Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
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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- Mother reports that teacher said child is withdrawn from peers in class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
- Physical exam unremarkable
- Laboratory studies WNL
- Child referred to psychiatry for evaluation
- Client seen by Psychiatric Nurse Practitioner
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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)
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. An African American Child Suffering From Depression Case study
Decision Point One
Select what the PMHNP should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BIDTherapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Begin Zoloft 25 mg orally dailyRESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Slight increase in mood
- No HAM-D results
- No adverse events reported
Increase dose to 37.5 mg orally dailyRESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- An African American Child Suffering From Depression Case study
- Depressive symptoms decrease by 20%. Client reports feeling a little bit better
Maintain current doseGuidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point OneRESULTS OF DECISION POINT ONE
- 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
Decision Point TwoRESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose
- An African American Child Suffering From Depression Case study
Decision Point ThreeGuidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, the PMHNP will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point OneRESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Child is unable to fall asleep at night
Decision Point TwoRESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- No change in sleeping patterns, child is getting more difficult to wake for school
Decision Point ThreeGuidance to Student
It is clear that the side effect after 4 weeks persists, the likelihood of it abating is quite low at this point, indicating that the PMHMP must do something. Administering both tablets of 75 mg in the morning may be an option, but then blood levels are not maintained throughout the day. There is also an increased risk of side effects (including seizure as this drug reduces seizure threshold). An African American Child Suffering From Depression Case study The correct answer would be to change the drug to an extended release formulation and administer in the morning.
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 An African American Child Suffering From Depression Case study.
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.
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. An African American Child Suffering From Depression Case study
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. An African American Child Suffering From Depression Case study You should be utilizing the primary and secondary literature.
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