NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders 

Assessing and Treating Pediatric Patients With Mood Disorders

Decision Point One

Select what you should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

Introduction

Growth and development are apparent and an inevitable process. As children progress through the developmental stages, they experience different psychological, emotional, sociological, and physical changes. During growth, the brain of a child is also under development, taking in various impulses into the neurons, which lead to the child’s decision making. One major contributor to a child’s brain development and reaction is the culture and society surrounding him or her during the development. As children are in their developmental stages, they perceive the environment differently, and some are often overwhelmed by the rapid developments (Petersen, 2017). It is the parents or the guardians’ responsibility to guide the young ones as they mature and begin to see life in different dimensions. However, some are unfortunate and get to experience different and difficult situations which may lead to mental health disorders such as depressions. In this paper, a case study of a young boy with symptoms of depression will be analyzed after which treatment decisions will be selected for the client. The client is a pediatric patient and thus it will be good to select the medications with good safety profile and few side effects/metabolic effects. The paper will also discuss the ethical issues likely to influence and affect the client’s treatment plan.

Case Study

The case study involves an eight-year-old African-American male who arrives at the ER with his mother accompanying him. According to his medical conditions, as described by his mother, he is exhibiting signs of depression with complains of feeling sad. His mother then states that his school teacher complained of his withdrawal from classwork and his peers and that he was no longer actively involved in school work and activities as before. His mother has also noticed a decrease in appetite, and his eating rate was going down to the drain. Also, his mother had occasionally noticed some sporadic episodes of irritation. Alex had successfully gotten past all developmental landmarks at the appropriate stages. physical examinations showed no abnormal findings. Alex was then referred to psychiatry for further evaluation.

After examination, the boy’s mental status exam exhibited alert and oriented x3, which showed that the boy was aware of his environment and surroundings, and he knew who he was during a specific time. The mental exam showed that his speech was clear, spontaneous, goal-oriented, and coherent. He said that he felt sad, affect was somewhat blunted, but he smiled on various occasions during the clinical interview. During examination, he denies visual or auditory hallucinations. The assessment did not indicate any paranoid or delusional thought process and his insight and judgment appeared appropriate for his age. From the examination, it can be concluded that the boy is not endorsing active suicidal ideation, but at times he thinks of himself as dead and what it would be like to be dead. The client was administered with the Children’s Depression Rating Scale and scored 30, indicating significant depression. The client was thus diagnosed with depression. Treatment goal for this client will include administering pharmacological agents to enhancing his appetite, improve sleep patterns, and decrease social anxiety that the boy showed in school withdrawing from his peers.

Decision Point One

The decision that was made from a mental health provider’s perspective, putting in mind the boy’s age and condition, was to administer with Zoloft 25 mg, which was to be taken orally daily for four weeks (month) where he was required to return to the clinic for evaluation. Zoloft, also known as Sertraline, is majorly used to treat panic attacks, depression, social anxiety, traumatic stress disorder, and a severe form of the premenstrual disorder  (Karp, 2017). To recommend this drug, it was certain from the mental exam that the eight-year-old boy has exhibited some forms of depression, which led to him withdrawing from his peers in school and reducing his appetite. The safety and tolerability of Zoloft in children have been established (Locher et al., 2017). The medication is an Selective Serotonin Reuptake inhibitors (SSRI) whose mechanism of action is to elevate the level of serotonin in the brain. The increased amount of serotonin in the brain will improve the client’s mood and thus help in improving the depressive symptoms.

Zoloft was the best option as while the other two options are also used to treat the same signs exhibited by the boy. It has not been clinically proven that Paxil, being administered 10mg in a day, would be the best option for a child. since Paxil is associated with numerous side effects such as sleep problems, nausea, loss of appetite, blurred vision, shaking, among other symptoms. Additionally, the drug is not known to be effective or safe among children, it has also been demonstrated to increase suicidal thoughts among children with depressive symptoms (Currie & MacLeod, 2018). Besides, Wellbutrin 75 mg orally BID was not a preferred option , while it can be used to treat depression, it is also associated with side effects such as vomiting, nausea, decreased appetite, sleep problems, increased swelling, dry mouth, headache, and blurred vision (Patel et al., 2016). Moreover, Locher et al (2017) explain that the tolerability, safety, and efficacy of Wellbutrin in the pediatric population have not been systematically studied.

It is ethically important and crucial to discuss the type of drug that you administer to a client. They have the right to informed consent; hence as a counsellor, it is ethically important to communicate the effects of the decisions you are making towards their health. The client also should be willing to participate in their journey towards good health, which can only be achieved through effective and logical communication.  Also, it will be important for the PHMNP to ensure confidentiality of the client data and ensure the health information, including the diagnosis is only accessible to authorized individuals such as the parents (Hiriscau et al., 2016).

Decision Point Two

This treatment was geared towards the betterment of the patient, which after four weeks, there were no changes at all in the functioning of the client as he still manifested depressive symptoms. The lack of improvement is attributable to the low dosage of Zoloft that led to the low efficacy of the medication. Hieronymus et al (2016) explains that the efficacy of SSRI antidepressants such as Zoloft is characterized by a dose-response relationship. Hence resulted in a decision to increase the dosage from 25mg to 50mg of Zoloft to be administered orally daily. However, it would not have been a wise decision to change the medication because the maximum dose of Zoloft has not been administered, and hence there is no clinical reason to change the medication. The decision to increase the dose of Zoloft to 37.5 mg was not chosen since Zoloft treatment should start at a dose of 25 mg and the dose titrated upwards after a week to 50 mg (Santarsieri & Thomas, 2015). Additionally, the decision to change the treatment regimen to Paxil was not chosen because of the many side effects associated with Paxil (Wang et al., 2018).

The ongoing treatment needed to bring back negative results so it could be ruled out for discontinuation. The client needs to understand the stakes that come along with an increase in the dosages and the side effects that may follow as a result. However, due to the need to get better, one must also understand the positive results of taking the prescribed dosage (Goldberg & Ernst, 2018). The second decision results were positive as, after the client returns to the clinic after four weeks for examination, there are tremendous improvements, which indicated the recession of the depressive symptoms by 50%, and the client was coping up well mg and the client also tolerated the increased dose.

Among the health and ethical considerations is giving the client the exact details of their medical conditions and letting them know of the options of the second decision as well as giving them an opportunity to be involved in making an informed decision. As explained above, it is crucial to let the client understand the reason behind your decisions, this will promote compliance and effective monitoring of side effects (Lomas et al., 2020).

Decision Point Three

The decision that was selected for decision three is to maintain the current dose, this decision was made based on the indication that the Zoloft 50 mg was effective and did not result in any side effects, this was manifested by the improvement of symptoms reported. According to Carvalho et al (2016) when selecting antidepressants like Zoloft, it is important to consider both the potential benefits, treatment responsiveness as well as side effects (Kato et al., 2018). Therefore, it is important to maintain the minimum effective dose to avoid potential side effects with increased dose. The decision to change the treatment regimen to SNRI was not chosen since there is no clinical reason as the client is already manifesting symptom remission. SSRIs are the first-line treatment choice when treating depression as they are effective and are associated with minimal side effects (Park & Zarate, 2019).

The decision to increase the Zoloft dose from 50 mg to 75 mg was not chosen since the client is already manifesting adequate response to Zoloft 50 mg as indicated by 50% symptoms improvement. Additionally, the client is tolerating Zoloft 50 mg as he did not report any side effects, and hence increasing the dose to 75 mg may lead to side effects (Carvalho et al., 2016).

Selecting the decision to maintain the current dose of Zoloft 50 mg expects that the client would continue exhibiting symptom improvement and finally achieve complete symptom remission. Additionally, it is expected that he would continue tolerating the medication, with few or no side effects.

Decisions being made towards client health should involve all the stakeholders’ responsible (Lomas et al., 2020). His mother who is his main caregiver, took the provider’s instructions, where she would continue administering the drug for another four weeks to track the trend that the depression signs took over time and other major complications. Before making treatment decisions, it is important to involve the client and family to understand the importance of the treatment options and the pros and cons of each options. Also, the client’s consent is required for all treatment decisions being made since it majorly involves their health (Belitz, 2018).NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

Conclusion

Mental disorders and mental health should be a priority in today’s society, and it should begin for the children at a young. Mental health for kids and children should be embraced by the guardians and parents, and the main key stakeholders to avoid mental health treatment for children at a very young age. Natural therapeutic sessions are supposed to be embraced in social institutions such as schools and churches. However, we cannot ignore the fact that medication is still needed in some instances. Zoloft can be administered to adults and pediatric patients whose conditions are beyond natural therapy. However, care must be taken, as children with problems such as kidney problems, liver problems, and other conditions can react differently towards the treatment highlighted. A health examination needs to be carried out on the kid before administration of the Zoloft dosage.

References

Belitz, J. (2018). Ethics in assessing and treating children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.), APA handbooks in psychology®. APA handbook of psychopathology: Child and adolescent psychopathology (p. 589–606). American Psychological Association.

Bodnar, C. N., Morganti, J. M., & Bachstetter, A. D. (2018). Depression following a traumatic       brain injury: uncovering cytokine dysregulation as a pathogenic mechanism. Neural             regeneration research, 13(10), 1693.

Carvalho A, Sharma, M., Brunoni. A., Vieta, E. & Fava, G. (2016). The Safety, Tolerability, and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom, 2016(85), 270–288.

Currie, J. M., & MacLeod, W. B. (2018). Understanding physician decision making: The case of depression (No. w24955). National Bureau of Economic Research.

Goldberg, J. F., & Ernst, C. L. (2018). Managing the side effects of psychotropic medications                   American Psychiatric Pub.

Hieronymus, F., Nilsson, S. & Eriksson, E. (2016). A meta-analysis of fixed-dose trials reveals dose-dependency and rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Transl Psychiatry, 6(6), e834.

Hiriscau E, Nicola S, Wasserman, D. & Theil, S. (2016). Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study. Int J Environ Res Public Health, 13(5), 489.

Karp, D. A. (2017). Speaking of sadness: Depression, disconnection, and the meanings of illness.    Oxford University Press.

Locher C, Koechlin H, Zion S, Werener C, Pine D, Kirsch I, Kessler R & Joe K. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents. JAMA Psychiatry, 74(10), 1011–1020.

Lomas, T., Roache, A., Rashid, T., & Jarden, A. (2020). Developing ethical guidelines for positive psychology practice: An ongoing, iterative, collaborative endeavor. The            Journal of Positive Psychology, 15(6), 716-721.

Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic advances in psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071

Petersen, A. (2017). Brain maturation and cognitive development: Comparative and cross-          cultural perspectives. Routledge.

Santarsieri, D. & Thomas, S. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs Context, 2015(4).

Wang, S. M., Han, C., Bahk, W. M., Lee, S. J., Patkar, A. A., Masand, P. S., & Pae, C. U. (2018). Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review. Chonnam medical journal, 54(2), 101–112. https://doi.org/10.4068/cmj.2018.54.2.101

Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

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. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

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. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

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. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).All papers submitted must use this formatting.

Psychopharmacologic Approaches to Treatment of Psychopathology (laureate.net)

NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders