Angela Cortez iHuman Case study Example Essay
Angela Cortez iHuman Case study Example Essay
Angela Cortez I-Human
Assessment: Angela is a 17-year-old female who presents with increased fatigue over the past two months. Angela has had recent weight gain. She also presents with increased irritability and tearfulness. Angela describes always being tired and loss of interest in every-day activities. She is obese with mild acne, states she’s feeling unhappy with the way she looks. Currently, Angela denies any suicidal ideation.
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Upon completion of the assessment, it appears that Angela is suffering from adolescent depression disorder. However, it is important to complete lab work to rule out any other cause of her symptoms. A complete blood count, thyroid studies and heterophile antibody test has been completed to determine if some pathological reason is contributing to Angela’s fatigue and lack of energy. The CBC has come back within normal limits, ruling out acute infection as a cause of Angela’s symptoms. Angela Cortez iHuman Case study Example Essay. The thyroid studies are also in normal limits, ruling out thyroid disorder as a cause of symptoms. Due to Angela’s age and symptoms, a heterophile antibody test is appropriate to rule out mononucleosis as a cause of symptoms. This test came back negative, ruling out mononucleosis. A urine cortisol test was completed to rule out pathological causes of Angela’s symptoms. This test was within normal limits.
Due to Angela’s personality changes and irritability, a urine drug screen is appropriate. This test was negative for all drugs. Angela admitted to being sexually active with her former boyfriend, so a pregnancy test is appropriate. The pregnancy test was negative. Angela Cortez iHuman Case study Example Essay.
Angela is mildly obese and has a family history of diabetes mellitus. A fasting blood sugar and hemoglobin A1C are appropriate to be checked. Angela’s blood sugar and hemoglobin A1C are within normal limits.
After ruling out pathological reasons for Angela’s symptoms, the healthcare provider can confidently begin treating for adolescent depression disorder. Angela will need a combination of both pharmacotherapy and psychotherapy. Angela Cortez iHuman Case study Example Essay.
Angela should be started on a selective serotonin re-uptake inhibitor (SSRI) (NIMH, 2018). SSRI’s are the first line antidepressant (NIMH, 2018). SSRI’s are used because they have very little side effects and are less likely to cause overdose in patients (NIMH, 2018). Fluoxetine, which is an SSRI, has been shown to be very effective in children and adolescents (NIMH, 2018).
Psychotherapy should be used in conjunction with pharmacotherapy. Angela should be contracted for safety (NIMH, 2018). A contract for safety is a tool used by the healthcare provider and the patient that the patient signs, stating they will not harm themselves or commit suicide (NIMH, 2018). The combination of pharmacotherapy and psychotherapy has been shown to be the most effective treatment for adolescents with depression (NIMH, 2018). Angela Cortez iHuman Case study Example Essay.
 
References
National Institute of Mental Health. (2018). NIMH: Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
 
Angela Cortez is a 17-year-old female who presents with a history of fatigue and lack of energy for the past two months; associated with irritability and weight gain. Her symptoms have led to a decline in her school performance and lack of participation in her usual activities. She has been crying on a near daily basis over the past month. Angela Cortez iHuman Case study Example Essay. On physical exam, she has an elevated BMI, is tearful, and is noted to have acne, striae, and acanthosis. She denies any active suicidal thoughts (i-Human).
Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.
Patient Health Questionnaire (PHQ-9) Modified for Adolescents (PHQ-A) is a self-administered instrument that assesses anxiety, eating, mood and substance use disorders among adolescent primary care patients. It is essential in this population due to the high risks of this age group and the need to assess for and manage/treat mental health disorders Angela Cortez iHuman Case study Example Essay.
Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.
According to the Journal of Adolescent Health findings support the diagnostic validity of the PHQ-A. The PHQ-A and the clinical interview produced similar estimates of the prevalence rates of anxiety, eating, mood, and substance use disorders. The PHQ-A demonstrated satisfactory sensitivity, specificity, diagnostic agreement, and overall diagnostic accuracy, compared with the clinical interview.  The PHQ-A may be used to assist primary care practitioners in identifying psychiatric disorders among their adolescent patients. Angela Cortez iHuman Case study Example Essay. The PHQ-A is the first such tool to be tested for use in adolescents and offers an acceptable and efficient tool for early detection and recognition of mental disorders in this high-risk group.
Apply this evaluation tool to a patient situation and summarize your opinion of the results
The PHQ-9 Modified for Adolescents PHQ-A was used to evaluate Angela regarding her current symptoms and changes in mood and behavior. Based on responses to the questionnaire and patient interview it is established that she has Depressive Disorder; scoring 19 on the PQH-9. More than half of her responses received a score of 3 in the nearly every day category for feelings, appetite, interests and concentration; for the past two weeks Angela Cortez iHuman Case study Example Essay.
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Describe a plan of care for the patient, depending upon the results
According to the American Family Physician the following is the client plan. Angela will be referred to a psychiatrist for initiation of both psychotherapy and pharmacotherapy in treatment of adolescent depression. As a first line agent she will be started on a selective serotonin reuptake inhibitor (SSRI); with titration over the course of several weeks. SSRIs plus cognitive-behavioral therapy (CBT) have been demonstrated to be effective in treating adolescent depression. The American Family Physician also takes this stance in regard to the PHQ-A; stating that this 9 item screening tool is more sensitive in adolescents than adults.
The initial management plan also includes the following actions:

Review common side effects of medication with the client and family; especially black box warnings and risk of suicide.
Assess patient’s suicide risk. Establish a no-suicide contract. Inquire about firearms in the home and accessibility Angela Cortez iHuman Case study Example Essay.
Provide education and information depression.
Nutritionist referral for regarding healthy eating/choices and physical activity.
Follow-up with PCP to assess management / therapy.

References
Gardner, W. (2014). Screening for Mental Health Problems: Does It Work? Journal of Adolescent Health,55(1), 1-2. doi:10.1016/j.jadohealth.2014.04.019
Ham, P., MD, & Allen, C., PhD. (n.d.). Adolescent Health Screening and Counseling. American Family Physician,86(12), 1109-1116.
Johnson, J. G., PhD, Harris, E. S., MD, & Williams, J. B., DSW. (n.d.). The patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health,30(3), 196-204 Angela Cortez iHuman Case study Example Essay.