NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Sample Answer for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders Included After Question

TO PREPARE FOR THIS ASSIGNMENT:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy.

THE ASSIGNMENT: 5 PAGES

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

• Depressive disorder causes and symptoms
• How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
• Medication considerations of medication examples prescribed (see last bullet item)
• What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
• Where to follow up in your local community for further information
• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing CenterLinks to an external site. provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632)Links to an external site.. All papers submitted must use this formatting.

A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Title: NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

NURS 6630 ASSESSING AND TREATING VULNERABLE POPULATIONS FOR DEPRESSIVE DISORDERS

Major Depressive Disorder is a mental health condition that affects millions of people worldwide.  Depression can range from mild to severe, and its symptoms can be both acute and chronic. It can affect people of all ages, genders, and backgrounds and can have a significant impact on individuals, families, and society as a whole.

Depression is one of the leading causes of disability worldwide and can increase the risk of other health problems, such as heart disease, diabetes, and substance abuse. Fortunately, depression is a treatable condition, and various therapies, including medication, psychotherapy, and lifestyle changes, can help manage its symptoms.

Depressive Disorder Causes and Symptoms

Depressive disorder, also known as major depressive disorder, is a common mental health condition that is characterized by feelings of sadness, hopelessness, and a loss of interest in activities that were once enjoyable.

There is no single cause of depressive disorder, but it is believed to be a combination of biological, genetic, environmental, and psychological factors (Kakhramonovich, 2022). Some of the biological factors that can contribute to depressive disorder include an imbalance of chemicals in the brain, such as serotonin, norepinephrine, and dopamine.

The symptoms of depressive disorder can vary from person to person, but typically include feelings of sadness, hopelessness, and a lack of interest in activities that were once enjoyable. Other common symptoms include fatigue, changes in appetite or sleep patterns, difficulty concentrating, feelings of worthlessness or guilt, and thoughts of suicide or self-harm (Kakhramonovich, 2022). These symptoms can have a significant impact on an individual’s daily life, affecting their ability to work, socialize, and maintain relationships.

Depression in Adolescents

Adolescents are considered a vulnerable population when it comes to the diagnosis of depression because they are in a stage of development where they are undergoing significant changes, physically, emotionally, and mentally. Depression can be difficult to diagnose in adolescents because they may not be able to express their feelings in a way that is easily understood by others.

Additionally, adolescents may not recognize that what they are feeling is depression or may feel embarrassed or ashamed to seek help (Daly, 2022). To diagnose depression in adolescents, mental health professionals typically conduct a thorough assessment that includes a review of the adolescent’s medical history, a physical exam, and a psychological evaluation.

During the psychological evaluation, the clinician may use various assessment tools, such as self-report questionnaires, interviews, and observation, to evaluate the adolescent’s symptoms and assess the severity of their depression.

The criteria for diagnosing depression in adolescents are similar to those for adults and include a persistent feeling of sadness or emptiness, loss of interest or pleasure in activities, changes in appetite or weight, difficulty sleeping or oversleeping, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and thoughts of death or suicide (Daly, 2022). To be diagnosed with depression, these symptoms must be present for at least two weeks and must significantly impair the adolescent’s ability to function in daily life.

Medication Treatment Options

When it comes to treating depression in adolescents, medication is an option that can be considered after a thorough assessment by a mental health professional. Medications used to treat depression are known as antidepressants and work by changing the levels of certain chemicals in the brain that are responsible for mood regulation. 

Antidepressants that have been approved by the FDA for use in adolescents include selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor XR) (Park & Zarate, 2019). These medications have been found to be effective in reducing depressive symptoms in adolescents, although they do come with some risks and potential side effects.

One potential risk associated with the use of antidepressants in adolescents is the increased risk of suicidal thoughts and behaviors, particularly during the early stages of treatment. Therefore, it is crucial that adolescents taking antidepressants are closely monitored by their mental health professional and caregivers. Other potential side effects of antidepressants can include weight gain, sleep disturbances, sexual dysfunction, and gastrointestinal problems.

Therapy, lifestyle changes, and support from family and friends should also be a part of the treatment plan. The decision to use medication should be made on a case-by-case basis, weighing the potential benefits against the risks and side effects (Park & Zarate, 2019). Additionally, it is important to involve the adolescent and their family in the decision-making process and to ensure that they have a good understanding of the risks and benefits of medication treatment.

Medication Considerations

When prescribing medication for depression in adolescents, there are several aspects that should be taken into account. These include the severity of the symptoms, the potential benefits and risks of the medication, the patient’s medical history and current medications, and the patient’s personal preferences and beliefs (Park & Zarate, 2019).

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) are commonly prescribed antidepressants for adolescents. These medications work by increasing the levels of serotonin in the brain, which can help to regulate mood.

When writing a prescription for an antidepressant medication, it is important to include the following information:

1. The name of the medication: For example, “Fluoxetine 20 mg tablets.”
2. The dosage and instructions for use: For example, “Take one tablet by mouth every morning with food.”
3. The duration of the prescription: For example, “Dispense 30 tablets with one refill, to be taken daily for four weeks.”

Here are three examples of how to write a proper prescription for an antidepressant medication:

1. Fluoxetine 20 mg tablets: Take one tablet by mouth every morning with food, dispense 30 tablets with one refill, to be taken daily for four weeks
2. Sertraline 50 mg tablets: Take one tablet by mouth every day, preferably in the morning, dispense 30 tablets with two refills, to be taken daily for six weeks
3. Escitalopram 10 mg tablets: Take one tablet by mouth every day, with or without food, dispense 30 tablets with one refill, to be taken daily for eight weeks

Importance of Lab Tests

When prescribing medication for depression in adolescents, it is important to monitor their labs and any comorbid medical issues they may have. This is important for several reasons. One reason is that some antidepressant medications can cause liver damage. Therefore, it is important to monitor liver function with regular blood tests.

This is especially important for adolescents who are taking other medications that can also affect the liver. If liver function is impaired, the dosage of the antidepressant may need to be adjusted or the medication may need to be switched to a different one (Oh et al., 2019). Another important lab to monitor is the complete blood count (CBC).

Some antidepressant medications can cause changes in blood cell counts, such as a decrease in white blood cells or platelets. This can increase the risk of infection or bleeding, respectively. Regular CBC monitoring can help catch these changes early and allow for appropriate management.

Special Considerations

Legal considerations refer to the laws and regulations that govern the prescribing of medication for minors. In many cases, parents or legal guardians must provide informed consent before a medication can be prescribed for a minor. It is important to ensure that this consent is fully informed and that the parents or guardians understand the potential risks and benefits of the medication.

Additionally, it is important to be aware of any state or federal laws that govern the prescribing of certain medications to minors (Evans & Erickson, 2019). It is important to consider issues such as autonomy, beneficence, non-maleficence, and justice. Healthcare professionals must ensure that they are acting in the best interests of the adolescent while respecting their autonomy and rights as a patient. Additionally, healthcare professionals must ensure that they are not causing harm to the adolescent and that the medication is being prescribed in a just and equitable manner.

Before prescribing medication in healthcare, it is important to consider their cultural background and beliefs. For example, some cultures may view mental illness differently than others, and may have different beliefs about the effectiveness of medication. Healthcare professionals should work to understand and respect these cultural beliefs, and tailor their treatment approach accordingly.

Adolescents from marginalized communities may face additional barriers to accessing mental health care, including lack of insurance, transportation, and language barriers (Evans & Erickson, 2019). It is important to consider these social determinants of health when prescribing medication for adolescents with depression, and to work to address these barriers in order to ensure that all adolescents have access to appropriate care.

Follow-up

One potential resource is my local community health center. These facilities often provide mental health services for adolescents and may have healthcare professionals on staff who can provide more information about the legal, ethical, cultural, and social considerations involved in prescribing medication for this population (Park & Zarate, 2019).

One may also want to reach out to local mental health advocacy organizations, such as the National Alliance on Mental Illness (NAMI) or Mental Health America. These organizations can provide information and resources related to mental health, including medication options for adolescents with depression.

Conclusion

Prescribing medication for patients with depression necessitates considerations of the legal, ethical, cultural, and social factors that can impact treatment outcomes. By taking these special considerations into account, healthcare professionals can ensure that they are providing the best possible care for their patients.

It is also important to remember that there are resources available in the local community, such as community health centers, mental health advocacy organizations, schools, and healthcare providers, that can provide further information and support related to medication treatment for adolescents with depression. By working together and building a network of support, we can improve outcomes for adolescents with depression and promote mental health and wellbeing for all.

References

Evans, C. R., & Erickson, N. (2019). Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008. Social Science & Medicine, 220, 1-11. https://doi.org/10.1016/j.socscimed.2018.10.019

Daly, M. (2022). Prevalence of depression among adolescents in the U.S. from 2009 to 2019: Analysis of trends by sex, race/Ethnicity, and income. Journal of Adolescent Health, 70(3), 496-499. https://doi.org/10.1016/j.jadohealth.2021.08.026

Kakhramonovich, T. P. (2022). Epidemiology of Pysichiatric Disorders. Texas Journal of Medical Science, 12, 102-105. https://doi.org/10.15863/tas.2021.10.102.61

Oh, J., Yun, K., Maoz, U., Kim, T., & Chae, J. (2019). Identifying depression in the national health and nutrition examination survey data using a deep learning algorithm. Journal of Affective Disorders, 257, 623-631. https://doi.org/10.1016/j.jad.2019.06.034

Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559-568. https://doi.org/10.1056/nejmcp1712493

Depressive disorders are usually familial recurrent mental conditions associated with increased mortality and morbidity. Timely diagnosis and appropriate treatment have been reported to reduce the impact of the disorder on vulnerable populations with reduced risks of substance abuse, suicide, and persistent depressive disorder later in life (Mullen, 2018).

Evidence-based treatment interventions have been developed comprising both the use of medication and psychotherapy to guide clinicians to improve the outcome of the given population. The purpose of this paper is to provide a patient medication guide for the assessment and management of depressive disorder among the pediatric population.

Causes and Symptoms

Depression can be described as a mood disorder characterized by feelings of sadness, hopelessness, or irritability (Tsehay et al., 2020). Most children develop depressive disorders due to a combination of several factors.

The risk factors are not able to account for depressive disorder independently but contribute to its development. Such risk factors include chronic or severe medical conditions, stressful events at school, at home, or with a friend, growing up in a chaotic or stressful environment, family history, and biochemical imbalances.

Childhood depression is more similar to adult depression in terms of clinical presentation. However, different patients may present different symptoms depending on the level of development of the mood disorder, comorbidities, course of treatment, and outcome (Hetrick et al., 2021).

Despite pediatric patients being unable to verbalize their feeling of depression, some of the common symptoms will include irritability, crankiness, social withdrawal, continuous feeling of hopelessness and sadness, changes in appetite, changes in sleep, concentrating difficulties, fatigue and low energy levels, feeling of worthlessness, and suicidal ideation.

Diagnosis of Depression in Children

Depression is one of the most common mental problems affecting children with approximately 3% of children in the United States dealing with a mood disorder (Tsehay et al., 2020). Children consequently lack the right to autonomous decision making which has made studies on the most effective diagnostic tools limited, for timely diagnosis of this vulnerable population. The diagnosis of childhood depression is thus based on the findings of a comprehensive psychiatric evaluation of the patient conducted by a psychiatrist among other mental health professionals (Vadukapuram et al., 2022).

The comprehensive psychiatric evaluation will also assess the risks or presence of any comorbidities such as anxiety and conduct disorder. Consequently, contextual factors like school problems, family environment, and interpersonal difficulties must also be assessed the role of contributing factors. The administration of questionnaires and interviews with the child’s parents and teacher is crucial for the development of the contextual factors mentioned above. Common screening tools for childhood depression include the Beck Depression Inventory and Patient Health Questionnaire for Children and Adolescents.

Medication Treatment Options

The management of depression in children can be done by either both pharmacotherapy or psychotherapy. The determination of which treatment approach to adopt depends on the diagnostic findings of the mood disorder, as either mild, moderate, or severe. Psychotherapy alone is recommended by most clinical guidelines for the management of the mild depressive disorder in children for at least 1 to 4 weeks (Vadukapuram et al., 2022). The most common psychotherapeutic approaches recommended for children include cognitive behavioral therapy (CBT), interpersonal therapy, dialectical behaviour therapy, and family therapy.

For children with mild to severe depression, the use of psychotherapy together with medication is usually recommended. The choice of which medication to prescribe usually depend on the available evidence, patient characteristics, the severity of depression, comorbidities, and response to reamendment among other factors.

Due to the limited evidence, only a few drugs under selective serotonin reuptake inhibitors (SSRIs) have been approved by the FDA for the management of depression in children including Fluoxetine, Escitalopram, Sertraline, and Fluvoxamine, depending on the pediatric patient’s age group (Lorberg et al., 2019). However, clinicians are advised to ensure that the benefits outweigh the risks of the drug for positive outcomes, given the high risks of suicidality among children on SSRIs. The following table provides the available evidence on antidepressants recommended for children:

Table 1: Antidepressants for Children with Depression

Selective Serotonin Reuptake Inhibitors (SSRIs)	Level of Evidence	FDA Approbation	Side Effects
Fluoxetine	A+	Approved	GI disturbances, insomnia, and headache
Escitalopram	A	Approved	GI disturbances, nausea, insomnia, and headache
Sertraline	A	Approved	GI disturbances, insomnia, dizziness, and headache
Fluvoxamine	A	Approved	GI disturbances, insomnia, nausea, and headache

Medication Considerations

Due to the high risk of side effects with the use of SSRIs in children, a low starting dose is usually recommended, with an increment of the dose or a change of the drug regimen done only after 4 weeks of treatment (Lorberg et al., 2019). The dose should only be increased with the minimal improvement of the patient’s symptoms.

In case of a lack of response or intolerable side effects, the treatment regimen should be changed. For consideration with the use of specific drugs, fluoxetine is associated with reduced weight gain, while escitalopram and fluvoxamine are discouraged for use by children less than 12 years due to side effects of weight loss and reduced appetite. Sertraline on the other hand should be observed for risks of suicidal ideation.

Medication Monitoring

Therapeutic drug monitoring for children on SSRIs is very crucial to avoid incidences of toxic reactions and adverse events. The FDA recommends clinical monitoring of children on SSRIs at least weekly after initiation of treatment for the first four weeks, then after every two weeks for the following four weeks, then at 12 weeks, then as indicated clinically henceforth (Hetrick et al., 2021).

Monitoring parameters are based on the possible side effects and response to the medication including the risk of suicidal ideation and weight loss among others. The serum concentration of the drug and pulse rate should be closely monitored for patients with comorbid medical conditions like kidney disease.

Special Considerations

The FDA has outlined several special considerations with the use of SSRIs among pediatric patients due to the increased risks of suicidality (Zhou et al., 2020). Legal considerations are associated with the off-label use of SSRIs among patients below the age of 18 years, given their lack of right to consent which has been delegated to their parents or caregivers.

Ethical considerations are associated with the patient’s right to information regarding their short-term and long-term risks and side effects. Since certain cultural factors can also impact the significance of using SSRIs with pediatric patients, genetic testing is necessary for patients who display poor outcomes with the medication. Finally, considering the patient’s social determinants of health such as socioeconomic status is also crucial for prescribing affordable drugs to promote patient compliance.

Follow-up

Pediatric patients on antidepressants are usually required to report back to the clinic after four weeks for follow-up evaluation and adjustment of the treatment regimen. However, to help with the management of childhood depression at home, parents are advised to seek further information from local community resources like mental health hospitals and psychiatric centers (Mullen, 2018).

Additional community resources can be accessed online at home including the National Alliance on Mental Illness,  National Suicide Prevention Lifeline, AACAP Resource Centre for Depression and Depression in Children and Adolescents – Facts for Families.

Prescription Writing

Writing a proper prescription for patients with mental disorders is crucial to avoid incidences of medication errors. For instance, the prescriber must countercheck and confirm that all the information in the prescription is accurate including date, name of patient and address, patients age, name of clinician, address and DEA number, drug name strength dosage form, and quantity prescribed, direction for use, refill number and prescriber’s signature (Zhou et al., 2020).

The second way of writing a proper prescription involves the use of computerized provider order entry to reduce the risks of medical errors. The last approach is by avoiding the use of abbreviations which might lead to confusion during administration by the patient or dispensing by the pharmacist.

Examples of Prescriptions

Pediatric Health Centre Address Date:6/12/2022 Patients Name: Jack Zadnick Address: DOB: Jan 27, 2012 Allergies: NKDA RX: Fluoxetine 10mg orally every morning for two weeks. Dispense 14 tabs Refills: 2 weeks Prescribers initials and Signature:

Pediatric Health Centre Address Date: 8/12/2022 Patients Name: Sharon Mat Address: DOB: March 23, 2014 Allergies: NKDA RX: Sertraline 25 mg orally once every day for 14 days Dispense 14 tabs Refills: biweekly Prescribers initials and Signature.

Assessing and Treating Vulnerable Populations for Depressive Disorders

Major depression is a mental disorder among most of the American population. Depression affects health, wellbeing and quality of life of the patients and their families. Psychiatric practitioners should be competent in the assessment, diagnosis, treatment, monitoring, and evaluation of depression.

They should be able to select evidence-based treatments for vulnerable populations for their recovery and health. Therefore, this essay examines depression among the elderly populations. It focuses on topics such as causes and symptoms, diagnosis, medication treatment options, monitoring and special considerations.

Causes and Symptoms of Depression

Depression among the elderly is attributed to several causes. One of the causes is genetics. An elderly patient born to a family with a history of major depression is at a risk of developing the disorder because of the role of genetics. Chronic illnesses also contribute to the development of major depression. For example, the experiences with health issues such as cancer or chronic obstructive pulmonary disease predispose patients to major depression.

The use of alcohol and other drugs can also cause depression. Substance use and abuse may produce side effects, which include major depression. Traumatic experiences in life also cause major depression. Patients with histories such as loss of a significant other, job, or undergoing challenges such as a divorce also increases the risk of developing major depression.

Imbalances in the neurotransmitters and hormones in the brain also cause major depression. Imbalances in hormones such as acetylcholine and dopamine predispose individuals to major depression (Trenoweth, 2022). Similarly, any disruption in the levels of neurotransmitters such as serotonin and norepinephrine also cause major depression.

The elderly patients suffering from major depression experience several symptoms. One of them is feeling sad in most of the days, nearly every day. They also raise a significant decline in their interest or pleasure nearly every day. The patients also report weight gain from increased appetite or loss because of decline in appetite. They also experience slowed thought processes, fatigue, and feel worthless or guilty almost every day.

The depressed mood makes it hard for them to concentrate or make decisions. In some cases, patients report recurrent suicidal thoughts, attempts, with or without a plan. A comprehensive history taking reveals that the symptoms are not because of a medical condition, medication use or substance abuse (Trenoweth, 2022). In addition, the symptoms affect the normal functioning of the patients in their environments.

Diagnosis

The diagnosis of major depression in the elderly patients require a detailed history taking and physical assessment. History taking provides subjective information about the disorder to the practitioner. The psychiatric nurse asks questions that quantify the existence and severity of a health problem. History taking provides insights into potential causes of major depression such as family history of the disease, substance abuse, a history of depression, and the patient experiencing a traumatic event.

Physical examination provides subjective information about the disorder. The practitioner relies on methods such as inspection, palpation, percussion, and auscultation. There are also the use of diagnostic and laboratory investigations in physical assessment. The investigations help rule out other potential causes of major depression symptoms in this population (Alshawwa et al., 2019). Nurse practitioners use both subjective and objective assessments to develop accurate diagnoses of their clients’ problems.

The elderly are considered a vulnerable population when diagnosing and treating mental health problems. First, they are a vulnerable population because of their increased predisposition to multiple comorbidities. Besides major depression, the elderly people also have a high risk of developing chronic conditions such as hypertension, heart failure, and dementia. The elderly patients are also a vulnerable population because of their decline in productivity. Social and occupational productivity decline with aging.

The elderly patients have limited involvement in most of the social and occupational roles. As a result, their access to healthcare and other social opportunities is low, making them a vulnerable population. Aging is also associated with decline in physiological functioning. Accordingly, the elderly patients have reduced functioning of the vital organs such as the liver and kidneys. The reduced functioning alters the normal processes such as drug metabolism and excretion (Saedi et al., 2019). The changes places them at a high risk of drug toxicity in disease management, hence, them being a vulnerable population.

Medication Treatment Options

Pharmacotherapy is the gold approach to depression treatment in the elderly patients. The treatment phases are three. They include acute, continuation, and maintenance phase. Prescription of drugs for this population should consider their environmental and social contexts.

For example, the availability of adequate social support and socialization improves outcomes in the elderly patients suffering from major depression. Most of the elderly patients have pre-existing comorbid conditions such as diabetes and heart failure (Hoel et al., 2021). As a result, the treatment options for major depression should be considered for safety and quality outcomes.

Antidepressants are the primary drugs of choice in major depression among the elderly. Tricyclic antidepressants such as amitriptyline, desipramine, and nortriptyline are used in some patients. However, patients should be monitored for cardiac and cognition abnormalities. Selective serotonin reuptake inhibitors have a high preference rate for major depression in the elderly patients because of their safety and efficacy levels.

Patients should be monitored closely for falls, insomnia, weight gain, and suicidal thoughts and attempts among patients (Li et al., 2021; Miller et al., 2020). The FDA approved antidepressants for use among the elderly patients with major depression include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion.

Medication Considerations

Practitioners can consider several medications for treating major depression among the elderly patients. They include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion. The other options for the disorder are venlafaxine, amitriptyline, desipramine, and nortriptyline (Li et al., 2021; Miller et al., 2020). Practitioners should always weigh the risks and benefits associated with the different classes of medications utilized for major depression.

Monitoring

Psychiatric mental health nurse practitioners should monitor patients for the side effects associated with the prescribed medications. The use of antidepressants have side effects such as dizziness, constipation, nausea, insomnia, headache, and sexual dysfunction. Patients should be informed that these side effects improve over time. It is important to monitor patients for any cognitive or cardiac abnormalities with the use of tricyclic antidepressants.

The risk of falls is also high with the use of antidepressants. Fall risk assessment should be undertaken before prescribing antidepressants to mitigate the risk. Laboratory investigations for serum electrolytes should also be undertaken. Drugs such as selective serotonin reuptake inhibitors increase the risk of hyponatremia due to the development of syndrome of inappropriate antidiuretic hormone secretion.

The risk of suicide with antidepressants is also elevated. Follow-up should seek to establish if the patient has developed suicidal thoughts, plans, or attempts (Krause et al., 2019; Perini et al., 2019). Weight changes should also be monitored with the use of antidepressants. Excessive weight gain may predispose the elderly to comorbidities such as diabetes, cardiovascular complications, and fractures.

Special Consideration and Follow-Up

Some special considerations influence the choice of treatment for major depression in the elderly patients. As identified initially, most of the elderly patients also suffer from comorbid conditions and decline in physiological processes. The risk of harm during the treatment is high. Psychiatric mental health nurse practitioners must ensure the use of evidence-based treatments that align with the patients’ needs.

The focus should be on ensuring quality and safety of the treatment, hence, benevolence and non-maleficence. The treatment of major depression in this population may also demand care coordination. Care coordination requires sharing of information among the different healthcare providers involved in disorder management. As a result, practitioners must ensure data privacy and confidentiality.

They should seek informed consent from the patients before sharing any information with the healthcare providers, hence, the protection of autonomy in the care process. Follow-up care is often after four weeks of the first and subsequent treatments (Kupfer, 2005; Pilotto et al., 2020). Patients can benefit from community resources such those by the American Psychological Association and the Centers for Disease Control and Prevention.

Example of Prescriptions

Po escitalopram 10 mg od

Po Sertraline 50 mg od

Po venlafaxine 37.5 mg bd

Conclusion

In conclusion, this paper has explored major depression among elderly populations. The elderly populations are considered vulnerable because of changes in their physiological and physical functioning. Safety should be considered when treating this population due to these changes and existence of multiple comorbidities. Antidepressants are largely used for major depression in the elderly patients. Ethical considerations should inform the selected treatments.

References

Alshawwa, I. A., Elkahlout, M., El-Mashharawi, H. Q., & Abu-Naser, S. S. (2019). An Expert System for Depression Diagnosis. http://dspace.alazhar.edu.ps/xmlui/handle/123456789/128

Hoel, R. W., Giddings Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients. Mayo Clinic Proceedings, 96(1), 242–256. https://doi.org/10.1016/j.mayocp.2020.06.012

Krause, M., Gutsmiedl, K., Bighelli, I., Schneider-Thoma, J., Chaimani, A., & Leucht, S. (2019). Efficacy and tolerability of pharmacological and non-pharmacological interventions in older patients with major depressive disorder: A systematic review, pairwise and network meta-analysis. European Neuropsychopharmacology, 29(9), 1003–1022. https://doi.org/10.1016/j.euroneuro.2019.07.130

Kupfer, D. J. (2005). The pharmacological management of depression. Dialogues in Clinical Neuroscience, 7(3), 191–205. https://doi.org/10.31887/DCNS.2005.7.3/dkupfer

Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neuroscience Bulletin, 37(6), 863–880. https://doi.org/10.1007/s12264-021-00638-3

Miller, K. J., Gonçalves-Bradley, D. C., Areerob, P., Hennessy, D., Mesagno, C., & Grace, F. (2020). Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Research Reviews, 58, 100999. https://doi.org/10.1016/j.arr.2019.100999

Perini, G., Cotta Ramusino, M., Sinforiani, E., Bernini, S., Petrachi, R., & Costa, A. (2019). Cognitive impairment in depression: Recent advances and novel treatments. Neuropsychiatric Disease and Treatment, 15, 1249–1258. https://doi.org/10.2147/NDT.S199746

Pilotto, A., Custodero, C., Maggi, S., Polidori, M. C., Veronese, N., & Ferrucci, L. (2020). A multidimensional approach to frailty in older people. Ageing Research Reviews, 60, 101047. https://doi.org/10.1016/j.arr.2020.101047

Saedi, A. A., Feehan, J., Phu, S., & Duque, G. (2019). Current and emerging biomarkers of frailty in the elderly. Clinical Interventions in Aging, 14, 389–398. https://doi.org/10.2147/CIA.S168687

Trenoweth, S. (2022). Understanding Mental Health Practice for Adult Nursing Students. Learning Matters.

Pediatric Health Centre Address Date: 7/12/2022 Patients Name: George Holm Address: DOB: April 17, 2010 Allergies: NKDA RX: Escitalopram 10 mg per oral every morning Dispense 30 tabs Refills: 1 month Prescribers initials and Signature.

Conclusion

Childhood depression is one of the most common types of mental illness affecting children. Management can either be entirely psychotherapeutically or together with medication. However, due to the limited research on the assessment and management of psychiatric illnesses in pediatric patients, only a few medications have been approved by the FDA for the management of this disorder for this age group. SSRIs like fluoxetine are recommended for the management of childhood depression with close monitoring for possible adverse effects to promote the safety of the drug.

References

Hetrick, S. E., McKenzie, J. E., Bailey, A. P., Sharma, V., Moller, C. I., Badcock, P. B., Cox, G. R., Merry, S. N., & Meader, N. (2021). New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.cd013674.pub2

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. IACAPAP e-Textbook of Child and Adolescent Mental Health (pp. A7). International Association for Child and Adolescent Psychiatry and Allied Professions.

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Tsehay, M., Necho, M., & Mekonnen, W. (2020). The Role of Adverse Childhood Experience on Depression Symptom, Prevalence, and Severity among School Going Adolescents. Depression Research and Treatment, 2020, 1–9. https://doi.org/10.1155/2020/5951792

Vadukapuram, R., Trivedi, C., Mansuri, Z., Shah, K., & Reddy, A. (2022). Bright Light Therapy for MDD in Children and Adolescents: a narrative review of the literature. European Psychiatry, 65(Suppl 1), S554. https://doi.org/10.1192/j.eurpsy.2022.1418

Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., Li, X., Cuijpers, P., Coghill, D., Xiang, Y., Hetrick, S. E., Leucht, S., Qin, M., Barth, J., Ravindran, A. V., Yang, L., Curry, J., Fan, L., Silva, S. G., & Cipriani, A. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601. https://doi.org/10.1016/s2215-0366(20)30137-1

Assessing and Treating Vulnerable Populations for Depressive Disorders

Depressive disorders are often recurring mental illnesses that run-in families and are linked to higher mortality and morbidity rates (Strawbridge & Young, 2022). Early detection and effective treatment have been shown to lessen the condition’s effects on at-risk groups, including lower rates of drug addiction, suicide, and recurrent depressive disorder later in life.

To help doctors better serve the target group, evidence-based treatment approaches that combine the use of medicine and psychotherapy have been produced. The goal of this study is to offer a patient’s medical guidance for the diagnosis and treatment of childhood depressive illness.

Causes and Symptoms

Depression is a mood disorder characterized by emotions of melancholy, despair, or anger. The majority of kids who have depressive disorders do so for a variety of reasons. The risk factors can help a depressive illness develop but cannot explain it on its own.

These risk factors include a family history of the disease, chronic or serious medical illnesses, traumatic childhood experiences, stressful events at the household, at the school environment, or with friends, stressful life circumstances as an adult, and metabolic abnormalities (Mullen, 2018).

In terms of clinical presentation, childhood depression is comparable to adult depression. However, different individuals may exhibit various symptoms based on the severity of the mood illness, co-morbid conditions, the course of therapy, and the final result (Strawbridge & Young, 2022).

Although pediatric patients are unable to express their feelings, some typical signs of depression include irritability, grumpiness, social withdrawal, a persistent sense of sadness and loss of hope, changes in appetite, changes in sleep, difficulty concentrating, exhaustion, and low energy levels, a sense of unworthiness, and suicidal thoughts.

Diagnosis of Depression in Children

A mood disorder, such as depression, affects around 3% of children across the United States, making it among the most prevalent mental health problems that can afflict young people (Mullen, 2018). Children do not have the same autonomy in decision-making as adults, which has hampered research on the best diagnostic methods for this vulnerable demographic.

Thus, a thorough psychiatric examination of the patient completed by a psychiatrist among several other mental health specialists serves as the foundation for the diagnosis of depression in children. The risks or existence of any comorbid conditions, like psychotic symptoms and anxiety, will also be evaluated as part of the thorough psychiatric examination.

As a result, it is necessary to analyze the influence of contextual elements such as interpersonal challenges, family problems, and school-related issues (Strawbridge & Young, 2022). The growth of the above-mentioned contextual elements depends on the distribution of interviews and surveys with the child’s teachers and parents. The Beck Depression Inventory and the Patient Health Questionnaire for Children and Adolescents are two frequently used screening instruments for pediatric depression.

Medication Treatment Options

Both medication and psychotherapy are effective ways to treat children with depression. Based on the diagnosis of the mental disorder as mild, intermediate, or severe, the appropriate treatment strategy is selected. Most professional guidelines advocate using just psychotherapy for at least one to four weeks for treating mild to moderate depressive illness in children (Mullen, 2018). The most often suggested psychotherapy modalities for kids include family therapy, dialectical behavioral therapy, interpersonal psychotherapy, and cognitive behavioral therapy (CBT).

Psychotherapy and medication are often prescribed for children with moderate to severe depression. The available data, patient characteristics, the degree of depression, morbidities, and responsiveness to reamendment are only a few of the aspects that are often taken into consideration when deciding which medicine to give (Strawbridge & Young, 2022).

Only a few numbers of selective serotonin reuptake inhibitors (SSRIs), including Prozac, Escitalopram, Zoloft, and Fluvoxamine, depending on the age range of the pediatric patient, have received FDA approval for the treatment of pediatric depression due to the paucity of available data (Zuckerman et al., 2018). Given the significant risk of suicidality in children on SSRIs, physicians are urged to make sure that the advantages of the drug outweigh the dangers for favorable results. The evidence that is currently available on antidepressants that are recommended for minors is shown in the following table:

Table 1: Antidepressants for Children with Depression

Selective Serotonin Reuptake Inhibitors (SSRIs)	FDA Approbation	Side Effects
Fluoxetine	Approved	GI issues, sleeplessness, and headaches
Escitalopram	Approved	GI problems, nausea, sleeplessness, and headache
Sertraline	Approved	GI disturbances, sleeplessness, vertigo, and headache
Fluvoxamine	Approved	GI disturbances, sleeplessness, motion sickness, and headache

 Medication Considerations

A modest initial dose is often advised when using SSRIs in youngsters due to the significant potential for adverse effects (Bernaras et al., 2019). only after four weeks of treatment is there a dosage increase or a change in medication regimen. Only when the patient’s symptoms see only a small improvement should the dose be raised. The treatment plan should be altered if there is no improvement or unmanageable adverse effects.

To take into account while using particular medications, fluoxetine is linked to decreased weight growth, while escitalopram and fluvoxamine are not recommended for use by children under the age of 12 since they might cause weight loss and decreased appetite (Strawbridge & Young, 2022). On the other hand, Zoloft has to be monitored for potential suicidal ideation concerns.

Medication Monitoring

To reduce the risk of toxic responses and adverse events in kids using SSRIs, therapeutic medication monitoring is absolutely essential. The FDA advises clinical monitoring of minors on SSRIs at least once every 2 weeks during the first four weeks after starting therapy, once each week for the next four weeks, once at 12 weeks, and then as necessary going forward (Zuckerman et al., 2018).

The risk of suicidal thoughts and weight loss, among other things, are among the monitoring metrics depending on potential side effects and how the medicine is responding. Patients with coexisting illnesses including renal disease should have their pulse rate and medicine serum levels thoroughly monitored.

Special Considerations

Due to the elevated risk of suicidality, the FDA has established some particular concerns regarding the use of SSRIs among juvenile patients (Cuijpers et al., 2020). Given that patients under the age of 18 cannot provide their permission, which is instead granted to their parents or other caretakers, there are legal issues involved with the off-label use of SSRIs in this population.

The patient’s access to knowledge about their immediate and long-term dangers and side effects is related to ethical issues. Genetic testing is required for patients who exhibit poor results with the medicine since certain cultural characteristics can also influence the relevance of utilizing SSRIs with juvenile patients. The patient’s socioeconomic position should also be taken into account when prescribing economical medicines to encourage patient compliance.

Follow-up

Antidepressant-treated children are often expected to return to the clinic after four weeks for a follow-up examination and modification of the treatment plan. However, parents are urged to seek out more information from nearby community resources including mental health institutions and psychiatric institutes to assist with the treatment of children’s depression at home.

The National Alliance on Mental Illness, National Suicide Prevention Lifeline, AACAP Research Center for Depression, and Depressed mood in Children and Adolescents – Facts for Families are a few additional community resources that may be accessed online at home (Cuijpers et al., 2020).

Prescription Writing

To reduce the likelihood of pharmaceutical mistakes, it is essential to write a correct prescription for patients with mental problems. For instance, the prescriber must verify that all the information on the prescription is correct, including the date, client’s name and home address, patient’s age, clinician’s name, address and DEA number, drug name, strength, dosage form (tabs or caps), and amount prescribed, as well as the prescription’s instructions for use and refill details (Bernaras et al., 2019).

The second method of drafting an accurate prescription uses provider order input on the EHR to lower the likelihood of medical mistakes. The last strategy is to refrain from using acronyms that might cause misunderstanding during patient use or pharmacist dispensing.

Conclusion

One of the most prevalent mental illnesses impacting children is depression. A  combination of medicine or psychotherapy is usually considered the most effective option for treatment. Only a few drugs, nevertheless, have been FDA-approved for the treatment of this problem in children because of the paucity of research on the screening and treatment of mental disorders in this age range. To ensure the safety of the medication, SSRIs like Prozac are advised for the treatment of pediatric depression while being closely monitored for any potential side effects.

References

‌Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10(543). https://doi.org/10.3389/fpsyg.2019.00543

Cuijpers, P., Stringaris, A., & Wolpert, M. (2020). Treatment outcomes for depression: challenges and opportunities. The Lancet Psychiatry, 7(11). https://doi.org/10.1016/s2215-0366(20)30036-5

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Strawbridge, R., & Young, A. (2022). Care pathways for people with major depressive disorder. European Psychiatry, 65(S1), S620–S620. https://doi.org/10.1192/j.eurpsy.2022.1587

Zuckerman, H., Pan, Z., Park, C., Brietzke, E., Musial, N., Shariq, A. S., Iacobucci, M., Yim, S. J., Lui, L. M. W., Rong, C., & McIntyre, R. S. (2018). Recognition and Treatment of Cognitive Dysfunction in Major Depressive Disorder. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00655

‌Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of vulnerable patient populations requiring antidepressant therapy.

The Assignment: 5 pages

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.).

You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

• Depressive disorder causes and symptoms
• How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
• Medication considerations of medication examples prescribed (see last bullet item)
• What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
• Where to follow up in your local community for further information
• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center

Links to an external site. provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632)

Links to an external site.. All papers submitted must use this formatting.

Psychopharmacologic agents are drugs that are used to treat various mental health conditions by targeting specific receptors in the brain. The agonist-to-antagonist spectrum of action refers to the range of effects that these drugs can have on the receptors they interact with (Mental Health TV, 2022). An agonist is a drug that binds to a receptor and activates it, producing a biological response. Agonists mimic the effects of naturally occurring neurotransmitters and increase receptor activity.

They can enhance the release of neurotransmitters, increase the sensitivity of postsynaptic receptors, or both. By increasing neurotransmission, agonists can alleviate symptoms of psychiatric disorders. On the other hand, an antagonist is a drug that binds to a receptor without activating it. Antagonists block the receptor, preventing other molecules from binding and producing a biological response. By inhibiting neurotransmission, antagonists can reduce the symptoms associated with excessive receptor activity.

Within the spectrum of action, there are also partial agonists and inverse agonists. Partial agonists bind to a receptor and activate it, but to a lesser extent compared to a full agonist (University et al., 2019). They have a lower maximal effect, even when all receptors are occupied. Partial agonists can have mixed effects, acting as agonists in some cases and antagonists in others. This property makes them useful in situations where excessive activation or inhibition of a receptor is undesirable.

Inverse agonists, on the other hand, produce effects opposite to those of agonists. They bind to receptors and reduce their constitutive activity. Inverse agonists can have therapeutic applications when there is excessive receptor activity even in the absence of an agonist. By reducing this constitutive activity, inverse agonists can bring the receptor activity back to baseline levels.

The efficacy of psychopharmacologic treatments can be influenced by the functionality of partial and inverse agonists. For example, in the treatment of anxiety disorders, benzodiazepines act as agonists at gamma-aminobutyric acid (GABA) receptors.

They enhance GABAergic neurotransmission, resulting in sedative and anxiolytic effects. However, prolonged use of benzodiazepines can lead to tolerance and dependence. In such cases, partial agonists like buspirone can be used. Buspirone has a lower risk of dependence and provides a moderate anxiolytic effect without the sedative properties associated with benzodiazepines.

Question 2:

G-protein-coupled receptors (GPCRs) and ion-gated channels are two distinct types of receptors involved in signal transduction within the nervous system (University et al., 2019). GPCRs are transmembrane proteins that span the cell membrane seven times. They are coupled to intracellular G-proteins, which mediate the downstream signaling events.

When an agonist binds to a GPCR, it induces a conformational change that allows the G-protein to dissociate into two subunits (alpha and beta-gamma). These subunits can then modulate various intracellular signaling pathways, leading to changes in cellular function. GPCRs are involved in a wide range of physiological processes and are the target of many psychopharmacologic drugs, including antipsychotics and antidepressants.

In contrast, ion-gated channels are transmembrane proteins that form a pore in the cell membrane, allowing the flow of specific ions in and out of the cell(Stahl,2021). These channels can be either ligand-gated or voltage-gated. Ligand-gated ion channels, also known as ionotropic receptors, open or close in response to the binding of specific neurotransmitters or other ligands.

When an agonist binds to the receptor, the channel opens, and ions flow across the membrane, generating an electrical current. Examples of ion-gated channels include the NMDA receptor, which is involved in learning and memory, and the nicotinic acetylcholine receptor.

The main difference between GPCRs and ion-gated channels lies in the mechanisms of signal transduction. GPCRs transmit signals through a series of intracellular signaling pathways involving G-proteins, enzymes, and second messengers. In contrast, ion-gated channels directly regulate the flow of ions, leading to changes in the electrical potential across the cell membrane. The activation of ion-gated channels can result in rapid changes in neuronal excitability and synaptic transmission.

Question 3:

Epigenetics refers to heritable changes in gene expression that do not involve alterations to the DNA sequence itself(Stahl,2021). These changes can be influenced by environmental factors and can impact the pharmacologic action of drugs. Epigenetic modifications, such as DNA methylation and histone modifications, can alter gene expression patterns, affecting the response to pharmacologic interventions.

Epigenetic modifications can influence the expression of drug-metabolizing enzymes, transporters, and drug targets. For example, DNA methylation can silence genes involved in drug metabolism, leading to altered drug concentrations and efficacy. Histone modifications can affect chromatin structure and accessibility, influencing the binding of transcription factors and the expression of drug-related genes.

The role of epigenetics in pharmacologic action has implications for personalized medicine. Variations in epigenetic profiles among individuals can result in different responses to the same medication. Understanding the epigenetic mechanisms involved in drug action can help predict treatment outcomes and optimize therapy.

Question 4:

Understanding the agonist-to-antagonist spectrum, the actions of G-protein-coupled receptors and ion-gated channels, and the role of epigenetics can significantly impact the way psychiatric mental health nurse practitioners prescribe medications to their patients. By considering these factors, practitioners can tailor treatments to individual patients, maximizing efficacy and minimizing adverse effects.

For example, let’s consider a case of major depressive disorder (MDD). Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed as first-line treatment for MDD. However, not all patients respond equally to SSRIs. Genetic and epigenetic factors can contribute to interindividual differences in treatment response.

Understanding the epigenetic modifications that affect the expression of serotonin receptors and transporters can help predict which patients are more likely to benefit from SSRIs and which may require alternative treatment strategies.

Additionally, the agonist-to-antagonist spectrum can guide medication choices based on the desired therapeutic effects and side effect profiles. Understanding the agonist-to-antagonist spectrum can help the psychiatric mental health nurse practitioner select an appropriate medication based on the patient’s symptoms and potential side effect profile.

For instance, a patient with prominent negative symptoms of schizophrenia may benefit from an atypical antipsychotic with a higher affinity for the dopamine D2 receptor, while a patient with significant positive symptoms and a higher risk of extrapyramidal symptoms may benefit from an atypical antipsychotic with a higher affinity for the serotonin 5-HT2A receptor.

Furthermore, knowledge of the actions of G-protein-coupled receptors and ion-gated channels can guide medication selection based on the underlying neurobiology of a patient’s condition. For instance, in the treatment of generalized anxiety disorder (GAD), medications that enhance GABAergic transmission are often prescribed.

GABA is the main inhibitory neurotransmitter in the central nervous system, and drugs that potentiate GABAergic transmission, such as benzodiazepines, can help alleviate anxiety symptoms. Understanding the mechanism of action of benzodiazepines, which act on GABA-A receptors to enhance inhibitory neurotransmission, allows the psychiatric mental health nurse practitioner to make informed decisions regarding medication selection for patients with GAD.

In summary, understanding the agonist-to-antagonist spectrum of action, the actions of G-protein-coupled receptors and ion-gated channels, and the role of epigenetics can greatly influence the way psychiatric mental health nurse practitioners prescribe medications to their patients. This knowledge allows for personalized and targeted treatment approaches, considering individual variations in pharmacologic response. By considering these factors, practitioners can optimize treatment outcomes, minimize side effects, and improve patient care.

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Depressive disorders are a source of considerable disease burden to the global population. The disorders affect productivity, lower the quality of life of the affected populations, and cause premature mortalities. Pharmacological interventions are the mainstream treatments for depressive disorders. Nurse practitioners should be aware of the safety, indications, and monitoring of different populations prescribed medications for depressive disorders. Therefore, this essay examines the medications used in treating major depression in children and adolescents, considerations, monitoring, follow-up, diagnosis, and its causes and symptoms.

Causes and Symptoms

Major depression in children and adolescents is an important public health concern since it affects 5% of 12-year-olds and 17% of 17-year-olds in America. Psychological, biological, and environmental factors cause major depression in children and adolescents. Some of the biological risk factors associated with major depression include overweight, female sex, having a family history of depression, early puberty in girls, chronic illness, and polymorphisms that affect dopamine, serotonin, or monoamine oxidase genes. Some of the psychological factors that cause major depression in this population include dysfunctional emotional regulation, body dissatisfaction, low self-esteem, negative thinking, and substance abuse (Boaden et al., 2020; Farley, 2020). Environmental causes of major depression among children and adolescents include bullying, victimization, exposure to traumatic events, parental rejection, and dysfunctional families.

Children and adolescents affected by major depression present to the hospital with a range of symptoms. They include hypersomnia or insomnia, weight gain or loss, difficulty concentrating, lack of interest and pleasure, easy irritability, and feeling sad or hopeless. Patients also report difficulties in making decisions, feeling guilty, and suicidal thoughts, plans, or attempts (Dwyer & Bloch, 2019; Selph & McDonagh, 2019). The symptoms affect the patient’s normal functioning in areas such as academic and social activities.

Diagnosing the Disorder and Why the Population is Considered Vulnerable

Screening tools such as PHQ-A are used in the diagnosis of major depression in children and adolescents. The screening tool helps healthcare providers rate the client’s depressive symptoms and rule out other potential causes such as generalized anxiety disorder and bipolar disorder. Major depression can present with symptoms that are seen in other conditions such as hypothyroidism. As a result, healthcare providers must perform laboratory investigations such as thyroid function tests to rule out other comorbidities.

The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) also guides the diagnosis of major depression in children and adolescents. The DSM-5 manual sets the criteria that must be met for a diagnosis of major depression to be made (Selph & McDonagh, 2019). For example, patients should report symptoms such as being depressed almost every day most of the time, lack of interest and pleasure, changes in appetite and weight, being hopeless or guilty, having difficulties concentrating and making decisions, and symptoms affecting normal functioning.

Children and adolescents are considered a vulnerable population. Firstly, children and adolescents are not mature enough to make safe decisions about issues that affect their health. Children and adolescents rely on others for decision-making and support. As a result, they are at risk of harm and practices that affect their health outcomes. Children and adolescents are also highly vulnerable to social, emotional, and physical changes. Exposure to negative experiences such as abuse, or violence can alter significantly their normal development and progression to adulthood.

This makes them a vulnerable group to other health problems based on their environmental exposures. Children and adolescents also have immature body systems and organs. This means that, unlike adults, children and adolescents are prone to harm from medications used for different conditions. Their risk of developing side and adverse effects due to immature organs involved in drug metabolism and elimination is higher than in adults (Farley, 2020). Therefore, they are considered a vulnerable population and caution must be taken when treating mental health problems that affect them.

Medication Treatment Options and Examples

The Food and Drug Administration (FDA) has approved escitalopram and fluoxetine for use in treating major depression in children and adolescents. The guidelines recommend the use of fluoxetine in children who are aged eight years and older while escitalopram is used for patients who are aged 12 years and above. The other FDA-non-approved antidepressants used for treating major depression in this population include paroxetine, sertraline, citalopram, and fluvoxamine (Feeney et al., 2022). Bupropion and mirtazapine might also be considered despite the lack of adequate evidence that supports their use in the population.

Antidepressants have the benefit of managing the depressive symptoms of major depression. The improvement in symptoms results in enhanced functioning, well-being, and quality of life. Antidepressants also reduce the risk of symptom relapse among children and adolescents with major depression. However, practitioners should be aware of the risks associated with antidepressants. They include predisposing patients to suicidal thoughts, plans, or attempts. Patients might also suffer from a negative self-image from weight gain associated with antidepressants (Boaden et al., 2020; Dwyer & Bloch, 2019). Patients and their families should also be educated about anticipated side effects such as insomnia, sedation, sexual dysfunction, gastrointestinal upset, hyperhidrosis, and dry mouth.

Monitoring

Close patient monitoring should be done for children and adolescents prescribed antidepressants. Firstly, children and adolescents should be monitored for suicide risks. Antidepressants are associated with the adverse effect of increasing the risk of suicide in patients. Laboratory investigations such as a lipid panel and complete blood count should be performed periodically. Antidepressants are associated with side effects such as weight gain. Patients should be assessed for cardiovascular risks such as hyperlipidemia with weight gain (Hazell, 2022). Blood pressure and weight should also be assessed regularly, and patients advised on effective interventions to promote healthy weight gain.  

Healthcare providers should also monitor children and adolescents for pediatric behavioral activation syndrome. The syndrome can be diagnosed based on symptoms such as mania, hyperactivity, and agitation. Patients should also be monitored for serotonin syndrome. Serotonin syndrome develops among patients with dual antidepressant therapy (Zhou et al., 2020). Patients with serotonin syndrome present to the hospital with symptoms that include hypertension, diarrhea, sweating, hyperthermia, and tachycardia.

Special Considerations

            Several considerations influence drug therapy for children and adolescents diagnosed with major depression. Firstly, ethical considerations influence the selected treatments. Ethical principles such as autonomy and non-maleficence guide the practitioner’s decisions. Autonomy entails protecting a client’s right to self-determination. Healthcare providers ensure informed consent is obtained from the parents and legal custodians of the children and adolescents when treating major depression (Dwyer & Bloch, 2019). They also make decisions that are associated with optimum benefits such as a reduction in symptoms of major depression and minimum risk of patient harm.

            Legal considerations also affect the treatment of major depression in children and adolescents. Healthcare providers must ensure data privacy and confidentiality when treating major depression in children and adolescents. They should ensure that unauthorized parties do not access the patient’s data. Informed consent should be obtained before sharing the information with other healthcare providers. Healthcare providers must also make decisions in the client’s best interest to prevent negligence in their practice. Nurse practitioners should also be aware of the effect of culture on treatment outcomes in children and adolescents with major depression. Cultural practices associated with mental health problems such as stigma and isolation lower treatment utilization and adherence (Zhou et al., 2020). Healthcare providers must advocate the adoption of strategies that address stereotypes related to mental health problems in their communities.

            Social determinants of health also influence major depression among children and adolescents. Children and adolescents born to poor families are likely to experience barriers in accessing their needed mental healthcare services due to issues such as cost. Income and education levels also influence the access to and utilization of mental health services by this population (Sokol et al., 2019). Therefore, addressing social determinants of health would result in increased access to mental healthcare services for children and adolescents.

Follow-Up

            Antidepressants take between two and six weeks to produce the desired effects in managing depressive symptoms. Therefore, patients should be followed up after two weeks to assess their response to treatment and identify any issues that should be addressed for optimum treatment outcomes. Patients should also be linked with social support groups for mental health problems to help them learn effective ways to cope with their conditions.

Examples of Proper Prescription

Name: L.L.

Age: 12 years

Diagnosis: Major depression

Treatment: Oral sertraline 25 mg OD for two weeks

Refills: none

Follow-up: after two weeks

Name of the prescriber and DEA number:

Name: Y.Y.

Age: 14 years

Diagnosis: Major depression

Treatment: Oral escitalopram 25 mg once daily for two weeks

Refills: none

Follow-up: two weeks

Name of the prescriber and DEA number:

Name: L.A.

Age: 17 years

Diagnosis: Major depression

Treatment: Oral Fluoxetine 25 mg once daily for two weeks

Refills: none

Follow-up: two weeks

Name of the prescriber and DEA number:

Conclusion

            In summary, major depression in children and adolescents is the selected depressive disorder of focus in this assignment. FDA-approved and non-approved antidepressants are used in treating major depression in children and adolescents. Healthcare providers should weigh the benefits and risks of the available treatment. Legal, ethical, and cultural considerations and social determinants of health inform treatment decisions in children and adolescents diagnose with major depression.

References

Boaden, K., Tomlinson, A., Cortese, S., & Cipriani, A. (2020). Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment. Frontiers in Psychiatry, 11. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00717

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for Pediatric Patients. Current Psychiatry, 18(9), 26-42F.

Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing2023, 50(10), 48. https://doi.org/10.1097/01.NURSE.0000697168.39814.93

Feeney, A., Hock, R. S., Fava, M., Hernández Ortiz, J. M., Iovieno, N., & Papakostas, G. I. (2022). Antidepressants in children and adolescents with major depressive disorder and the influence of placebo response: A meta-analysis. Journal of Affective Disorders, 305, 55–64. https://doi.org/10.1016/j.jad.2022.02.074

Hazell, P. (2022). Antidepressants in adolescence. Australian Prescriber, 45(2). https://doi.org/10.18773/austprescr.2022.011

Selph, S. S., & McDonagh, M. S. (2019). Depression in Children and Adolescents: Evaluation and Treatment. DEPRESSION IN CHILDREN AND ADOLESCENTS, 100(10).

Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., Doss, G., Dotson, A., Urbaeva, V., Singichetti, B., Brevard, K., Wright, S. T., Lanier, P., & Shanahan, M. (2019). Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics, 144(4), e20191622. https://doi.org/10.1542/peds.2019-1622

Zhou, X., Teng, T., Zhang, Y., Giovane, C. D., Furukawa, T. A., Weisz, J. R., Li, X., Cuijpers, P., Coghill, D., Xiang, Y., Hetrick, S. E., Leucht, S., Qin, M., Barth, J., Ravindran, A. V., Yang, L., Curry, J., Fan, L., Silva, S. G., … Xie, P. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601. https://doi.org/10.1016/S2215-0366(20)30137-1

Foundational Neuroscience in Psychiatric Nursing Practice

Agonist-to-Antagonist Spectrum of Action

The spectrum of action in psychopharmacologic agents, ranging from agonists to antagonists, plays a pivotal role in psychiatric nursing practice. Agonists and antagonists play crucial roles in psychopharmacologic treatments, each with distinct mechanisms. Agonists, binding to receptors, elicit responses, while antagonists bind to a receptor to block the activation of the receptors thus inhibiting a response. The spectrum of action involves a concentration-dependent relationship, impacting the efficacy of psychopharmacologic treatments. Partial agonists create a reduced response, and inverse agonists decrease receptor activity, producing strong or weak partial agonists. Examples of agonists include opioids such as Oxycodone, morphine and heroin. They act by binding to specific receptor sites in the brain and produce opioid effects such as analgesic and withdrawal effects (Edinoff, et al, 2021). Antagonists on the other hand naloxone. Understanding these mechanisms is essential for psychiatric mental health nurse practitioners as they navigate the delicate balance of neurotransmitter modulation, affecting treatment outcomes (Braslow & Marder, 2019).

Comparison of G Couple Proteins and Ion-Gated Channels

G couple proteins and ion gated channels are pivotal in cellular communication. G couple proteins, located on cell membranes, interact with neurotransmitters, influencing a wide array of proteins. In contrast, ion gated channels, formed by pores on cell membranes, regulate ion flow, facilitating substance transport (Alexander et al., 2019). Psychopharmacologic agents often target these components to modulate neuronal signaling. Recognizing the distinctions between these mechanisms is crucial for psychiatric mental health nurse practitioners, enabling them to select appropriate medications based on the specific neurobiological targets.

The Role of Epigenetics in Pharmacologic Action

Epigenetics introduces an additional layer of complexity to pharmacologic action in psychiatric nursing. Epigenetics, focusing on changes in gene expression rather than genetic code alterations, contributes significantly to pharmacologic action. Understanding patient-specific factors such as age, weight, comorbidities, and family predispositions helps healthcare providers tailor medication choices and dosages. This awareness is particularly relevant in psychiatric care, where individual variations in drug response can significantly impact treatment efficacy (Lauschke et al., 2019). Psychiatric mental health nurse practitioners must integrate epigenetic considerations into their prescribing practices to optimize therapeutic outcomes for their patients.

Impact on Medication Prescription Practices

The acquired knowledge of the agonist-to-antagonist spectrum, the intricacies of G couple proteins and ion-gated channels, and the influence of epigenetics significantly shapes the psychiatric mental health nurse practitioner’s approach to prescribing medications. Incorporating knowledge of pharmacoepigenetics and the agonist-to-antagonist mechanism is integral to informed medication prescribing. Consider the case of benzodiazepines, known for their sedative effects. Psychiatric mental health nurse practitioners must be adept at understanding the mechanism of action, half-life, potential side effects, and addiction risks associated with benzodiazepines. This comprehensive understanding allows practitioners to make informed decisions, ensuring the safety and efficacy of medication therapy. By tailoring prescriptions based on individual patient characteristics and considering the broader neurobiological context, practitioners enhance their ability to provide patient-centered care in the realm of psychiatric and mental health nursing.

References

Alexander, S. P., Christopoulos, A., Davenport, A. P., Kelly, E., Mathie, A., Peters, J. A., Veale, E. L., Armstrong, J. F., Faccenda, E., Harding, S. D., Pawson, A. J., Sharman, J. L., Southan, C., & Davies, J. A. (2019). The Concise Guide to Pharmacology 2019/20: G protein‐coupled receptors. British Journal of Pharmacology, 176(S1). https://doi.org/10.1111/bph.14748

Links to an external site. 

Braslow, J. T., & Marder, S. R. (2019). History of psychopharmacology. Annual Review of Clinical Psychology, 15(1), 25–50. https://doi.org/10.1146/annurev-clinpsy-050718-095514

Links to an external site. 

Edinoff, A. N., Kaplan, L. A., Khan, S., Petersen, M., Sauce, E., Causey, C. D., Cornett, E. M., Imani, F., Moradi Moghadam, O., Kaye, A. M., & Kaye, A. D. (2021). Full opioid agonists and Tramadol: Pharmacological and clinical considerations. Anesthesiology and Pain Medicine, 11(4). https://doi.org/10.5812/aapm.119156

Links to an external site.

Lauschke, V. M., Zhou, Y., & Ingelman-Sundberg, M. (2019). Novel genetic and epigenetic factors of importance for inter-individual differences in drug disposition, response and toxicity. Pharmacology & Therapeutics, 197, 122–152. https://doi.org/10.1016/j.pharmthera.2019.01.002 Links to an external site.

Rubric

NURS_6630_Week4_Assignment_Rubric

NURS_6630_Week4_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome Develop a patient medication guide for treatment of depressive disorders in a vulnerable population you selected. • Depressive disorder causes and symptoms • How depression is diagnosed for the vulnerable population of your choice	20 to >17.0 pts Excellent Point range: 90–100 Discussion includes Depressive disorder causes and symptoms; Discussion includes how depression is diagnosed for the chosen vulnerable population. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 17 to >15.0 pts Good Point range: 80–89 Discussion is vague regarding Depressive disorder causes and symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population. 15 to >13.0 pts Fair Point range: 70–79 Discussion is vague regarding Depressive disorder and missing causes and/or symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population. 13 to >0 pts Poor Point range: 0–69 Discussion is inaccurate regarding Depressive disorder and missing causes and/or symptoms; Discussion is missing and/or inaccurate on how depression is diagnosed for the chosen vulnerable population.	20 pts
This criterion is linked to a Learning Outcome • Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice • Medication considerations of medication examples prescribed • What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring of medications prescribed	20 to >17.0 pts Excellent Point range: 90–100 Medication treatment options are discussed including risk vs benefits; side effects; FDA approvals for the chosen vulnerable population; Medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring. 17 to >15.0 pts Good Point range: 80–89 Medication treatment options are briefly discussed and vague regarding risk vs benefits; side effects; FDA approvals for the chosen vulnerable population is vague; vague discussion medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring. 15 to >13.0 pts Fair Point range: 70–79 Medication treatment options are vague and missing risk vs benefits; side effects; missing discussion of FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed; missing elements of discussing items important to monitor in terms of labs, comorbid medical issues with why important for monitoring. 13 to >0 pts Poor Point range: 0–69 Medication treatment options are inaccurate, vague and/or missing including risk vs benefits; side effects; missing or inaccurate discussion on FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed discussed; contains inaccurate, minimal, or no discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.	20 pts
This criterion is linked to a Learning Outcome • Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health • Where to follow up in your local community for further information	20 to >17.0 pts Excellent Point range: 90–100 Special Considerations are discussed and specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information. 17 to >15.0 pts Good Point range: 80–89 Special Considerations are discussed not specific, but general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information. 15 to >13.0 pts Fair Point range: 70–79 Special Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion directions for where to follow up in local community for further information are vague. 13 to >0 pts Poor Point range: 0–69 Special Considerations are discussed not specific, is inaccurate and/or general and missing 3+ or more or does not discuss any of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion does not include directions for where to follow up in local community for further information.	20 pts
This criterion is linked to a Learning Outcome • The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.	15 to >13.0 pts Excellent Point range: 90–100 The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables. 13 to >11.0 pts Good Point range: 80–89 The medication guide is vague in discussion why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables. 11 to >9.0 pts Fair Point range: 70–79 The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide has limited appeal with use of graphics/tables. 9 to >0 pts Poor Point range: 0–69 The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is not interesting and appealing in and/or missing use of graphics/tables.	15 pts
This criterion is linked to a Learning Outcome Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 to >13.0 pts Excellent Point range: 90–100 Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 13 to >11.0 pts Good Point range: 80–89 Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 11 to >9.0 pts Fair Point range: 70–79 Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 9 to >0 pts Poor Point range: 0–69 Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 to >4.0 pts Excellent Point range: 90–100 Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 pts Good Point range: 80–89 Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 pts Fair Point range: 70–79 Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic. 3 to >0 pts Poor Point range: 0–69 Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources. Paper is limited to 5 pages not including title and reference page.	5 to >4.0 pts Excellent Point range: 90–100 Uses correct grammar, spelling, and punctuation with no errors; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is limited to 5 pages not including title and reference page. 4 to >3.5 pts Good Point range: 80–89 Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources; Paper is 6 pages not including title and reference page. 3.5 to >3.0 pts Fair Point range: 70–79 Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided; Paper is 7 pages not including title and reference page resources. 3 to >0 pts Poor Point range: 0–69 Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholaraly supporting resources outside of course provided resources; Paper is 8+ pages not including title and reference page.	5 pts
Total Points: 100