Assessing and Treating Pediatric Clients With Mood Disorders Essay Example

Assessing and Treating Pediatric Clients With Mood Disorders Essay Example

Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression

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• Mother reports that teacher said child is withdrawn from peers in class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. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.
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 Zoloft 25 mg orally daily

Begin P
Begin Paxil 10 mg orally daily

axil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID Begin Wellbutrin 75 mg orally BID

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:
o Decision #1
 Which decision did you select? Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.
 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?
o 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? Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.
o 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.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
The references should be within 5 years.

Clinical Scenario

This assignment involves a client who is 8 years old who is an African American male who presents at the Emergency Room with his mother. The client was exhibiting signs of depression and had complaints of feeling sad. The mother reportedly informed that the teacher had examined that the child was withdrawn from peers in class. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example The mother had also noted that the child had a decreased appetite with occasional irritation periods despite reports that he had reached all landmarks of development at the appropriate ages. The physical examination was unremarkable while the laboratory studies WNL.

The mental status exam revealed that the client was alert and oriented X3, his speech was clear, coherent spontaneous and goal oriented. The client self-reported a sad mood and had an affect which was somewhat blunted. The client denied visual and auditory hallucinations and no delusional or paranoid processes of thought were noted Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. The client also appeared to have an appropriate, did not endorse active suicidal ideation but admitted that he often thought about being dead and what it would feel like to be dead. In administering the Children’s Depression Rating Scale, a score of 30 was obtained, indicating the client had significant depression

Decision Point One

            The primary mental nurse practitioner should begin Zoloft 25 mg orally daily. Zoloft is a selective serotonin reuptake inhibitor that is used as a first line drug for the management of major depressive disorder and other mental health disorders. It works by increasing the amount of serotonin in the brain to improve symptoms of anxiety and depression (Cummings, Caporino & Kendall, 2014).  Similarly, the client, in this case, had been diagnosed with major depression which required relevant medications.

With this medication, I was hopeful that the symptoms the client experienced a sad mood, a blunted affect and irritations would be done away with. Instead, he would have a happy mood, an increased appetite, a fluent affect and no thoughts about being dead. Zoloft helps to improve sleep, mood, appetite and the level of energy such that, the overall interest of an individual in daily life is restored (Cox, et al., 2014). It also influences a significant reduction in anxiety and thoughts that are unwanted.

Instead, the client returned to the clinic in four weeks, stating that, although he improved in terms of mood, appetite and other life’s aspects, he had frequent suicidal thoughts that negatively influenced his life in general. Despite being the first line of treatment for depression in children, Zoloft is known to increase suicidal behavior and thoughts in children, adolescents and even young adults (Cooper, et al., 2014).  This risk increases within the first few months of treatment or in case of dosage changes Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. It is for this reason that it has a black box warning from the Food and Drug Administration to alert healthcare providers and patients on how dangerous some of the side effects of drugs may change. For patients already having suicidal behavior and thoughts, administering Zoloft is likely to worsen the situation as it is in this case (Cooper, et al., 2014). This means that to reduce these side effects, the dosage can be reduced. However, the effects of suicidal thoughts and behavior would still be existent. Therefore, the best option would be to stop the Zoloft 25 mg orally daily.

Decision 2

The second decision would be to begin praxis 10mg orally daily. Praxil is a selective serotonin reuptake inhibitor that is indicated for the management of depression. It functions by influencing chemical balance in the brain which is associated with anxiety and depression disorders (Walkup, 2017). Similarly, the client, in this case, had been diagnosed with depression and had experienced intense symptoms of mood changes, reduced appetite, and feelings similar to suicidal thoughts and behavior. Praxil has the ability of increased appetite, mood, level of energy and sleep and helps to reduce unwanted thoughts Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. With this decision, it was certain that by administering praxil 10mg orally daily, the client would have no more negative symptoms of behavior, mood or emotions. Besides, it was expected that he would not experience any suicidal thoughts.

After two weeks, the client returned to the clinic accompanied by his mother with complaints of losing weight for the last two weeks when therapy was started. Praxil inhibits growth among pediatric patients such that, periodic monitoring of weight and height is needed and clients are urged to take medications with food (Bachmann et al., 2016).  An alternative option would be to reduce the dosage to 5mg orally daily. However, with this dosage therapeutic outcomes cannot be achieved. Similarly, the dosage for the client, in this case, cannot be increased. Increasing the dosage will influence clinical worsening and unusual behavioral changes. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

The Food and Drug Administration warns that high doses of praxil beyond the recommended guidelines increases the risk of suicidal behavior and thoughts in children especially during the first weeks of treatment. It is even worse among children with depressive symptoms who present with a history of suicidal ideation before treatment requiring that, children are closely monitored during the course of treatment for strange behaviors and worsening of depression (Cooper, et al., 2014). The best decision would, therefore, be to discontinue the medication by rapidly tapering the dosage since abrupt discontinuation of praxil has also proven to cause adverse symptoms.

Decision 3

At this point, the best decision would be to start Wellbutrin 75 mg orally BID. Wellbutrin has been noted to be a better antidepressant among children as compared to tricyclic’s as it also has a totally different mechanism of action as compared to selective serotonin reuptake inhibitors. It has also been approved by the Food and Drug Administration for managing depression. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. It works as a norepinephrine-dopamine reuptake inhibitor, increasing the amount of norepinephrine produced by the body (Bachmann, et al., 2016).  This helps to balance inactive and dull moods which are as a result of depression. Therefore, by administering this drug, it was expected that the client’s symptoms of a sad mood, irritation and appetite loss will gradually reduce and eventually resolve.  Similarly, it was certain that the client’s symptoms of suicidal thoughts will gradually resolve and that he will fully regain his health status after treatment (Bachmann, et al., 2016).

After two weeks, the client returned with complaints of weight loss and a suppressed appetite but no reports of seizures. Wellbutrin is known to cause loss of appetite as well as low blood sugars. This increased risk for seizures is associated with hypoglycemia. The dosage cannot be increased or reduced in this case. Increasing the dosage will result in more advanced adverse side effects and reducing the dosage will hinder the achievement of therapeutic outcomes (Walkup, 2017).  The best option would be maintaining the dosage at 75mg orally daily and adhering to dietary recommendations of eating mid-morning, midafternoon and bedtime snacks. Similarly, the child’s weight will have to be monitored closely. These effects are only expected to be more intense during the first few weeks of treatment, after which they will gradually decline Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

How Ethical Considerations Might Impact Treatment Plan and Communication with Clients

            Working which children and adolescents can pose significant challenges for mental health providers. Major ethical considerations for this population are confidentiality and patient autonomy and require varied approaches that are highly dependent on a child’s and family’s characteristics to address (Coyne et al., 2014). Irrespective of age, children have the right to confidentiality and mental health providers are required to disclose information to parents or other people with the child’s informed consent. Similarly, children have a right to be part of decision making regarding their treatment. By observing these ethical considerations, it is certain that the therapeutic relationship between the client and mental health practitioner will be long term and promote the development of trust (Coyne et al., 2014).  This increases the chances of treatment success and reduces the likelihood of resistance. With regards to communication, a therapeutic relationship that is built on trust promotes a safe and conducive environment where the client and mental health provider can openly and freely communicate to achieve more specific and targeted health outcomes(Coyne et al., 2014). Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

References

Bachmann, C. J., Aagaard, L., Burcu, M., Glaeske, G., Kalverdijk, L. J., Petersen, I., & Hoffmann, F. (2016). Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012. European Neuropsychopharmacology26(3), 411-419.

Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin140(3), 816.

Cox, G. R., Callahan, P., Churchill, R., Hunot, V., Merry, S. N., Parker, A., & Hetrick, S. E. (2014). Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane database of systematic reviews, (11).

Cooper, W. O., Callahan, S. T., Shintani, A., Fuchs, D. C., Shelton, R. C., Dudley, J. A.,  & Ray, W. A. (2014). Antidepressants and suicide attempts in children. Pediatrics, peds-2013. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

Coyne, I., Amory, A., Kiernan, G., & Gibson, F. (2014). Children’s participation in shared decision-making: Children, adolescents, parents and healthcare professionals’ perspectives and experiences. European Journal of Oncology Nursing18(3), 273-280.

Walkup, J. T. (2017). Antidepressant efficacy for depression in children and adolescents: industry-and NIMH-funded studies. American Journal of Psychiatry174(5), 430-437. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

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