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Nursing, Pages: 4, Term paper

Management of Generalized Anxiety Disorder in Ten-Year-Old Patient

Management of Generalized Anxiety Disorder in Ten-Year-Old Patient

Finding an effective and safe medication is significant for patients with generalized anxiety disorder (GAD), such as children and adolescents (Munir & Takov, 2022). The case will involve choosing the appropriate drug for a boy with GAD who is ten years old: Management of Generalized Anxiety Disorder in Ten-Year-Old Patient.

Selection of Appropriate Medication and Rationale

To make a proper selection, the caregiver has to know the details of this patient and the possibilities of medication that can be recommended. Concerning the treatment of GAD in the described case of a 10-year-old boy, fluoxetine is the preferred medication. The efficacy and safety of fluoxetine as an antidepressant medication in the SSRI category in anxiety disorder for children is high. It has as well FDA approval to treat depression in children (Sohel et al., 2024).

It is usually prescribed for a variety of purposes outside its specification because there is evidence of the drug’s efficacy in managing anxiety disorders. Hence, for this patient’s continued anxiety, agitation, irritability, and concerns, fluoxetine is recommended.

Dosing Schedule and Therapeutic Goals

When prescribing fluoxetine to children, extra care should be taken, and the correct dosage should be given to prevent unintended side effects. In pediatric patients, the initial dose of fluoxetine is 10 mg per oral daily in the morning to prevent sleep disturbances (Sohel et al., 2024). Depending on response and tolerability, the dose may be gradually increased to 20 mg per oral once daily after one to two weeks and exclusively for treating symptoms as the objective.

Antidepressive effects can take from 8 to 12 weeks and may present with decreased anxiety, enhanced mood, reduced level of agitation, and improved functioning. Special monitoring is made during this process so that the patient gets to the desired therapeutic level while avoiding toxicity effects.

Patient and Family Education on Medication Use

Education of patients and their families is an essential component of pharmacologic care, especially among children. In the course of the educational session, they should be informed that fluoxetine can decrease manifestations of anxiety, stabilize the mood, and facilitate functioning. However, typical side effects, including gastrointestinal problems, headache, insomnia, and increased behavioral activity, should also be explained to the patient and the parent (Strawn et al., 2023).

There are few yet potentially severe adverse effects, like suicidal thoughts, in the early phase of the treatment, which implies the necessity of monitoring. Education of the child and the parent aids in building trust and ensures early detection of any adverse effects.

Laboratory Tests and Diagnostic Evaluations

An initial assessment of growth outcome indicators, including height and weight, is advised to establish the effects of the condition and medications on the child’s growth later on. Moreover, a proper psychiatric examination should be conducted to rule out any bipolar spectrum disorder and note the possible elevated mood and increased energy levels that may occur after using fluoxetine, as it may trigger a manic episode in some patients (Chen et al., 2022).

Other additional tests may be suggested if a patient shows signs of having medical conditions such as thyroid disorders or metabolic disorders; therefore, thyroid stimulating hormone (TSH) levels and metabolic profile tests could be encouraged. Medical assessment before providing medication helps reduce disregarded contraindication cases due to a robust initial check-up.

Monitoring Efficacy and Side Effects

Fluoxetine should be monitored in a young patient, as well as the effects of whether the drug is effective for this age group and the side effects. The first review should be conducted within two weeks of starting, after one month, and then until the patient stabilizes, focusing on change, side effects, and compliance. Hence, These should include the application of special pediatric anxiety rating scales to assess any developments, such as improvement or deterioration of the condition (Hilliard et al., 2024).

Apart from the changes in mood, behavior, sleep, and energy levels, it is also essential to track the parents’ observations to evaluate the effectiveness of the prescribed treatment plan. In special education, it is necessary to assess therapy at times to establish whether or not positivism has been made and whether the child has deteriorated.

Evaluation of Alternative Medication Options

A brief comparison of the other medications elucidates why quetiapine and duloxetine are not appropriate for this patient. Quetiapine is an atypical antipsychotic that has risks of metabolic syndrome, sedation, and extrapyramidal effects and hence should not be used as the first-line in treating pediatric anxiety (Chokhawala & Stevens, 2023).

The other drug, duloxetine, is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) and is sometimes prescribed to adolescents but has limited use in young children and is even more dangerous due to the side effects it is known to cause, including hypertension and liver function disorders. Therefore, quetiapine and duloxetine have additional risks not evident in fluoxetine, making fluoxetine the best option.

Interdisciplinary Collaboration and Family Education

To address GAD, healthcare providers need to work with other professionals to develop a network of care. The healthcare professional should educate the patient’s parents on the medical management plan, therapeutic behaviors, patient compliance, and dosages for the treatment (Aremu et al., 2022). Coordinating with the child’s primary health care provider helps ensure follow-up care and assessment of physical growth, development, and psychiatric health.

Cognitive-behavioral therapy may be a practical addition to pharmacological interventions since it behaviorally addresses anxiety. This enhances treatment effectiveness while ensuring that the family is provided support.

Addressing Nonadherence and Alternative Treatment Options

It is essential to plan and prepare for nonadherence issues in childhood psychopharmacology. Some specific inquiries would be to ask general open-ended questions regarding constraints in medication use, check on the child and parent’s understanding of the medication, and eliminate any possible adverse effects and stigma associated with the treatment plan. In case of related nonadherence, motivational interviewing techniques can bring the family back on track with the treatment plan.

Other possibilities may include dose reduction or focusing on intensified psychotherapy, such as cognitive behavioral therapy, in case maintenance of pharmacotherapy remains problematic (Nakao et al., 2021). This way, the child and family’s needs are considered, and active changes can be made to the treatment plan as the child grows.

Conclusion

In summary, the decision to prescribe fluoxetine to a 10-year-old male with GAD is justified, considering the non-risk profile and relevance to the patient’s symptoms and age. Understanding the risks and benefits of the process, intensive monitoring, and involvement of the broader network of caregivers help enhance therapeutic outcomes while avoiding adverse effects.

References

Aremu, T. O., Oluwole, O. E., Adeyinka, K. O., & Schommer, J. C. (2022). Medication adherence and compliance: Recipe for improving patient outcomes. Pharmacy, 10(5), 106. https://doi.org/10.3390/pharmacy10050106

Chen, C., Wu, L. S., Huang, M., Kuo, C., & Cheng, A. T. (2022). Antidepressant treatment and manic switch in bipolar I disorder: A clinical and molecular genetic study. Journal of Personalized Medicine, 12(4), 615. https://doi.org/10.3390/jpm12040615

Chokhawala, K., & Stevens, L. (2023, February 26). Antipsychotic medications. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519503/

Hilliard, W., Kearney, K., Lucas, S., & Flores, M. E. D. (2024). Improving diagnostic strategies for pediatric anxiety disorders: Advice for the clinician. Psychology Research and Behavior Management, 17, 4035–4042. https://doi.org/10.2147/prbm.s431337

Munir, S., & Takov, V. (2022, October 17). Generalized anxiety disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441870/

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w

Sohel, A. J., Shutter, M. C., Patel, P., & Molla, M. (2024a, February 28). Fluoxetine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459223/

Strawn, J. R., Mills, J. A., Poweleit, E. A., Ramsey, L. B., & Croarkin, P. E. (2023). Adverse effects of antidepressant medications and their management in children and adolescents. Pharmacotherapy the Journal of Human Pharmacology and Drug Therapy, 43(7), 675–690. https://doi.org/10.1002/phar.2767

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Question 

Special Considerations for Patient Populations Paper

To complete this assignment, you will utilize the case study assigned to you by faculty for a patient population for special consideration during prescribing practices. You will consider the specific patient and determine the appropriate medication to prescribe, based on the patient specifics and medication attributes in various case studies.

You will construct a 4- to 5-page paper in which you determine the medication, the dosing, necessary patient education, and potential side effects. You will also indicate why the other medications would not be appropriate, as well as any necessary labs or diagnostics that might be needed. You will develop a plan to enhance medication adherence for the nonadherent patient.

Special Considerations for Patient Population Case:

  • Patient 4: 10-year-old male who comes in with his father. He has been diagnosed with generalized anxiety disorder. He has constant worries that he cannot control. He feels nervous and tense. He is easily irritable. He struggles to settle down or relax. He is also quite fidgety and restless. He and his father are interested in medications to manage these symptoms. Med List: quetiapine, duloxetine, fluoxetine
TO PREPARE:

  • Review the Learning Resources.
  • Carefully review your assigned vulnerable population patient.
  • Carefully review the medication list to determine the best medication to prescribe.
  • Consider the implications, impact, advantages, and disadvantages of the listed medications.

    Management of Generalized Anxiety Disorder in Ten-Year-Old Patient

    Management of Generalized Anxiety Disorder in Ten-Year-Old Patient

THE ASSIGNMENT (4–5 PAGES)

You are to write a paper on your assigned Patient Population Case. (Case assignments are shown below.) Your paper cannot exceed five pages. Points are deducted as shown in the grading rubric if your document exceeds five pages.
Your paper must follow the APA format adopted by the nursing program. You must use a minimum of five peer-reviewed, evidence-based scholarly references outside of course resources. In your paper you are required to:
  • Determine which medication would be most appropriate to prescribe to your patient. You are to choose a medication from the three medication choices listed at the end of the case you were assigned. (For patient #4, the medication list to choose from is quetiapine, duloxetine, fluoxetine).
  • Explain your rationale for choosing this medication.
  • Explain the dosing schedule for the specific patient including the therapeutic endpoint.
  • Provide necessary education to the patient to review risks, benefits, and potential side effects of the medication.
  • Describe any necessary labs or additional diagnostics needed prior to prescribing this medication.
  • Explain how you might monitor efficacy or side effects of the medication.
  • Explain why the other medications listed are not appropriate for this patient.
  • Include any additional collaboration or education to others that would be necessary for this patient. Consider family members, home health care, primary care providers, etc.
  • What would you need to include in your assessment for a patient who may become nonadherent with your prescribing plan for your scenario? What are alternative treatment solutions based upon how you assessed? Describe your new treatment plan.

CASE STUDY NO MORE than 5 pages (not including title page and references)