You are a psychiatric/mental health nurse practitioner employed in an outpatient community counseling center. Shortly before you leave for the day, you receive a phone call from the father of a new 13-year-old client, that you began seeing who informs you that the client is experiencing violent behaviors.
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How would you address this psychiatric emergency?
In addressing this situation, I would gather relevant information to contextualize the case such as violence started, adherence to medication, social and interpersonal conflicts. I would also ensure that the patient and those around him/her are safe and guide the father on how to handle the situation.
Besides, I would make an inquiry of the patient’s substance use and psychiatric histories is important. Moreover, i would try and inquire whether the patient is at risk of harm self, other people, or property. I would then advice the father to keep items that can act as weapons from a psychiatric patient showing violence, the patient calmed, confrontations avoided. Also, the case reported immediately through 911. After ensuring that the father has successfully de-escalated his child’s violence through the provided strategies, I would make an emergency psychiatric care referral. I would connect the father with crisis response team for emergency psychiatric care and close observation.
2. What is the follow-up management and treatment for this adolescent?
The follow-up management and treatment for the thirteen-year-old adolescent showing violence will involve several things. First, making a comprehensive assessment of the case to understand the patient’s needs. Second, creating and implementing a tailored treatment plan. Thirdly, it will involve creating a plan for the safety of the psychiatric patient and his/her loved ones. Besides, screening for substance use and mental disorders like ADHD, mood disorders, and oppositional defiant disorder will be essential. Moreover, i would recommend psychotherapy for the patient to promote positive behaviors and cognition. Cognitive behavioral therapy (CBT) is an effective psychotherapy method for psychiatric patients showing violence.
3. What are the ways psychotherapy methods are different with children and adolescents as opposed to adults?
Psychotherapy approach in children and adolescents differ from that of adults. This is because in children, besides their mental needs, developmental deficits may be also target in psychotherapy. Also, children and adolescents may act as a response to their developmental age-related emotions, behaviors, hormonal changes, or cognition/thinking. Play therapy are appropriate for children due to the relevance of play in childhood and adolescence but not in adulthood. Furthermore, family involvement in psychotherapy is pivotal because of the clinically significant impact that family dynamics play in a child’s mental health.
4. What are the legal and ethical principles integrated into the care of this patient?
The ethical principles include informed consent and assent, confidentiality, beneficence, non-maleficence, mandatory reporting of the violent behaviors, and cultural competence and sensitivity.