How to complete a psychopharmacology case study: Natalee williams case (Solved)

How to complete a psychopharmacology case study: Natalee williams case (Solved)

Case study prompt:
Review the case study and then answer the questions that follow.
Natalee Williams, a 10-year-old African American girl, comes to your psychiatric nurse practitioner office for evaluation. She has been sad and withdrawn, complaining about headaches and “tummy aches.”

Her mother, Trina, accompanies her to the appointment. Trina notes that Natalee has seemed depressed and presents as irritable. The mother notes her daughter’s mood change occurred about two months ago. Natalee’s school performance has fallen, and she is now getting Cs on her work. The last term, she earned all As. She wants to sleep more, and her appetite has decreased. She rarely wants to play with friends and spends a lot of time in her room alone. Her height and weight are normal for her age, but she has lost two pounds over the last two months.

There is a history of depression in the family, as Natalee’s maternal grandmother and maternal aunt both have had major depression. Her maternal grandmother was hospitalized for psychiatric care 20 years ago for depression and a suicide attempt by an overdose of Tylenol.
From your perspective as Natalee’s psychiatric nurse practitioner, answer the following questions in a paper that is in APA format. Include at least three peer-reviewed, evidence-based references that are current within the past 5 years.

1. What are some differential diagnoses you would give? Identify one medical differential diagnosis and two psychiatric differential diagnoses.

2. What diagnosis would you give Natalee? On what evidence/symptoms do you base your diagnosis?

3. What medication(s) would you prescribe for Natalee and why? Please note the medication, initial dose, and dosing schedule. If you would use an off-label medication to treat Natalee, provide your rationale for doing so.

4. Fill out a prescription (PDF) (Links to an external site.) for this medication. Print the template, fill it out, and scan it or take a photo. Insert the image at the end of your Microsoft Word document.

5. How will you educate and inform Trina (Natalee’s mother) about how this medication will work?

6. How will you discuss with Trina the commonly expected side effects, potentially serious adverse effects, and FDA black box warnings for a child of this age with taking this medication?

This paper must include a thesis statement.

Natalee Williams Case Study SOLUTION

Major depressive disorder (MDD) is among the most common psychiatric illnesses in children that are often unrecognized and untreated. This condition can have significant effects when onset occurs in childhood and adolescence ranging from impaired school performance to increased risk for other mental conditions later in life. Early intervention is the key treatment of major depression in children and it includes psychotherapy and the use of antidepressant medications (Mullen, 2018). This discussion focuses on Natalee Williams, a 10-year-old girl presenting with signs of major depressive disorder. Early diagnosis of the disease, effective prescription of medication, and the use of educational approaches can help Natalie cope with the condition.

Differential Diagnoses

Differential diagnoses help the healthcare provider filter other conditions that may mimic signs and symptoms of a suspected disease leading to effective diagnosis. Natalie presents with sadness, social withdrawal, and complaints of headaches and stomachache. Additional information from her mother indicates that she has been depressed and irritable for two months. She has decreased appetite, poor school performance, weight loss, and rarely wants to associate with her peers. Based on these symptoms, the medical differential diagnosis can be Addison’s disease. This condition involves the attack of the adrenal glands leading to disrupted production of steroid hormones and cortisol. This condition presents with signs like lack of energy or motivation, muscle weakness, low mood, loss of appetite, and weight loss.

Apart from the medical differential diagnosis, two other possible psychiatric diagnoses include dysthymia and adjustment disorder. Dysthymia is a continuous long-term form of depression that causes individuals to lose interest in normal activities, lack productivity, feeling of hopelessness. Individuals with this condition present with symptoms like irritability, sleeping problems, avoidance behavior, and poor appetite that are also observed in major depressive disorder (McIntyre et al., 2019). Adjustment disorder on the other hand occurs in response to an identifiable stressor occurring within three months of symptoms onset. The condition is characterized by low mood, insomnia, sadness, low self-esteem, loss of interest, and social isolation.

Diagnosis

The probable diagnosis for Natalee is major depression. The DSM-5 criteria for major depressive disorder involve presentation with persistently low mood, decreased interest in pleasurable activities, feeling of worthlessness, sleep disturbance, lack of energy, poor concentration, appetite changes, and sometimes suicidal thoughts. A patient with this diagnosis must have five or more of the above symptoms for a discrete period of two weeks or more (Mullen, 2018). Natalee qualifies for this diagnosis based on her presenting symptoms that include irritability, social withdrawal, change in appetite, sleep disturbance, and loss of interest in pleasurable activities.

Medication and Education

Antidepressants are considered the first-line choice of treatment for children and adults with moderate to severe depression. Among these medications, selective serotonin reuptake inhibitors are the first choice. The medication I will prescribe for Natalee is Fluoxetine 10mg PO. This drug is FDA approved for children 8 years of age and older (Neavin et al., 2018). As an antidepressant, the black box warning for this drug is that it can trigger suicidal thoughts. Upon prescription, I will educate Trina about the common side effects of the drug that may include sweating, headache, restlessness, and sleep disturbance. I will also explain how the medication works by explaining serotonin and how fluoxetine will help to increase its sufficiency leading to alleviation of MDD symptoms. I will elaborate on the tendency of antidepressants to trigger suicidal thoughts and educate the mother to monitor for signs of anxiety, violence, and other behavior changes that can be indicative of the advanced progression of the disease.

References

McIntyre, R. S., Zimmerman, M., Goldberg, J. F., & First, M. B. (2019). Differential diagnosis of major depressive disorder versus bipolar disorder: Current status and best clinical practices. The Journal of Clinical Psychiatry, 80(3), ot18043ah2. https://doi.org/10.4088/JCP.ot18043ah2

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

Neavin, D. R., Joyce, J., & Swintak, C. (2018). Treatment of major depressive disorder in pediatric populations. Diseases (Basel, Switzerland), 6(2), 48. https://doi.org/10.3390/diseases6020048

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