lOMoAR cPSD| 63316909
NR606 – Diagnosis and Management in Psychiatric-Mental Health II
Exam Study Guide – Midterm Exam
Week 1
• Ethical Considerations in Treating Children and Adolescents o Privacy and HIPAA
▪ Children under 18 have limited privacy rights; parents generally have access
to medical records.
▪ Confidentiality must be balanced with the adolescent's right to privacy,
especially regarding sensitive issues (e.g., sexual health, substance use).
▪ Providers should discuss confidentiality boundaries with both the minor and
the parent at the outset.
o Informed consent
▪ Parents or legal guardians provide consent for minors; however, assent (the
minor’s agreement) should also be obtained.
▪ Some states allow minors to consent to specific types of care (e.g., mental
health, sexual health, substance abuse treatment) without parental permission.
▪ Providers must ensure both legal and ethical considerations are met by
explaining treatment in developmentally appropriate language.
o Prescribing considerations
▪ Pediatric patients have different pharmacokinetics; dosages must be
weightbased.
▪ Monitor for increased risk of side effects (e.g., suicidal ideation with
antidepressants).
▪ Careful documentation and frequent reassessment are critical.
o Mandatory reporting
▪ Providers are legally required to report suspected abuse, neglect, or harm (to
self or others).
▪ Failure to report can lead to legal consequences.
▪ It's important to inform families of these legal obligations during initial visits.
o Prescribing Considerations for Maternal Mental Health Treatment
▪ Considerations During Pregnancy
▪ Weigh the risks of untreated mental illness against the risks of
medication
▪ SSRIs are commonly used but require evaluation of risks in each
trimester
▪ Avoid teratogenic medications
▪ Collaborate with OB/GYNs and perinatal psychiatrists when possible
▪ Considerations for Breastfeeding
▪ Assess medication safety through lactation (Zoloft preferred due to
low transfer in breast milk)
▪ Monitor infant for side effects like sedation or irritability
▪ Engage in shared decision making with the mother, considering her
mental health and breastfeeding goals
o Substance Use Disorder in the Perinatal Period
, lOMoAR cPSD| 63316909
▪ Substance risks
▪ Risks include neonatal abstinence syndrome, miscarriage, preterm
birth, and fetal anomalies.
▪ Alcohol, opioids, and stimulants pose risks
▪ Ethical and legal considerations
▪ Some states have laws that criminalize substance use in pregnancy
which may deter women from seeking care
▪ Ethical care involves nonjudgemental, supportive interventions that
prioritize maternal and fetal health
▪ Stigma
▪ Pregnancy individuals with SUD face structural, self, and public
stigma that prevents help-seeking and reduces treatment adherence
▪ Providers must address stigma through trauma-informed,
compassionate care
▪ Assessment and screening
▪ Use validated tools like 4p’s, AUDIT-C
▪ Screen all pregnant individuals as part of routine prenatal care
▪ Positive screen should lead to brief intervention and referral to
treatment
▪ Treatment
▪ Medications for opioid use disorder are safe and recommended during
pregnancy
▪ Integrated care models that include prenatal, mental health, and
addiction services are ideal
• Key Concepts to Study o Barriers to Seeking Mental Health Care
▪ Stigma, lack of providers, transportation issues, language barriers, limited
insurance coverage, high out-of-pocket costs, cultural beliefs about mental
illness
o Social Determinants and Access to Care
▪ Poverty, unstable housing, and food insecurity negatively affect
mental health and access to services.
▪ Children from marginalized communities often have fewer mental
health resources o Developmentally Appropriate Teaching
▪ Use age-appropriate language, visual aids, and interactive tools
▪ Involve caregivers while respecting the autonomy of adolescents
▪ Tailor education to the child’s cognitive and emotional maturity o
Racial and Ethnic Barriers
▪ Historical mistrust of healthcare, language differences,
underrepresentation of minority providers
▪ Implicit bias may affect diagnosis and treatment
▪ Culturally responsive care improves engagement and outcomes o
Types of Stigma
▪ Structural stigma: policies or systems that limit access to care
▪ Self-stigma: internalized shame or guild about one’s condition
NR606 – Diagnosis and Management in Psychiatric-Mental Health II
Exam Study Guide – Midterm Exam
Week 1
• Ethical Considerations in Treating Children and Adolescents o Privacy and HIPAA
▪ Children under 18 have limited privacy rights; parents generally have access
to medical records.
▪ Confidentiality must be balanced with the adolescent's right to privacy,
especially regarding sensitive issues (e.g., sexual health, substance use).
▪ Providers should discuss confidentiality boundaries with both the minor and
the parent at the outset.
o Informed consent
▪ Parents or legal guardians provide consent for minors; however, assent (the
minor’s agreement) should also be obtained.
▪ Some states allow minors to consent to specific types of care (e.g., mental
health, sexual health, substance abuse treatment) without parental permission.
▪ Providers must ensure both legal and ethical considerations are met by
explaining treatment in developmentally appropriate language.
o Prescribing considerations
▪ Pediatric patients have different pharmacokinetics; dosages must be
weightbased.
▪ Monitor for increased risk of side effects (e.g., suicidal ideation with
antidepressants).
▪ Careful documentation and frequent reassessment are critical.
o Mandatory reporting
▪ Providers are legally required to report suspected abuse, neglect, or harm (to
self or others).
▪ Failure to report can lead to legal consequences.
▪ It's important to inform families of these legal obligations during initial visits.
o Prescribing Considerations for Maternal Mental Health Treatment
▪ Considerations During Pregnancy
▪ Weigh the risks of untreated mental illness against the risks of
medication
▪ SSRIs are commonly used but require evaluation of risks in each
trimester
▪ Avoid teratogenic medications
▪ Collaborate with OB/GYNs and perinatal psychiatrists when possible
▪ Considerations for Breastfeeding
▪ Assess medication safety through lactation (Zoloft preferred due to
low transfer in breast milk)
▪ Monitor infant for side effects like sedation or irritability
▪ Engage in shared decision making with the mother, considering her
mental health and breastfeeding goals
o Substance Use Disorder in the Perinatal Period
, lOMoAR cPSD| 63316909
▪ Substance risks
▪ Risks include neonatal abstinence syndrome, miscarriage, preterm
birth, and fetal anomalies.
▪ Alcohol, opioids, and stimulants pose risks
▪ Ethical and legal considerations
▪ Some states have laws that criminalize substance use in pregnancy
which may deter women from seeking care
▪ Ethical care involves nonjudgemental, supportive interventions that
prioritize maternal and fetal health
▪ Stigma
▪ Pregnancy individuals with SUD face structural, self, and public
stigma that prevents help-seeking and reduces treatment adherence
▪ Providers must address stigma through trauma-informed,
compassionate care
▪ Assessment and screening
▪ Use validated tools like 4p’s, AUDIT-C
▪ Screen all pregnant individuals as part of routine prenatal care
▪ Positive screen should lead to brief intervention and referral to
treatment
▪ Treatment
▪ Medications for opioid use disorder are safe and recommended during
pregnancy
▪ Integrated care models that include prenatal, mental health, and
addiction services are ideal
• Key Concepts to Study o Barriers to Seeking Mental Health Care
▪ Stigma, lack of providers, transportation issues, language barriers, limited
insurance coverage, high out-of-pocket costs, cultural beliefs about mental
illness
o Social Determinants and Access to Care
▪ Poverty, unstable housing, and food insecurity negatively affect
mental health and access to services.
▪ Children from marginalized communities often have fewer mental
health resources o Developmentally Appropriate Teaching
▪ Use age-appropriate language, visual aids, and interactive tools
▪ Involve caregivers while respecting the autonomy of adolescents
▪ Tailor education to the child’s cognitive and emotional maturity o
Racial and Ethnic Barriers
▪ Historical mistrust of healthcare, language differences,
underrepresentation of minority providers
▪ Implicit bias may affect diagnosis and treatment
▪ Culturally responsive care improves engagement and outcomes o
Types of Stigma
▪ Structural stigma: policies or systems that limit access to care
▪ Self-stigma: internalized shame or guild about one’s condition
