Case Study on Therapy for Pediatric Clients with Mood Disorders
Case Study on Therapy for Pediatric Clients with Mood Disorders
Case Study on Therapy for Pediatric Clients with Mood Disorders
BACKGROUND INFORMATION
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- Mother reports that teacher said child is withdrawn from peers in class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
Case Study on Therapy for Pediatric Clients with Mood Disorders
- Physical exam unremarkable
- Laboratory studies WNL
- Child referred to psychiatry for evaluation
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.
You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression). An African American Child Suffering From Depression Case Study
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
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 BIDAn African American Child Suffering From Depression Case Study
Therapy for Pediatric Clients with Mood Disorders
Childhood mood disorders including depression have been discovered to have a high prevalence amongst children and adolescents. According to the scholarship on the matter, such disorders have characteristic behavioral, interpersonal, and emotional dysfunction that can result into impairments
across multifarious areas of functioning such as social and academic arenas. The diagnosis of various mood disorders such as depression in children present with certain challenges associated with developmental overlap and variations as well as the manner in which pertinent symptoms present. However, adapting significant screening questions when undertaking psychiatric evaluation through the interview technique leads to accurate diagnosis of mood disorders, specifically depression, in children. According to Stahl (2014), whereas psychiatric mental health nurse practitioners can manage mood disorders, the establishment of relevant therapies should be preceded by an accurate diagnosis of a condition. Fundamentally, PMNHPs may prefer the psychopharmacologic therapy using psychotropic drugs in severe conditions, which depends on certain pharmacokinetic and pharmacodynamics processes such as drug metabolism. Even then, the response of a patient to the prescribed regimen as well as the effectiveness of the same may influence whether a nurse may explore the usage of a different drug in addition to interpersonal therapy. Therefore, the purpose of the present paper entails examination of the potential pharmacotherapeutic interventions concerning Kara, a 13-year-old African-American child, who presents with symptoms of significant depression, by evaluating the efficacy of the chosen pharmacological agent at various decision points. An African American Child Suffering From Depression Case Study
Decision Point One
Selected Decision
Begin Zoloft 25 mg orally daily
Reasons for the Selection
Studies have revealed that the administration of Selective serotonin reuptake inhibitors (SSRIs) has proven efficacious in the management of major depressive disorders. Zoloft, also referred to as Sertraline, acts as the first line of treatment when a psychopharmacologic therapy is preferred by a PMNHP (Stahl, 2013). When the Children’s Depression Rating Scale was administered to Kara, a score of 30 was indicated implying that the child was suffering from significant depression. From the given list, Zoloft 25 mg will be prescribed to the patient since it is a first line medication and has proven efficacious in previous studies. A Cochrane review discovered that children from 6 years have expressed high tolerance to Zoloft and the side effects associated with the drug are minimal. In addition, studies such as Murphy et al. (2013), have revealed that African-Americans, because of their genetic makeup, have a poor metabolism of Sertraline, which offers a greater therapeutic effect hence benefits to a patient of this origin.
An African American Child Suffering From Depression Case Stdy
Moreover, Paxil 10 mg has also proven effective in the pharmacotherapeutic management of major depression yet its associated side effects, particularly its propensity to heighten suicidal thoughts in children, and the age of the patient disqualify it from consideration (Gordon & Melvin, 2014; Seedat, 2014). Similarly, Wellbutrin 75 mg is not preferred because of its adverse reactions such as increased suicidal behaviors and thoughts in young adults and adolescents. Further, Stahl (2013) posits that Wellbutrin 75 mg can only be prescribed after the first line medications fail to resolve the depressive symptoms and also when affect is not overly pronounced. Also, the PMNHP should not countenance a combination therapy involving Zoloft and Paxil since they have the same mechanism of action, implying that a possibility of a higher SSRI dosage exists, which may predispose the client to Serotonin Syndrome. Having considered all these factors, administering Zoloft 25 mg using oral administration is the best option for the client. An African American Child Suffering From Depression Case Study
Expected Results
Antidepressants normally produce their desired effects within the first six weeks of administration as they prove effective in the management of long term depression. Studies have revealed that certain symptoms of depression should resolve within two weeks of using Zoloft (Sanchez, Reines, & Montgomery, 2014). However, the reduction of some of these symptoms to close to normal depends on the correct administration of the medication. Thus, within two weeks, the client is expected to show improvement in sadness and more interaction with classmates. Also, within the first three weeks, Kara should demonstrate improvement in appetite and irritation. Therefore, a majority of the symptoms of depression presented by Kara should have improved by the fourth week.
Difference between Expected Results and Actual Results
Upon returning to the clinic after four weeks of Zoloft therapy, the patient displayed unresolved depression symptoms. This was inconsistent with the objective of the formulated care plan as well as the expectations by the PMNH. While Zoloft has a few side effects, the PMNHP expected it to have resolved some of the symptoms displayed by Kara. The symptomatology of depression was anticipated to have improved within four weeks before the patient came in for evaluation. The actual result could be attributed to nonconformity to the dosage regimen, non-responsiveness as well as underdosage. For this reason, the outcome of the Zoloft pharmacotherapy was diametrically opposite to the anticipated results the PMNHP had during the drawing of the care plan.
Decision Point Two
Selected Decision
Increase dose to 50 mg orally daily
Reasons for the Selection
The primary reason for administering SSRIs is to influence the remission of depression symptoms. Since they had not resolved within the expected four weeks, it would be assumed that Kara either did not strictly adhere to the dosage instructions or the patient did not respond to the drug. Thus, the PMNHP would be advised to either change the drug or increase the dosage to maximum while observing the therapeutic limits with respect to the patient’s age (Walkup, 2017). However, given that a clearer picture regarding the cause of the situation does not exist, the best decision would be to increase the dosage of Zoloft to 50 mg orally daily, which is recommended for children from 6 years of age. Further, this is in line with recommendations made by various studies, which reveal that the effectiveness of Zoloft is felt at 50 mg as opposed to 25 mg (Miller et al., 2015). The reason for the increase of dosage is thus found in the fact that higher levels of Sertraline trigger the release of serotonin, which modulates the reduction of the symptoms associated with depression. An African American Child Suffering From Depression Case Study
Expected Results
The increased dosage from 25 mg to 50 mg is expected to increase the levels of serotonin within the central nervous system. As a consequence, the PMNHP expects Zoloft to induce the desired effects at this level since 50 mg is the maximum dosage for children of this age while 25 mg is the starting dose (Carvalho et al., 2016). This implies that the therapeutic effect of Zoloft is expected within four weeks of administration of this dosage since it falls within the therapeutic range of the drug. As such, by the eighth week of using Zoloft, Kara is expected to show improved appetite, reduced sadness, and have more willingness to engage classmates.
Difference between Expected Results and Actual Results
When the patient visited the facility in week eight of the Zoloft pharmacotherapy, the PMNHP expected him to show remission of depression symptoms. When Kara was evaluated, the symptoms had decreased by 20%, which was in conformity with the expected results to an extent. Due to the therapeutic effect of Zoloft, the client reported improved feelings, thus indicating reduced depressive symptoms. However, at this dose, the nurse also expected the presence of some adverse effects of the drug yet this did not occur. The absence of side effects could be attributed to better tolerance by Kara. Thus, the increased dosage produced expected results even when the percentage was lower. An African American Child Suffering From Depression Case Study
Decision Point Three
Selected Decision
Change to a different SSRI
Reasons for the Selection
After eight weeks of using Zoloft for Kara’s depression, it was expected that the symptoms would have reduced by more than 40%. However, given that only 20% of the symptoms have improved, it implies that the patient suffers from a difficult to treat depression. Further, the responsiveness of the patient to Zoloft may also play a role in the lower percentage of reduced symptoms registered so far. Ciprian, Zhou and Del Giovane (2016) posit that in a scenario such as this one, a PMNHP should consider to either introduce another antidepressant to the active drug or change from Sertraline to a different molecule. Maintaining the current dose as well as increasing the dosage of Zoloft cannot be countenanced as the former has proven ineffective while the latter will introduce dangerous side-effects to the patient. As such, given that the first assertion by Ciprian, Zhou and Del Giovane (2016) does not exist, the present PMNHP will have to introduce a different SSRI while withdrawing Zoloft.
Expected Outcomes
According to Walkup (2017), the introduction of a different SSRI, which may be stronger that Zoloft, is expected to resolve more than 30% of the depressive symptoms affecting Kara. The resolution of these symptoms is expected to occur within the first four weeks, which is by week 12 of the pharmacotherapy, after the PMNHP has prescribed a different SSRI. It is hoped that the introduction of the new drug will enhance the confidence of the patient in the therapy, further aiding Kara’s adherence to the medication regimen. An African American Child Suffering From Depression Case Study
Difference between Expected Outcomes and Actual Results
According to treatment guidelines for childhood depression, upon the administration of maximum therapeutic dosage of a pharmacological agent without results, a PMNHP should consider withdrawing the drug in question and introduce a new molecule. For this reason, the decision to change from Zoloft to another SSRI conformed to the standard pharmacotherapy intervention for depression. Scholarship on the matter has revealed that each individual responds uniquely to a given psychopharmacological intervention and in cases where one proves ineffective, the introduction of a more efficacious drug becomes necessary.
Impact of Ethical Considerations on Treatment Plan
The Food and Drug Administration has warned that most antidepressants heighten suicidal tendencies in childhood depression. As a consequence, whereas some of these drugs may effectively manage symptoms, it becomes incumbent upon a nurse practitioner to discuss the side effects associated with a client (Breggin, 2016). Given that Kara was a 13-year-old and was accompanied by the mother, the PMNHP was supposed to discuss the possibility of increased suicidal thoughts with the parent. A full disclosure of the benefits and dangers of Zoloft and the other SSRI to the mother is necessary in order to allow her to green light or reject the therapy. The disclosure is particularly important in this case given that the patient demonstrates withdrawal from classmates and thus may require close monitoring. Also, based on this fact, the PMNHP may consider a different treatment regimen with less adverse events. Therefore, ethical considerations in this pharmacotherapeutic intervention is integral in determining the safest drug to utilize as part of the care plan.
Conclusion: An African American Child Suffering From Depression Case Study
Therefore, a psychopharmacological intervention has proven to be more effective in the management of significant depression in children. To this end, a PMHNP needs to formulate an intervention therapy based on aspects such as tolerance, safety, and metabolism of a drug. During the ensuing evaluations, the PMHNP needs to observe the response of the patient and make necessary adjustments to the therapy including increasing the dosage, changing the molecule or introducing a combination therapy. Even then, PMHNPs need to communicate the benefits and side effects of a pharmacological agent to a client or their parent so as to ensure all ethical points are covered.
References: An African American Child Suffering From Depression Case Study
Breggin, P. (2016). Rational principles of Psychopharmacology for therapists, Healthcare providers and clients. Journal of Contemporary Psychotherapy, 46(1), 1-13.
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. Psychotherapy and Psychomatics, 25(5), 270-288.
Ciprian, A., Zhou, X., & Del Giovane, C. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: A network Meta-analysis. The Lancet, 388, 881-890.
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
Miller, S., McTeague, L. M., Gyurak, A., Patenaude, B., Williams, L. M., Grieve, S. M., … Etkin, A. (2015). Cognition-childhood maltreatment interactions in the prediction of antidepressant outcomes in major depressive disorder patients: results from the ispot-d trial. Depression & Anxiety (1091-4269), 32(8), 594–604. https://doi.org/10.1002/da.22368
Murphy, E., Hou, L., Maher, B. S., Woldehawariat, G., Kassem, L., Akula, N., Laje, G., … McMahon, F. J. (2013). Race, genetic ancestry and response to antidepressant treatment for major depression. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology, 38(13), 2598-606.
Sanchez, C., Reines, E. H., & Montgomery, S. A. (2014). A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike?. International clinical psychopharmacology, 29(4), 185-96.
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Walkup, J. (2017). Antidepressant efficacy for depression in children and adolescents: Industry- And NIMH-funded studies. Am J Psychiatry, 174, 430-437.
Week 4: Therapy for Patients With Major Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module.
Learning Objectives
Students will:
- Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan
- Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy
- Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy
- Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan.
Learning Resources
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. Case Study on Therapy for Pediatric Clients 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 #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.
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.
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.
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.
Case Study on Therapy for Pediatric Clients with Mood Disorders. Case Study on Therapy for Pediatric Clients with Mood Disorders. Case Study on Therapy for Pediatric Clients with Mood Disorders. Case Study on Therapy for Pediatric Clients with Mood Disorders
Is it hard to Place an Order?
1. Click on the “Order Now” on the main Menu and a new page will appear with an order form to be filled.
2. Fill in your paper’s requirements in the “PAPER INFORMATION” section and the system will calculate your order price/cost.
3. Fill in your paper’s academic level, deadline and the required number of pages from the drop-down menus.
4. Click “FINAL STEP” to enter your registration details and get an account with us for record-keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.
5. From there, the payment sections will show, follow the guided payment process and your order will be available for our writing team to work on it.
Services Offered
Use the following coupon code :
NursesHomework
