16 Jul Therapy for Pediatric Clients with Mood DisordersA
Therapy for Pediatric Clients with Mood DisordersAn African American Child Suffering From Depression.BACKGROUND INFORMATIONThe client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.A client complained of feeling sadMother reports that teacher said child is withdrawn from peers in classMother notes decreased appetite and occasional periods of irritationClient reached all developmental landmarks at appropriate agesPhysical exam unremarkableLaboratory studies WNLChild referred to psychiatry for evaluationMENTAL STATUS EXAMAlert & oriented X 3, speech clear, coherent, goal-directed, spontaneous. The 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.You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)Decision Point OneBegin Wellbutrin 75 mg orally BIDRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksChild is unable to fall asleep at nightDecision Point TwoChange to Lexapro 10 mg orally dailyRESULTS OF DECISION POINT TWOClient returns to clinic in four weeksChild is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptomsDecision Point ThreeContinue current doseAt this point, there is no indicating that you should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. You could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.APA citation 4 to 5 references within 5 years.
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