Examination of an African American Child Suffering From Depression Paper

Introduction

Clinical depression or major depressive disorder is a mood malady that produces persistent emotions of sadness and disinterest (Mullen, 2018). Depression affects all ages starting from children, youths, and adults. In pediatrics, disorders associated with depression are termed mood disorders, the most difficult type of depression to diagnose, treat, and manage.

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Due to the distinct stages of growth and development in children compared to adults who have already reached maturity and passed developmental milestones, depressive illnesses are frequently more difficult to treat in children. Due to their bodily surface area to volume ratio, youngsters react to drugs quickly, which further complicates matters (Mullen, 2018). The situation being discussed in this essay is a sick African American youngster who comes to the medical facility with his mother. Because the patient is eight years old and may find it difficult to speak effectively with the care provider during the assessment in order to develop a patient-centered treatment strategy, the parent’s presence is essential (Laureate Education, 2016).

Different therapeutic interventions will be discussed in three decisions for this particular case study after depression diagnosis. The ethical considerations in the choice of treatment and involvement of the patient will also be explored.

As reported by the mother, the child had sad emotions that have been witnessed for quite some time and isolated himself from his peers. Other clinical manifestations include anorexia nervosa syndrome, pessimistic feelings about his state, primarily visualizing his dead self, and intermittent infuriation. From the clinical assessment, it can be depicted that the developmental milestones in the child are just in line with his age. The physical examination is exceptional, and the mental review shows a patent and logical speech (Laureate Education, 2016). From the assessment, a case of depression is implicated. There is a need for psychiatric nurse practitioners to be more vigilant while dealing with therapeutics for the pediatric patient as different medications and dosages apply differently depending on the client’s age.

First decision

Among the three remedies suggested (Zoloft 25mg, Paxil 10mg, and Wellbutrin75mg) are both to be administered once every day except for Wellbutrin that is to be given twice a day via the oral route, I picked out Zoloft 25mg. Zoloft is a drug that some refer to it as Sertraline (Poweleit et al., 2019). It is the first-line drug of choice proposed for the treatment of depressive disorders in pediatrics. Zoloft is known for posing an excellent counteraction for depression symptoms. The medication primarily inhibits the re-absorption of serotonin inside the nerve cells of the brain. Serotonin is responsible for relaying impulses just like any other compound neurotransmitter. The working mechanism of Sertraline permits the blocked neurotransmitter to abide at the synaptic gap for quite longer to necessitate the amelioration of the mood, more so the sad mood. I find the 25mg dosage being the most suitable portion for the patient in the case study due to his younger age of eight years (Poweleit et al., 2019).

I didn’t choose 10mg of Paxil because there is no specification in terms of dosage when it comes to managing depression in children despite its close mechanism of action with Sertraline. The unclear dosage prompted me to leave out Paxil to avoid uncertainties that might arise from the drug reactions on the child (Poweleit et al., 2019). Wellbutrin 75mg wasn’t anywhere close to my choices due to its known contraindications in patients under 18 years. The 75mg dosage of Wellbutrin can be ideal when managing mature patients since it augments dopamine neurotransmitter levels in the brain tissue, enhancing cheerful humor.

I was optimistic about getting better patient outcomes when administering the dosage since the decision was made appropriate to the patient (Yang et al., 2017). However, the results were not as I had anticipated after the second assessment. I thought the dosage and choice of the drug were ideal as per the patient’s age. There was a need for an adjustment in the dosage or changing the medication. Ethically, enlightening the patient about the treatment options available and the respective aftermaths as required by informed consent affects the treatment plan (Yıldız, 2019 Examination of an African American Child Suffering From Depression Paper). If the sensitization is not done correctly, the patient might choose the wrong option, drastically affecting the treatment plan. An example, in this case, could be if the patient Paxil has no dosage specifications. Informed consent also affects the physician’s communication with the patient, like in instances of the language barrier or the patient not paying attention.

Second Decision

The three available options are introducing 10mg Prozac to be taken orally every day, increasing Zoloft dosage to 37.5mg daily, or increasing Zoloft to 50mg every day via the oral route. In this case, I prefer raising the Zoloft dosage to 37.5mg daily. I presume the patient’s disorder establishes making the first dosage of 25mg ineffective or showing slight improvements. The fact that Sertraline is the right drug for this case, only that the dosage should be modified, necessitated my decision to significantly increase the dosage by 12.5mg daily (Poweleit et al., 2019).

I didn’t go for the option of increasing Zoloft to 50mg daily drastically. Doubling the 25 dosages to 50mg might cause unpleasant aftermaths as the patient might fail to adapt to such a significant shift in the dosage instantly. Changing the initial drug to a new one isn’t a prudent idea for this eight-year-old child. The body is still adapting to Zoloft, so I didn’t want to introduce Prozac. Besides, Prozac and Zoloft have correlated mechanisms of action, and a 10mg dosage might only drag the patient’s recovery process (Powelet et al., 2019).

By increasing the dosage, my aim was for the patient to react positively to the slightly increased dosage. I wanted to attain changes in sad emotions since I expected Zoloft to have worked on the patient’s feelings via the neurotransmitter-inhibition mechanism (Powelet et al., 2019). Ethical considerations most likely to influence my treatment plan and communication with the patient is beneficence which encourages health care practitioners to always do good things for the patient like I did in opting to alter the medications by increasing the dosage a bit. The communication aspect can be affected by the principle of integrity, like in my case where I had to explain the effect of race on the patients. Being truthful involves patient-physician communication during the examination sessions (Yıldız, 2019).

Third Decision

The therapeutic options for decision three are maintaining the current dose, increasing the Zoloft dosage to 50g daily, or introducing a different serotonin reuptake inhibitor. I adopt increasing the Sertraline dosage to 50mg daily. The reason for my choice is to ensure a speedy recovery of the patient. The patient had shown mild improvements from decision two with the 37.5mg of Zoloft without any fallout. The patient’s body seems to have adapted well to the drug and the slight increment in dosage. More positive improvements are expected by increasing the dosage to 50mg (Poweleit et al., 2019).

The option of maintaining the 37.7mg dosage could still work, but the patient’s return to normalcy will be gradual. The patient will also be forced to use the drug for more extended periods to achieve the intended outcomes, creating a harmful habit of drug addiction to manage upcoming mood disorders. Introducing a divergent serotonin re-absorption inhibitor is not prudent at this stage since the drug has similar mechanisms of action as Sertraline. Besides, the body is already used to Zoloft, and changes are already being noticed, which incapacitates introducing a different therapeutic measure (Poweleit et al., 2019).

The patient’s responsiveness towards the drug is what spearheaded my decision (Yang et al., 2017). I was expecting to attain improved patient outcomes within the shortest time possible from the earlier assessment. The drug seemed to have worked well on the condition since the patient had already exhibited signs of recovery. I was hopeful that the body’s adaptation to the pill would cause a significant improvement with increasing the dosage so long as the instances of overdosing are avoided. The nonmaleficence ethical conduct affects the treatment plan of the patient, especially in drug and dosage selection. Whether to maintain the dosage and expose the patient to addiction harm or increase the dosage for a quicker recovery is solely influenced by ethics of practice. The informed consent whereby the provider is expected to educate the patient on the treatment options affects the communication between the psychiatrist and the patient depending on the prevailing circumstances (Yıldız, 2019).

Conclusion

Managing depression in children can prove challenging, but positive treatment outcomes are attained with care and sensitivity. It is noted that depression manifests in different ways, which, if not diagnosed early, can lead to tremendous health effects, for it is a cumulative disorder. In my therapeutic choices, I opted for Zoloft as the drug of choice in decision one. The known usage of Zoloft as a first-line drug in treating pediatrics depression and its dosage validated my choice (Poweleit et al., 2019). From the analysis, the drug seemed safe and effective in handling the case.

In the second and third responses, I opted to increase the dosage to 37.5mg daily and 50mg daily for the same drug. I chose to maintain the medication because I was sure it would work out; I focused on regulating the dosage. The healthcare prerequisites pioneered my decision to maintain the drug while altering the dosage (Krist et al., 2020). Also, the patient started showing positive signs of improvement, and hence there was no need to change the drug. The other drug options seemed to have possibilities of causing unsafe healthcare outcomes for the case.

Examination of an African American Child Suffering From Depression Paper References

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2020). Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. Jama, 323(22), 2301-2309. https://doi.org/10.1001/jama.2020.8020

Laureate Education (2016). Case study: An African American child suffering from depression. [Interactive media file]. Baltimore, MD: Author

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283. https://doi.org/10.9740/mhc.2018.11.275

Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B. (2019).

Pharmacogenetics of sertraline tolerability and response in pediatric anxiety and depressive disorders. Journal of child and adolescent psychopharmacology, 29(5), 348- 361. https://doi.org/10.1089/cap.2019.0017

Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., … & Xie, P. (2017). Efficacy and acceptability of cognitive-behavioral therapy for depression in children: A systematic review and meta-analysis. Academic Pediatrics, 17(1), 9-16. https://doi.org/10.1016/j.acap.2016.08.002

Yıldız, E. (2019). Ethics in nursing: A systematic review of the framework of evidence perspective. Nursing Ethics, 26(4), 1128-1148. https://doi.org/10.1177%2F0969733017734412

The Case Study: An African American Child Suffering From Depression Assignment Question

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: Essay Assignment NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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?

Decision #2

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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?

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.