Assignment: Therapy for Pediatric Clients With Mood Disorders

Assignment: Therapy for Pediatric Clients With Mood Disorders

Assignment Therapy for Pediatric Clients With Mood Disorders

Depression is a common mental disorder with severe symptoms, especially in pediatric patients. The condition causes substantial impairment among the pediatric population in several aspects of life such as interpersonal interactions, family engagement, suicidal thoughts, interpersonal communication, and academics. There are however numerous challenges when it comes to diagnosing mood disorders such as depression, especially among pediatric patients due to developmental variations and overlap and presentation of appropriate symptoms. Accurate diagnosis of depression among pediatric patients can be achieved by using fundamental screening questions to evaluate the psychiatric characteristic of the patient through interview methodology (Gupta, Gersing, Erkanli, & Burt, 2016). It is only through accurately diagnosing this mental disorder that a Psychiatric-mental health nurse practitioner (PMHNP) can formulate a relevant therapeutic care plan for the patient comprising of both pharmacological and behavioral interventions.

The choice of the most appropriate treatment regimen is based on drug efficacy and potency. In the case of drug combination therapy, the nurse must make sure that the interaction between the two drugs is synergistic (Stahl, 2013). However, in case the care plan is not effective within the predetermined duration of time, the PMHNP will have to review the treatment regimen, and enhance interpersonal psychotherapy with the patient. This paper examines a case of an African American male, aged 8-year old, who was diagnosed with depression and the treatment options that were recommended by the PMHNP (Weersing et al., 2017). The care plan outcome including the effectiveness of the choice of treatment will also be discussed for a comprehensive understanding of the management of depression among the pediatric population.

Decision Point One

Selected Decision. Begin Zoloft 25 mg OD

Reason for selection. Zoloft (sertraline) belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), which are very effective in managing depression. Several studies have approved the safety and effectiveness of this drug among the pediatric population. Considering the above case scenario, the 8-year-old patient scored a 30, according to the PMHNP report, on the Children’s Depression Rating Scale. The patient’s score suggests a significant depression that needs immediate medical intervention. From the antidepressant list provided for this case study, Zoloft is the best choice of drug, in this case, given that it is the most effective and better tolerated by pediatric patients in managing depression (Dobson & Strawn, 2016). Inasmuch as Paxil 10mg could also be administered, it would not be useful given the patient’s age, and the side effects associated with the drug in managing the symptoms of depression, especially heightened suicidal thoughts.
Consequently, Wellbutrin can only be used as a second-choice drug in case of failure of the SSRI to elicit the desired treatment outcome, or when the level of depression is not pronounced. Combination of Zoloft and Paxil is also discouraged given that both two drugs belong to the same class, SSRI, hence having the same mechanism of action (Stahl, 2014), which can lead to toxic doses causing serotonin syndrome. Consequently, this leaves us with Zoloft 25mg as the best choice of drug for this case scenario.
Expected Results. Given than SSRIs are used for long term depression therapy, Zoloft’s therapeutic effects are expected within about six weeks from the initial dose. However, several studies have revealed that Zoloft is expected to mitigate the symptoms of depression within four weeks. When properly administered, Zoloft should be able to reduce the patient’s symptoms close to normal, in terms of the level of concentration within two weeks (Varigonda et al., 2015). Within three weeks, the patient should be able to have an improved appetite with no irritations. Hence, four weeks of Zoloft use should enable the patient to relate well to his peers. The withdrawal and isolation symptoms should have seized by this time.
Difference between Expected Results and Actual Results. After four weeks, the patient reported back to the hospital with unresolved symptoms. This was not entirely expected according to the prescribed care plan and the expected therapeutic outcome as outlined by the PMHNP. The patient depression state was expected to improve after four weeks of medical therapy. In as much as the drug might exhibit some side effects, failing to work was entirely out of the picture. The only explanation for this incident might be a failure to adhere strictly to the dosage regimen. The patient might have been taking an underdose. Generally, the treatment outcome was quite the opposite of the expected care plan results.

Decision Point Two

Selected Decision. Increase dose to 50 mg orally daily.
Reason for Selection. Antidepressants work by taking away or reducing the symptoms of depression. When the patient’s depression

state did not resolve or become better within four weeks of medication therapy, the only two assumptions that can be drawn are that either the drug was not working, or the dose of the drug administered was below the therapeutic index. Since Zoloft was not responsive in this case, the PMHNP can either increase the dose of the drug to maximum, but within pediatric therapeutic limits or use another antidepressant (Stahl, 2013). However, the main reason behind the drug not working is not known, and thus increasing the dose seems to be the best intervention. Most studies recommend a dose of 50mg rather than 25mg for the desired effects to be felt. The main reason behind this is that a higher dose will trigger the release of serotonin to desired levels to reduce the symptoms caused by depression.
Expected Results. An increased dose from 25mg to 50mg should be able to elicit the desired effects and reduce the symptoms of depression. Initially, the patient was given 25 mg Zoloft, which is the starting or minimum dose for pediatric patients. 50 mg is still within the therapeutic range for this age group. Given that this is the maximum dose for pediatrics, the desired effects and reduced symptoms are expected within the shortest time possible (Zehgeer et al., 2018). The patient is expected to exhibit improved appetite, reduced irritations and improved social interactions with his peers.
Differences between Expected Results and Actual Results. The patient came back to the hospital after four weeks from the day that the Zoloft dose was increased from 25mg to 50mg. The expected outcome was that the patient would have reduced symptoms and in a better mental state. Remarkably, the patient registered a 20% decrease in depression symptoms, just as anticipated. The patient claimed he felt better than before. It was also astonishing that even after increasing the dose, the patient did not report any side effects of the drug, given that most studies have related Zoloft to several side effects. Generally, the treatment outcome of the patient was positive in as much as it was to a lower extent.

Decision Point Three

Change to a different SSRI

Reason for Selection. The eight-week therapeutic management of depression by Zoloft called for the need for an intervention. The drug was only able to reduce 20% of the patient’s symptoms. Previous studies have recommended a change in drug regimen in case of failure of a given antidepressant drug to elicit the desired outcome. Studies have also claimed that there is a likelihood of improved outcome when the fairly active drug is combined with another therapeutic agent to boost its effect (Riddle, 2019). Considering the two options, changing the drug regimen from Zoloft to another antidepressant agent is the most favorable solution.
Expected Results. Administering a different antidepressant agent, other than Zoloft, is expected to produce the desired outcome and reduce the depression symptoms. The patient is expected to show more than 30% reduced symptoms within four weeks of taking the new medication. The responsiveness of the new antidepressant agent in terms of reduced symptoms will improve the patient’s attitude towards adhering to the new treatment regimen and maintain the dosage to attain complete recovery (Southammakosane & Schmitz, 2015).
Differences between Expected Results and Actual Results. The therapeutic intervention of changing the antidepressant agent seems to be the standard way of handling such a situation. After increasing the dose of the initial drug to maximum, the only way that the patient’s condition could improve was by changing from the initial drug to a different antidepressant agent (Association for Youth, Children and Natural Psychology, 2012). According to several studies, different people respond differently to various antidepressant agents and hence, administration of the best choice of drug will undoubtedly elicit the desired treatment outcome.

Impact of Ethical Considerations on Treatment Plan

The use of antidepressant agents in pediatric patients has posed several challenges as a result of therapeutic complications. According to the FDA, most antidepressant agents heighten the suicidal tendencies among teenagers, and thus only a few should be used when necessary (Riddle, 2019). Nonetheless, even the recommended few exhibit undesired effects which undermine the health of the minors. As a result, patient evaluation by nurses reveals that majority of antidepressant agents should not be used in cases of depression among the pediatric population. For instance, when a patient presents with symptoms such as being isolated or withdrawn from classmates, such a patient’s treatment plan should not include antidepressants that are prone to inducing suicidal thoughts.
Conclusion
Pediatric depression is a severe mental condition that should be addressed by psychopharmacological intervention with immediate

effect. Depressed children tend to exhibit symptoms such as poor social interaction skills, low self-esteem and suicidal thoughts which affects both their academics and family. Hence, upon conducting an accurate diagnosis of the mental condition, an appropriate care plan should be formulated with the most suitable medication. However, since the bests drug regimen for the mental condition is not definite, the clinicians need to observe the patient’s response make the necessary interventions. Lastly, the clinician must also consider other interventions such as psychoeducation apart from pharmacotherapy.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Assignment: Therapy for Pediatric Clients With Mood Disorders

 

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 res
ult, 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 a
re, 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 persona
lized 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
© 2015 Laureate Education, Inc. Page 6
of 45 Week 2 Therapy for Pediatric Clients
With Mood Disorders 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
:
A
n 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 pharmac
odynamic
processes.
•
At each decision point stop to complete the following
•
Decision #1
o
Which
d
ecision did you select?
o
Why did you select this
d
ecision? Support your
response with evidence and references to the
Learning Resources.
o
What were you hoping to a
chieve by making this
d
ecision? Support your response with evidence
and references to the Learning Resources.
o
Explain any difference between what you
expected to achieve with Decision #1 and the
results of the decision. Why were they different?
•
Decision #
2
o
Why did you select this Decision? Support your
response with evidence and references to the
Learning Resources.
o
What were you hoping to achieve by making this
d
ecision? Support your response with evidence
and references to the Learning Resources.
o
Explain any difference between what you
expected to achieve with Decision #
2
and the
results of the
d
ecision. Why were they different?
•
Decision #3
o
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.
o
Explain any difference between what you
expected to achieve with Decision #3 and the
results of the decision. Why were they
different?
© 201
5
L
aureate Education, Inc.
Page
7
of
45
Week
2
Therapy for Pediatr
ic Clients
W
ith Mood Disorders
•
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.

© 201
5
L
aureate Education, Inc.
Page
4
of
45
Week
2
Therapy for Pediatr
ic Clients With Mood Disorders
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.
o
Chapter 6, “Mood Disorders”

Chapter 7, “Antidepressants” •
Stahl, S. M. (2014b
).
The prescriber’s guide (5th ed.).
New York, NY: Cambridge University Press.

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource