Pediatric Case Study
1. What important information is missing from the case study?
Important information missing from the case study are any family history of mental health care problems. Also, information about any mediation the client is currently taking or has taken in the past. Also, any assessment of trauma or abuse in the past or in the family.
2. Discuss normal developmental achievements and potential vulnerabilities.
Normally, 10-year-old such as Madeleine develop concrete operational abilities where she can identify conservation of mass, area, and volume. During this time, 10-year-old can reason accurately and can understand reversibility that certain operations can reverse and negate the effects of each other. During this time, information in the brain travels at a great speed to work in coordination with one another. This allows the child to normally make logical argument (Brezinka et al., 2020).
Also, problem-solving abilities increase during this time as children can utilize more than one strategy and rehearse their actions in a more accurate manner. Also, at this age, the child can develop decentration where she can successfully take other’s point of view and consider more than one dimension. Logical reasoning is increased at this stage however, children at this period still have a hard time with abstract as well as hypothetical concepts and mental operations.
Obsessive-compulsive disorder (OCD) can really impact and disrupt the child’s activities of daily living. Potential vulnerabilities include disruption in the normal social functioning and development of the child. As mentioned in the case study, the child has become isolated from her peers and has not developed any friends (Brezinka et al., 2020). Because of anxiety, the child has problems adjusting to changes in her environment which is a critical developmental milestone for a child this age. Also, the child is particularly vulnerable o depression as she struggles with intrusive and compulsive thoughts. Cognitive development may be affected as the child struggle to finishes schoolwork.
3. What precipitating factors could be contributing to the current symptoms?
Stress can be a great factor that might precipitate the current symptom. It was mentioned in the case study that six months ago. Madeline’s father lost his job in the hotel industry and her mother had to increase her hours at work as a certified nursing assistant. This is also the onset of the child’s signs and symptoms which has been attributed to the stress at home. Because Madeline has been spending more time with her grandmother, and she received less time with her parents, it could have also exacerbated her symptoms and compulsions.
4. What is the differential diagnosis?
· Obsessive compulsive disorder
· Phobic disorder
· Generalized anxiety disorder
5. Describe the etiology of the primary diagnosis.
The exact cause for the development of OCD is not completely understood. Genetics brain abnormalities coupled with environmental factor are though to play a role. A study from Nazeer et al. (2020), pointed out that there are problems within the structures and pathways within basal gangliathalamo- cortical circuits of patient with OCD (Ziegler et al., 2021). It was determined that most consistently the orbitofrontal cortex, the cingulated cortex and the basal ganglia, and more recently also regions within the parietal lobe abnormalities are thought to play a role in eh development of compulsion and obsessive thoughts (Stein et al., 2019). It was also determined that there is a problem in the regulation of serotonin.
6. How should physiologic complications be monitored and assessed?
A child with OCD needs to be assessed using screening questions such as experiencing image or impulses about obsessions, worms, dirt, germs, and bad thoughts happening. Also, OCD children need to be also assessed regarding suicidal ideation. They need to be assessed for any looming issues such as stress in the home such as financial problems, marital conflict, abuse, violence, or neglect. Also, it is important for the provider to assess the insight of the child regarding her OCD and her rituals (Stein et al., 2019). Ensuring that the child is in a safe environment is important for Madeline. A helpful communication system should be established with Madeline so Madeline can signal the caregiver, teacher, or family members if OCD symptoms are coming on.
7. What are the usual nonpharmacologic therapies that would help?
Non-pharmacological interventions for children with OC include the use of cognitive behavioral therapy called exposure and responsive prevention or ERP. In ERP, children develop a competency to face their fears without giving into the compulsion. The provider can guide them into the process as Madeline can learn that they can allow the anxiety to come and go without needing to do the rituals. For severe cases of OCD, ERP may need to be combined with pharmacotherapeutic management such as a selective serotonin reuptake inhibitor (Geller et al., 2021).
8. What medications could help and why?
There are only four medications that has been approved by the FDA for use in children and they are clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft). Children are usually started with a lower dose base and adjusted based on how they respond to the medication. For example, Prozac is given 10-80 mg/day. Usually, Anafranil is usually tried first for children as studies suggests that Anafranil has more positive outcome among children with OCD (Geller et al., 2021).These medications are prescribed because they are effective in improvement of the mood, remission, compulsion, and obsessive thoughts.
9. Identify safety risks and how they should be dealt with in the treatment plan.
Safety risks for example n taking medications, SSRI are usually associated with common side effects such as nausea, abdominal pain, inability to sit still, insomnia, weight gain, drowsiness, palpitations, problems with voiding and dry mouth. It is important for Madeline to be closely monitored for these side effects especially kidney, liver function, and echocardiogram (Ziegler et al., 2021). Sometimes children ma turns to vices such as drugs and alcohol to manage their condition. It is important for Madeline to receive the right support and love from her parents as well as guidance as she grows up (Ziegler et al., 2021). Because children with OCD have a hard time falling asleep because of intrusive thought as well may have a lack of appetite because of medication side effects, it is important for the parents to ensure that she is eating a well-balanced meal as she sustains her developing and growing body.
References
Brezinka, V., Mailänder, V., & Walitza, S. (2020). Obsessive compulsive disorder in very young children – a case series from a specialized outpatient clinic. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02780-0
Geller, D. A., Homayoun, S., & Johnson, G. (2021). Developmental Considerations in Obsessive Compulsive Disorder: Comparing Pediatric and Adult-Onset Cases. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.678538
Nazeer, A., Latif, F., Mondal, A., Azeem, M. W., & Greydanus, D. E. (2020). Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis, and management. Translational Pediatrics, 9(1), S76–S93. https://doi.org/10.21037/tp.2019.10.02
Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature Reviews. Disease Primers, 5(1), 52. https://doi.org/10.1038/s41572-019-0102-3
Ziegler, S., Bednasch, K., Baldofski, S., & Rummel-Kluge, C. (2021). Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLOS ONE, 16(12), e0261169. https://doi.org/10.1371/journal.pone.0261169
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