Case Study: Psychopharmacologic Approaches to Treatment of Psychopathology Essay

Case Study: Psychopharmacologic Approaches to Treatment of Psychopathology Essay

Case Study: Psychopharmacologic Approaches to Treatment of Psychopathology Essay

Assessing and treating patients with ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by hyperactivity, impulsivity, and inattention. Such symptoms can significantly impede a child’s ability to undertake daily tasks. The clinical presentation of ADHD varies among individuals based on factors such as age group, gender, and unique circumstances (Magnus et al., 2023). Recognizing the diverse manifestations of the disorder is crucial for accurate diagnosis and effective management strategies.

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The case is about Katie, an 8-year-old Caucasian girl, who is being assessed for possible ADHD based on observations made by her school teacher. The teacher’s report, documented through the “Conner’s Teacher Rating Scale-Revised,” describes a child who struggles academically and exhibits forgetfulness, easy distractibility, and limited attention span. These academic and attention-related difficulties contrast Katie’s account of a positive home environment and a good relationship with her parents. However, she does acknowledge occasional moments in school where she becomes engrossed in thoughts that compete with her immediate academic tasks.
Katie’s parents’ reluctance to acknowledge the ADHD possibility underscores a prevailing misunderstanding of the disorder, often associating it solely with overt hyperactivity. Their stance accentuates the importance of enlightening families about ADHD’s diverse presentations, especially the inattentive type. A deeper dive into Katie’s mental status does not reveal any significant neurological or psychiatric red flags. Her cognitive and emotional responses align with her age. Nonetheless, the preliminary diagnosis of “Attention deficit hyperactivity disorder with predominantly inattentive presentation” calls for a meticulous evaluation to map out the best therapeutic interventions. Making medication decisions for young patients like Katie demands a holistic view, incorporating her age, symptoms, potential medication side effects, academic challenges, and the imperative of continuous monitoring. The overarching therapeutic goal is alleviating her symptoms, bolstering her educational journey, and ensuring holistic well-being. Weighing the benefits against potential medication risks is crucial.
Decision #1
Administer the patient with 10 mg chewable methylphenidate (Ritalin) tablets to take first thing in the morning. Based on the results of clinical trials, which consistently show methylphenidate to be a good starting treatment for ADHD in kids (Moran, 2023), this decision was made. Research has shown that Ritalin, a short-acting methylphenidate formulation, is quite effective. It not only has comparatively minor side effects but also significantly reduces symptoms like impulsivity, hyperactivity, and inattention in children with ADHD (Mechler et al., 2021). By treating Katie’s primary symptom of inattention, the goal of prescribing stimulant medication such as Ritalin is to help her focus better and perform better academically.
The options Wellbutrin XL (bupropion) and Intuniv extended-release were not selected as the treatment options for Katie since these medications are typically not the first choice for pediatric ADHD patients. Methylphenidate is more effective in managing symptoms of pediatric ADHD, making it a more appropriate initial option (Kazda et al., 2021). My goal with prescribing Ritalin is to reduce Katie’s lack of focus and improve her academic performance. Additionally, I will closely monitor for potential side effects such as decreased appetite, sleep disturbances, or abdominal discomfort and adjust dosage accordingly to minimize these effects.
In pediatric ADHD management, ethical considerations hold great importance. As a PMHNP, I must ensure that Katie and her parents understand the advantages, drawbacks, and potential side effects of Ritalin. Emphasizing collaborative decision-making while respecting their values and preferences is of utmost priority. Regular evaluation will be conducted to assess the efficacy of medication and adjust the treatment plan as necessary. Maintaining confidentiality remains essential; however, involving Katie’s parents in her treatment journey is equally vital. Ultimately, our goal is to provide both Katie and her family with the necessary knowledge and resources for effective management of ADHD symptoms.

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Decision #2
Based on Katie’s current response and symptom presentation after the initial treatment, she should switch to Ritalin LA 20 mg, which should be taken orally in the morning. Katie’s teacher observed a significant improvement in her symptoms during the mornings following the administration of Ritalin. However, her inattention symptoms became noticeable again by the afternoon. This pattern suggests that while Ritalin effectively addresses her symptoms, its effect does not last throughout the school day. Prescribing Ritalin LA, an extended-release form of methylphenidate designed explicitly for sustained therapeutic effects, can provide symptom control for Katie throughout her school hours (Coghill et al., 2023).
The cardiovascular concerns raised should not be overlooked. Katie’s mention of her heart experiencing strange sensations and the subsequent discovery of her tachycardia (130 beats per minute) are significant indicators. There is a possibility that stimulant medications can lead to an increase in heart rate. However, switching to Ritalin LA might provide a smoother and more consistent release of medication, potentially reducing the cardiovascular side effects she encountered. On the other hand, Adderall XR, which contains a combination of amphetamine salts, has been linked to a more pronounced profile of cardiovascular side effects when compared with treatments containing methylphenidate (Wolraich et al., 2019). Feedback from Katie and her parents plays a crucial role in the decision-making process. They acknowledge the advantages of Ritalin but also express legitimate worries about its potential side effects. Transitioning to Ritalin LA addresses both the requirement for efficacy and concerns regarding safety, striving for a more well-rounded therapeutic strategy.
From an ethical perspective, it is crucial to prioritize the principle of informed consent. Open communication with Katie and her parents is necessary to ensure they fully comprehend the reasoning behind switching medications, the anticipated advantages, and any possible adverse effects. One must consider their preferences, values, and concerns when making treatment decisions. Additionally, regular monitoring should be prioritized due to potential side effects associated with stimulants. This will promote Katie’s well-being and help reassure her parents while fostering trust in the therapeutic approach.
Decision #3
I would go with maintaining the current treatment plan, which is to continue taking Ritalin LA at the current dosage of 20 mg and reevaluate in four weeks, depending on the patient’s clinical condition and medication response. ADHD medication management should be tailored to the patient’s response and side effect profile (Drechsler et al., 2020). Ritalin LA may not need to be increased now because Katie’s academic performance has improved, and her reports of feeling “funny” in her heart have decreased. Moreover, increasing the dosage might make adverse effects like drowsiness and decreased appetite more likely (Carucci et al., 2021). There is no need to adjust the medication or dosage in light of the significant improvement and sufficient symptom control. Therefore, physicians should try to prescribe stimulants that have the lowest possible level of efficacy.
It is not necessary to get an EKG based on her current heart rate because her pulse has returned to normal, and her complaints of having a “funny” heart have stopped. It is recommended that patients with established medical conditions that may result in cardiac side effects from stimulants have their ECG monitored (Torres-Acosta et al., 2020). In this case, the child does not exhibit any such risk factors. To reduce the likelihood of side effects and improve academic performance, I intend to maintain Katie’s Ritalin LA dosage at the current level. Regular reevaluations also allow for ongoing monitoring of her response and possible adverse effects.
In this case, ethical concerns include ensuring Katie and her family are fully informed about the benefits and risks of the medication as well as their values and choices. Getting informed consent for interventions and protecting privacy and confidentiality are also essential. Effective communication is critical to establishing a therapeutic alliance and facilitating shared decision-making with Katie’s family.

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Conclusion

Based on Katie’s symptoms, I recommend transitioning her to Ritalin LA 20 mg orally each morning. This choice is based on the observation that Ritalin has been effective in improving her symptoms in the mornings but loses its effect by the afternoon, indicating a short duration of action. By using Ritalin LA, an extended-release formulation, she will experience consistent therapeutic coverage throughout the day, which aligns better with her school hours. Furthermore, considering Katie’s reported cardiovascular concerns, it would be beneficial to opt for a medication like Ritalin LA that offers smoother drug release. On the other hand, Adderall XR may not be as suitable in this context due to its side effect profile and potential impact on cardiovascular health.
This approach considers input from Katie and her parents while prioritizing efficacy and safety. The goal is to manage symptoms while minimizing potential side effects effectively. Maintaining Katie’s well-being, academic performance, and overall quality of life are critical priorities in this treatment plan. Open communication with Katie and her family is crucial throughout the therapeutic process, along with regular monitoring, to ensure informed decision-making involving collaboration between all parties. This recommendation reflects current best practices by addressing patient-specific needs supported by evidence from primary literature sources.

References
Carucci, S., Balia, C., Gagliano, A., Lampis, A., Buitelaar, J. K., Danckaerts, M., Dittmann, R. W., Garas, P., Hollis, C., Inglis, S., Konrad, K., Kovshoff, H., Liddle, E. B., McCarthy, S., Nagy, P., Panei, P., Romaniello, R., Usala, T., Wong, I. C. K., … Zuddas, A. (2021). Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 120, 509–525. https://doi.org/10.1016/j.neubiorev.2020.09.031
Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., Daley, D., Danckaerts, M., Dittmann, R. W., Doepfner, M., Ferrin, M., Hollis, C., Holtmann, M., Paramala, S., Sonuga-Barke, E., Soutullo, C., Steinhausen, H.-C., Van der Oord, S., Wong, I. C. K., … Simonoff, E. (2023). The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry, 32(8), 1337–1361. https://doi.org/10.1007/s00787-021-01871-x
Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics, 51(05), 315–335. https://doi.org/10.1055/s-0040-1701658
Kazda, L., Bell, K., Thomas, R., McGeechan, K., Sims, R., & Barratt, A. (2021). Overdiagnosis of attention-deficit/hyperactivity disorder in children and adolescents: A systematic scoping review. JAMA Network Open, 4(4), e215335. https://doi.org/10.1001/jamanetworkopen.2021.5335
Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2023). Attention Deficit Hyperactivity Disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441838/
Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 230(107940), 107940. https://doi.org/10.1016/j.pharmthera.2021.107940
Moran, L. V. (2023). Long-term safety of methylphenidate in children with ADHD. The Lancet. Psychiatry, 10(5), 306–307. https://doi.org/10.1016/s2215-0366(23)00092-5
Torres-Acosta, N., O’Keefe, J. H., O’Keefe, C. L., & Lavie, C. J. (2020). Cardiovascular effects of ADHD therapies. Journal of the American College of Cardiology, 76(7), 858–866. https://doi.org/10.1016/j.jacc.2020.05.081
Wolraich, M. L., Hagan, J. F., Jr, Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & Subcommittee On Children And Adolescents With Attention-Deficit/Hyperactive Disorder. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-2528

Case Study: Psychopharmacologic Approaches to Treatment of Psychopathology (waldenu.edu)

ASSESSING AND TREATING PATIENTS WITH ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

THE ASSIGNMENT: 5 PAGES

Examine Case Study: A Young Caucasian Girl with ADHD. 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.

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.

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.

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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.

 

Case study: Psychopharmacologic Approaches to Treatment of Psychopathology (waldenu.edu)