Therapy for Pediatric Clients with Mood Disorders

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·  Mother reports that teacher said child is withdrawn from peers in class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 ( Depression is diagnosed).

The Assignment

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 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:

·  

o Decision #1

§ Which 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?

§  

o Decision #2

§ 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 #2 and the results of the decision. Why were they different?

§  

o Decision #3

§ 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 #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients.

Hint ( available on the required media on resource below)

Decision 1; begin Zoloft 25mg orally( Pt has no change)

Decision 2; increase dose to 37.5 mg orally ( Little effect of 20%)

Decision 3; increase dose to 75 mg orally ( pt feeling better. Will maintain this dose). 

Other option, Begin paxil ( pt has N/V/D, refused meds), Begin Welbutrin( pt unable to sleep).

Resources for reference

IACAPAP e-Textbook of Child and Adolescent Mental Health”> 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. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

Magellan 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.pdf

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

Note: Retrieved from Walden Library databases.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791. doi:10.1002/da.22171

Required Media

Laureate 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.