THE CASE STUDY Pediatric depression Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression BACKGROUND INFORMATION The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression. Client complained of feeling “sad” Mother reports that teacher said child is withdrawn from peers in class Mother notes decreased appetite and occasional periods of irritation Client reached all developmental landmarks at appropriate ages Physical exam unremarkable Laboratory studies WNL Child referred to psychiatry for evaluation Client seen by Psychiatric Nurse Practitioner MENTAL STATUS EXAM Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) RESOURCES Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. Decision Point One Select what the PMHNP should do: Begin Zoloft 25 mg orally daily Begin Paxil 10 mg orally daily Begin Wellbutrin 75 mg orally BID Questions 1) Which decision did you select? 2) Why did you select this decision? Support your response with evidence and references to the Learning Resources. 3) What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. 4) Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision two Client returns to clinic in four weeks No change in depressive symptoms at all Decision Point Two Base on your decision part two Select what the PMHNP should do next: Increase dose to 37.5 mg orally daily Increase dose to 50 mg orally daily Change to Prozac 10 mg orally daily 1) Why did you select this decision? Support your response with evidence and references to the Learning Resources. 2) What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. 3) Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision point 3 Client returns to clinic in four weeks Depressive symptoms decrease by 50%. Cleint tolerating well Base on the above outcome, what will you do? Select what the PMHNP should do next: Maintain current dose Increase to 75 mg orally daily Change to a SNRI 1) Why did you select this decision? Support your response with evidence and references to the Learning Resources. 2) What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. 3) Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
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