Response 1

Nice post. Interesting to learn that children presenting with bipolar disorder spend more time in the mixed state with symptoms depression and hyperactivity. In contrast to adults who commonly present with periods of either mania or depression with periods of remission which makes it easier to diagnose than children and adolescents (Suppes, 2021). I knew that atypical antipsychotics would be the drug of choice but the treatment seems very similar to adults and with the side effects being metabolic syndrome, they have to be monitored so closely as it can be detrimental to their lives and predispose them to hyperlipidemia and diabetes (Stahl, 2013). Reading about the children and adolescents with bipolar disorder risk of increased suicidal ideation, attempts, and substance use makes me feel really sad and realize that their childhood is going to be more complicated and challenging than it already is. This not only creates a stressful environment for them to grow up in but for their parent and guardians which is why family focused therapy is crucial, as you have mentioned (Miklovich & Chung, 2016). References Miklowitz, D. J., & Chung, B. (2016). Family-focused therapy for bipolar disorder: reflections on 30 years of research. Family Process, 55(3), 483–499. https://doi.org/10.1111/famp.12237 Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press. Suppes, T. (2021, February 18). UpToDate. https://www.uptodate.com/contents/bipolardisorder-in- adults-assessment-and-diagnosis ?search=bipolar%20diagnosis% 20in%20 adults&source =search_ result&selectedTitle=1~ 150&usage_type= default&display_rank=1#H 975421

Response 2

Great job on your project! It was very informative and detailed. I am well attuned to adult generalized anxiety. I work with the adult population and have very little experience with pediatric anxiety. I was not aware that in order to be given a diagnosis of generalized anxiety disorder, that the anxiety had to occur for longer than six months. This presents questions in regard to how acute episodes of anxiety are handled in the pediatric population. I will need to do further research to see how an acute episode of anxiety would be treated. I was not aware that there were specific screening tools for child and adolescent anxiety. This would be beneficial because the screening tool can be designed in a way easy for the patient to understand. This is also beneficial because the symptoms of anxiety differ in children verse adult populations. You stated that children have more difficulty controlling worry. I find this sad because children also have reduced coping skills and are unable to regulate emotions as well as adults. Pediatric anxiety is on the rise and is becoming a more common complaint brought up to practitioners. It often presents with many symptoms that differ and some symptoms may be mistaken for other illnesses (Crowe, K., & Spiro-Levitt, C., 2021). Pharmacological treatment is often not the only treatment available for pediatric patients. There are many types of psychotherapy that are also beneficial for pediatric populations. If anxiety is caused by particular situations or places, exposure therapy has been deemed effective (Gervasio, M., & Herren, J., 2020). REFERENCES: Crowe, K., & Spiro-Levitt, C. (2021). Sleep-Related Problems and Pediatric Anxiety Disorders. Child and Adolescent Psychiatric Clinics of North America, 30(1), 209–224. https://doi.org/10.1016/j.chc.2020.09.004 Gervasio, M., & Herren, J. (2020). Managing emergent life events in exposure therapy for pediatric anxiety. Brown University Child & Adolescent Behavior Letter, 36(9), 1–4. https://doi.org/10.1002/cbl.30485 Peris, T. S., & Rozenman, M. (2019). Assessment of pediatric anxiety. In S. N. Compton, M. A. Villabø, & H. Kristensen (Eds.), Pediatric anxiety disorders. (pp. 301–316). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-813004-9.00014-1

Patient 1 response

Hi , Your explanation of the immunization plans that you stated you would initiate for these two children sounds like an effective way to manage their vaccination regimen. Being able to differentiate patient specific regimens and immunization plans is important for a provider to understand. There are scenarios and situations where parents are unable to get their child in for a vaccination to complete a series and most patients do not follow the CDC guidelines to an absolute “t”. It is important to be flexible and continue to educate on the importance of vaccines, but not make a patient or parent feel as if they are neglecting their child’s health.There have been numerous occasions that I have had to discuss immunizations with parents. Working in an obstetric unit, infants receive their first dose of Hepatitis B vaccine within the first 24 hours of life. Every patient that I encounter chooses whether or not they would like to receive this vaccine. When a patient declines, it is important to educate them on the importance of this vaccination and provide pertinent information in layman terms. For example, often times parents will stated “I will get it at their first pediatric appointment”. Obviously receiving the vaccine is better than not receiving the vaccine, however, to achieve the most effective immunity from Hepatitis B, CDC (2020) explains that it is important for the infant to receive this vaccine prior to 24 hours of age (CDC, 2020). By providing them with this information and reiterating that this would mean that they would only receive one vaccine at this time would be effective to monitor the infant for any adverse reactions. Suggestions to deal with misinformation on this topic is to have resources that are accessible. Often, patients will respond well if they have the informational materials in front of them and presented without bias. For example, Whitford (2018) and colleagues explains that perinatal HBV transmission is much higher in infants that received the dose late or did not receive all three doses of the series (Whitford et al., 2018). Brief points and explanations are effective to educate parents to encourage vaccination. To summarize, many children have different vaccination schedules and schedules should be personalized. By removing bias, parents often will listen and take things into consideration related to vaccinating their children.ReferencesCDC. (2020). Viral hepatitis: vaccination of infants, children, and adolescents. Retrieved from https://www.cdc.gov/hepatitis/HBV/VaccChildren.htmWhitford, K., Liu, B., Micallef, J., Yin, J. K., Macartney, K., Van Damme, P., & Kaldor, J. M. (2018). Long-term impact of infant immunization on hepatitis B prevalence: a systematic review and meta-analysis. Bulletin of the World Health Organization, 96(7), 484–497. https://doi.org/10.2471/BLT.17.205153

Patient 3 response

Thank you for your post. You provided some good factual information regarding the influenza vaccine and the recommendations for those who may be at increased risk for infection including children and older adults. According to your post vaccinations such as influence help decrease the risk of contagious illness in these age groups (Munnoch, Cashman, Peel, Attia, Hure, & Durrheim, 2019). It is important to educate these age groups on the illnesses that pose them at a greater risk and ways to protect them self through vaccination and other infection prevention measures such as staying away from those who feel ill and proper hand washing. In my line of work in the neonatal ICU I frequently educate families on vaccinations and providing accurate information surrounding vaccination risk and benefits. Providing the families with the vaccination schedule and showing them how vaccinating their children can protect them from various illness has had a positive impact on my experience when getting consent for infant vaccinations. The vaccination schedule also provide families with the ability to see how providing their infant with combination vaccinations allows them to have less shots overall (2020). It has also been important to educate the families on ways they can protect there infant through vaccinating themselves through community or herd immunity which provides coverage to those who may not be able to receive certain vaccinations such as newborns (2020). Education and honest is key when providing factual and not opinion information on vaccinations, risk, and benefits.ReferencesBirth-18 Years Immunization Schedule. (2020, February 03). Retrieved July 15, 2020, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.htmlMunnoch, S. A., Cashman, P., Peel, R., Attia, J., Hure, A., & Durrheim, D. N. (2019). Participant-Centered Online Active Surveillance for Adverse Events Following Vaccination in a Large Clinical Trial: Feasibility and Usability Study. Journal of medical Internet research, 21(10), e14791. https://doi.org/10.2196/14791Vaccines Protect Your Community. (2020). Retrieved July 15, 2020, from https://www.vaccines.gov/basics/work/protection