Anxiety Disorder Assignment Discussion Paper

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? Anxiety Disorder Assignment Discussion Paper

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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.html To Prepare Your Instructor assigned Generalized Anxiety 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 Anxiety Disorder Assignment Discussion Paper

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a mental condition that is defined by constant worry, apprehension, and fear. It manifests itself in children and adolescents as an overwhelming feeling of unease that may take on a variety of forms and is aggravated by external sources of stress. Such individuals commonly present with symptoms such as trouble focusing their attention, restlessness, weariness, difficulties sleeping, and hyperactivity. Treatment of GAD takes various forms. As such, this paper seeks to propose one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for the treatment of this disorder in children and adolescents Anxiety Disorder Assignment Discussion Paper.

FDA-Approved Drug

Duloxetine is the only FDA-approved medication for the treatment of GAD in children and adolescents between the ages of 7 and 17. This medication is a selective serotonin reuptake inhibitor (SSRI), and it has been linked to better symptom decrease on the Pediatric Anxiety Rating Scale, as well as remission and improved functioning (Leonte et al., 2018). In this particular patient population, the recommended starting dosage of duloxetine is 30 milligrams to be taken orally once per day for a period of at least two weeks. After two weeks of taking the first dosage, it is appropriate to think about increasing it to 60 mg once a day by oral administration. If the recommended daily dosage of 60 mg is exceeded, the increase should be carried out in 30-mg-per-day increments afterward.

Off-Label Drug

Quetiapine is an off-label medicine that I recommend for the treatment of generalized anxiety disorder in children and adolescents. This medicine is an antipsychotic that is prescribed to patients suffering from schizophrenia. Additionally, it is often used off-label to treat mental health conditions like as anxiety and depression. Quetiapine functions by assisting in the restoration of chemical messenger equilibrium in the brain. It may be helpful in enhancing patients’ ability to concentrate, lowering their levels of anxiety, and improving their emotions as well as their levels of energy (Strawn et al., 2018). For children aged 10 and above, monotherapy with quetiapine XR is beneficial for the treatment of GAD at dosages ranging from 50 to 300 mg per day Anxiety Disorder Assignment Discussion Paper.

Nonpharmacological Intervention

As a nonpharmacological method for the treatment of generalized anxiety disorder (GAD) in children and adolescents, cognitive-behavioral therapy (CBT) comes highly recommended by me. CBT has been demonstrated to be effective in assisting children and young people in overcoming the challenges associated with anxiety by teaching them new forms of thinking and encouraging them to confront their worries (James et al., 2020). For children and adolescents who suffer from GAD, it is advised that they participate in 16–20 CBT sessions on a weekly basis.

Risk Assessment

The risk assessment that I would use to guide my decision-making regarding treatment would consist of identifying and defining the benefit and risk features of potential therapies based on the available clinical data that has been collected from recent studies.

There is considerable potential for addiction and dependency connected with duloxetine, in addition to the possibility that it might induce unpleasant side effects such as dry mouth, constipation, diarrhea, and abdominal pain (Dhaliwal et al., 2019). The fact that this medicine has been connected to greater symptom decline on the Pediatric Anxiety Rating Scale, as well as remission and improved functioning, is the significant benefit that comes with taking it.

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On the other hand, Quetiapine has a number of risks, the most significant of which is the possibility that it may encourage suicide ideation or behavior in a subset of children and adolescents (Zuschlag, 2021). The potential of this drug to improve patients’ moods as well as their levels of energy, as well as its ability to boost patients’ concentration, are some of the benefits that come as a result of using it.

Clinical Practice Guidelines

The American Association of Child and Adolescent Psychiatry has published clinical practice guidelines for treating Generalized Anxiety Disorder in children and adolescents. According to the American Academy of Child and Adolescent Psychiatry (AACAP), both selective serotonin reuptake inhibitors (SSRI) and cognitive-behavioral therapy (CBT) have substantial evidence-based backing as effective and safe therapeutic interventions for anxiety in children and adolescents (Walter et al., 2020). This supports my recommendations of Duloxetine as the FDA-approved medication for GAD and CBT as a non-pharmacological intervention Anxiety Disorder Assignment Discussion Paper.

References

Dhaliwal, J. S., Spurling, B. C., & Molla, M. (2019). Duloxetine. https://www.ncbi.nlm.nih.gov/books/NBK549806/

James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2020(11). https://doi.org/10.1002/14651858.cd013162.pub2

Leonte, K. G., Puliafico, A., Na, P., & Rynn, M. A. (2018). Pharmacotherapy for anxiety disorders in children and adolescents. Waltham, MA.(Accessed on March 21, 2018: UpToDate.

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

Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107-1124. https://doi.org/10.1016/j.jaac.2020.05.005

Zuschlag, Z. D. (2021). Second-generation antipsychotics and suicide. The Journal of Clinical Psychiatry, 82(5). https://doi.org/10.4088/jcp.21ac13955 Anxiety Disorder Assignment Discussion Paper