NUR 6665 Across Life Span Essay

NUR 6665 Across Life Span Essay

Anxiety disorder entails more than a temporary fear or worry. While a normal worry or fear is occasional and may quickly go away, anxiety disorder is characterized by anxieties that don’t go away and may only worsen with time. The symptoms due to the condition may be unpleasant and can interfere with an individual’s daily activities like relationships and school work, and work performance (Borza et al.,2022). The implication is that there needs to be an appropriate approach to managing and treating patients with anxiety disorder. Therefore, the purpose of this assignment is to explore pharmacological and nonpharmacological interventions for generalized anxiety disorder.

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FDA-Approved, Off-Label Drug and Nonpharmacological Intervention

FDA has approved several medications for generalized anxiety disorders. One such medication includes escitalopram (Lexapro), which is an antidepressant under the classification of selective serotonin reuptake inhibitors (Strawn et al.,2020). This medication acts by restoring the serotonin balance in the brain. Apart from the FDA-approved medications, there are also various off-label medications that have been shown to be effective in the treatment of anxiety disorder. One of them is Zoloft which is also a selective serotonin reuptake inhibitor (Strawn et al.,2018). Even though pharmacological approaches are widely used in the management of mental health disorders such as anxiety, nonpharmacological approaches are also widely accepted and used. One of the approaches is cognitive behavioral therapy (Borza et al.,2022). This approach has been shown to be the most potent psychotherapy approach and focuses on teaching an individual how to improve symptoms.

The Risk Assessment for Treatment Decision Making, Risks and Benefits of FDA-Approved Drug and Off-Label Drug

Risk assessment for treatment decision-making helps in coming up with the best treatment approaches while considering patient safety. The process will involve considering the patient’s age and other comorbidities. It will also be key to consider any allergic reactions. One benefit of escitalopram is that it has been shown to be effective in treating the condition. However, an individual may experience suicidal thoughts, painful urination, and reduced interest in sex (Strawn et al.,2020). Zoloft has also been used widely due to its effectiveness. However, some of the risks include being suicidal at the beginning of the treatment and being fatigued.

The Clinical Practice Guidelines For Generalized Anxiety Disorder

The negative impacts of generalized anxiety disorder have led to the formulation of clinical practice guidelines. According to the current clinical practice guideline, the condition should be treated for at least six to eight months (Strawn et al.,2018). In some cases, the treatment should be extended to prevent any chances of relapse. In addition, anxiolytic medication should be combined with cognitive behavioral therapy for the best patient outcomes. The choice of medication to be considered should be of the SNRI and SSRI classes of medications. The clinical practice guidelines are in line with the recommendation given in the treatment and management section, as escitalopram belongs to the SSRI class, while cognitive behavioral therapy was also suggested as a nonpharmacological treatment approach.

Conclusion

Generalized anxiety disorder results in various negative impacts on a person’s life as it can impair the daily life of an individual. Therefore, it is important to appropriately treat and manage it. The use of escitalopram has been suggested as an FDA-approved medication, while Zoloft has also been suggested as an off-label drug. In addition, cognitive behavioral therapy has also been suggested as a nonpharmacological approach.

References

Borza, L. (2022). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2017.19.2/lborza

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070. https://doi.org/10.1080/14656566.2018.1491966

Strawn, J. R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., … & DelBello, M. P. (2020). Escitalopram in adolescents with generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. The Journal of Clinical Psychiatry, 81(5), 6584. https://doi.org/10.4088/jcp.20m13396

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INTRODUCTION

 

There is probably no greater responsibility that the psychiatric-mental health nurse practitioner assumes than the responsibility of prescribing medications. While patients can be harmed by psychotherapy, the level and intensity of the harm generally does not approach the same level of harm that can occur from improper prescribing. PMHNPs must understand their responsibility, both at the state and federal levels, when it comes to prescribing medications.

This week, you will explore the particular clinical considerations associated with prescribing for children and adolescents.

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LEARNING OBJECTIVES

Students will:

• Recommend psychopharmacological interventions for children and adolescents
• Recommend nonpharmacological interventions for children and adolescents in mental health settings
• Analyze clinical decision making related to treatment of children and adolescents in mental health settings
• Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
• Create a study plan for the nurse practitioner national certification examination
  

  PRESCRIBING FOR CHILDREN AND ADOLESCENTS

  Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

  —Agency for Healthcare Research and Quality

   

  Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

  For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

  Reference:

  Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlLinks to an external site.

  RESOURCES

   

  Be sure to review the Learning Resources before completing this activity.
  Click the weekly resources link to access the resources.

  WEEKLY RESOURCE

  TO PREPARE

• Your Instructor will assign a specific disorder for you to research for this Assignment.
• Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

• THE ASSIGNMENT (1–2 PAGES)

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

• BY DAY 7 OF WEEK 3

  Submit your Assignment.

  SUBMISSION INFORMATION

  Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

• To submit your completed assignment, save your Assignment as WK3Assgn1+last name+first initial.
• Then, click on Start Assignment near the top of the page.
• Next, click on Upload File and select Submit Assignment for review.

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  Rubric

  NRNP_6665_Week3_Assignment1_Rubric

  NRNP_6665_Week3_Assignment1_Rubric

  Criteria	Ratings	Pts
  This criterion is linked to a Learning OutcomeIn 1–2 pages, address the following: • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.	25 to >22.0 ptsExcellent The response accurately and concisely explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 22 to >19.0 ptsGood The response accurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 19 to >17.0 ptsFair The response somewhat vaguely or inaccurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 17 to >0 ptsPoor The response vaguely or inaccurately explains interventions that would be appropriate for treating the assigned disorder in children and adolescents. Interventions may not represent the three types of interventions required, or response may be missing.	25 pts
  This criterion is linked to a Learning Outcome• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?	25 to >22.0 ptsExcellent The response accurately and concisely explains the risk assessment you would use to inform your treatment decision making. A concise and accurate explanation of the risks and benefits of each pharmacological intervention is provided. 22 to >19.0 ptsGood The response accurately explains the risk assessment you would use to inform your treatment decision making. An adequate explanation of the risks and benefits of each pharmacological intervention is provided. 19 to >17.0 ptsFair The response somewhat vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The explanation of the risks and benefits of each pharmacological intervention is somewhat vague or inaccurate. 17 to >0 ptsPoor The response vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The risks and benefits of each pharmacological intervention is vague or inaccurate. Or, the response is missing.	25 pts
  This criterion is linked to a Learning Outcome• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.	25 to >22.0 ptsExcellent The response accurately and concisely uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 22 to >19.0 ptsGood The response accurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 19 to >17.0 ptsFair The response somewhat vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 17 to >0 ptsPoor The response vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. Or, the response is missing.	25 pts
  This criterion is linked to a Learning Outcome• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Be sure they are current (no more than 5 years old). Attach the PDFs of your sources.	10 to >8.0 ptsExcellent The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. The resources reflect the latest clinical guidelines and provide strong justification for decision making. 8 to >7.0 ptsGood The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. 7 to >6.0 ptsFair Three evidence-based resources are provided to support the intervention recommendations, but they may only provide vague or weak justification. 6 to >0 ptsPoor Two or fewer resources are provided to support the intervention recommendations. The resources may not be current or evidence based.	10 pts
  This criterion is linked to a Learning OutcomeWritten 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 to >4.0 ptsExcellent 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. 4 to >3.5 ptsGood Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3.5 to >3.0 ptsFair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 3 to >0 ptsPoor Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided.	5 pts
  This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 ptsExcellent Uses correct grammar, spelling, and punctuation with no errors 4 to >3.5 ptsGood Contains one or two grammar, spelling, and punctuation errors 3.5 to >3.0 ptsFair Contains several (three or four) grammar, spelling, and punctuation errors 3 to >0 ptsPoor Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding	5 pts
  This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list.	5 to >4.0 ptsExcellent Uses correct APA format with no errors 4 to >3.5 ptsGood Contains one or two APA format errors 3.5 to >3.0 ptsFair Contains several (three or four) APA format errors 3 to >0 ptsPoor Contains many (five or more) APA format errors	5 pts
  Total Points: 100

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  LEARNING RESOURCES

  Required Readings

• Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental healthLinks to an external site.. American Psychiatric Association Publishing.
  • Chapter 14, “Psychosocial Interventions”
  • Chapter 15, “Psychotherapeutic Interventions”
  • Chapter 16, “Psychopharmacological Interventions”Links to an external site.
• Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
  • Chapter 43, “Pharmacological, Medically-Led and Related Treatments”

• Required Media

• Walden University. (n.d.). Developing SMART goalsLinks to an external site.. https://academicguides.waldenu.edu/ld.php?content_id=51901492Links to an external site.
• Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
  • Chapter 5, “Psychopharmacology”
  • CriticalThinkRx. (2019, June 9). Module 5: Links to an external site.Specific drug classes: Focus on adverse effectsLinks to an external site. [Video]. YouTube. https://youtu.be/Gbq6RnOsGKQLinks to an external site.
  • CriticalThinkRx. (2019, June 9). Module 2: Use of psychotropics with youth_prevalence and concernsLinks to an external site. [Video]. YouTube. https://youtu.be/NRef-g4Ding