Question Mood disorders can impact every facet of a human being’s life,… Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. As a PNP working with pediatric patients, 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 three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also Quiz on the concepts addressed throughout this module.Assignment- Decision treeRequired: media file within classroomYou will formal paper no more than long addressing the media file as directed in the classroom directionsAfter each decision, you will be presented with the outcome of that decision. You need to discuss how that outcome was what you expected or if it was different than what you expected and why. You will do the above for all three decision points. You need to use evidence to support your rationale. [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. Credible reference material only will be accepted. Sites such as WebMD and drugs.com (among others) will not be counted.] How to move through the case study….. You will be presented with three options at the bottom of the case for decision point one. You must click on one of these options to move to decision point 2. You will then be presented with the outcome of the decision you chose for decision point 1. The outcome is different for each of the three options (see below).Here are some examples of what I DO want: “As the PMHNP caring for this client, Zoloft 25 mg daily would be the first choice of therapy for this patient. Selective Serotonin Reuptake Inhibitors (SSRIs) are known to be the first line of treatment for children with depression (DeFilippis & Wagner, 2014). While sertraline and paroxetine are both SSRIs, sertraline is FDA approved when treating children whereas paroxetine has been found to be affective when treating children with depression, it is not specifically approved by the FDA at this point in time (Stahl, 2014b).” “Paroxetine is not recommended in use for children due to its short half-life which can lead to withdrawal when the medication is stopped abruptly (Nathan & Gorman, 2015).” Evidence supporting the effectiveness of one agent over another. How did one agent perform when compared to another medication in clinical trials. I really like seeing these types of comparisons. What do the guidelines recommend? You can typically find the reason for their recommendation in the body of the guidelines. What side effects are the most concerning for the patient case study? For example: you wouldn’t want to prescribe a medication that causes excessive sedation in a patient that operates heavy machinery or drives transport trucks across the country. Consider genetics and the role genetics have in drug metabolism. Evaluate for the potential for drug-drug interactions. The main point is to be very specific regarding the reason you made your choice. I have posted the essay requirements as a checklist. I would strongly recommend using the checklist prior to submitting your decision tree assignments to make sure you included the required information. Don’t forget to include information related to the ethical considerations and how they might impact your treatment plan and communication with your clients. In summary: What needs to be in your essay. Use this as a checklist prior to submitting each decision tree essay.Decision Point OneBegin Zoloft 25 mg orally dailyPaxil 10 mg po dailyWellbutrin 75 mg po BIDRESULTS OF DECISION POINT ONE Client returns to clinic in four weeks No change in depressive symptoms at allDecision Point TwoSelect what you should do next:Increase dose to 37.5 mg orally dailyIncrease dose to 50 mg orally dailyChange to Prozac 10 mg orally dailyDecision Point OneBegin Paxil 10 mg orally dailyRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksReduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrheaDecision Point TwoSelect what you should do next:Decrease dose for 7 days then return to previous 10 mg day doseIncrease dose to 20 mg orally dailyChange to Prozac 10 mg orally dailyDecision Point OneBegin Wellbutrin 75 mg orally BIDRESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Child is unable to fall asleep at nightDecision Point TwoSelect what you should do next:Change from immediate release to extended release 150 mg orally daily in the morningGive second dose of the day at 1:00 pm in the afternoonChange to Lexapro 10 mg orally daily================================================================================================================ Introduction Childhood depression is a genuine problem that often goes undetected or untreated. While it is normal for children to become upset, sad, or unhappy, childhood depression grows beyond this to a deeper level. It sometimes can be hard for parents to recognize when their child is in distress. Childhood depression often appears different than depression in adults. Parents may think that their child is acting out when its existence they are in deep distress. (Tsehay, Necho, & Mekonnen, 2020). The content of the case study provides discussions on the decision-making process for the medicinal treatment of major depressive disorder. Statements like This depression medication is helpful in the management of depression, panic attacks, temper tantrums, social anxiety, and a severe premenstrual dysphoric disorder” Information provided in the study will guide the treatment plan in the decision and process on what treatment is most appropriate for this client. This paper aims to decide the validation for the child for depression medication management, medications side effect, and unable to sleep. We have a case study about an African American adolescent presenting depressive symptoms. Background Information The child arrives at the ER with his mother. He is displaying signs of depression. His teacher said to his mother-child is withdrawn from peers in class. The mother reports that he has been not eating well and intermittent times of irritation. His physical assessment is unremarkable, laboratory findings are within normal limits, and he is developmentally appropriate for his age. According to the mental status exam, he is alert & oriented x 3, speech clear, coherent, goal-directed, spontaneous. He said that mood is and affect slightly blunted, but the child smiled appropriately at various points during the clinical interview. He denies visual or auditory hallucinations. There are no delusional or paranoid thought processes were noted. Judgment and insight appear to be age-right. He does not endorse active suicidal ideation, but he does say that he frequently thinks about being dead and what it would be like to be deadthe children’s Depression Rating Scale, obtaining a score of 30, indicating significant depression. Decision One Zoloft 25 mg PO daily Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. The medication, Zoloft, is helpful in the management of depression, panic attacks, temper tantrums, social anxiety, and a severe premenstrual dysphoric disorder. The drug is right for this client since it helps lessen fear and anxiety (Stahl, 2013). A syndrome of symptoms characterizes major depressive disorder; The symptoms are several of the following: depressed or irritable mood , not interest in previously pleasurable activities, significant not intentional weight loss or weight gain, insomnia or hypersomnia, physical agitation or slowness, loss of energy or fatigue, feelings of worthlessness or excessive guilt, indecisiveness or a diminished ability to concentrate, and recurrent thoughts of death (Oyama, Ph.D., & Piotrowski, Ph.D. 2021). The proportion of commercially insured children initiating a Paxil, SSRI with a low dose was higher after the 2004 FDA on the risk of suicidality among children, suggesting improved prescribing practices surrounding SSRI dosing (Bushnell et al., 2016). Bupropion is a distinctive class of antidepressants. It is associated with tachycardia, altered mental status, and a dose-dependent risk of seizures in overdose, which can delayed. Even though being a common medication, there is a lack of data comparing toxicity in younger versus older children with bupropion exposures (Offerman et al., 2020). The medication is used as a mood stabilizer to enhance more energy in the body, better sleep, eat better food, and interest in performing daily chores. I hope the child tolerated Zoloft 25 mg po daily and stabilized his mood to go back to his normal again. Why? It is essential to note that sleep disorders surpass episodes of depression, increasing the probability of re-occurrence and relapse. Decision Two Increase dosage to Zoloft 50 mg Daily Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. The client went back to the clinic in four weeks, and no change in depressive symptoms at all. The care provider decided to increase the Zoloft dose to 50mg while maintaining the frequency of administration. As mentioned earlier, the treatment effect of Zoloft may take longer to be experienced. On the off chance that the client fails to make a positive response to the medication by the 8thweek of treatment, it calls for augmentation of dosage failure to which will not be experienced a positive reaction (Stahl, 2013). Increasing the dosage of the medication increases the chances of alleviating symptoms since Zoloft functions blocking the reuptake of serotonin, boosting the neurotransmission of the chemical. I did not choose Zoloft 37.5 mg orally daily because the client did not have depressive symptoms. The child does not experience adequate improvement from first-line treatments; it is crucial to determine whether they have experienced sufficient dosing, duration, and quality of medication and psychotherapy. I want to see Zoloft 50 mg is strong enough his mood can change. Also, I did not change to Prozac 10 mg PO daily. If the patient does not notice a significant response after six weeks at a higher dosage, switching to another antidepressant is probably the most appropriate therapeutic intervention. The reason for not starting Prozac is that health care practitioners usually tapper down the dosage of Zoloft before completely stopping it; the medications the effectiveness take some of them will take weeks or months. I hope patients’ symptoms are progressive with the current regimen without significant side effects. The expectation was a 50 % improvement in depressive symptoms in the next couple of days. Sertraline is unlikely to reduce depressive symptoms within six weeks in primary care. Still, we observed improvements in anxiety, quality of life, and self-rated mental health, which are likely to be clinically significant. Decision Three The medication list choice is to increase Zoloft to 75 mg. Prematurely discontinuation of antidepressant therapy has been associated with the patient negative experienced. It could happen confusion, seizures, psychomotor retardation, and severe muscle rigidity after discontinuing the drug (Sertraline withdrawal, 2009). 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. The patient had only 50 % improvement in his depression symptoms. No indication should be changed from drug therapy to Serotonin and norepinephrine reuptake inhibitors (SNRIs) as the client responds to this therapy. The patient and the general practitioner were uncertain about the potential benefit of antidepressant treatment. A total of 655 participants received sertraline at a starting dose of 50 mg/day or placebo, with dosages increased after a week to 100 mg/day and a maximum of 150 mg/day for up to 11 weeks. Measured Depressive symptoms were with the nine-item version of the Patient Health Questionnaire. On the primary outcome of the total score on the PHQ-9 at six weeks, sertraline did not show a more significant reduction in depressive symptoms. On secondary effects, however, sertraline treatment resulted in reduced symptoms of anxiety and improved mental health-related quality of life (Sertraline treatment in primary care effective for secondary outcomes, 2020, January 1). Long-term treatment plans include collecting data and data synthesis from various sources; Was the outcome what you expected? I would expect a result of more than 50%. He must have any adverse reactions during the medication therapy. The mother should inform if the child has any side effects to come to the clinic as soon as possible. Selective serotonin reuptake inhibitor (SSRI) antidepressant. Common Usage: Sertraline is indicated for the treatment of depression, panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), social anxiety disorder (Sertraline (generic): Zoloft (brand), 2018, August 1). Given that the client has experienced a treatment response and tolerates the medication effectively, the care provider monitors the medication, dosage, Zoloft if he takes it well and has no adverse reaction and frequency of administration. The therapist can maintain the medicines for the next 4 weeks to monitor their effectiveness in treating the client’s depression. As the American Psychiatric Association (2013), if the patient fails to experience a positive response to the medication by the 8th treatment week. The therapist is assessing reasons for the ineffectiveness of the medication and making appropriate alterations to the treatment approach for the patient. Ethical Considerations All problems with clients should handle with ethical sensitivity. Any therapy with a sensitive date should be confidential. The patient’s mother needs to be informed about the plan of medication therapy, side effect, and outcome. The mother should involve in all aspects of the treatment plan. When you are caring with clients, especially those who are children or adolescents is ethically complex. Any information therapy dealing with data should be confidentialan “off-label” drug. Some critics argue that behavior drugs are often prescribed for children “off-label,” meaning that the medications have been approved for adults and older children but have not been tested for younger ones. However, randomized controlled studies conducted on the same population prove that the drug is effective and has significant benefits when used on people (Kang et al., 2021). (Bailey & Carson-Dewitt, 2019). After thoroughly discussing the benefits and risks associated with the preferred pharmacological intervention with the client’s parent and the “off-label” status for Zoloft (more details in the ethical considerations section), the parent agreed that there was a need to initiate selective serotonin reuptake inhibitor (SSRI). The laboratory and baseline clinical values emanated monitoring that covered the short-term and long-term periods. As a provider, the responsibility is to understand all ethical considerations for treating children and communicating with the client and the parents or guardian’s involvement (Hiriscau, Stingelin-Giles, Wasserman, & Reiter-Theil, 2016). Conclusion discussed the three decisions were in the different medication that is the client the benefit treating his depression. Timely treatment is critical in the reduction of symptoms, improving functions, and reduces odds of relapse. With no treatment, depression among children may become chronic and severe, resulting in impaired social, mental, and academic functions. A child can effectively manage their state of mind with the help of support from parents. Moderate to severe depressive symptoms can be controlled by antidepressants; the achievement of each decision is shown with evidence and references to support or not support the conclusion of the medication. The differences of what is expected and the results of each medication decision made references for support or differences.Please revise underline parts and proofread rest of the parts. Thanks. ReferencesAmerican Psychiatric Association (2013)..Diagnostic and statistical manual of mental disorders. [electronic resource] : DSM-5 (5th ed.). Bailey, E., & Carson-Dewitt, R. (2019). Debate on behavioral drugs and children. Salem Press Encyclopedia.Bushnell, G. A., Stürmer, T., Swanson, S. A., White, A., Azrael, D., Pate, V., & Miller, M. (2016). Dosing of Selective Serotonin Reuptake Inhibitors Among Children and Adults Before and After the FDA Black-Box Warning. Psychiatric Services, 67(3), 302-309. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ps.201500088Hiriscau, E. I., Stingelin-Giles, N., Wasserman, D., & Reiter-Theil, s. (2016). Identifying ethical issues in mental health research with minors adolescents: Results of a Delphi study. International Journal of Environmental Research and Public Health, 13(5), 489. Doi:10.3390/ijerph13050489Kang, S.-Y., Socal, M. P., Bai, G., & Anderson, G. F. (2021). Off-Label Coverage of High-Cost Drugs by Independent Charity Patient Assistance Programs. Journal of General Internal Medicine, 36(2), 555-556. https://doi-org.ezp.waldenulibrary.org/10.1007/s11606-020-05682-9Offerman, S., Levine, M., Gosen, J., & Thomas, S. H. (2020). Pediatric Bupropion Ingestions in Adolescents vs. Younger Childrena Tale of Two Populations. Journal of Medical Toxicology, 16(1), 6-11. https://doi-org.ezp.waldenulibrary.org/10.1007/s13181-019-00738-7Oyama, O., PhD, & Piotrowski, N. A., PhD. (2021). Depression. Magill’s Medical Guide (Online Edition).Sertraline (generic): Zoloft (brand). (2018, August 1). The Brown University Psychopharmacology Update, 29(8), 9.American Psychiatric Association (2013)..Diagnostic and statistical manual of mental disorders. [electronic resource] : DSM-5 (5th ed.). Sertraline treatment in primary care effective for secondary outcomes. (2020, January 1). The Brown University Psychopharmacology Update, 31(1), 8.Sertraline withdrawal. (2009). Reactions Weekly, 1267, 28. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Health Science Science Nursing NURS 6630 Share QuestionEmailCopy link Comments (0)
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