African American Child Suffering from Depression decision tree case study
Introduction
This paper examines the case study of: An African American Child Suffering from Depression. The client did not present any underlying medical condition, comorbidity or congenital abnormality that could impact pharmacokinetic and hence no genetic testing for CYP 450 enzymes was performed. Accordingly, this paper will make three decisions about the medication to prescribe to the client African American Child Suffering from Depression decision tree case study.
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Decision Number 1
The first decision is to prescribe Zoloft 25mg orally daily. Even though Sertraline (Zoloft) is not FDA approved for treatment of depression children, it is used as an off-label medication. The rationale for selecting this medication is that evidence shows that that Zoloft has been shown to effective in the treatment of depressive symptoms in pediatric population. Zoloft is an SSRI that works by elevating serotonin levels within the brain ((Zhang et al, 2018). Serotonin is a neurotransmitter that improves mood, emotion, and sleep (Clevenger et al, 2018).
Selection of this decision hoped that the client would show significant symptom improvement evidence by improved interactions in class, improved appetite, and reduced irritation, indicating symptom remission. This is because the medication has been shown to be…
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
Client complained of feeling “sad”
Mother reports that teacher said child is withdrawn from peers in class
Mother notes decreased appetite and occasional periods of irritation
Client reached all developmental landmarks at appropriate ages
African American Child Suffering from Depression decision tree case study
Physical exam unremarkable
Laboratory studies WNL
Child referred to psychiatry for evaluation
Client seen by Psychiatric Nurse Practitioner
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) African American Child Suffering from Depression decision tree case study.
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.
Depression
Introduction
This paper examines the case study of: An African American Child Suffering from Depression. The client did not present any underlying medical condition, comorbidity or congenital abnormality that could impact pharmacokinetic and hence no genetic testing for CYP 450 enzymes was performed. Accordingly, this paper will make three decisions about the medication to prescribe to the client. African American Child Suffering from Depression decision tree case study.
Decision Number 1
The first decision is to prescribe Zoloft 25mg orally daily. Even though Sertraline (Zoloft) is not FDA approved for treatment of depression children, it is used as an off-label medication. The rationale for selecting this medication is that evidence shows that that Zoloft has been shown to effective in the treatment of depressive symptoms in pediatric population. Zoloft is an SSRI that works by elevating serotonin levels within the brain ((Zhang et al, 2018). Serotonin is a neurotransmitter that improves mood, emotion, and sleep (Clevenger et al, 2018).
Selection of this decision hoped that the client would show significant symptom improvement evidence by improved interactions in class, improved appetite, and reduced irritation, indicating symptom remission. This is because the medication has been shown to be effective in treatment of major depressive disorder (Zhang et al, 2018).
However, the client did not manifest any symptom remission as expected. This could be attributed to non-response due to the low dose during the acute treatment phase African American Child Suffering from Depression decision tree case study.
Decision Number 2
The second decision was to increase the dose to 50 mg orally daily. The rationale for selecting this decision is that the 25mg was the acute phase treatment and non-responsive and hence increasing the dose to 50 mg would achieve the optimal balance between tolerability and efficacy (Vries et al, 2016).
By selecting this decision, it was hoped that the client would achieve symptom remission. This is because increased dose of SSRI has been shown to achieve efficacy (Vries et al, 2016). It was also hoped that the client would tolerate the medication and not show any side effects. African American Child Suffering from Depression decision tree case study.
Just like expected, the client tolerated the medication well and showed 50% symptom reduction.
Decision Number 3
The third decision was to maintain the current dose of Zoloft 50 mg orally daily. The rationale for selecting this decision is that evidence recommends use of single psychotropic agent for the short-term treatment childhood mental disorders such as depression. Secondly, the client was showing symptom improvement and hence it was practical to maintain the medication and the dose (Vries et al, 2016).
By selecting this decision, it was hoped that the client will continue showing symptom improvement and that he would tolerate the medication well with minimal or no side effects. African American Child Suffering from Depression decision tree case study.
Ethical Considerations
The main ethical consideration involving this client is the use of an “off-label” medication in the pediatric population. A medication is considered off-label when it is used in treatment of symptoms or conditions not approved by FDA (Mullen, 2018). Another ethical consideration is that antidepressants such as Zoloft are associated with increased suicide ideation in children and adolescents (Mullen, 2018). Lastly, it is important to ensured informed consent is sought and the parent is explained about the risks and benefits associated with Zoloft to ensure they make an informed decision (Mullen, 2018).
Conclusion
The first is for the client to start Zoloft 25mg because the medication has been shown to be effective in the treatment of depressive symptoms. The second decision was to increase the dose to 50 mg, while the third decision was to maintain the current dose of Zoloft 50 mg. legal and ethical issues associated with the treatment of this client include use of an off-label medication and the suicidal risk associated with the medication. African American Child Suffering from Depression decision tree case study.
References
Clevenger S, Malhotra D, Dang J, Vanle B & William W. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Ther Adv Psychopharmacology. 8(1), 49–58.
Mullen S. (2018). Major depressive disorder in children and adolescents. Ment Health Clin. 8(6), 275–283.
Vries Y, Jonge P, Luuk K, Bos J & Hak F. (2016). Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose. Eur Child Adolesc Psychiatry. 25(11), 1161–1170.
Zhang Y, Zhou X, Pu J, Zhang H, Yang L, Liu L, Zhou C, Yuan S, Jiang X & Xie P. (2018). Antidepressants for depressive disorder in children and adolescents: a database of randomised controlled trials. BMC Psychiatry. 18(162). African American Child Suffering from Depression decision tree case study.