Psychiatric Diagnosis and Management: Child

Psychiatric Diagnosis and Management: Child

 

Response to Brewer

Hello Brewer,

I have read your informative and instructional post. To ensure safe prescribing, factors to consider include; evidence-based prescribing,  prescribing within capability limits, and dosage checking. Effective drug prescription necessitates comprehension of the pharmacodynamic, pharmacokinetic, and pharmacogenomic interrelations (Anker, Reed, Allegaert, & Kearns, 2018). The physician should also define the child’s or adult’s problem, categorize the therapeutic objective, and choose the suitable drug treatment. Other psychotropic medications include mood stabilizers, anti-anxiety medications, stimulants, and antipsychotics. Psychiatric ailments in the geriatric populace might have a varying presentation than in the adult and child populations. Psychiatrists require proper training to recognize and manage the psychiatric illnesses in this population and other populations.

Notably, there has been a continuous upsurge in the geriatric populace globally, particularly in developing states. This population is more likely to develop psychiatric ailments due to augmented stress in later life, age-connected brain alterations, and physical illnesses. Understanding the pharmacokinetic changes in absorption, metabolism, excretion, and distribution with age is crucial. With age, slow absorption of drugs and action onset are apparent. Certain metabolism methods and hepatic blood flow also decrease with age. The main groups of drugs used in the geriatric population are antipsychotic medications, antidepressant medications, mood stabilizers, benzodiazepines and other anxiolytics, and anti-dementia drugs. Age-related body changes in the elderly population necessitate different psychiatric drug prescriptions. Mental disorders in adult populations include schizophrenia, bipolar affective disorder, somatoform disorder, and unipolar depression (Vitiello & Davico, 2018). There are substantial variances between adults and children in drug disposition that impact drug dose-up routines. Some dosing regimens are triggered by physiological changes, age, and others related to the ailment. Child pharmacology varies from adult pharmacology. Among other factors, physicians should prescribe the medications based on the patient’s demands, age, and needs.

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References

Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25. https://doi.org/10.1002/jcph.1284

Vitiello, B., & Davico, C. (2018). Twenty years of progress in pediatric psychopharmacology: accomplishments and unmet needs. Evidence-Based Mental Health, 21(4), e10-e10. http://dx.doi.org/10.1136/ebmental-2018-300040

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– Brewer

COLLAPSE

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Evidence supporting the pharmacological treatment of child and adolescent psychiatric disorders has increased over the last several decades (Saddock et al., 2007). While prescription of any medication requires a comprehensive assessment, an evidence-based approach, and a plan for how to measure treatment outcomes, prescribing psychiatric medications to children and adolescent carries additional risk (Saddock et al., 2007). The risks vs benefits of prescribing in the pediatric population have greater consequences than ever before, as numbers of children and adolescents diagnosed with mental disorders continues to increase. The National Institute of Health (NIH) has funded research initiatives comparing outcomes for children and adolescents who received psychosocial and/or psychopharmacological interventions (Saddock et al., 2007). First-line treatments have been identified in regard to prescribing psychotropic medications for childhood mental disorders such as OCD, major depressive disorder, and ADHD (Saddock et al., 2007). In the United States, approval from the Food and Drug Administration, as well as an evidence-based body of literature, provide a safer environment for all pediatric providers.

Two classes of psychiatric medications spark particular debate when used in pediatrics – antidepressants and second-generation antipsychotics. The Food and Drug Administration recommended in 2004 that a black-box warning be placed on antidepressants warning of a related suicidality increase in pediatric patients (Saddock et al., 2007). Second-generation antipsychotics are known to have an increased risk of adverse metabolic effects such as hyperlipidemia (Vitiello & Davico, 2018). Concern for the use of stimulants in younger children drove the need for more extensive research investigating correlation between stimulant and substance abuse later in life (Vitiello & Davico, 2018).

Kaplan and Saddock’s Synopsis of Psychiatry identifies three areas in which physiologic differences between children/adolescents and adults impact pharmacokinetics – hepatic capacity, glomerular filtration, and amount of fatty tissue (Saddock et al., 2007). These differences cause commonly prescribed psychiatric medications such as stimulants, antipsychotics, and tricyclic drugs to be eliminated more rapidly in children and affect drug storage in fat accumulations (Saddock et al., 2007). Rapid drug elimination from the human body reduces the half life expectancy of medications and requires adjustment and titration of dosages to provide appropriate coverage for children and adolescents (Saddock et al., 2007). Whereas in the adult population blood and plasma serum levels can be monitored to indicate how drug metabolism is affecting treatment response, the same concepts cannot be applied to children and adolescents (Saddock et al., 2007).

As the efficacy and safety of the most utilized psychotropic medications for childhood disorders continue to be studied, it is the goal for treatment interventions to better target neurodevelopmental outcomes for these vulnerable populations (Vitiello & Davico, 2018). Future advances in neuroscience and their integration into clinical practice can greatly impact treatment approaches in the years to come.

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References

Sadock, B. J., Kaplan, H. I., & Sadock, V. A. (2007). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins.

Vitiello, B., & Davico, C. (2018). Twenty years of progress in paediatric psychopharmacology: accomplishments and unmet needs. Evidence Based Mental Health, 21(4), e10–e16. https://doi.org/10.1136/ebmental-2018-300040

Reply

Appendix C1 & C2: Discussion Question Response #1 and #2 15 points per response

 

Assignment Description

Each student submits a response to the Discussion Board question. This is done in the appropriate module discussion board in Blackboard (Course Objectives 1-8).

 

Assignment Objectives

The student will:

1. Synthesize the evidence-based literature for the week (learning opportunities, other identified resources);
2. Apply synthesized knowledge to understand the posted question;
3. Demonstrate understanding by developing a written response to the question; and
4. Demonstrate appropriate application of technology for communication and learning.

 

Assignment Steps

To complete this assignment:

1. Read the posted question.
2. Use the assigned readings and other resources to develop a written response to the question.
3. Post the developed response to the appropriate week discussion board in Blackboard by the date assigned in the course calendar.

 

Assignment Evaluation

Each Discussion Board Response will be evaluated according the to the following rubric:

 

Criterion	Possible
Relevance	4	Response addresses the prompt.
Evidence Based	4	Response identifies and synthesizes the evidence in the literature, including DSM 5.
Critical Thinking	5	Review demonstrates critical thinking.
Mechanics	2	Writing is logical, APA 7th used; no errors in spelling, grammar, citations or references.

 

 

Required text book

Yalom, I. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.