Depression in Children
Child with Depression
Child with Depression
Decision Tree
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.
•
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Mother reports that teacher said child is withdrawn from peers in class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.
The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
Decision #1 (1 page)
• Which decision did you select? Begin Zoloft 25mg daily (only medicine FDA approved for children – the other 2 options are not)
• 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. After 4 weeks, client returned:
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 #2 (1 page) I increased Zoloft to 50g
• 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.
RESULTS OF DECISION POINT TWO (after increasing Zoloft to 50mg)
Client returns to clinic in four weeks
Depressive symptoms decrease by 50%. Client tolerating well
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 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.
Guidance to Student
At this point, sufficient 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
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
References
Howland RH. (2008). Sequenced treatment alternatives to relieve depression (STAR*D): part 2: study outcomes. Journal of Psychosocial Nursing & Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05
Dowd, E. T., & Stovall, S. D. L. D. (2001). Children’s Depression Rating Scale, Revised. The Fourteenth Mental Measurements Yearbook.
Rao, U. (2013). Biomarkers in pediatric depression. Depression and Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.2217110.
