Generalized Anxiety Disorder
Please complete this assignment Generalized Anxiety
PRESCRIBING FOR CHILDREN AND ADOLESCENTS
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.(Generalized Anxiety Disorder Comprehensive Essay Example)
—Agency for Healthcare Research and Quality
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?(Generalized Anxiety Disorder Comprehensive Essay Example)
For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know.https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlLinks to an external site.
RESOURCES
Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources.
TO PREPARE
· Your Instructor will assign a specific disorder for you to research for this Assignment.
· Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.(Generalized Anxiety Disorder Comprehensive Essay Example)
THE ASSIGNMENT (1–2 PAGES)
· Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
· Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
· Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.(Generalized Anxiety Disorder Comprehensive Essay Example)
· Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
BY DAY 7 OF WEEK 3
Submit your Assignment.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
1. To submit your completed assignment, save your Assignment as WK3Assgn1+last name+first initial.
2. Then, click on Start Assignment near the top of the page.(Generalized Anxiety Disorder Comprehensive Essay Example)
3. Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6665_Week3_Assignment1_Rubric
NRNP_6665_Week3_Assignment1_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeIn 1–2 pages, address the following: • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.(Generalized Anxiety Disorder Comprehensive Essay Example)
25 to >22.0 pts
Excellent
The response accurately and concisely explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents.(Generalized Anxiety Disorder Comprehensive Essay Example)
22 to >19.0 pts
Good
The response accurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents.
19 to >17.0 pts
Fair
The response somewhat vaguely or inaccurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents.
17 to >0 pts
Poor
The response vaguely or inaccurately explains interventions that would be appropriate for treating the assigned disorder in children and adolescents. Interventions may not represent the three types of interventions required, or response may be missing.(Generalized Anxiety Disorder Comprehensive Essay Example)
25 pts
This criterion is linked to a Learning Outcome• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
25 to >22.0 pts
Excellent
The response accurately and concisely explains the risk assessment you would use to inform your treatment decision making. A concise and accurate explanation of the risks and benefits of each pharmacological intervention is provided.(Generalized Anxiety Disorder Comprehensive Essay Example)
22 to >19.0 pts
Good
The response accurately explains the risk assessment you would use to inform your treatment decision making. An adequate explanation of the risks and benefits of each pharmacological intervention is provided.
19 to >17.0 pts
Fair
The response somewhat vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The explanation of the risks and benefits of each pharmacological intervention is somewhat vague or inaccurate.(Generalized Anxiety Disorder Comprehensive Essay Example)
17 to >0 pts
Poor
The response vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The risks and benefits of each pharmacological intervention is vague or inaccurate. Or, the response is missing.
25 pts
This criterion is linked to a Learning Outcome• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
25 to >22.0 pts
Excellent
The response accurately and concisely uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations.(Generalized Anxiety Disorder Comprehensive Essay Example)
22 to >19.0 pts
Good
The response accurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations.
19 to >17.0 pts
Fair
The response somewhat vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations.(Generalized Anxiety Disorder Comprehensive Essay Example)
17 to >0 pts
Poor
The response vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. Or, the response is missing.
25 pts
This criterion is linked to a Learning Outcome• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Be sure they are current (no more than 5 years old). Attach the PDFs of your sources.
10 to >8.0 pts
Excellent
The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. The resources reflect the latest clinical guidelines and provide strong justification for decision making.(Generalized Anxiety Disorder Comprehensive Essay Example)
8 to >7.0 pts
Good
The response provides at least three current, evidence-based resources from the literature to support the intervention recommendations.
7 to >6.0 pts
Fair
Three evidence-based resources are provided to support the intervention recommendations, but they may only provide vague or weak justification.(Generalized Anxiety Disorder Comprehensive Essay Example)
6 to >0 pts
Poor
Two or fewer resources are provided to support the intervention recommendations. The resources may not be current or evidence based.
10 pts
This criterion is linked to a Learning OutcomeWritten 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.
5 to >4.0 pts
Excellent
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.(Generalized Anxiety Disorder Comprehensive Essay Example)
4 to >3.5 pts
Good
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 are brief and not descriptive.(Generalized Anxiety Disorder Comprehensive Essay Example)
3.5 to >3.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.
3 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided.(Generalized Anxiety Disorder Comprehensive Essay Example)
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4 to >3.5 pts
Good
Contains one or two grammar, spelling, and punctuation errors
3.5 to >3.0 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors
3 to >0 pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list.
5 to >4.0 pts
Excellent
Uses correct APA format with no errors
4 to >3.5 pts
Good
Contains one or two APA format errors
3.5 to >3.0 pts
Fair
Contains several (three or four) APA format errors
3 to >0 pts
Poor
Contains many (five or more) APA format errors
5 pts
Total Points: 100
Generalized Anxiety Disorder Comprehensive Essay Example
Generalized anxiety disorder (GAD) is marked by excessive worry and anxiety about activities or events that individuals cannot control. As a result, individuals experience symptoms such as irritability, fatigue, restlessness, inability to concentrate, sleeplessness, or muscle tension (American Psychiatric Association [APA], 2019). These symptoms present within six months or more, leading to significant distress or impaired social, academic, and other crucial areas of functioning. This assignment discusses the FDA-approved, off-label, and nonpharmacological treatment of GAD in children and adolescents. Moreover, the discussion justifies the choice of FDA-approved, off-label, and nonpharmacological intervention based on available clinical practice guidelines.(Generalized Anxiety Disorder Comprehensive Essay Example)
Duloxetine is the FDA-approved drug for GAD. Duloxetine is an antidepressant approved for GAD in children and adolescents. The approval was based on a randomized controlled trial involving youth and children between 7 and 17 diagnosed with GAD. The study established that Duloxetine improves GAD symptoms per the Paediatric Anxiety Rating Scale and a 50% reduction in the severity of GAD and high remission (Strawn et al., 2015). Moreover, Duloxetine for children and adolescents has a high safety profile (Strawn et al., 2018). An off-label drug for GAD in the pediatric population is Escitalopram. Escitalopram effectively reduces anxiety symptoms among children aged 12 to 17 (Strawn et al., 2020). Escitalopram is indicated for major depressive disorder and has been effectively used for GAD.(Generalized Anxiety Disorder Comprehensive Essay Example)
One nonpharmacological intervention for GAD in the pediatric population is cognitive behavioral therapy (CBT). CBT has been widely studied in children and adolescents across various mental health disorders with positive results (James et al., 2020). A meta-analysis examining the effects of CBT on anxiety disorders in youths established that the intervention is an effective treatment for anxiety disorders in children and adolescents (Yin et al., 2021). The study stressed the roles of psychologists and parents in the CBT treatment for the pediatric population, with parent-driven CBT being effective in treating the condition (Yin et al., 2021).
A risk assessment for a child and adolescent diagnosed with GAD involves evaluating potential risks associated with the drug and its benefits. The benefits of Duloxetine as a medication for GAD include reduced anxiety symptoms, improved functioning, lowered relapse rates, and fewer side effects (Strawn et al., 2018; Strawn et al., 2015). These benefits are associated with the impact of Duloxetine on increasing serotonin and norepinephrine levels, which regulates mood and reduce anxiety symptoms, and improves the quality of life and a child’s or adolescent’s ability to function in their daily life.(Generalized Anxiety Disorder Comprehensive Essay Example)
The risks associated with Duloxetine include weight, systolic blood pressure, and loss increased heart rate (Strawn et al., 2018). Duloxetine is also associated with hepatic failure and should be discontinued when related symptoms are noted (Walter et al., 2021). On the other hand, the benefits of Escitalopram include reduced anxiety symptoms, improved functioning, and high tolerability (Strawn et al., 2020). However, Escitalopram is also associated with activation syndrome, which can increase anxiety and cause restlessness and insomnia during the early course of treatment (Lu Lu et al., 2021).(Generalized Anxiety Disorder Comprehensive Essay Example)
There are various clinical practice guidelines for assessing and managing anxiety disorders. Walter et al. (2020) provide a clinical guideline for evaluating and treating GAD in children and adolescents based on the AACAP Clinical Practice Guidelines, whose recommendations are founded on critically assessed and synthesized scientific and clinical information. The guideline recommends independent and combined pharmacological and nonpharmacological interventions for anxiety disorders for the pediatric population aged 3 to 18. Selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) are recommended medications and cognitive behavioral therapy psychotherapy. Duloxetine (SNRI) and Escitalopram (SSRI) are recommended for treating anxiety disorders. Moreover, CBT has crucial empirical evidence for treating anxiety in the pediatric population.(Generalized Anxiety Disorder Comprehensive Essay Example)
References
American Psychiatric Association (APA). (2019). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing(Generalized Anxiety Disorder Comprehensive Essay Example)
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioral therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD013162.pub2
Lu, L., Mills, J. A., Li, H., Schroeder, H. K., Mossman, S. A., Varney, S. T., … & Strawn, J. R. (2021). Acute neurofunctional effects of Escitalopram in pediatric anxiety: a double-blind, placebo-controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 60(10), 1309-1318. https://doi.org/10.1016/j.jaac.2020.11.023(Generalized Anxiety Disorder Comprehensive Essay Example)
Pegg, S., Hill, K., Argiros, A., Olatunji, B. O., & Kujawa, A. (2022). Cognitive Behavioral Therapy for Anxiety Disorders in Youth: Efficacy, Moderators, and New Advances in Predicting Outcomes. Current Psychiatry Reports, 1-7. https://doi.org/10.1007%2Fs11920-022-01384-7
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070. https://doi.org/10.1080%2F14656566.2018.1491966(Generalized Anxiety Disorder Comprehensive Essay Example)
Strawn, J. R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., … & DelBello, M. P. (2020). Escitalopram in adolescents with generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. The Journal of Clinical Psychiatry, 81(5), 6584. https://doi.org/10.4088%2FJCP.20m13396
Strawn, J. R., Prakash, A., Zhang, Q., Pangallo, B. A., Stroud, C. E., Cai, N., & Findling, R. L. (2015). A randomized, placebo-controlled study of Duloxetine for treating children and adolescents with generalized anxiety disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(4), 283-293. https://doi.org/10.1016/j.jaac.2015.01.008(Generalized Anxiety Disorder Comprehensive Essay Example)
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for assessing and treating children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107-1124. https://doi.org/10.1016/j.jaac.2020.05.005(Generalized Anxiety Disorder Comprehensive Essay Example)
Yin, B., Teng, T., Tong, L., Li, X., Fan, L., Zhou, X., & Xie, P. (2021). Efficacy and acceptability of parent-only group cognitive behavioral intervention for treating anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. BMC Psychiatry, 21, 1-12. https://doi.org/10.1016/j.jaac.2020.05.005(Generalized Anxiety Disorder Comprehensive Essay Example)
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