NUR 6630 Week 4 Assignment: Psychopharmacological Approach to Treat Psychopathology

Psychopharmacological Approach to Treat Psychopathology

The incidence of major depressive disorder (MDD), including pediatric depression, is increasing dramatically in the United States. This trend is associated with genetic factor, which significantly increases the risk of depression in various age brackets, including children (Shadrina et al., 2020). Therefore, the risk of becoming depressed is 4 times higher among children of depressed parents compared to healthy parents. Hence, mental health providers should focus on diagnosing MDD in children and developing the most appropriate pharmacological treatment to meet the healthcare needs of an individual patient. In the provided case study, the client is an African American 8yo male whose mother accompanies him to ER. He is portraying depressive symptoms. The client reports feeling “sad.” His mother reveals that the teacher’s report indicated withdrawing from his peers in class. The mother added that she had noticed decreased appetite and becoming irritated occasionally. The client was referred to a psychiatrist for further evaluation. Upon conducting a mental status exam, the Psychiatric Nurse Practitioner reported that the client is alert and oriented X 3. His speech is clear. He is coherent, spontaneous, and goal-directed. His self-reported mood is “sad” with a blunt affect. However, the client smiled appropriately during the clinical interview. He denies auditory or hallucinations. Additionally, the psychiatric nurse practitioner does not notice paranoid or delusional thought processes. The client appears to be age-appropriate with clear judgment and insight. He denies suicidal ideation or thoughts. Nonetheless, the client reports thinking about himself being dead and the feeling of being dead. Upon administering the Children’s Depression Rating Scale, the client’s score was 30, portraying significant depression. This paper presents three pharmacological interventions for managing and treating a client’s depressive symptoms, considering the patient’s pharmacokinetics and pharmacodynamics processes.

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Decision Point 1

The first treatment intervention involves beginning Zoloft 25 mg orally daily. The FDA recommends selective serotonin reuptake inhibitors (SSRIs) as the first antidepressant for treating depression in children and adults. Furthermore, Tini et al. (2022) reported that selective serotonin reuptake inhibitors (SSRIs) effectively treat several psychiatric symptoms, including obsessive-compulsive disorder (OCD) and depression, in children aged 6 to 12 years. Zoloft 25 mg orally daily was selected since it’s an SSRI; hence effective in managing presented depressive symptoms in the 8yo African-American male. Therefore, beginning Zoloft 25 mg orally daily is the best treatment option for this client.

Other potential options, including beginning Paxil 10 mg orally daily and beginning Wellbutrin 75 mg orally BID, were rejected. Beginning Paxil 10 mg orally daily was dismissed since it is not recommended for treating depression in children and adults. Instead, Paxil is recommended as the first-line treatment for anxiety in pediatrics and adults (Strawn et al., 2018). Additionally, Wellbutrin was rejected due to severe side effects, including the risk of anorexia, seizure, dry mouth, headache, and insomnia (Lee et al., 2021). Hence, beginning the client’s treatment with Wellbutrin 75 mg orally BID would increase the risk of these drug-related side effects.

Beginning Zoloft 25 mg orally daily was expected to improve the client’s depressive symptoms. According to Tini et al. (2022), Zoloft 25 mg orally daily is an SSRI, effective in treating depressive symptoms in children and adolescents. Nonetheless, the client did not report a change in the initial symptoms upon returning to the clinic after 4 weeks.

In developing this treatment, the PMHNP adhered to the ethical consideration of beneficence that holds that mental health providers should focus on benefiting their clients through the administered treatment. Hence, the PMHNP started the client’s treatment with Zoloft 25 mg orally since it would improve his depressive symptoms.

Decision Point 2

The second decision is Sertraline 50 mg by mouth daily. This treatment option was selected following the ineffectiveness of Zoloft 25 mg orally in improving the client’s symptoms. The client did not report a change in the initial symptoms after taking Zoloft 25 mg orally for 4 weeks. According to Tini et al. (2022), Sertraline’s dosage for treating depression in children can be titrated upwards to 250 mg to enhance its effectiveness. Hence, increasing the client’s dosage to 50 mg by mouth daily would strengthen the effectiveness of Sertraline in improving initial depression symptoms.

Other alternatives include Prozac 10 mg by mouth daily and Sertraline 37.5 mg by mouth daily. Prozac 10 mg by mouth daily was rejected due to its inefficacy in treating significant depressive symptoms in children. Zhou et al. (2022) reported that Prozac 10 mg is effective for treating acute depressive symptoms in children. Hence, this option is inappropriate for this client since he was diagnosed with significant depression. Additionally, Sertraline 37.5 mg by mouth daily was rejected since the client did not report improvement in depressive symptoms after taking Zoloft 25 mg orally for four weeks. Similarly, Sertraline 37.5 mg by mouth daily would not result in the desired improvement in depressive symptoms.

Sertraline of 50% mg by mouth daily was expected to reduce the client’s depressive symptoms by 50%. According to Tini et al. (2022), the effectiveness of Sertraline in treating depression in children increase with dosage. The client reported a 50% decrease in initial symptoms upon returning to the clinic after 4 weeks.

While developing this treatment plan, the PMNHP adhered to the ethical principles of beneficence. The most beneficial option, Sertraline 50 mg by mouth daily, was prescribed to the patients. The PMHNP dismissed other options, including Prozac 10 mg by mouth daily and Sertraline 37.5 mg daily, due to their inefficacy in treating the client’s depressive symptoms.

Decision Point 3

The third treatment option involves maintaining the current dose, Sertraline 50 mg by mouth daily. The decision to maintain the current dose was preferred due to its effectiveness in improving the client’s depressive symptoms. The client reported a 50% decline in depressive symptoms after taking Sertraline 50 mg for four weeks. Therefore, continuing this dosage for the next four weeks would result in total remittance of the reported depressive symptoms. Furthermore, studies indicate that the current antidepressant dosage should be maintained if a positive response to a medication with minimum or zero side effects are reported (Dell’Osso et al., 2020). Therefore, maintaining the current dosage is the best treatment option for this client.

Other options, including changing to SNRI and increasing to Sertraline 75 mg by mouth daily, were dismissed. Changing to SNR was rejected since the client was responding well to Sertraline 50 mg by mouth daily, which is an SSRI. Thus, a new drug class with no history of improving the client’s depressive symptoms should not be introduced at this stage of the treatment process. Additionally, increasing to Sertraline 75 mg by mouth daily was rejected. During week eight clinic visits, the client reported a 50% reduction in symptoms with no drug-related side effects. These results indicated that the client responded positively to the current dosage; hence an alternative dosage is unnecessary. Additionally, the risk of side effects and adverse drug events in SSRIs increases with dosage (Edinoff et al., 2021). Hence, increasing the current dosage to Sertraline 75 mg raises the risk of adverse reactions and drug-related side effects.

Maintaining the current dose, Sertraline 50 mg by mouth daily, would result in total remittance of presented depressive symptoms. The client reported a 50% decline in depressive symptoms after taking Sertraline 50 mg for four weeks. Additionally, Tini et al. (2022) said that the effectiveness of Sertraline in treating depression in children increases with dosage. Hence, maintaining the current dosage would further improve depressive symptoms.

In developing this treatment plan, the PMHNP adhered to the ethical principle of parent autonomy. This ethical guideline gives the parents the right to consent during the treatment of individuals with no consenting capacity, including individuals below 18 years (Bieber et al., 2020). In this case, the mother was involved in making all significant decisions since the client is a minor with no capacity to consent. Additionally, the mother will be educated about the risk of suicidal thoughts, which are common among children diagnosed with depressive symptoms. Therefore, she should monitor the client closely and visit a psychiatrist if she notices any suicidal thoughts.

Conclusion

The paper has presented three pharmacological decisions for treating depressive symptoms in an 8yo African- American male. The first treatment intervention involves beginning Zoloft 25 mg orally daily. This medication was preferred since it’s a selective serotonin reuptake inhibitor (SSRIs), effective in treating depression in children. On the contrary, beginning Paxil 10 mg orally daily and beginning Wellbutrin 75 mg orally BID were rejected. Beginning Paxil 10 mg orally daily was dismissed since it is not recommended for treating depression in children and adults. Additionally, Wellbutrin was rejected due to severe side effects, including the risk of anorexia, seizure, dry mouth, headache, and insomnia. After taking this medication for four weeks, the client did not report improvement in the initial symptoms. The second decision is Sertraline 50 mg by mouth daily, which was selected following the ineffectiveness of Zoloft 25 mg orally in improving the client’s symptoms, implying that a higher dosage was needed. Other alternatives, including Prozac 10 mg by mouth daily and Sertraline 37.5 mg by mouth daily, were rejected. Prozac 10 mg by mouth daily was rejected due to its inefficacy in treating significant depressive symptoms in children. Additionally, Sertraline 37.5 mg by mouth daily was rejected since the client did not report improvement in depressive symptoms after taking Zoloft 25 mg orally for four weeks, implying that 37.5 mg would not result in the desired improvement in depressive symptoms. The client reported a 50% decrease in initial symptoms upon returning to the clinic after 4 weeks. The third treatment option involves maintaining the current dose, Sertraline 50 mg by mouth daily. This decision was preferred due to its effectiveness in improving the client’s depressive symptoms, implying that continuing with this dosage for the next four weeks would result in total remittance of the reported depressive symptoms. Other options, including changing to SNRI and increasing to Sertraline 75 mg by mouth daily, were dismissed since the client was responding well to Sertraline 50 mg by mouth daily, hence no need for an alternative dosage or drug class.

References

Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. (2020). The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report. Frontiers in Psychiatry, 1094. https://doi.org/10.3389/fpsyt.2020.559263

Dell’Osso, B., Albert, U., Carrà, G., Pompili, M., Nanni, M. G., Pasquini, M., … & Fiorillo, A. (2020). How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist. Annals of General Psychiatry, 19(1), 1-8. https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-020-00306-2

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., … & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: a narrative review. Neurology International, 13(3), 387-401. https://doi.org/10.3390/neurolint13030038

Lee, W. K., Au Yeung, K. L., Lam, H. B., Wong, C. K., Wong, T. C., Fu, C. K., … & Ki‐Yan Mak, D. (2021). Consensus statements on the clinical understanding and use of bupropion in Hong Kong. CNS Neuroscience & Therapeutics, 27, 20-24. https://doi.org/10.1111/cns.13376

Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics factors in major depression disease. Frontiers in psychiatry, 9, 334. Doi: 10.3389/fpsyt.2018.00334.

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. Doi: 10.1080/14656566.2018.1491966

Tini, E., Smigielski, L., Romanos, M., Wewetzer, C., Karwautz, A., Reitzle, K., … & Walitza, S. (2022). Therapeutic drug monitoring of Sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of obsessive-compulsive disorder. Comprehensive Psychiatry, 115, 152301. https://doi.org/10.1016/j.comppsych.2022.152301

Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., … & Xie, P. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581-601. DOI:https://doi.org/10.1016/S2215-0366 (20)30137-

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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)

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)

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.

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Submit your Assignment.

Submission and Grading InformationRubric Detail

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Name: NURS_6630_Week4_Assignment_Rubric
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Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
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.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)

• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)