Case Study Essay on An African American Child Suffering From Depression
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 (NURS 6630 WEEK 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders).
Sample Solution for Case Study: An African American Child Suffering From Depression
Introduction to the case (1 page)
The case for this assignment is an 8-year-old African American male who is accompanied by the mother to a hospital’s ER. The boy is exhibiting signs of depression, including sadness, withdrawal, decreased appetite, and occasional irritation (Mullen, 2018). In contrast, the boy had achieved developmental landmarks, while physical and laboratory examinations are unremarkable and within normal limits, respectively. Psychiatric assessment using the Children’s Depression Rating Scale obtained a score of 30, which is a significant indication of depression. According to Posznaski & Mokros (1996), a CDRS-R score of 30 and above indicates depression.(Case Study Essay on An African American Child Suffering From Depression)
In children and adolescents, depression is a leading cause of morbidity and mortality (Rao, 2013). Major depressive disorder (MDD) is the most prevalent depressive disorder in children, but it frequently goes undiagnosed and untreated due to symptom differences from those seen in adults (Mullen, 2018). Depression is said to be caused by diverse relationships with several genetic and environmental causes. However, there are instances when similar psychopharmacologic treatments are used for both adults and children. As such, caution must be taken when prescribing psychotropic medications. Equally, the question of how to assess and treat pediatric patients with mood disorders is significantly relevant.(Case Study Essay on An African American Child Suffering From Depression)
CDRS-R is a reliable and valid measure for depression in a pediatric population (Poznanski & Mokros, 1996). Similarly, Rao (2013) argues that biomarkers are critical in determining underlying mechanisms that predispose a child to depressive disorders. The biomarkers may also improve clinical phenotype classifications or distinguish between biological components with varied clinical/treatment representation (Rao, 2013). Since drug metabolism’s genetic heterogeneity regulates variations in drug clearance, half-life, and highest blood concentrations, these tests help the practitioner select a suitable antidepressant drug for a specific condition. They’re handy for detecting potential side effects and determining the best dosage (Rao, 2013).(Case Study Essay on An African American Child Suffering From Depression)
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 (NURS 6630 WEEK 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders)
Decision #1
I selected Zoloft 25 mg orally daily. Sertraline has been found in studies to be effective in treating depression in young children. (Stahl, 2020). According to Magellan Health Services (2013), Zoloft is an SSRI (selective serotonin reuptake inhibitor) that works to increase mood by maintaining serotonin balance in the brain. Additionally, Zoloft 25 mg is a lower dosage critical for the commencement of treatment since antidepressants are known to increase anxiety when first used (Stahl, 2020). Thus, a higher dosage would not be ideal for the client.(Case Study Essay on An African American Child Suffering From Depression)
Paxil was not chosen because it is classified as a class D antidepressant, thus, have a positive teratogenic effect. It is also contraindicated for children less than 18 years (Magellan Health Services, 2013). In contrast, Wellbutrin was not chosen because it is not typically recommended for children since its efficacy and effectiveness has not been established, has other risks of anorexia and seizures (Magellan Health Services, 2013).(Case Study Essay on An African American Child Suffering From Depression)
The primary goal for this medication and dosage choice was to decrease the symptoms of depression and improve the patient’s mood. Zoloft has been shown to restore the brain’s serotine balance, leading to improved mood and minimal depressive symptoms (Stahl, 2020). On the contrary, there was no change after four weeks. The probable cause could have been the initial effects of antidepressants increasing rather than reducing anxiety (Stahl, 2020). Equally, the lack of improvement could be because of the low dosage necessary to achieve immediate impact (Stahl, 2013).
Sertraline is a generic drug and is primarily used as an off-label. It is, therefore, significant to communicate with the client/representative on the lack of Food and Drug approval of the drug despite its efficacy in controlling depression through empirical evidence (Lorberg et al., 2019). As a psychiatric practitioner, it is crucial to remain truthful to the client on the overall efficacy and safety of medications. Equally, it is significant to advise the client of the mean half-life of the dosage and the significance of taking medication as prescribed to ensure consistent treatment and prevent withdrawal (Lorberg et al., 2019).(Case Study Essay on An African American Child Suffering From Depression)
Decision Point Two #1 (1 page)
I chose to titrate the oral Sertraline to 50 mg per day. According to Magellan Health Services (2013), Sertraline is suitable for treating children, and the prescription quantity can be gradually up to 200mg depending on the client’s response. The initial therapeutic dosage of 25mg might not be adequate for effective treatment and could not realize the anticipated result of decreasing the client’s depression symptoms. According to Howland (2008), a subsequent treatment strategy may be sufficient for patients who do not respond well with initial treatment.(Case Study Essay on An African American Child Suffering From Depression)
I did not choose Zoloft 37.5mg since it was relatively below the suggested therapeutic dosage. I did not select Prozac 10mg to be consistent with the current medication since there was no significant reason to change medicine. I also intended to continue the same medicines and increase their dosage until the client exhibits no signs of depression. Moreover, Prozac 10mg dosage is primarily recommended for preschoolers by the pharmaceutical products working group (PPWG) (Gleason et al., 2007).(Case Study Essay on An African American Child Suffering From Depression)
The primary goal for increasing Zoloft dosage to 50mg per day was intended to improve the patient’s brain serotonin balance (Stahl, 2020). Consequently, the expectation was that the desired outcome, i.e., reducing the client’s depression symptoms, was to be achieved since the initial dosage was insufficient. The result was expected as the client reported a 50% reduction of his depressive symptoms after four weeks under the adjusted medication. The patient also reported effective toleration of the medicines since there was no reported symptom of drugs. (Case Study Essay on An African American Child Suffering From Depression)
As a psychiatric practitioner, more awareness of a patient’s cultural attitude to treatment and the variation between the expected and actual outcome of a given dosage is vital in ensuring the patient compliant with the treatment plan (Yasuda et al., 2008). Therefore, it was significant to discuss with the client’s parent concerning the causes of depression to avoid recurrence. It is crucial to communicate to the client/representative concerning the symptoms of depression and the cause. Patient education is associated with better compliance, improvements, and social functioning among psychiatric patients.(Case Study Essay on An African American Child Suffering From Depression)
Decision Point Three #1
I chose to maintain the current dose, 50mg of oral Zoloft daily. I decided because the patient was reacting well to medication with a significant reduction of the depressive symptoms. Equally, the client’s adjustment to the current dosage implied optimal treatment and subsequent decrease of depressive symptoms without any adverse side effects (Stahl, 2020). According to Stahl (2013), a pharmacodynamics response to a prescription is the impact a drug has on particular physiologic and pathological mechanisms concerning efficacy and adverse reactions during treatment with an antidepressant.(Case Study Essay on An African American Child Suffering From Depression)
It’s best to stick with a prescription if the patient has had a good reaction to it. As a result, I passed on the other treatments because the person was reacting well to treatment and had already seen a 50% improvement in symptoms. The primary goal for my choice was to allow the patient to continue responding to medication until full recovery. As expected, the outcome increased the dosage to an optimum level with positive results on the client’s status (Stahl, 2020). After another four weeks, I anticipated a further decrease in symptoms, eventually leading to symptom remission. Therefore, there was no need to change medication.(Case Study Essay on An African American Child Suffering From Depression)
The decision was medically justified as the patient was already responding well to medication. Equally, there is no evidence further increase will result in additional advantages (Stahl, 2013; Stahl, 2020). Further, the standard safe dosage of Zoloft for depression in children is 50mg. Thus up-titrating the dosage would increase intolerance and side effects of the medication (Gordon & Melvin, 2014; Vitiello, 2012).(Case Study Essay on An African American Child Suffering From Depression)
Conclusion
Children can display off behavior as a regular part of development. However, it is crucial to watch for significant signs such as withdrawal and irritability. Depress children are often irritable and do not get along with their peers, and feel rejected. These are bridge symptoms serving as risk factors for depressive disorders (Mullen, 2018). For instance, in this case, the child exhibited signs of depression, including sadness, withdrawal, decreased appetite, and occasional irritation despite achieving typical development landmarks.(Case Study Essay on An African American Child Suffering From Depression)
In this case, the Children’s Depression Rating Scale was used to prove valid and reliable. The resulting score of 30 gave a clear indication that the child had depression and thus needed medication to lower the symptoms (Posznaski & Mokros, 1996). Consequently, a dosage of Zoloft 25mg oral was initially prescribed and later increased to 50mg leading to a significant reduction in depressive symptoms. The decision to increase the dosage was recommended because when a patient does not respond to an initial dosage, an increase in the dosage is necessary (Howland, 2008). Further, I decided to maintain the dosage since the child had positive toleration and a significant reduction of symptoms exemplified with zero side effects.(Case Study Essay on An African American Child Suffering From Depression)
Moreover, I was responsible for upholding clinical ethics and responsibility, educating the parent on the chosen medication, expected outcomes, and possible side effects. This was crucial in creating rapport and earning the trust of the clients. Equally, a positive connection ensured that the child’s mother complied with the medication, further improving the child’s condition (Lorberg et al., 2019). The monthly monitoring allowed me to determine the subsequent course of action in terms of the most effective dosage/medication for the child’s condition. As a result, the chosen medication, ethical consideration, and monthly monitoring proved significant in the medical plant’s effectiveness. (Case Study Essay on An African American Child Suffering From Depression)
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 (NURS 6630 WEEK 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders)(Case Study Essay on An African American Child Suffering From Depression)
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Gleason, M. M., Egger, H. L., Emslie, G. J., Greenhill, L. L., Kowatch, R. A., Lieberman, A. F., … & Zeanah, C. H. (2007). Psychopharmacological treatment for very young children: contexts and guidelines. Journal of the American Academy of Child & Adolescent Psychiatry, 46(12), 1532-1572.
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal?. Journal of pediatrics and child health, 50(11), 847-854. https://doi.org/10.1111/jpc.12655
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf
Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283. https://doi.org/10.9740/mhc.2018.11.275
Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171
Stahl, S. M. (2020). Prescriber’s Guide: Stahl’s Essential psychopharmacology. Cambridge University Press.
Stahl, S. M., & Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
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 (NURS 6630 WEEK 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders)
Stallwood, E., Monsour, A., Rodrigues, C., Monga, S., Terwee, C., Offringa, M., & Butcher, N. J. (2020). Systematic Review: The Measurement Properties of the Children’s Depression Rating Scale-Revised in Adolescents With Major Depressive Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2020.10.009
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. IACAPAP e-textbook of child and adolescent mental health. Geneva, Switzerland: International Association for Child and Adolescent Psychiatry and Allied Professions.
Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
Case Study: An African American Child Suffering From Depression Instructions
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.(Case Study Essay on An African American Child Suffering From Depression)
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.(Case Study Essay on An African American Child Suffering From Depression)
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.(Case Study Essay on An African American Child Suffering From Depression)
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.(Case Study Essay on An African American Child Suffering From Depression)
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?(Case Study Essay on An African American Child Suffering From Depression)
- 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).(Case Study Essay on An African American Child Suffering From Depression)
- 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.(Case Study Essay on An African American Child Suffering From Depression)
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.(Case Study Essay on An African American Child Suffering From Depression)
- 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).(Case Study Essay on An African American Child Suffering From Depression)
- 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.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Case study link
Therapy for Pediatric Clients with Mood Disorders – Case Study: An African American Child Suffering From Depression
Decision #1
Which decision did you select?
Begin Zoloft 25 mg orally daily.
Why did you select this decision?
Zoloft is a selective serotonin reuptake inhibitor (SSRI) that functions by restoring serotonin balance in the brain to improve mood, particularly the client’s depression. Besides that, it is highly effective in treating mood disorders and depression among children. In addition, starting at the lower dose of 25 mg since antidepressants tend to increase anxiety when first used Stahl, 2014) Case Study: An African American Child Suffering From Depression.(Case Study Essay on An African American Child Suffering From Depression)
What were you hoping to achieve by making this decision?
The prescribed medication was intended to improve the client’s mood and address the depression by restoring the serotonin balance in the brain (Stahl, 2014).
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
The prescription and its dosage was intended to improve the client’s mood and address the depression (Stahl, 2014). But, this objective was not achieved. Instead, the client returned to the clinic after four weeks reporting that she had not experienced any changes to her depressive symptoms. The lack of response is likely the result of the low medication dosage with a higher dose anticipated to further improve the serotonin balance in the brain to alleviate the depressive symptoms (Stahl, 2013). Case Study: An African American Child Suffering From Depression(Case Study Essay on An African American Child Suffering From Depression)
Decision #2
Increase Zoloft dose to 50 mg orally daily.
Why did you select this decision?
The dosage was increased since the initial dose did not achieve the desired outcome of reducing the depressive symptoms. The increased dose is anticipated to further improve serotonin balance in the brain thereby reducing the depressive symptoms (Stahl, 2014).(Case Study Essay on An African American Child Suffering From Depression)
What were you hoping to achieve by making this decision?
The decision to increase the prescribed medication dose was intended to reduce the client’s depressive symptoms by improving serotonin balance in the brain (Stahl, 2014).
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
The expected result from increasing the dosage to 50 mg was to reduce the depressive symptoms. This was achieved since the client visited the clinic four weeks later with the depressive symptoms reduced by 50% and the client reporting that he was tolerating well (Stahl, 2014).(Case Study Essay on An African American Child Suffering From Depression)
Decision #3
Maintain the current dose of Zoloft at 50 mg orally daily.
Why did you select this decision?
The decision to maintain the current dose was made for two reasons. Firstly, the client was responding well to the current dosage with clear symptoms reduction. Secondly, the client had adjusted well to the current dosage to imply that it was an optimum dosage for reducing the symptoms without presenting adverse effects (Stahl, 2014).
What were you hoping to achieve by making this decision?
The decision to maintain the current dosage was made with the intention of building on the current positive results. The dosage is already working in relieving the depressive symptoms, and maintaining it is expected to continue the current trend of relieving the symptoms (Stahl, 2014) Case Study: An African American Child Suffering From Depression.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
It was expected that additional symptom reduction would be reported beyond the current 50%. But this was not the case with no further reduction in symptoms reported after four weeks. Given that the 50% reduction in symptoms was not in full remission, the client was responding to the medication so a change in drugs was not warranted, then the next step would be to recommend the use of psychotherapy as an additive therapy to complement the prescription medication. This decision is informed by ethical justifications that the client is already responding to medication whose dosage cannot be increased so psychotherapy is recommended as a complement that would provide additional benefits (Stahl, 2013; Stahl, 2014). Besides that, the standard safe Zoloft dose for children is 50 mg daily for mood disorders and depression. Increasing the dose beyond 50 mg daily is likely to reduce the symptoms further but also result in client intolerance and adverse side effects that include suicide tendencies (Gordon & Melvin, 2014; Magellan Health, Inc., 2013; Vitiello, 2012).
References
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847-854. doi:10.1111/jpc.12655 Case Study: An African American Child Suffering From Depression
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: a clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-textbook of child and adolescent mental health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf Case Study: An African American Child Suffering From Depression
Required Readings
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.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06
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/content/uploads/A.7-Psychopharmacology-2019.1.pdf
Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171
Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
IBM Corporation. (2020). IBM Micromedex.
Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.
Review the following medications:
| amitriptylinebupropioncitalopramclomipraminedesipraminedesvenlafaxinedoxepinduloxetineescitalopramfluoxetinefluvoxamine | imipramineketaminemirtazapinenortriptylineparoxetineselegilinesertralinetrazodonevenlafaxinevilazodonevortioxetine |
https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html
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