Walden nurs6630 week 2 Assessing and Treating Pediatric Clients With Mood Disorders

Symptom presentation of depression in children varies with age. Often, it is difficult to identify depression in this age group. Emotional and cognitive developments influence the symptom presentation, so do comorbidities. Prevalence of depression is about 2% in prepubertal children, which increases to 4%–8% in adolescents.[1] Recent epidemiological studies show an increasing trend of depression in youth.[2] Childhood depression is a recurrent, relapsing condition causing significant morbidity and mortality. Onset of depression in childhood often results in poor academic outcome, long-standing impairment, poor quality of life, and high risk for suicide and substance abuse.[1] Here, I discuss the clinical presentations of childhood depression with focus on assessment and management based on evidence-based guidelines.

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CASE VIGNETTES

Tarun^*, a 4-year-old boy, underwent hospitalization for intractable vomiting. He was sent for psychiatric care when no physical basis of symptoms could be identified. His vomiting would become worse when he approached school so much, so that his parents stopped sending him to school. He appeared dull, listless, became jittery when offered the chair. He did not look at the crayons or balloons which were his favorite.

Taslima^*, an 11-year-old girl, had deteriorated in her studies to the extent of scoring 24 out of 100 in her session examinations. Earlier an Avid Reader, she would not even feel like looking at her books and would often get reprimanded for keeping her belongings in a disorderly manner. She would not take the phone from her mother even when offered to talk to her aunt, which she used to earlier fight for.

Although the diagnostic criteria for diagnosing depression remain the same even for children and adolescents, application of these is often felt difficult as symptoms differ by age due to cognitive, emotional, and social aspects of development. Biological functions such as sleep and appetite may not be disturbed, but experience of low mood, anhedonia, and cognitive distortions is distinctly felt.[3]

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Title: Walden nurs6630 week 2 Assessing and Treating Pediatric Clients With Mood Disorders

Assessing and Treating Patients with Bipolar Disorder 

Mental health disorders are a crucial public health concern because of its rising rates and impacts on the health of the population. Mental health problems such a bipolar disorder affect the patient’s quality of life and productivity. Mental health nurse practitioners explore effective, evidence-based interventions that will promote recovery and prevent relapse among the affected populations. Often, pharmacological and non-pharmacological interventions are effective in facilitating bipolar disorder management and prevention of symptom relapse. Therefore, the purpose of this paper is to explore bipolar I disorder. It examines topics that include prevalence and neurobiology of bipolar I disorder, differences with bipolar II disorder, treatment in a special population and consideration, and monitoring drug use in the population.  

Prevalence and Neurobiology 

The selected type of bipolar disorder for analysis in the project is bipolar I disorder. Bipolar I disorder is a mental disorder characterized by patients experiencing episodes of irritable or highly elevated mood. The mood is referred to as mania. The expansive mood may be accompanied by other symptoms such as grandiosity, decreased need for sleep, racing thoughts, talkativeness, and engaging in risk-taking behaviors. The mood swings may shift between irritability, depression, anger and mania, resulting in mixed features in the bipolar disorder (Jones et al., 2022). Bipolar I disorder affects the health, wellbeing, and functioning of the patients, hence, the need for responsive strategies to optimize outcomes.  

Bipolar I disorder has a lifetime prevalence of 0.6%. The prevalence is distributed equally between males and females. However, males tend to experience more manic episodes with the disorder while female experience more of depressive cycling episodes. The rates of bipolar I disorder is high in the developed countries (1.4%) as compared to the low-income countries (0.7%). Separated, widowed, or divorced individuals have the highest rate of bipolar I disorder. The cumulative prevalence of the three types of bipolar disorders is 1.8%. The onset of bipolar I disorder in the USA is at the age of 20 years while it is 29 years in the European countries (Psychdb.com, 2022). The prevalence rate among adults aged 18 years and above is 2.8%, with 4.4% of this population expected to develop it at some point in their lives. Adolescents have a lifetime prevalence of 2.9% of developing bipolar I disorder, with 2.6% of them suffering from severe impairment (Psychom.net, 2021). The risk factors for developing bipolar I disorder include genetics and environment risks such as traumatic experiences, substance abuse, and maternal vital infections during the prenatal period.  

Bipolar I disorder has neurobiological basis. First, most studies have shown that individuals with bipolar disorder, including bipolar I experience death of neurons and glial cells. Persistent exposure to stress or traumatic events affects the functioning of glial cells and neurons, precipitating the onset of symptoms. There is also the role of neurotransmitters in the development of bipolar disorder. Accordingly, patients with bipolar disorder demonstrate changes in the regulation of dopamine, serotonin, and acetylcholine neurotransmitters (Young & Juruena, 2021). Alterations in the balance as well as their receptor systems affect functions such as behavior, endocrine regulation, and sleep-wakefulness.  

Patients with bipolar I disorder also have problems with intracellular signaling in their brains. Studies have found the existence of macroscopic changes in brain regions and circuits, which are accompanied by chemical and histopathological brain changes. Stressors promote oxidative processes, which destroy brain cells, neurons, and cause imbalance in chemicals causing symptoms of bipolar I disorder (Scaini et al., 2020). For instance, there is an increase in the activity of chemical superoxide dismutase, which can depression and manic episodes in the affected patients.  

Differences 

A comparison is made between bipolar I and bipolar II disorder. The both types of bipolar have periods of depressive symptoms and elevated mood. The disorders also share similar symptoms during manic episode such as euphoria, insomnia, excessive talking, racing thoughts, and inflated self-esteem.  They also have the same symptoms of depression such as low energy, sadness, decreased appetite, feelings of guilt, and isolation (Jones et al., 2022). However, they have some differences. The first one is that patients experience full manic episodes in bipolar I disorder. They experience extreme shifts in energy and mood. The symptoms are severe to affect the functioning of the patients in the social and occupational roles. The symptoms of mania and depression are less severe in bipolar II disorder. For example, hypomanic symptoms in this disorder such as elevated mood are not intense to affect the individual’s functioning. The depressive symptoms in bipolar I disorder lasts at least two weeks while in bipolar II they last at least two weeks but longer than bipolar I. Patients experiencing bipolar I disorder also have at least an episode of mania while there is no mania in bipolar II disorder (Coda, 2022). There is also the experiences of delusions and hallucinations in bipolar I disorder, which are not evident in bipolar II disorder.  

Special Population and Considerations 

Treatment of bipolar I disorder in special populations present unique challenges to mental health practitioners. The special populations include children, adolescents, pregnant mothers, post-operative adults, and the elderly. Each of this populations have unique needs that influence the selection of treatment in bipolar disorders. Children and adolescents have immature organs such as the liver and kidneys. These vital organs are involved in the metabolism and excretion of the different drugs used in treating bipolar disorders. Psychiatric mental health nurse practitioners must weigh the benefits and risks of the different options for treatment before prescribing them. Most of the treatments utilized for children and adolescents are also off-label. This places them at an increased risk of harm due to the use of drugs with unknown safety and efficacy index. The elderly patients also experience considerable functional declines that affect the options of treatment for bipolar disorders (Healthcare, 2023; Skidmore-Roth, 2022). For example, the decline in renal and hepatic functions affect the dosing of different medications for use in treating bipolar I disorder. Psychiatric mental health nurse practitioners must also assess the efficacy of the different drugs to prenatal mothers to eliminate risks of teratogenicity.  

One of the legal consideration when treating bipolar I disorder is the psychiatric mental health nurse practitioner providing care within her scope. This includes ensuring the prescription of drugs for bipolar I disorder within her prescriptive authority. Practicing within the scope eliminates potential issues that may arise due to harm from the provided care. PMHNP should also make decisions based on ethical considerations. This includes seeking informed consent, and promoting privacy and confidentiality of the patients’ data. The nurse must also ensure safety in the care process. The prescribed treatments should not predispose the special populations to any harm. The decisions made should also aim at safeguarding the rights and needs of the patients, hence, non-maleficence and benevolence. PMHNP should also adopt patient-centered interventions in bipolar I disorder management. This includes utilizing interventions that align with the values, beliefs, practices, and expectations of the patients and their families (Healthcare, 2023; Williams, 2021). The consideration of patient factors in the treatment process promotes outcomes such as enhanced adherence to the prescribed interventions.  

FDA and or Clinical Practice Guidelines 

The Food and Drug Administration (FDA) is mandated with the responsibility of recommending drugs for use in treating conditions in different populations. The FDA has approved olanzapine-fluoxetine combination for treatment of bipolar disorder with depressive symptoms. The other approved drugs for acute treatment of bipolar depression include quetiapine and lurasidone. The FDA has also approved Risperdal, quetiapine, and aripiprazole for use in children and adolescents experiencing any stage of bipolar disorder. Lithium is approved for use in adolescents aged 12 and above years (Skidmore-Roth, 2022). Olanzapine recommendations is used for adolescents aged 13 years and above. The FDA also recommends lithium and aripiprazole use in children and adolescents to prevent symptom relapse. The FDA has also approved caplyta for treating bipolar disorder in the elderly population. The FDA approved treatment for mixed bipolar disorder entails the use of quetiapine and combination of fluoxetine and olanzapine (Citrome, 2020; Wang & Osser, 2020). Healthcare providers may also consider antipsychotics such as aripiprazole, asenapine, risperidone, and ziprasidone for maintenance treatment, as they are FDA approved.  

Side Effects, FDA Warnings and Monitoring 

Safety and quality should be upheld when treating patients with bipolar disorder. As a result, patients should be monitored closely for side effects and adverse reactions to the above treatments. The healthcare providers should monitor patients prescribed Risperdal, quetiapine, and aripiprazole for side effects that include weight gain, dizziness, akathisia, tiredness, nausea, night tremors, and decreased libido. They should also assess for increased appetite, drowsiness, and heartburn. Rare side effects that must be reported include seizures, parkinsonian side effects such as tremors and muscle stiffness, changes in ECG, and neuroleptic malignant syndrome (Healthcare, 2023; Williams, 2021). The signs to monitor related to neuroleptic malignant syndrome include fainting spells, racing heart rate, fever, and muscle stiffness.  

Patients prescribed lithium should be monitored for side effects that include drowsiness, bradycardia, fainting, confusion, and weight gain. The additional side effects include diarrhea, seizures, blurred vision, tinnitus, and vomiting. Patients prescribed fluoxetine should be monitored for side effects such as weight gain, decreased libido, and insomnia. The use of antidepressants such as fluoxetine carriers the risk of suicidal thoughts, attempts, or plans. Patients and family members should be educated about the importance of monitoring mood and sudden surge in the patient’s energy. Such observations are clues to potential intent of self-harm by the patient. Weight gain in already obese or overweight patients should also be considered an issue of concern (Skidmore-Roth, 2022). Patients should be referred to a nutritionist for dietary recommendations and be educated about the importance of healthy lifestyles and behaviors such as engaging in active physical activity.  

Proper Prescription 

Name: Mr. V 

Age: 35 

Diagnosis: Bipolar I disorder 

Treatment: po risperidone 2 mg od 1/12 

Refills: none 

Signature:  

Name: AA 

Age: 15 

Diagnosis: Bipolar I disorder 

Treatment: po Lithium 300mg od 1/12 

Refills: none 

Signature:  

Name: Mrs. W 

Age: 25 

Diagnosis: Bipolar I disorder 

Treatment: po risperidone 3mg od 1/12 

Refills: none 

Signature:  

Conclusion 

In summary, bipolar I disorder is a type of a mental health disorder associated with severe mania and hypomania. It affects negatively patient’s health, wellbeing, and functioning. Bipolar I disorder is severe than bipolar II. The FDA has approved several drugs for use in bipolar disorder. Psychiatric mental health nurse practitioners should monitor patients for side and adverse reactions to the prescribed treatments. 

 

References 

Citrome, L. (2020). Food and Drug Administration–Approved Treatments for Acute Bipolar Depression: What We Have and What We Need. Journal of Clinical Psychopharmacology, 40(4), 334. https://doi.org/10.1097/JCP.0000000000001227 

Coda, F. (2022). 2023 Foundations of Psychiatric-Mental Health Nursing. Amazon Digital Services LLC – Kdp. 

Healthcare, S. (2023). Pharmacology, Nutrition, Paediatric Nursing—2023. Svastham Healthcare. 

Jones, D. J. S., Jones, J. S., & Beauvais, D. A. M. (2022). Psychiatric Mental Health Nursing: An Interpersonal Approach. Jones & Bartlett Learning. 

Psychdb.com. (2022, January 16). Bipolar I Disorder. PsychDB. https://www.psychdb.com/bipolar/bipolar-i 

Psychom.net. (2021, July 14). Prevalence of Bipolar 1 Disorder. https://pro.psycom.net/assessment-diagnosis-adherence/bipolar-disorder/bipolar-disorder-prevalence-and-risks 

Scaini, G., Valvassori, S. S., Diaz, A. P., Lima, C. N., Benevenuto, D., Fries, G. R., & Quevedo, J. (2020). Neurobiology of bipolar disorders: A review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Brazilian Journal of Psychiatry, 42, 536–551. https://doi.org/10.1590/1516-4446-2019-0732 

Skidmore-Roth, L. (2022). Mosby’s 2023 Nursing Drug Reference—E-Book. Elsevier Health Sciences. 

Wang, D., & Osser, D. N. (2020). The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An update on bipolar depression. Bipolar Disorders, 22(5), 472–489. https://doi.org/10.1111/bdi.12860 

Williams, L. (2021). Nursing 2022: Drug Handbook. Independently Published. 

Young, A. H., & Juruena, M. F. (2021). The Neurobiology of Bipolar Disorder. Current Topics in Behavioral Neurosciences, 48, 1–20. https://doi.org/10.1007/7854_2020_179 

 

Walden nurs6630 week 2 Assessing and Treating Pediatric Clients With Mood Disorders Grading Rubric

Performance Category	100% or highest level of performance 100% 16 points	Very good or high level of performance 88% 14 points	Acceptable level of performance 81% 13 points	Inadequate demonstration of expectations 68% 11 points	Deficient level of performance 56% 9 points	Failing level of performance 55% or less 0 points
Total Points Possible= 50	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic topics.	Presentation of information was exceptional and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was good, but was superficial in places and included all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information was minimally demonstrated in all of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in one of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in two of the following elements: Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.	Presentation of information is unsatisfactory in three or more of the following elements Provides evidence of scholarly inquiry relevant to required TD topic(s). Presents specific information from scholarly sources to develop a comprehensive presentation of facts. Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.* Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
	16 Points	14 Points	13 Points	11 Points	9 Points	0 Points
Application of Course Knowledge Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations	Presentation of information was exceptional and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was good, but was superficial in places and included all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information was minimally demonstrated in the all of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in one of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from and scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in two of the following elements: Applies principles, knowledge and information from scholarly resources to the required topic. Applies facts, principles or concepts learned from scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.	Presentation of information is unsatisfactory in three of the following elements Applies principles, knowledge and information and scholarly resources to the required topic. Applies facts, principles or concepts learned scholarly resources to a professional experience. Application of information is comprehensive and specific to the required topic.
	10 Points	9 Points			6 Points	0 Points
Interactive Dialogue Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic.	Demonstrated all of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 3 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.			Demonstrated 2 of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.	Demonstrated 1 or less of the following: Initial post must be a minimum of 300 words. The peer and instructor responses must be a minimum of 150 words each. Responses are substantive Responses are related to the topic of discussion.
	8 Points	7 Points	6 Points	5 Points	4 Points	0 Points
Grammar, Syntax, APA Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error.	The following was present: 0-3 errors in APA format AND Responses have 0-3 grammatical, spelling or punctuation errors AND Writing style is generally clear, focused on topic,and facilitates communication.	The following was present: 4-6 errors in APA format. AND/OR Responses have 4-5 grammatical, spelling or punctuation errors AND/OR Writing style is somewhat focused on topic.	The following was present: 7-9 errors in APA format. AND/OR Responses have 6-7 grammatical, spelling or punctuation errors AND/OR Writing style is slightly focused on topic making discussion difficult to understand.	The following was present: 10- 12 errors in APA format AND/OR Responses have 8-9 grammatical, spelling and punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand.	The following was present: 13 – 15 errors in APA format AND/OR Responses have 8-10 grammatical, spelling or punctuation errors AND/OR Writing style is not focused on topic, making discussion difficult to understand. AND/OR The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.	The following was present: 16 to greater errors in APA format. AND/OR Responses have more than 10 grammatical, spelling or punctuation errors. AND/OR Writing style does not facilitate communication
	0 Points Deducted					5 Points Lost
Participation Requirements	Demonstrated the following: Initial, peer, and faculty postings were made on 3 separate days					Failed to demonstrate the following: Initial, peer, and faculty postings were made on 3 separate days
	0 Points Lost					5 Points Lost
Due Date Requirements	Demonstrated all of the following: The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.					Demonstrates one or less of the following. The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT. A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.