Exploring Maternal Schizophrenia, Medication Choices, and Advancing the PMHNP Profession

QUESTION

The patient, a young boy, has been experiencing poor behavior and academic performance. His grandmother reports that he has been impulsive and aggressive, with poor listening skills. The mother feels he is irritable and aggressive at home and school. The patient has been physically aggressive, hitting his grandfather and wetting the bed at night. The patient is considering bed alarms and medication to rule out medical issues. His diagnosis is Oppositional Defiant Disorder F91.3, with intermittent angry moods and argumentative behavior. The patient has lost his temper at home and school, often arguing with authority figures. The patient has comorbid diagnoses, such as ADHD, which impact his functioning. The patient’s comorbidity rate with ODD is approximately 50-60%.Grandparent (maternal) was treated for depression.  The mother was treated for schizophrenia and was previously hospitalized.  Uncle (maternal) was treated for ADHD. The grandparent (maternal) was treated for alcohol abuse.

Olanzapine work for mother

Question

• The mother of the patient, who has been previously hospitalized multiple times is diagnosed with schizophrenia. What does the literature say about a connection between maternal schizophrenia and oppositional defiant disorder in offspring?
• In this patient’s case aripiprazole may not be effective, why might lurasidone have a better effect on or /outcome for this patient’s symptoms?
• How can we as PMHNPs elevate our profession and invoke the trust and respect of our patients and how do we differ in that respect from our physician assistant colleagues?

ANSWER

Exploring Maternal Schizophrenia, Medication Choices, and Advancing the PMHNP Profession

Introduction

Oppositional Defiant Disorder (ODD) is a psychiatric condition characterized by defiant, disobedient, and hostile behavior. When comorbid with other disorders, such as Attention-Deficit/Hyperactivity Disorder (ADHD) and maternal schizophrenia, the impact on functioning can be significant. In this essay, we will delve into the literature regarding the connection between maternal schizophrenia and ODD in offspring, discuss the potential benefits of lurasidone over aripiprazole for symptom management, and explore ways in which Psychiatric-Mental Health Nurse Practitioners (PMHNPs) can enhance their profession and differentiate themselves from their Physician Assistant (PA) colleagues.

Maternal Schizophrenia and Oppositional Defiant Disorder

The literature suggests a potential association between maternal schizophrenia and an increased risk of oppositional defiant symptoms in offspring. Studies have found that children of mothers with schizophrenia are more likely to exhibit externalizing behavior problems, including oppositional and aggressive behaviors. The exact mechanisms underlying this connection are not fully understood but may involve genetic, environmental, and psychosocial factors. It is crucial to consider maternal mental health history when evaluating and managing oppositional defiant symptoms in children.

Lurasidone versus Aripiprazole

In the case of this patient, aripiprazole may not be as effective for symptom management compared to lurasidone. Lurasidone is an atypical antipsychotic that has shown efficacy in treating irritability associated with various psychiatric disorders, including ODD and disruptive mood dysregulation disorder. Lurasidone’s unique pharmacological profile, including its antagonist activity at serotonin and dopamine receptors, may contribute to its effectiveness in managing aggressive and irritable behaviors. Additionally, lurasidone’s favorable side effect profile and once-daily dosing enhance adherence and tolerability, potentially improving patient outcomes.

Elevating the PMHNP Profession and Building Patient Trust

Expertise and Specialization: PMHNPs can elevate their profession by acquiring advanced education and specialization in psychiatric and mental health nursing. By continuously expanding their knowledge and expertise, PMHNPs demonstrate their commitment to delivering high-quality, evidence-based care in the field of mental health.

Collaborative Approach: PMHNPs prioritize collaborative care, working closely with patients, families, and interdisciplinary teams to develop comprehensive treatment plans. This patient-centered approach fosters trust, ensures holistic care, and promotes shared decision-making, empowering patients to actively participate in their treatment journey.

Therapeutic Relationship: Building a therapeutic alliance based on empathy, active listening, and mutual respect is paramount. PMHNPs create a safe and non-judgmental environment, fostering open communication and establishing a foundation of trust with patients. This therapeutic relationship enhances patient engagement, improves treatment adherence, and positively impacts outcomes.

Distinguishing PMHNPs from Physician Assistants

While both PMHNPs and PAs contribute significantly to healthcare, several factors differentiate PMHNPs and highlight their unique role in mental health care delivery:

Specialized Mental Health Focus: PMHNPs receive specific education and training in psychiatric and mental health care, allowing them to develop expertise in diagnosing and managing mental health disorders. This specialized knowledge equips PMHNPs to provide comprehensive, evidence-based mental health care to patients across the lifespan.

Holistic and Integrative Care: PMHNPs adopt a holistic approach, considering not only the patient’s psychiatric symptoms but also their physical, emotional, and social well-being. They integrate mental health care into the broader context of the patient’s life, taking into account the impact of psychosocial factors on mental health.

Therapeutic Interventions and Psychotherapy: PMHNPs are trained in various therapeutic interventions and psychotherapy modalities. They can provide counseling, psychoeducation, and evidence-based psychotherapies tailored to individual patient needs. This comprehensive approach addresses both pharmacological and non-pharmacological aspects of mental health treatment.

Conclusion

Maternal schizophrenia has been associated with an increased risk of oppositional defiant symptoms in offspring. Selecting appropriate antipsychotic medications like lurasidone can help manage these symptoms effectively. To elevate the PMHNP profession, it is crucial to prioritize expertise, collaborative care, and the therapeutic relationship with patients. PMHNPs differentiate themselves from their PA colleagues by their specialized mental health focus, holistic care approach, and ability to provide therapeutic interventions and psychotherapy. By highlighting these qualities, PMHNPs can enhance the trust and respect of their patients and contribute to improving mental health outcomes.