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Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression

Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionTherapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionCase Study: An African American Child Suffering From DepressionBACKGROUND INFORMATIONThe client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.Client complained of feeling “sad”Mother reports that teacher said child is withdrawn from peers in classMother notes decreased appetite and occasional periods of irritationClient reached all developmental landmarks at appropriate agesPhysical exam unremarkableLaboratory studies WNLChild referred to psychiatry for evaluationClient seen by Psychiatric Nurse PractitionerMENTAL STATUS EXAMAlert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionORDER A PLAGIARISM-FREE PAPER HEREThe PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)RESOURCES§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.SAMPLE SOLUTION APPROACH: Case Study: An African American Child Suffering From DepressionExamine Case Study: An African American Child Suffering From DepressionIntroductionAs per the National Institute of Mental Health, over 10% of teens aged between 12 and 17 years suffer depression yearly. Nevertheless, what is overwhelming is that the prevalence of the disorder is increasing among younger kids (The National Institute of Mental Health, 2018). A large number of children suffer from depression even if they do not have a family history of the disorder. The vulnerability of children developing depression is high in case they are exposed to environmental stress like neglect, abuse, losses, trauma, domestic issues, or major peer conflicts like love problems or bullying. Furthermore, children suffering from persistent clinical conditions or other behavioral issues, for example, anxiety, are very vulnerable to the development of depression (De Bellis, Nooner, Scheid & Cohen, 2019). Timely and sustained treatment can help lessen the probability of recurrence and minimize the seriousness of the manifestations at the same time enhancing wellbeing and functioning. Based on the above, this assignment aims at making 3 treatment decisions for a Black American child aged 13 diagnosed with depression. Over the past eight years, the child has been experiencing sleep problems, challenges in making decisions, temper tantrums, incongruous behavior, and impulsivity. Also, the paper will reflect on ethical implications that ought to be considered when treating the client presented in the case.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionDecision OneBased on the client’s case, the care provider will begin her on 25 mg Zoloft. Zoloft is classified under selective serotonin reuptake inhibitors, which is a group of medications that work by balancing chemicals in brain cells (Stahl, 2013). This medication is helpful in the management of depression, panic attacks, temper tantrums, social anxiety, and a serious premenstrual dysphoric disorder. The medication is utilized as a mood stabilizer and also for enhancing energy in the body, sleep, desire for food, and interest in performing daily chores. The drug is appropriate for this client since it helps lessen fear and anxiety (Stahl, 2013). It is critical to note that sleep disorders surpass episodes of depression, and they increase the probability of re-occurrence and relapse.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionThe rationale for opting to begin the client on 25 mg Zoloft is premised on the age of the patient, and the presenting symptoms. Stahl (2013) maintains that it is critical to assess the presenting manifestations of a client prior to diagnosing him/her. For a therapist to ascertain a certain disorder, the patient ought to portray no less than 5 of the DSM-5 illustrated manifestations. Focusing on this case, the client is manifesting a number of symptoms that include reduced appetite, sadness feelings, isolation from members of the family and friends, the prevalence of SI, and chronic irritation. Furthermore, Zoloft is the ideal drug to start the patient since is FDA certified for the management of major depression symptoms in pediatric patients (Vitiello, 2012).Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionVarious Zoloft alternatives could be prescribed. Starting the client on 75mg Wellbutrin is one of the options. Paxil 10mg is the other option. Nevertheless, the therapist did not consider the alternatives since they are not approved by the FDA for treating young children suffering from depression (Stahl, 2014). Paxil is not a first line of defense for managing MDD among patients. Besides, its efficacy does not exceed 61%, its chances of causing serious reactions like anticholinergic effects are high. This side effect is normally experienced amid the early treatment period (Southammakosane & Schmitz, 2017). Conversely, Wellbutrin is effective in managing depression in pediatric patients, though it takes longer for its treatment effect to be manifested (Southammakosane & Schmitz, 2017).Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionAll options taken in this stage is intended to achieve a certain treatment endpoint. For the choice of beginning the client on Zoloft, the endpoint of treatment is to facilitate the abatement of manifestations of depression manifested by the client. Zoloft is likewise intended to stabilize the patient’s mood and also lessen the odds of relapse following the maintenance of the treatment for 12 months.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionWith Zoloft, I expect the client to visit the hospital 4 weeks after the implementation of this decision with over 50% abatement of manifestations. However, this was not the case since the patient came without having experienced any change. Since the efficacy of the available antidepressants is low, and in case antidepressant agents are not utilized appropriately, or prescribed after a delay, meeting treatment endpoints will be difficult. As mentioned earlier, the first antidepressants do not necessarily prompt remission (Stahl 2013). The treatment effect of Zoloft is experienced after 2-4 treatment weeks. Nonetheless, therapists must contemplate making dosage alterations in case the patient fails to make a positive response to the medication by the 8th week of treatment (Rao, 2013).Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionDecision TwoThe care provider decided to increase the Zoloft dose to 50mg while maintaining the frequency of administration. As mentioned earlier, the treatment effect of Zoloft may take longer to be experienced. On the off chance that the client fails to make a positive response to the medication by the 8th week of treatment, it calls for augmentation of dosage failure to which a positive response will not be experienced (Stahl, 2014b).  Increasing the dosage of the medication increases the chances of alleviation of symptoms since Zoloft functions blocking the reuptake of serotonin, boosting the neurotransmission of the chemical.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionThe care provider had other alternatives to consider in this stage such as augmenting the dosage to 37.5 mg through the mouth per day or introducing 10mg Prozac per day. However, increasing the dosage to 37.5 mg at the moment is not ideal since the appropriate starting dose for this medication is 25 or 50 mg once a day with the option of augmenting it by the same measurement until the upper limit of 200mg is achieved for pediatrics (Kasper et al., 2010). This is the case when the previously starting dose is ineffective in initiating a treatment response. Given that sertraline’s half-life is 24 hours, it is appropriate to increase the dose after a one-week interval (Kasper et al., 2010).  Prozac 10mg is an improper intervention since its probability of inducing negative reactions is high and this is evidenced by the black box warning that it comes with which is very serious.  The warning intends to caution the therapist and the client concerning the risks associated with the medicine. Also, according to Stahl 92014b), Prozac is likely to precipitate self-harm feelings among teens and young children. In case the medication results in excessive accumulation of serotonin, it can lead to serotonin syndrome (Stahl, 2014b).Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression The care provider implements this decision to eliminate the manifestations of depression and see the stabilization of the client’s state of mind which had not been attained in the preceding decision. The care provider is certain that this decision will prompt the achievement of the goals.The client expressed a 50% abatement of symptoms during the following presentation 4 weeks later. With this, it is apparent that the client was able to tolerate the increased dosage. As stated by Stahl (2013), antidepressants cause a significant abatement of manifestations of MDD, and when the improvement is termed as a treatment response when it achieves a 50% margin.  Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionDecision ThreeGiven that the client has experienced a treatment response and tolerating the medication effectively, the care provider decided to maintain the medication, its dosage, and frequency of administration. The therapist can maintain the medication for the next 4 weeks to monitor its effectiveness in treating the client’s depression. As per the American Psychiatric Association (2015), if the patient fails to experience a positive response with the medication by the 8th treatment week, the therapist is tasked with the role of assessing the likely reasons for the ineffectiveness of the medication and make appropriate alterations to the treatment approach for the patient. The care provider had other alternatives to consider that include increasing Zoloft dose to 75mg while maintaining the administration route and frequency or introducing SNRI drugs.   The alternative of augmenting the dose would be ideal given that the client has already responded positively to the medication as opposed to introducing SNRI agents.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionEthical considerationsWhen interacting with depressed people, a therapist is expected to develop a customized treatment approach using the presenting symptoms and other considerations as a platform (Kornaros, Zwedberg, Nissen & Salomonsson, 2018). As minors advance in age, their capacity of comprehending issues concerning their treatment and the expectations, responsibilities, and roles of each of the involved parties expand. Hence, according to Shawler et al. (2018), the care provider must get in informed consent to treatment since this is necessary. As the minor’s ability to take part in the exercise of sharing information and making treatment choices under the guidance of parents, the care provider can increase his or her level of engagement in treatment. The care provider should consider incorporating Kara in the treatment plan. He or she ought to establish her capacity to partake in discussions concerning informed consent and making decisions impacting treatment.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionBesides, it is significant to educate the client and individuals from her family about the advantages and risks of prescribed drugs. As indicated by Kornaros, Zwedberg, Nissen, Salomonsson (2018), despite each medication having clinical advantages, it is associated with various risks, hence the need to counsel the client and individuals from his or her family on what is expected of them in case the side effects manifest. Also, the care provider ought to be observant of the minor’s rights and her anonymity and autonomy. This facilitates the development of treatment rapport, energize the client on self-behalf, and foster the feeling that the patient will actively take part in the treatment exercise (DeFilippis & Wagner, 2014).Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionConclusionIn case you think that your child is suffering from MDD, you can request for referral to a psychiatrist who handles teens and children from the child’s pediatrician. Timely treatment is critical in the abatement of symptoms, improving functions, and reduces odds of relapse. With no treatment, depression among children may become chronic and serious, resulting in impaired social, mental, and academic functions. A child can effectively manage his/her state of mind with the help of support from parents. Moderate to severe depressive symptoms can be managed by antidepressants, for example, Zoloft.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionReferencesAmerican Psychiatric Association (2015). Practice guideline for the treatment of patients withObsessive-compulsive disorder. Retrieved from http://www.guideline.gov/content. Aspx? Id=11078.De Bellis, M. D., Nooner, K. B., Scheid, J. M., & Cohen, J. A. (2019). Depression in maltreatedChildren and adolescents. Child and Adolescent Psychiatric Clinics, 28(3), 289-302. DOI: https://doi.org/10.1016/j.chc.2019.02.002.Kasper, S., Hajak, G., Wulff, K., Hoogendijk, W. J., Luis Montejo, A., Smeraldi, E., … & Baylé J. (2010). Efficacy of the novel antidepressant agomelatine on the circadian rest-activity cycle and depressive and anxiety symptoms in patients with major depressive disorder: a randomized, double-blind comparison with sertraline. Journal of Clinical Psychiatry, 71(2), 109. Retrieved from https://pdfs.semanticscholar.org/ffa4/59079c57c55bf61e6aeb34638d42f8b103e1.pdfKornaros, K., Zwedberg, S., Nissen, E., & Salomonsson, B. (2018). A hermeneutic study of integrating Psychotherapist competence in postnatal child health care: nurses’ perspectives. BMC nursing, 17(1), 42. Retrieved from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-018-0311-1Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionRao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. DOI:10.1002/da.22171Southammakosane, C., & Schmitz, K. (2015). Pediatric psychopharmacology for treatment of ADHD, depression, and anxiety. Pediatrics, (2), 351. DOI: 10.1542/peds.2014-1581. Shawler, P. M., Bard, M. E., Taylor, E. K., Wilsie, C., Funderburk, B., & Silovsky, J. F. (2018). Parent-child interaction therapy and young children with problematic sexual behavior: a conceptual overview and treatment considerations. Children and Youth Services Review, 84, 206-214. https://doi.org/10.1016/j.childyouth.2017.12.006Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical             Applications (4th ed.). New York, NY: Cambridge University Press.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionStahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.The National Institute of Mental Health. (2018). Depression. Retrieved fromhttps://www.nimh.nih.gov/health/topics/depression/index.shtml.Vitiello, B. (2012). Principles in using the psychotropic medication in children and adolescents. IACAPAP e-textbook of child and adolescent mental health. Geneva, Switzerland:    International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap. Org/wp-content/uploads/A.The Assignment: Case Study: An African American Child Suffering From DepressionWhen pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionNote: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionRequired ReadingsNote: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.Chapter 6, “Mood Disorders”Chapter 7, “Antidepressants”Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionNote: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.Review the following medications:amitriptylinebupropioncitalopramclomipramineMagellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdfRao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171Note: Retrieved from Walden Library databases.Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdfPoznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.Note: Retrieved from Walden Library databases.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionRequired MediaLaureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.Note: This case study will serve as the foundation for this week’s Assignment.Optional ResourcesEl Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497To prepare for this Case Study: An African American Child Suffering From Depression Assignment:Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.The AssignmentExamine 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 #1Which decision did you select?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 #1 and the results of the decision. Why were they different?Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionORDER A PLAGIARISM-FREE PAPER HEREDecision #2Why 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 #3Why 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?Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionAlso include how ethical considerations might impact your treatment plan and communication with clients.Assessing and Treating Pediatric Patients With Mood DisordersWhen pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.To prepare for this Assignment:Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionReview this week’s Learning Resources, including the Medication Resources indicated for this week.Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.The Assignment: 5 pagesExamine 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. 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.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionIntroduction 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.Decision #1 (1 page)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.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionDecision #2 (1 page)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.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionDecision #3 (1 page)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.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionConclusion (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.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionTherapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionBACKGROUND INFORMATIONThe client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.·  Client complained of feeling “sad”·  Mother reports that teacher said child is withdrawn from peers in class·  Mother notes decreased appetite and occasional periods of irritation·  Client reached all developmental landmarks at appropriate ages·  Physical exam unremarkable·  Laboratory studies WNL·  Child referred to psychiatry for evaluation·  Client seen by Psychiatric Nurse PractitionerTherapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionMENTAL STATUS EXAMAlert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation but does admit that he often thinks about himself being dead and what it would be like to be dead.The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) RESOURCES§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression1-Decision Point OneSelect what the PMHNP should do: 1-Begin Zoloft 25 mg orally dailyBegin Zoloft 25 mg orally dailyRESULTS OF DECISION POINT ONE·  Client returns to clinic in four weeks·  No change in depressive symptoms at allegin Zoloft 25 mg orally daily2Increase dose to 37.5 mg orally daily ·  Client returns to clinic in four weeks·  Depressive symptoms decrease by 20%. Client reports feeling a little bit better At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression-Begin Wellbutrin 75 mg orally BID · Client returns to clinic in four weeks·  Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea Decrease dose for 7 days then return to previous 10 mg day doseGuidance to StudentGuidance to StudentThe PMHNP has two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, the PMHNP could also increase the dose to 20 mg orally daily. A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy. 2-RESULTS OF DECISION POINT TWO Begin Paxil 10 mg orally dailyBegin Paxil 10 mg orally daily·  Client returns to clinic in four weeks·  Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea· Decrease dose for 7 days then return to previous 10 mg day dose  Client returns to clinic in four weeks·  Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose·· Attempt to decrease dose for another 7 days then return to 10 mg doseTherapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression· Guidance to Student Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, the PMHNP will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.3-Begin Wellbutrin 75 mg orally BIDBegin Wellbutrin 75 mg orally BID·  Client returns to clinic in four weeks·  Child is unable to fall asleep at nightTherapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionChange from immediate release to extended release 150 mg orally daily in the morningive second dose of the day at 1:00 pm in the afternoon· Client returns to clinic in four weeks·  Child’s sleep patterns return to baseline. No change in depressive symptoms  Change to SSRI Guidance to Student The PMHNP can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.hange to Lexapro 10 mg orally daily Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionGive second dose of the day at 1:00 pm in the afternoon ·  Client returns to clinic in four weeks·  No change in sleeping patterns, child is getting more difficult to wake for school3-Decision Point Three· Begin Wellbutrin 75 mg orally BID Begin Wellbutrin 75 m·  Client returns to clinic in four weeks·  Child is unable to fall asleep at night Change to Lexapro 10 mg orally daily ·  Client returns to clinic in four weeks·  Child is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptoms Decrease dose for 7 days then return to previous 10 mg day dose ·  Client returns to clinic in four weeks Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose· Attempt to decrease dose for another 7 days then return to 10 mg dose·Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionTemporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, the PMHNP will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all client. Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression

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