Therapy for Pediatric Clients With Mood Disorders Case Study

Therapy for Pediatric Clients With Mood Disorders Case Study

Samanthah please
Therapy for Pediatric Clients With Mood Disorders
 
Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.
 
This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.
 
Photo Credit: GettyLicense_185239711.jpg
 
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
 
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.
 
Learning Objectives
 
Students will:
 
Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
 
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
 
Evaluate efficacy of treatment plans
 
Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
 
Learning Resources
 
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
 
Required Readings
 
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
 
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
 
 
 
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
 
Chapter 6, “Mood Disorders”
 
Chapter 7, “Antidepressants”
 
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
 
 
 
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
 
 
 
Review the following medications:
 
amitriptyline
 
bupropion
 
citalopram
 
clomipramine
 
desipramine
 
desvenlafaxine
 
doxepin
 
duloxetine
 
escitalopram
 
fluoxetine
 
fluvoxamine
 
imipramine
 
ketamine
 
mirtazapine
 
nortriptyline
 
paroxetine
 
selegiline
 
sertraline
 
trazodone
 
venlafaxine
 
vilazodone
 
vortioxetine
 
 
 
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from https://www.magellanprovider.com/media/11740/psychotropicdrugsinkids.pdf
 
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
 
Note: Retrieved from Walden Library databases.
 
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
 
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
 
Note: Retrieved from Walden Library databases.
 
Required Media
 
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
 
 
 
Note: This case study will serve as the foundation for this week’s Assignment.
 
Optional Resources
 
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3
 
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655
 
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. doi:10.2989/17280583.2014.938497
 
To prepare for this Assignment:
 
Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
 
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
 
Which decision did you select?  See below.
 
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
 
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
 
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.
 
 
 
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
 
 
 
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.
 
 
 
 
 
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 BID
 
 
 
Case Study of the above client
 
Decision Point One
 
I selected  Zoloft 25 mg orally daily
 
RESULTS OF DECISION POINT ONE
 
Client returns to clinic in four weeks
 
No change in depressive symptoms at all
 
Decision Point Two
 
Increase dose to 50 mg orally daily
 
RESULTS OF DECISION POINT TWO
 
Client returns to clinic in four weeks
 
Depressive symptoms decrease by 50%. Cleint tolerating well
 
Decision Point Three
 
Maintain current dose
 
Guidance to Student
 
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy

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