Case Study: An African American Child Suffering From Depression
Therapy for Pediatric Clients with Mood Disorders
Introduction
Pediatric Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders. Recent studies have shown a correlation between affective disorders in children, and depression or anxiety disorders in the adult years. It is suggestive that the onset of adult psychopathologic disorders can be linked to behavioral or emotional symptoms displayed as a child or adolescent.(Medscape, 2018). Case Study: An African American Child Suffering From Depression.
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Mood disorders in children remain one of the most under diagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.(chop,2018). Treatments vary depending on the symptoms of the depression. Treatment is aimed at decreasing the signs of the illness. In order to properly treat a patient, there needs to be a complete assessment , past mental health history, psychological therapies and pharmacological interventions should be part of the treatment plan.
The purpose of this assignment is to discuss mood disorders and its effect on children and treatment options available.
Summary of patient
The patient is an 8 year old African American male with chief complaints of feeling “sad, withdrawn, decreased appetite and occasional irritation. Upon assessment the child is alert and oriented x 3, overall mood is sad. He denies visual or auditory hallucinations, however, admits to thinking about himself being dead. The Children’s Depression rating scale is 30, translates to significant depression. The CDRS was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds.(Poznanski,1986). Case Study: An African American Child Suffering From Depression.
Decision 1
Options: Sertraline 25mg by mouth daily, Paxil 10 mg by mouth daily and Wellbutrin 75mg by mouth 2x/daily
I chose Sertraline 25 mg by mouth daily. Studies have shown that Sertaline is appropriate for treating depression in young children.”(SSRIs) have a relatively good response rate (40-70%)”(p.7). Paxil is contraindicated for children younger than 18 and Wellbutrin is contraindicated as well. Wellbutrin has other risks for anorexia and seizures (p.16). The initial goal of treatment of mood disorders is a decrease in symptoms. The outcome of treatment was not as I expected , I expected a minimal reduction in symptoms. However, the client reported no change in symptoms.
Decision 2
Options: Prozac 10 mg by mouth daily, Sertraline 37.5 mg by mouth daily, Sertraline 50 mg by mouth daily
I chose to increase the Sertraline to 50 mg by mouth daily. Sertraline is appropriate for treating children and the dosage can be titrated to up 200 mgs (p.18). The 25 mg dose might not be the right therapeutic dose and to give it more time to become effective. I did not pick Sertraline 37.5 because it is below the therapeutic dose suggestion. The reason for not choosing Prozac 10 mg by mouth daily, is to stay with the current medication and titrate up till symptoms decrease and client does not report depression symptoms. The goal of treatment is to have a reduction in symptoms. The results were some of what I expected, I did not expect a 50% reduction in depressive symptoms. Case Study: An African American Child Suffering From Depression.
Decision 3
Options: Maintain current dose, change to SNRI, or Increase to Sertraline 75 mg by mouth daily
My choice is to maintain the current dose. Stahl (2013) has mentioned that a 50% reduction in symptoms after treatment with an antidepressant is a “response”. If there is a positive response to a medication it is best to maintain that current treatment. There reason I did not chose the other two options was because the client had a 50% reduction in symptoms without any further symptoms. The goal is for the client to respond positively to medication leading to complete reduction of symptoms. The outcome was as I expected. The goal of titrating a medication that has shown positive results .After a 50% reduction, there should be more reduction after the next 4 weeks, leading to a complete remission of symptoms.
Conclusion with Ethical considerations
Children, including adolescents can display disruptive or irritability as a normal part of this stage in development. But key signs to watch for include irritability and not getting along with other children, stating other children do not like them, the feeling of rejection, these are “bridge symptoms” that can be early signs of risk for a anxiety or affective disorder. Parents, teachers, and care givers need to be aware of what is typical teen behavior and what is atypical to help prevent future mental health disorders.
The ethics and responsibility of prescribing medication falls in the hands of the provider. The provider is responsible for educating the client and the parents in this case of the risk. Children that are younger than 14 are not able to consent to treatment.” They cannot give legal permission for treatment, which must come from their parents. It is the responsibility of the prescribing clinician to inform the parents of the expected benefits and risks of the medication” (Vitiello, 2012, p.12). The clinician has the responsibility to monitor the clients response to medication and compliance . Involving the parents in the plan of care can help monitor the effectiveness of the treatment. Case Study: An African American Child Suffering From Depression.
References
Children’s Hospital of Philadelphia.(2018) Retrieved from https://www.chop.edu/conditions- diseases/mood-disorders-children-and-adolescents
Laurate Education (2016e). Case study. An African American Child Suffering From Depression [Interactive media file]. Baltimore, MD: Author.
Medscape (2018). Retrieved from https://www.medscape.com
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed. New York, NY: Cambridge University Press.
Vitiello B. (2012). Principles in using psychotropic medication in children and adolescents. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-
Case Study: An African American Child Suffering From Depression NURS 6630 – Week 2
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. Case Study: An African American Child Suffering From Depression.
- 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? Case Study: An African American Child Suffering From Depression.
- 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.
Therapy for Pediatric Clients with Mood Disorders – Case Study: An African American Child Suffering From Depression
Decision #1
Which decision did you select?
Begin Zoloft 25 mg orally daily.
Why did you select this decision?
Zoloft is a selective serotonin reuptake inhibitor (SSRI) that functions by restoring serotonin balance in the brain to improve mood, particularly the client’s depression. Besides that, it is highly effective in treating mood disorders and depression among children. In addition, starting at the lower dose of 25 mg since antidepressants tend to increase anxiety when first used Stahl, 2014) Case Study: An African American Child Suffering From Depression.
What were you hoping to achieve by making this decision?
The prescribed medication was intended to improve the client’s mood and address the depression by restoring the serotonin balance in the brain (Stahl, 2014).
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
The prescription and its dosage was intended to improve the client’s mood and address the depression (Stahl, 2014). But, this objective was not achieved. Instead, the client returned to the clinic after four weeks reporting that she had not experienced any changes to her depressive symptoms. The lack of response is likely the result of the low medication dosage with a higher dose anticipated to further improve the serotonin balance in the brain to alleviate the depressive symptoms (Stahl, 2013). Case Study: An African American Child Suffering From Depression
Decision #2
Increase Zoloft dose to 50 mg orally daily.
Why did you select this decision?
The dosage was increased since the initial dose did not achieve the desired outcome of reducing the depressive symptoms. The increased dose is anticipated to further improve serotonin balance in the brain thereby reducing the depressive symptoms (Stahl, 2014).
What were you hoping to achieve by making this decision?
The decision to increase the prescribed medication dose was intended to reduce the client’s depressive symptoms by improving serotonin balance in the brain (Stahl, 2014).
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
The expected result from increasing the dosage to 50 mg was to reduce the depressive symptoms. This was achieved since the client visited the clinic four weeks later with the depressive symptoms reduced by 50% and client reporting that he was tolerating well (Stahl, 2014).
Decision #3
Maintain the current dose of Zoloft at 50 mg orally daily.
Why did you select this decision?
The decision to maintain the current dose was made for two reasons. Firstly, the client was responding well to the current dosage with clear symptoms reduction. Secondly, the client had adjusted well to the current dosage to imply that it was an optimum dosage for reducing the symptoms without presenting adverse effects (Stahl, 2014).
What were you hoping to achieve by making this decision?
The decision to maintain the current dosage was made with the intention of building on the current positive results. The dosage is already working in relieving the depressive symptoms, and maintaining it is expected to continue the current trend of relieving the symptoms (Stahl, 2014) Case Study: An African American Child Suffering From Depression.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
It was expected that additional symptoms reduction would be reported beyond the current 50%. But this was not the case with no further reduction in symptoms reported after four weeks. Given that the 50% reduction in symptoms was not full remission, the client was responding to the medication so that a change in drugs was not warranted, then the next step would be to recommend the use of psychotherapy as an additive therapy to complement the prescription medication. This decision is informed by ethical justifications that the client is already responding to medication whose dosage cannot be increased so that psychotherapy is recommended as a complement that would provide additional benefits (Stahl, 2013; Stahl, 2014). Besides that, the standard safe Zoloft dose for children is 50 mg daily for mood disorders and depression. Increasing the dose beyond 50 mg daily is likely to reduce the symptoms further but also result in client intolerance and adverse side effects that include suicide tendencies (Gordon & Melvin, 2014; Magellan Health, Inc., 2013; Vitiello, 2012).
References
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 Case Study: An African American Child Suffering From Depression
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
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf Case Study: An African American Child Suffering From Depression