Assessing and Treating Pediatric Patients with Mood Disorder

Assessing and Treating Pediatric Patients with Mood Disorder

This assignment is about an 8-year-old African American boy who visits the ER with his mother. He exhibits symptoms of depression and describes himself as “sad.” His mother has been informed by one of his instructors that he seems to be retreating from his peers. He has a reduced appetite and is irritable at times. At the proper ages, he has completed all developmental stages. The practitioner does a physical check, requests lab tests, and discovers hardly anything to be concerned about. The practitioner determines that the kid should be referred to a psychiatrist for assessment Assessing and Treating Pediatric Patients with Mood Disorder.

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The practitioner observes that the child is oriented x3 and alert, and his speech is coherent and clear. He is also purpose-driven and impulsive during the mental state assessment. He maintains a hushed demeanor, yet he grins and nods when needed. The client disputes experiencing any auditory or verbal hallucinations, as well as any suicidal thoughts, although he does admit to fantasizing about death and what it might look like. The rating scale for children with depression was 30, which signified major depressive disorder Assessing and Treating Pediatric Patients with Mood Disorder.

Decision #1: Begin Zoloft 25mg Orally Daily

This choice was made considering Zoloft is a selective serotonin reuptake inhibitor (SSRI), and this type of drug has proven to be highly effective for mood disorders (Dwyer & Bloch, 2019). Sertraline should be begun between 25mg and 50mg daily in young children, with a usual maximum dosage of 100mg to 200mg (Dwyer & Bloch, 2019). SSRIs were shown to be highly successful in research, with approximately 80% of teenagers exhibiting some indications of recovery after nine months of therapy (Dwyer & Bloch, 2019). The maximum value of SSRIs might not be apparent for at least eight weeks, and it is recommended that patients try the drug for a minimum of a 4-to-6-week period before concluding that it is unhelpful (Dwyer & Bloch, 2019).

Wellbutrin was not an option for me since it has been linked to a higher risk of suicide thoughts in youngsters under 13. In addition, it has been shown to cause side effects like sleeplessness, vertigo, vomiting, nausea, and other digestive problems. I also did not choose Paxil since research suggests that using this medicine reduces the likelihood of suicidal ideation (Bernstein & Cha, 2015) Assessing and Treating Pediatric Patients with Mood Disorder.

I hoped that by using Zoloft, I would be able to reduce the patient’s present score of 30 on the Children’s Depression Rating Scale by a minimum of half (Stern et al., 2016).

When giving medicines to youngsters, it is important to consider if the practitioner intends to stigmatize the client for the longest time. This implies that the kid should depend on medication and professionals to address issues rather than their own resource. Furthermore, the stigma connected with psychiatric drugs may have an impact on a teenager’s future prospects.

Decision #2: Increase the Dose of Zoloft to 50mg Orally Daily

This choice was made since it is anticipated that depressive symptoms would not improve (Dwyer & Bloch, 2019). This is because the real impact of Zoloft does not appear for a minimum of four to six weeks (Dwyer & Bloch, 2019). This indicates that the client can raise the dosage because there was no improvement at the 25mg dose and evaluate in four weeks to see whether symptoms have improved.

Since Zoloft’s beginning dosages are often 25mg or 50mg daily, I decided to raise the dose to 50 instead of 37.5. (Dwyer & Bloch, 2019). I do not think it is an excellent decision to switch to Prozac at this point since we haven’t granted Zoloft a sufficient period to bring value (Dwyer & Bloch, 2019).

I hoped to see a significant improvement in this patient’s symptoms. The concept is that raising the dosage of a drug previously begun to function will make it more beneficial at greater dosages (Stern et al., 2016) Assessing and Treating Pediatric Patients with Mood Disorder.

It is critical for my decision and anticipation that I evaluate the therapies and utilize these measures to analyze the magnitude of the treatment impact (Vitiello, 2015). This is what I did when I decided to raise the dose based on the evidence as well as the way the client responded to the medicine. The FDA issued a public health alert in 2003 regarding an upsurge in suicidal ideation associated with the usage of antidepressants in children, and it became necessary to include a black box alert on the label (Hirsch, 2018). During prescription of antidepressant medications to pediatrics, this is an ethical choice that should be taken and considered (Hirsch, 2018).

Decision #3: Increase the Dose of Zoloft to 75mg Orally Daily

I selected this since increasing the dose to 50mg resulted in a half reduction in symptoms within four weeks, and the patient is taking the drug effectively. As a result, it might be worthwhile to examine whether raising the dose to 75mg reduces depressed symptoms further. Zoloft’s usual recommended dosage range is between 100mg and 200mg (Dwyer & Bloch, 2019). As a result, raising the dosage to 75mg is not unusual and could help this client even more.

Due to the standard recommended dosage range, I decided not to keep the amount at 50mg and instead raise it to test if it makes a significant difference. I do not think it’s appropriate to move to an SNRI right now since the SSRI is functioning well and the child is coping with it well.

Understanding how psychiatric medicines may influence the client is an ethical consideration. The longer and sooner a client is on medicine, the more impact it has on the way the brain is developing (Carpenter et al., &, 2017). Numerous research has also shown that psychotropic drugs, particularly SSRIs, raise the likelihood of suicide and mania (Carpenter et al., &, 2017). The issue of ethnicity and race is also an ethical concern. They are recognized as variables since there is proof that every ethnic group has different pharmacodynamics and pharmacokinetics (Alomar, 2014). There are extremely precise guidelines for the effectiveness and safety of medicines for ethnic backgrounds in certain treatments (Alomar, 2014). This may be due to the medication’s pharmacokinetics, which is a mechanism that has just recently been explored Assessing and Treating Pediatric Patients with Mood Disorder.

Conclusion

My initial option was to take Zoloft 25mg orally once a day. I selected this medicine because research indicates that SSRIs are very beneficial in kids. My next option was to increase the dose to 50mg, which I did since studies indicate that most people do not observe a reduction in symptoms till four to six weeks. Lastly, I increased the dosage to 75mg since the case study indicated a significant reduction in symptoms and that this is deemed a positive reaction to treatment. It also suggests that it is a prudent practice to retain this dose for the following four weeks to determine if any additional reductions occur. If complete recovery is not accomplished, it could be essential to raise the dosage again, and the client should be informed about the benefits and drawbacks of doing so. This is done to engage the client by including them in the treatment plan decision-making process. There is no need to alter the pharmacological treatment since the SSRI is effective, and the patient is reacting well to the medicine, and is nearly fully recovered. Addressing the potential of stigmatizing the kid and perhaps limiting future prospects are ethical concerns.

Furthermore, the black box alert for heightened suicidal ideation in children on antidepressant medications should be taken into account. This is an ethical concern since the practitioner may unintentionally inflict more damage to the client. Lastly, the last ethical concern is the documented alterations in the teenager’s brain that arise when they take psychotropic medications. Since psychotropic drugs may impact teenagers for the rest of their lives, the physician must decide whether all of these ethical issues are worth administering to them Assessing and Treating Pediatric Patients with Mood Disorder.

References

Alomar, M. J. (2014). Factors affecting the development of adverse drug reactions (Review article). Saudi Pharmaceutical Journal, 22(2), 83-94. https://doi.org/10.1016/j.jsps.2013.02.003

Bernstein, & Eunjung Cha. (2015, September 16). Researchers: 2001 paxil study seems to play down suicide risks to youths. Washington Post. https://www.washingtonpost.com/national/health-science/researchers-2001-paxil-study-seems-to-play-down-suicide-risks-to-youths/2015/09/16/fb6096de-5c9a-11e5-9757-e49273f05f65_story.html

Carpenter, D., Gonzalez, D., Retsch-Bogart, G., Sleath, B., & Wilfond, B. (2017). Methodological and ethical issues in pediatric medication safety research. Pediatrics, 140(3), e20170195. https://doi.org/10.1542/peds.2017-0195

Hirsch, G. S. (2018). Dosing and Monitoring: Children and Adolescents. Psychopharmacology bulletin, 48(2), 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875361/

Stern, Favo, Wilens, & Rosenbaum. (2016). Antidepressants. In Massachusetts general hospital psychopharmacology and neurotherapeutics (1st ed., pp. 27–43). Elsevier.

Vitiello, B. (2015). Principles in using psychotropic medications in children and adolescents. https://iris.unito.it/retrieve/handle/2318/1646557/356125/Vitiello.IACAPAP%20Textbook.A.7-PSYCHOPHARMACOLOGY-072012.pdf

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. 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 Assessing and Treating Pediatric Patients with Mood Disorder.

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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. 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 Assessing and Treating Pediatric Patients with Mood Disorder