due 10-12-23@10am

Advanced Psychopharmacology and Health Promotion

Unit 9 peer response. ADHD Medications. 800W. APA. 4 references due 10-30-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Mihaela

Unit 9 – ADHD Medications

1.
What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

One commonly used screening tool is the Adult ADHD Self-Report Scale (ASRS). The ASRS consists of a series of questions that evaluate both inattentive and hyperactive-impulsive symptoms (Anbarasan et al., 2020). Another useful screening tool is the Conners' Adult ADHD Rating Scales (CAARS), which assesses various domains affected by ADHD, such as attention problems, hyperactivity/impulsivity, and executive functioning (Smyth et al., 2019).

2.
Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Once it is confirmed through further assessment that Mr. Deliver meets the criteria for ADHD, inattentive type, the current recommendation for pharmacological treatment would typically involve stimulant medications such as methylphenidate or amphetamine derivatives. These medications have consistently shown efficacy in improving attention, reducing impulsivity, and enhancing executive functions in adults with ADHD (Farhat et al., 2022). Non-stimulant options like atomoxetine or viloxazine (norepinephrine modulator) may also be considered if there are contraindications or intolerance to stimulants (Mechler et al., 2022). However, considering Mr. Deliver's concerns about stigma and psychotropic medications' risks, it may be worth discussing non-pharmacological interventions as well. Cognitive-behavioral therapy (CBT) has demonstrated efficacy in managing symptoms of adult ADHD. CBT can help Mr. Deliver develop strategies to improve organization skills, time management, and enhance his ability to focus on tasks (Young et al., 2020).

3.
Assume that instead of Mr. Deliver being 36 years old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

In the case of Thomas, a 13-year-old boy diagnosed with ADHD hyperactive type who is not currently taking any medications, the most probable treatment approach would involve the use of stimulant medications. According to the American Academy of Pediatrics (AAP), stimulant medications like methylphenidate are recommended as first-line treatment options for children and adolescents with ADHD, as they have been shown effective in reducing symptoms and improving functioning (Shrestha et al., 2020). However it is important to monitor growth and potential side effects in pediatric patients (Vertessen et al., 2023).

References

Anbarasan, D., Kitchin, M., & Adler, L. A. (2020). Screening for adult adhd. 
Current Psychiatry Reports, 
22(12). 

https://doi.org/10.1007/s11920-020-01194-9Links to an external site.

Farhat, L. C., Flores, J. M., Behling, E., Avila-Quintero, V. J., Lombroso, A., Cortese, S., Polanczyk, G. V., & Bloch, M. H. (2022). The effects of stimulant dose and dosing strategy on treatment outcomes in attention-deficit/hyperactivity disorder in children and adolescents: A meta-analysis. 
Molecular Psychiatry, 
27(3), 1562–1572. 

https://doi.org/10.1038/s41380-021-01391-9Links to an external site.

Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for adhd in children and adolescents. 
Pharmacology & Therapeutics, 
230, 107940. 

https://doi.org/10.1016/j.pharmthera.2021.107940Links to an external site.

Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: A review. 
Translational Pediatrics, 
9(S1), S114–S124. 

https://doi.org/10.21037/tp.2019.10.01Links to an external site.

Smyth, A. C., & Meier, S. T. (2016). Evaluating the psychometric properties of the conners adult adhd rating scales. 
Journal of Attention Disorders, 
23(10), 1111–1118. 

https://doi.org/10.1177/1087054715624230Links to an external site.

Vertessen, K., Luman, M., Swanson, J. M., Bottelier, M., Stoffelsen, R., Bet, P., Wisse, A., Twisk, J. R., & Oosterlaan, J. (2023). Methylphenidate dose–response in children with adhd: Evidence from a double-blind, randomized placebo-controlled titration trial. 
European Child & Adolescent Psychiatry. 

https://doi.org/10.1007/s00787-023-02176-xLinks to an external site.

Young, Z., Moghaddam, N., & Tickle, A. (2016). The efficacy of cognitive behavioral therapy for adults with adhd: A systematic review and meta-analysis of randomized controlled trials. 
Journal of Attention Disorders, 
24(6), 875–888. 

https://doi.org/10.1177/1087054716664413Links to an external site.

Ruth

Unit 9: Initial Discussion ADHD Medications

What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neuropsychiatric disorder of childhood, with impairing symptoms persisting into adulthood in approximately 70% of cases. Several screening tools are available to help providers identify and diagnose ADHD. The World Health Organization (WHO) Adult ADHD Self-Report Scale Part A is the most commonly used screening tool for ADHD cases in adults. The tool is available in national and international ADHD guidelines.  The screening tool contains six questions that cover inattentive and hyperactive-impulsive symptoms. It also includes a threshold of four or more, which is used for probable ADHD.  The score is calculated according to the number of questions that meet the criteria: sometimes endorsing/often/very often for questions 1–3 and endorsing usually/very often for questions 4–6. However, this screening, even if the patient is positive, may not have an active diagnosis of ADHD; further evaluation is required to ensure symptoms are related to ADHD diagnosis (Chamberlain et al., 2021). 

Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

According to his age and diagnosis, the current recommendation for this patient will be amphetamine 12.5 mg daily. Recommend that the patient start CBT and encourage exercise. A study showed that ADHD drugs are more effective and tolerated by children and adolescents than adults; the reason for this discrepancy is unknown. Amphetamines, methylphenidate, atomoxetine, and modafinil cause weight loss in children, adolescents, and adults. Amphetamines and atomoxetine increased blood pressure in children and adolescents, and methylphenidate increased blood pressure in adults. Methylphenidate showed better symptom control with the most minor side effects for children and adolescents, and amphetamines produced the best results for adults (Gupta, 2018). 

Reference:

Chamberlain, S. R., Cortese, S., & Grant, J. E. (2021). Screening for adult ADHD using brief rating tools: What can we conclude from a positive screen? Some caveats. 
Comprehensive Psychiatry, 
106, 152224. https://doi.org/10.1016/j.comppsych.2021.152224

Gupta, S. (2018). Best First-Line ADHD Medications for Children, Adults: Study Results. 
Attitude. https://www.additudemag.com/adhd-drugs-methylphenidate-vs-amphetamine-treatment/

Mayo Clinic. (2023). Amphetamine (Oral Route). 

https://www.mayoclinic.org/drugs-supplements/amphetamine-oral-route/proper-use/drg-20150941Links to an external site.

 

 

Post an explanation of how you anticipate enacting personal and professional commitment for advocacy to positively impact your patients, communities, and the profession. Be specific. Then, explain how your role as a DNP-prepared nurse contributes to advocacy for positive social change.

1. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031In the nursing profession, advocating for our patients is something that is deeply ingrained in us.  One of the five key areas of the social determinants of health is access to healthcare (Centers for Disease Control and Prevention, 2021).  Unfortunately, approximately one in ten patients do not have health insurance (Berchick et al., 2018).  In the field of mental health, we often see patients who are too disorganized to navigate the health insurance system and experience lapses in insurance.  In Massachusetts, we are required to abide by the Expedited Psychiatric Inpatient Admissions (EPIA) Policy, which mandates that “no individual boarding in an ED waiting placement in a psychiatric hospital will wait more than 96 hours before Department of Mental Health has been notified, regardless of whether the individual is uninsured or has coverage not regulated by Division of Insurance” (Executive Office of Health and Human Services, 2023).  The pressure to decompress emergency rooms and move psychiatric patients out as quickly as possible means that we often receive patients who are uninsured.  In order to help our patients get the services they need, nurses and social workers assist our patients in taking the necessary steps to obtain health insurance.  This often means lengthy phone wait times on phone calls, but as advocates, we do what is necessary to ensure positive outcomes for our patients.   

                                                                     Advocacy in my Community

As an agent of positive change, I will advocate at the community level for residents who suffer from mental illness.  In spite of the “growing recognition of the burden associated with mental illnesses and the availability of cost-effective treatments, they are not yet afforded the same policy or program priority as comparably disabling physical conditions” (Stuart, 2017).  I aim to increase access to mental health services by expanding my organization’s service lines to include outpatient services for mental health and substance use disorders.  In order to gain buy-in from the community, I plan to attend town meetings to advocate for increased services as well as partnering with local Emergency Departments to educate them about the mental health services that my organization offers.  I plan to seek meetings with local politicians to advocate that resources be invested into increasing services for mental health and substance use disorder services. 

                                                                     Advocacy in my Profession

            According to a recent survey conducted by the American Psychiatric Nurses Association (APNA), “only 4% of licensed registered nurses (RNs) work in psychiatric-mental health, If that percentage is still consistent, then there are approximately 154,000 RNs working in psychiatric-mental health, which is not nearly enough to meet the demand” (APNA, 2018).  As a doctorally prepared nurse, it is critical that I take steps now to increase the number of nurses who specialize in mental health.  I aim to do this on the local level by partnering with local nursing schools to invite them into my organization for their psychiatric clinical rotations.  Additionally, I will attend local universities’ career fairs so that I can provide information to nursing students about the advantages of working in the field of mental health.

                                                                          Advocacy and Social Change

As a doctorally prepared nurse, I aim to help close the gaps in the inequities of access in the field of mental health.  To do so, I must first identify opportunities to advocate for my own patients by assisting them in obtaining health insurance so that they are able to have access to outpatient services.  At the community level, I aim to increase access to mental health services by expanding my organization’s service lines to include more outpatient services for psychiatry and substance use disorders.  With regard to the profession of nursing, specifically psychiatric nursing, it is imperative that I identify ways to increase interest for newly graduated RNs to join the field by promoting the field at local nursing schools.  By acting as an advocate on all three levels, I will be able to effect positive social change in the field of psychiatric nursing.

                                                                                   References

American Psychiatric Nurses Association. (2018). Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey. https://journals.sagepub.com/doi/abs/10.1177/1078390318777873?journalCode=japa

Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdfLinks to an external site. [PDF – 1.4 MB]

Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health. https://www.cdc.gov/socialdeterminants/index.htmLinks to an external site.

Executive Office of Health and Human Services. (2023). Expedited Psychiatric Inpatient Admissions (EPIA) Policy. https://www.mass.gov/info-details/expedited-psychiatric-inpatient-admissions-epia-policyLinks to an external site.

Stuart, H. (2017). Reducing the Stigma of Mental Illness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314742/

2. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031

• Week 5: The Theoretical/Conceptual Framework

 

Respond to two (2) of the following prompts:

1. How is masculinity described by the authors of our text? Using specific examples, discuss why patriarchal masculinity is not the only form of masculinity. (USLO 5.1, 5.3)
2. How is sexism explained by the authors of our text? Using specific examples, discuss how society propagates misogyny and objectification of women. (USLO 5.3)
3. Using one of the three theoretical primary sociological perspectives featured in our text (i.e., functionalism, conflict, and symbolic interactionism) discuss the social construction of gender. Present two tangible examples of how this theory best explains how gender is socially constructed. (USLO 5.4)
4. Where and how do you get your news? Do you watch network television? Read the newspaper? Go online? How about your parents or grandparents? Do you think it matters where you seek out information? Why, or why not? (USLO 5.5)
5. How have digital media changed social interactions? Do you believe it has deepened or weakened human connections? Defend your answer. (USLO 5.6)
6. Do you think technology has truly leveled the world in terms of opportunity? What is your community’s situation in terms of digital inclusion – do you feel there are communities in your region that are struggling to achieve digital inclusion and equity? What are some techniques that we may use to achieve digital equity and inclusion in the U.S.? (USLO 5.7)
7. In what ways has the Internet and digital apps changed your perception of reality? Explain using a symbolic interactionist, functionalist, and conflict theory perspective. (USLO 5.8)