Case study: African American child with Depression Essay
Case study: African American child with Depression Essay
Depression in children
Depression is a mental health disorder that disrupts interpersonal relationships due to agitation, psychomotor retardation, and loss of emotional expression. In children, depression is perceived as a normal emotional and psychological change in development. Persistent sadness that interferes with schoolwork, social activities, and hobbies is the main symptom of depression. Other symptoms are anger, social withdrawal, changes in sleep and eating habits, being more sensitive to rejection, feelings of guilt, and trouble concentrating (Clery, et al, 2022). This child has depression because he presents with sadness, loss of appetite, withdrawal from peers, and irritability. This paper describes three decisions made in treating a child with depression. I will also describe the impact of ethical consideration in the treatment. Case study: African American child with Depression Essay
Decision one
Which decision did you select?
Begin Zoloft 25mg orally daily
Why did you select this decision?
I began Begin Zoloft 25mg orally daily because it is FDA approved for treating pediatric patients with depression (Ballinger, J. 2022). It has an immediate mode of action hence achieves its therapeutic goals. Its plasma peak is within 4 hours and it has a plasma half-life of 26hours. It does not have side effects on this patient. Zoloft is a selective serotonin reuptake inhibitor that increases the concentration of serotonin to enhance mood, wakefulness, and personality. Therefore, it will improve symptoms such as sadness, loss of appetite, insomnia, withdrawal from peers, and irritability.
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Why did you not select the other two options provided in the exercise?
Paxil is a selective serotonin reuptake inhibitor that balances the serotonin hormone in the brain. It helps in improving mood, sleep, energy level, and appetite. In addition, it reduces fear, anxiety, and unwanted thoughts (Plowden, et al, 2022). Therefore, it is the appropriate drug for anxiety disorders, PTSD, and panic attacks. However, I did not select Paxil 10mg orally daily because its safety and efficacy are not established in children. In addition, it has undesirable effects on children like nausea, drowsiness, dry mouth, blurred vision, and loss of appetite. Case study: African American child with Depression Essay
Welbutrin is a norepinephrine-dopamine reuptake inhibitor that acts on the dopaminergic pathway. It is a better antidepressant than anti-tricyclic antidepressants. It is effective in a depressive mood, ADHD, obsessive-compulsive disorder, and PTSD (Athreya, et al, 2022). However, I did not select this drug because it has undesirable effects such as trouble falling asleep, GI symptoms such as severe abdominal pain, nausea, vomiting, convulsions, and suicidal ideation.
What were you hoping to achieve by making this decision?
The expectations of giving Zoloft 25mg are to improve the patient’s symptoms (mood, appetite, reduce the episodes of agitation, and his relationship with his peers). Zoloft increases the concentration of serotonin hormone in the brain. Serotonin enhances mood, personality, and increases the energy in a patient. the expected side effects are mild headache and drowsiness.
The Impact Of Ethical Considerations To The Treatment
Moral principles guide nursing practice, especially when treating patients with mental health disorders. Treating a patient entails assessment, diagnostic findings, and prescriptions. Principles such as justice and fairness, seeking consent, and non-maleficence improve patient treatment. Justice and fairness is the ability of a care provider to use the standard of rightness without reference to feelings and interests (Yoder, et al, 2022). This enables all patients to access quality healthcare despite their age, gender, and race. Consent is the act of seeking permission before performing a physical examination or initiating treatment. Non-maleficence is the act of protecting the patient from medication errors. This enables the care provider to prescribe the correct drug and avoid prescription errors.
Decision #2
Which decision did you select?
Increase the dose to 50mg orally daily
Why did you select this decision?
Zoloft is the most appropriate antidepressant recommended for children. However, the standard upward dosage titration is 25mg after every four weeks (Ballinger, J. 2022). The patient reports a slight improvement of the symptoms after four weeks of taking 25mg. Increasing to 50mg would improve the mood, improve the HAM-D results, reduce irritability, and improve the patient’s ability to interact with other people.
Why did you not select the other two options provided in the exercise?
Increasing the dose to 37.5mg orally daily is not recommendable because there would be a slight improvement in the symptoms. In addition, the standard upward dosage titration is 25mg after every four weeks and not 12.5mg. Prozac is an antidepressant that blocks the reuptake of serotonin and norepinephrine. It improves mood, increases energy, and brightens the personality. However, the drug’s initial effect is experienced after two weeks after treatment. Therefore, the drug is not appropriate for the child because the therapeutic goal is to improve the symptoms immediately. Moreover, the drug induces insomnia, anxiety, and pharyngitis in children (Wang, E. 2022). It is not just to switch the child to another drug because they have already responded well with Zoloft with no side effects.
What were you hoping to achieve by making this decision?
The expectations anticipated after increasing Zoloft to 50mg are to gradually reduce the negative symptoms (withdrawal from his peers and irritability) and enhance the patient’s mood.
The Impact Of Ethical Considerations To The Treatment
The ethical principle I will apply to this patient is beneficence. Beneficence is the act of doing good to a patient to ensure recovery from the symptoms (Yoder, et al, 2022). For example, increasing the dose of Zoloft to 50mg helps to improve the symptoms from the previous episode. In addition, the drug has no side effects for the patient. This enables the patient to comply with treatment and hence quick recovery.
Decision #3
Which decision did you select?
Maintain the current dose
Why did you select this decision?
I will maintain the current dose because the patient is responding well to it. The drug has no side effects on the patient. The child’s symptoms improved by 50%. Maintaining the current dose throughout four will improve the patient’s symptoms to full recovery.
Why did you not select the other two options provided in the exercise?
Increasing Zoloft to 75mg orally daily is not appropriate for this patient. The American psychiatric association recommends 50mg daily for children 8-12 years old. Increasing the dose may precipitate unfavorable side effects such as drowsiness, fatigue headache, and insomnia. A high dose of Zoloft increases the incidence of suicidal ideation and attempt (Ballinger, J. 2022). I did not switch the child to SNRI because they are approved for generalized anxiety disorders and not depression. Moreover, it has adverse side effects compared to other SSRIs. SNRI increases the risk of suicidal ideation among patients younger than 25years.
What were you hoping to achieve by making this decision?
The expectations of maintaining Zoloft 50mg include improving the symptoms by 75% while avoiding the associated side effects.
The Impact Of Ethical Considerations To The Treatment
During this visit, the child has marked improvement in symptoms. Therefore, I would encourage the patient to make treatment decisions like enrolling in therapy and continuing with medicine. I will apply the principle of respect for autonomy. I will apply this by educating the patient about their illness and the treatment methods. I will also explain the expected side effects of treatment and the prognosis. This will enable the patient to make an informed medical education. Case study: African American child with Depression Essay
Conclusion
Depression is a mental health disorder that disrupts interpersonal relationships due to agitation, psychomotor retardation, and loss of emotional expression. The American psychiatric association DSM-V criteria for the diagnosis includes loss of interest, increased sadness, sleep disturbance, change of eating habits, hopelessness, loss of memory and concentration, and self-isolation. Treating depression involves the use of antidepressants like tricyclic antidepressants, SSRI, SNRI, and MOAI. However, SSRIs are more suitable for treating children with depression because they have no side effects. These antidepressants increase the risk of convulsions and suicidal ideation in children. Therefore, the PNP should initiate treatment at the lowest dose and titrate upwards to watch out for side effects and its efficiency. Ethical principles are the moral values that impact the treatment methods in the psychiatric clinic. Examples of these principles are justice and fairness, beneficence, consent, respect for autonomy, and non-maleficence. These principles enable the PNP to provide quality healthcare to all patients. They improve patients’ symptoms by protecting them from medical harm. It also promotes patient education through informed consent and respect for autonomy.
Case Overview
An 8-year old male African American presents at the emergency department with a complaint of feeling sad, a decrease in appetite, occasional periods of irritation, and withdrawal from peers. Upon mental state examination, the child is oriented and alert. He has a clear speech, sad mood, and a blunted affect. He smiles appropriately during the interview. However, he denies visual and auditory hallucinations. He has no delusional or paranoid thought process. His insight and judgment are age-appropriate. He has no suicidal ideation but thinks about himself as dead and how it feels.
Depression is a mental health disorder that disrupts interpersonal relationships, lost work, and substance abuse. The patient presents with psychomotor retardation, loss of emotional expression, and agitation. The American psychiatric association DSM-V criteria for depression includes sadness, loss of interest, sleep disturbance, psychomotor agitation, fatigue, change of appetite, feelings of worthlessness, and suicidal ideation (Prigerson, et al, 2021). The child has depression because he has been sad and lost appetite. He has occasional periods of irritation and withdrawal from peers. In this paper, I will describe three decisions for treating a child with depression and the impact of ethical considerations.
Decision 1#
Decision Selected
Zoloft 25mg orally daily
Reason For Selecting The Decision
Zoloft or sertraline is a selective serotonin reuptake inhibitor SSRI FDA-approved in treating a major depressive disorder, anxiety, ADHD, and OCD in children. Zoloft is an antidepressant that inhibits the reuptake of serotonin in the central nervous system to regulate mood, personality, and wakefulness (Rouse, A. 2021). The drug is taken orally once daily from 25mg to a maximum of 200mg daily. Zoloft has side effects such as dizziness, lightheadedness, fatigue, diarrhea, and nausea. It is the most appropriate drug for the patient because FDA recommends it in treating depression and it helps in relieving its symptoms. Compared to other antidepressants, the drug is tolerable in children and has fewer side effects. Zoloft increases suicidal ideation among patients. Therefore, the child should attend psychotherapy sessions for cognitive and behavioral change. Moreover, he should be under close suicidal watch from the parents and other care providers. Case study: African American child with Depression Essay
Why I Did Not Select The Other Two Options
Paxil is a selective serotonin reuptake inhibitor for treating depression, obsessive-compulsive disorder, anxiety, and post-traumatic stress disorder. Paxil blocks the serotonin reuptake transporter to increase the presynaptic serotonin concentration that contributes to its antidepressant effect (Feeney, et al, 2022). However, I did select Paxil for this patient because its safety in children less than 18 years is yet to be established. Moreover, Paxil has severe adverse effects in children, such as nausea, vomiting, dizziness, and confusion. Paxil has an increased risk of suicidal ideation and attempts compared to Zoloft. Therefore, it is not a suitable drug for this child.
Wellbutrin is an antidepressant FDA approved for smoking cessation, adult depression, ADHD, and sexual dysfunction. It inhibits the reuptake of dopamine and norepinephrine. It also acts on the nicotinic and serotonin receptors (Alba, B. M. 2021). However, the onset of its effect is two weeks after drug intake. I did not select this drug for this patient because there is no clear indication of its safety and effectiveness in children. In addition, the drug takes a longer duration before it proves its effectiveness.
The Expected Outcome
After administering Zoloft 25mg orally, I was expecting the patient to improve his sleep, mood, concentration, and activity. There would be a significant decrease in the children’s depression scale. I also expected the child would complain of mild headache, dizziness, and nausea.
Ethical Consideration
Ethics are the moral values that guide the nursing practice. The PNP should apply ethical principles such as consent, beneficence, and non-maleficence (Ilkafah, et al, 2021). Consent is asking for permission from a patient or the guardian before initiating treatment. in this scenario, the child is below 18 years, and therefore, he cannot consent to his treatment. as the PNP, I would inform the guardian of the illness affecting the child and the treatment methods. Then, I would request them to sign the consent form. Beneficence is having the best interest of a patient by doing the right thing. I would apply beneficence by prescribing the best medication that would relieve the symptoms. Non-maleficence is protecting the patient from harm. I would apply this by avoiding medication errors during prescription and dispensing the medicine. In addition, I would recommend a tolerable drug with no side effects.
Decision Two#
Decision Selected
Increase the dose to 50mg orally daily
Reason For Selecting The Decision
The patient reports slight improvement from the previous symptoms. There was a slight increase in the mood, no HAM-D results, and the patient did not experience adverse effects. This is an indication that the drug is effective for this patient. according to xxxxxx, Zoloft dosage increment is by 50% to establish its effectiveness in a patient.
Why I Did Not Select The Other Two Options
I did not increase the dose to 37.5mg because the American psychiatric association recommends dosage increments by 25-50mg to establish the effectiveness of the drug. Prozac is an antidepressant that lowers the levels of serotonin uptake sites causing the activating effect. It is used as an off-label drug in treating ADHD and anxiety disorder. However, its effectiveness and efficiency are established two to four weeks after initiating the treatment. Therefore, I did not select this drug because of adverse side effects and the longer duration of action. Case study: African American child with Depression Essay
The Expected Outcome
During the second visit, I was expecting the child will improve the symptoms by 50%. This includes, improves speech and concentration, ability to interact with other children, and decrease of the HAM-D results. The child did not complain of any side effects in the previous visit. Therefore, I did not expect any side effects.
Ethical Consideration
As the PNP, I will apply the principle of efficiency and proportionality when treating this patient. Proportionality is the quality of being in proper balance about treatment. This expounds on the principle of justice and fairness by maintaining the quality of care through all the stages of treatment. Efficiency is an action that brings out the best results, especially in patients. As the PNP, my main goal is to produce the desired results and ensure there is patient satisfaction.
Decision Three#
Decision Selected
Maintain the current dose
Reason for selecting this decision
Zoloft 50mg orally improved the patient’s symptoms by 50%. I would continue with the same dose to achieve the maximum effect of the drug.
Why I Did Not Select The Other Two Options
I did not increase Zoloft to 75mg because it is not appropriate for children. The American psychiatric association recommends 50mg as the maximum dosage. In addition, increasing the dosage to 75mg may precipitate adverse effects. I did not change to SNRI because the drug was already effective in the patient’s symptoms. There is no indication for switching the patient to a new drug at this level. In addition, SNRIs have severe side effects compared to SSRIs.
The Expected Outcome
After weeks of drug continuation, my expectation is for the child to fully recover and restore both behavioral and cognitive functions. The child would not experience any side effects because it has been tolerable in the previous stages.
Ethical Considerations
During the third visit, I will apply the principle of respect for autonomy. Autonomy is the principle that allows the patient to make informed medical decisions. As the PNP, I would empower the guardian about the disease and treatment process to facilitate informed decisions.
Conclusion
Conclusively, depression is a disorder whose main symptoms are loss of interest, suicidal ideation, sleep disturbance, agitation, and loss of cognitive functions. Treatment modalities in depression can be psychotherapy and pharmacotherapy. Selective serotonin reuptake inhibitors are the most appropriate antidepressants for children. They are tolerable and have less severe side effects. Ethical principles are the moral values that guide treatment and nursing practice. These principles are consent, beneficence, non-maleficence, respect for autonomy, efficiency, and proportionality.
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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 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. Case study: African American child with Depression Essay
References
Athreya, A. P., Vande Voort, J. L., Shekunov, J., Rackley, S. J., Leffler, J. M., McKean, A. J., … & Croarkin, P. E. (2022). Evidence for machine learning guided early prediction of acute outcomes in the treatment of depressed children and adolescents with antidepressants. Journal of Child Psychology and Psychiatry.
Ballinger, J. (2022). Zoloft review.
Clery, P., Royston, A., Driver, K., Bailey, J., Crawley, E., & Loades, M. (2022). What treatments work for anxiety and depression in children and adolescents with chronic fatigue syndrome? An updated systematic review. BMJ open, 12(1), e051358.
Plowden, K. O., Legg, T., & Wiley, D. (2022). Attention deficit/hyperactivity disorder in adults: A case study. Archives of Psychiatric Nursing.
Wang, E. (2022, January). The Controversy Over the Use of Prozac Because of Side Effects. In 2021 International Conference on Public Art and Human Development (ICPAHD 2021) (pp. 128-132). Atlantis Press.
Yoder, C. M., Soule, I., Nguyen, C., & Saluta, I. (2022). Ethical global health in nursing education: An integrative review. Nurse Education in Practice, 58, 103263. Case study: African American child with Depression Essay
