Treatment of Psychiatric Emergencies in Children Versus Adults

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the Psychiatric and Mental Health Nurse Practitioner (PMHNP) must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Learning Objectives

Students will:

· Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients

· Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

· Review the Learning Resources concerning emergency psychiatric medicine.

· Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.)

ASSIGNMENT

· Briefly describe the case you selected.

· Explain how you would treat the client differently if he or she were a child or adolescent.

· Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)

· Chapter 31, “Child Psychiatry” (pp. 1226–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Bipolar and Related Disorders”

Note: You will access this book from the Walden Library databases.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Reversal of benzodiazepine effects

· flumazenil

Aggression	Behavioral problems	Cataplexy syndrome
clozapine propranolol zuclopenthixol	aripiprazole asenapine chlorpromazine haloperidol iloperidone lurasidone olanzapine paliperidone quetiapine risperidone ziprasidone	clomipramine imipramine sodium oxybate

Catatonia	Extrapyramidal side effects	Mania
alprazolam chlordiazepoxide clonazepam clorazepate diazepam estazolam flunitrazepam flurazepam loflazepate lorazepam midazolam oxazepam quazepam temazepam triazolam	benztropine diphenhydramine trihexyphenidyl	alprazolam (adjunct) aripiprazole asenapine carbamazepine chlorpromazine clonazepam (adjunct) iloperidone lamotrigine levetiracetam lithium lorazepam (adjunct) lurasidone olanzapine quetiapine risperidone sertindole valproate (divalproex) ziprasidone zotepine

Note:  Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

· Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)

· Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)