Assigned Disorder: Disruptive Mood Dysregulation Disorder
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?
- For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
- Use the assigned specific disorder (Disruptive Mood Dysregulation Disorder) to research for this Assignment.
- Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
- Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
- Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
- Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
- Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
Disruptive Mood Dysregulation Disorder (DMDD) is a relatively new disorder characterized by severe and recurrent temper outbursts that are grossly out of proportion to the situation in which they occur. DMDD is often accompanied by a persistent irritable or angry mood between temper outbursts. There is no FDA-approved medication specifically for DMDD. However, there are medications approved for other disorders that have shown efficacy in treating some of the symptoms of DMDD. Additionally, nonpharmacological interventions, such as cognitive-behavioral therapy (CBT), have also been shown to be effective in treating DMDD.
FDA-Approved Drug:
The FDA has approved the use of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), for the treatment of depression in children aged 8-18 years old. Fluoxetine has also been found to be effective in reducing irritability and aggression in children with DMDD. The recommended starting dose for fluoxetine in children with DMDD is 10 mg/day, which can be increased up to 20-60 mg/day depending on the child’s response and tolerability. The benefits of fluoxetine include its efficacy in treating irritability and aggression, its relatively mild side effect profile, and its long-term safety record. However, potential risks include increased risk of suicidal ideation or behavior, as well as the possibility of adverse effects such as nausea, insomnia, and sexual dysfunction.
Off-Label Drug:
Although there are no medications specifically approved for DMDD, atypical antipsychotics have been used off-label to treat irritability and aggression in children and adolescents. One such medication is risperidone, which has been shown to be effective in reducing irritability, aggression, and explosive temper outbursts in children with DMDD. The recommended starting dose for risperidone in children with DMDD is 0.25 mg/day, which can be increased up to 3 mg/day depending on the child’s response and tolerability.