Assessing and Treating Pediatric Patients With Anxiety Discussion

Assessing and Treating Pediatric Patients With Anxiety Discussion

Mood disorders, including major depression, bipolar disorder, and dysthymia, have become common diagnoses in children and adolescents below 18. Particularly, major depression has become highly prevalent among teenagers. According to Mullen (2018), major depression is the most common psychiatric disorder reported among children and teenagers. Various symptoms, including depressed mood, characterize depression, decreased energy, loss of interest in activities that one used to enjoy, lack of concentration, reduced energy, agitation, irritability, mood swings, and change in sleeping and eating patterns (Colizzi et al., 2020). The severity of depressive symptoms is classified into mild, moderate, or severe. Depression is also associated with emotional and behavioral dysfunction, in which impairments function in various areas of life, including academic performance and social life. This mood disorder might affect a child’s school attendance, ability to learn, concentration level, violence, substance use, and social relations. Additionally, these symptoms persist into adulthood mostly due to a lack of appropriate and timely diagnosis and treatment of depressive symptoms. Consequently, depression among adolescents has become a significant healthcare concern among parents and mental healthcare stakeholders. Mental healthcare providers focus on using pharmacological interventions to treat depressive symptoms in teenagers to improve their mood and enhance their functioning, academic performance, social interactions, and quality of life. In the provided scenario, the client is a 13-year-old Jeanette. She reports struggling at home and in school. She further reports suffering from temper tantrums, inappropriate behavior, impulsiveness, difficulty in judgment, and sleep issues for over eight years. This paper presents three decisions concerning a patient’s pharmacological treatment, considering factors likely to influence the client’s pharmacokinetics and pharmacodynamics processes. Assessing and Treating Pediatric Patients With Anxiety Discussion

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Decision Point 1

The first treatment decision involves administering Zoloft 25 mg. This option was preferred following the effectiveness and safety of Zoloft in treating depressive symptoms in children and adolescents. According to Tini et al. (2020), Zoloft was approved by the FDA as the first-line treatment for children and adolescents. Zoloft hinders serotonin intake, elevating serotonin levels in the brain, which improves depressive symptoms. Therefore, administering Zoloft 25 mg is the best decision.

Other potential interventions were rejected, including Paxil 10 mg by mouth daily and Wellbutrin 75mg by mouth BID. According to Zhang et al. (2019), Paxil 10 mg causes severe side effects, including headache, fatigue, nausea, dizziness, and sleep disturbances, making it unsafe for children. Additionally, Wellbutrin and Paxil cause trouble sleeping when administered to patients with depressive symptoms (Zhang et al., 2019). Thus, these drugs are inappropriate for this client since she reported sleep issues. Administering them to the client would worsen her sleep issues.

Administering Zoloft 25 mg daily was expected to improve the client’s depressive symptoms due to its effectiveness in improving depression symptoms (Tini et al., 2020). Thus, the client was expected to report a decline in sadness and irritability and improvement in appetite and social interactions after returning to the clinic after four weeks. However, the client denied improvement in depression symptoms.

The ethical guideline in developing this treatment plan is informed consent, which was obtained from the client’s mother. Parental consent is considered when providing mental health care to minors without consenting capacity (Bieber et al., 2020)Assessing and Treating Pediatric Patients With Anxiety Discussion. The mother supported using this drug to manage presented depressive symptoms after understanding the efficacy and safety of Zoloft in treating depression in children and adolescents.

Decision Point 2

The second treatment decision involves prescribing Zoloft 50 mg to the client. This option was selected following the ineffectiveness of Zoloft 25 mg in improving the client’s depressive symptoms. The client denied improvement in the initial symptoms after taking Zoloft 25 mg for four weeks. Furukawa et al. (2019) reported that Zoloft is dose-dependent; hence its efficacy in improving depressive symptoms increases with dosage. Hence, increasing the dosage to Zoloft 50 mg is the best treatment intervention for this client.

Other potential options were rejected. Zoloft 37.5 mg was dismissed since no improvement in depressive symptoms was reported after taking 25mg for four weeks. Therefore, Zoloft 37.5 mg would not result in the desired results since Zoloft is dose-efficacy (Furukawa et al., 2019). Additionally, Paxil was rejected due to multiple side effects, including headache, fatigue, nausea, dizziness, and sleep disturbances (Zhang et al., 2019)Assessing and Treating Pediatric Patients With Anxiety Discussion. Additionally, it is recommended to enhance the effectiveness of the first-line medication before prescribing an alternative medication.

Increasing the dosage to Zoloft 50 mg was expected to improve depressive symptoms. Furukawa et al. (2019) reported the effectiveness of a higher dosage of Zoloft in improving depressive symptoms due to an increase in serotonin levels in the brain. The client reported a 50% symptom decrease with no side effects.

In developing this treatment plan, mental healthcare providers adhered to the ethical consideration of beneficence. This ethical guideline requires PMHNPs to benefit clients through treatment (Bipeta, 2019). Thus, the PMHNP would benefit the client through provided treatment.

Decision Point 3

The last treatment decision entails maintaining the current dosage (Zoloft 50 mg). This option was selected since the client reported a 50% improvement in depressive symptoms after taking the current dosage for four weeks with no side effects, indicating efficacy and tolerability of the current dosage. Additionally, Furukawa et al. (2019) hold that the current dosage of an SSRI should be maintained if improvement in depressive symptoms is reported to prevent side effects, which are more common in higher dosages. Hence taking the dosage for the next four weeks would result in 100 improvements in depressive symptoms. Assessing and Treating Pediatric Patients With Anxiety Discussion

Other alternative options were rejected. First, the mental healthcare provider should not switch the client from SSRI to SNRI since the client responds well to SSRI (Zoloft 50 mg) with zero side effects. Additionally, SSRIs should be maintained since the FDA approves them as the first-line treatment for depressive symptoms in children and adolescents (Dwyer & Bloch, 2019). Additionally, Zoloft 75 mg was rejected since the risk of side effects increased with Zoloft dosage since it is dose-dependent (Furukawa et al., 2019).

By maintaining the current dosage of Zoloft 50 mg, the client was expected to achieve further improvement in depressive symptoms while tolerating the current dosage. It is anticipated that the client would report total remittance in depressive symptoms upon returning to the clinic after four weeks due to the effectiveness of a higher dosage of Zoloft in improving depressive symptoms (Furukawa et al., 2019).

Ethical principles of beneficence and nonmaleficence were considered in developing this treatment plan (Bipeta, 2019)Assessing and Treating Pediatric Patients With Anxiety Discussion. The PMHNP preferred to maintain the current dosage of Zoloft 50mg. This medication would improve depressive symptoms with no drug-related side effects since it has a history of efficacy and tolerability in this client.

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Conclusion

The client is a 13-year-old Jeanette. She reports struggling at home and in school. She further reports suffering from temper tantrums, inappropriate behavior, impulsiveness, difficulty in judgment, and sleep issues for over eight years. Three pharmacological interventions have been prescribed to improve her depressive symptoms. The first treatment decision involves administering Zoloft 25 mg. This option was preferred following the effectiveness and safety of Zoloft in treating depressive symptoms in children and adolescents. Other potential interventions, including Paxil 10 mg daily and Wellbutrin 75mg by mouth BID, were rejected due to their severe side effects. However, no improvement in symptoms was reported after taking Zoloft 25 mg for four weeks. The second treatment decision involves prescribing Zoloft 50 mg to the client. This option was selected following the ineffectiveness of Zoloft 25 mg in improving the client’s depressive symptoms. Other potential options were rejected. Zoloft 37.5 mg was dismissed since no improvement in depressive symptoms was reported after taking 25mg for four weeks, implying that Zoloft 37.5 mg would not result in the desired results since Zoloft is dose-efficacy. Additionally, Paxil was rejected due to multiple side effects.

The client reported a 50% improvement in initial symptoms after taking Zoloft 50 mg for 4weeks. The last treatment decision entails maintaining the current dosage (Zoloft 50 mg). This option was selected since the client reported a 50% improvement in depressive symptoms after taking the current dosage for four weeks with no side effects, indicating efficacy and tolerability of the current dosage. Other alternative options were rejected. First, the mental healthcare provider should not switch the client from SSRI to SNRI since the client responds well to SSRI. Additionally, Zoloft 75 mg was rejected since the risk of side effects increased with Zoloft dosage since it is dose-dependent. By maintaining the current dosage of Zoloft 50 mg, the client was expected to achieve further improvement in depressive symptoms while tolerating the current dosage. Assessing and Treating Pediatric Patients With Anxiety Discussion

References

Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. (2020). The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report. Frontiers in Psychiatry, 11, 559263. https://doi.org/10.3389/fpsyt.2020.559263

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian journal of psychological medicine, 41(2), 108-112. Doi: 10.4103/IJPSYM.IJPSYM_59_19

Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?. International Journal of Mental Health Systems, 14(1), 1-14. https://ijmhs.biomedcentral.com/articles/10.1186/s13033-020-00356-9

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatric patients. Current Psychiatry, 18(9), 26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738970/

Furukawa, T. A., Cipriani, A., Cowen, P. J., Leucht, S., Egger, M., & Salanti, G. (2019). The optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. The Lancet Psychiatry, 6(7), 601-609. https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(19)30217-2.pdf

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283. Doi: 10.9740/mhc.2018.11.275.

Tini, E., Smigielski, L., Romanos, M., Wewetzer, C., Karwautz, A., Reitzle, K., … & Walitza, S. (2022). Therapeutic drug monitoring of sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of the obsessive-compulsive disorder. Comprehensive Psychiatry, 115, 152301. https://doi.org/10.1016/j.comppsych.2022.152301

Zhang, D., Cheng, Y., Wu, K., Ma, Q., Jiang, J., & Yan, Z. (2019). Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis. BMC urology, 19(1), 1-12. https://bmcurol.biomedcentral.com/articles/10.1186/s12894-018-0431-7

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 weekâ€™s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

To prepare for this Assignment: Assessing and Treating Pediatric Patients With Anxiety Discussion
Review this weekâ€™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 patientâ€™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)Assessing and Treating Pediatric Patients With Anxiety Discussion

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)

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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. Assessing and Treating Pediatric Patients With Anxiety Discussion