Assessing and Treating Pediatric Clients with Mood Disorders.

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.

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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. 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? 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.

Assessing and Treating Pediatric Clients with Mood Disorders

Introduction

The case study in this assignment involves an 8-year-old boy who was diagnosed with depression. The client exhibited symptoms like blunt affect, sadness, decreased appetite, withdrawal from her peers, irritability, thinking about death, in addition to a score of 30 for the depression rating scale. The assignment discusses three decisions about the client’s treatment choices and the ethical considerations likely to affect his treatment plan.

Decision Point One

The first decision is for the client to begin Zoloft 25 mg orally. The medication was chosen because even though it is an “off-label” in the treatment of depression in children, the medication has shown efficacy in treating depression and it is also safe and well-tolerated in the pediatric population (Locher et al, 2017). The medication is an SSRI and thus increases the amount of serotonin in the brain. An increased amount of serotonin in the brain improves mood and other depressive symptoms (Locher et al, 2017). Paxil 10 mg and Wellbutrin were not selected because the medications are not indicated for the pediatric population. Additionally, the medications are associated with numerous side effects such as nausea, sleep problems, loss of appetite, drowsiness, dizziness, among other symptoms (Locher et al, 2017).

Selection of Zoloft expected that the client would manifest symptom improvement as indicated by improved mood, reduced irritability, improved appetite, and socializing with his peers. This is because the efficacy of Zoloft in the treatment of depressive symptoms has been shown (Jakubovski et al., 2016). It is also expected that the client would experience minimal side effects because the medication is well tolerated in the pediatric population.

However, the client did not show any symptom improvement. This is attributable to the initial low dose and hence low efficacy. The efficacy of antidepressants like Zoloft manifests a dose-response relationship (Hieronymus et al., 2016).

Decision Point Two

The second decision is to increase the dose to 50 mg. The decision was chosen because the response of SSRIs like Zoloft is dose-dependent and thus increased is expected to be more effective (Hieronymus et al, 2016).

Changing to Paxil was not chosen because of the side effects allied to the drug in the pediatric population. The decision of increasing Zoloft to 37.5 mg was not chosen since the initial dose of Zoloft should be 25 mg and then titrated to 50 mg after seven days (Santarsieri& Thomas, 2015).

The decision to increase the dose to 50 mg hoped that the client would start manifesting symptom improvement. According to Hieronymus et al (2016), the efficacy of Zoloft is dose-dependent, and thus increases the dose is expected to have increased efficacy. It is also expected that the client would tolerate the dose increment.

As was expected, the client manifested 50% symptom reduction and he tolerated the increased dose. The symptom improvement is attributable to the increased efficacy due to the upward titration of Zoloft (Hieronymus et al, 2016).

Decision Point Three

The third decision is to maintain the current dose. This is because the client is already manifested adequate symptom improvement and therefore it is important to consider the likely side effects and the response to treatment (Carvalho et al, 2016).

Changing to SNRI was not chosen since the client is already manifesting adequate symptom improvement with the Zoloft. The decision to have the dose increased to 75 mg was not chosen due to the potential side effects associated with higher doses (Carvalho et al, 2016).

Maintaining the current dose hopes that the client would achieve complete symptom remission and tolerate the dose.

Ethical Considerations

The ethical issues relevant during the treatment of this client encompass informed consent, autonomy, and confidentiality. The client is a minor and thus he cannot make autonomous decisions about his treatment. The parents will make the client’s treatment decisions and also, they will give informed consent. The PMHNP should also ensure that the confidentiality and privacy of the client’s information are maintained (Hiriscau et al, 2016).

Conclusion

The initial decision is for the client to start Zoloft 25 mg orally because the medication’s efficacy and safety in the treatment of depression among the pediatric population have been established. The client did not manifest any symptom improvement and thus the second decision is to increase the dose to 50 mg since the efficacy of SSRIs like Zoloft is dose-dependent. With the increased dose, the client manifested 50% symptom reduction and thus last decision is to maintain the dose. Ethical aspects relevant during the treatment of this client encompass confidentiality, informed consent, and autonomy.