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Obsessive Compulsive Disorder Decision Tree Assignment

Obsessive Compulsive Disorder Decision Tree AssignmentObsessive Compulsive Disorder Decision Tree AssignmentBACKGROUNDTyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for. Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). Obsessive Compulsive Disorder Decision Tree AssignmentORDER A PLAGIARISM-FREE PAPER HEREShe reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street. His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.” Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.Obsessive Compulsive Disorder Decision Tree AssignmentOBJECTIVE During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders. When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.Obsessive Compulsive Disorder Decision Tree AssignmentMENTAL STATUS EXAMTyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation. Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal.Obsessive Compulsive Disorder Decision Tree AssignmentExamine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.At each Decision Point, stop to complete the following: Topic: Obsessive Compulsive DisorderIntroduction with purpose of the studyDecision One: Obsessive Compulsive disorder (OCD)Decision #1: Differential DiagnosisWhich Decision did you select? Obsessive Compulsive disorderWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?Obsessive Compulsive Disorder Decision Tree AssignmentIn your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.Decision Two: begin Fluvoxamine IR 25 mg orally at bedtimeDecision #2: Treatment Plan for PsychotherapyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?Obsessive Compulsive Disorder Decision Tree AssignmentRESULTS OF DECISION POINT TWOClient returns to clinic in four weeks Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall. She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.Obsessive Compulsive Disorder Decision Tree AssignmentDecision Three: Increase Fluxoxamine to 50 mg orally at bedtimeDecision #3: Treatment Plan for PsychopharmacologyWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Obsessive Compulsive Disorder Decision Tree AssignmentResults from decision 3In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime. At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects. Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen. Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.Obsessive Compulsive Disorder Decision Tree AssignmentAlso include how ethical considerations might impact your treatment plan and communication with clients and their families. ConclusionReferences Obsessive Compulsive DisorderIntroductionObsessive compulsive disorder (OCD) is a mental ailment characterized by anxiety. In this case, the patient presents with an obsession (as unwanted and recurring sensations, ideas and thoughts) that drive the patient to be compulsive (as repetitive actions). The condition is significant because it pointedly inhibits social interactions and daily activities. The implication is that an OCD diagnosis must identify the presence of time-consuming obsessions and compulsions that impairs social functions and cause distress (Pittenger, 2017). The present paper considers the different aspects of OCD, presents a differential aspect and discusses aspects of treatment that focuses on medication.Obsessive Compulsive Disorder Decision Tree AssignmentDecision One: Differential diagnosis: Obsessive Compulsive disorder (OCD)Which Decision did you select?A differential diagnosis has been made that the patient is suffering from OCD.Why did you select this Decision?The diagnosis is based on the symptoms presented by the patient as well as the definition for OCD presented in DSM-5. In fact, OCD is defined as a psychological condition characterized by compulsions and obsessions. The descriptions of obsessions and compulsions apply different criteria. The first criterion used in the definition of compulsion considers repeated actions by the patient that are intended to act as reassurance. Often the patient believes that failing to perform the action would result in an adverse effect. The second criterion accepts that action is repeatedly done, although it disconnects the repetitions from reassurances and the belief that an unfavorable result will ensue if the activity is not conducted (Davey, Dash &Meeten, 2014). Tyrell meets the two conditions for diagnosis as having compulsions. He has increasingly become nervous around his classmates and even avoids playing with his friends to keep his hands clean thereby fulfilling the requirements of the first criterion. He also repeatedly washes his hands believing that they are dirty even when he hasn’t used them, thereby meeting the requirements for the second criterion (Collier, 2014). As a result, Tyrell can be diagnosed as having compulsions.Obsessive Compulsive Disorder Decision Tree AssignmentApplying DSM-5 to define obsession shows that four criteria are applicable. Firstly, persistent images, ideas, actions, impulses and even thoughts that caused distress. Secondly, the problems are very intrusive and may not affect real life. Thirdly, suppressing the obsession with an activity. Finally, the person recognizes that the obsession is a consequence of their mind (Pittenger, 2017). Tyrell meets three of the four conditions. He repeatedly thinks of contracting diseases and germs from daily activities when using his hands thereby meeting the first two conditions. He suppresses his obsession when he avoids using his hands thereby meeting the third condition. He, however, does not meet the fourth condition since he does not express his awareness of the irrationality of his obsessive behavior. In this respect, Tyrell can be diagnosed as obsessive (Pittenger, 2017). In this respect, Tyrell can be correctly diagnosed as having OCD.Obsessive Compulsive Disorder Decision Tree AssignmentWhat were you hoping to achieve by making this Decision?The decision made is a prioritized diagnosis that forms the basis for the care plan. With the available information, general diagnostic theories have been applied (focusing on eliminating and accepting possible conditions based on the available symptoms and signs) to give rise to probable hypothetical diagnoses. That is considering that the decision is a diagnostic optimality that is based on the post-diagnostic objectives. It is notable that the decision made advocates for additional utilities and requires additional explanation since the solution’s granularity will depend on usage. In this case, the statement made for the differential diagnosis that the patient is suffering from OCD is an actuality about the patient that is based on an existing list of problems. Based on the decision (diagnosis), the medical care team can set achievable and measurable objectives for the patient’s care.Obsessive Compulsive Disorder Decision Tree Assignment.  It is important to note that the decision is prioritized according to the level of importance with the OCD diagnosis considered to have the highest priority. In essence, the decision can be considered as a diagnostic domain that is concerned with the WHAT aspect of the patient’s symptoms and signs. It assumes that the patient’s health is faulty thereby seeking a source of the fault and presenting a plan that is concerned with constructing action plans to achieve the desired objective of good health. Additionally, the decision has been made in consideration of the ensuing therapeutics, going on to formalize diagnostic approaches by applying probabilistic discriminators and classifiers that model causal and coincidental relations. It is evident that the decision is an expected or potential discriminatory result of the collected information thus showing that the decision is in actuality a reasoned that serves as the natural interface for the accompanying treatment as a planner (Pittenger, 2017; Veale, 2018). In this respect, the diagnostic decision has been made as a dependent task that serves the purpose of repairing an existing condition since it presents the possibility that Tyrell’s condition can be corrected.Obsessive Compulsive Disorder Decision Tree AssignmentExplain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?Based on the first decision that presented a differential diagnosis of OCD, it would have been expected that all the symptoms would have matched those presented in DSM-5. In particular, DSM-5 presents four criteria for the diagnosis of obsession. Tyrell meets three conditions and does not meet one condition. In fact, he does not recognize that obsession is a consequence of his mind. Tyrell does not express his awareness of the irrationality of his obsessive behavior. Although he does not meet all the four criteria, he meets three of them and only misses one thereby allowing for the diagnosis to hold that he is obsessive. This could be an indication that his OCD is at the early stages and has not advanced. This means that if the OCD proceeds unabated, then it would be expected that Tyrell would meet the fourth condition for obsession criteria in the OCD diagnosis (Pittenger, 2017).Obsessive Compulsive Disorder Decision Tree AssignmentDecision Two: Treatment plan for psychotherapy: begin Fluvoxamine IR 25 mg orally at bedtimeWhy did you select this Decision?The decision to prescribe Fluvoxamine for treating Tyrell’s OCD has been informed by the fact that the medication has high efficacy for treatment of OCD and is considered as a first-line treatment option. This is based on the medication’s pharmacodynamics properties that allow it to modulate sigma, dopaminergic and serotonergic transporters and receptors that allow it to present a complex pattern of activity to manage OCD. Firstly, the medication’s main mechanism of therapeutic action is that it inhibits serotonin reuptake in the brain. The enhanced serotonin amounts are presented in the orbitofrontal cortex of the brain where they activate normosensitive postsynaptic 5-HT-like receptors and desensitize terminal 5-HT receptors in a biological cascade that is beneficial against OCD.Obsessive Compulsive Disorder Decision Tree Assignment.  Secondly, the medication’s modulation of dopaminergic receptions (increasing availability of dopaminergic type 2 receptors in the ventral and dorsal striatum) also presents antiobsessional effects for OCD patients. In essence, the medication reduces concentrations of dopamine so that it modifies the dopaminergic system to reduce striatal dopamine receptors to facilitate the treatment of OCD patients. Finally, it modulates sigma receptors that are in turn responsible for regulating ion channels and releasing neurotransmitters that include acetyl-coline, norepinephrine, serotonin, dopamine and glutamate. This allows the medication to exhibit strong affinity and high level of occupancy of sigma receptors in a dose-dependent mode that facilitates a sense of task completion to break the compulsive behavior and counter the OCD (Pittenger, 2017; Veale, 2018). In this respect, Fluvoxamine was selected because it facilitates a comprehensive treatment of OCD by modulating sigma, dopaminergic and serotonergic transporters and receptors.Obsessive Compulsive Disorder Decision Tree AssignmentBesides that, oral administration of Fluvoxamine is absorbed in the gastrointestinal tract without being affected by the stomach contents such as food. Additionally, the oral administration is accompanied by maximum plasma concentration and bioavailability. In fact, the medication presents low dosage presenting disproportionately lower plasma concentrations with high dosage presenting disproportionately higher plasma concentrations (nonlinear steady-state pharmacokinetics). Also, the medication also shows extensive tissue distribution since its plasma protein binding is circa 80%. In addition, the medication undergoes extensive oxidative metabolism thereby making it safer. The metabolism begins in the liver where it is turned into biotransformation products that are recovered in urine. In fact, it is excreted as metabolites with more than 96% of the active parent compound remaining in the body. Its mean half-life is approximately sixteen hours (Veale, 2018). As such, the medication was selected because it is safe for the body as exhibited by its metabolism.Obsessive Compulsive Disorder Decision Tree AssignmentWhat were you hoping to achieve by making this Decision?The decision hopes to achieve a comprehensive treatment of the OCD by addressing the three principal causes. Unlike other medications that might address only one or two causes of OCD, Fluvoxamine addresses the three main causes as presented in the brain to include modulating sigma, dopaminergic and serotonergic transporters and receptors. Besides that, the medication’s metabolism shows that it is safe. In essence, it facilitates rapid titration regiment that hastens the OCD treatment response (Pittenger, 2017; Veale, 2018). In this respect, the decision was made because Fluvoxamine offers comprehensive treatment for OCD and its metabolism is safe for the body.Obsessive Compulsive Disorder Decision Tree AssignmentExplain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?The expectation from decision two was to alleviate the patient’s OCD using the medication. The results show that the patient’s OCD was partially alleviated with shorter remission time. This means that there is a need for a larger dose to be prescribed and administered to improve the outcome. In essence, an increase in the dose is anticipated to cause the still remaining symptoms to regress. This is based on the understanding that increasing the dosage will not only offer more medication, but it will also present the more important ingredient for fighting the OCD battle. Besides that, serious side effects were expected but did not occur thus allowing the patient to use an even higher medication.Obsessive Compulsive Disorder Decision Tree AssignmentRESULTS OF DECISION POINT TWOClient returns to clinic in four weeks upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the hand washing has decreased, and Tyrel seems a bit more “relaxed” overall. She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.Decision Three: Treatment Plan for Psychopharmacology: Increase Fluvoxamine to 50 mg orally at bedtimeWhy did you select this Decision?Obsessive Compulsive Disorder Decision Tree AssignmentAs the situation stands in which some of Tyrell’s symptoms still persist without abating, three options were available to present satisfactory improvements. The first option was to increase the dosage of the current medication in use. The second option was to continue using the same dosage of Fluvoxamine and adding a second medication as either augmented therapy (another type of medication) or combination therapy (another type of anti-OCD medication). The third option is to switch medications by gradually stopping the use of Fluvoxamine and replacing it with a second anti-OCD medication. The decision to go with the first option and increase dosage was informed by a range of factors. The first factor is tolerability where the presence of side effects were evaluated, their severity and how much they affect the patient. In Tyrell’s case, Fluvoxamine has not presented any severe side effects. The second factor is time whereby Tyrell has been using Fluvoxamine for four weeks and it has produced some favorable results so that it can be considered at least partially effective. The final factor is the amount of improvement exhibited whereby it is noted that Tyrell’s OCD symptoms have improved in proportion to the length of time he has been on medication (Goodman, Rudorfer& Maser, 2017). Besides that, the initial prescriptions started at the lowest dose of medication that would not work that well to monitor the present of side effects before increasing the dosage to one that would work better(Veale, 2018). In essence, the amount of improvement that Tyrell has made with the previous dosage is not satisfying. In this case, he is doing well with the current dosage but there is room for improvement to imply that he can do even better increasing the dosage to facilitate faster and better improvement is a good decision since he has not exhibited any side effected.Obsessive Compulsive Disorder Decision Tree AssignmentWhat were you hoping to achieve by making this Decision?Increasing the dosage is anticipated to clear the OCD symptoms faster. The initial dose acted as a test to evaluate whether the medication works in clearing the symptoms and if it had any notable side effects. Since it has been established that the medication works in clearing symptoms and does not produce any notable side effects, then it is prudent to increase the dosage to allow the symptoms to be cleared at a faster rate.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Increasing the dosage expected to achieve better treatment results without attracting any notable side effects. But that was not the case. In fact, better treatment results were noted although the medication side effects become more significant. It is postulated that increasing the dosage increased the amount of active drug compounds available in the body resulting in a larger reaction presented as the more significant side effects.Obsessive Compulsive Disorder Decision Tree AssignmentResults from decision 3In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime. At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects. Atypical antipsychotics are typically not used in the treatment of OCD. Obsessive Compulsive Disorder Decision Tree Assignment.There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen. Cognitive behavioral therapy (CBT) is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has a social anxiety disorder, CBT is effective in treating this condition as well.How ethical considerations might impact your treatment plan and communication with clients and their families.Obsessive Compulsive Disorder Decision Tree AssignmentThere is a conflict between doing what is good for the patient (maximally helping the patient) and telling the whole truth about the existing condition (respecting optimal autonomy). The ethical question was whether it was necessary to withhold information from Tyrell concerning his emotional needs and psychodynamics. The decision was made to initially withhold some information because disclosing this information would likely alienate Tyrell from the treatment plan. Ethically, the extent to which information can be withheld does disrespect Tyrell’s autonomy as an individual and could even be considered as lying by omission. However, this was the right decision warranted by the situation since it benefits the patient by allowing him to view the PMHNP as an ally (cementing the alliance) rather than demoralizing the patient if all the information is disclosed at once (Collier, 2014). In essence, withholding some information (presenting partial truth) reduced the risk of avoidable harm.Obsessive Compulsive Disorder Decision Tree AssignmentConclusionOne must accept that OCD is a distressing condition that interferes social activities. In the present case, Tyrell is presented as an OCD patient who has difficulty in interacting socially. His symptoms clearly show that he is suffering from the condition. As such, a treatment plan is presented for oral Fluvoxamine. The initial treatment presents positive results without any undesirable side effects thereby showing that the medication is effective. In essence, Tyrell shows good tolerability with acceptable improvement after using the medication for four weeks. Following this awareness, the dosage is increased to guarantee greater symptoms alleviation since the initial dose was a test that evaluated whether the medication works in clearing the symptoms and if it had any notable side effects. Still, it is considered that CBT could guarantee better OCD treatment outcomes if used in combination with the medication. Another notable aspect is that existence of an ethical dilemma that impacted the treatment plan and communication, particularly in withholding some information and only presenting partial truth to reduce the risk of avoidable harm on the patient.Obsessive Compulsive Disorder Decision Tree Assignment  ReferencesCollier, R. (2014). Obsessive-compulsive disorder: a guide for family, friends, and pastors. New York, NY: Routledge.Davey, G., Dash, S. &Meeten, F. (2014). Obsessive compulsive disorder. New York, NY: Palgrave Macmillan.Goodman, W., Rudorfer, M. & Maser, J. (2017). Obsessive-compulsive disorder: contemporary issues in treatment. New York, NY: Taylor & Francis.Pittenger, C. (2017). Obsessive-compulsive disorder: phenomenology, pathophysiology, and treatment. New York, NY: Oxford University Press.Veale, D. (2018). Overcoming obsessive compulsive disorder: a self-help guide using cognitive behavioral techniques. London: Little, Brown Book Group.Obsessive Compulsive Disorder Decision Tree AssignmentAssessing, Diagnosis, and Treating Children with Attention Deficit Hyperactivity Disorder            Attention deficit hyperactivity disorder (ADHD) is a disorder that is prevalent in children as well as in adults. Thissen, Rommelse, Hoekstra, Hartman, Heslenfeld, Luman, &Buitelaar (2014) noted that ADHD is a heritable neuro-developmental disorder in 70-75% of the offspring’s diagnosed with this disorder. This childhood disorder is diagnosed when symptoms have been persistent for at least six months and directly interferes with social and academic activities.  Inattentiveness pertains to the child failing to pay close attention to details at school and in the home setting, has difficulties staying focused during conversations, reading, or lectures, show difficulty managing the task, and dislike to engage in activities that require sustained mental efforts, etc. On the other hand, American Psychiatric Association (2013)Obsessive Compulsive Disorder Decision Tree Assignment, diagnosis and statistical manual of mental disorders (DSM-5) noted that hyperactivity and impulsivity symptoms in addition to inattentiveness must be present for at least six months to the extent that is incoherent to the developmental level. Interrupting, fidgeting, excessive talking, and unable to sit still in certain situations are some symptoms to look out for when ADHD diagnosis in children/adolescents is indicated. The purpose of this assignment is to evaluate a young girl with difficulties in school, analyze the decisions made with rationales, and decide on an appropriate treatment option specifically for the presenting disorder.Obsessive Compulsive Disorder Decision Tree AssignmentMany children with ADHD usually grow into adults with ADHD, but early diagnosis and the initiation of the appropriate treatment option yields a good prognosis. Various treatment options currently applied include: medications (stimulants and non-stimulants), diet modification (balanced diet), cognitive behavior therapy, behavior therapy, and sometimes adequate sleep can help reduce the symptoms (Tye, Asherson,Ashwood, Azadi, Bolton,McLoughlin, 2014). Depending on the client/parent preferences, two or more treatment options might be indicatedDecision #1: Differential Diagnosis: ADHD, anxiety disorder, conduct disorder, oppositional defiant disorder, Autism spectrum disorderAttention Deficit Hyperactivity Disorder, predominantly inattention presentation is the decision selected for the child (Katie). Based on the report from clients’ teacher on the Conners’ teacher rating scale, an appropriate tool that centers on assessing children’s’ behaviors in the academic and social setting. The client has been reported to be easily distracted, inattentive, makes mistakes on homework, forgets things already learned, poor in spelling, reading, arithmetic with a short attention span as reported by Laureate Education (Producer)(2017b) are classic symptoms of ADHD. The report also shows that the client (Katie) exhibit some difficulties interacting with peers in the classroom and during recess. Stein (2011) conducted a study on the relationship between Apgar’s score and ADHD. The study shows that children with low birth weight, low Apgar’s score of 1-6, prematurity, are a higher risk of 63-75% of developing ADHD.Obsessive Compulsive Disorder Decision Tree AssignmentEven though ADHD may present some overlapping symptoms with conduct disorder, oppositional defiant disorder, autism spectrum disorder, and anxiety disorder, the clinical symptoms presented in this case study matches more with ADHD than other options. The other two options Autism spectrum disorder (ASD), mild and co-occurring social anxiety disorder were not selected as they do not meet the criteria presented in DSM-5.Also, the fact that Katie is poor in reading, spelling, and arithmetic does not qualify her for a specific learning disorder with impairment in reading and mathematics.Obsessive Compulsive Disorder Decision Tree AssignmentThe PMHNP hoped that Katie symptoms of ADHD predominantly inattention in school and at home will improve once she is assessed and the treatment option specific to her presenting symptoms is initiated. Sadock, Sadock, & Ruiz, (2014) noted that the diagnosis of ADHD requires the child to exhibit persistent symptoms of either hyperactivity/impulsivity or inattention in at least two different settings predominantly at home or in school. A comprehensive evaluation of Katie is needed to obtain a full description of the presenting symptoms in addition to the child’s previous psychiatric and medical illnesses. Informed consent for treatment must first be obtained from the parents before any psychiatric evaluation is initiated. Since the diagnosis is based on clinical observation and reports from teachers/parents, the Connors Abbreviated Parent-Teacher Rating Scale-Revised is a ten point semi-structured clinical teacher interview diagnostic assessment tool used to assess children for hyperactivity and inattention. A meta-analysis conducted by Chang research group (2016) indicated that the Conners Abbreviated Symptom Questionnaire has a high diagnostic accuracy and brevity in diagnosing ADHD.Obsessive Compulsive Disorder Decision Tree AssignmentBoth the expected and actual results from decision point one coincided with the diagnosis of ADHD during a four-week follow-up office visit. Katie’s predominant symptom of inattentiveness is more common in girls. Also, the client shows inattention to details and makes careless mistakes, is easily distracted, forgets to recall previously learned, and shows interest in things she likes. She has been reported to constantly interrupts during the interview session with the parents and unable to sit still. Developmental assessment is necessary to rule out other sources of inattention such as anxiety, mood disorders, poor self-esteem, social relationships with siblings, or learning disabilities as noted by Sadock, Sadock, & Ruiz (2014)Obsessive Compulsive Disorder Decision Tree AssignmentDecision Two: Begin Adderall 10 mg extended release orally dailyAdderall is a stimulant and a dopamine, norepinephrine reuptake inhibitor and releaser (DN-RIRe) which is the first-line of treatment that has been shown to be effective in the treatment of ADHD in children (Stahl, 2014b). Adderall has been approved by the Food and Drug Administration (FDA) for the treatment of ADHD in children 3-12-years-old. When Adderall treatment is initiated, enhancement of dopamine and norepinephrine in the prefrontal cortex helps to improve inattention, concentration and executive function. Also, stimulants are noted to have mildly tolerable and rebound side effects.Obsessive Compulsive Disorder Decision Tree AssignmentThe goal of ADHD treatment of choice is to reduce the initial symptoms of inattention which has caused impairment in school and social functioning. The PMHNP hoped that by starting Katie on Adderall 10 mg extended release orally daily, symptoms of inattention will reduce by 50% and Katie will return to her normal level of functioning with improved grades at school. Close monitoring is required as an increase in norepinephrine and dopamine centrally causes central nervous system side effects such as cardiac arrhythmias, tachycardia, insomnia, hypertension, and tremor once Adderall treatment is initiated (Stahl, 2014b).Obsessive Compulsive Disorder Decision Tree AssignmentThe results from decision two after the initiation of Adderall 10 mg XR pharmacotherapy shows that there was some improvements in Katie’s inattentiveness as verbalize by the parents. This implies that the Psychiatric mental health nurse practitioner (PMHNP) made the right decision in selecting ADHD as the diagnosis and Adderall as the first-line of choice for the treatment of her symptoms. Other valid concerns verbalized by parents and the teachers’ report shows that inattention in school during morning sessions has improved but Katie still “daydream” during the early afternoon hours. Thus Adderall 10 mg XR duration of clinical action is approximately eight hours and it probably wears out of her system in the early afternoon. It is importation to provide psycho-education tips to Katie’s parents about dosing Adderall XR, which is controlled-released which should be taken in the morning with food, swallowed rather than chewed. French (2015) conducted a study to assess and evaluate the treatment of clients with ADHD diagnosis shows that 65%-75% of the participants had favorable clinical response with amphetamines.  Decrease in appetite issues can be addressed with some appetite booster. Reported side effects of Adderall are: anorexia, dry mouth, constipation, diarrhea, and weight loss (Stahl, 2014b).Obsessive Compulsive Disorder Decision Tree AssignmentWellbutrin 75 mg daily as well as Strattera 25 mg was not the appropriate choices to select for Katie’s presenting symptoms. The Food and Drug Administration has approved Wellbutrin (bupropion), dopamine reuptake and release inhibitor for the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation (Stahl, 2014b). On the other hand, Strattera 25 mg daily would have equally been an appropriate choice, but the associated side effects of sedation and decreased appetite will pose a problem with compliance.Obsessive Compulsive Disorder Decision Tree AssignmentDecision Three: Add a small dose of immediate release Adderall in early afternoonA small dose of immediate release Adderall 2.5-5 mg given in the early afternoon will help Katie with daydreaming issues encountered in school. Immediate release (IR) formulations have 3-6 hour duration of clinical action. Thissen et al., (2014) in their research noted that Adderall 5 mg/day as an immediate release formulation, can be safely administered to children 6-12 years who require an extra dosage in the early afternoon to avoid the risk of insomnia.Obsessive Compulsive Disorder Decision Tree AssignmentIt is assumed that an extra dose of immediate release given in the early afternoon is a clinically sound decision to be made by the PMHNP. Legitimate concerns by Katie’s parents and the teachers’ report of “daydreaming” enabling her to focus on her homework and improve her quality of life. Although a decrease in appetite has been noted upon the initiation of pharmacotherapy with Adderall, this side effect is often transient and less troublesome than adverse effects associated with amphetamine salts are not life-threatening. The loss in appetite may affect the growth of the child, but Katie may be given drug holidays when school is out to allow her catch-up with any growth suppression, and pharmacotherapy reinstituted when school resumes (Stahl, 2014b)Obsessive Compulsive Disorder Decision Tree AssignmentWhile making decision #3, the PMHNP expected that the extra dose of Adderall would address the lack of focus to complete homework within a designated timeframe. Once this goal is accomplished, Katie together with her parents will be satisfied with the treatment plan and her grades and focus in school will improve as a result of this implementation.Ethical Considerations that might Impact the Treatment plan and Communication with Clients/Families with ADHD.            Diagnosing and treating clients especially children with ADHD symptoms can be challenging and pose lots of ethical issues about when to initiate psychotherapeutic treatment. The clinician sometimes might either misdiagnose, underdiagnosed, or over-diagnosed the clients (Thissen et al., 2014). It is necessary for the PMHNP to conduct a comprehensive evaluation taking into consideration other contributing factors by asking the appropriate questions. Even though most studies have indicated that medications (stimulants, non-stimulants) are effective in treating ADHD symptoms, treatment still depends on how each metabolizes the drug.Obsessive Compulsive Disorder Decision Tree Assignment ConclusionChildren/adolescent diagnosed with ADHD are at a higher risk of developing other psychiatric mental illnesses if a comprehensive, individualized treatment plan is not initiated in time. The treatment duration and the complexity depend on whether short-acting or long-acting stimulants/non-stimulants will be the best practice.Obsessive Compulsive Disorder Decision Tree Assignment  ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders   (5th ed.). Washington, DC: AuthorChang,L.,  Wang, M.,  Tsai, P. (2016). Diagnostic Accuracy of Rating Scales for Attention-            Deficit/Hyperactivity Disorder: A Meta-analysis. Retrieved from            http://pediatrics.aappublications.org/content/137/3/e20152749French, W. P. (2015). Assessment and treatment of attention-Deficit/Hyperactivity disorder: Part 2. Pediatric Annals, 44(4), 160-168.          http://dx.doi.org.ezp.waldenulibrary.org/10.3928/00904481-20150410-11 Retrieved from    http://ezp.waldenulibrary.org/login?url=https://search-proquest            com.ezp.waldenulibrary.org/docview/1676679361?accountid=14872Obsessive Compulsive Disorder Decision Tree AssignmentLaureate Education (Producer)(2017). A young girl with difficulties in school. [Multimedia file],  Baltimore, MD, AuthorSadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan &Sadock’s synopsis of psychiatry:          Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.Stein, M. T. (2011). Low apgar scores linked with ADHD. Journal Watch.Pediatrics&      Adolescent            Medicine, http://dx.doi.org.ezp.waldenulibrary.org/10.1056/PA201105250000002 Retrieved from http://ezp.waldenulibrary.org/login?url=https://search-proquest            com.ezp.waldenulibrary.org/docview/1284132184?accountid=14872Stahl, S.M. (2014b). The Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5thed.).         New York, NY. Cambridge University PressThissen, A. J. A. M., Rommelse, N. N. J., Hoekstra, P. J., Hartman, C., Heslenfeld, D., Luman,    M., Buitelaar, J. K. (2014). Attention deficit hyperactivity disorder (ADHD) and          executive functioning in affected and unaffected adolescents and their parents: Challenging the endophenotype construct.Psychological Medicine, 44(4), 881-92.            http://dx.doi.org.ezp.waldenulibrary.org/10.1017/S0033291713001153 Retrieved from            http://ezp.waldenulibrary.org/login?url=https://search-proquest            com.ezp.waldenulibrary.org/docview/1507760292?accountid=14872Tye, C., Asherson, P., Ashwood, K. L., Azadi, B., Bolton, P., &McLoughlin, G. (2014). Attention and         inhibition in children with ASD, ADHD and co-morbid ASD + ADHD: An event-related   potential study. Psychological Medicine, 44(5), 1101-16.           http://dx.doi.org.ezp.waldenulibrary.org/10.1017/S0033291713001049 Retrieved from            http://ezp.waldenulibrary.org/login?url=https://search-proquest            com.ezp.waldenulibrary.org/docview/1506758799?accountid=14872 Obsessive Compulsive Disorder Decision Tree Assignment

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