sufficient symptom reduction has been achieved.

The child referred to psychiatry for evaluation
June 19, 2019
Healing and Autonomy.
June 19, 2019

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

 

 

 

Case Study of the above client

 

Decision Point One

 

I selected  Zoloft 25 mg orally daily

 

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

 

No change in depressive symptoms at all

 

Decision Point Two

 

Increase dose to 50 mg orally daily

 

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

 

Depressive symptoms decrease by 50%. Cleint tolerating well

 

Decision Point Three

 

Maintain current dose

 

Guidance to Student

 

At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy

 

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