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.
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.
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
—
Assessing and Treating Pediatric Patients with Mood Disorders
Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date
Assessing and Treating Pediatric Patients with Mood Disorders
Introduction
Treating pediatric patients with mood disorders can present various considerations. The considerations include selecting the medication, the need to increase the dosage, change the drug, and observe ethical principles. The case study involves an 8-year-old African American male. The child presents with various symptoms such as sadness, isolation, loss of appetite, and irritation. The decision to treat the condition will involve Zoloft 25mg tablet daily during bedtime. The drug will be increased to 50mg to increase the chances of recovery. The provision of care will observe different ethical considerations such as informed consent and beneficence.
Decision One
The first decision to treat the depression in the child is to prescribe Zoloft 25mg tablet daily during bedtime. Zoloft is an antidepressant classified under selective serotonin reuptake inhibitors.
The rationale for selecting the medication is that it effectively treats depression and other mental or mood disorders. Zoloft is effective among children since it acts as a mood stabilizer and lessens the symptom’s severity (Stahl, 2013). For example, the medication reduces fear and anxiety, enhances sleep, appetite, and interest in daily activities. Addressing sleep disorders among patients with depression improves recovery and prevents relapse (Cameron et al., 2020). The medication was chosen because it effectively treats depression and other mental or mood disorders. Zoloft is effective in children because it acts as a mood stabilizer and reduces the severity of the symptoms (Stahl, 2013). For example, the medication alleviates fear and anxiety while also improving sleep, appetite, and interest in daily activities. Addressing sleep disorders in depressed patients improves recovery and prevents relapse (Cameron et al., 2020).
Another rationale for selecting the drug is the age of the patients. Children require 25mg tablet daily since it presents minimal side effects. Prescribing a high dose to children can trigger negative effects such as nausea, sleepiness, and drowsiness (Cameron et al., 2020). The drug dosage will be increased after an assessment of the patient’s progress. The reason for selecting Zoloft is because it is certified by Food and Drug Administration (FDA) for pediatric use (Cameron et al., 2020).
The other two options, including Wellbutrin 75mg and Paxil 10mg, are not effective in treating the patient’s condition. One of the reasons is that the drugs are not certified by FDA for use among children (Diener et al., 2021). Another reason is that drugs such as Paxil 10mg are not preferable as the first line of defense in treating depression. Paxil causes anticholinergic effects in children making it less preferable (Diener et al., 2021). Wellbutrin is effective, but the results of the effect will take longer compared to Zoloft.
I expect the patient’s mood to stabilize and relieve the depression. Zoloft is effective among children since it acts as a mood stabilizer and lessens the symptom’s severity (Diener et al., 2021). I expect improvements after four weeks when the client will return to the clinic. Improvement should include 50 percent of the abatement of the symptoms.
Ethical and legal issues will affect treatment and communication. One of the considerations is informed consent (Singh et al., 2017). For example, the patient is below the age of consenting to treatment. A parent or guardian should consent to the treatment.
Decision Two
The second decision is to increase the dosage to Zoloft 50mg tablet daily during bedtime to enhance recovery.
The rationale for increasing the dose is to enhance the efficacy of the drug. Evidence-based practice shows that higher dosage triggers better recovery. Another reason is that after the client returned to the clinic, there was little improvement compared to the expectations (DeFilippis, 2018). Zoloft can take between two to four weeks to demonstrate quality results. Increasing the same dosage is effective compared to changing the drug. It will increase the reuptake of serotonin and neurotransmission of the chemical components in the brain. I did not select the other two options since polypharmacy is not recommended since it can trigger diverse mental illness treatment outcomes. For example, increasing the dosage to 37.5 is not a common trend since evidence-based practice shows that augmenting the drug from 25 to 50 is efficient. Introducing the other alternatives can trigger side effects which can undermine the recovery process (DeFilippis, 2018). For example, the other drugs can lead to serotonin syndrome, increasing the severity of the symptoms.
The purpose of the decision is to alleviate the symptoms such as depression. The intention was to enhance the stability of the patient (DeFilippis, 2018). The reason is that the previous decision did not attain the expectations of stabilizing the patient’s condition.
When the client returns after four weeks for the clinic, there is positive feedback. The client’s condition has stabilized with a 50 percent abatement of the symptoms. The increase in the dosage did not affect the patient’s condition (Walkup, 2017). The improvement justifies Stahl’s (2012) argument that antidepressants can relieve symptoms of depression.
The ethical and legal issues that affect the quality of care are beneficence and trust. Physician should use their best knowledge to take care of the patient while eliminating the risk of negative outcomes (Walkup, 2017). Quality communication and rapport should improve trust with the patient and parent or guardian.
Decision Three
The decision was to maintain the medication, frequency, and mode of administration. Maintaining the drug effectively ensures full recovery and stabilization of the child (Diener et al., 2021). According to the American Psychiatric Association, psychiatrists are responsible for changing medication if clients do not experience positive outcomes. For example, if, after 4 to 8 weeks, the client does not show any progress, the practitioner can change the medication (Diener et al., 2021).
The rationale for maintaining the medication, frequency, and mode of administration is because the client is improving significantly. It is expected that in the next few weeks, the clients will resume normal daily activities (Diener et al., 2021). I did not select the other two options since the client is already showing positive signs of recovery. Polypharmacy is not preferable in the provision of care to clients with mental illness. Mixing different can alter the brain’s chemical balance leading to severe side effects (Stahl, 2013). Another reason for avoiding the other options is because treatment with one drug helps the psychiatrists to trace the outcomes. Multiple drugs can lead to a mixture of outcomes that can complicate the treatment decisions. Polypharmacy in pediatric patients can trigger severe outcomes that can undermine the recovery process (Stahl, 2013).
I was hoping to achieve a positive recovery from the patient. I expect the patient’s mood to stabilize and relieve the depression. The stabilization should help the client to improve interactions with other learners. Another expectation is relief from occasional irritation. During the next clinic, the patient should demonstrate recovery signs such as attending school, playing, and interacting with learners. The mood should stabilize without signs of sadness. Treatment of depression is essential for pediatric patients since it can affect their physical health (Stahl, 2013). Another risk of suicidal thoughts or self-harm may occur.
Ethical issues affect the treatment process and decisions. Healthcare workers are responsible for observing patient autonomy and establishing trust (Cameron et al., 2020). Patient-centered care improves patient trust since a patient or family members realize the psychiatrist is genuinely interested in the patient’s successful recovery.
Ethical Considerations Impacting Treatment and Communication
Ethical considerations are important precautions in the provision of care. Healthcare workers should use ethical principles to deliver efficient, legal, and patient-centered care. One of the requirements is to observe beneficence (Singh et al., 2017). Healthcare workers should take precautions with pediatric patients to avoid poor health outcomes. Beneficence involves informing the patient or parent about the treatment. For example, it is important to educate the patient or the family about Zoloft and its side effects (Singh et al., 2017). The patient education will reduce the risk of suspicion in case side effects emerge. For instance, the guardian or parent should know that a high dosage of Zoloft can trigger side effects such as suicidal thoughts (Singh et al., 2017). Open, honest, and evidence-based communication will improve the quality of care and enhance trust.
Conclusion
Pediatricians have a responsibility to diagnose and treat mental conditions. The case study of an 8-year-old African American male shows the need for antidepressants. Treatment of depression requires Zoloft 25mg. Increasing the dosage to 50mg is necessary to enhance the efficiency and chances of recovery. Polypharmacy is not recommendable in the treatment of mental illnesses since it can trigger mixed outcomes. One of the requirements is to observe beneficence. Healthcare workers should take precautions with pediatric patients to avoid poor health outcomes. At the end of the treatment, the patient should demonstrate recovery signs such as attending school, playing, and interacting with learners. The mood should stabilize without signs of sadness.
References
Cameron, L. A., Phillips, K., Melvin, G. A., Hastings, R. P., & Gray, K. M. (2020). Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review. The British Journal of Psychiatry, 1-10.
DeFilippis, M. (2018). Depression in children and adolescents with autism spectrum disorder. Children, 5(9), 112.
Diener, M. J., Gottdiener, W. H., Keefe, J. R., Levy, K. N., & Midgley, N. (2021). Treatment of depression in children and adolescents. The Lancet Psychiatry, 8(2), 97.
Singh, I., Morgan, C., Curran, V., Nutt, D., Schlag, A., & McShane, R. (2017). Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight. The Lancet Psychiatry, 4(5), 419-426.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Walkup, J. T. (2017). Antidepressant efficacy for depression in children and adolescents: industry-and NIMH-funded studies. American Journal of Psychiatry, 174(5), 430-437.
