Assignment: PSYC 6640 Week 10 – Adolescent Mental Health Evaluation<\/p>\n
Assignment: PSYC 6640 Week 10: IHuman Assignment<\/p>\n
\u25a0 Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.
\n\u25a0 Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.
\n\u25a0 Apply this evaluation tool to a patient situation and summarize your opinion of
\nthe results.
\n\u25a0 Describe a plan of care for the patient, depending upon the results.
\nCASE STUDY:
\nAngela Cortez is a 17-year-old female who presents with a history of fatigue and a lack of energy for the past two months, associated with irritability and weight gain. These symptoms have led to a decline in her school performance and a decrease in her participation in her usual activities. Angela has been experiencing daily episodes of crying over the past month. During a physical exam, she was found to have an elevated BMI, appeared tearful, and exhibited signs of acne, striae, and acanthosis. She denies any active suicidal thoughts.<\/p>\n
In this assignment, we will apply information from the iHuman Case Study to answer the following questions:<\/p>\n
Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.<\/p>\n
Apply the findings of scholarly research articles to the use of this evaluation tool and describe its validity and reliability.<\/p>\n
Apply this evaluation tool to a patient situation and summarize your opinion of the results.<\/p>\n
Describe a plan of care for the patient, depending upon the results.<\/p>\n
Please ensure that you use references no later than 5 years old and include in-text citations with appropriate page numbers or paragraphs being cited.<\/p>\n
Associated Symptoms\/Characteristics:<\/p>\n
How are your grades in school?
\nDo you blame yourself for everything wrong?
\nHave you had any thoughts of hurting or killing yourself?
\nHave you been nervous, anxious, or worried about something?
\nIs it possible that you are pregnant?
\nAre you crying more than usual?
\nDo you wish you were not alive anymore or fell asleep and didn\u2019t wake up? If so, how often have you had these thoughts?
\nRisk Factors:<\/p>\n
PMH:<\/p>\n
Any new or recent change in medications?
\nSH:<\/p>\n
Tell me about your diet, what you normally eat.
\nTell me about daily exercise or sports that you play.
\nHas drinking alcohol ever caused you problems?
\nHas anyone suggested that you should reduce the amount of alcohol you drink?
\nDo you feel guilty about the amount of alcohol you drink?
\nAre there any guns in your home? If so, are they stored in a secure location?
\nEtiology:<\/p>\n
Are you taking any over-the-counter or herbal medications?
\nHow is your appetite? Any recent change?
\nHPI\/ROS:<\/p>\n
Do you have any problems with: itchy scalp, skin changes, moles, thinning hair, brittle nails?
\nDo you have any problems with: headaches that don\u2019t go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty with night vision, problems hearing, ear pain, sinus problems, chronic sore throats, difficulty swallowing?
\nHave you noticed: any discharge from your breast, lumps, scaly nipples, pain or swelling, redness?
\nDo you experience: chest pain, discomfort, pressure, pain\/pressure\/dizziness with exertion or getting angry, palpitations, decreased exercise tolerance, blue\/cold fingers and toes?
\nDo you experience: shortness of breath, wheezing, difficulty catching your breath, chronic cough, sputum production?
\nDo you have problems with: nausea, vomiting, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, bloating?
\nHave you noticed: any bruising, bleeding gums or other sites of increased bleeding?
\nDo you have any of the following: dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, tremor?
\nWhen you urinate, have you noticed: pain, difficulty starting or stopping, dribbling, incontinence, urgency during the day or night. Any changes in frequency? Any blood in your urine?
\nSkin<\/p>\n
No sign of self-harm (no cutting, picking, and burning)
\nMild, comedonal acne, acanthosis nigricans at the nape of the neck
\nStriae noted on abdomen and buttocks.
\nEyes are teary
\nAbdomen<\/p>\n
Tanner V pubic hair distribution, scattered abdominal striae noted.
\nBowel sounds are normal.
\nAbdomen is soft and nontender.
\nKey Findings:<\/p>\n
The medical key findings list, or list of pertinent findings, includes everything that is out of the ordinary about this patient, even when it is not a \u201cproblem\u201d in the true sense of the word. The key findings list allows you to begin to see the overall or unified constellation of significant signs and symptoms. It is also the starting point for developing and ranking diagnostic hypotheses. The pertinent presence or absence of other critical signs and symptoms will aid your assessment of the severity of the presenting complaint and your assessment of potential comorbidities.<\/p>\n
Angela\u2019s main reason for her visit today and most significant active problem (MSAP) is her anhedonia or loss of interest and decreased energy for activities that used to give her pleasure. Her fatigue, irritability, and daily episodes of crying could be related factors contributing to her anhedonia. Angela also states that she has had difficulty concentrating at school. Her decline in her school grades could be a result of all of the chronic issues listed above.<\/p>\n
Because Angela has had fatigue, her decreased level of activity could contribute to her weight gain and obesity.<\/p>\n
The physical exam findings of acanthosis nigricans, acne, and striae are important to note, but at this point, we are unsure if they are related to the most significant active problem.<\/p>\n
Her family history of obesity, DM, and HTN is also important to note as this will guide our differential and testing. However, we are unsure at this point if it is related to the most significant active problem.<\/p>\n
Problem Statement:<\/p>\n
16-year-old white female presents with complaints of anhedonia and decreased energy. She has been experiencing fatigue, irritability, and daily episodes of crying, which could be related factors contributing to her anhedonia. Angela also reports difficulty concentrating at school, resulting in a decline in her school grades. She expresses feelings of hopelessness regarding her weight and acne.<\/p>\n
Problem categories are:<\/p>\n
Psychologic \u2013 irritable, and crying daily for months
\nEndocrine – fatigue, emotional lability, and weight gain.
\nHematologic – fatigue
\nIntegumentary – striae, acanthosis nigricans, and acne
\nDifferential Diagnoses:<\/p>\n
Low self-esteem – R45.81
\nOther depressive episodes – F33.8
\nChronic fatigue, unspecified – R53.82
\nInfectious mononucleosis, unspecified \u2013 B27.9
\nPregnancy – Z34.00
\nCushing’s syndrome
\nCushing’s syndrome is a differential diagnosis that should be considered because:<\/p>\n
The common signs and symptoms of Cushing syndrome include the following:<\/p>\n
Weight gain, particularly around the midsection of the upper back, face, and between the shoulders.
\nStriae
\nHeadache, irritability, chronic fatigue
\nHypothyroidism
\nDepression
\nThe leading diagnosis is depressive disorder, given the patient\u2019s fatigue, anhedonia, withdrawal from social interaction, decreased ability to concentrate, and declining grades.<\/p>\n
Lab Work Up:<\/p>\n
Other Tests
\nDrug toxicology testing, urine
\nCushing\u2019s syndrome
\nComplete blood count (CBC)
\nCortisol, PM
\nCortisol, AM
\nCortisol, urine
\nHypothyroidism
\nComplete blood count (CBC)
\nThyroid function tests (TFT)
\nThyroid-stimulating hormone (TSH)
\nFree thyroxine (FT4)
\nAttention deficit hyperactivity disorder (ADD\/ADHD)
\nDepressive disorder
\nMononucleosis, Epstein-Barr virus (EBV)
\nHeterophile antibody test (mononucleosis spot)
\nComplete blood count (CBC)
\nAnemia
\nComplete blood count (CBC)
\nTotal iron-binding capacity (TIBC)
\nTotal serum iron (TSI)
\nPregnancy
\nHuman chorionic gonadotropin (hCG), urine
\nDiabetes mellitus type 2
\nComplete blood count (CBC)
\nGlycated hemoglobin (HbA1c)
\nGlucose, blood (BG)
\nAngela’s PHQ-A score was 19-<\/p>\n
References:<\/p>\n
Johnson, J. (n.d.). PHQ-9 modified for adolescents (PHQ-A) [Pdf]. Http:\/\/www.uacap.org.
\nBhatia S, Bhatia S. Childhood and adolescent depression. American Family Physician. 2007; 75(1).
\nBraverman PK, Breech L. Gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010; 126(3):583-590.
\nBrent D, Birmaher B. Adolescent depression. New England Journal of Medicine. 2002; 347(9).
\nCheung A, et al. Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics. 2007; 120;e1313.
\nMarch J, et al. Fluoxetine, cognitive behavioral therapy, and their combinations for adolescents with depression: Treatment for adolescents with depression study (TADS): Randomized controlled trial. JAMA. 2004; 292(7):807-820.
\nMoses S. Female Tanner stage. Family Practice Notebook. 2014
\nPrager LM. Depression and suicide in children and adolescents. Pediatrics in Review. 2009; 30(6):199-206.
\nRome E. Obesity prevention and treatment. Pediatrics in Review. 2011; 32(9):363-372.
\nSaluja G, et al. Prevalence of and risk factors for depressive symptoms among young adolescents. Archive of Pediatric and Adolescent Medicine (JAMA). 2004; 158:760-765.
\nSchneider M, Brill S. Obesity in children and adolescents. Pediatrics in Review. 2005; 26(5):155-161.
\nWilliams S, et al. Screening for child and adolescent depression in primary care settings: A systematic evidence review. U.S. Preventive Services Task Force Report. Pediatrics. 2009; 123:e716-e735.
\nTreatment:<\/p>\n
Angela will be referred to a psychiatrist for the initiation of both psychotherapy and pharmacotherapy in the treatment of adolescent depression. She will be started on fluoxetine, a selective serotonin reuptake inhibitor (SSRI), with upward dosage adjustment over several weeks. SSRIs plus cognitive-behavioral therapy (CBT) have been demonstrated to be effective in treating adolescent depression.<\/p>\n
The initial management plan also includes the following actions:<\/p>\n
Review common side effects (nausea, vomiting, decreased appetite, sleep disturbance) with the patient and parent. Review the black box warning and the risk of suicidality with the patient and parent.
\nReview and document the assessment of the patient\u2019s suicide risk. Establish an oral no-suicide contract and a safety plan should suicidal thoughts develop while on medication. Clinicians should ask about the availability of firearms and other dangerous items in the home and request that they be removed.
\nEducate patients and parents by providing verbal and written information about the prevalence, symptoms, and treatment of depression.
\nRefer to a nutritionist to assess the patient\u2019s nutritional risk factors for recent weight gain and assist the patient in setting goals to reduce BMI (dietary modification, behavioral modification, increased physical activity).
\nSchedule follow-up appointments with a primary care physician to assess the response to therapy.<\/p>\n","protected":false},"excerpt":{"rendered":"
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