Week 2 discussion
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.
Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
- Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
- Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
- Evaluate efficacy of treatment plans
- Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
To prepare for this Assignment:
- Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
The Assignment
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
- At each decision point stop to complete the following:
Decision #1
- Which decision did you select?
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
(Please see attached case study: An African American Child Suffering From Depression)
Required Readings
Note: All Stahl resources can be accessed through this link provided.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
- Chapter 6, “Mood Disorders”
- Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Review the following medications:
- amitriptyline
- bupropion
- citalopram
- clomipramine
- desipramine
- desvenlafaxine
- doxepin
- duloxetine
- escitalopram
- fluoxetine
- fluvoxamine
- imipramine
- ketamine
- mirtazapine
- nortriptyline
- paroxetine
- selegiline
- sertraline
- trazodone
- venlafaxine
- vilazodone
- vortioxetine
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Note: Retrieved from Walden Library databases.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791. doi:10.1002/da.22171
Required Media
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
Walden NURS 6630 Week 2 Sample Paper
(Assessing and Treating Pediatric Clients With Mood Disorders)
Treating Pediatric Patients with Mood Disorders
Student’s Name:
Institutional Affiliation:
Treating Pediatric Patients with Mood Disorders
Diagnosing and treating pediatric patients with mood disorders can be complicated and difficult. Mood disorders refer to feelings and thoughts that are difficult to manage, intense, and persistent. According to researchers and clinicians, one of the most underdiagnosed health problems in children is a mood disorder. Failure to diagnose mood disorders on time can put pediatrics at risk of developing other health complications. Some of the mood disorders that affect pediatrics include bipolar disorder, persistent depressive disorder, and major depression (Kumar, 2016). This paper discusses some of the decisions made concerning the medications to prescribe to a client who is an African American child suffering from depression.
Decision One
The first decision that I made regarding the medication that should be administered to the client is to prescribe the 8-year old with 25mg Zoloft daily. The reason for making this decision is because the medication is used for the treatment of depression, which is beneficial in this case, considering that the client is exhibiting signs of depression. The medicine has been approved by the Food and Drug Administration to treat depressive disorders. Another reason for making this decision is that after only a few weeks, the medication usually produces its full effects when treated for a mood disorder, and it will, therefore, be important to use it in this case since the self-reported mood for the child is “sad.” I also selected this decision because the Zoloft 25mg capsule is usually administered once a day; therefore, the risk of medication error occurring is minimal, unlike when a medication is to be taken several times a day since the patient or caregiver can easily forget (Kolomeyer, & Renk, 2016). The medicine can be taken with or without food, and therefore if the patient is not in a position of eating, he can still take Zoloft 25mg medicine. The reason for making the decision to administer the 25mg Zoloft was also to monitor whether the medicine will have an adverse effect on the client.
By making this decision, I was hoping to improve the mood of the child and also reduce any form of anxiety that the child could be having, considering that he is endorsing active suicidal ideation, although he does not admit that he often thinks about himself being dead. Zoloft can help improve the mood of the child and treat any serious mental health problem that the child is suffering from by slowing reabsorption of the serotonin chemical in the brain (Kumar, 2016). I was hoping after taking the medication; the child will be in a better position of socializing with his peers. There was no difference between what I expected to achieve after making the decision.
Decision Two
The second decision that I made, in this case, was to increase the Zoloft dosage from 25mg to 50 mg. The reason for making this decision is because the patient was responding well to it, and no adverse effect was reported. The decision was also appropriate for the child because children usually have more water body with less plasma albumin. Zoloft is the most prescribed type of antidepressant in the United States that is considered to have fewer side effects as compared to other antidepressants, and also it is a non-addictive drug, and therefore, it is suitable for the patient in this case. Another reason for maintaining the same drug without changing it is because the patient can develop resistance and refuse to take another medication, and hence, it was appropriate to increase the dosage instead. Change of medication can also cause an increase in the patient’s level of anxiety, which affects the health outcome of the patient negatively (Neal, 2019). Zoloft dosage starts at 25 mg and can be increased to 50mg after one week. Depending on the tolerability of the patient, the medicine can be increased up to a maximum of 200 mg per day. According to past research, it is not appropriate to discontinue the use of ZOLOFT abruptly since adverse reactions may occur upon discontinuation (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015).
By making this decision, I was hoping to increase the appetite of the patient, reduce periods of irritation, and improve the overall health outcome of the patient. After making this decision, there was no difference between what I expected and the actual results since the patient was improving as expected.
Decision Three
The third decision that I selected was the client to continue using Zoloft 50 mg. The reason for selecting this decision is to ensure that the symptoms of severe depression are all cleared up. It was important to continue using the medication to control the serotonin levels in the brain. Serotonin is a neurotransmitter chemical that helps in carrying signals between brain cells that help in controlling the mood of a patient (Aggarwal, Jethani, Rohatgi, & Kalra, 2016). I was hoping to increase the energy level of the client, improve his overall mood, and help him gain interest in daily life. There was no difference between what was expected to be achieved with decision three and the actual results of the decision. The health of the patient had improved significantly. He has started to socialize with his peers, and his mood had begun to change to being “happy”. In addition to that, his appetite increased.
Ethical Considerations
One of the ethical considerations that might impact the treatment plan with the client is the ethical principle of autonomy whereby, as a health provider, I am required to respect the decision of the patients or their caregiver. Another ethical consideration that might impact the treatment plan and communication with the client is ensuring that their privacy is enhanced and that third parties do not have access to any information that they provide (American College of Clinical Pharmacy, 2014). .
References
Aggarwal, A., Jethani, S. L., Rohatgi, R. K., & Kalra, J. (2016). Selective serotonin re-uptake inhibitors (SSRIs) induced weight changes: a dose and duration dependent study on albino rats. Journal of clinical and diagnostic research: JCDR, 10(3), AF01.
American College of Clinical Pharmacy. (2014). Standards of practice for clinical
pharmacists. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(8), 794-797.
Kolomeyer, E., & Renk, K. (2016). Family-Based Cognitive–behavioral Therapy for an Intelligent, Elementary School-Aged Child With Generalized Anxiety Disorder. Clinical Case Studies, 15(6), 443-458.
Kumar, S. (2016). Comparative bioavailability study comparing single tablet of SERLIFT 100 mg contains Sertraline hydrochloride equivalent to 100 mg sertraline of Ranbaxy M SDN BHD with two tablets of ZOLOFT contains sertraline hydrochloride equivalent to 50 mg sertraline total dose 100 mg of Pfizer Malaysia SDN BHD in healthy adult human subjects under fasting condition.
Neal, P. (2019). Pediatric anxiety disorder: When to worry about the “worrier.”. In 40th National Conference on Pediatric Health Care (pp. 7-10).
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual
Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345-365.
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