During this visit, we will meet Tenisha, a 15-year-old female, in the clinic for her annual
wellness exam. She reports that she has been feeling depressed. I would utilize a PHQ-2 and
SCARED form as these are the recommended screening tools for depression and anxiety in our
patient’s age. Many children have anxiety and depression, so it will be important to screen for
both when a patient presents with one of these diagnoses. (Zsamboky et al., 2021)
Many questions would be beneficial to ask and discuss with our patient. I would ask if
Mom has noticed any behavior, sleep, or hygiene changes. I would also ask Mom if there have
been any recent changes within the family or school and obtain family history regarding mental
health diagnosis and suicide attempts. I would meet with Tenisha individually and assess her
appearance, attitude, and interaction with me throughout our visit. I will ask her if she feels sad
or hopeless, if she has been cutting, is she using drugs or alcohol, and is she having suicidal
thoughts or a suicidal plan. I will also ask Tenisha if she has fears or worries about anything, is
she having trouble sleeping, and is she having panic attacks. (Garzon et al., 2019)
After completing a physical exam, reviewing the PHQ-2, SCARED form, and talking
with Tenisha and her mother, I can formulate a diagnosis. Tenisha has moderate depression and
mild anxiety and denies suicidal thoughts or plans. Psychotherapy is the first-line option when
treating mild to moderate depression that does not include suicidality. Initiating medication is
indicated when psychotherapy is not helping by itself. Selective serotonin reuptake inhibitors are
first-line medications in treating. The US Food and Drug Administration only endorsed two
medications for pediatrics: fluoxetine and escitalopram. If treatment is not successful within six
to eight weeks, it is recommended to refer to a psychiatrist or other mental health practitioner.
(Zsamboky et al., 2021)
My plan for this situation would be to place a referral for psychotherapy and discuss
options for starting a low dose of medication. Mom and Tenisha are agreeable regarding the
referral, and they would like to move forward with starting a medication. I will start fluoxetine
10mg once daily and review with them that she could have nausea, headaches, and fatigue for the
first couple of weeks. If this occurs, it should resolve in the first week or two, and if it does not,
I would ask that they call and let me know. It will be important to review that there is a potential
that the symptoms of anxiety and depression could worsen for a short time before starting to
improve. (Sohel, 2022) I would end our appointment by asking Tenisha to make a suicide pact
with me that will include that if she has any feelings of wanting to harm herself or others, before
acting upon her feelings, she will call her doctor’s office and talk to us, talk to a teacher or a
trusted adult at school, or another adult family member who can provide support and assistance.
I would also have her schedule a follow-up visit with me in the office in four weeks and call in
two weeks to ensure Tenisha is doing okay. (Wilhelm, n.d.)
Reference
, Garzon, D. L., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., & Duderstadt, K.
(2019a). Behavioral and Mental Health Promotion. In Burns’ Pediatric Primary Care (pp.
164–196). Elsevier.
Sohel, A. J. (2022, July 4). Fluoxetine. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK459223/
Wilhelm, M. (n.d.). Mental Health. Week 10 Learning Resources, United States of America.
Zsamboky, M., Haskell, B., Vick, R., & Schroer, M. (2021). Treating child and adolescent
depression and anxiety in primary care. The Journal for Nurse Practitioners, 17(1), 54–
59. https://doi.org/10.1016/j.nurpra.2020.08.019
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