Posted: September 30th, 2023

Assignment: PSYC 6640 Week 10 – Adolescent Mental Health Evaluation

Assignment: PSYC 6640 Week 10 – Adolescent Mental Health Evaluation

Assignment: PSYC 6640 Week 10: IHuman Assignment

■ Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.
■ Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.
■ Apply this evaluation tool to a patient situation and summarize your opinion of
the results.
■ Describe a plan of care for the patient, depending upon the results.
CASE STUDY:
Angela 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.

In this assignment, we will apply information from the iHuman Case Study to answer the following questions:

Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.

Apply the findings of scholarly research articles to the use of this evaluation tool and describe its validity and reliability.

Apply this evaluation tool to a patient situation and summarize your opinion of the results.

Describe a plan of care for the patient, depending upon the results.

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.

Associated Symptoms/Characteristics:

How are your grades in school?
Do you blame yourself for everything wrong?
Have you had any thoughts of hurting or killing yourself?
Have you been nervous, anxious, or worried about something?
Is it possible that you are pregnant?
Are you crying more than usual?
Do you wish you were not alive anymore or fell asleep and didn’t wake up? If so, how often have you had these thoughts?
Risk Factors:

PMH:

Any new or recent change in medications?
SH:

Tell me about your diet, what you normally eat.
Tell me about daily exercise or sports that you play.
Has drinking alcohol ever caused you problems?
Has anyone suggested that you should reduce the amount of alcohol you drink?
Do you feel guilty about the amount of alcohol you drink?
Are there any guns in your home? If so, are they stored in a secure location?
Etiology:

Are you taking any over-the-counter or herbal medications?
How is your appetite? Any recent change?
HPI/ROS:

Do you have any problems with: itchy scalp, skin changes, moles, thinning hair, brittle nails?
Do you have any problems with: headaches that don’t 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?
Have you noticed: any discharge from your breast, lumps, scaly nipples, pain or swelling, redness?
Do you experience: chest pain, discomfort, pressure, pain/pressure/dizziness with exertion or getting angry, palpitations, decreased exercise tolerance, blue/cold fingers and toes?
Do you experience: shortness of breath, wheezing, difficulty catching your breath, chronic cough, sputum production?
Do 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?
Have you noticed: any bruising, bleeding gums or other sites of increased bleeding?
Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, tremor?
When 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?
Skin

No sign of self-harm (no cutting, picking, and burning)
Mild, comedonal acne, acanthosis nigricans at the nape of the neck
Striae noted on abdomen and buttocks.
Eyes are teary
Abdomen

Tanner V pubic hair distribution, scattered abdominal striae noted.
Bowel sounds are normal.
Abdomen is soft and nontender.
Key Findings:

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 “problem” 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.

Angela’s 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.

Because Angela has had fatigue, her decreased level of activity could contribute to her weight gain and obesity.

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.

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.

Problem Statement:

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.

Problem categories are:

Psychologic – irritable, and crying daily for months
Endocrine – fatigue, emotional lability, and weight gain.
Hematologic – fatigue
Integumentary – striae, acanthosis nigricans, and acne
Differential Diagnoses:

Low self-esteem – R45.81
Other depressive episodes – F33.8
Chronic fatigue, unspecified – R53.82
Infectious mononucleosis, unspecified – B27.9
Pregnancy – Z34.00
Cushing’s syndrome
Cushing’s syndrome is a differential diagnosis that should be considered because:

The common signs and symptoms of Cushing syndrome include the following:

Weight gain, particularly around the midsection of the upper back, face, and between the shoulders.
Striae
Headache, irritability, chronic fatigue
Hypothyroidism
Depression
The leading diagnosis is depressive disorder, given the patient’s fatigue, anhedonia, withdrawal from social interaction, decreased ability to concentrate, and declining grades.

Lab Work Up:

Other Tests
Drug toxicology testing, urine
Cushing’s syndrome
Complete blood count (CBC)
Cortisol, PM
Cortisol, AM
Cortisol, urine
Hypothyroidism
Complete blood count (CBC)
Thyroid function tests (TFT)
Thyroid-stimulating hormone (TSH)
Free thyroxine (FT4)
Attention deficit hyperactivity disorder (ADD/ADHD)
Depressive disorder
Mononucleosis, Epstein-Barr virus (EBV)
Heterophile antibody test (mononucleosis spot)
Complete blood count (CBC)
Anemia
Complete blood count (CBC)
Total iron-binding capacity (TIBC)
Total serum iron (TSI)
Pregnancy
Human chorionic gonadotropin (hCG), urine
Diabetes mellitus type 2
Complete blood count (CBC)
Glycated hemoglobin (HbA1c)
Glucose, blood (BG)
Angela’s PHQ-A score was 19-

References:

Johnson, J. (n.d.). PHQ-9 modified for adolescents (PHQ-A) [Pdf]. Http://www.uacap.org.
Bhatia S, Bhatia S. Childhood and adolescent depression. American Family Physician. 2007; 75(1).
Braverman PK, Breech L. Gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010; 126(3):583-590.
Brent D, Birmaher B. Adolescent depression. New England Journal of Medicine. 2002; 347(9).
Cheung A, et al. Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics. 2007; 120;e1313.
March 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.
Moses S. Female Tanner stage. Family Practice Notebook. 2014
Prager LM. Depression and suicide in children and adolescents. Pediatrics in Review. 2009; 30(6):199-206.
Rome E. Obesity prevention and treatment. Pediatrics in Review. 2011; 32(9):363-372.
Saluja 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.
Schneider M, Brill S. Obesity in children and adolescents. Pediatrics in Review. 2005; 26(5):155-161.
Williams 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.
Treatment:

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.

The initial management plan also includes the following actions:

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.
Review and document the assessment of the patient’s 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.
Educate patients and parents by providing verbal and written information about the prevalence, symptoms, and treatment of depression.
Refer to a nutritionist to assess the patient’s nutritional risk factors for recent weight gain and assist the patient in setting goals to reduce BMI (dietary modification, behavioral modification, increased physical activity).
Schedule follow-up appointments with a primary care physician to assess the response to therapy.

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