Treatment Of Psychiatric Emergencies In Children Vers 339593

Treatment of Psychiatric Emergencies in Children Versus Adults

We are presented with an adult woman with a history of chronic pain and thyroid disease, presenting with severe depression and suicidal ideation. The patient had periods of severe anger towards her husband because of his alleged lack of emotional support and love. When she engaged in self harm to gain his attention, the husband’s response was not to offer the emotional attention and love, but rather to arrange for commitment of his wife to the inpatient psychiatric unit. Treatment of this patient starts with ruling out of any life threatening organic causes of the patient’s behavior, such as; hypoglycemia, hypoxia, thyroid, liver or kidney dysfunction.

After medical clearance, this patient requires emergency psychiatric evaluation to determine the true level of suicide risk (Monnens, 2005, p. ). If this were a child or adolescent, the treatment also getting the patient medically cleared prior to psychiatric evaluation. These patients who have psychiatric disorders that impair emotional, cognitive, physical, and/or behavioral functioning are evaluated in the context of the family, school, community, and culture (Garson & Havens, 2015; Wharff, Ginnis, & Ross, 2012). Most of their identified signs and symptoms with their associated impairments in developmental functioning respond to established treatments (Chun, Katz, Duffy, & Gerson, 2015). The psychiatric evaluator must prioritize symptoms and diagnosis so that a reasonable treatment plan will address multiple problems.

Ethically, similar rules apply to all children up to age 18 years. Parents must consent to treatment but children may agree or disagree (Sondheimer & Jensen, 2009). When guardian and child agree, care can proceed smoothly, and when they disagree, fundamental ethical considerations is required. Because safety of the child is important (beneficence and nonmaleficence), guardian and/or child opposition to psychiatric intervention is disregarded in the event of imminent danger. When, parent’s consent and children disagrees, the same principles are used as a basis for reasoning, but because of developmental dissimilarities they will be applied differently (justice) (American Academy of Child and Adolescent Psychiatry (2009).

Paper For Above instruction

The management of psychiatric emergencies varies significantly between adults and children, owing to differences in developmental stages, legal considerations, and ethical principles. A comprehensive understanding of these differences ensures appropriate, ethical, and effective care in emergency psychiatric situations. This essay compares the treatment approaches for adult and pediatric psychiatric emergencies, emphasizing key legal and ethical considerations, and illustrates these points through a hypothetical case scenario.

Case Description

Consider an adult woman presenting with severe depression and suicidal ideation. She has a history of chronic pain and thyroid disease and exhibits episodes of intense anger and self-harm behaviors aimed at garnering emotional attention from her spouse. Emergency intervention involves ruling out organic causes such as hypoglycemia and thyroid dysfunction, followed by psychiatric assessment to evaluate suicide risk. The initial step includes medical clearance, crucial for identifying potentially life-threatening physical illnesses that may precipitate or exacerbate psychiatric symptoms, consistent with standards outlined by Monnens (2005). Upon stabilization and medical clearance, psychiatric evaluation prioritizes the immediate safety concerns, risk assessment, and formulation of an emergency treatment plan.

Differences in Treatment Approaches

While adult psychiatric emergency management emphasizes immediate stabilization, risk assessment, and initiation of pharmacological or psychotherapeutic interventions, treatment modalities for children and adolescents must incorporate developmental considerations. For pediatric patients, the treatment approach involves not only addressing the psychiatric symptoms but also evaluating functioning in family, school, and social contexts (Garson & Havens, 2015). The involvement of family members is vital, as family-based interventions have shown to improve compliance and outcomes in young patients (Wharff, Ginnis, & Ross, 2012).

In adults, consent procedures focus primarily on the individual’s autonomy. In contrast, pediatric emergencies necessitate navigating complex legal and ethical frameworks. Parental consent is mandatory for minors, but the child's assent or dissent must also be considered, respecting the developing autonomy of the minor (Sondheimer & Jensen, 2009). When disagreements arise between guardian and child regarding treatment, ethical principles such as beneficence, nonmaleficence, and justice guide clinicians to weigh the child's safety against respect for burgeoning independence. In situations where imminent danger exists, clinicians may proceed with treatment despite parental or child opposition, consistent with the ethical guidelines provided by the American Academy of Child and Adolescent Psychiatry (2009). An example includes intervening against a child's wishes to prevent suicide or harm to others.

Legal and Ethical Considerations

Legal frameworks delineate the boundaries of emergency psychiatric intervention. For adults, informed consent and capacity assessments are central, and involuntary hospitalization requires meeting criteria such as imminent danger to self or others, per laws like the Mental Health Parity Act and state statutes (Gerson & Havens, 2015). Pediatric patients, however, are protected by additional legal statutes such as the Parens Patriae doctrine, which allows for involuntary treatment if the child's safety is at risk, even without parental consent under certain circumstances (Sondheimer & Jensen, 2009).

Ethically, pediatric emergency care must balance respect for the minor’s developing autonomy with the obligation to prevent harm. The principle of beneficence mandates acting in the child's best interest, justifying involuntary interventions when necessary to prevent imminent self-harm or harm to others. Nonmaleficence emphasizes minimizing harm through appropriate, minimally intrusive measures. Justice directs equitable treatment, ensuring that minors receive care comparable to adults when warranted by their condition (American Academy of Child and Adolescent Psychiatry, 2009).

Conclusion

In summary, treatment of psychiatric emergencies must be tailored to the patient's age, developmental status, and legal-ethical context. While adults have autonomy that facilitates direct consent, minors require a nuanced approach respecting parental authority and their emerging independence. Both require prompt assessment, stabilization, and ethically responsible intervention, but the strategies and legal frameworks differ substantially. Ethical principles such as beneficence and nonmaleficence underpin all interventions, with particular importance placed on safeguarding minors in emergency settings.

References

• American Academy of Child and Adolescent Psychiatry. (2009). Code of Ethics. Retrieved from https://www.aacap.org
• Garson, J., & Havens, J. (2015). The child and adolescent psychiatric emergency: A public health challenge. Psychiatric Times, 32(11).
• Gerson, R., & Havens, J. (2015). Psychiatric emergencies in youth. Psychiatric Times.
• Monnens, J.B. (2005). Mental health emergencies. In L. Newberry & L.M. Criddle (Eds.), Sheehy’s Manual of Emergency Care (6th ed.). Elsevier, Mosby.
• Sondheimer, A., & Jensen, P. (2009). Ethics and child adolescent psychiatry. In S. Bloch & S. Green (Eds.), Psychiatric Ethics (4th ed.). Oxford University Press.
• Wharff, E.A., Ginnis, K.M., & Ross, A.M. (2012). Family-based crisis intervention with suicidal adolescents in the emergency room. Social Work, 57(2).