Assessing and treating pediatric clients with mood disorders decision tree case study
Stahl (2013) argues that one of the best ways of understanding depressive symptoms among the pediatric clients defining them as a continuum. However, in the provided case, a diagnostic decision proves necessary for the purposes of defining the various needs and the reasons behind the treatment. According to Vitiello (2012), it is important that medical professionals adapt the key screening questions with respect to depression whenever undertaking a psychiatric evaluation Assessing and treating pediatric clients with mood disorders decision tree case study. For instance, the screening interrogations for depression may entail either a sad or irritable mood as well as anhedonia.
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In the current assessment of the pediatric client, it will be important to come up with a connection and a highly confidential relationship with the child. In order to capture or rather bring on board the underlying psychopathology, the best strategy will entail gathering information from as many participants as possible. However, if it will be necessary to prioritize a single information source, the symptoms will have to be internalized in general, and most particularly the depressive ones. Indeed, depressive symptoms tend to be reported frequently by the children when compared to the assigned caregivers or teachers. Assessing and treating pediatric clients with mood disorders decision tree case study.
Poznanski & Mokros (1996) have argued for the need to bring families on board during the process of assessing pediatric clients with mood disorders. They base their arguments on empirical studies that have demonstrated that including family during this kind of assessment and diagnosis in general enhances the process of understanding, preventing as well as treating depressive disorders among children. In the current pediatric diagnosis, the family assessment will take into account quite a number of sociocultural elements that seem to end up influencing the presentation and description together with interpretation of the symptoms. Other than focusing only on problems, positive aspects will also be taken into account, since they will be of great relevance in the process of planning therapeutic approaches.
During the assessment, caution will be taken with regard to the difficulties associated with diagnosing pediatric patients as compared to adolescents and older adults. This is based on the fact that the diagnostic criteria adopted in the current century were purposefully meant for diagnosing the adult population rather than the children. Furthermore, the diagnostic approaches have neglected quite a number of developmental differences that exist between children and adults. Rao (2013) argues that despite the current diagnostic approaches serving the needs of the older adults, there are quite a number of symptoms that demonstrate little applicability among the youths. Some of these symptoms include excessive guilt and suicidal ideation among others. Moreover, recognition of depression among the children and adolescents is quite low as compared to the case of adults. This possibly arises from factors like symptom fluctuations, the reactions of moods and high levels of irritability among others. The diagram illustrates the assessment procedure, retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462013000500004
Pharmacokinetic And Pharmacodynamic Processes
According to Magellan Health, Inc. (2013), every pediatric treatment addressing depression should be taken into account developmental aspects such as psychoeducation an family support among other risk behaviors. The current treatment will go the same way, though establishing clear objectives together with patients and their families will be one of the top priorities. This will not only be meant for the acute treatment with respect to the current episode, but extending to consolidation and maintenance aspects as well as monitoring and preventing the possibilities of new episodes. Assessing and treating pediatric clients with mood disorders decision tree case study.
In the same way depression is managed and treated among the adults, the current pediatric treatment will encompass psychoeducation and support measures which will assist in addressing mild episodes more satisfactory with target on environemtal stressors. The treatments will bring on board physical activities that are particularly meant for symptomatology among the pediatric clients, with lower levels of intervention that have significant effects. However, if the symptoms emerge to be quite intense, the entire treatment process will have to adapt more specific strategies that will facilitate the same.
The pharmacological treatment to be adopted will address both the acute phase and possible cases of relapse and recurrences. The acute case phase will entail therapeutic activities such as crisis stabilization with respect to psychosis, other related cases of suicidal behavior and agitation. Effective management of the pediatric client will require the use of medication while at the same time enhancing social skills and support from the family. The primary objective in this case will be achieving mood stabilization, since this will see the patient realizing his optimal development with respect to emotional, cognitive and social aspects.
Poznanski & Mokros (1996) have argued that the choice of the suggested medication will be based on the available scientific evidence, the state of mood and the availability of either suicidal or psychotic symptoms. Other factors to be brought on board under the same will include how aggressiveness of the client, the potential side effects, patient’s history with regard to drug response as well as the family’s preference. To some extent, adjunctive treatment with bupropion may be adapted, though it will have to be indicated with high more caution basing on the risk that is associated with inducing a manic switch.
In all cases, pediatric patients express significant differences in physiology impacting on such aspects like drug absorption, distribution and metabolism among other related cases of elimination. Assessing and treating pediatric clients with mood disorders decision tree case study. Indeed, is these factors that will determine the medication process to prescribe to the client.
According to Bartelink (2006), drug absorption (DA) in pediatric patients is impacted on by the process through which the organ systems mature. The pediatric gastrointestinal tract is characterized by such aspects like high levels of gastric pH, minimized intestinal motility and low rate of bile acid synthesis. There are also those characteristics that speeding up DA such as a thinner stratum corneum and higher water content. This implies that the child will be administered drugs that are in line with the absorption factors of their gastrointestinal tract. For instance, the IM injections will be given through the water-soluble drugs since they do not precipitate at the junction; will dissolve in the system. Since the client has a high surface area to weight, he will be subjected to transdermal absorption. Assessing and treating pediatric clients with mood disorders decision tree case study.
The volume of drug distribution significantly varies between children and adults, hence an important factor in determining medication for the client. As a pediatric patient, the client will be administered higher dose of drugs that are water soluble, since the bigger portion of his body weight is water.
Metabolism and Elimination
According to Al-Delaimy (2002), there is significant variation in metabolism and elimination of drugs among children and adults. For instance, the processes of oxidation, reduction and hydrolysis is quite high among pediatric patients as compared to adults, hence subjecting the client to medication that best suit the rate of his phase I metabolism. The same applies to phase II, which entails the processes of hydroxylation and conjugation. In addition to drugs, the client will be recommended for diet and special therapies that will positively alter metabolism and elimination of drugs administered to him.
Basing on the client’s pharmacokinetic and pharmacodynamic processes, there are three major decisions that will be made with regard to the medical decisions to prescribe to the child. These will include:
Use of Lithium Mood Stabilizers
The child can be prescribed traditional mood stabilizers by use of lithium medications. The choice of lithium will be based on the available empirical analysis, which has proven that the use of lithium has been effective in controlling mood disorders as well as preventing the recurrences of the same in future Assessing and treating pediatric clients with mood disorders decision tree case study. Therefore, the choice of this medication will be driven by the desire to achieve controlled mood disorders and further prevent the possible recurrences.
Brown (2000) argued that antiseizure medications were initially developed with the prime objective of combating epilepsy. Therefore, the adoption of antiseizure medication in the provided case will be guided by the positive effect they have always demonstrated on the symptoms of mood disorders. The adoption of this medication will have the objective of achieving mood-stabilization, acute treatment and getting rid of possible future occurrences of the mood disorder. Possibly, this decision will pave way for the adoption of two important drugs; valproate and carbamazepine.
According to Wladysiuk et al (2011), also known as new-generation antipsychotics, these drugs were initially developed with the aim of treating schizophrenia. Fortunately enough, these drugs have emerged more effective when treating mood disorders, just like in the current case of the African child. Similarly, prescribing atypical antipsychotics to the child will be aimed at stabilizing his moods as well as taking care of the associated acute symptoms, through risperidone and ziprasidone
During the entire psychiatric medication, I expect to come across ethical conflicts which will come into play between assisting the African child fully while at the same time respecting his autonomy optimally. As per the current situation, I will embark on respecting the client’s autonomy even if he may respond to the medication negatively.
Al-Delaimy, W. (2002). Hair as a biomarker for exposure to tobacco smoke. Tobacco Control, 11(3), 176. doi:http://dx.doi.org/10.1136/tc.11.3.176
Bartelink, I. H., Rademaker, C. M., Schobben, A. F., & van den Anker, J. N. (2006). Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations. Clinical pharmacokinetics, 45(11), 1077-1097.
Brown, M. B. (2000). Diagnosis and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of Counseling and Development : JCD, 78(2), 195-203. Retrieved from https://search.proquest.com/docview/219024311?accountid=45049
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from https://www.magellanprovider.com/media/11740/psychotropicdrugsinkids.pdf
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
Wladysiuk, M., Araszkiewicz, A., Godman, B., Szabert, K., Barbui, C., & Haycox, A. (2011). Influence of patient co-payments on atypical antipsychotic choice in poland. Applied Health Economics and Health Policy, 9(2), 101-10. doi:http://dx.doi.org/10.2165/11318840-000000000-00000 Assessing and treating pediatric clients with mood disorders decision tree case study.