Explain how ethical considerations may impact your treatment plan and communication with patients.

Explain how ethical considerations may impact your treatment plan and communication with patients.

Explain how ethical considerations may impact your treatment plan and communication with patients. 150 150 Nyagu

Assessing and Treating Pediatric Patients With Mood Disorders Essay
Assessing and Treating Pediatric Patients With Mood Disorders Essay

I WILL LIKE THE WRITER 1747 TO EXECUTE THIS ORDER PLEASE. PLS FOLLOW THE RUBRICS. PLS COPY AND PASTE THE LINK BELOW TO YOUR BROWSER TO ASSESS THE CASE STUDY. https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html 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. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Assessing and Treating Pediatric Patients With Mood Disorders Essay. 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. RUBRICS 1) 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. 2) Decision #1 (1–2 pages) • Which decision did you select? • 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. 3) Decision #2 (1–2 pages) • Which decision did you select? • 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. Assessing and Treating Pediatric Patients With Mood Disorders Essay. • 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. 4) Decision #3 (1–2 pages) • Which decision did you select? • 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. 5) 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. Learning Resources Required Readings (click to expand/reduce) 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 Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05 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).Assessing and Treating Pediatric Patients With Mood Disorders Essay. 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

Psychopharmacologic Management (Off-Label) of an 8 Year-Old African American Male Child Presenting with Depression and Suicidal Ideation

Major depressive disorder (MDD) belongs to a diagnostic category known as ‘Depressive Disorders’ in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The other conditions in this diagnostic category include mood dysregulation disorder and dysthymia (persistent depressive disorder) among others. The main common characteristics for all these depressive conditions are a feeling of sadness, an irritable mood, and emptiness (APA, 2013). The case study presents an 8 year-old male African American child who is diagnosed with significant depression (major depressive disorder) using the Children’s Depression Rating Scale (CDRS). Assessing and Treating Pediatric Patients With Mood Disorders Essay. According to the history and mental status examination (MSE), the 8 year-old boy also meets the DSM-5 diagnostic criteria for MDD. He has complained of feeling sad (anhedonia), he isolates himself from the other children in school, is irritated occasionally, and shows a blunted affect on MSE. Among the criteria for this diagnosis in the DSM-5 are a markedly reduced interest/ pleasure in daily activities, sustained sadness or emptiness as shown in the mood, feelings of worthlessness, psychomotor retardation or agitation, inability to concentrate, and thoughts about death (APA, 2013). The 8 year-old boy meets all these criteria, meaning that the diagnosis is correct. It is reported that his growth and development has so far been normal and the physical examination and laboratory tests done on him have revealed nothing significantly wrong physically. This paper is about the decision to be made on the psychopharmacological management of this 8 year-old boy’s depression.

Decision Point 1: Choice of Appropriate Medication

The decision taken in making the choice of medication for this 8 year-old African American boy with MDD was to give him off-label sertraline (Zoloft) at an initial dose of 25 mg orally every day (Rosenthal & Burchum, 2018; Stahl, 2017). Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant that is only FDA-approved for treating major depressive disorder in adults. In children, it is only approved by the FDA for treating obsessive-compulsive disorder (Stahl, 2017). The choice to use it here to treat depression in a child falls under off-label prescription of antidepressants to children (Vijay et al., 2018; Allen et al., 2018; Mir & Geer, 2017). Off-label drugs are medications that are FDA-approved for use in adults to treat a condition that presents in a child. Because of lack of alternatives, the clinician decides to use the medication in the child and tailor its dosage to their weight and profile. Assessing and Treating Pediatric Patients With Mood Disorders Essay. It is referred to as off-label use because there is no safety profile information on the use of sertraline (Zoloft) in children to treat depression. This kind of use is not indicated in the package insert and is also not covered in the drug’s license (it is off-label). However, this is a common practice.

Some of the reasons for off-label prescription of psychopharmacologic agents are:

Lack of FDA-approved medications for a particular condition in children when a similar condition has an FDA-approved medication in adults.
When the child’s life is at risk such as from suicidal ideation/ suicidality.
The decision to select sertraline was made because it has proved to be efficacious in treating childhood depression before when used off-label (Chon et al., 2017). The other two options available were not chosen because in terms of relative effectiveness in treating depression even in adults, sertraline (Zoloft) has proven to be better (Chon et al., 2017). It has shown that it can produce symptom remission within the first four weeks of use, with the effect directly proportional to the daily dosage. By making the decision to prescribe sertraline, I was hoping to achieve symptom remission as confirmed by the CDRS. If this were to be the case, the subsequent CDRS test for the boy would show a score below 30 points (Shanahan et al., 1987). This would mean the severity of the depression is going down. Assessing and Treating Pediatric Patients With Mood Disorders Essay

The ethical considerations that would impact my treatment plan are beneficence and nonmaleficence (Haswell, 2019). The lack of a safety profile for the use of Zoloft in treating depression in children will mean that the child is monitored very closely to avoid causing them harm (nonmaleficence). However, the use of the medication will go on because the benefits clearly outweigh the risks. The boy had admitted to thinking about death; meaning that use of the medication (sertraline) is actually life-saving in this case (beneficence).

Decision Point 2: Return Visit in 4 Weeks

This is the return or follow-up visit for the boy to be reviewed after taking the sertraline (Zoloft) at a dose of 25 mg orally daily for four weeks. The return visit gives the opportunity to review the symptom profile and to adjust or change the treatment if necessary. When this 8 year-old boy returned with his parents after four weeks, they reported that there has been no change in his depressive symptoms at all. This was not surprising to the psychiatric-mental health nurse practitioner (PMHNP) at all. According to Stahl (2017), the onset of therapeutic action of sertraline in the treatment of depression usually delays by to four weeks. For this reason, the action taken at this second decision point was to increase the dose of the sertraline (Zoloft) to 50 mg orally daily. This would maximize the therapeutic effect when it starts to be apparent. Evidence-based literature also states that an increase in the dosage is warranted if the initial dose does not begin to reduce the symptoms in four to six weeks (Stahl, 2017). Therefore, the decision to increase the dose of sertraline instead of stopping it was evidence-based practice (EBP). Compared to the other options that could have been made, sertraline is he drug most likely to continue having a significant therapeutic effect for many years after commencement of therapy (Stahl, 2017). This is desirable as it would prevent the relapse of depressive symptoms in the child for a much longer time. Assessing and Treating Pediatric Patients With Mood Disorders Essay

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The reason why the other two options were not selected is that the best decision would have been to increase the dose of sertraline since there was evidence in support of this action as outlined above. An increase of the sertraline dose to 37.5 mg orally daily would have been too minimal to make a difference in the outcome desired. On the other hand, a change to fluoxetine (Prozac) 10 mg orally daily would have been premature as the off-label sertraline would not have been given a chance to produce its full range of therapeutic effects within 4-6 weeks. This is despite the fact that fluoxetine is FDA-approved to treat MDD in children from 8 years old (Stahl, 2017). The treatment decision is not based on FDA approval alone, but also on evidence-based practice.

What I was hoping to achieve by this decision to increase the sertraline dose by half to 50 mg orally per day was to achieve a symptom remission by at least 50%. This would be a therapeutic response that is significant and desirable. The ethical considerations at this stage would be about involving the parents and the boy in the treatment decision making. This would be relevant concordance and will also respect the bioethical principle of autonomy (Haswell, 2019). The child will not be ordered to continue taking the sertraline at higher doses. They will be counselled together with the parents and an explanation given why the dose was being adjusted upwards instead of changing the medication.Assessing and Treating Pediatric Patients With Mood Disorders Essay

Decision Point 3: Second Follow-Up Visit Eight Weeks after Commencement of Drug Therapy

Eight weeks after starting sertraline (Zoloft) at 25 mg orally daily and four weeks after increasing the dose to 50 mg orally daily, the boy is returned for the second follow-up. It is very good news because this time, the parents report a significant decrease in depressive symptoms. They also report that the 8 year-old boy is tolerating the sertraline well without showing signs of any adverse effects or reactions. This is confirmed by the CDRS that shows that the depressive symptoms have gone down by 50% or half. In therapeutics, this is considered a good response even though it is not complete remission yet. What this outcome showed was that the sertraline had now started producing its therapeutic effect as expected within 4-6 weeks. The determination was therefore that the treatment was going well and that the choice of off-label sertraline had been a good choice informed by EBP. At this juncture and given the outcome seen, the decision made was to increase the daily dose of the sertraline again to 75 mg orally daily.

The decision to increase the dose to 75 mg was taken for several reasons. This medication dose is still within the therapeutic range and the increase was motivated by the fact that the patient was responding well to the treatment. The other two options were not considered because the patient was already responding to the treatment by sertraline. What was hoped to be achieved was an even bigger reduction in the symptoms by up to 75% at the next visit in another four weeks (Stahl, 2017). The ethics in this stage remain the same – to keep the boy safe from unwanted adverse effects as the drug is off-label.Assessing and Treating Pediatric Patients With Mood Disorders Essay

Conclusion

Major depressive disorder (MDD) in children presents many challenges with regard to psychopharmacologic management. The reason for this is that not many drug options are available to treat this condition in children. That is drugs that have been studied through randomized controlled trials and proven to be safe, effective, and efficient in treating MDD in children (FD-approved). This case study of the 8 year-old African American boy with MDD has shown that despite paucity in FDA-approved medications for MDD in children, there are off-label alternatives. These must however be used judiciously and with utmost caution for lack of a safety profile in children. In this particular case, off-label sertraline was chosen due to its proven efficacy from scholarly evidence. It was commenced at a starting dose of 25 mg orally daily. This was increased to 50 mg orally daily when there was no response within the first four weeks. The increase produced results as the boy had symptom reduction of 50% by the next visit. At this 8-week mark in the treatment, the decision was made to increase the sertraline dose again to 75 mg orally daily. The hope was that the trend would continue and there would be complete remission of symptoms soon. Assessing and Treating Pediatric Patients With Mood Disorders Essay

References

Allen, H.C., Garbe, M.C., Lees, J., Aziz, N., Chaaban, H., Miller, J.L., Johnson, P., & DeLeon, S. (2018). Off-label medication use in children, more common than we think: A systematic review of the literature. The Journal of the Oklahoma State Medical Association, 111(8), 776–783. https://europepmc.org/article/pmc/pmc6677268

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Chon, M-W., Lee, J., Chung, S., Kim, Y., & Kim, H-W. (2017). Prescription pattern of antidepressants for children and adolescents in Korea based on nationwide data. Journal of Korean Medical Science, 32(10), 1694-1701. https://doi.org/10.3346/jkms.2017.32.10.1694

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Mir, A.N. & Geer, M.I. (2017). Off-label use of medicines in children. International Journal of Pharmaceutical Sciences and Research. https://ijpsr.com/bft-article/off-label-use-of-medicines-in-children/?view=fulltext

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.Assessing and Treating Pediatric Patients With Mood Disorders Essay

Shanahan, K.M., Zolkowski-Wynne, J., Coury, D.L., Collins, E.W., & O’Shea, J.S. (1987). The Children’s Depression Rating Scale for normal and depressed outpatients. Clinical Pediatrics, 26(5), 245-247. https://doi.org/10.1177/000992288702600506

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6th ed. Cambridge University Press.

Vijay, A., Becker, J.E., & Ross, J.S. (2018). Patterns and predictors of off-label prescription of psychiatric drugs. PLoS ONE 13(7): e0198363. https://doi.org/10.1371/journal.pone.0198363

Assessing and Treating Pediatric Patients With Mood Disorders Essay