Ethical Issues in Child and Adolescent Psychiatry Discussion

Week 4 Assignment

Major depressive disorder is among the most prevalent psychiatric disorder in adolescence that affects emotional, physical and social development and is often unrecognized and untreated. It often results in reduced school performance, interpersonal difficulties in life, increases the risk of substance use disorder or other mental disorders, and early parenthood (Wartberg et al., 2018). According to WHO, the disease is the leading cause of disability among adolescents aged 10 to 19 years.

According to Mullen (2018), the causes of MDD are multifactorial and complex as a result of interactions between environmental factors and biological vulnerabilities, which include; Ethical Issues in Child and Adolescent Psychiatry Discussion

Psychosocial risk factors

Stressful life occurrences are the onset and recurrence of depressive episodes and symptoms in adolescents, especially in the female gender. Stressful situations in this age group include; romantic break-ups, maltreatment, events involving loss, parent-child conflicts, and being bullied by peers.

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Genes and Heritability

Research has stated that genetic predisposition is a major risk factor for mental health problems between 13 and 35 years old. According to Wartberg et al., 2018, children of a depressed parent have a higher likelihood of 2 to 4 times compared with offspring of non-depressed parents. The environmental-gene interaction is responsible for the risk, particularly by increasing susceptibility to environmental stress. Several clinical studies also suggest that the serotonin transporter gene variant might increase the risk of depression in the presence of early maltreatment or adverse life events.

Cognitive risk factors

Clinical studies have found a mutual relationship between depression and adolescents’ low perceived competence. The majority of depressed adolescents have memory and attentional bias. They recall fewer positive words and more negative words than their non-depressed counterparts. Reflection and dwelling excessively also predict the onset and continuation of depression.

Other associated factors include;

• Mental illnesses include PTSD, anxiety disorder, and OCD.
• Comorbid medical illnesses such as multiple sclerosis, diabetes, and epilepsy are also associated with MDD.
• Substance use, such as marijuana and alcohol.
• Medications such as propranolol, corticosteroids, implanted progestin contraceptives, and interferons.
• Sleep problems which include; decreased sleep efficiency, shorter rapid eye movement latency, higher slow wave activity, and higher rapid eye movement density, are associated with the development of depression. Ethical Issues in Child and Adolescent Psychiatry Discussion

Clinical presentation

The manner in which symptoms of MDD present in adolescents may differ from adults. Adolescents are more likely to present with; boredom, anhedonia, weight changes, hypersomnia, hopelessness, alcohol or drug use, and suicidal or self-harm ideations. When diagnosing MDD, health care providers must also consider some of the medical causes of similar presentation, such as hyperthyroidism, hypothyroidism, anemia, and medications such as isotretinoin, corticosteroids, beta-blockers, and others.

According to the DSM-5 criteria for diagnosing clinical depression, the presence of at least five of the following symptoms in the same two-week period with alteration of the level of function. One of the symptoms should be at least a depressed mood or loss of pleasure or interest (Bains & Abdijadid, 2022). Also, it is important to note that other medical conditions cannot explain the symptoms. They include;

• Lack of energy
• Failure to gain weight or decrease or increase in daily appetite
• Irritable or depressed mood most of the days
• Decreased in pleasure or interest on most days
• Excessive or lack of sleep almost every day
• Psychomotor retardation or unrest almost every day
• Recurrent thoughts of death repeated suicidal ideations without specific plans or suicide attempts.
• They have decreased capacity to concentrate or think or indecisiveness almost every day.
• Feeling of inappropriate guilt or worthlessness nearly every day.

It is also important to take note of the following;

• The episode should not be triggered by the physiological effect of a substance or medical condition.
• The patient should not have any manic or hypomanic episodes.
• The MDD symptoms should not be explained by delusional disorder, schizophrenia, schizoaffective or schizophreniform disorder, or other psychotic or specified or unspecified schizophrenia spectrum disorder.
• The disease results in remarkable impairment or distress in occupational, social, and other important areas of functioning. Ethical Issues in Child and Adolescent Psychiatry Discussion

Screening tools

The US preventive services task force recommends that adolescents between 12 to 18 years be screened for a major depressive disorder. Some of the screening tools that can be used include;

• The Beck Depression Inventory –II is a 21-item self-report inventory
• The Zung Self-Rating Depression Scale is a 20-item self-report questionnaire.
• PHQ9 is a 9-item patient health questionnaire that scores each of the nine DSM criteria as 0 to 3, thus totaling to 0 TO 27 severity score.

Vulnerable

According to a study done in 2016, approximately 12.8% of the US population aged 12-17 years have been diagnosed with at least one episode of major depressive disorder (Pataki & Carlson, 2016). 8% of the adolescents with major depressive disorder have completed suicide by young adulthood, thus making suicide the 2^nd leading cause of death among adolescents between 12 to 17 years.

Treatment

The goal of treatment should focus on recovery, attaining full remission of symptoms, and return to the premorbid level of functioning. In children and adolescents, the initial treatment plan is psychosocial intervention, especially in mild to moderate depression. It consists of the following;

• Cognitive and behavioral therapy to help identify the cognitive distortion and learn problem-solving and cognitive restructuring skills to cope with the situation.
• Interpersonal therapy plays a role in decreasing interpersonal conflict by helping the individual change dysfunctional communication and learns interpersonal problem-solving skills.
• Psycho-education involves educating the individual and family members on the illness and the essence of good nutrition and good sleep.
• Incorporating physical exercises for at least 30 minutes a day. Ethical Issues in Child and Adolescent Psychiatry Discussion

Pharmacological intervention

In child and adolescent psychiatry, the patients and caregivers are fully informed about their confidentiality rights and limitations in a developmentally appropriate manner. Informed consent may only be given by competent individuals of legal age, whereas assent refers to the willingness to accept the treatment offered. When it comes to adolescents, the health care provider must get the consent of the guardian and the assent from the patient before making a treatment plan (Goldsmith & Roberts, 2016). Although under-age patients cannot give legal consent, they should be included in treatment-related decisions to the degree possible according to their ability to express coherent preferences and understand their options. Ethical Issues in Child and Adolescent Psychiatry Discussion

Follow up

The patient should be followed up weekly for the first month of initiating treatment. This is to allow for close monitoring together with supportive treatment.

Writing a prescription

• PO sertraline 50mg OD for 1/52.
• References

Bains, N., & Abdijadid, S. (2022, June). Major Depressive Disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Goldsmith, M., & Roberts, L. W. (2016). Ethical Issues in Child and Adolescent Psychiatry. FOCUS, 14(1), 64–67. https://doi.org/10.1176/appi.focus.20150032

Mullen, S. (2018). Major depressive disorder in children and adolescents. The Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Pataki, C., & Carlson, G. A. (2016). Major Depressive Disorder Among Children and Adolescents. FOCUS, 14(1), 10–14. https://doi.org/10.1176/appi.focus.20150037

Wartberg, L., Kriston, L., & Thomasius, R. (2018). Depressive Symptoms in Adolescents. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2018.0549

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. Ethical Issues in Child and Adolescent Psychiatry Discussion

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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
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. Ethical Issues in Child and Adolescent Psychiatry Discussion