NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology-Walden University

Week 2: Therapy for Pediatric Clients With Mood Disorders

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.

As a psychiatric mental health nurse practitioner working with pediatric clients, 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 to recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Assignment: 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 result, 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 https://cIass.content.laureate.net/a98532d83c73f7979272641 bd6be5ed1.html#section_containerO 1/7

  NURS-6630 Week 02

• Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
• Decision #1
• Which decision did you select?
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? o Decision #3
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
• Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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SOLUTION

NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology-Walden University

A CHILD WITH DEPRESSION

Decision #1

For the first treatment of the patient, I choose to administer Paxil 10 mg orally daily to the patients. This was because the child showed symptoms of major depressive disorders in that they complained of fleeing sad, being withdrawn from peers and decreased appetite.  I also believed that Paxil 10mg would be the most appropriate drug for the patients as they were only eight years old.

According to Locher, Koechlin, Zion, Werner, Pine, Kirsch, & Kossowsky (2017), Paxil is an effective medication to administer to young people and has been shown to be effective in alleviating symptoms of different disorders. These include major depressive disorder, obsessive-compulsive disorders, panic disorders, generalized anxiety disorders, social anxiety disorder, and post-traumatic stress disorders, among others (Locher et al., 2017).

I believed that the treatment would not have substantial adverse side effects on the patients and would help alleviate the patient’s depressive symptoms in a short time period. I also opted for Paxil because different studies have demonstrated the efficacy of Paxil in maintaining the negative symptoms of major depressive disorder for up to a period of the year which were tested through placebo-controlled trials (Clevenger, Malhotra, Dang, Vanle, & IsHak, 2018).

By taking the decision to administer Paxil, I expected to reduce the depressive symptoms in the patient by a significant proportion without a lot of adverse side effects from the drug. However, the result of my decisions showed that though I succeed in reducing the depressive symptoms on my patients by at least 5 point scale the patients experienced a lot of severe side effects from the medication including, vomiting, diarrhea, and nausea.

Decision #2

For my second decision, I decided to decrease the dose of Paxil 10 mg for a week and then return to the previous 10mg dose. I made this decision to try and mitigate the severe side effects that the patients were experiencing from the first dose, including diarrhea, vomiting, and nausea. According to Sangkuhl, Klein, & Altman, (2016), reducing the dose of medication to certain levels while still maintaining its therapeutic level can help reduce the side effects caused by a given drug.

By reducing the dosage of Paxil administered to the African American Boy I, therefore, hoped I would mitigate adverse side effects that patients were experiencing. However, though the adverse side effects such as vomiting, diarrhea, nausea subsided with the reduction of the Paxil dose the reinitiating of the 10mg dose after a week brought back all the side effects as before.

When making the decision, I, therefore, expected that the adverse side effects would not come back after reinitiating the 10mg dose as the patients would have acclimatized to the drugs. However, my assumption was different from the results as the negative side effects continued after reinitiating the 10mg dose.

Decision #3

For the third decision, I decided to withdrawal the Paxil 10mg medication and offered the patient a different SSRI.  This because the Paxil dosage caused adverse side effects on the patient, which threatened their general health as they struggled to feed or hold on to what they had eaten. According to Clevenger et al., (2018), if an SSRI has negative side effects on patients, an ideal step would be to withdraw it and prescribe another.

By withdrawing the Paxil 10mg dose and opting for another SSRI such as Prozac 10mg daily I was hoping to continue to treat the major depressive disorder which the patient suffered from while at the same time alleviate the adverse side effects of the previous treatment. Changing to Prozac 10 mg would mitigate the side effects of the previous treatment while continuing to help the client get rid of their condition.

References

Clevenger, S. S., Malhotra, D., Dang, J., Vanle, B., & IsHak, W. W. (2018). The role of selective

serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic advances in psychopharmacology, 8(1), 49–58. DOI:10.1177/2045125317737264.

Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., … Kossowsky, J.

(2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry, 74(10), 1011–1020. DOI:10.1001/jamapsychiatry.2017.2432.

Sangkuhl, K., Klein, T. E., & Altman, R. B. (2016). Selective serotonin reuptake inhibitors

pathway. Pharmacogenetics and genomics, 19(11), 907–909. DOI:10.1097/FPC.0b013e32833132cb.

Also check:  Epidemiology Paper