Case Study Assessing and Treating Pediatric Patients With Depression

Case Study Assessing and Treating Pediatric Patients With Depression

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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 patientâ€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. Case Study Assessing and Treating Pediatric Patients With Depression

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Decision Tree Case Study and My decisions

This case study will serve as the foundation for this weekâ€s Assignment

BACKGROUND INFORMATION
The 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• Mother reports that teacher said child is withdrawn from peers in class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 Practitioner

MENTAL STATUS EXAM
Alert & 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) Case Study Assessing and Treating Pediatric Patients With Depression

RESOURCES
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

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.
Decision #1 (1 page)
• Which decision did you select? In the first decision I chose Zoloft 25mg orally daily. I chose this decision because of the research that I found. Zoloft is a selective serotonin reuptake inhibitor (SSRI), and this class of medications has been shown to be very affective for anxiety disorders…..
• 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. Other two options were Wellbutrin and Paxil. I decided against choosing Wellbutrin because of the evidence that SSRIs are very effective for adolescents. Paxil has many side effects…… Case Study Assessing and Treating Pediatric Patients With Depression
• 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.
Reuslts in my choice:
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Slight increase in mood
• No HAM-D results
• No adverse events reported

Decision #2 (1 page
(choices were to: Select what I should do next:
Increase dose to 37.5 mg orally daily
Increase dose to 50 mg orally daily
Change to Prozac 10 mg orally daily
) I chose to increase the dose to 50 and not 37.5 because the starting doses of Zoloft are usually 25mg or 50mg daily (Dwyer & Bloch, 2019). I don’t believe at this point it is time to try a change in medication to Prozac because we have not given the Zoloft enough time to make a difference…….
• 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. Case Study Assessing and Treating Pediatric Patients With Depression
• 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.
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Depressive symptoms decrease by 50%. Client tolerating well
Decision #3 (1 page) Select what the PMHNP should do next:
Maintain current dose
Increase to 75 mg orally daily
Change to a SNRI
I chose to : Decision Point Three
Maintain current dose

Guidance to Student
At this point, sufficient symptom reduction has been achieved. It is considered a full response to therapy when symptoms are reduced by 50% or more on the HAM-D. Do not confuse this with full symptom resolution which would be a 100% reduction in symptoms as measured on the HAM-D. It would be in the best interest of the patient to continue with the current dose of medication and re-assess in 4 weeks. Remember, any change in dose resets the “clock” for a full assessment of therapy efficacy. Waiting an additional 4 weeks (8 weeks total from dose change) would allow additional benefit to be recognized. An increase in dose would not be warranted at this point in time as it would lead to an increased potential for adverse events. This could fracture the therapeutic alliance created with your patient and lead to loss to follow-up, loss of symptom control, and other negative consequences to the patient. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

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• 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. Case Study Assessing and Treating Pediatric Patients With Depression
• 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.
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.
Note: Support your rationale with a minimum of five academic resources. Case Study Assessing and Treating Pediatric Patients With Depression