Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample

Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample

Individuals exposed to one or more traumatic severe episodes like emotional abuse, sexual or physical assault, serious accidents, or natural disasters may develop post-traumatic stress disorder (PSTD) as children and adolescents. Keeshin & Strawn (2017) note that the Diagnostic and Statistics Manual of Mental Disorders fifth edition (DSM-5) has made revisions to the diagnostic criterion of PSTD to focus more on sensitivity to developmental milestones than its predecessors. Phone survey statistics conducted in the US indicate that up to 80% of children and adolescents will encounter a minimum of one traumatic event in their childhood. The data underscores the need for mental health and psychiatric practitioners to incorporate broad-based and effective interventions using a multimodal therapeutic approach while prescribing measures to resolve trauma-specific symptoms. Therefore, the paper recommends an FDA-approved drug, an off-label drug, and pharmacological intervention for treating and managing minors diagnosed with PSTD.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

      Recommended FDA-approved Drug, Off-Label Drug, and Non-Pharmacological Intervention for Treating PSTD in Children and Adolescents

Sertraline (Zoloft) 25 mg or 50 mg daily is recommended as the initial treatment with 25 mg to 50 mg incremental increase every week to reach a maximum dosage of 200 mg for child patients suffering from PSTD is FDA– approved (Krystal et al., 2017). Prazosin is an antiadrenergic agent that has demonstrated efficacy; hence its endorsement for off-label use alleviates PSTD symptoms like nightmares, general irritability, and aggressive behaviors (Ferrafiat et al., 2020). Lastly, trauma-focused psychotherapy, like cognitive processing therapy, is a non-pharmacological intervention recommended in treating PSTD in children (Shafi et al., 2019). Being a subtype of Cognitive-behavioral Therapy (CBT), CPT is a first-line treatment recommended for minors with PSTD, particularly if addressing the chronic effects of childhood traumas.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

The Risk Assessment Mental Health Provider Would Use To Inform the Treatment Decision Making

Risk factors for childhood PSTD development include being of the female gender, the number of traumatic episodes experienced, increased exposure to the index trauma, and parental psychopathology. Additional factors are social support (particularly parent support and the presence of pre-existing psychiatric comorbidities (Soria-Saucedo et al., 2018). Screening should proceed with an assessment to establish the minor has a history of trauma and the presence of trauma-related symptoms. A positive screening of the client demands more action where an assessment recognizes and defines the struggles that emerge to help develop a suitable treatment plan (Soria-Saucedo et al., 2018). The treatment plan should also ensure informed and collaborative decisions concerning treatment placement.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

The Risks and Benefits of the FDA-Approved Medicine

Frakt (2018) opines that every drug has risks, and FDA approval does not waiver the risks inherent in a specific drug. Some drugs show safety risks after their release, yet the FDA could take up to four years to warn unsuspecting consumers. The approval of other drugs is laden with conflict of interest issues as some of the pharmaceutical companies that submit their medications to the approval also contribute part of the funds that run the activities of the FDA.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

The benefits of prescribing FDA-approved drugs are that one can be sure that FDA has conducted a thorough evaluation of the risks of the medication and benefits for that user based on robust scientific data. The approved drug labeling offers vital information about the drug, like the specific disease and conditions the drug is approved to treat and how to use the drug in treating those particular conditions.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

The Risks and Benefits of the Off-Label Drugs

Off-label drug prescribing may carry serious risks the likelihood of the patient developing severe adverse effects since the appropriate dosing and mechanism of action remains unclear primarily to the scientific research community. Besides adverse drug reactions, the prescriber may face legal action if a patient sued them after treatment has gone awry. However, several benefits of prescribing off-label drugs are that the provider can treat a disease or condition with no medication. For example, chemotherapy may be approved to treat a type of cancer, but the provider may use it to treat a different kind of cancer. The prescriber may also use a medication approved only in capsule form yet use an oral solution instead. (Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)

      Clinical Practice Guidelines for PSTD in Children and Adolescents

· There is a CPG for treating PTSD in adults, but none exists to date in the case of children and adolescent populations. Some of the recommendations I like to see included in CPG for PTSD for Children are effects and dosage of recommended drugs to manage children living with PTSD since children are not miniature adults.    (Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)                                                            

References

Danielson, C. K., Cohen, J. R., Adams, Z. W., Youngstrom, E. A., Soltis, K., Amstadter, A. B., & Ruggiero, K. J. (2017). Clinical decision-making following disasters: Efficient identification of PTSD risk in adolescents. Journal of abnormal child psychology, 45(1), 117-129.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample) URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075270/

Ferrafiat, V., Soleimani, M., Chaumette, B., Martinez, A., Guilé, J. M., Keeshin, B., & Gerardin, P. (2020). Use of prazosin for pediatric post-traumatic stress disorder with nightmares and sleep disorder: case series of 18 patients prospectively assessed. Frontiers in psychiatry, 11, 724.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample) URL: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00724/full

Frakt, A. B. (2018). The Risks and Benefits of Expedited Drug Reviews. Jama, 320(3), 225-226.URL: https://jamanetwork.com/channels/health-forum/fullarticle/2760039

Keeshin, B., & Strawn, J. R. (2017). Pharmacologic considerations for youth with post-traumatic stress disorder. Journal of the Korean Academy of Child and Adolescent Psychiatry, 28(1), 14-19.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample) URL: https://www.jkacap.org/journal/view.html?doi=10.5765/jkacap.2017.28.1.14

Krystal, J. H., Davis, L. L., Neylan, T. C., Raskind, M. A., Schnurr, P. P., Stein, M. B., … & Huang, G. D. (2017). It is time to address the crisis in the pharmacotherapy of post-traumatic stress disorder: a consensus statement of the PTSD Psychopharmacology Working Group. Biological psychiatry, 82(7), e51-e59.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample) URL: https://www.ptsd.va.gov/professional/articles/article-pdf/id48035.pdf

Shafi, R., Bieber, E. D., Shekunov, J., Croarkin, P. E., & Romanowicz, M. (2019). Evidence-based dyadic therapies for 0-to 5-year-old children with emotional and behavioral difficulties. Frontiers in psychiatry, 10, 677. (Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample)URL: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00677/full

Soria-Saucedo, R., Chung, J. H., Walter, H., Soley-Bori, M., & Kazis, L. E. (2018). Factors that predict the use of psychotropics among children and adolescents with PTSD: Evidence from private insurance claims. Psychiatric Services, 69(9), 1007-1014.(Prescribing for Children and Adolescents Diagnosed with Posttraumatic Stress Disorder Comprehensive Nursing Paper Sample) URL: https://www.koreascience.or.kr/article/JAKO201710758143110.pdf