Mental health treatment #1d.ppt [read-only]

• Need to have designated staff for duties – mental health ‘Champion’, clinical and • There are certain steps to consider… – Handling the screens (copying, handing out)– Scoring the screens– Communicating to the physician– Orchestrating disposition, talking to family– Following up on compliance– Proper reimbursement • Discussion of treatment options• Evaluate for potential referral Sometimes children, when they are alone, hear voices or see things, or smell things and they don't quite know where they come from.
Hallucinations:
– Mild: Definitely present but subject is generally aware it is his
imagination and usually able to ignore it. Occurs no more than – Moderate: Generally believes in the reality of the hallucinations,
but it has little influence on his behavior. (Or) Occurs at least – Severe: Convinced his hallucination is real and significantly
effects his actions. i.e.: locks door to keep pursuers away. (or) – Extreme: Actions based on hallucinations have major impact on
him or others: Unable to do school work because of constant "conversations." (or) Occurs most of the time.
Do you have any ideas about things that you don't tell anyone because they might not understand? What are they? Do you have any secret Delusions
– Mild: Delusion definitely present but at times subject
– Moderate: Generally has conviction in his false belief.
– Severe: Delusion has a significant effect on his
actions, e.g., often asks family to forgive his sins, preoccupied with belief that he is a new Messiah.
– Extreme: Actions based on delusions have major
impact on him or others, e.g., stops eating because Sometimes children who get upset or feel bad think about dying or even killing themselves. Have you ever had such thoughts? Suicidal Ideation
– Slight: Thoughts of his death (without suicidal thoughts), " I
would be better off dead" or "I wish I were dead" or only in the – Mild: Occasional thoughts of suicide but has not thought of a
– Moderate: Often thinks of suicide and has thought of a specific
– Severe: Often thinks of suicide and has thought of, or mentally
rehearsed a specific plan, or has made a suicidal gesture of a communicative rather than a potentially medically harmful type, or has heard a voice telling him to kill himself – Extreme: Has made preparations for a potentially serious
• A predisposition toward rapid, unplanned reactions to internal or external stimuliwithout regard to the negativeconsequences of these reactions tothemselves or others activities without recognizing the highpotential for painful consequences.
• Are you ever curious as to how you make your decisions? Do you want tounderstand it better? • Therapy can help you learn ways, non- medication ways, to better handle theseoverwhelming emotions.
– Gets me into too many power struggles – I just present potential benefits/side effects– Oh, and the risks of no treatmentThings I say everyday I think it would help, what do you think?You have my permission to stop this medication atanytime. Just give me a call to let me know.
• All meds can make things worse• Small initial doses and small increases• As long as there are no side effects, keep – As long as there are identified benefits – Subjective comfort level– Answering all the needs of the child/family– Comorbidity Issues– Treatment response – Time constraints– Reimbursement– Consultation availability • Severity of symptoms• Comorbidities• Refer if you’re thinking… – ‘I need to see this kid back in less than a – ‘This parent needs support’ or ‘This family is a – ‘Just medication is not gonna do it here’– ‘Wow’ ADHD (without comorbidity), depression without SI ADHD + depression, unresponsive depression (-SI), Oppositional Defiant D/o, Conduct D/o, Substance Abuse, SI or Self-Injurious Behavior, Bipolar, PTSD,Social Phobia, Autism Spectrum, Eating Disorders,Psychosis, Obsessive-Compulsive D/o, abuse/neglect This is endorsed by no one, nor is it evidence-based • Know the insurance carrier and #, and whether a (even laws are not powerful enough to get rid of this)Deductible, co-pays, and coverage limits • When calling, chief complaint and time request• Have the family call office to confirm appt• Have the family call you to confirm they went to • www.alapsych.org• Find a psychologist search engine – Location (city or zip code)– Ages served– Specialized services provided– Theoretical orientation– Languages spoken We need to talk about meds
Years of age
( ) demarks range for 90% of kids approximately – Ritalin 10 bid– Metadate CD, Ritalin LA = 20 mgs– Concerta = 36 mgs– Focalin XR = 10 mgs– Adderall XR = 15 mgs– Vyvanse = ??? (maybe 30 mgs) – Shoot for 1.5 mg/kg, but I go up to 2-3 mgs/kgs – Extrapyramidal symptoms– Tardive dyskinesia– Metabolic syndromethen don’t prescribe it (general rule) effective for mood symptoms, bipolar andtreatment resistant depression

Source: http://www.sublimedesignportfolio.com/resources/AAP/PDF/meeting/meeting_MentalHealthTreatment1.pdf