Formal Decision Tree Instructions
Examine Case Study: An African American Child Suffering from Depression. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_02/index.html. 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.
• Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.
Body of your document
• The body of your document should contain three sections that are labeled as follows: decision #1, decision #2, and decision #3. Each section should address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.
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. *Ethical considerations must be clearly identified/labeled. You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.” Either option is acceptable.
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 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.
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.

An African American Child Suffering From Depression

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An African American Child Suffering From Depression

Introduction

Every human being must feel sad or low at one point in life, however, these feelings often pass with little time. Depression or major depressive disorder is a different case. It causes severer symptoms that affect how one thinks, behaves, and performs daily activities. Depression occurs at any stage when the patient is exposed to stressful situations (Kim, 2021). Depression is generally described as the feeling of sadness due to a mood or mental disorder. It can have detrimental effects on the life of the patient. It is associated with a feeling of sadness, social withdrawal, and lack of interest, among other things (Kim, 2021). People suffering from depression often experience difficulties completing their daily activities or duties. Mental illness affects a significant number of U. S. citizens.

In the presented case study, an 8-year-old African American male arrived at the emergency department showing signs of depression, accompanied by his mother. The patient complained of a feeling of sadness while the mother reiterated that he has been withdrawn from other children while at school (Poznanski & Mokros, 1996). The mother was told by the teacher that the child tends to stay lonely away from others. Furthermore, the patient experiences occasional periods of irritation and reduced appetite. Mental examination revealed that he is alert and orientedX3. He did not experience any visual or auditory hallucinations. This information as well as other factors such as age, weight, ethics, and patient preference must be taken into consideration when designing a treatment plan (Kim, 2021). This paper used the information presented in the case study and literature to discuss the best decisions to treat the patient.

 

Decision Point One

The selected decision is to begin Zoloft 25 mg orally daily. This decision was selected because it was deemed appropriate for the patient. Zoloft is a medication known as a selective serotonin reuptake inhibitor (Elbe et al., 2019). Mediation is used to treat major depressive disorder symptoms, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Zoloft works by rebalancing chemicals in the brain, such as serotonin, that normally appears imbalanced in people with depression (Elbe et al., 2019). It prevents the reuptake of serotonin by nerves, leading to an increase in serotonin concentrations within the nerve synapse.

The other two options were not selected because Zoloft is considered the best option in this case. For example, the use of Paxil in pediatric is not recommended, unlike Zoloft that is also used in the treatment of OCD in children. Paxil is only recommended for use in adults. Additionally, Paxil has more adverse effects compared to Zoloft (Elbe et al., 2019). On the other hand, Wellbutrin 75mg was a good option but it is associated with a higher risk of seizures. Also, Wellbutrin is cheaper compared to Zoloft. Therefore, Zoloft was considered the best option.

The expected result for this particular decision is to improve the symptoms of the patient to 50% and above. It was expected that the feeling of sadness would reduce to measurements below 50 percent on the HAM-D scale (Poznanski & Mokros, 1996). The patient was expected to improve sleep, stop withdrawn symptoms, and gain interest in certain things he used to love (Kim, 2021). Additionally, the patient’s mood is expected to reduce and perform daily activities successfully. However, the objectives were not achieved. The patient returned to the clinic after four weeks reporting a slight increase in mood, however, there were no adverse events.

Ethical considerations include allowing parents to participate in the decision-making processes, educating the family and the patient about their condition before giving medications, encouraging parents to support the child (Chenneville & Schwartz-Mette, 2020). Also, care providers must be respectful and empathetic with the patient. The treatment plan should not cause any harm to the patient.

Decision Point Two

The selected decision two is to Zoloft 25mg to Zoloft 50mg orally daily. The patient experienced a slight increase in mood, which propelled the need to increase the dose to 50mg. Unlike adults, children should have a start dose of 25mg when using Zoloft (Elbe et al., 2019). Adults usually begin from 50mg. The dose increases by 25mg based on the symptoms, patient condition, and adverse events. The physician or psychiatrist adjusts medication after proper assessment of the patient.

The other two options were not selected because they were not very appropriate for the case. For instance, Prozac 10mg could only be selected if there was a need to discontinue Zoloft. However, the patient’s progress did not provide any reason to discontinue Zoloft (Kim, 2021). Additionally, increasing Zoloft from 25mg to 37.5mg would have no significant impact on the patient’s illness. The best recommendation is either Zoloft 25mg or Zoloft 50mg.

The expected result at this point was evaluated in the fourth week when the patient returned to the clinic. The expected result was to improve the symptoms. They include improved moods, reduced symptoms of withdrawal, and improved sleep (Kim, 2021). The symptoms associated with a feeling of sadness and lack of interest are expected to reduce. The results of this decision were very promising. The patient experienced a 50% reduction of depressive symptoms (Poznanski & Mokros, 1996). This was a significant improvement. 50% symptom reduction is a good indicator that the therapeutic plan could be effective. My ethical considerations are beneficence, justice, autonomy, and non-maleficence (Chenneville & Schwartz-Mette, 2020). The parents should be allowed to make decisions after proper education.

Decision Point Three

The selected decision three include maintaining the current dose, which is 50 mg orally daily. Since the patient experienced 50% symptom improvement, which is considered a full response, there was no need to make adjustments or change the regimen. For that reason, the health care provider decided to maintain the dose for another four weeks and then monitor results (Elbe et al., 2019). There was no need to change to an SNRI since Zoloft was showing positive results.  Additionally, increasing the Zoloft dose to 75mg might result in adverse events putting the patient through unnecessary pain and risk of exacerbated symptoms and adverse events.

The expected result in decision point three (by maintaining the current dose) is to ensure full recovery of the patient (100% symptom improvement). For example, the feeling of sadness is expected to resolve completely. The patient is expected to have smooth sleep without disturbance due to depressive symptoms (Kim, 2021). The withdrawal symptoms are expected to end and the child to begin playing with others as needed. During the treatment, certain ethical considerations must be observed to ensure successful outcomes.

It is important as a therapist to practice within the defined expertise to avoid mistakes and errors. The principles of beneficence and non-maleficence should be observed. The treatment plan as well as the medications should only bring benefit to the patients while avoiding any harm (Chenneville & Schwartz-Mette, 2020). Fidelity and responsibility are also important ethical considerations.

Conclusion

Depression is also called a major depressive disorder. It leads to a severe feeling of sadness and lack of interest. Depression can affect any person of any age. People who are depressed may find it difficult to complete daily activities. The case study is about an 8-year-old African American male who arrived at the emergency department showing signs of depression, accompanied by his mother. The symptoms presented by the patient-matched those of depression. Three decisions were designed to help the patient recover. Decision point one was to begin Zoloft 25 mg orally daily. The results of this decision were evaluated in four weeks. The patients showed a slight increase in mood. This outcome was slightly against the expected results.

The second decision was to increase the dose to Zoloft 50mg orally daily. The decision indicated a positive result with 50% of the symptoms getting resolved.  The patient returned to the clinic four weeks after while feeling better. The expected result was similar to the actual results. Prozac was not selected for several reasons including its increased ability to cause seizures. The decision tree was to maintain the current dose (50 mg orally daily). There was no need to change or adjust the current regiment because it was showing a positive outcome. It is expected that the client will have recovered fully from the illness in the next four weeks.  Certain ethical issues must be considered for the treatment plan to be successful.

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References

Chenneville, T., & Schwartz-Mette, R. (2020). Ethical considerations for psychologists in the time of COVID-19. American Psychologist, 75(5), 644. https://doi.org/ 10.1037/amp0000661

Elbe, D., Black, T. R., McGrane, I. R., & Procyshyn, R. M. (2019). Clinical handbook of psychotropic drugs for children and adolescents. Hogrefe Publishing.

 Kim, Y.-K. (2021). Major depressive disorder: Rethinking and understanding recent discoveries. Springer.

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.