User Interface Design: Unit 2 Individual Project

User Interface Design: Unit 2 Individual Project

Table of Contents

Project Outline. 2

Project Site Description. 2

Project Purpose and Discussion Topics. 2

User Interface Technical Requirements. 3

Kiosk Requirements. 3

Smart Devise Requirements. 4

User Interface Human Interaction Requirements. 5

Kiosk Interaction Requirements. 6

Smart device Interaction Requirements. 6

User Interface Design Prototypes. 7

Kiosk Application. 7

Mobile Application. 9

Usability Test Questionnaire. 11

Usability Instruction Guide. 12

Usability Test Results. 13

 

Project Outline

Project Site Description

The project focuses on tourist attractions and things to do in Sedona, Arizona. Sedona is among the most beautiful tourist destinations in Arizona, with multiple activities to engage in and tourist attraction sites. The sceneries are stunning, and the views are outstanding across the whole region when walking, driving, or hiking. Sedona is often referred to as a spiritual center because of its energy vortexes. Tourists with different interests can have fun in the city because of its unique vibe. Multiple attractions are present, ranging from scenic natural areas and Native American ruins to galleries, sacred cities, and architecture. Tourists can engage in many activities in Sedona, including mountain biking, hiking, and stargazing, which are free.

For those who want to stay longer, which is worthwhile, there is adequate accommodation, with price ranges suitable for all classes of people. For those staying longer than a day, a trip to the Grand Canyon or Flagstaff is recommended. The most popular tourist attractions include cathedral rock, uptown Sedona, Red Rock Scenic Byway, Oak Creek Canyon scenic drive, hiking trails, jeep tours, Chapel of the Holy Cross, mountain biking trails, Vortexes, Bell Rock, Boynton Canyon, a day trip to the Grand Canyon, Slide Rock State Park, Palatki Ruins, Red Rock Crossing and Crescent Moon Picnic Site, Tlaquepaque Arts and Crafts Village, Amitabha Stupa and Peace Park, 1st Friday in the Art Galleries, and Airport Mesa.

Project Purpose and Discussion Topics 

In a place like Arizona, it would be convenient if tourists can find their way around without needing a tour guide or asking around too much. Therefore, web applications like the Tourist Kiosk application are designed to help tourists find their way around using either their computers, laptops, or smartphones. The application will include attractions and activities such as restaurants, shops, transportation, real estate, entertainment, services, and many others. The major discussion points in the project include user interface technical requirements and user interface human interaction requirements for both the kiosk and the smart device, user interface design prototypes, usability test questionnaire, usability instruction guide, and usability test results.

User Interface Technical Requirements

User Interface Design: Unit 2 Individual Project

Kiosk Requirements

The web application will be accessible through a computer, either a desktop or a laptop. The first prototype for the Tourist Kiosk will be developed per the following technical requirements. User insights are invited during the usability test of the prototype and additional requirements will be adopted in designing and developing the final product. Technical requirements for the kiosk include:

  • Operating System
    • Windows requirements: Windows 8 or later
    • Mac requirements: macOS High Sierra 10.13 or later
    • Linux requirements: 64-bit, Ubuntu 14.04+, Debian 8+, openSUSE 13.3+, or Fedora Linux 24+
  • Processor
    • Windows requirements: Intel Pentium 4 or later
    • Mac requirements: Intel
    • Linux requirements: Intel Pentium 4 or later
  • Memory: 2 GB minimum, 4 GB recommended
  • Screen Resolution: 1280×1024 or larger
  • Application window size: 1024×680 or larger
  • Internet connection: WIFI, LAN, modem, tethered.

(User Interface Design: Unit 2 Individual Project)

Smart Devise Requirements

The phone device will be available for Android devices and iPhones to ensure scalability. The requirements provided below are for the first prototype, which will be tested for usability, and in case of additional user requirements, like a call to expand specifications to cover more mobile devices, the specifications will be updated and integrated into the design of the final application. Technical requirements for smart devices include:

  • iOS and Phone requirements
    • iOS version >13
    • Phone hardware specifications: iPhone 6s onwards
  • Android OS and Phone Version
    • Android version >6.0.1
    • Phone hardware specifications:
      • ARM64, X86_64
      • Min 1GB RAM
      • Min Screen size: 5 inches
    • Provider web portal
      • Google Chrome (use latest version)
      • Firefox (use latest version)
      • Microsoft Edge (use latest version)
      • Minimum Resolution: 1024-pixel width

User Interface Human Interaction Requirements

Schneiderman’s eight golden rules of human interface interaction will guide the development of the Tourist kiosk. The design of the application will strive for consistency, consider universal usability, provide informative feedback, prevent errors, ensure action referrals, promote internal locus of control, and minimize short-term memory load. These rules will also be adopted during usability testing of the UI. The design seeks to ensure the application has simple task structures, visible controls, and correct mapping, is aesthetic and minimalistic, and promotes efficiency of use.

  • Regarding general interactivity for the kiosk and the smart device, the design will ensure consistency, provide meaningful feedback, require authentication, promote easy reversal of actions, minimize information that should be remembered, excuse mistakes, ensure context sensitivity, and utilize simple verbs and short phrases on controls.
  • The information displayed will be necessary and minimal to allow rapid navigation, labels and controls will be standard, colors probable, and visuals appropriate and not distractive. Tabs will be used to classify or categorize different information.
  • On data entry, the application will ensure fewer data input actions, steady information display and data input, and users can turn on their favorite input mode. Also, unsuitable demands per the context will be disabled and the user will be in control of the interaction. Help will be available for all input actions.

Kiosk Interaction Requirements

Developing the user interface for the tourist kiosk takes into perspective what the user values most when using an application or website and their perception of what the application should center on. Multiple principles guide the development of a user interface, especially ease of navigation, comfortable to use, and use of appropriate visuals and controls for the application to enhance user experience (Microsoft, 2022). The behavior and the UI of the application or site will be based on the what “feeling” the user gets from using the app. It will not be about how good-looking the application is but rather the great work it will perform in guiding tourists around Sedona. When designing the tourist kiosk user interface, these basic principles and guidelines will be adopted: spacing and positioning, size, grouping, and intuitiveness.

The design will ensure a professional-looking dialogue with proper spacing and appropriately placed controls. The labels will be aligned with the text baseline of the text boxes and other controls around them (Microsoft, 2022). Size consideration is fundamental when designing the UI. The design will ensure buttons are of perfect height and width, making it easy for users to notice them without fail. The third guideline is on grouping controls, and the design will employ intuitive grouping to make the controls easier to use. Tab controls will be used to group controls. Finally, the design will consider intuitiveness, which is imperative for a greater user experience. When designing tourist kiosk UI, color coding will be adopted to make navigation easier. It will enhance the recognition of texts using colors. The UI will contain easy-to-understand language and limited wording of controls.

Smart Device Interaction Requirements

The design of the smartphone or mobile user interface considers that tourists expect an almost perfect experience in their destination areas. To help tourists navigate Sedona with ease, the smartphone or mobile user interface will use well-known screens to help them feel comfortable when using the site or app. For instance, “Getting Started” and “Search Results” are among well-known screens that can be used (Baloh, 2023). The design will also ensure minimal clutter to enhance comprehension and eliminate anything unnecessary on the website or app. Gradual disclosures will be used, and additional information elements will be used. The design will also make interactive elements familiar and predictable for users. Because smartphone users depend solely on touch, the design will prioritize making controls accessible through familiarity and predictability. These design guidelines will enhance the tourist experience in Sedona.

User Interface Design Prototypes

The following prototypes represent the first design features of the kiosk and mobile applications:

Kiosk Application

For the Kiosk application, tourists are required to log in or sign up if they do not have an account. After signing in, users can engage with other pages and see some things to engage in in Sedona as tourists. There are categories, including attractions, activities, entertainment and family activities, arts and history, and fun activities, including sports, cycling, hiking, and drives. There is a category for people’s recommendations, which entails some images tourists can share on the website when reviewing it. To see what is under attractions, users will click on the attractions button to open up options. It is the case for the other categories. The buttons are links to options available for the specific category. For instance, if a tourist wants to see sporting activities, they will click the “Sports, cycling, hiking & drives” button or section. Each category is a link to its specific page with more details, including locations, maps, prices, and ratings of the various options. The information will make it easier for tourists to make their decisions on where to go based on their interests and budget. There is a category for the events calendar highlighting some events and dates specific to Sedona tourists might be interested in while there.

Mobile Application

The mobile application is a little different from the kiosk application, including its layout. The tourist will still be required to log in or sign up if they are using the application for the first time. After logging in, the tourist is taken to the “Things to Do” page with various categories of what to engage in while in Sedona. Categories include attractions and activities, restaurants and accommodations, entertainment and family, arts and history, sports, cycling, hiking, and drives. The user will have to click on a category to open a specific page for that category, which includes options and information specific to the options, including a map or location, prices, and ratings. Users can click on the “120 Posts” and similar buttons to view some of the images posted on the site.

(User Interface Design: Unit 2 Individual Project)

Usability Test Questionnaire

 

Usability Instruction Guide

 

Usability Test Results

 

 References

Baloh, I. (2023, April 7). Mobile App UI Design: An Expert’s Complete Guide for 2023. https://relevant.software/mobile-app-ui-design-guide/

Microsoft. (2022, September 02). User interface principles. https://learn.microsoft.com/en-us/windows/win32/appuistart/-user-interface-principles

 
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Controversy Associates with Dissociative Disorder 2

Controversy Associates with Dissociative Disorder 2

Controversy Associates with Dissociative Disorder

Controversy Associates with Dissociative Disorder 

The controversy that surrounds dissociative disorders

Dissociation and dissociative disorders (DD) have been the subject of debate ever since the development of contemporary psychiatry and psychology. Even among professionals, dissociation/DD views are frequently not supported by the scientific literature. Multiple lines of research point to a strong connection between psychological trauma, particularly cumulative and/or early-life trauma, and dissociation/DD (Loewenstein, 2019). The argument presented by skeptics is that DDs are artifactual states caused by iatrogenic and/or sociocultural influences and that dissociation causes fantasies of trauma. Almost no clinical or research data lend weight to this assertion.

Dissociative identity disorder (DID) is the most common and controversial DD. The DID controversy is founded on the argument that the development of existing diagnostic measures renders first-person claims of dissociation based on those scales unreliable (Loewenstein, 2019). According to the argument, how these scales are made causes more false positives. The misinterpretation of other conditions, poor patient care, and insufficient treatment of depression have all been attributed to DID diagnoses (Loewenstein, 2019). Even when DID is treated with the best of intentions, psychotherapy may have unintended negative effects, and some patients report worsening symptoms and/or declining functionality. On whether DID is fake, some medical professionals question whether those who advocate the diagnosis of dissociative identity disorder have any financial or other conflicts of interest. An income of up to $20,000 per patient can be generated by the long-term, intensive psychotherapy care that people with DID typically get (Loewenstein, 2019). It gives doctors a strong incentive to identify DID.

(Controversy Associates with Dissociative Disorder 2)

My professional beliefs about dissociative disorders

Besides the controversy, I believe dissociative disorders are real and impact a significant part of the population. In most cases, the disease is misdiagnosed as schizophrenia due to the unjustified belief that the individual might be delusional (Mitra & Jain, 2021). Dissociative disorders are widespread in both general and clinical populations, and they constitute a significant underserved group with a high risk of self-harm and suicide (Pietkiewicz et al., 2021). Serious DD patients’ symptoms, including suicidal and self-destructive tendencies, significantly improved after treatment, according to prospective studies of treatment outcomes (Loewenstein, 2019). A significant public health initiative is required to promote understanding of dissociation/DD, including educational initiatives in all programs for mental health professionals and more financing for research.

Strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder

Building rapport and fostering trust in the therapeutic process are the main goals of the initial phase of treatment. The therapist tells the client that they will not be required to confront any topics that they do not feel comfortable facing and emphasizes that symptoms are a byproduct of identified factors during the assessment (Thayyil & Rani, 2020). The therapist empowers the client’s capacity for self-regulation and willingness to effect change within themselves while establishing a strong therapeutic alliance and retaining professional neutrality. The therapeutic relationship is reinforced by establishing and maintaining clear boundaries, developing reliable strategies to deal with emotions during therapy, establishing appropriate ways to assert oneself and deal with interpersonal conflict, acting mindfully, acknowledging changes, and appreciating the significance of the client’s efforts towards change and recovery.

Ethical and legal considerations related to dissociative disorders that should be brought to practice and why they are important

There are more than nine parts of lore and less than one part of the law in the entire legal situation pertaining to dissociation and pathological dissociation. In regards to all facets of the putative “special status” that dissociation phenomena, whether normal or sick in nature, purportedly deserve, there is a great deal more communal (and contradictory) tradition than statutory or judicial law (Kabene et al., 2022). The objective of the present examination is to determine if a person with DID is legally accountable for the offence they committed and whether they are capable of facing trial. There is no agreement within the legal system as to whether DID patients should be held accountable for their conduct, despite the fact that the disease is fundamentally defined by dissociative amnesia and that the host personality may only have minimal or no contact with the alters. Additionally, courts typically reject the accusations of insanity made by DID sufferers (Kabene et al., 2022). The excessive dependence on secondary data requires people to accept the inferences that have already been formed, and there is no chance to independently confirm those results, hence it is recommended that additional studies in the field integrate primary data into this study.

References

Kabene, S. M., Neftci, N. B., & Papatzikis, E. (2022). Dissociative Identity Disorder and the Law: Guilty or Not Guilty?. Frontiers in Psychology13.

Loewenstein R. J. (2019). Dissociation debates: everything you know is wrong. Dialogues in clinical neuroscience20(3), 229–242. https://doi.org/10.31887/DCNS.2019.20.3/rloewenstein

Mitra, P., & Jain, A. (2021). Dissociative identity disorder. Statpearls [Internet].

Pietkiewicz, I. J., Bańbura-Nowak, A., Tomalski, R., & Boon, S. (2021). Revisiting false-positive and imitated dissociative identity disorder. Frontiers in psychology12, 637929.

Thayyil, M. M., & Rani, A. (2020). Structural Family Therapy with a Client Diagnosed with Dissociative Disorder. Indian Journal of Psychological Medicine43(6), 549-554.

 
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Bipolar Disorder and Conduct Disorder

Bipolar Disorder and Conduct Disorder

Bipolar Disorder and Conduct Disorder SOAP Note

Bipolar Disorder and Conduct Disorder

Patient Initials: R.G.

Gender: Male

SUBJECTIVE:

CC: “I want to be left alone and be respected.”

HPI: The patient has a history of oppositional defiant disorder and mood dysregulation disorder and has now been admitted to the inpatient unit due to property destruction. Reportedly, the patient was getting his phone fixed, and he got into an argument with people at the mall. The police were called, and he was brought to the hospital. The patient has been irritable, threatening his parents, and does not follow rules at home. He has not been taking medication, but smoking marijuana. Patient was suspended from school after he was found with the possession of cannabis. He has a history of irritable mood, anger outbursts, physical and verbal aggression.  patient has no history of suicidal ideation or suicide attempt. No history of homicidal ideations or attempts.

Social History: R.G. lives with his parents. Patient has two other siblings.

Education and Occupation History: R.G. is in high school.

Substance Current Use and History: Recreational Drugs, Cannabis, Marijuana, 1 Daily

Legal History: The client denies any legal history, but he been punished in school by suspension.

Family Psychiatric/Substance Use History: Patient denies family mental health. Reports mother and father using alcohol occasionally.

Past Psychiatric History:

            Hospitalization: History of multiple hospitalizations at BNBMC.

Medication trials: Denies history of medical trials

Psychotherapy or Previous Psychiatric Diagnosis: Patient is historically noncompliant with medication after leaving hospital. History of physically aggressive behavior towards mother and sister with property destruction but a diagnosis was not established.

Medical History: None.

  • Current Medications: Denies using any medications currently.
  • Allergies:
  • Reproductive Hx: Sexually active. R.G. states using protection.

ROS:  

General: Patient is well-nourished, normal activity levels. Denies fever or fatigue.

HEENT: Eyes: Patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: Patient denies diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation. History of GERD.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: The patient denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports concentration and attention problems.

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness. Moves all extremities well.

Psychiatric: History of behavior problems. Recent complaints of ill conduct.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating. No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 98.1F

B.P.: 128/62

P: 84

R.R.: 20

O2: 100% Room air

Pain: 0/10

Ht: 5’9 feet

Wt: 170 lbs

BMI: 25.1

BMI Range: Overweight

LABS:

Lab findings WNL

Tox screen: Positive

Alcohol: Positive

Physical Exam:

General appearance: The patient is awake, healthy-appearing, well-developed, and well-nourished.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is within normal range, and capillaries refill within two seconds.

Musculoskeletal: Normal range of motion. Normal motor strength and tone.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. The patient has occasional headaches.

Psychiatric: The patient is easily distracted and is irritable and uncooperative in some instances.

Neuropsychological testing: Social-emotional functioning is impaired.

Behavior/motor activity: Patient was easily irritable and uncooperative in some instances.

Gait/station: Stable.

Mood: Fair.

Affect: Fair.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: the patient was irritable and uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

Language: clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: Negative.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The male patient, 17, complains of wanting be left alone and respected. The patient presents with ill and uncontrollable behavior and conduct. The patient is combative, bullying, uncooperative, and easily agitated and angered. Building rapport was difficult because the patient had trouble focusing and paying attention. His mood and affect were fair, but he was apathetic, had difficulty concentrating, and was quickly disoriented. He denies having any suicidal or homicidal ideas.

Differential Diagnosis:

  1. 9 Conduct Disorder and F31.1 Bipolar I Disorder (Confirmed)

Bipolar disorder, commonly referred to as bipolar affective disorder, ranks as one of the top 10 major causes of disability worldwide. It is common to first misdiagnose bipolar disorder, which is characterized by recurrent periods of mania or hypomania that alternate with depression (Jain & Mitra, 2022). Bipolar and related disorders include undefined bipolar or related disorders, bipolar I disorder (BD-I), bipolar II disorder (BD-II), cyclothymic disorder, and other specified bipolar and related illnesses. Per the DSM-5 diagnosis, for a patient to be diagnosed with bipolar I disorder, criteria should meet for at least one manic episode, which could have been preceded or followed by a significant depression or hypomanic episode, although major depressive or hypomanic episodes are not necessary for the diagnosis (Jain & Mitra, 2022). In clinical, epidemiological, and research samples, a strong and bidirectional connection between pediatric bipolar I (BP-I) disorder and conduct disorder (CD) has continuously been found (Wozniak et al., 2019). Even though BP-I and CD are two separate, highly morbid illnesses, their co-occurrence signals a gravely compromised clinical condition.

Disruptive behavioral disorders include conduct disorder (CD) and oppositional defiant disorder (ODD). In some circumstances, ODD appears before CD. CD is characterized by a series of behaviors that include showing hostility and violating other people’s rights. Conduct disorder frequently co-occurs with other psychiatric diseases, such as depression, attention deficit hyperactivity disorder, and learning problems (Mohan et al., 2023). It is vital to remember that occasional rebellious conduct and a propensity to disrespect and disobey authority figures can be seen frequently during childhood and adolescence. The signs and symptoms of CD show a pervasive and recurrent pattern of hostility towards people and animals, as well as the destruction of property and breaking of regulations (Sagar et al., 2019). Per the DMS-5 criteria, an individual has to exhibit behaviors that include violation of other people’s rights and disregard acceptable conduct. The individuals should demonstrate dysfunction in various areas, including aggression toward other people and animals such as initiating fights, carrying and using weapons, bullying, threatening, and being cruel towards people and animals, deliberate property destruction, stealing and lying, and significant violation of rules like running away from home and staying out late (Zhang et al., 2018). R.G. presents with all these dysfunctions, confirming the diagnoses.

  1. 3 Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is another disruptive behavioral condition that frequently precedes CD. ODD is infrequently recognized in older children and teenagers, owing partially to the continuously established disagreements between children and their parents. Males are more prevalent than girls to have ODD in preadolescence (1.4:1), however, this male predominance does not exist in adolescents or adults (Aggarwal & Marwaha, 2022). Symptoms are thought to be steady around the ages of five and 10, after which they begin to decline. The prevalence reduces as people age. It primarily involves problems with emotional and behavioral inhibition. A recurrent pattern of anger or irritation, argumentative or rebellious behavior, or revenge towards other people is the primary hallmark of ODD, per the DSM-5 criteria (Aggarwal & Marwaha, 2022). Because the patient also displayed additional symptoms that met CD criteria alongside the ODD symptoms, this diagnosis was ruled out.

  1. 9. Attention Deficit Hyperactivity Disorder

ADHD co-occurs frequently with CD, hampering an individual’s capacity to function. People who suffer from this condition have excessive degrees of impulsivity, hyperactivity, or inattentiveness. According to Magnus et al. (2023), young children with ADHD frequently display inattentiveness, lack of attention, disorganization, difficulties finishing tasks, forgetfulness, and losing things. For symptoms to be considered ADHD, they must appear before the age of 12, last for six months, and interfere with daily tasks. It must be present in numerous settings, such as at home and work or in both after-school programs and classes (Magnus et al., 2023). Large-scale effects could lead to challenging social relations, an increase in risky behavior, job losses, and challenges in the classroom. Because ADHD was not recognized before the age of 12 and because the client only exhibits inattentiveness and no functioning challenges, the diagnosis was rejected.

PLAN:

The patient would benefit from combining medication and psychotherapy.

Safety Risk/Plan:

R.G. has no present objective or desire to hurt himself or others. There are no suicidal or homicidal ideas in the patient. It is not essential to register.

Pharmacological Interventions:

Pharmacotherapy tries to treat mental co-morbidities using the appropriate medications, such as stimulants and non-stimulants for the treatment of ADHD, antiepileptic drugs for the treatment of bipolar illness, and mood stabilizers for the treatment of aggression and mood dysregulation (Mohan et al., 2023). Traditional mood stabilizers that can elevate mood include second-generation antipsychotics and antiepileptic drugs (AEDs). Proposal medication plan includes Depakote 250 in AM, 500 at bedtime, (delay release) Risperidone 1 mg bid and Cogentin 0.5 once a day.

Psychotherapy:

The psychosocial treatment that can help address conduct disorder in R.G. includes parent management training, which teaches parents ways to discipline their children consistently, reward positive behavior properly, and promote prosocial behavior in young people, multisystemic therapy, which focuses on family, school, and individual issues, and anger management training. Additionally, individual psychotherapy that emphasizes problem-solving skills helps treat CD by fostering connections through resolving interpersonal conflicts and by teaching assertiveness to reject negative communal influences (Mohan et al., 2023). Community-based treatment will be centered on creating therapeutic school settings that can provide a structured program to reduce disruptive behaviors in the future.

Education:

  1. Educate parent and patient on drug adherence, potential adverse effects, and complications from taking the medication.
  2. Educate the patient regarding consistent therapy sessions and why they are necessary.
  3. To prevent relapse, monitor withdrawal symptoms frequently.
  4. Inform the client regarding healthy behaviors and attitudes.
  5. Encourage the patient to cooperate with the medical staff and to seek assistance at any time.
  6. Encourage the client to take part in group therapy or a support group to develop social skills.

Consultation/follow-up: Follow-up is in two weeks for further assessment.

Reflection

Children with bipolar disorder are more likely to experience conduct issues. Children and adolescents who have conduct disorders are prevalent, and these disorders are frequently linked to developmental stages and traits. Adolescence is a time when occasional disobedience and bad behavior is normal or anticipated. When there is a reoccurring pattern and behavioral dysfunctions are present, the situation becomes problematic. In some cases, such as this one, parents and instructors are unable to effectively handle conduct dysfunctions and must seek professional assistance. Since the patient is seen as problematic and may become aggressive toward the practitioner, dealing with CD presents difficulties for practitioners as well. But when professionals, parents, and instructors collaborate, the process is more successful.

At some point in their lives, over half of all Americans will receive a mental condition diagnosis. Healthy People 2030 emphasizes the prevention, screening, evaluation, and treatment of behavioral and mental problems (Healthy People 2030, n.d.). The goals for mental health and mental disorders also include improving the health and standard of living for those who suffer from these problems. Health promotion techniques for conduct disorder can assist reinforce responsible conduct by providing consistent adult caregiving, positive emotional support, proper learning and social skills, an easy temperament, a sense of competence, and optimistic worldviews. Autonomy and confidentiality are ethical issues that arise when working with the client, given he is a minor. Any sort of treatment should only be given with the parent’s informed consent. If I were given another chance to work with the client, I would ask the instructor and the school’s disciplinary staff for information so that I could create a more thorough diagnosis and treatment plan.

 

References

Healthy People 2030. (n.d.). Mental Health and Mental Disorders. https://health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders

Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing.

Mohan, L., Yilanli, M., & Ray, S. (2017). Conduct disorder. In: StatPearls [Internet]. StatPearls Publishing.

Aggarwal, A., & Marwaha, R. (2022). Oppositional Defiant Disorder. In StatPearls [Internet]. StatPearls Publishing.

Magnus, W., Nazir, S., & Anilkumar, A.C. (2023). Attention Deficit Hyperactivity Disorder. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Wozniak, J., Wilens, T., DiSalvo, M., Farrell, A., Wolenski, R., Faraone, S. V., & Biederman, J. (2019). Comorbidity of bipolar I disorder and conduct disorder: a familial risk analysis. Acta psychiatrica Scandinavica139(4), 361–368. https://doi.org/10.1111/acps.13013

Zhang, J., Liu, W., Zhang, J., Wu, Q., Gao, Y., Jiang, Y., Gao, J., Yao, S., & Huang, B. (2018). Distinguishing Adolescents With Conduct Disorder From Typically Developing Youngsters Based on Pattern Classification of Brain Structural MRI. Frontiers in human neuroscience12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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Controversy Associates with Dissociative Disorder

Controversy Associates with Dissociative Disorder

Controversy Associates with Dissociative Disorder

Controversy Associates with Dissociative Disorder

The controversy that surrounds dissociative disorders

Dissociative disorders (DD) have been the subject of debate ever since the development of contemporary psychiatry and psychology. Even among professionals, DD views are frequently not supported by the scientific literature. Multiple lines of research point to a strong connection between psychological trauma, particularly cumulative and early-life trauma, and DD (Loewenstein, 2019). The argument presented by skeptics is that DDs are artifactual states caused by iatrogenic or sociocultural influences and dissociation causes trauma fantasies. However, almost no clinical or research data lend weight to this assertion.

Dissociative identity disorder (DID) is the most common and controversial DD. It is founded on the argument that the development of existing diagnostic measures renders first-person claims of dissociation based on those scales unreliable (Loewenstein, 2019). According to the argument, how these scales are made causes more false positives. The misinterpretation of other conditions, poor patient care, and insufficient treatment of depression have all been attributed to DID diagnoses (Loewenstein, 2019). Even when DID is treated with the best of intentions, psychotherapy may have unintended negative effects, and some patients report worsening symptoms and declining functionality. On understanding if DID is fake, some medical professionals question whether those who advocate the diagnosis of dissociative identity disorder have any financial or other conflicts of interest. According to Loewenstein (2019), physicians or organizations can generate an income of up to $20,000 per patient from the long-term intensive psychotherapy care that people with DID typically get, giving doctors a strong incentive to identify DID. It implies that doctors can continue to wrongfully diagnose people with DID because its treatment is a significant revenue stream.

My professional beliefs about dissociative disorders

Besides the controversy, I believe dissociative disorders are real and impact a significant part of the population. In most cases, the disease is misdiagnosed as schizophrenia due to the unjustified belief that the individual might be delusional (Mitra & Jain, 2021). Dissociative disorders are widespread in both general and clinical populations, and they constitute a significant underserved group with a high risk of self-harm and suicide (Pietkiewicz et al., 2021). Serious DD patients’ symptoms, including suicidal and self-destructive tendencies, significantly improved after treatment, according to prospective studies of treatment outcomes (Loewenstein, 2019). A significant public health initiative is required to promote understanding of dissociation/DD, including educational initiatives in all programs for mental health professionals and more financing for research.

(Controversy Associates with Dissociative Disorder)

Strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder

Building rapport and fostering trust in the therapeutic process are the main goals of the initial phase of treatment. The therapist tells the client that they will not be required to confront any topics that they do not feel comfortable facing and emphasizes that symptoms are a byproduct of identified factors during the assessment (Thayyil & Rani, 2020). The therapist empowers the client’s capacity for self-regulation and willingness to effect change within themselves while establishing a strong therapeutic alliance and retaining professional neutrality. The therapeutic relationship is reinforced by establishing and maintaining clear boundaries, developing reliable strategies to deal with emotions during therapy, establishing appropriate ways to assert oneself and deal with interpersonal conflict, acting mindfully, acknowledging changes, and appreciating the significance of the client’s efforts towards change and recovery.

Ethical and legal considerations related to dissociative disorders that should be brought to practice and why they are important

There are more than nine parts of lore and less than one part of the law in the entire legal situation pertaining to dissociation and pathological dissociation. In regards to all facets of the putative “special status” that dissociation phenomena, whether normal or sick in nature, purportedly deserve, there is a great deal more communal (and contradictory) tradition than statutory or judicial law (Kabene et al., 2022). The objective of the present examination is to determine if a person with DID is legally accountable for the offence they committed and whether they are capable of facing trial. There is no agreement within the legal system as to whether DID patients should be held accountable for their conduct, despite the fact that the disease is fundamentally defined by dissociative amnesia and that the host personality may only have minimal or no contact with the alters. Additionally, courts typically reject the accusations of insanity made by DID sufferers (Kabene et al., 2022). The excessive dependence on secondary data requires people to accept the inferences that have already been formed, and there is no chance to independently confirm those results, hence it is recommended that additional studies in the field integrate primary data into this study.

References

Kabene, S. M., Neftci, N. B., & Papatzikis, E. (2022). Dissociative Identity Disorder and the Law: Guilty or Not Guilty?. Frontiers in Psychology13.

Loewenstein R. J. (2019). Dissociation debates: everything you know is wrong. Dialogues in clinical neuroscience20(3), 229–242. https://doi.org/10.31887/DCNS.2019.20.3/rloewenstein

Mitra, P., & Jain, A. (2021). Dissociative identity disorder. Statpearls [Internet].

Pietkiewicz, I. J., Bańbura-Nowak, A., Tomalski, R., & Boon, S. (2021). Revisiting false-positive and imitated dissociative identity disorder. Frontiers in psychology12, 637929.

Thayyil, M. M., & Rani, A. (2020). Structural Family Therapy with a Client Diagnosed with Dissociative Disorder. Indian Journal of Psychological Medicine43(6), 549-554.

 
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Assignment 1 – Professional Presentation

Assignment 1 – Professional Presentation

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Assignment 1 - Professional Presentation

Assignment 1

Professional presentation allows sharing of ideas and research findings with a specific audience. It is imperative to deliver the message clearly and concisely. These presentations contribute to the evidence base the evaluation team will utilize to provide feedback regarding the presentation and the subject matter. Professional presentation skills are critical in nursing because they help students pass information and convince stakeholders to engage in positive changes that impact the organization and patients in the facility. A personal strength regarding professional presentation would be delivering well-organized and researched work. I take time researching a particular topic to ensure I understand the concepts well and find appropriate evidence base to go along and make the work more compelling. I also organize my presentation well to ease readability and flow and make it easier to deliver the right message clearly. Proper organization and robust research on the topic build my confidence before a presentation because I feel I am well-prepared for any form of evaluation or question (University of Minnesota, 2023). Although it is a strength, I can still improve by establishing a purpose and identifying the main ideas, organizing them in an outline, researching them, developing a presentation, and rehearsing it, before delivering it to the audience.

(Assignment 1 – Professional Presentation)

I am always anxious before a presentation, which impacts my confidence and thought organization. Being organized and conducting robust research is a method of minimizing anxiety before a presentation, but mostly, I cannot help it. It eases after beginning to present, but I need to minimize anxiety right before a presentation. Methods I can adopt to be calmer before a professional presentation would be recognizing that I am anxious and it is typical before a major presentation, observing my instincts, and trying to be comfortable that anxiety is part of the process (Su, 2019). Something positive is that confidence builds during presentations because I have prepared my work well. I should accept that anxiety before it is normal and be comfortable with it.

References

Su, J. A. (2019). How to Calm Your Nerves Before a Big Presentation. Harvard Business Review. https://hbr.org/2016/10/how-to-calm-your-nerves-before-a-big-presentation

University of Minnesota. (2023). 14.1 Organizing a Visual Presentation. Libraries. https://open.lib.umn.edu/writingforsuccess/chapter/14-1-organizing-a-visual-presentation/

 
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451 Week 8 – Health in Older Adults

451 Week 8 – Health in Older Adults

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

451 Week 8 - Health in Older Adults

451 Week 8

To enhance my career readiness and as a form of professional development for the future, I plan to enroll in the NP program in the Fall. I will continue to work while participating in the NP program until I complete it hence the need for a work-education balance. My future career goal is to work as an acute care nurse practitioner. I also intend to contribute globally to make the world a better place by closing the gap in social determinants of health (SDOH). Social determinants of health for seniors, such as housing, food, financial resources, transportation, and social connections, are crucial for bettering overall well-being and for improving health outcomes (Perez et al., 2022). In this context, I wish to encourage and fight for a just and compassionate society where everyone can age with dignity, meaning, and security. I hope to take part in projects like NCOA’s efforts to create the Aging Hub of the 100 Million Healthier Lives (100MLives) program, a collaboration with the Institute for Healthcare Improvement (IHI), and other initiatives like these that support equitable care for senior citizens.

To accomplish the objective of a reformed health care system, including meeting the challenges of taking care of older and sicker patients, incorporating patient safety and quality of care into practice, and understanding economics and its effect on the workforce, strong leadership will be necessary in addition to reforms in nursing practice and education. Every nurse should serve as a leader in the design, execution, and assessment of the ongoing system reforms that will be required, as well as in advocating for them (Stewart, 2021). Although the public is not accustomed to seeing nurses as leaders and not all nurses start their careers with aspirations concerning becoming a leader, this is a must. Additionally, nurses must possess leadership abilities and competencies to participate fully in redesign and reform initiatives across the healthcare system with doctors and other medical professionals. Nursing research and practice must keep exploring and creating evidence-based care advances, and the healthcare system as a whole need to evaluate and implement these transformations through policy changes (Stewart, 2021). The practice environment, nursing education, and practice and policy all require leaders in nursing to incorporate new research discoveries into practice.

(451 Week 8 – Health in Older Adults)

Being a complete partner demands leadership abilities and capabilities that must be used both inside the profession and in cooperation with other health professionals, which goes for all nursing levels. To be a full partner in care environments and support the ongoing changes in the healthcare system, I intend to be accountable for recognizing issues and areas of waste, developing and putting into practice an improvement plan, monitoring progress over time, and making required adjustments to achieve set goals (Stewart, 2021). I want to be involved in decision-making about how to enhance the provision of care since nurses are powerful patient advocates, and as a nurse, I have a better understanding of patients’ needs. Being a full partner has broader applications in the field of health policy. I must view policy as an element that I can influence rather than something that occurs to me, whether at the local organizational level or the national level, if I am to be effective in reconceptualized roles and to be recognized and accepted as a leader (Stewart, 2021). I must effectively participate in the political process, speak the language of policy, and collaborate as part of a team in my line of work. Conclusively, to be involved in healthcare reform implementation efforts, I ought to have a say in the formulation of health policy.

References

Perez, F. P., Perez, C. A., & Chumbiauca, M. N. (2022). Insights into the Social Determinants of Health in Older Adults. Journal of biomedical science and engineering15(11), 261–268. https://doi.org/10.4236/jbise.2022.1511023

Stewart, D. (2021). Nurses: a voice to lead: a vision for future healthcare. International Council of Nurses. https://www.icn.ch/system/files/documents/2021-05/ICN%20Toolkit_2021_ENG_Final.pdf

 
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Evidence-based Practice in Nursing Profession

Evidence-based Practice in Nursing Profession

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Assignment 2

Evidence-based Practice in Nursing Profession

EBP improves nurses’ capacity for decision-making and their capacity to create personalized care plans that result in effective patient care. According to the literature, nurses value EBP, yet, its application is uneven since it is frequently complicated by a variety of issues, including a lack of facilities, time, funds, support, knowledge, and skills (Alqahtani et al., 2022). Lack of support and supervision can impend the EBP change proposal from continuing to obtain the same desired results 6 months to a year from now. Hospital administrators’ lack of information, guidance, support, and leadership abilities in implementing EBP reduces the sustainability of an EBP project. According to a survey, 27% of nurses said nurse managers do not support the implementation of EBP projects (Alatawi et al., 2020). A total of 91% of nurses said that an EBP mentor or champion is needed in the ICU to improve the efficient implementation of EBP (Alatawi et al., 2020). Lack of support from institutional managers, head nurses, and coworkers may hinder EBP project implementation. Approximately 58% of nurses agreed that one obstacle to implementing EBP was a lack of authority to change practice (Alatawi et al., 2020). Furthermore, the lack of power to alter practice in the critical care unit is a barrier to implementing EBP, according to 34% of nurses, of whom 23% strongly agreed (Alatawi et al., 2020). The evidence stresses the importance of leadership support and supervision to the success of EBP projects. Leaders and administrators should be at the forefront of encouraging EBP change projects in their organization and channeling resources to these initiatives to increase the chances of success.

Lack of education and training is viewed as a hindrance to the implementation of EBP and the continued realization of desired results. Although the training itself may have been a requirement, nurses do not feel completely comfortable using EBP. The supervisors, according to the nurses, did not give more opportunities for nurses to learn more about evidence-based practice enough attention. Approximately 50% of nurses believed that in-service training on EBP would encourage continued use of EBP, and 47% agreed that the critical care unit needed an EBP mentor to conduct searches and share the results with the rest of the staff (Alatawi et al., 2020). Inservice training, according to 50% of participants, would encourage knowledge of and adherence to evidence-based practices (Alatawi et al., 2020). Best-practice recommendations could support evidence-based practices, according to 50% of participants who strongly agreed with this statement (Alatawi et al., 2020). The results imply that continued training and education after implementing the EBP project would help ensure the sustainability and continued realization of the desired outcomes.

References

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science9(1), 35.https://doi.org/10.11648/j.ajns.20200901.16

Alqahtani, J. M., Carsula, R. P., Alharbi, H. A., Alyousef, S. M., Baker, O. G., & Tumala, R. B. (2022). Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study. Nursing reports (Pavia, Italy)12(2), 313–323. https://doi.org/10.3390/nursrep12020031

 
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Bipolar Disorder and Conduct Disorder SOAP Note

Bipolar Disorder and Conduct Disorder SOAP Note

Bipolar Disorder and Conduct Disorder SOAP Note

Bipolar Disorder and Conduct Disorder SOAP Note

Patient Initials: R.G.

Gender: Male

SUBJECTIVE:

CC: “I want to be left alone and be respected.”

HPI: The patient has a history of oppositional defiant disorder and mood dysregulation disorder and has now been admitted to the inpatient unit due to property destruction. Reportedly, the patient was getting his phone fixed, and he got into an argument with people at the mall. The police were called, and he was brought to the hospital. The patient has been irritable, threatening his parents, and does not follow rules at home. He has not been taking medication, but smoking marijuana. The patient was suspended from school after he was found possessing cannabis.

Social History: R.G. lives with his parents. Patient has two other siblings, a sister and brother.

Education and Occupation History: R.G. is in high school.

Substance Current Use and History: Recreational drugs, Cannabis, 1 Daily

Legal History: The client denies any legal history, but he been punished in school by suspension.

Family Psychiatric/Substance Use History: Patient denies family mental health. Reports mother and father using alcohol occasionally.

Past Psychiatric History:

            Hospitalization: History of multiple hospitalizations at BNBMC.

Medication trials: Denies history of medical trials

Psychotherapy or Previous Psychiatric Diagnosis: Patient is historically noncompliant with medication after leaving hospital. He has a history of physically aggressive behavior towards mother and sister with property destruction but a diagnosis was not established.

Medical History: None.

  • Current Medications: Denies using any medications currently.
  • Allergies:
  • Reproductive Hx: Sexually active. R.G. states using protection.

ROS:  

General: Patient is well-nourished, normal activity levels. Denies fever or fatigue.

HEENT: Eyes: Patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: Patient denies diet changes, feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation. History of GERD.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: The patient denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports concentration and attention problems.

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness. Moves all extremities well.

Psychiatric: History of behavior problems. Recent complaints of ill conduct.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating. No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 98.1F

B.P.: 128/62

P: 84

R.R.: 20

O2: 100% Room air

Pain: 0/10

Ht: 5’9 feet

Wt: 170 lbs

BMI: 25.1

BMI Range: Overweight

LABS:

Lab findings WNL

Tox screen: Positive

Alcohol: Positive

Physical Exam:

General appearance: The patient is awake, healthy-appearing, well-developed, and well-nourished.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is within normal range, and capillaries refill within two seconds.

Musculoskeletal: Normal range of motion. Normal motor strength and tone.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. The patient has occasional headaches.

Psychiatric: The patient is easily distracted, irritable, and uncooperative in some instances.

Neuropsychological testing: Social-emotional functioning is impaired.

Gait/station: Stable.

Mood: Fair.

Affect: Fair.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.

Attitude: The patient was irritable and uncooperative at times

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Impaired

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

Language: clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: Negative.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The male patient, 17, complains of wanting be left alone and respected. The patient presents with ill and uncontrollable behavior and conduct. The patient is combative, bullying, uncooperative, and easily agitated. Building rapport was difficult because the patient had trouble paying attention, and was quickly disoriented. His mood and affect were fair, but he was apathetic. He denies having any suicidal or homicidal ideation.

Differential Diagnosis:

  1. 9 Conduct Disorder and F31.1 Bipolar I Disorder (Confirmed)

Bipolar disorder or bipolar affective disorder ranks as one of the top 10 major causes of disability worldwide. Bipolar and related disorders include undefined bipolar or related disorders, bipolar I disorder (BD-I), bipolar II disorder (BD-II), cyclothymic disorder, and other specified bipolar and related illnesses. It is common to first misdiagnose bipolar disorder, which is characterized by recurrent periods of mania or hypomania that alternate with depression (Jain & Mitra, 2022). Per the DSM-5 diagnosis, for a patient to be diagnosed with bipolar I disorder, criteria should meet for at least one manic episode, which could have been preceded or followed by a significant depression or hypomanic episode, although major depressive or hypomanic episodes are not necessary for the diagnosis (Jain & Mitra, 2022). Bipolar I disorder often co-occurs with conduct disorder. In clinical, epidemiological, and research samples, a strong and bidirectional connection between pediatric bipolar I (BP-I) disorder and conduct disorder (CD) has continuously been found (Wozniak et al., 2019). Even though BP-I and CD are two separate, highly morbid illnesses, their co-occurrence signals a gravely compromised clinical condition.

Conduct disorder (CD), like oppositional defiant disorder (ODD), is a disruptive behavioral disorder. The patient has previously been diagnosed with ODD. In some circumstances, ODD appears before CD. CD is characterized by a series of behaviors that include showing hostility and violating other people’s rights (Mohan et al., 2023). It is vital to remember that occasional rebellious conduct and a propensity to disrespect and disobey authority figures can be seen frequently during childhood and adolescence. The signs and symptoms of CD show a pervasive and recurrent pattern of hostility towards people and animals, and the destruction of property and breaking of regulations (Sagar et al., 2019). Per the DMS-5 criteria, an individual has to exhibit behaviors that include violation of other people’s rights and disregard acceptable conduct. The individuals should demonstrate dysfunction in various areas, including aggression toward other people and animals such as initiating fights, carrying and using weapons, bullying, threatening, and being cruel towards people and animals, deliberate property destruction, stealing and lying, and significant violation of rules like running away from home and staying out late (Zhang et al., 2018). R.G. presents with all these dysfunctions, confirming the diagnoses.

  1. 3 Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) frequently precedes CD. ODD is infrequently recognized in older children and teenagers, owing partially to the continuously established disagreements between children and their parents. Males are more likely than girls to have ODD in preadolescence (1.4:1). However, this male predominance does not exist in adolescents or adults (Aggarwal & Marwaha, 2022). Symptoms tend to be steady around the ages of five and 10, after which they begin to decline as prevalence reduces as people age. It primarily involves problems with emotional and behavioral inhibition. A recurrent pattern of anger or irritation, argumentative or rebellious behavior, or revenge towards other people is the primary hallmark of ODD, per the DSM-5 criteria (Aggarwal & Marwaha, 2022). Because the patient also displayed additional symptoms that met CD criteria alongside the ODD symptoms, this diagnosis was ruled out.

(Bipolar Disorder and Conduct Disorder SOAP Note)

  1. 9. Attention Deficit Hyperactivity Disorder

ADHD co-occurs frequently with CD, hampering an individual’s capacity to function. People who suffer from this condition have excessive degrees of impulsivity, hyperactivity, or inattentiveness. According to Magnus et al. (2023), young children with ADHD frequently display inattentiveness, lack of attention, disorganization, difficulties finishing tasks, forgetfulness, and losing things. For symptoms to be considered ADHD, they must appear before the age of 12, last for six months, and interfere with daily tasks. It must be present in numerous settings, such as at home and work or in both after-school programs and classes (Magnus et al., 2023). Large-scale effects could lead to challenging social relations, an increase in risky behavior, job losses, and challenges in the classroom. Because ADHD was not recognized before the age of 12 and because the client only exhibits inattentiveness and no functioning challenges, the diagnosis was rejected.

PLAN:

The patient would benefit from combining medication and psychotherapy.

Safety Risk/Plan:

R.G. has no present objective or desire to hurt himself or others. There are no suicidal or homicidal ideas in the patient. It is not essential to hospitalize the patient.

Pharmacological Interventions:

Pharmacotherapy tries to treat mental co-morbidities using the appropriate medications, such as stimulants and non-stimulants for the treatment of ADHD, antidepressants for treating depression, antiepileptic drugs treating bipolar illness, and mood stabilizers for treating aggression and mood dysregulation (Mohan et al., 2023). Traditional mood stabilizers that can elevate mood include second-generation antipsychotics and antiepileptic drugs (AEDs). Proposed medication plan includes Depakote 250 in AM, 500 at bedtime, (delay release) Risperidone 1 mg bid and Cogentin 0.5 once a day.

(Bipolar Disorder and Conduct Disorder SOAP Note)

Psychotherapy:

The psychosocial treatment that can help address conduct disorder in R.G. includes parent management training, which teaches parents ways to discipline their children consistently, reward positive behavior properly, and promote prosocial behavior in young people, multisystemic therapy, which focuses on family, school, and individual issues, and anger management training. Additionally, individual psychotherapy that emphasizes problem-solving skills helps treat CD by fostering connections through resolving interpersonal conflicts and by teaching assertiveness to reject negative communal influences (Mohan et al., 2023). Community-based treatment will be centered on creating therapeutic school settings that can provide a structured program to reduce disruptive behaviors in the future.

Education:

  1. Educate parent and patient on drug adherence, potential adverse effects, and complications from taking the medication.
  2. Educate the patient regarding consistent therapy sessions and why they are necessary.
  3. To prevent relapse, monitor withdrawal symptoms frequently.
  4. Inform the client regarding healthy behaviors and attitudes.
  5. Encourage the patient to cooperate with the medical team and to seek assistance at any time.
  6. Encourage the client to take part in group therapy or a support group to develop social skills.

Consultation/follow-up: Follow-up is in two weeks for further assessment.

Reflection

Children with bipolar disorder are more likely to experience conduct issues. Children and adolescents who have conduct disorders are prevalent, and these disorders are frequently linked to developmental stages and traits. Adolescence is a time when occasional disobedience and bad behavior is normal or anticipated. When there is a reoccurring pattern and behavioral dysfunctions are present, the situation becomes problematic. In some cases, such as this one, parents and instructors are unable to effectively handle conduct dysfunctions and must seek professional assistance. Since the patient is seen as problematic and may become aggressive toward the practitioner, dealing with CD presents difficulties for practitioners as well. But when professionals, parents, and instructors collaborate, the process is more successful.

(Bipolar Disorder and Conduct Disorder SOAP Note)

At some point in their lives, over half of all Americans will be diagnosed with a mental condition. Healthy People 2030 emphasizes the prevention, screening, evaluation, and treatment of behavioral and mental problems (Healthy People 2030, n.d.). The goals for mental health and mental disorders also include improving the health and standard of living for those who suffer from these problems. Health promotion techniques for conduct disorder can assist reinforce responsible conduct by providing consistent adult caregiving, positive emotional support, proper learning and social skills, an easy temperament, a sense of competence, and optimistic worldviews. Regarding ethical considerations in treating patients with bipolar and conduct disorders, autonomy and confidentiality issues can arise, given that the client is a minor. Any sort of treatment should only be given with the parent’s informed consent. If I were given another chance to work with the client, I would ask the instructor and the school’s disciplinary staff for information so that I could create a more thorough diagnosis and treatment plan.

 References

Healthy People 2030. (n.d.). Mental Health and Mental Disordershttps://health.gov/healthypeople/objectives-and-data/browse-objectives/mental-health-and-mental-disorders

Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing.

Mohan, L., Yilanli, M., & Ray, S. (2017). Conduct disorder. In: StatPearls [Internet]. StatPearls Publishing.

Aggarwal, A., & Marwaha, R. (2022). Oppositional Defiant Disorder. In StatPearls [Internet]. StatPearls Publishing.

Magnus, W., Nazir, S., & Anilkumar, A.C. (2023). Attention Deficit Hyperactivity Disorder. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Wozniak, J., Wilens, T., DiSalvo, M., Farrell, A., Wolenski, R., Faraone, S. V., & Biederman, J. (2019). Comorbidity of bipolar I disorder and conduct disorder: a familial risk analysis. Acta psychiatrica Scandinavica139(4), 361–368. https://doi.org/10.1111/acps.13013

Zhang, J., Liu, W., Zhang, J., Wu, Q., Gao, Y., Jiang, Y., Gao, J., Yao, S., & Huang, B. (2018). Distinguishing Adolescents With Conduct Disorder From Typically Developing Youngsters Based on Pattern Classification of Brain Structural MRI. Frontiers in human neuroscience12, 152. https://doi.org/10.3389/fnhum.2018.00152

 
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Girl with ADHD

Girl with ADHD

Girl with ADHD

Introduction to the Case

The case is of an 8-year-old Caucasian female presenting at the office accompanied by the father and the mother, who report that they have been referred to seek advice after the patient’s teacher suggested she might have ADHD. Per their primary care provider, the patient should be examined by a mental health practitioner to ascertain the condition. The parents shared the teacher-filled Conner’s Teacher Rating Scale-Revised, which indicated that the patient is inattentive, easily distracted, forgetful, and poor in reading, spelling, and arithmetic. She has a short attention span unless it is something she is interested in. The patient has no interest in school work and is easily distracted, never finishing what she started or following instructions. The patient does not complete her schoolwork. The parents do not believe the patient has ADHD because she is not “running around like a wild person, defiant, or have temper outbursts.”

(Girl with ADHD)

The assessment data indicates the patient does not see the issue as a big deal as she is “OK” in school and prefers art and recess. The patient perceives other subjects as boring or hard and feels lost sometimes. She admits to her mind wandering during class to things she enjoys and would sometimes think about nothing, and when the teacher calls her name, she would not remember what they were talking about. She perceives her life as just fine, loves her parents because they are good and kind to her, denies any abuse or bullying at school, and has no other current concern. The mental status exam indicates that the patient is well-developed for her age, and speech is clear, coherent, logical, and appropriately oriented to person, place, time, and event. Her dressing is appropriate for the weather and time of year, and her mannerism, gestures, and tics are noteworthy. She indicates a euthymic mood, bright affect, and no visual or auditory hallucinations, delusions, or paranoia. Her attention and concentration are grossly intact, insight and judgement appropriate, and has no suicidal or homicidal ideation.

Decision #1

Ritalin is the initial treatment for the patient’s ADHD for this patient. Ritalin led to the patient’s improved academic performance, although her attention declined as the day progressed. Per the guidance, the discontinuation of the drug would have the same side effects, and the side effects would wear off with time. Research shows that Ritalin has favorable effects on ADHD symptoms, especially in reducing hyperactivity and impulsivity (Verghese & Abdijadid, 2022). The drug is FDA-approved, and the prescription is appropriate for children 6 years and older.

The other two drug options were Adderall and Intuniv. Adderall was rejected because it has similar side effects as Ritalin, and shifting to it would not change the current state. Ritalin also reaches peak levels quicker than Adderall. Additionally, Adderall leads to loss of appetite, stomach upset, headache, fever, diarrhea, and nervousness (Brown et al., 2018). Intuniv has significant side effects like sedation, which is not favorable for a school-going child because it would be challenging to maintain concentration and attention throughout the day (Harricharan & Adcock, 2018). Intuniv also causes low blood pressure, dry mouth, irritability, constipation, and decreased appetite.

(Girl with ADHD)

Administering Ritalin aimed at addressing the negative symptoms of ADHD, particularly hyperactivity and impulsivity. Ritalin has been indicated effectiveness in treating ADHD and has favorable effects on the symptoms (Verghese & Abdijadid, 2022). Improving the symptoms would help the patient perform better at school. On ethical considerations, working with a minor raises ethical concerns regarding autonomy, beneficence, and informed consent. Any treatment option should follow the parents’ preferences and consent. Minors cannot make autonomous decisions, hence the need to involve the parent throughout the treatment process. Additionally, the PMHNP should evaluate the drug selected and its potential effects on the patient, ensuring beneficence.

Decision #2

Wellbutrin is the second-choice treatment in this case. Results indicate a slight improvement in symptoms, although the patient reports decreased appetite, which is worsening. Research also shows that Wellbutrin can improve ADHD and decrease symptoms associated with the illness (Verbeeck et al., 2019). It is an appropriate non-stimulant drug for patients that cannot or will not take stimulant drugs because not all people are responsive to stimulants, and some cannot tolerate them.

The other two options not selected initially are Intuniv and Strattera. Sedation is one of the serious side effects of Intuniv, which is not favorable for a student since it would be difficult for them to focus and pay attention all day (Harricharan & Adcock, 2018). Low blood pressure, dry mouth, irritability, constipation, and decreased appetite are additional side effects of Intuniv (Harricharan & Adcock, 2018). Strattera is a good alternative to Wellbutrin, associated with significant side effects in children, particularly suicidal ideation (Fedder et al., 2022). However, Strattera can also lead to decreased appetite, headache, constipation, nausea, feeling sleepy and weak, and heart attack in severe cases.

(Girl with ADHD)

Administering Wellbutrin aimed at decreasing ADHD side effects. Wellbutrin has indicated effectiveness in treating ADHD, working as an antidepressant and non-competitive antagonist of nicotinic acetylcholine receptors (Verbeeck et al., 2019). It is anticipated that the patient’s ADHD would improve after taking Wellbutrin. Ethically, the provider must consider the side effects of administering Wellbutrin, particularly suicidal ideation, which presents potential harm to the patient. The provider must involve parents in critical decision-making and develop a drug therapy of preference per the patient’s response to the current drug therapy. The PMHNP must also disclose to the parents any additional risks associated with taking Wellbutrin.

Decision #3

The last treatment option is Intuniv, a non-stimulant treatment of ADHD, targeting oppositional behaviors. Intuniv can help improve focus and attention, controlling behavior, and manage hyperactivity and overactivity. Research shows significant improvement in subjective ADHD rating scales and scales in executive function for children and adolescents using Intuniv (Harricharan & Adcock, 2018). It is also appropriate for children with ADHD who are not adequately controlled with methylphenidate.

The other two options rejected were clonidine and Wellbutrin. Clonidine is more sedating than Intuniv, hence would not improve the current state. It can also lead to the patient developing depression, sleeping difficulties, constipation, and feeling weak, tired, and sleepy (Yasaei & Saadabadi, 2022). Wellbutrin is a good alternative but has considerable side effects and is associated with a high treatment discontinuation due to increased risk to the patient as it leads to suicidal ideation (Huecker et al., 2022). It can also cause rhinitis, tachycardia, weight loss, dizziness, and tremors.

(Girl with ADHD)

Prescribing Intuniv is aimed at improving ADHD symptoms, especially focus, attention, controlling behavior, and managing hyperactivity and overactivity. The prescription also aimed to avoid side effects associated with stimulant drugs when treating ADHD in children. Intuniv indicates effectiveness in relieving ADHD symptoms; hence recommended as the third option (Harricharan & Adcock, 2018). It is ethical practice to consider drug-drug interaction when prescribing Intuniv to ensure no harm due to complications. The PMHNP should also disclose the drug’s risks and benefits to the parent and elaborate on effective monitoring areas to report during follow-up. Any treatment decision should follow the parents’ consent and preferences, given the patient is a minor.

Conclusion

The initial purpose of recommending each drug is to improve SDHD symptoms, help the patient be more focused and attentive in school and bolster memory and behaviors such as completing school work and any activity she started. The patient’s ADHD is initially being treated with Ritalin. The patient’s academic performance increased as a result of taking Ritalin, but her attention started to wane as the day went on. According to the instructions, stopping the medicine would have the same negative effects, but they would eventually go away. Ritalin has been shown to improve ADHD symptoms, particularly by lowering impulsivity and hyperactivity (Verghese & Abdijadid, 2022). The prescription is authorized for children aged 6 and older, and the medication is FDA-approved.

The second-choice treatment in this instance is Wellbutrin. Results show a little improvement in symptoms; however, the patient is reporting a worsening loss in appetite. According to research, Wellbutrin can treat ADHD symptoms and improve the condition overall (Verbeeck et al., 2019). Because not everyone responds to stimulants and some individuals cannot tolerate them, it is a suitable non-stimulant medication for patients who cannot or will not take stimulant medications. Intuniv, a non-stimulant medication for ADHD that focuses on oppositional behaviors, is the final option for treatment. The use of Intuniv can help regulate hyperactivity and overactivity as well as increase focus and attention. According to research (Harricharan & Adcock, 2018), Intuniv significantly improves executive function and subjective ADHD rating scales for kids and teenagers. It is also suitable for kids with ADHD whose symptoms are not sufficiently managed by methylphenidate.

References

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational pediatrics7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02

Fedder, D., Patel, H., & Saadabadi, A. (2022). Atomoxetine. In StatPearls [Internet]. StatPearls Publishing.

Harricharan, S., & Adcock, L. (2018). Guanfacine hydrochloride extended-release for attention deficit hyperactivity disorder: a review of clinical effectiveness, cost-effectiveness, and guidelines.

Huecker, M.R., Smiley, A., Saadabadi, A. (2022). Bupropion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470212/

Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2019). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews10(10), CD009504. https://doi.org/10.1002/14651858.CD009504.pub2

Verghese, C., & Abdijadid, S. (2022). Methylphenidate. In StatPearls [Internet]. StatPearls Publishing.

Yasaei, R., & Saadabadi, A. (2022). Clonidine. In StatPearls [Internet]. StatPearls Publishing.

 
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Personal Perspective About Experience with Course Content

Personal Perspective About Experience with Course Content

The course content has been student-centered, descriptive, and outcome-based, helping learners focus on the end goals and objectives. The course has adopted multiple teaching and evaluation methodologies to engage learners and reinforce their understanding of course concepts. The experience with the course content has been amazing so far, but also challenging. I have struggled to understand some concepts, derailing efforts towards achieving Student Learning Objectives (SLOs). Some medical terms, anatomy, and therapeutic and diagnostic procedures are complex and require maximum input to understand and memorize them. Achieving this objective requires super engagement with course materials and internet sources.

(Personal Perspective About Experience with Course Content)

Personal Perspective About Experience with Course Content

I enjoyed learning about the history of medical coding classification systems used by healthcare organizations in the United States, including ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. Understanding the history is critical for medical billing and coding. All areas of the healthcare dynamics are governed by legal, ethical, and regulatory requirements. This course provided knowledge and insights into the legal, ethical, and regulatory requirements attached to the processes around medical record coding, billing, and reimbursement. Understanding these aspects is fundamental to the medical professional because medical billing, coding, and reimbursement are part of the practice and should be executed per the guidelines. I have also learned about the education, responsibilities and scope of practice of healthcare leaders’ roles in providing oversight of clinical departments and healthcare organizations. The course materials have been comprehensive in this regard, bolstering understanding and enhancing experience, which is vital for future careers.

 
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