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The mother of a nine-year-old African American male patient, Mike M., complained about him recently developing difficulties sleeping at night. Particularly, Mike had frequent nightmares and insomnia, which the mother claimed to have aggravated over the past few days. The patient also showed a decline in his concentration abilities, which made studying difficult for him.
According to the mother, the observed phenomena were barely noticeable at first, which was why pinpointing the exact day of acquiring the disease does not seem possible. However, it was a week ago when Mike’s teacher pointed to a drop in his performance levels, and a couple of days ago he had trouble sleeping during the night because of bad dreams. Sleep deprivation, in turn, has aggravated the child’s condition, leading to fatigue and increasing his blood pressure slightly.
Moreover, Mike has had several outbursts at school, which was rather unusual for him. The first case involved him getting into a fight with another student, which was something that he had never done before. Furthermore, several days ago, the child seems to have lost his interest in most of the hobbies that he used to find fascinating. For instance, he no longer watches his favorite animated TV shows and avoids talking to his friends. At the same time, Mike has not acquired any other hobbies that could explain the sudden change in his priorities. Therefore, the patient requires a thorough analysis.
Mental Status Exam
The patient appears to be perplexed and quite exhausted. He has been showing the signs of worrying throughout the examination. For instance, he kept asking whether the examination would take long, and was evidently in a hurry, although there was no clear reason for it. In addition, Mike seemed to have attention difficulties, which makes him forget important information comparatively quickly and have a very short attention span. The child seems rather irritable, which can be explained by the stress that he has been experiencing, including sleep deprivation.
Throughout the examination, Mike has been showing the lack of interest toward the process and was rather indifferent, yet he was evidently annoyed at the end of it. Overall, his attitude toward the physician and the overall examination is slightly unnatural and, thus emblematic of the disorder that he has developed. In addition, the patient’s mood is far from being positive. Although the patient did not have any aggressive outbursts during the examination and, instead, seemed quite calm, his apathy is indicative of a larger problem.
The speech and thought of the patient do not seem to deviate from the norm. Mike spoke rather fast during the assessment process and seemed to lose track of his thoughts, yet his mother claimed that the specified behavior had been rather characteristic of Mike’s personality before the health concerns emerged. The child has no perceptual disturbances and seems to have proper orientation and consciousness, although his reactions are slightly increased. Mike has minor short-term memory issues, which his mother claims to have existed long before the signs of anxiety developed. The reliability and judgement of the patient’s condition also seem to be within the expected range.
Although Mike is rather introversive and, therefore, has only a few friends, the recent changes in his attitude have made him reduce communication with his peers to an even greater extent. As his mother states, Mike has not been socializing with his friends for over three days. Based on the information that the mother retrieved from Mike’s teachers, the patient has also stopped conversing with his friends at school. The degree to which his social interactions have deteriorated shows that there is a health concern that needs to be addressed.
Medical and Mental Health History
The patient has had a moderately positive health history. According to the health records, there were no problems during either the mother’s pregnancy or the child’s birth. Mike was not breastfed, however, since his mother had low milk supply, which resulted in the child having comparatively low weight (currently, it is 57.4 lbs). There have been no sleep issues up until recently.
The child has no known allergies; however, there are certain endocrine problems that require further attention. Particularly, Mike sweats a lot, according to his mother. Apart from the recent shortness of breath, there have been no cardiovascular issues in Mikes’ history of health. The child has no rashes or other skin conditions. The condition of the patient’s eyes, nose, throat, and ears is good; likewise, his musculoskeletal system is within the established norm.
Mike does not have major genitourinary concerns aside from the fact that he seems to urinate more frequently than he used to several weeks ago. His respiratory system functions properly, and there are no blood or lymph concerns, either. However, the psychiatric and neurological condition requires further management since he has been showing the signs of stress and anxiety.
Judging by the present issues that the patient has been developing, there is a strong probability of an anxiety disorder developing. According to the official definition provided by the American Psychiatric Association, child anxiety is an umbrella term for a larger number of anxiety-related mental health issues (2013). The fact that the child has developed problems regarding communication with his peers shows that he may have acquired one of the forms of childhood anxiety (Strauss, Cavanagh, Oliver, & Pettman, 2014). Particularly, given the rapid and unexplainable drop in the interest toward his usual hobbies and conversations with friends, along with other symptoms such as apathy and troubles sleeping, one may suspect the mixed anxiety and depressive disorder (MADD) (Cummings, Caporino, & Kendall, 2014).
MADD is defined in DSM-V in a rather self-explanatory manner as a condition in which “a combination of depression and anxiety is predominant” (American Psychiatric Association, 2013). In the case under analysis, there are clear signs of depression, which manifest themselves in the changes in sleeping patterns and the attitude toward hobbies and school activities, as well as communication with peers. The sleep patterns are also indicative of anxiety, which can also be seen as the primary cause of an increase in fatigue, irritability, and concentration issues. Therefore, MADD can be deemed as the reason for the current health concerns.
To ensure that the disorder has been diagnosed correctly, one will have to run several tests. Specifically, the test designed by the Anxiety and Depression Association of America (n.d.) will have to be viewed as a necessary tool. The specified questionnaire known as Screen for Child Anxiety Related Disorders, or SCARED, will help one to determine the presence of depression and anxiety in a child, thus pointing to the necessity to take actions.
In order to address Mike’s needs properly, one will have to deploy a strategy that combined the use of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) (Locher et al., 2017). The specified strategy will allow reducing the negative effects that anxiety has on the patient’s well-being, at the same time creating the environment in which his behavior can be altered. Furthermore, by using CBT, one will be able to locate the core of the problem and learn why Mike has developed anxiety and depression in the first place.
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In addition, it will be crucial to promote the active family involvement in the treatment process. Since the recovery will also involve alterations in the child’s behavior and the identification of the issues that may have prompted the development of anxiety, the active family support will be required. Mike’s parents will have to cooperate with the therapist to create the setting in which the patient will feel comfortable and safe, thus managing his anxiety issues.
Even after the patient shows the signs of recovery and restores his initial healthy behavior and attitudes, it will be necessary for the therapist to supervise him for a certain amount of time. For this purpose, a therapist must establish the consistent dialogue with the mother of the patient. In addition, the therapist will have to set a schedule for the follow-up visits of a nurse to check on the child’s development and well-being. Thus, the development of comorbid issue and other problems associated with the current condition will be prevented. In addition, a nurse will provide the parents of the child with crucial information about managing mental health issues such as depression and anxiety, as well as give them directions or locating resources for the further health education.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (vol. 5). Washington, DC: APA.
Anxiety and Depression Association of America. (n.d.). Screening for an anxiety disorder: Children. Web.
Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816-845. Web.
Locher, M. C., Koechlin, M. H., Zion, M. S. R., Werner, M. C., Pine, D. S., Kirsch, I.,… Kossowsky, J. (2017). Efficacy and safety of SSRIs, SNRIs, and placebo in common psychiatric disorders: A comprehensive meta-analysis in children and adolescents. JAMA Psychiatry, 74(10), 1011-1020. Web.
Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLOS One, 9(4), 1-13. Web.