MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. 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. 

The PMHNP administers 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

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

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• No change in depressive symptoms at all

Decision Point Two

Increase dose to 50 mg orally daily 

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Depressive symptoms decrease by 50%. Cleint tolerating      well

· Decision Point Three

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· Increase to 75 mg orally daily 

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· Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

Examine Case Study: An African American Child Suffering From Depression.  You will be asked to make three decisions concerning the medication to  prescribe to this client. Be sure to consider factors that might impact  the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:    
  • Decision #1      
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?  Support your response with evidence and references to the Learning  Resources.
    • Explain any difference between what you expected to achieve  with Decision #1 and the results of the decision. Why were they  different?
  • Decision #2      
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?  Support your response with evidence and references to the Learning  Resources. 
    • Explain any difference between what you expected to achieve  with Decision #2 and the results of the decision. Why were they  different?
  • Decision #3      
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?  Support your response with evidence and references to the Learning  Resources.
    • Explain any difference between what you expected to achieve  with Decision #3 and the results of the decision. Why were they  different?
• Also include how ethical considerations might impact your treatment plan and communication with clients.