When 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.
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Therapy for Pediatric Clients with Mood Disorders
An African American Child Su�ering From Depression
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”
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� Mother reports that teacher said child is withdrawn from peers in class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”. A�ect 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 signi�cant
depression)
RESOURCES
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§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological
Services.
Decision Point One
Select what the PMHNP should do:
Begin Zoloft 25 mg orally daily
(1.html)
Begin Paxil 10 mg orally daily
(2.html)
Begin Wellbutrin 75 mg orally BID
(3.html)
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Therapy for Pediatric Clients with Mood Disorders
An African American Child Su�ering From Depression
Decision Point One
Begin Zoloft 25 mg orally daily
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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 Point Two
Increase dose to 50 mg orally daily
RESULTS OF DECISION POINT TWO
� Client returns to clinic in four weeks
� Depressive symptoms decrease by 50%. Client tolerating well
Decision Point Three
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Maintain current dose
Guidance to Student
At this point, su�cient 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 e�cacy. Waiting an additional 4 weeks (8 weeks total from dose change) would allow
additional bene�t 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.
Start Over (index.html)
To prepare for this Assignment:
Review 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 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.
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?
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.
Decision #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.
Decision #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
12/12/21, 6:49 PM Psychopharmacologic Approaches to Treatment of Psychopathology
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Therapy for Pediatric Clients with Mood Disorders
An African American Child Su�ering From Depression
Decision Point One
Begin Zoloft 25 mg orally daily
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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 Point Two
Select what the PMHNP 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
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