Assessing and Treating Pediatric Clients With Mood Disorders
Mood disorders are fairly prevalent in both children and adults. There is a decline in physical exercise with the progression of technologies therefore children are now fascinated with playing computer games. as a result, their minds are now deficient in creativity. not taking part in physical exercise and excessive exposure to online gaming is among the most key considerations for the increased prevalence of various mood disorders in children. There are several illnesses, and they impact a child in a different way compared to an adult. In children, this disorder has different consequences as opposed to adults, and these consequences could be more serious in them. Another fascinating aspect of these kinds of disorders is their co-morbidity with other mood and anxiety conditions in children and young adults. They happen concurrently; at a given point in time, no such condition seems to exist by itself (Lee, Kim & Lee, 2019). The mood problems in children are often a bipolar disorder, major depressive disorder, and dysthymic disorder. The most prominent characteristic of all these conditions is depression. Children with ADHD are more inclined to develop the aforementioned mood disorders (Jarett et al., 2016).
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Case Study
The case study presented in the learning resources is entitled “An African American Child Suffering from Depression.” The title specifically suggests that the child has depression and, most likely, other mood or anxiety problems because they are comorbid in kids. as per the scenario, the child appeared intent-oriented and well-focused. All of his laboratory findings were also consistent, and his visual and auditory examinations were impressive. Even so, he was reported to be in an unhappy’ mood when examined by a PMHNP and was often noticed to have thoughts of him being dead. His mother mentioned him currently having reduced his circle of acquaintances and developed a reduced appetite. Besides that, he easily gets annoyed.
Aim of the Study
This study seeks to design the boy’s therapeutic plan to mitigate his depressed mood and restore him to his usual life. A psychotherapeutic treatment strategy has been put in place to assist him to view life from a different perspective instead of a negative view and having thoughts of dying.
Decision #1
Commence Paxil 10 mg orally daily
After the administration of this drug, the child went back to the facility to get another check-up after four weeks. Having taken this medication, the child’s degree of depression decreased by five points on the depression rating scale. Nevertheless, he also registered problems like vomiting, nausea, and diarrhea.
Paxil originates from the antidepressant group referred to as the selective serotonin reuptake inhibitors. For individuals suffering from depression, this medication is commonly prescribed. The drug blocks the serotonin A1 receptors demonstrates moderate norepinephrine reuptake inhibition and has moderate anticholinergic impacts as well. Nevertheless, the dosage should be closely controlled, so that the adverse effects associated with the medication will not be debilitating and predominate over positive effects. Typically this drug is effective for anxiety disorders that arise concurrently with depression. The beginning of its impact is 4 weeks and beyond. It reduces anxiety, depression, and stress levels (Stahl, 2014).
In regards to the prescription drug context, it was anticipated that the child would transcend his depressed mood and would interact socially with other people. To a certain degree, the outcomes were favorable, nevertheless, the prescribed drug is not perceived to completely cure the disorder. This can be as a result of the child’s complaints of diarrhea and nausea. The medication can also cause insomnia. In addition, the patient’s reaction to the medication may regress, and the individual may not respond to its impact, thereby further struggling with depression. As has already been mentioned, the medication is not a complete remedy for depression and should therefore be taken in conjunction with other antidepressant medications to achieve the intended outcomes (Ampong, 2018).
Decision #2
Change to Prozac 10mg, Orally, Daily
After another period of four weeks, the child went back to the facility. The PMHNP needs to administer him with fluoxetine (Prozac). The medication is also from SSRIs drug classification and has rather similar consequences to Paxil’s. Even so, the benefit of taking this medication included the considerable reduction of indications of diarrhea, vomiting, and nausea, as well as a decrease in depression symptoms by a quarter (Stahl, 2014).
The predicted outcome of the prescription adjustment was to offer relief from prior problems experienced with the drug administered earlier. The achieved outcomes were in line with anticipated outcomes, and the drug offered relief from prior symptoms.
Decision #3
Continue Current Dose
The proper thing to do is to let the child take the prescribed dose without increasing it. The present dosage is well-calculated, hence, it is more reasonable to proceed. The adverse effects are also present as a part of the SSRI medications and can worsen if the dosage is unexpectedly increased. Therefore the dosage cannot be raised until the child starts showing a substantial reaction to the medication’s recommended dosage. Besides that, it is not yet feasible to settle on the medicine in conjunction with another antidepressant medication, since the child has only used the drug for four weeks, which is not ample duration to consider other combination drugs to be provided (Ampong, 2018).
Impact of Ethical Considerations on Treatment
In the field of medicine, it is important to uphold codes of ethics. Ethics generally needs to be followed in all aspects of life. Similarly, ethical issues also carry prominent significance in psychopharmacology during the care and treatment plan. in psychotherapy treatment, l the therapist is required to inquire about the client’s present health situation, family background, as well as history. Certain details are somewhat confidential and should not be revealed to anybody, thus, the therapist needs to gain the client’s trust throughout treatment for the client to have complete confidence with the practitioner and release the information with no reluctance (Gordon & Melvin, 2017). In addition, the practitioner should not deceive their patient so that the patient does not feel betrayed and become anxious and depressed following the outcomes. the therapist should also include the immediate family members, like the patient’s parents. this will ensure that they are fully conscious about the problem and provide certain details that the patient may not have given (Seedat, 2014). above all, a practitioner should educate the family members in advance about the benefits and side effects of the drug, thereby contributing significantly to treatment management.
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References
Ampong, D. N. (2018). Depression and pharmacogenetics. Archives of psychiatric nursing, 32(1), 71-74.
Gordon, M. S., & Melvin, G. A. (2017). Evidence-Based Assessment and Intervention for Depression in School Psychology. In Handbook of Australian School Psychology (pp. 269-290). Springer, Cham.
Jarrett, M. A., Wolff, J. C., Davis III, T. E., Cowart, M. J., & Ollendick, T. H. (2016). Characteristics of children with ADHD and comorbid anxiety. Journal of attention disorders, 20(7), 636-644.
Lee, H. J., Kim, S. H., & Lee, M. S. (2019). Understanding Mood Disorders in Children. In Frontiers in Psychiatry (pp. 251-261). Springer, Singapore.
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.
Stahl, S. M. (2014). Stahl’s Essential Psychopharmacology: Prescriber’s Guide. Cambridge University Press.
When pediatric clients 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 clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders. Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. ASSIGNMENT: BACKGROUND INFORMATION 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 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) 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: Begin Paxil 10 mg orally daily – Client returns to clinic in four weeks – Reduction in The Children\’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea 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: Change to Prozac 10mg orally daily – Client returns to clinic in four weeks – There is a 25% reduction in symptoms, client’s side effects of nausea, vomiting, and diarrhea have resolved. Client reports that he is feeling a “little bit better” 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: Continue current dose The PMHNP has two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, the PMHNP could also increase the dose to 20 mg orally daily.
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A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy. 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. Assessing and Treating Pediatric Clients With Mood Disorders