Risks, Benefits, and DiagnosisPrior to beginning work on this discussion, read the required chapters from the text and
review the required articles for this week.
The risk-benefit calculation for any drug assumes a correct diagnosis of the disorder.
Many investigators and clinicians feel the current epidemic of child psychiatric disorders
is largely due to inappropriate diagnosis. Evaluate the risk and benefits of using
psychoactive drugs in children correctly diagnosed with a disorder versus those
incorrectly diagnosed with a disorder. Consider the risks and benefits of not treating
(drug treatment) a child because they are not correctly diagnosed with a disorder. In
your evaluation summarize the natural course of the disorder, the drug action on the
neurotransmitter systems in question, and the likelihood of short-term, long-term, and
permanent positive and negative effects of drug treatment. Make sure to take into
account the ethical dimension of this risk-benefit calculation.
I need this done:
Guided Response: Review several of your
colleagues’ posts and respond to at least two of your
peers by 11:59 p.m. on Day 7 of the week. You are
encouraged to post your required replies earlier in
the week to promote more meaningful interactive
discourse in this discussion. What was the
substance of your colleague’s argument? Do you
agree with this argument? Why, or why not? To what
extent did your colleague consider the ethical
dimension to this risk-benefit calculation when
prescribing drugs for children who are too young to
be of the age of legal consent? Whether you agree
or disagree with the conclusion, was the ethical
aspect dealt with in a responsible manner? What
insights did your colleague include that you had not
considered? What might you suggest they consider
which was not already included? Please use your
research to support your assertions.
Student one: Dominique Artis
Bipolar disorder is an illness that typically develops in childhood and adolescence that
appears with episodes of extreme mania or depression. According to Hirschfeld, the
symptoms of unipolar and bipolar disorder overlap, making it difficult to diagnose.
Episodes of mania and hypomania may sometimes go unreported due to the
overlapping symptoms. According to our texts, n a study, it was determined that 1/5 of
individuals that are initially diagnosed with unipolar disorder subsequently end up
having bipolar disorder. When this disorder is misdiagnosed it can cause the individual
to receive inappropriate treatment that can further destabilize the person, and will not
alleviate the symptoms of the disorder (Nasarallah, 2015). Misdiagnosis can also lead
down a spiral of disastrous events including substance abuse, social and occupational
impairments, and even suicidal behavior. One in every four to five
mistreated/misdiagnosed patients commits suicide during the course of illness (Advokat
et al, 2018). At least 60% of individuals diagnosed with type I and type II bipolar
disorder, experience the effects of comorbid substance abuse with substances including
alcohol, cocaine, marijuana, and other medications. This substance abuse increases
the positive correlation of switching episodic states of the disorder. Although the most
common form of pharmacological treatment for bipolar depression is antipsychotics, it is
sometimes combined with mood stabilizers which used long term, may also worsen the
symptoms. “Examining specific symptoms of bipolar disorder and monitoring their
change with treatment may help a prescriber determine which patients will achieve a
more durable improvement and also potentially identify those depressed patients who
may be at risk for a switch to mania (Advokat et al., 2018).”
References
Advokat, C. D., Comaty, J. E., & Julien, R. M. (2018). Julien’s primer of drug action: A
comprehensive guide to the actions, uses, and side effects of psychoactive drugs (14th
ed.). Worth Publishers.
Nasrallah H. A. (2015). Consequences of misdiagnosis: inaccurate treatment and poor
patient outcomes in bipolar disorder. The Journal of clinical psychiatry, 76(10),
e1328. https://doi.org/10.4088/JCP.14016tx2cLinks to an external site.
Student two: Dawn Turnquist
Depression is a result of a major lack in serotonin and norepinephrine. Serotonin
reuptake inhibitors are the most effective in treating the disorder. Misdiagnoses of
depression as ADHD can result in patients taking amphetamines. ADHD children can
become either overly sedated or overexcited if the dosage is too high. Theoretically, any
dose of amphetamines would be considered too high for children without ADHD.
Psychoactive drugs have pleasurable side effects including analgesia, sedation,
reduction in irritability, and increase in focus and performance, which create opportunity
for recreational use and misuse. Short term use allows tolerance to build, and
emotions/moods become unregulated. Long term use is linked to dementia (Moncrieff et
al., 2013).
Overdiagnosis and underdiagnosis of psychological disorders severely impacts society.
Physicians prescribe most medications for ADHD; many without having the proper
psychological training or including other psychiatric or psychological evaluations.
Misdiagnoses have many causes including bias, discoveries in illnesses, changes to
criteria, and pharmaceutical profiting. Children with difficulties paying attention do not
always have ADHD. Many depressed children express attention deficits. Overlapping
symptoms of multiple disorders, lack of evaluations, and bias of symptoms all contribute
to misdiagnoses (Merten et al., 2017).
Children in foster care are more likely to be diagnosed with ADHD and prescribed
medication more than other children on Medicaid. The CDC confirmed unethical and
inappropriate prescribing does more harm than good. Patients taking psychotropic
drugs without needing them usually experience worse symptoms after being removed
from the medication. The withdraw symptoms are more severe in these cases (Smith,
2012).
Untreated depression results in risky behaviors and addiction. Ironically misdiagnoses
of depression may already provide experience with psychoactive drugs and open the
door for said addiction.
Merten, E.C., Cwik, J.C, Mourgraf, J., & Schneider, S. (2017). Overdiagnosis of mental
illness in children and adolescents (in developed countries). Child and adolescent
psychiatry and mental health, 11, 5. https://doi.org/10.1186/s13031-016-0140-5Links to
an external site.
Moncrieff, J., Cohen, D., & Porter, S. (2013). The psychoactive effects of psychiatric
medication: the elephant in the room. Journal of psychoactive drugs, 45(5), 409415. https://doi.org/10.1080/02791072.2013.845328Links to an external site.
Smith, B. (2012). Inappropriate prescribing. Monitor on psychology,
43(6). https://apa.org/monitor/2012/06/prescribingLinks to an external site.
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