Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example

Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example

Case Summary

The case involves a 7-year-old girl named Cora. The initial physical exam presents no physical abnormalities. Cora had colic in the first three months following birth, cried expensively, and was often difficult to comfort. Later, she became passive and cried very little with the comfort of her mother. The mother, Lupus, had a normal pregnancy and birth. Equally, Coral had normal growth and development through her first three years despite being tearful and anxious with a babysitter. Because of her shyness, Coral experienced difficulty being dropped off school at age four. However, she adjusted to the new settings and made friends.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

At age six, Cora enrolled for first grade at a public elementary school. In the last two weeks, Cora has declined to go to school, missing six school days. She routinely brushes her hair before bed with even strokes, has her mother tuck her in bed on the right and father on the left. She becomes tearful and upset without the routine. Moreover, she experiences sleepless nights, worrying about school, and repeatedly asks the same questions concerning the school environment, teachers, and students. The parents report that Cora cries and screams when school time, chewing holes in her shirt, pulling her hair, punching the wall, digging her face, and throwing herself on the floor. As a result, she develops stomachaches, headaches, and vomits.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Furthermore, the parents report that Cora has become gloomy, ceased reading for fun, and constantly worries about her mother, thinking she might die. She asks about her mother every night and dreams about attending her funeral. Cora exhibits phobia of dogs, public speaking, and writing. She also wets the bed every night. Family history reveals that the mother is sick of Lupus while her two siblings are alive and well. The mother was diagnosed with panic disorder, while the father was diagnosed with ADHD as a child. Besides, her cousin has a diagnosed Asperger’s syndrome. (Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

What is your provisional diagnosis, as well as the possible differentials?

Cora’s primary diagnosis is Obsessive-Compulsive Disorder (OCD), with poor insight. The possible diagnoses include moderate major depressive disorder (MDD), social anxiety disorder (SAD), persistent depressive disorder (PDD), or generalized anxiety disorder (GAD).(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Justify your answer with DSM-5 criteria (be short, brief, and to the point).

OCD diagnostic criterion includes obsessions that are defined by repeated thoughts or images and marked by distress or anxiety, or compulsions characterized by repetitive mental acts or behaviors to prevent and reduce anxiety or distress (American Psychiatric Association). Cora’s compulsive behaviors, i.e., she routinely brushes her hair before bed with an even number of strokes, has her mother tuck her in bed on the right, and her father on the left. She becomes tearful and upset without the routine.  Moreover, Cora presents obsessions such as persistent worry about her mother, asking about her every night, and dreams about attending her funeral.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Cora presents symptoms crucial for MDD diagnoses, such as depressed mood, diminished pleasure in certain activities, and insomnia causing distress and social impairment (American Psychiatric Association, 2013). She resisted going to school in the past two weeks, missing six school days, and stopped reading for fun. Besides, she is awake all night; she has become gloomy and worries about going to school and her mother’s condition. Cora also presents SAD symptoms, including marked persistent anxiety and avoidance of associated social situations (American Psychiatric Association, 2013). Cora is persistently anxious about going to school, the teachers, and the students and has since missed six school days in the last two weeks. PDD symptoms such as depressed mood and insomnia, meeting the criteria for MDD. Lastly, Cora presents symptoms associated with GAD diagnoses such as excessive worry and inability to control worry associated with sleep disturbances (American Psychiatric Association, 2013). These symptoms have caused significant distress and social impairment in Cora.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Is Cora too young to diagnose, or is there a basis for early identification and intervention?

While Cora’s age cannot articulate most OCD behaviors or mental acts (American Psychiatric Association, 2013), she can be screened for OCD and enrolled for appropriate intervention.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

What psychiatric scales or assessment tools might you use with this patient? With the parents? List and describe briefly.

1. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): Y-BOCS is used to assess the severity of OCD symptoms, including depression and anxiety disorders (Novara et al., 2020).
2. The Child Behavior Checklist (CBC): CBC is a self-report assessment tool that parents and teachers can evaluate a child’s psychological and social competencies (Saad et al., 2017).(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

What would be your treatment plan for medications, if any? If you do choose to offer medication as part of the treatment plan, please address the following medications issues:

• Treatment plan

Start Zoloft 25mg of Zoloft mg PO QID for 30 days with the possibility of increasing the dosage depending on patient response. Zoloft is an approved and well-tolerant medication for pediatric anxiety and social phobia symptoms associated with OCD, providing an immediate effect on patients’ symptoms (Fenske & Petersen, 2015).(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

• Target symptoms

The target symptoms include fear of the school environment, students, teachers, compulsive behaviors such as brushing her hair evenly and having her mother and father tuck her to sleep, obsessive thoughts or compulsions, insomnia, mood swing, and self-destructive behaviors that can lead to injuries.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

• Receptors affected

Sertraline is classified as a selective serotonin reuptake inhibitor (SSRI). In this regard, sertraline affects the serotonin receptor (5-hydroxytryptamine receptor). Sertraline increases the activity of serotonin neurotransmitters to help manage the symptoms of OCD, including intrusive thoughts and depression.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

• Psychiatric and system effects

Psychiatric side effects of sertraline include hallucinations, tremors, overactive reflexes, insomnia, and lack of concentration. The systems affected by sertraline include the respiratory, nervous, musculoskeletal, digestive, and gastrointestinal systems leading to outcomes such as shallow breath, muscle stiffness, unsteadiness, overactive reflexes, loss of coordination, nausea, vomiting, and loss of appetite.  (Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

• Possible parental concerns

A parent should be concerned when the side effects of medication significantly impact the child’s behavior than usual. Therefore, the family should be involved in Cora’s treatment to help maintain OCD symptoms and requesting help during rituals (Pontillo et al., 2020).(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

What would be your school-based treatment plan, if any?

Recommend a school-based therapy. School-based therapy integrates mental health treatment for children and schoolwork. School-Based Therapists work within the school facilities to help students overcome self-destructive thoughts and behaviors, emotions, and social concerns. For instance, they planned an escape route to help Cora identify OCD symptoms and react to them by moving to a secure place without embarrassing herself or experiencing destructive blow-up symptoms.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

What would be the implications for the families of children and adolescents with these diagnostic pictures?

OCD diagnosis in a family affects almost every aspect of family life. OCD can cause stress and anxiety on family members, social isolation, difficulty retaining work, affect relationships, and disrupt routines (Stein et al., 2019).  Therefore, family education and therapy are crucial in enhancing their accommodation of the social and psychological impacts of OCD.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

How does the mother’s health play into the picture of Cora’s diagnosis? What type of therapy would you recommend for Cora (and her family) to work through her issues?

The mother’s health exacerbates Cora’s condition and shows increased anxiety over her health. In this regard, I would recommend CBT involving both parents. CBT effectively teaches children how to recognize their obsessive thoughts and avoid the associated rituals, allowing the child to learn how to respond differently to certain situations. Cora can use the techniques learned during therapy to reduce the effects of OCD in their life (Cimen, 2018). Encouraging the mother to talk to her about her condition would reduce her anxieties and associated psychological and social impacts.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Identify resources for patients/families with this diagnosis in the form of community groups, websites, advocacy, and treatment resources available in your service area.

In Connecticut, a child diagnosed with mental disorders can get help from include:

• OCD Connecticut (A new IOCF affiliate)
• The Connecticut Mental Health Center (New Haven, CT)
• Southwest CT Regional Mental Health Board
• Yale OCD Research Clinic Support Group
• OCD Support Groups in Connecticut
• NAMI (National Alliance on Mental Illness) Support Groups in Connecticut
• Clutters Anonymous (Greenwich, CT)
• Connecticut’s Network of Care for Behavioral Health
• Yale OCD Research Clinic
• Impulse – Online OCD Treatment  
• NOCD
• OCD Challenge
• OCDTribe.com, A New Online Support Community
• Stuck In A Doorway (Online OCD Support Forum)

What are you worried about (if anything)? Consider this question regarding treatment, assessment, alliance, compliance, effectiveness, safety, and other factors.

• Concerning safety: I am worried about Cora’s suicide ideation and self-destructive behavior.
• Treatment and assessment: I am concerned about Cora’s response to Zoloft and the consequent evaluation of their response to medication.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)
• Alliance: I am concerned about the client’s parent’s contribution to her treatment and recovery. There is a plan to educate the parents on their contribution to Cora’s treatment plan to achieve accommodation.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.   (Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)

Cimen, I. D. (2018). Cognitive-Behavioral Therapy of Obsessive-Compulsive Disorder in Children and Adolescents. Cognitive Behavioral Therapy and Clinical Applications, 27. http://dx.doi.org/10.5772/intechopen.70612

Fenske, J. N., & Petersen, K. (2015). Obsessive-compulsive disorder: diagnosis and management. American family physician, 92(10), 896-903. https://www.aafp.org/afp/2015/1115/p896.html#afp20151115p896-b17

Novara, C., Pardini, S., Cardona, F., & Pastore, M. (2020). Comparing models of the Children Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in an Italian clinical sample. Frontiers in Psychiatry, 11, 615.(Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example) https://doi.org/10.3389/fpsyt.2020.00615

Pontillo, M., Demaria, F., Tata, M. C., Averna, R., Gargiullo, P., Pucciarini, M. L., … & Vicari, S. (2020). Clinical significance of family accommodation and parental psychological distress in a sample of children and adolescents with obsessive-compulsive disorder aged 8-17 years old. Italian Journal of Pediatrics, 46(1), 1-10. https://doi.org/10.1186/s13052-020-00932-2

Saad, L. O., do Rosario, M. C., Cesar, R. C., Batistuzzo, M. C., Hoexter, M. Q., Manfro, G. G., … & Alvarenga, P. G. (2017). The Child Behavior Checklist—Obsessive-Compulsive subscale detects severe psychopathology and behavioral problems among school-aged children. Journal of child and adolescent psychopharmacology, 27(4), 342-348. (Pediatric Anxiety and OCD Comprehensive Solved Nursing Essay Example)https://dx.doi.org/10.1089%2Fcap.2016.0125

Stein, D. J., Costa, D. L., Lochner, C., Miguel, E. C., Reddy, Y. J., Shavitt, R. G., … & Simpson, H. B. (2019). Obsessive-compulsive disorder. Nature Reviews Disease Primers, 5(1), 1-21. https://dx.doi.org/10.1038%2Fs41572-019-0102-3