperation with these stakeholders to promote the management of the root needs and create effective strategies and means for maximum results. Moreover, there should be good follow-up strategies to assess the effectiveness, tolerability, and adverse effects linked to the treatment plan provided.

References

American Academy of Child and Adolescent Psychiatry. (2019). Practice guidelines, updates and parameters. Aacap.org. https://www.aacap.org/AACAP/Resources_for_Primary_Care/Practice_Parameters_and_Resource_Centers/Practice_Parameters.aspx

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.

Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical practice guidelines for bipolar affective disorder (BPAD) in children and adolescents. Indian Journal of Psychiatry, 61(8), 294. https://doi.org/10.4103/psychiatry.indianjpsychiatry_570_18

Janiri, D., Moccia, L., Montanari, S., Zani, V., Prinari, C., Monti, L., Chieffo, D., Mazza, M., Simonetti, A., Kotzalidis, G. D., & Janiri, L. (2023). Use of Lithium in Pediatric Bipolar Disorders and Externalizing Childhood- related disorders: A Systematic Review of Randomized Controlled Trials. Current Neuropharmacology, 21(6), 1329–1342. https://doi.org/10.2174/1570159×21666230126153105

Liu, L., Meng, M., Zhu, X., & Zhu, G. (2022). Research Status in Clinical Practice Regarding Pediatric and Adolescent Bipolar Disorders. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.882616  NRNP-6665 Week 3: Assignment 1 – off label medications for bipolar disorder essay

Disruptive Mood Dysregulation Disorder Off-label Treatment Essay