Psychiatric Emergencies In Children And Adults Discussion Paper

Psychiatric Emergencies In Children And Adults Discussion Paper

Week 6 Main Post

Treatment of Psychiatric Emergencies in Children Versus Adults

It is important to remember that, unlike with adults, most psychiatric interventions for children and adolescents are not initiated by the patients themselves, but by their parents, family members, teachers, mental health clinicians, primary care physicians, or child protective services (Sadock, Sadock, & Ruiz, 2014). Another difference in the emergency care of children versus adults is that the emergency setting is usually the setting for the initial evaluation of a chronic problematic behavior for pediatric patients (Sadock, Sadock, & Ruiz, 2014). Studies show that 5% of pediatric emergency department (ED) visits are for mental health complaints (Sheridan et al. 2016). Psychiatric Emergencies In Children And Adults Discussion Paper

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Clinical Case

            The patient I encountered in the crisis/ED setting was a 9-year-old Caucasian male (“Ben”) who was brought in by his mother and the local police department after receiving a complaint of violent behavior. Ben had been upset with his mother over being denied use of electronics and had retaliated by throwing her kitten against the wall, ultimately killing the animal. I cared for Ben during a previous ED visit where he was hospitalized after hiding a lighter under his pillow and threatening to set his house on fire after his family went to sleep. Psychiatric Emergencies In Children And Adults Discussion Paper. Ben’s clinical presentation and history is consistent with a diagnosis of conduct disorder, childhood-onset type (F91.1) as he has been physically cruel to people and animals, engaged in fire setting, and often lies to get what he wants (APA, 2013). Ben’s mother was frightened by his behavior and felt that she could no longer safely care for her son at home. A report was filed with the Department for Children and Families (DCF) and Ben was ultimately admitted to a pediatric inpatient psychiatric facility. One of the medications Ben was prescribed was guanfacine 1 mg QHS, an alpha 2A agonist often used for ADHD and conduct disorder (Stahl, 2014). Psychiatric Emergencies In Children And Adults Discussion Paper

Ethical/Legal Concerns

It is important to consider the cost versus benefit of inpatient treatment for pediatric patients. Due to the lack of inpatient pediatric beds, many patients are boarded in the ED for extended periods of time (Gardner, Ruest, & Cummings, 2016). “A single-center study demonstrated a significant increase in volume, length of stay (LOS), and financial cost for children and adolescents in the pediatric ED (PED) with mental health disease over a recent 5-year period” (Sheridan et al. 2016, p. 121). Medical units, including EDs, are often not equipped to provide counseling services, medication management, or behavior care plans for psychiatric boarders (Gardner, Ruest, & Cummings, 2016). While the goal of ED care of most psychiatric emergencies is to maintain safety, nonmaleficence becomes a concern when care is not provided to a pediatric boarder. In the case of Ben, he requires specialized psychiatric treatment and oversight. It would not be wise for an ED physician to make medication changes when they do not have extensive specialized training. Psychiatric Emergencies In Children And Adults Discussion Paper

References

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

Gardner, K., Ruest, S., & Cummings, B. (2016). Diagnostic Uncertainty and Ethical Dilemmas in Medically Complex Pediatric Patients and Psychiatric Boarders. Hospital Pediatrics, 6(11), 689–692. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=27803074&site=eds-live&scope=site

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. Psychiatric Emergencies In Children And Adults Discussion Paper

Sheridan, D. C., Sheridan, J., Johnson, K. P., Laurie, A., Knapper, A., Fu, R., … Hansen, M. L. (2016). The Effect of a Dedicated Psychiatric Team to Pediatric Emergency Mental Health Care. The Journal Of Emergency Medicine50(3), e121–e128. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jemermed.2015.10.034

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Psychiatric Emergencies In Children And Adults Discussion Paper