NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
Sample Answer for NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders Included After Question
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.
By Day 7
Submit your Assignment.
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- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
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Week 4 Assignment Rubric
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Submit your Week 4 Assignment draft and review the originality report.
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Week 4 Assignment
What’s Coming Up in Week 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will build on your assessment and treatment skills as you examine patients presenting with bipolar disorders.
Next Week
A Sample Answer For the Assignment: NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
Title: NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
Module 2: Disorders With Affective Components
As a psychiatric nurse practitioner (PNP), does that research finding surprise you? How do PNPs ensure that effective psychopharmacologic treatments are prescribed to address the prevalence of affective disorders?
Consider for example that current treatments are sub-optimal, resulting in poor patient responses and uncertain modes-of-action (Plant, 2017). While it is no surprise that mental health medicine and clinical approaches are constantly evolving, novel insights into the underlying mechanisms of how affective disorders arise, remain. Additionally, the use of psychopharmacologic treatments may not always be consistent with a patient’s preferred treatment plan. Thus, your skills and understanding of how to assess and treat patients with affective disorders are important in ensuring positive patient outcomes and may also contribute to the research needed to connect clinical observations to the neuroscience, physiology, and pharmacologic processes needed to treat these disorders.
Reference:
Plant, N. (2017). Can a systems approach produce a better understanding of mood disorders? Biochimica et Biophysica Acta, 1861(1), 3335-3344. https://doi.org/10.1016/J.BBAGEN.2016.08.016
What’s Happening This Module?
Module 2, Disorders With Affective Components, is a 6-week module. During Week 4, you will begin applying your assessment and therapy skills as you engage in your first Assignment assessing and treating pediatric patients with mood disorders. In Week 5, you will continue to apply your assessment and therapy skills as you assess and treat patients presenting with bipolar disorders. As you engage with the decision tree exercises, reflect on the critical decision-making skills that you, as a psychiatric nurse practitioner, are making, as these skills are essential to your current and future practice. In Week 6, you will assess and treat patients presenting with anxiety and posttraumatic stress disorder (PTSD). You will also complete your Midterm Exam. During Week 7, you will assess and treat patients presenting with schizophrenia. In Week 8, you will complete a Short Answer Assessment in which you will synthesize your understanding of sleep/wake disorders. You will also continue to apply your assessment and therapy skills as you assess and treat patients presenting with sleep/wake disorders. During Week 9, you will examine psychopharmacologic therapies for patients with ADHD/ODD and you will complete a Quiz to test your understanding of the content explored in this module
| What do I have to do? | When do I have to do it? |
| Review your Learning Resources. | Days 1–7, Weeks 4–9 |
| Assignment: Assessing and Treating Pediatric Patients With Mood Disorders | Submit your Assignment by Day 7 of Week 4. |
| Assignment: Assessing and Treating Patients With Bipolar Disorder | Submit your Assignment by Day 7 of Week 5. |
| Assignment: Assessing and Treating Patients With Anxiety Disorders | Submit your Assignment by Day 7 of Week 6. |
| Midterm Exam | Complete Midterm Exam by Day 7 of Week 6. |
| Discussion: Treatment for a Patient With Insomnia | Post by Day 3 of Week 7 and respond to your colleagues by Day 6 of Week 7. |
| Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia | Submit your Assignment by Day 7 of Week 7. |
| Assignment 1: Short Answer Assessment | Submit your Assignment by Day 7 of Week 8. |
| Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders | Submit your Assignment by Day 7 of Week 8. |
| Assignment: Assessing and Treating Patients With ADHD/ODD | Submit your Assignment by Day 7 of Week 9. |
| Quiz: Assessing and Treating Patients With Psychopharmacology | Complete Quiz by Day 7 of Week 9. |
Go to the Weekly Content
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6630_Week4_Assignment_Rubric
| Excellent
Point range: 90–100 |
Good
Point range: 80–89 |
Fair
Point range: 70–79 |
Poor
Point range: 0–69 |
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| 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. |
Points Range: 9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. |
Points Range: 8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. |
Points Range: 7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
Points Range: 0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
|
| Decision #1 (1–2 pages)
• Which decision did you select? |
Points Range: 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
|
| Decision #2 (1–2 pages)
• Which decision did you select? |
Points Range: 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
|
| Decision #3 (1–2 pages)
• Which decision did you select? |
Points Range: 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
|
| 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. |
Points Range: 14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. |
Points Range: 12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. |
Points Range: 11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. |
Points Range: 0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. |
|
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. |
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. |
Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. |
|
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. |
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. |
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. |
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. | Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. |
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors. |
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors. |
|
| Total Points: 100 | |||||
Name: NURS_6630_Week4_Assignment_Rubric
A Sample Answer For the Assignment: NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
Title: NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
Depression is a major psychiatric disorder affecting a significant number of children and adolescents in the United States. The major depressive disorder was found to affect about 5% and 17% of children and adolescents in 2016 (Selph & McDonagh, 2019). The process of assessing, diagnosing, and treating children with mood disorders is quite complex compared to adults. This is because the signs and symptoms of mood disorders differ in children compared to adults. The process of drug metabolism is significantly different. However, the same pharmacological interventions for mood disorders may be used for children and adults. Therefore, nurse practitioners must be cautious when prescribing psychotropic medications to these patients. The aim of this essay is to examine a case study of a child with a depressive disorder and how to consider three choices for treating the patient.
Background Information of the Case
The client in this scenario is an African American male child aged eight years and arrives at the emergency room accompanied by his mother. The patient exhibits signs of depression. He complains of feelings of sadness, and the mother reports that the teacher said the child is withdrawn from peers in class. The mother notes reduced appetite and occasional periods of irritability in the patient. The patient has reached all the developmental landmarks at the appropriate ages. However, the physical examination is remarkable. Upon investigation, the laboratory studies are within the normal ranges. The child is referred for psychiatric evaluation and is seen by a Psychiatric Nurse Practitioner.
Mental status examination shows that the patient is alert and oriented X3. He has a clear and coherent speech; he is goal-oriented and spontaneous. The self-reported mood is sad, and the effect is somehow blunted. He smiles appropriately at various points of the clinical interview. However, the patient denies any visual or auditory hallucinations. No delusional or paranoid thoughts were noted. His judgment and insight are appropriate for his age. Although he has active suicidal ideation, he admits that he often thinks of himself being dead and how it would look. After the administration of the Children’s Depression Rating Scale, the child scores 30, which is indicative of significant depression.
Decision #1; Start with Zoloft 25 mg orally daily
The first choice of treatment for the patient, in this case, is Zoloft 25 mg. Zoloft (Sertraline) is a serotonin reuptake inhibitor which had demonstrated effectiveness, safety, and tolerability in the treatment of adults with major depressive disorder. Although few studies have been carried out to evaluate the effects of SSRIs in children and adolescents, a significant number of research demonstrate improved symptoms of children with the major depressive disorder when compared to placebo (Sharmi 2018). Sertraline improved the symptoms of children with depression compared to placebo over a period of ten weeks (Liu et al., 2021). Despite the adverse side effects that occurred after sertraline use, Sertraline is recommended for short-term treatment of depression in depressed children and adolescents (Sharmi 2018). In this case, after treating the patient with Zoloft 25 mg OD, the patient returned to the clinic after four weeks with a slight increase in mood, no HAM-D results, and no reported adverse events. Thus, it is ethically acceptable to continue with Zoloft since there are slight improvements and no adverse reactions are reported.
Moreover, since FDA- evaluations on the safety of Paxil are not yet completed, FDA recommends that Paxil should not be used in the treatment of children and adolescents with major depressive disorder. Further, although Wellbutrin may be effective in the treatment of MDD and ADD, it has not been shown to be effective in the treatment of patients under the age of eighteen years old. Besides, there is no approved dosage of Wellbutrin for children by the FDA. While making the treatment decisions, the main focus is on the effectiveness and safety of the patient. Patient safety is a key issue of concern in healthcare settings. Ensuring patient safety helps in the prevention and minimization of injuries and adverse reactions which may risk the health of the patient or even cause death. Effective communication with the patient is crucial to establish rapport with the patient and explain the benefits and risks of the treatment. It helps in medication adherence, thus, improving the outcomes of the treatment.
Decision #2; Increase Zoloft dose to 50 mg orally daily
The reason for choosing this decision is that, after the patient returns to the clinic after four weeks, the depressive symptoms have significantly improved by 50%, and the client is tolerating the medication well. 50 mg per day Sertraline was found to be an effective and tolerable therapeutic dose for treating individuals with depressive symptoms. The second choice of medication depends on the effectiveness of the drug in improving depressive symptoms. I did not choose to increase the dose to 37.5 mg orally daily because only a small change in symptoms (20%) was noted. At this point, sufficient symptom reduction was not achieved. The choice is either to increase the Zoloft dose or consider another SSRI. Evidence suggests that by eight weeks post-initiation of therapy, the symptoms of the disease should significantly decrease by 50% for the antidepressant to be considered appropriate and effective (Zhou et al., 2020). Besides, changing Zoloft to Prozac 10 mg orally daily would not be effective for the patient since after the client returns after four weeks, there are no changes in symptoms at all. Therefore, the best option would be to increase the Zoloft dose to 50 mg orally daily due to symptoms improvement by 50% and without any adverse reactions reported. The main consideration while making the decision is the degree of symptom improvement and side effects. Although no adverse events are reported, Zoloft 50 mg orally daily works the most effective for the patient. The ethical decision aims at improving the patients’ quality of life and ensuring the effectiveness and safety of the medication.
Decision #3; Increase Zoloft Dose to 75 mg Orally Daily
The main reason for choosing this decision is because sufficient symptom is achieved, is considered a response therapy. Therapy effectiveness and safety are the main focus when treating individuals with psychiatric disorders. The main goal of the treatment is to alleviate the symptoms of the conditions while ensuring the safety of the patient and achieving desirable therapy outcomes (Anvari et al., 2020). Although maintaining the current dose of Zoloft leads to sufficient symptom reduction, this would not be considered a full response therapy when the symptoms are reduced by 50% or more on the HAM-D. Therefore, this should not be confused with full symptom resolution, which should be achieved by 100% symptom reduction as measured on the HAM-D. Thus, continuing with the current dose would reset the full assessment of therapy efficacy. Besides, there is no indication that the patient should change from SSRI to SNRI at this point since the patient is clearly responding to the Zoloft therapy. At this point, the decision is guided by full resolution of the depressive symptoms and if there is an indication for changing therapy to SNRI. The patient should continue with Zoloft 75 mg orally daily and be reassessed after four weeks to monitor any further reduction of symptoms. An increase of the dose of warranted since the patient has not reached full remission. However, effective communication between the psychiatrist and the patient is key at this point. It would be ethical to explain to the patient the pros and cons of increasing the Zoloft dose at this time. This empowers the patient to be part of the decision-making concerning his health. However, since the patient is a child, informed consent should be sought from the mother.
Conclusion
The case involves a child aged eight years who presents to the emergency department with depressive symptoms. The choices for treating the patient depend on the effectiveness, safety, and tolerability of the therapy. Zoloft is the first choice for treating the patient since it has been approved by the FDA for the treatment of mood disorders in the pediatric population due to its effectiveness and safety. However, the start dose should be low to avoid any adverse events of the medication. After giving Zoloft 25 mg orally daily, there is a significant improvement of depressive symptoms, and no adverse reactions are reported. Thus, the next option is to step up the Zoloft dose to 50 mg. At this point, the patient is tolerating the dose, and the symptoms improve by 50%. This indicates that the patient is responding to the therapy effectively without any side effects. However, further dose increment may be warranted to achieve full remission of symptoms. Thus, the third decision would be to increase the Zoloft dose from 50 mg orally daily to 75 mg orally daily and monitor the patient for full remission of the depressive symptoms.
References
Anvari, A. A., Carroll, M. P., & Klein, D. A. (2020). Primary Care Clinicians Can Effectively Treat Depression in Children and Adolescents. American Family Physician, 102(4), 198-199.
Liu, W., Li, G., Wang, C., Wang, X., & Yang, L. (2021). Efficacy of Sertraline Combined with Cognitive Behavioral Therapy for Adolescent Depression: A Systematic Review and Meta-Analysis. Computational and Mathematical Methods in Medicine, 2021.
Selph, S., & McDonagh, M. S. (2019). Depression in children and adolescents: Evaluation and treatment. American family physician, 100(10), 609-617.
Sharmi, V. J. (2018). A prospective randomised open-label comparative study of efficacy and safety of escitalopram versus Sertraline in major depressive disorder in a tertiary care hospital (Doctoral dissertation, Chengalpattu Medical College, Chengalpattu).
Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., … & Xie, P. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581-601.
Week 4: Therapy for Patients With Major Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.
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 complete a Quiz on the concepts addressed throughout this module.
Learning Objectives
Students will:
- Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan
- Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy
- Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy
- Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
Baek, J. H., Nierenberg, A. A., & Fava, M. (2016). Pharmacological approaches to treatment-resistant depression. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 44–47). Elsevier.
Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 27–43). Elsevier.


Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/_Resources/Persistent/a97650fb538f47bb697c47873b0e58d493684a07/A.7-Psychopharmacology-2019.1.pdf



Medication Resources (click to expand/reduce)
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
Review the following medications:
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Required Media (click to expand/reduce)
Case Study: An African American Child Suffering from Depression
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources (click to expand/reduce)


iii–v. https://doi.org/10.2989/17280583.2014.938497
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.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
- Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 4 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment
What’s Coming Up in Week 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will build on your assessment and treatment skills as you examine patients presenting with bipolar disorders.
Next Week
FEEDBACK
Week 4 Assignment
Good job on your introduction!
Good job on your first decision point. You did a great job with your explanations and rationale. Your essay needs to include in-text citations (references) in the body of your essay when you reference external information. There are several sections of your essay in which you didn’t include references.
Great job on decision point 2. Good use of references.
Good job on decision point 3.
The goal for this week’s case was for students to understand the safety profile associated with various antidepressants for the treatment of pediatric depression. As outlined in decision #1, there is an abundance of strong safety and efficacy data from clinical trials, meta analyses and case series to support the use of sertraline in this patient. Additionally, the pediatric depression treatment guidelines point to sertraline as an appropriate first-line therapy.
Paxil carries a litany of safety concerns in the pediatric population, and you probably discovered the multiple black box warnings. Paxil should be avoided at all costs in this patient population
Buproprion is not well studied for treating depression in the pediatric population and would not be considered an appropriate or evidence-based first line therapy.
When selecting sertraline in decision #1, you were faced with an option to titrate sertraline dosing or switch to fluoxetine in decision #2. The appropriate and evidence-based treatment decision here would be to increase the sertraline dosage (either the 37.5 mg or 50 mg dose is fine and could be supported by the literature). Although there is strong data to support the safe and effective use of fluoxetine in the pediatric population, it would be inappropriate to change therapies at this time given that the patient is tolerating sertraline and not showing signs of worrisome adverse events. Keep in mind that the patient has not yet been trialed on an adequate (therapeutic) dose of sertraline and has only been on therapy for 4 weeks. In many cases, we do not observe meaningful therapeutic benefit from antidepressants until patients have been on therapy for 6-8 weeks, or sometimes longer.