This chapter focuses on comorbidity as the combination of a psychiatric syndrome and one or more medical illnesses in the same client. It presents common comorbid conditions in individuals with psychiatric syndromes. The management of clients with psychiatric syndromes and medical comorbidity is complex and requires significant coordination of care. A “collaborative care” approach that uses a multidisciplinary team to provide care for both medical and mental conditions is paramount. Medications can play an important role in the management of comorbidities and can also be a cause of comorbidities. Given the advances in biological psychiatry, treatments of mental health, and medical disorders, a holistic approach that includes a biopsychosocial perspective should be an intricate component of treatment. The management of children with comorbid medical and psychiatric disorders should be treated from the perspective of lifelong impact of disease management.

Working with clients is dynamic and challenging. Although there are many variations of psychiatric-mental health problems, there are specific core issues to be considered for all clients. These include the overall purpose of treatment, theory base and resources, client’s perspective and resources, and stages of treatment. This chapter discusses the concepts to be considered for all clients and all types of psychiatric-mental health treatment. The foundation is the development of a therapeutic relationship. The resources of the advanced practice registered nurse as well as the client are identified as necessary to bring about change including increased self-awareness, broader perspective, increased functioning, and neurobiological shifts during psychotherapy. The stages of treatment across the process of therapy are based upon Peplau’s Interpersonal Therapy and the sections of each individual session are also presented. The chapter provides the groundwork for the chapters focusing upon treatment of specific symptom clusters later in the book.

There are many opportunities for global connections based on one’s area of expertise and the model for partnership development that is desired. Professional organizations in nursing rely on the volunteers at both the elected and appointed levels to make certain that the organizational goals and activities are successfully accomplished. Nurse leaders in all specialties are masters at “paying forward”, investing in future generations of nurses through mentoring and coaching formally and informally. One of the most important responsibilities that advanced practice nurses share is that of improving future generations of clinicians through education and dissemination of scholarship. In addition to the disciplinary partnerships within nursing, there are multiple opportunities for interdisciplinary partnerships. Advanced practice psychiatric-mental health nurses have a responsibility to participate in the development and dissemination of scholarship through their professional work.

Working with individuals who are self-injuring or contemplating suicide is complicated and difficult. This chapter provides information to assist with methodical and sound clinical approaches in the assessment and treatment of individuals who are considering self-harm or engaging in self-injuring. Caring for an individual who is self-injuring is a reality for most psychiatric-mental health advanced practice registered nurses and is a rising occurrence for nurses (e.g., family nurse practitioners, school health nurses, and others) caring for individuals in the general population. Fortunately, the literature providing evidence-based approaches to self-injury prevention and treatment is increasing.

The relationship between the psychiatric-mental health advanced practice registered nurse (PMH-APRN) and the client is the foundation for any assessment or intervention. This chapter describes the ethical principles underpinning psychiatric-mental health nursing, and shows that any intervention can be described by pointing out the various tensions inherent within these principles. The components of building a therapeutic relationship have been described by several nurse authors, beginning with Peplau. However, recent studies have moved on to explore the process of decision-making within that therapeutic relationship. In an ideal world, everyone would be in possession of all necessary evidence to support any decision they were making. The chapter shows that concordance should be viewed as the ethical goal of partnership, and that partnership can be broken down into achievable goals. It considers the place of knowledge, health beliefs, and collaboration as aspects of successful practice.

Integrative treatment is a prospective, relationship-based, client-centered, holistic approach that focuses on clients’ priorities for well-being, as well as preventing, managing, and rehabilitating diseases. This chapter provides definitions and a basic understanding of the synergy of integrated treatment as it is delivered by psychiatric-mental health advanced practice registered nurses (PMH-APRNs). It addresses the rationale and importance of an integrated approach. Furthermore, the chapter presents the importance of the clinician recognizing their own theory base and ways of thinking that may or may not facilitate the ability to provide integrated treatment. Although the Diagnostic and Statistical Manual of Mental Disorders is referred to throughout, the actual focus of treatment is transdiagnostic syndromes presented by each client. The chapter explores this concept in depth, and emphasizes the nonlinear thinking and recognition of a continuum of interventions.

This chapter focuses on psychosis that is associated with severe mental illness recognized within the schizophrenia spectrum, such as schizophrenia, delusional disorder, schizophreniform disorder, and schizoaffective disorder. Caring for individuals with psychosis can be a challenging yet rewarding aspect of nursing practice. Interviewing and communication have always been primary nursing skills, but these skills are the core of the assessment and care of the client with mental health concerns. In brief psychotic disorder, the psychotic symptoms are sudden and last for at least a day or more, but do not persist beyond a month. Psychotic illness continues to have many misconceptions and myths surrounding it. There remains much fear, stigma, and stereotyping about the concept of psychosis; this is not only perpetuated in the media, but at times even with other health professionals. Nurses are in an excellent position to help educate individuals about these disorders and to help destigmatize these ideas.

Over the past decade, the role of the psychiatric-mental health advanced practice registered nurse (PMH-APRN) has become a more visible presence in the specialty of forensics, which is the application of science to legal questions. This chapter provides an in-depth look at the role of the PMH-APRN in the forensic settings. The largest area of practice opportunities is in corrections. The chapter explores at length the personal and professional rewards of providing service to the truly severely mentally ill, as well as the challenges of doing so in a correctional setting. It introduces specific skill sets and tools, such as a Forensic APRN Practice Conceptual Model-Decision Tree, for successful navigation of the many challenges. Selfcare strategies, active clinical supervision, and management of healthy boundaries are stressed as essential professional traits for this work environment.

Working with clients is dynamic and challenging. Although there are many variations of psychiatric-mental health problems, there are specific core issues to be considered for all clients. These include the overall purpose of treatment, theory base and resources, client’s perspective and resources, and stages of treatment. This chapter discusses the concepts to be considered for all clients and all types of psychiatric-mental health treatment. The foundation is the development of a therapeutic relationship. The resources of the advanced practice registered nurse as well as the client are identified as necessary to bring about change including increased self-awareness, broader perspective, increased functioning, and neurobiological shifts during psychotherapy. The stages of treatment across the process of therapy are based upon Peplau’s Interpersonal Therapy and the sections of each individual session are also presented. The chapter provides the groundwork for the chapters focusing upon treatment of specific symptom clusters later in the book.

This chapter includes an overview of the science, including the theory and research dimensions that form the basis of psychiatric-mental health nursing, that is particularly relevant to the advanced practice nurse. It also includes educational and credentialing requirements for psychiatric-mental health advanced practice registered nurses (PMH-APRNs) along with attention to the graduate level competencies for PMH-APRNs. While there are a number of theoretical perspectives that have influenced the development of psychiatric-mental health nursing, the emphasis on nursing science, including theory development and research, holds the most promise for the further development of PMH-APRNs' practice. The integration of a range of therapeutic interventions is particularly relevant to the holistic perspective of nursing science. Advanced education and credentialing position PMH-APRNs for a wide range of roles in mental health prevention and treatment. PMH-APRNs play a pivotal role in expanding mental healthcare services, including services to those throughout the United States.