Question

You are called to a home in the city where parents report a decreased mental status in their adolescent child. As you approach the house you are greeted by an adult who reports their daughter has locked herself in her room and will not open the door. They state she will respond verbally to them with statements like “just leave me alone.” While there appears to be a moderate amount of anxiety present in the home,

Your assessment reveals a 14 year old adolescent in no acute distress. She is calm and cooperative with your assessment and history questions. Her airway is clear, respirations and pulse are normal. There is no evidence of trauma or abuse. Her vital signs are within normal limits. During your assessment, you found the patient to be sullen, alert, and oriented to all domains and coherent in her thinking. She did not disclose any thoughts of suicide. Her memory (both short and long term) was intact. She denied any traumatic events or recent losses. When asked about her recent decline in school performance and her departure from the track and field team, she reports that she simply lost interest and is unable to concentrate on her studies. She became tearful when describing how her behavior was "disappointing her family." She explained that she just wants to stay in bed in her room because she is so tired that she does not have the energy to worry about things or get a good night's sleep.

What additional assessment information would you gather on this patient?

What is your field impression for this patient? What are the probabilities on your problem list for her?

If you responded to her in another three months, what class of antidepressant medication would you most likely you expect to see in her history? What class would be least likely?

Answer 1

Ask her if she has any problems with his peers in schools, obesity problems or bullying problems, any issues in academics or love failures that cause the child to haveblow self esteem.

It seems the child is not having any problems with his parents and she feels so sad in disappointing her parents and family members. The problem lies in the school, whether with peers or teachers. So its better to have a school visit and get additional information about any peer problems, love failure, bullying or any academic problems that doesnt allow her to get presence of mind.

Fluoxetine is an FDA approved drug to be used in paediatric depression. Its an SSRI, selective serotonin reuptake inhibitor.Other antidepressants should not be used. Mirtazapine us also not allowed for depression in paediatric adolescents. Tetracyclic antidepressants are least likely to be used.