Assessing and Treating Pediatric Patients with Mood Disorders Essay

Assessing and Treating Pediatric Patients with Mood Disorders Essay

Assessing and Treating Pediatric Patients with Mood Disorders Essay

Depression in children is one of the health challenges that psychiatric mental health nurse practitioners (PMHNP) experience in their practice. Depression management in children often relies on the use of pharmacological interventions that may pose harm to them. As a result, PMHNP should weigh the benefits and risks of utilizing specific treatments in managing mental health problems in pediatric populations. This paper is a case study analysis of an 8-year-old African American child diagnosed with depression. They present to the emergency department with symptoms that include feeling sad, the mother reporting that the teacher said the child is withdrawn from peers, and experiencing decreased appetite and occasional irritation. The child’s developmental milestones are appropriate for age, with unremarkable physical examinations and laboratory studies being normal. The child has been referred for psychiatric evaluation.

ORDER A PLAGIARISM-FREE PAPER HERE ON;Assessing and Treating Pediatric Patients with Mood Disorders Essay

The performed mental status examination shows that the child is well-oriented, hasa sad mood, blurred affect, and admits thinking about himself being dead and what it feels like being dead. The child scores 30 on the Children’s Depression Rating Scale, implying significant depression. Therefore, the specific patient factors that will influence the clinical decisions for treating depression include the subjective complaints related to depression, suicidal thoughts, and the Children’s Depression Rating Scale scores.

Decision 1

Begin Zoloft 25 mg orally daily.

Reason for the Selection

I chose the decision to begin the treatment with Zoloft 25 mg orally daily. Zoloft is a serotonin selective reuptake inhibitor recommended for use in treating depression in children(Walkup, 2017). The existing evidence shows that Zoloft has a high level of efficacy in improving the symptoms of major depression in children. The use of Zoloft for pediatric depression also has a good response rate ranging from 40-70%. Evidence supports the initiation of pediatric populations with Zoloft dosage of 25-50 mg and titration up to 200 mg (Dwyer & Bloch, 2019). Zoloft is also associated with a reduced risk for suicidal thoughts, making it the desirable drug of choice for pediatric depression(Boaden et al., 2020).

Why Other Options were Not Selected

Initiating the child on Paxil 10 mg orally daily was not chosen because it is not recommended in children under 18 years. Wellbutrinwas not considered the first line of treatment due to its associated negative effects. It is associated with adverse effects such as seizures and anorexia (Kweon& Kim, 2019).

Expected Outcomes

I was hoping to achieve improvement in depressive symptoms being experienced by the child. I was also expecting a decline in the Children’s Depression Rating Scale score. The inhibition of serotonin reuptake results in its buildup, which causes improvement in mood in the affected patients(Dwyer & Bloch, 2019). Therefore, improvement in depressive symptoms was anticipated.

Ethical Considerations

The FDA has approved a limited range of antidepressants in pediatric populations. PMHNP should consider the most appropriate antidepressants to optimize the treatment outcomes. The selected treatments should have minimal adverse effects on the patients to enhance tolerability and outcomes(Dwyer & Bloch, 2019). As a result, Zoloft is the most appropriate and safe drug for treating depressive symptoms compared to the other alternatives.

Decision 2

Increase dose to 50 mg orally daily.

Reason for the Selection

I chose the above decision because the client returned to the clinic after four weeks with no change in depressive symptoms at all. The most appropriate decision would be to increase the dosage to 50 mg orally daily to produce the desired effect. Zoloft effectively treats depressive symptoms in pediatric populations(Boaden et al., 2020). Its dosage can be titrated up to 200 mg to improve depressive symptoms. Increasing dosage to 50 mg will increase the therapeutic and plasma level of the drug, hence, improvement in depressive symptoms(Dwyer & Bloch, 2019).

Why Other Options were Not Selected

I did not select the decision to increase the dose of Zoloft to 37.5 mg orally daily because it is below the recommended therapeutic dosage. As a result, the dose may not significantly change the depressive symptoms(Dwyer & Bloch, 2019). I did not choose to change to Prozac 10 mg orally daily because the recommended practice of titrating Zoloft up to 200 mg had not been undertaken in patient’s care. In addition, the patient has not demonstrated adverse outcomes to Zoloft to warrant a change in the course of treatment(Boaden et al., 2020).

Expected Outcomes

I selected the above decision with the expected reduction in depressive symptoms. I expected an increase in the dosage of Zoloft to produce the desired symptom improvement due to enhanced inhibition of serotonin reuptake. The other expected outcome is reducing the Children’s Depression Rating Scale by at least 50% due to Zoloft’s efficacy in treating depressive symptoms(Walkup, 2017).

Ethical Considerations

PMHNP is responsible for ensuring best practices in prescribing psychiatric medications for pediatric patients. They utilize the best practice recommendations and clinical guidelines to make informed decisions on the treatment for their clients. The existing evidence recommends titration of Zoloft up to 200 mg if patients do not demonstrate adverse reactions. Therefore, PMHNP ensured responsibility and professionalism in treating depression in pediatric patients(Stringaris et al., 2018).

Decision 3

Maintain current dose.

Reason for the Selection

I chose the above decision because the child returned to the clinic after four weeks with a decrease in depressive symptoms by 50%. The client also reported improved treatment tolerability. Symptom improvement by at least 50% is considered an appropriate response in treating depression. Maintenance of the current dose is recommended in cases where positive medication response has been achieved in the treatment process(Poweleit et al., 2019). Therefore, the current dose of Zoloft should be maintained.

Why Other Options were Not Selected

I did not choose to increase Zoloft to 75 mg orally because a positive response to treatment had been achieved. I did not choose to change to an SNRI because a positive response to treatment had been achieved. The client also demonstrated high tolerance to Zoloft, ruling out the need to change the current treatment (Poweleit et al., 2019).

Expected Outcomes

I was hoping to maintain the current improvement in depressive symptoms being experienced by the patient. A positive response to treatment would have translated into a further reduction in the depressive symptoms (Poweleit et al., 2019).

Ethical Considerations

PMHNPs are responsible for upholding best practices in treating pediatrics with mental health problems. They advocate protecting children’s rights in the treatment since minors do not have the authority to consent to their treatments. Therefore, PMHNPs have to monitor the minors for response to treatment and make appropriate decisions to optimize outcomes(Poweleit et al., 2019). Consequently, maintaining the current dose is the most appropriate decision that would enhance the management of depressive symptoms being experienced by the child.

Conclusion

The use of Zoloft in treating the patient in this case study was effective. Zoloft is the recommended drug of choice in depression. It inhibits the reuptake of serotonin, leading to its accumulation and improvement in mood. The initial decision to begin treatment with Zoloft 25 mg led to a lack of symptom improvement. The dose did not reach the required therapeutic level to produce symptom improvement. As a result, it informed the decision to increase its dosage to 50 mg. The existing evidence supports the titration of Zoloft dosage up to 200 mg. As a result, the decision made by the PMHNP was evidence-based. The increase in the dosage of Zoloft led to a positive response to the treatment. Evidence recommends the maintenance of the current dosage if a 50% improvement in symptoms is reported. The recommendation informed the decision to maintain the dosage of Zoloft at 50 mg orally daily in the third step of the treatment process(Boaden et al., 2020; Dwyer & Bloch, 2019). Therefore, the case study aligns with the existing evidence supporting the use of Zoloft in the treatment of pediatric depression.

Ethics informed the treatment decisions made in the case study. Firstly, PMHNPs are responsible for promoting safe prescribing in their practice. They weigh the benefits and risks of the available treatments before deciding. The aim is to optimize treatment outcomes that include safety and quality. The child in the case study cannot provide consent to treatment. As a result, the PMHNP advocates protecting the child’s rights by ensuring minimum harm in the treatment process. The nurse also educates the parents about the potential side and adverse effects of monitoring their child. There is also the need for close monitoring to make informed decisions on the treatments appropriate for the patient (Poweleit et al., 2019). Though it, PMHNP promotes safety, quality, and efficiency in patient care.

References

Boaden, K., Tomlinson, A., Cortese, S., & Cipriani, A. (2020). Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment. Frontiers in Psychiatry, 0. https://doi.org/10.3389/fpsyt.2020.00717

Dwyer, J. B., & Bloch, M. H. (2019).Antidepressants for Pediatric Patients.Current Psychiatry, 18(9), 26-42F.

Kweon, K., & Kim, H.-W. (2019). Effectiveness and Safety of Bupropion in Children and Adolescents with Depressive Disorders: A Retrospective Chart Review. Clinical Psychopharmacology and Neuroscience, 17(4), 537–541. https://doi.org/10.9758/cpn.2019.17.4.537

Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B. (2019). Pharmacogenetics of Sertraline Tolerability and Response in Pediatric Anxiety and Depressive Disorders.Journal of Child and Adolescent Psychopharmacology, 29(5), 348–361. https://doi.org/10.1089/cap.2019.0017

Stringaris, A., Vidal-Ribas, P., Brotman, M. A., &Leibenluft, E. (2018).Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people.Journal of Child Psychology and Psychiatry, 59(7), 721–739. https://doi.org/10.1111/jcpp.12823

Walkup, J. T. (2017).Antidepressant Efficacy for Depression in Children and Adolescents: Industry- and NIMH-Funded Studies.American Journal of Psychiatry, 174(5), 430–437. https://doi.org/10.1176/appi.ajp.2017.16091059

BUY A CUSTOM-PAPER HERE ON;Assessing and Treating Pediatric Patients with Mood Disorders Essay

When pediatric patients 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 patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
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 patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. The paper has to have a title page, introduction and summary.
RUBRIC:
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
Decision #1 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Decision #2 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Decision #3 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors