Prescribing for Children and Adolescents
Post-traumatic stress disorder (PTSD) occurs after exposure to or witnessing a life-threatening event. People with the disorder experience difficulties coping with their routine activities. The signs and symptoms of the disorder are diverse. They include flashbacks, nightmares, responses to traumatic reminders, aversion towards the triggers, anxiety, altered cognition, and anhedonia. The onset of the manifestations can be delayed for more than a month since the exploration of the trigger factor. Early diagnosis of PTSD can facilitate the initiation of different interventions, pharmacological and non-pharmacological.
Pharmacological interventions entail both FDA-approved and off-label medication. An example of an FDA-approved medication is Sertraline. Sertraline belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs) (Zoellner et al., 2019). Its starting dose is 25 mg orally daily, which may be increased by the same dose weekly. The maximum daily dose of the drug is 200 mg (Zoellner et al., 2019). An example of an off-label medication is Prazosin. It belongs to a class of drugs called alpha-1 receptor antagonists (Reist et al., 2021). The starting dose is 1 mg orally at bedtime. The dose is adjusted based on response to a maximum of 15 mg per day (Reist et al., 2021). Psychotherapy is an example of a non-pharmacological intervention for PTSD. Studies have reported that trauma-focused psychotherapy yields similar or superior results to pharmacological therapy (Marseille et al., 2020). This encompasses strategies such as cognitive behavioral therapy and cognitive processing therapy. Therefore, both pharmacological and non-pharmacological approaches should be explored.
Two criteria can be used to guide treatment decision-making. The first approach is the utility of self-report scales. They include the DSM-5 checklist, Trauma symptom checklist, and distressing event questionnaire (American Psychological Association, 2017). The second approach is reviewing the patient’s past medical history to identify any contraindications. Sertraline increases the risk of suicidal thoughts and behaviors (Zoellner et al., 2019). Patients should be closely monitored. It has the merit of being among the first-line interventions with desirable results. Prazosin predisposes patients to syncope (Reist et al., 2021). It has shown stellar results in managing PTSD-related nightmares and sleep disorders. Psychotherapy has demonstrated superior outcomes to pharmacological interventions. However, it does not affect the long-term course of PTSD.
Elaborate clinical practice guidelines on the management of PTSD exist. The American Psychiatrist association and the USA Department of Veterans Affairs and Department of Defense guidelines for the basis of my research (American Psychological Association, 2017). The guidelines evaluate all pharmacological and non-pharmacological interventions. Selective serotonin reuptake inhibitors (SSRI) are recommended as the first-line management intervention for PTSD. Examples include Paroxetine Sertraline, and Fluoxetine (American Psychological Association, 2017). Furthermore, alpha-1 adrenergic antagonists are recommended for the management of PTSD-related insomnia and nightmares. An example is Prazosin (American Psychological Association, 2017). The guidelines prohibit the use of Benzodiazepines in the management of PTSD. Benzodiazepines are most likely to worsen the prognosis of the disorder. Non-pharmacological approaches listed include psychological first aid, cognitive behavioral therapy, and eye movement desensitization and reprocessing (American Psychological Association, 2017). These guidelines are the basis for my recommendations: Sertraline, an SSRI, Prazosin, an alpha-1 receptor antagonist; and psychotherapy in the management of PTSD.
Post-traumatic stress disorder (PTSD) occurs after exposure to or witnessing a life-threatening event. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, guides the diagnosis of PTSD. This is based on the presenting signs and symptoms. Pharmacological and non-pharmacological interventions facilitate the management of PTSD. Pharmacological interventions entail both FDA-approved and off-label medication. An example of an FDA-approved medication is Sertraline. An example of an off-label medication is Prazosin. An example of a non-pharmacological intervention is the use of psychotherapy.
References
American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD). Washington, DC: APA, Guideline Development Panel for the Treatment of Posttraumatic Stress Disorder in Adults., 139. https://doi.org/10.1162/jocn
Marseille, E., Kahn, J. G., Yazar-Klosinski, B., & Doblin, R. (2020). The Cost-Effectiveness Of MDMA-Assisted Psychotherapy for the Treatment of Chronic, Treatment-Resistant PTSD. PLoS ONE, 15(10 October), 1–14. https://doi.org/10.1371/journal.pone.0239997
Reist, C., Streja, E., Tang, C. C., Shapiro, B., Mintz, J., & Hollifield, M. (2021). Prazosin for Treatment of Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis. CNS Spectrums, 26(4), 338–344. https://doi.org/10.1017/S1092852920001121
Zoellner, L. A., Roy-Byrne, P. P., Mavissakalian, M., & Feeny, N. C. (2019). Doubly Randomized Preference Trial of Prolonged Exposure Versus Sertraline for Treatment of PTSD. American Journal of Psychiatry, 176(4), 287–296. https://doi.org/10.1176/appi.ajp.2018.17090995
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Question 
For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Prescribing for Children and Adolescents
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html
To Prepare
• Your Instructor will assign a specific disorder for you to research for this Assignment.
I was assigned Posttraumatic Stress Disorder.
• Use the Walden Library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
The Assignment (1–2 pages)
• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision-making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes, this will come in the form of formal studies and approvals for drugs in children. Other times, you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment will be considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?