Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
Introduction
In this paper, strong emphasis is placed on developing an evidence-based patient medication guide for treatment of depressive disorders in adolescents, a vulnerable population. Some of the key areas covered in this patient guide include an overview of the causes and symptoms of depressive disorders; diagnosis of depression; why the selected group is considered vulnerable; and medical treatment options including risks vs. benefits, side effects, FDA approvals for the identified vulnerable population. Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
Depressive Disorders in Adolescents
With a prevalence of 3-9%, depressive disorders are common in adolescents and are characterized by a range of symptoms and signs (including severe irritability or sadness, low mood, self-loathing and pervasive feelings of worthlessness) that could have numerous impairments in academic, social and family functioning of the affected person (Painter & Scannapieco, 2021a). Some of the most common types of depressive disorders reported amongst the selected population include major depressive disorder, disruptive mood dysregulation disorder and persistent depressive disorder (dysthymia) (Kaser & Sahakian, 2019). The table below highlights some of the basic manifestations as well as the main causes of depressive disorders in the selected vulnerable population as indicated in Diagnostic and Statistical Manual, fifth revision (DSM-5) and other prevailing nosological systems.
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| Depressive Disorders | Signs and Symptoms | Causes and risk factors |
| 1. Disruptive Mood Dysregulation Disorder (DMDD) | For diagnosis, the following symptoms must be present for 12 months and more: Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
· Persistent and intense irritability · Maladaptive behaviors (severe and recurrent temper outbursts in at least 2 to 3 settings (at school, at home, with peers) · Adolescents with this condition have traits such as moodiness, anxiousness, difficult behavior and irritability.
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ü DMDD develops from a combination of genetic, biological and environmental factors.
ü Being of school-age ü Gender; being male ü Trauma in early childhood (sexual, physical or emotional abuse) ü Low parental support ü Disciplinary problems at school ü Family conflicts ü Parental hostility and substance abuse |
| 2. Major Depressive Disorder | · Discrete depressive episode lasting more than 2 weeks
· irritability and sadness · weight loss · Fatigue or loss of energy · Hypersomnia or insomnia · Suicidal plans or ideation · Reduced ability to concentrate, think and make choices · Psychomotor retardation or agitation observed by others · The criterion symptoms for MDD must be present for most of the day, nearly every day and must led to substantial functional impairment or distress. |
ü A combination of environmental, temperamental, genetic and psychological factors
ü Lower socioeconomic status ü Poor academic performance ü Lower social support/family environment ü Past and/or Family history of depression ü Social stress ü Negative health behaviors (e.g. alcohol drinking, smoking, poor medication compliance, obesity) ü Individual risk factors (e.g. personality, psychiatric comorbidity, gender. |
| 3. Persistent Depressive Disorder (PDD) | For diagnosis, at least two of the following must be present most of the day, more days than not:
ü Feelings of hopelessness ü Fatigue or low energy ü Poor appetite or overeating ü Low self-esteem ü Insomnia or hypersomnia ü Reduced concentration ü Sleep problems ü Feeling of guild ü Loss of interest in daily activities ü PDD may be characterized by significant functional impairment over an extended period. |
ü Stressful or traumatic life events
ü Personality traits that include low self-esteem, negativity, being too self-critical or dependent) ü Changes in brain chemistry ü Heritability (having a first-degree blood relative with this condition may heighten the risk)
ü History of other mental health conditions e.g. personality disorder
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| Table showing types of depressive disorders (Grover & Avasthi, 2019; Kaser & Sahakian, 2019; Abouzed, 2018) Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment | ||
Assessment of Depressive Disorders in Adolescents
The assessment of depression in adolescents entails the establishment of an accurate diagnosis; evaluation of comorbid conditions; consideration of all the potential differential diagnoses; analysis of psychosocial concerns behind the depression (Grover & Avasthi, 2019). The assessment process also entails development of supportive and favorable therapeutic relationship with adolescents and their families and in the pursuit of shared decision-making about treatment plans, patient’s safety, among others (Painter & Scannapieco, 2021b). In reference to the DSM-5, the diagnostic criteria for depressive disorders requires that a set of signs and symptoms must be present and they include sad or irritable mood accompanied by cognitive, somatic and behavioral changes that have detrimental effect on the individual’s ability to cope and function due to significant distress and/or functional impairment (Abouzed, 2018). In terms of the evaluation structure, conducting a diagnostic interview for depressive disorders includes the patient and the guardian/parent, either together or separately or both, as clinically and developmentally outlined. Applying age-appropriate assessment methods and techniques is integral to collecting relevant diagnostic information. Tailored family assessments may also provide vital information on parenting behaviors and styles, as well as environmental precipitants of depressive episodes (Patel & Rose, 2022). Other collateral sources (e.g. symptom rating scales, interviews, records, interviews with teachers, family members, agency workers, and behavioral health clinicians) can provide useful information to inform an accurate diagnostic evaluation (Harrison, 2019).
Table 2: Assessment and evaluation of Depression in Adolescents (Grover & Avasthi, 2019) Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
Why the Selected Group Is Considered Vulnerable
This age group is considered a highly vulnerable population due to the growing prevalence of depression among adolescents. According to data from the National Comorbidity Study, there is a 11.7% lifetime prevalence for MDD and PDD. Equally, adolescents represent a distinctive developmental stage, and hence the biological, cognitive, physiological and psychological changes witnessed during this period may heighten the risk of depression among adolescents (Grover & Avasthi, 2019). Painter and Scannapieco (2021a) established that Depressive disorders may be associated with numerous impairments and complications that could be detrimental effects on the personal, social, professional, educational and family life of the affected individual. Some of the complications associated with adolescent depression as identified in the reviewed literature include: increased risk of developing anxiety disorders, major depression and other mood disorders; reduced quality of life; impaired academic and occupational functioning; substance misuse; personality disorders or other mental health conditions; continuing pain and general medical illnesses; problematic interpersonal relationships; maladaptive tendencies including suicidal behaviors and thoughts, among others (Korczak et al., 2023; Patel & Rose, 2022). Therefore, depressive disorders have significant implications for the affected young individuals and their families, communities and the society at large.
Treatments for Depressive Disorders in Adolescents
SSRIs are considered beneficial since they can significantly relieve the symptoms and complications of severe depression amidst long-term risks such as reduced libido, blood clots, insomnia, weight gain, suicidal thoughts or behavior, addiction and increased risk of internal bleeding (Painter & Scannapieco, 2021b). Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
| Drug | Formulations | Daily dose range | FDA Approved | Side effects | Notes | |||
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Paroxetine (Paxil) | Tablet: 10/20/30/40 mg
Tablet CR: 12.5/25/37.5 mg Suspension: 10 mg/5 m |
10–50 mg | -Headaches
-Agitation -Activation -Irritability -Gastrointestinal symptoms (diarrhea, stomachaches, nausea, -Sexual side effects
|
SSRI highly linked with drug interactions | |||
| Fluoxetine (Prozac) | Tablet and capsule: 10/20/40/60 mg
Suspension: 20 mg/5 ml |
20–60 mg
(initial dose may be 10 mg) |
FDA approved for children age 12 and up | |||||
| Sertraline (Zoloft) | Tablet: 25/50/100 mg
Suspension: 20 mg/ml |
50–200 mg
(initial dose may be 12.5–25 mg) |
Second-Line | |||||
| Fluvoxamine (Luvox) | Tablet: 25/50/100 mg | 50–200 mg
(initial dose may be 25 mg) |
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| Escitalopram (Lexapro) | Tablet: 5/10/20 mg
Suspension: 1 mg/1 ml |
10–20 mg
(initial dose may be 2.5–5 mg) |
FDA-approved for children age 8 sand up | Second-Line | ||||
| Non-SSRI antidepressants | Bupropion XL (Wellbutrin)
|
Tablet: 75/100 mg
Tablet ER 12 hour: 100/150/200 mg |
150–300 mg
(first dose may be 37.5–75 mg) |
-dry mouth
-Drowsiness -Anxiety -Dizziness -Nausea -Excitement -Sleep problems
|
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| Duloxetine (Cymbalta) | Tablet: 20/30/40/60 mg | 40–60 mg
(first dose may be 20 mg) |
-blurred vision
-Diarrhea -Dry mouth – Constipation -Headaches -Sweating and hot flushes -nausea Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
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| Venlafaxine XR (Effexor) | Tablet: 25/37.5/50/75/100 mg
Capsule and Tablet ER 24 hour: 37.5/75/150/225 mg |
150–300 mg
(first dose may be 37.5 mg) |
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| Levomilnacipran (Fetzima) | Capsule ER 24 hour: 20/40/80/120 mg | 40–120 mg (first dose may be 20 mg) | ||||||
| Vortioxetine (Trintellix) | Tablet: 5/10/20 mg | 20 mg (first dose may be 10 mg) | ||||||
| Desvenlafaxine (Pristiq) | Tablet ER 24 hour: 25/50/100 mg | 50–100 mg
(first dose may be 25–50 mg) |
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| Trazodone (Desyrel) | Tablet: 50/100/150/300 mg | 100–150 mg
(first dose may be 25–50 mg) |
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| Pharmacological treatments (Korczak et al., 2023; Patel & Rose, 2022; Grover & Avasthi, 2019) | ||||||||
In relation to special considerations, the adoption of a multimodal approach can ensure the unique ethical factors, legal factors, cultural factors and social determinants of health are taken into consideration. In line with the National Mental Health Act, mental health practitioners must assume a set of legal and ethical responsibilities in order to uphold the rights of patients with mental illness. Some of the legal considerations are related to instances where a competent psychiatrist is requested to appear in court an expert witness; outcomes of insanity pleas; dealing with absconding behaviors in mental health patients; and access to disability benefits of persons with mental disorders (Bipeta, 2019). In relation to the ethical considerations, a myriad of ethical issues must be given ultimate consideration and they include: the need for upholding patient confidentiality and disclosure of information and data about the patient and his/her medical condition; the use of an explicit written informed consent to guide the sharing of patient’s medical records; and the lack of adequate information on psychiatric patients due to concerns by the various practitioners to protect data privacy (Korczak et al., 2023). It is also highly imperative for healthcare professionals and other parties involved in the management and treatment of adolescents with depressive disorders to uphold the ethical principles of beneficence, non-maleficence, accountability and transparency as the basis for ensuring improved patient care outcomes and health outcomes. Routine follow-up at the community mental healthcare center should be initiated in the event the patient fails to respond to the initial SSRI trial. Arranged visits during the continuation and maintenance phases may also help to determine effectiveness of the pharmacological treatments as well as an analysis of the risks and benefits. Follow-up (every 2-4 months) is also highly recommended during the discontinuation phase in order to alleviate the withdrawal symptoms, reduce the risk of relapse and recurrence and reinstitute effective treatment (Grover & Avasthi, 2019). Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
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Conclusion
This patient guide offers important insights into the assessment and treatment of depressive disorders in adults. The development and implementation of a patient-centered treatment plan is a first step toward achieving an accurate diagnosis and prescription correct pharmacological treatments to alleviate symptoms and complications of depressive disorders in adolescents. As a highly vulnerable group, adolescents are increasingly affected by depressive disorders and hence the greater need for evidence-based treatment options to cater for the distinct issues and needs of this patient population.
References
Abouzed, M. (2018). Disruptive mood dysregulation disorder in offspring of parents with ADHD. https://doi.org/10.26226/morressier.5a7070e2d462b80290b569bd
Bipeta, R. (2019).Legal and Ethical Aspects of Mental Health Care. Indian Journal of Psychological Medicine, 41(2): 108–112.doi: www.10.4103/IJPSYM.IJPSYM_59_19
Grover, S., & Avasthi, A. (2019). Clinical practice guidelines for the management of depression in children and adolescents. Indian Journal of Psychiatry, 61(8), 226. https://doi.org/10.4103/psychiatry.indianjpsychiatry_563_18
Harrison, J. E. (2019). The assessment of cognitive dysfunction in major depressive disorder. Cognitive Dimensions of Major Depressive Disorder, 59-72. https://doi.org/10.1093/med/9780198810940.003.0006
Kaser, M., & Sahakian, B. J. (2019). Major depressive disorder as a disorder of cognition. Cognitive Dimensions of Major Depressive Disorder, 23-34. https://doi.org/10.1093/med/9780198810940.003.0003
Korczak, D. J., Westwell-Roper, C., & Sassi, R. (2023). Diagnosis and management of depression in adolescents. Canadian Medical Association Journal, 195(21), E739-E746. https://doi.org/10.1503/cmaj.220966
Painter, K., & Scannapieco, M. (2021a). Depressive disorders. Understanding the Mental Health Problems of Children and Adolescents, 64-88. https://doi.org/10.1093/oso/9780190927844.003.0005
Painter, K., & Scannapieco, M. (2021b). Treatment of depressive disorders. Understanding the Mental Health Problems of Children and Adolescents, 89-100. https://doi.org/10.1093/oso/9780190927844.003.0006
Patel, R.K., & Rose, G.M. (2022). Persistent Depressive Disorder. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541052/ Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources. Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
In your patient guide, include discussion on the following:
Depressive disorder causes and symptoms
How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
Reading materials for this assignment plus any other.
Medication considerations of medication examples prescribed (see last bullet item)
What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
Where to follow up in your local community for further information
Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
Chapter 6, “Mood Disorders and the Neurotransmitter Networks Norepinephrine and y-Aminobutyric Acid (GABA)” (pp. 244-282)
Chapter 7, “Treatments for Mood Disorders: So-Called “Antidepressants†and “Mood Stabilizers†(pp. 283-338)
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health ServicesLinks to an external site., 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06
Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health ServicesLinks to an external site., 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05 Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
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 healthLinks to an external site.. https://iacapap.org/_Resources/Persistent/45bdffb25befc353c9f61988e82105029504ab85/A.7-Psychopharmacology-2019.1.pdf
Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monographLinks to an external site.. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—RevisedLinks to an external site.. Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & AnxietyLinks to an external site., 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 & TherapeuticsLinks to an external site., 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf Assessing and Treating Vulnerable Populations for Depressive Disorders Assignment
