Advanced Practice Psychiatric Nursing, Third Edition: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span

Graduate psychiatric-mental health nursing programs have rapidly expanded to increase the knowledge and skillbase while maintaining the core of their specialty—interpersonal, psychodynamic concepts within a holistic framework. These forces were the impetus for the first edition of Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span; with the goal of assisting in the organization of the thinking while broadening the perspective of practitioners, teachers, and students in advanced practice psychiatric nursing.Since the publication of the first edition of Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span, there has been increased research examining the onset and course of many psychiatric illnesses with the hope of increasing effectiveness of treatment as well as prevention. Combining this research with feedback from readers propelled the development of subsequent editions of the book. We were fortunate that many of the senior authors continued with this edition; we also added several new stellar clinicians and educators.This third edition continues to meet the practice standards developed by the American Psychiatric Nurses Association, International Society of Psychiatric-Mental Health Nurses, and American Nurses Association, which require all PMH-APRNs to have skills in psychotherapy, psychopharmacology, and holistic assessment. Cover Feedback Half Title: Advanced Practice Psychiatric Nursing Author Bio Book Title: Advanced Practice Psychiatric Nursing Copyright Contents Contributors Foreword to the First Edition Note on the Third Edition Preface Instructor Resources Section 1: The Dynamic Nature of Advanced Practice Psychiatric-Mental Health Nursing Chapter 1: Introduction‌‌‌‌‌ to the Development of Science HISTORICAL OVERVIEW OF THEORETICAL DEVELOPMENTS IN PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE COMMONLY USED THEORIES IN PSYCHIATRIC-MENTAL HEALTH PRACTICE NURSING THEORIES SPECIFIC TO PSYCHIATRIC NURSING INTERRELATIONSHIP BETWEEN THEORY AND RESEARCH DISTINCTIONS BETWEEN RESEARCH AND EVIDENCE-BASED PRACTICE EDUCATION FOR ADVANCED PRACTICE PSYCHIATRIC-MENTAL HEALTH NURSING CREDENTIALING OF PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE NURSES SUMMARY Chapter 2: Shared Decision-Making‌‌‌‌: Concordance Between Psychiatric-Mental Health OVERVIEW ADVANCED PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE CONCORDANCE IMPROVING CONCORDANCE SUMMARY Section 2: Foundations for Integrative Practice Chapter 3: Synergy of Integrative Treatment OVERVIEW RATIONALE FOR INTEGRATive TREATMENT THINKING ABOUT THE WORLD TRANSDIAGNOSTIC SYNDROMES EFFECTS OF INTEGRATIVE TREATMENT CONTINUUM OF TREATMENT INTERVENTIONS Chapter 4: Overview of Psychotherapy Overview PSYCHODYNAMIC THERAPY COGNITIVE THERAPY INTERPERSONAL THERAPY BEHAVIORal THERAPy SUMMARY Chapter 5: Overview of Psychopharmacology overview INTERNAL MILIEU, HOMEOSTASIS, AND ALLOSTASIS OVERVIEW OF SYNAPTIC TRANSMISSION PHARMACOKINETICS PHARMACODYNAMICS NEUROTRANSMITTER RECEPTOR SYSTEMS CLASSES OF PSYCHOTROPIC DRUGS ROLE OF THE psychiatric-mental health advanced practice registered nurse PSYCHOPHARMACOGENETICS Summary and Additional Thoughts Chapter 6: Overview of Complementary, Alternative, and Integrative Approaches OVERVIEW TYPES OF COMPLEMENTARY, ALTERNATIVE, AND INTEGRATIVE APPROACHES TYPES OF COMPLEMENTARY, alternative, AND INTEGRATIVE INTERVENTIONS‌‌‌ PRACTICE GUIDELINES SUMMARY‌ Notes‌‌‌ Chapter 7: Stages of Treatment OVERVIEW TECHNIQUES FOR DEVELOPING THERAPEUTIC RELATIONSHIPS INSTILLING HOPE COMMUNICATION STRATEGIES FOR FOLLOWING UP ON LEADS AND INSTILLING HOPE CLIENT RESOURCES psychiatric-mental health advanced practice registered nurse RESOURCES SKILL AND KNOWLEDGE STAGES OF TREATMENT ASSESSMENT AND DIAGNOSIS TRANSITIONING TO NEW TOPICS PERSONAL DEVELOPMENTAL HISTORY VALUES OR ASPIRATIONS USING SELF-REPORT QUESTIONNAIRES SYNTHESIZING INFORMATION RISK FORMULATION DIAGNOSIS (Diagnostic and Statistical Manual of Mental Disorders) CASE FORMULATION ADVANTAGES AND DISADVANTAGES OF SPLIT TREATMENT DELIVERY (MORE THAN ONE PROVIDER) COMPARISON OF INDIVIDUAL AND GROUP THERAPY FURTHER TESTING OR REFERRALS ACUTE TREATMENT THERAPEUTIC COMMUNICATION TECHNIQUES STABILIZATION/MAINTENANCE TERMINATION APPENDIX 7.1 GENOGRAM Chapter 8: Legal and Ethical Decision-Making‌‌‌ BASIC PRACTICE QUALIFICATION‌‌‌S SCOPE AND STANDARDS OF PRACTICE THE LEGAL AND ETHICAL ARENA CREATING A SAFE SPACE TO MAKE DECISIONs SUMMARY Section 3: Integrative Management of Specific Syndromes Chapter 9: Integrative Management of Disordered Mood OVERVIEW‌‌‌‌‌ SPECTRUM OF MOODS SHARED DECISION-MAKING OR ACHIEVING CONCORDANCE BEARING WITNESS TO SUFFERING ASSESSMENT Suicidal and homicidal thoughts HISTORY OF MOOD DISORDER SYMPTOMS COLLABORATIVE CASE CONCEPTUALIZATION EXPECTED OUTCOMES TREATMENT Transcranial Magnetic Stimulation Chapter 10: Integrative Management of Anxiety-Related Conditions OVERVIEW ANXIETY-RELATED CONDITIONS THE ANXIETY CYCLE PHYSIOLOGICAL RESPONSES ETIOLOGY OF ANXIETY AND ANXIETY-RELATED DISORDERS CONCORDANCE AND TREATMENT PLANNING EXPECTED OUTCOMES TREATMENT INITIATION PSYCHOTHERAPY MEDICATIONS EMERGING TREATMENTS: PSYCHEDELIC-ASSISTED THERAPY SPECIAL CONSIDERATIONS: PREVENTION Chapter 11: Integrative Management of Psychotic Symptoms OVERVIEW INCIDENCE and PREVALENCE HISTORY ETIOLOGY ASSESSMENT STAGES OF SCHIZOPHRENIA CONCORDANCE AND SHARED DECISION-MAKING EXPECTED OUTCOMES DIAGNOSIS TREATMENT MEDICATIONS MANAGING SIDE EFFECTS TREATMENT: PSYCHOSOCIAL AND OTHERS SUMMARY Note Chapter 12: Integrative Management of Sleep Disturbances OVERVIEW SLEEP Physiology SLEEP ACROSS THE LIFE SPAN FAMILIAL AND GENETIC IMPLICATIONS SLEEP ASSESSMENT SLEEP AND PSYCHIATRIC DISORDERS SLEEP AND MEDICAL DISORDERS NURSING DECISION TREES SHARED DECISION MAKING AND COLLABORATIVE TREATMENT PLANNING nON-pHARMACOLOGIc AND pHARMACOLOGIC tREATMENTS MANAGEMENT OF SLEEP DISORDERS summary Chapter 13: Integrative Management of Disordered Eating OVERVIEW BODY SHAPE AND WEIGHT: A NORMATIVE DISCONTENT TYPES OF FEEDING AND EATING DISORDERS ASSESSMENT SIGNS SCREENING TOOLS AND OBJECTIVE OUTCOME MEASURES ACHIEVING CONCORDANCE EXPECTED OUTCOMES TREATMENT OBESITY Chapter 14: Integrative Management of Disordered Cognition OVERVIEW CLASSIFICATION OF NEUROCOGNITIVE DISORDERS GENERAL PRINCIPLES FOR ASSESSMENT OF OLDER ADULTS DELIRIUM MILD NEUROCOGNITIVE DISORDERS MAJOR NEUROCOGNITIVE DISORDERS Clinical Signs and Course of Alzheimer’s Disease (as the Prototype Neurocognitive Disorder) summary Chapter 15: Integrative Management‌‌‌‌ of Disordered Impulse Control OVERVIEW: CLARIFYING THIS CLUSTER OF DISORDERS‌‌‌‌‌ EPIDEMIOLOGY OF IMPULSIVE OR DISRUPTIVE DISORDERS VULNERABILITIES and POSTULATED ETIOLOGIES Encoded Meanings of Aggression in the adult world ASSESSMENT AND INSTRUMENTS EARLY PREVENTION and INTEGRATIVE TREATMENTS SUMMARY Chapter 16: Integrative Management of Disordered Attention OVERVIEW ATTENTION DEFICIT HYPERACTIVITY DISORDER ATTENTION DEFICIT HYPERACTIVITY DISORDER AND THE BRAIN Attention Deficit Hyperactivity Disorder AND THE ROLE OF NEUROTRANSMITTERS ATTENTION DEFICIT HYPERACTIVITY DISORDER AND GENETICS‌‌ ATTENTION DEFICIT HYPERACTIVITY DISORDER Environment Exposures and Protective Factors ASSESSMENT DIAGNOSIS TREATMENT INITIATION NONPHARMACOLOGICAL TREATMENTS COMPLEMENTARY AND ALTERNATIVE THERAPIES PHARMACOLOGICAL TREATMENTS CULTURAL CONSIDERATIONS AUTISM SPECTRUM DISORDER Chapter 17: Integrative Management of Self-Directed Injury OVERVIEW DEFINITIONS EPIDEMIOLOGY THE CHRONOLOGICAL ASSESSMENT OF SUICIDE EVENTS APPROACH TO Nonsuicidal Self-Injurious Behavior/Sui ASSESSMENT WITHIN THE CASE APPROACH RELATIONSHIP BUILDING DURING ASSESSMENT INTEGRATION OF THERAPEUTIC MODELS PULLING IT TOGETHER: CHRONOLOGICAL ASSESSMENT OF SUICIDE EVENT APPROACH Chapter 18: Integrative Management of Other-Directed Violence OVERVIEW ASSESSMENT ASSESSMENT OF INDIVIDUAL POTENTIAL FOR VIOLENCE ETIOLOGY: CLIENT POPULATIONS AT RISK FOR PERPETRATING VIOLENCE MOST COMMON TYPES OF OTHER-DIRECTED VIOLENCE Effects of Violence on Survivors Increased Challenges for At-Risk Populations During a Pandemic Requiring Quarantine EXPECTED OUTCOMES CONCORDANCE IN MANAGEMENT OF INCIDENTS OF VIOLENCE TREATMENT MAINTENANCE INTERVENTIONS THERAPEUTIC INTERVENTIONS TRAINING OF PSYCHIATRIC PERSONNEL IN VIOLENCE MANAGEMENT LEGAL CONSIDERATIONS PROVIDING CULTURALLY COMPETENT CARE SUMMARY Section 4: Special Considerations Chapter 19: Integrative Management of Substance Use Disorders OVERVIEW Substance Use Disorders EPIDEMIOLOGY THEORies OF ADDICTION ESTABLISHING A DIAGNOSIS OF Substance Use Disorder SUBSTANCES OF ABUSE DETERMINING APPROPRIATE LEVELS OF CARE FOR TREATMENT OF Substance Use Disorders TAKING A CLIENT HISTORY FOR INDIVIDUALS WITH SUSPECTED SUBSTANCE USE PHYSICAL FINDINGS IN CLIENTS WITH SUBSTANCE USE LABORATORY TESTING AND FINDINGS SPECIAL POPULATIONS SUMMARY Chapter 20: Medical Problems and Psychiatric Syndromes OVERVIEW COMORBID PSYCHIATRIC AND MEDICAL CONDITIONS ASSESSMENT CONCORDANCE DEPRESSIVE DISORDERS ANXIETY DISORDERS BIPOLAR DISORDER SCHIZOPHRENIA PARKINSON’S DISEASE MEDICAL AND PSYCHIATRIC COMORBIDITIES RELATED TO PHARMACOLOGY OVERVIEW OF TREATMENT SUMMARY Chapter 21: Integrative Management of Pregnancy During Psychiatric Syndromes OVERVIEW CONCORDANCE PRINCIPLES OF FETAL DEVELOPMENT AND PHARMACOLOGY STRESS AND ANXIETY DISORDERS POSTTRAUMATIC STRESS DISORDER OBSESSIVE-COMPULSIVE DISORDER DEPRESSION BIPOLAR DISORDER SCHIZOPHRENIA SUBSTANCE USE DISORDERS OTHER CONSIDERATIONS FOR TREATMENT IN THE PERINATAL PERIOD SPECIAL CONSIDERATIONS IN THE POSTPARTUM PERIOD LACTATION SUMMARY Chapter 22: Forensic Issues and Psychiatric Syndromes FORENSICS CORRECTIONS INTERPERSONAL PROCESS ANTISOCIAL PERSONALITY DISORDER TRUE SEVERE AND PERSISTENT MENTAL ILLNESS SPECIAL CONSIDERATIONS THE REWARDS OF WORKING WITH THE TRULY MENTALLY ILL INCARCERATED SUMMARY Chapter 23: Telehealth HISTORICAL OVERVIEW OF TELEHEALTH‌‌ TELEMENTAL HEALTH technological considerations in telehealth CLINICAL CONSIDERATIONS IN TELEMENTAL HEALTH Chapter 24: LGBTQ+ Issues: Care of Sexual and Gender Minority Clients Overview BACKGROUND HISTORICAL AND CULTURAL CONTEXT MISTRUST OF MENTAL HEALTH PROFESSIONALS MINORITY STRESS MODEL CONSIDERATIONS ACROSS THE LIFE SPAN FRAMEWORK TO APPROACH DIAGNOSIS AND MANAGEMENT SUMMARY‌‌‌ Section 5: Maintaining Competence and Quality Chapter 25: Increasing Resilience in Psychiatric-Mental Health Advanced Practice Nurses The Construct of Resilience‌‌ Factors Contributing to Resilience Strategies to Increase Personal Resilience Recharging the Coping Reservoir summary‌‌ Chapter 26: Global Perspectives and the Future of Psychiatric-Mental Health OVERVIEW GLOBAL INITIATIVES IN PSYCHIATRIC NURSING EXEMPLARY PSYCHIATRIC-MENTAL HEALTH NURSE: A GLOBAL ROLE MODEL STRATEGIES FOR GLOBAL CONNECTIONS PROFESSIONAL SELF-DEVELOPMENT INTERDISCIPLINARY PARTNERSHIPS FUTURE DIRECTIONS FOR PRACTICE AND RESEARCH IN PSYCHIATRIC-MENTAL HEALTH NURSING Index Named a 2013 Doody's Core Title!'There are few new books to direct PMH-APRN treatment options...Now, this book provides the path to integration of treatment options for the holistic care of psychiatric client by PMH-APRNs.'--Doody's Medical ReviewsìThis text is a wonderful compilation of information that is needed within current advanced practice psychiatric mental health nursing. The chapters are informative, have excellent references and provide up to the minute information that is grounded in evidence-based practices.î Barbara Jones Warren, PhD, RN, CNS-BC, PMH, FAANProfessor, Clinical NursingDirector, Psychiatric Nursing Specialty National Institutes of Health/American Nurses Association Ethnic/Racial Minority Fellow The Ohio State College of NursingThis groundbreaking core text fills a void in nursing literature by integrating psychotherapy, psychopharmacology, and complementary and alternative medicine (CAM) approaches into advanced practice nursing. It is organized around psychiatric'syndromes'rather than DSM diagnoses, so it will remain current even after the publication of the DSM-5. The book provides clear and relevant treatment options in the form of decision trees with additional explanatory narratives. These decision trees enable practitioners to distinguish ìnormalî patients from those who require more customized therapeutic interventions. This holistic text integrates neurobiology, theory, and research evidence related to psychotherapy, psychopharmacology, and complementary and alternative medicine interventions. While providing comprehensive information on theory and practice, it simplifies complex aspects of treatment with clarity and provides the depth of content appropriate to support sound clinical reasoning required in advanced practice. The book responds to the current backlash against overmedication in psychiatry. It also fulfills the upcoming requirements by APNA and ISPN that advanced practice psychiatric nurses must have skills in psychotherapy. Additionally, the text focuses on treatment issues across the life span and highlights pertinent clinical differences from the adult population through pediatric pointers and aging alerts. Advanced Practice Psychiatric Nursing reflects the extensive practice and educational experience of editors and contributors from the United States, Canada, and Scotland, all of whom are expert APNs.Key Features: Organized around psychiatric ìsyndromes,î rather than DSM diagnoses, so it will remain relevant after the DSM-5 is publishedIntegrates neurobiology, theory, and research evidence related to psychotherapy. psychopharmacology, and CAM therapies Provides the much-needed content on psychotherapy newly required for all psychiatric advanced practice nurses (APNA & ISPN White Papers) Supports clinical decision skills through thoughtfully designed, easy-to-follow decision treesICONS highlight life span clinical management differences through Pediatric Pointers and Aging Alerts

"This textbook is our go-to book, it is an excellent overview of advanced practice in psychiatric nursing. This is the text that we use in our seminar courses during clinical, and we also use it in our review for our ANCC boards. Our student’s scores were 92% this past year! We are very pleased with this textbook!"

-Dr. Cheryl Zauderer, PhD, CNM, PMHNP-BC

Associate Dean of Graduate Programs

Co-Coordinator, PMHNP Program

Hunter-Bellevue School of Nursing

Now in its third edition, this revised reference continues to serve as the only foundational resource for APRNs to incorporate a focus on integrative interventions with mental health issues across the lifespan. New chapters on Legal and Ethical Decision Making and LGBTQ Issues: Care of Sexual and Gender Minority Patients, and Increasing Resilience in Advanced Practice Mental Health Nurses, shed light on vital contemporary issues. This text offers expanded coverage on telehealth, population health, and the updated AACN Essentials. Additionally, the third edition provides 10 practical case studies illustrating specific syndromes as well as 2019 updates to the ANCC certification exam. It provides expanded instructor resources including a Test Bank and PowerPoints.

Comprehensive and practical, this text is organized around commonly seen clinical constellations of psychiatric symptoms and covers neurobiology, theory, and research evidence along with pharmacological information relevant to each syndrome. It delivers an abundance of valuable interventions from which clinicians and clients can co-create the most effective, individualized interventions. Popular decision trees provide an algorithm to help students work through the process of evaluating and treating patients, and a lifespan focus prepares students for treating patients in all age groups.

New to the Third Edition:

• New Chapters:
  • Legal and Ethical Decision Making
  • LGBTQ Issues: Care of Sexual and Gender Minority Patients
  • Increasing Resilience in Advanced Practice Mental Health Nurses
• Includes 10 new case studies delivering practical information on specific syndromes
• Updated to reflect 2019 ANCC certification exam and 2020 AACN Essentials

Key Features:

• Simplifies complex concepts using clear language while retaining depth of information
• Includes diverse treatment options, decision trees, easy-to-follow algorithms, and pertinent pharmacological data
• Edited by internationally acclaimed PMH-APRN practitioner/educators
• Contains "Aging Alerts" and "Pediatric Points"
• Reflects the DSM 5 and discusses genetic testing
• Expanded instructor resources include a Test Bank and PowerPoints

"This textbook is our go-to book, it is an excellent overview of advanced practice in psychiatric nursing. This is the text that we use in our seminar courses during clinical, and we also use it in our review for our ANCC boards. Our student's scores were 92% this past year! We are very pleased with this textbook!" -Dr. Cheryl Zauderer, PhD, CNM, PMHNP-BC Associate Dean of Graduate Programs Co-Coordinator, PMHNP Program Hunter-Bellevue School of Nursing Now in its third edition, this revised reference continues to serve as the only foundational resource for APRNs to incorporate a focus on integrative interventions with mental health issues across the lifespan. New chapters on Legal and Ethical Decision Making and LGBTQ+ Issues: Care of Sexual and Gender Minority Patients, and Increasing Resilience in Advanced Practice Mental Health Nurses, shed light on vital contemporary issues. This text offers expanded coverage on telehealth, population health, and the updated AACN Essentials. Additionally, the third edition provides 10 practical case studies illustrating specific syndromes as well as 2019 updates to the ANCC certification exam. It provides expanded instructor resources including a Test Bank and PowerPoints. Comprehensive and practical, this text is organized around commonly seen clinical constellations of psychiatric symptoms and covers neurobiology, theory, and research evidence along with pharmacological information relevant to each syndrome. It delivers an abundance of valuable interventions from which clinicians and clients can co-create the most effective, individualized interventions. Popular decision trees provide an algorithm to help students work through the process of evaluating and treating patients, and a lifespan focus prepares students for treating patients in all age groups. New to the Third Edition: New Chapters: Legal and Ethical Decision Making LGBTQ+ Issues: Care of Sexual and Gender Minority Patients Increasing Resilience in Advanced Practice Mental Health Nurses Includes 10 new case studies delivering practical information on specific syndromes Updated to reflect 2019 ANCC certification exam and 2020 AACN Essentials Key Features: Simplifies complex concepts using clear language while retaining depth of information Includes diverse treatment options, decision trees, easy-to-follow algorithms, and pertinent pharmacological data Edited by internationally acclaimed PMH-APRN practitioner/educators Contains "Aging Alerts" and "Pediatric Points" Reflects the DSM 5 and discusses genetic testing Expanded instructor resources include a Test Bank and PowerPoints "Psychiatric-mental health advanced practice registered nurses (PMH-APRN) are like water-they are flexible, fluid, and go where they are needed. Deinstitutionalization of psychiatric patients resulted in not only more community-based treatment, but also new and expanded outpatient roles for psychiatric nurses. Now, in addition to employing them for outpatient needs, our society is seeking PMH-APRNs to provide treatment in nursing homes and prisons. Further, the recent COVID-19 pandemic has substantially increased the need for mental health providers, providing tele-mental health services as well as traditional services in a number of venues. The longer terms effects of the pandemic place have led to an increased demand for mental health services, for the worried well as those who suffer from a wide range of mental illnesses. The continued need for APRNs is reflected by the U.S. Bureau of Labor Statistics, which predicts a 31% growth in the number of all APRNs from 2014 to 2024, while the prediction for all other occupations is only a 7% increase. Furthermore, in an increasing number of states, APRNs are able to independently function within their full scope of practice"-- Provided by publisher "Psychiatric-mental health advanced practice registered nurses (PMH-APRN) are like water-they are flexible, fluid, and go where they are needed. Deinstitutionalization of psychiatric patients resulted in not only more community-based treatment, but also new and expanded outpatient roles for psychiatric nurses. Now, in addition to employing them for outpatient needs, our society is seeking PMH-APRNs to provide treatment in nursing homes and prisons. Further, the recent COVID-19 pandemic has substantially increased the need for mental health providers, providing tele-mental health services as well as traditional services in a number of venues. The longer terms effects of the pandemic place have led to an increased demand for mental health services, for the worried well as those who suffer from a wide range of mental illnesses. The continued need for APRNs is reflected by the U.S. Bureau of Labor Statistics, which predicts a 31% growth in the number of all APRNs from 2014 to 2024, while the prediction for all other occupations is only a 7% increase. Furthermore, in an increasing number of states, APRNs are able to independently function within their full scope of practice"-- Résumé de l'éditeur This ground-breaking core text integrates psychopharmacology, psychotherapy, and complementary and alternative medicine (CAM) approaches into advanced practice nursing and fills a void in the nursing literature. It is organized around psychiatric 'syndromes,' rather than DSM diagnoses, so it will remain current even after the publication of the DSM-V.