Case study : The client is an 8-year-old African American male who arrives at the ER with his mother.
NURS 6630 An African American Child Suffering From Depression Essay

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

Client complained of feeling “sad”
Mother reports that teacher said child is withdrawn from peers in class
Mother notes decreased appetite and occasional periods of irritation
Client reached all developmental landmarks at appropriate ages
Physical exam unremarkable
Laboratory studies WNL
Child referred to psychiatry for evaluation

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but

NURS 6630 An African American Child Suffering From Depression Essay
NURS 6630 An African American Child Suffering From Depression Essay

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)

RESOURCES

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what you should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

Decision Point One

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Begin 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

Select what you should do next:

Increase dose to 37.5 mg orally daily

Increase dose to 50 mg orally daily

Change to Prozac 10 mg orally daily

Decision Point One

Begin Paxil 10 mg orally daily

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks
Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two

Select what you should do next:

Decrease dose for 7 days then return to previous 10 mg day dose

Increase dose to 20 mg orally daily

Change to Prozac 10 mg orally daily

ecision Point One

Begin Wellbutrin 75 mg orally BID

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks
Child is unable to fall asleep at night
Decision Point Two

Select what you should do next:

Change from immediate release to extended release 150 mg orally daily in the morning

Give second dose of the day at 1:00 pm in the afternoon

Change to Lexapro 10 mg orally daily