Emergency Psychiatric Care in Childhood and Adolescence

Question

Emergency Psychiatric Care in Childhood and Adolescence

"I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work."

Jessica, age 13

When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency.

This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients. You will also take your Midterm Exam. 

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Learning Resources

Required Readings

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

• “Bipolar and Related Disorders”

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)

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

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

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

Review the following medications:

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)

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Discussion: 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 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 an adult client had a psychiatric emergency. If you have not had a personal experience with an adult client who had a psychiatric emergency, you can conduct an internet or library search to identify one. 

Write a 2 page paper:

• 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.

• Include an introductory and conclusive paragraph