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

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.

The Assignment

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:
  • 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
    • 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.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Sample Expert Answer

Assessing and Treating Pediatric Clients With Mood Disorders

The patient who visited the healthcare facility is an 8-year-old African American boy exhibiting signs of depression. The patient noted that he feels sad. His mother reported that, according to his teacher, the child is withdrawn from peers in class (Laureate Education (2016e). The mother also notes that the patient experiences occasional irritation periods and decreased appetite. During the clinical interview, the child had clear speech, was spontaneous, goal-oriented, and alert.

The clinical interview revealed that the child is not delusional or paranoid. He often thinks of himself as dead. When the Children’s Depression Rating Scale was administered, a score of 30 was obtained, indicating that the kid has significant depression (Laureate Education (2016e). As a result, three decisions were made to treat the patient, as discussed below.

Decision 1

My first decision was recommending that the child begin Zoloft 25 mg orally daily. I selected the decision because Zoloft is a drug belonging to selective serotonin reuptake inhibitors (SSRIs) and used to treat depression, panic disorder, post-traumatic disorder (PTSD), obsessive-compulsive disorder, and anxiety (Lorberg, Davico, Martsenkovskyi & Vitiello, 2019). The authors recommend that when prescribing Zoloft to children, a caregiver should prescribe 25 mg. I was hoping to reduce the patient’s symptoms by 50%, as Lorberg et al. (2019) suggested.

I expected to reduce the patient’s depressive symptoms significantly. However, the client returned to the facility in four weeks, arguing that he did not see any changes after taking the medications as prescribed. The decisions were different because the patient did not respond to the mediations. As a result, I was forced to re-think my decision and make new recommendations.

Decision 2

The second decision was increasing the dose to 37.5 mg orally daily. According to Stahl (2014b), if the first Zoloft prescription does not make significant changes, the dosage can be increased by 12.5 mg. Therefore, I increased the dosage to 37.5 mg orally daily to improve the effectiveness of the medication. I hoped that the second decision would reduce the depressive symptoms experienced by the kid by 50%.

Improving the dosage of any SSRI medication can significantly affect a patient by reducing depressive systems (Stahl, 2013). However, my expectations and the results were different. The patient returned four weeks later and reported that the depressive symptoms decreased by 20% and felt somehow better. Though my full expectations were not achieved, the patient started regaining his optimal health.

Decision 3

The third decision was to increase the Zoloft dosage to 50 mg orally daily. I made this decision because of the results of decision point two. I through that increasing Zoloft dosage to50 mg orally daily would further reduce the depressive symptoms experienced by the patient.  I decided to hope to improve the current patient’s health condition by 30%. However, sufficient symptom reduction was not realized after four weeks of usage. The patient had not experienced a 50% symptom decrease after taking the medication for eight years. The medication can either be increased or the therapy changed to another agent (Lorberg et al., 2019).

Ethical Considerations

To make decisions, the following ethical considerations should be considered because they might impact treatment plans. The first consideration is patient informed consent. The nurse must ask for consent before prescribing medications to the patient (Resnik, MacDougall & Smith, 2018). Second, the nurse should respect the patient’s autonomy and how his mother to decide on his health.

References

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

Lorberg, B.,  Davico, C.,  Martsenkovskyi, D., & Vitiello, B. (2019).  Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

Resnik, D. B., MacDougall, D. R., & Smith, E. M. (2018). Ethical dilemmas in protecting susceptible subpopulations from environmental health risks: Liberty, utility, fairness, and accountability for reasonableness. The American Journal of Bioethics, 18(3), 29-41. https://www.tandfonline.com/doi/abs/10.1080/15265161.2017.1418922

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. https://stahlonline.cambridge.org/prescribers_guide.jsf

Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level  assignment writers.Use Coupon: NEW30 to Get 30% OFF Your First Order

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 Point One

• Begin Zoloft 25 mg orally daily

Results Of Decision Point One

•  Client returns to clinic in four weeks
•  No change in depressive symptoms at all

Decision Point Two

• Increase dose to 37.5 mg orally daily

Results Of Decision Point Two

•  Client returns to clinic in four weeks
•  Depressive symptoms decrease by 20%. Client reports feeling a little bit better

Decision Point Three

• Increase to 50 mg orally daily
• Guidance to Student

At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.

Decision Point One

• Begin Paxil 10 mg orally daily

Results Of Decision Point One

•  Client returns to clinic in four weeks
•  Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea

Decision Point Two

• Decrease dose for 7 days then return to previous 10 mg day dose

Results Of Decision Point Two

•  Client returns to clinic in four weeks
•  Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose

Decision Point Three

• Change to a different SSRI

Guidance to Student

Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.

Decision Point One

• Begin Wellbutrin 75 mg orally BID
• RESULTS OF DECISION POINT ONE
•  Client returns to clinic in four weeks
•  Child is unable to fall asleep at night

Decision Point Two

• Change from immediate release to extended release 150 mg orally daily in the morning

Results Of Decision Point Two

•  Client returns to clinic in four weeks
•  Child’s sleep patterns return to baseline. No change in depressive symptoms

Decision Point Three

• Maintain current dose for another 4 weeks
• Guidance to Student

You can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Guide to Treating Depression in African American Children: A Case Study Approach to Medication, Therapy, and Cultural Sensitivity

Introduction

Depression in children is a growing concern, particularly among African American youth who face unique cultural, socioeconomic, and systemic challenges. This article explores a real-world case study of an 8-year-old African American boy diagnosed with major depressive disorder, examining treatment decisions, pharmacogenetic considerations, and culturally competent care.

1. Understanding Pediatric Depression in African American Children

Key Statistics

Source: CDC, SAMHSA

Cultural and Social Factors

• Exposure to racism and discrimination
• Socioeconomic stressors
• Underdiagnosis due to atypical symptom presentation

2. Case Summary: An African American Child with Depression

Patient Profile:

• Age: 8 years
• Symptoms: Sadness, withdrawal, decreased appetite, irritability
• Assessment Tool: Children’s Depression Rating Scale (CDRS) score of 30

Initial Treatment Options:

• Sertraline 25 mg daily
• Paxil 10 mg daily (contraindicated)
• Wellbutrin 75 mg twice daily (risk of seizures)

Decision: Sertraline 25 mg daily

Source: Online Nursing Papers

3. Pharmacogenetic Considerations in African American Populations

Genetic Variability

African American children may metabolize SSRIs differently due to CYP450 enzyme variations.

Clinical Guidance

• AACAP recommends caution with pharmacogenetic testing in children due to limited evidence
• Race-based screening is controversial and may reinforce stereotypes

4. Medication Titration and Monitoring

Second Decision Point:

• Increase Sertraline to 50 mg daily
• Rationale: 25 mg below therapeutic threshold

Third Decision Point:

• Maintain 50 mg dose due to 50% symptom reduction
• Avoid switching to SNRI or increasing dose prematurely

Outcome: Continued improvement expected over next 4 weeks

5. Integrating Cognitive Behavioral Therapy (CBT)

Why CBT Works

• Addresses negative core beliefs
• Builds racial pride and empowerment
• Reduces internalized racism and stereotype threat

Culturally Adapted CBT Techniques

• Downward arrow technique to uncover race-related core beliefs
• Positive data logs to reinforce self-worth
• Historical review of racial identity development

Source: Beck Institute

6. Ethical and Consent Considerations

Legal Framework

• Children under 14 cannot legally consent to treatment
• Parental involvement is mandatory

Ethical Responsibilities

• Inform parents of risks and benefits
• Monitor compliance and side effects
• Respect cultural beliefs and stigma around mental health

7. Addressing Mental Health Disparities

Barriers to Care

• Mistrust of healthcare system
• Lack of culturally competent providers
• Insurance and access limitations

Solutions

• Community-based interventions
• School-based mental health programs
• Training clinicians in cultural humility

8. Recommendations for Clinicians

Conclusion

Treating depression in African American children requires more than just prescribing medication. It demands a nuanced understanding of cultural identity, genetic variability, and ethical responsibility. By integrating pharmacological care with culturally adapted CBT and family engagement, clinicians can offer holistic and effective treatment.

References

• Case Study Source
• AACAP Policy on Pharmacogenetics
• Beck Institute on CBT and Racism
• CDC Youth Suicide Data
• SAMHSA Mental Health Statistics

Frequently Asked Questions (FAQs)

1. What are the signs of depression in African American children?

African American children may exhibit:

• Persistent sadness or irritability
• Withdrawal from family or peers
• Changes in appetite or sleep
• Difficulty concentrating
• Somatic complaints (e.g., headaches, stomachaches)

These symptoms may be misinterpreted due to cultural stigma or atypical presentation.

2. How does racial discrimination impact mental health in African American youth?

Studies show that both personal and vicarious racial discrimination are linked to:

• Increased anxiety and depressive symptoms
• Lower self-esteem
• Higher risk of internalizing disorders

Early exposure to racism can shape core beliefs and coping mechanisms.

3. What medications are commonly prescribed for pediatric depression?

• Fluoxetine (Prozac) – FDA-approved for children 8+
• Sertraline (Zoloft) – Often used off-label
• Escitalopram (Lexapro) – Approved for adolescents

SSRIs are typically first-line, but dosage and response vary by individual and genetic profile.

4. Are African American children metabolizing antidepressants differently?

Yes. Genetic variations in CYP450 enzymes (e.g., CYP2D6, CYP2C19) may affect drug metabolism. This can lead to:

• Altered efficacy
• Increased side effects
• Need for personalized dosing

Pharmacogenetic testing may help but should be used cautiously in children.

5. Is pharmacogenetic testing recommended for African American children?

Not routinely. The AACAP advises against using pharmacogenetic testing to select psychotropic medications in children due to limited evidence. Race-based screening is also discouraged due to genetic diversity within racial groups.

6. How effective is CBT for African American children with depression?

Cognitive Behavioral Therapy (CBT) is highly effective when culturally adapted:

• Addresses internalized racism and stereotype threat
• Builds racial pride and empowerment
• Uses techniques like positive data logs and historical review

CBT can be paired with medication for optimal outcomes.

7. What role does family play in treatment?

Family involvement is crucial:

• Enhances trust and compliance
• Helps monitor symptoms and side effects
• Addresses cultural stigma around mental health

Therapists should engage caregivers in psychoeducation and treatment planning.

8. What are the barriers to mental health care for African American children?

• Mistrust of healthcare systems
• Lack of culturally competent providers
• Financial and insurance limitations
• Stigma within communities

Community-based and school-based interventions can help bridge these gaps.

9. Can trauma-focused CBT address cultural trauma?

Yes. TF-CBT has been proposed as a framework to address cultural trauma in African American youth:

• Builds resilience and positive self-image
• Mitigates effects of systemic oppression
• Incorporates mentoring and empowerment strategies

10. What ethical considerations are involved in treating pediatric depression?

• Children cannot legally consent; parental involvement is required
• Clinicians must respect cultural beliefs and stigma
• Transparent communication about medication risks and benefits is essential