NR 668 – Week 6 Advanced Psychiatric Concepts, Psychiatric Mental Health Nurse Practitioner
Course, Lecture Summary and Clinical Applications
ADHD - ✔✔-long-term disorder characterized by either hyperactivity & impulsivity or
inattention
-affect the development of proper cognitive, behavioral, emotional, social, & academic function
-Symptoms of the hyperactivity & impulsivity subtype:
• excessive fidgeting or talking, feelings of restlessness & impatience, frequent interruption,
difficultly playing quietly
• reach peak severity when the child is around 8 years of age
-symptoms of inattentive subtype
• difficulty organizing tasks, maintaining a routine, paying attention to detail
• Children may avoid tasks that are intellectually challenging, resulting in poor academic or
cognitive performance
• may not be distinguishable until 8-9 years of age
-primarily disrupts neuronal connections within the frontal lobe & prefrontal cortex
FDA approved medications for ADHD - ✔✔Stimulants
-Methylphenidate
• Azstaryz
• Concerta
• Focalin
• Jornay PM
• Metadate CD or ER
• Ritalin
-Amphetamine
• Adderall
,• Adzenys ER or XR-ODT
• Dexedrine
• Vyvanse
Non-stimulants
-Norepinephrine reuptake inhibitors
• Strattera
• Qelbree
-Alpha agonist
• Kapvay
• Intuniv
https://chadd.org/wp-content/uploads/2021/09/ADHD-MEDICATIONS-APPROVED-BY-THE-US-
FDA-2021.pdf
Behavior Management: Parent training - ✔✔-What parents learn when trained in behavior
therapy
• Positive Communication
• Positive Reinforcement
• Structure & Discipline
Seamus is a 13-year-old who was referred to the psychiatric mental health nurse practitioner
(PMHNP) by a family court judge for evaluation. Seamus was arrested after breaking into several
cars on his street overnight and stealing loose change and small electronics. Seamus's parents
endorse that he has had problems since he was a young boy. Starting in kindergarten, he has
had "anger management" issues and argues with his parents and with teachers. He has difficulty
sitting still in the classroom and was frequently disciplined for interrupting teachers, talking
constantly, and running in the halls. At home, he often exhibits vindictive behavior towards his
siblings and blames them for his actions. His parents describe him as "driven by a motor." He is
,irritable most of the time. He has never liked school and has struggled academically since first
grade. He was suspended twice in elementary school for bullyi - ✔✔yes
Rationale: symptoms consistent with ODD include anger and irritability, argumentative and
vindictive behavior, and blaming others.
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for conduct disorder?
yes
no
unable to determine - ✔✔yes
Rationale: Symptoms consistent with conduct disorder include a history of repetitive, persistent
behavior that violates societal norms within the past twelve months, including bullying, fighting,
vandalism, theft, and truancy.
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for intermittent explosive
disorder?
yes
no
unable to determine - ✔✔no
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for ADHD?
yes
no
unable to determine - ✔✔yes
, Rationale: His symptoms consistent with ADHD include "non-stop" energy, speaking out of turn,
talkativeness, excessive running, and interrupting others. The behaviors occur in school and at
home and have been present consistently for several years. His behaviors have negatively
impacted his academic performance to the extent that he has been expelled from school.
Fetal alcohol spectrum disorder (FASD) - ✔✔-Cognitive
• Problems with memory & learning, especially math
• Poor reasoning & limited executive function
• Problems with attention
• Intellectual disability
-Physical
• Prenatal growth deficits
• Poor motor skills & coordination
• Vision & hearing problems
• Problems with heart, bones, kidneys
• Short stature & low body weight
• Small head size
• Abnormal facial features
-Behavioral problems
• Poor social skills
• Poor emotional control
• Impulsivity
• Hyperactivity
Course, Lecture Summary and Clinical Applications
ADHD - ✔✔-long-term disorder characterized by either hyperactivity & impulsivity or
inattention
-affect the development of proper cognitive, behavioral, emotional, social, & academic function
-Symptoms of the hyperactivity & impulsivity subtype:
• excessive fidgeting or talking, feelings of restlessness & impatience, frequent interruption,
difficultly playing quietly
• reach peak severity when the child is around 8 years of age
-symptoms of inattentive subtype
• difficulty organizing tasks, maintaining a routine, paying attention to detail
• Children may avoid tasks that are intellectually challenging, resulting in poor academic or
cognitive performance
• may not be distinguishable until 8-9 years of age
-primarily disrupts neuronal connections within the frontal lobe & prefrontal cortex
FDA approved medications for ADHD - ✔✔Stimulants
-Methylphenidate
• Azstaryz
• Concerta
• Focalin
• Jornay PM
• Metadate CD or ER
• Ritalin
-Amphetamine
• Adderall
,• Adzenys ER or XR-ODT
• Dexedrine
• Vyvanse
Non-stimulants
-Norepinephrine reuptake inhibitors
• Strattera
• Qelbree
-Alpha agonist
• Kapvay
• Intuniv
https://chadd.org/wp-content/uploads/2021/09/ADHD-MEDICATIONS-APPROVED-BY-THE-US-
FDA-2021.pdf
Behavior Management: Parent training - ✔✔-What parents learn when trained in behavior
therapy
• Positive Communication
• Positive Reinforcement
• Structure & Discipline
Seamus is a 13-year-old who was referred to the psychiatric mental health nurse practitioner
(PMHNP) by a family court judge for evaluation. Seamus was arrested after breaking into several
cars on his street overnight and stealing loose change and small electronics. Seamus's parents
endorse that he has had problems since he was a young boy. Starting in kindergarten, he has
had "anger management" issues and argues with his parents and with teachers. He has difficulty
sitting still in the classroom and was frequently disciplined for interrupting teachers, talking
constantly, and running in the halls. At home, he often exhibits vindictive behavior towards his
siblings and blames them for his actions. His parents describe him as "driven by a motor." He is
,irritable most of the time. He has never liked school and has struggled academically since first
grade. He was suspended twice in elementary school for bullyi - ✔✔yes
Rationale: symptoms consistent with ODD include anger and irritability, argumentative and
vindictive behavior, and blaming others.
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for conduct disorder?
yes
no
unable to determine - ✔✔yes
Rationale: Symptoms consistent with conduct disorder include a history of repetitive, persistent
behavior that violates societal norms within the past twelve months, including bullying, fighting,
vandalism, theft, and truancy.
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for intermittent explosive
disorder?
yes
no
unable to determine - ✔✔no
According to the DSM-5-TR, does Seamus meet the diagnostic criteria for ADHD?
yes
no
unable to determine - ✔✔yes
, Rationale: His symptoms consistent with ADHD include "non-stop" energy, speaking out of turn,
talkativeness, excessive running, and interrupting others. The behaviors occur in school and at
home and have been present consistently for several years. His behaviors have negatively
impacted his academic performance to the extent that he has been expelled from school.
Fetal alcohol spectrum disorder (FASD) - ✔✔-Cognitive
• Problems with memory & learning, especially math
• Poor reasoning & limited executive function
• Problems with attention
• Intellectual disability
-Physical
• Prenatal growth deficits
• Poor motor skills & coordination
• Vision & hearing problems
• Problems with heart, bones, kidneys
• Short stature & low body weight
• Small head size
• Abnormal facial features
-Behavioral problems
• Poor social skills
• Poor emotional control
• Impulsivity
• Hyperactivity
