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[SOLVED]: Natalee Williams, a 10-year-old African American girl, comes to your psychiatric nurse practitioner office for evaluation.

Depression: Natalee Williams

  1. There are several differential diagnosis of dysthymic disorders; for instance,

            Personality disorders normally coexist with these dysthymia disorders.

            Mood disorder, as a result of a broad medical illness whereby the depressive symptoms constant with dysthymia take place in a range of medical complications. These medical illnesses comprise, Parkinson’s disease, cancer of the pancreas, hypothyroidism, multiple sclerosis, HIV/AIDS, Huntington’s disease, lack of vitamin B12,  stroke, Cushing syndrome, among others. In order to dismiss, it is important to do the history taking, head to toe physical examination and laboratory investigations as indicated (Eichsenring, F., Rabung, S., Leibing, E. 2004).

            Substance-induced mood disorder. Substances such as liquor, benzodiazepines as well as sedative hypnotics can present similar to dysthymia symptoms. Also chronic usage of the likes of cocaine as well as amphetamines can result to this disorder. Usages of oral contraceptives for longer periods, beta blockers as well as methyldopa are as well connected to these disorders. In order to dismiss this, carefully take the history of the previous medication consumed as well as drugs and substance used (Ornstein, G., Wohlreich, M. et al. 2007).

            Psychotic disorders are also associated with depressive symptoms especially in chronic instances. At this point, it is important to note that, dysthymia should not be diagnosed if the symptoms present all through psychosis only and inclusive of the remaining or rather the residual phases.

  • On diagnosis, Natalee William’s presents with a depressed mood whereby symptoms are poor feeding habits unlike previous times as evidenced by the 2 pounds drop in weight, poor concentration especially in class as evidenced by her poor performance where she now attains C grade compared to the previous term where she was at A grade, low interest in the most enjoyable activities whereby she now no longer goes out to play with her friends but instead chooses to lock herself in her room during the day, low energy which is evident as Natalee only wants to just lie down in her room which is unlike of her.
  • Treatment for this condition, I would subject Natalee to antidepressant medication whereby a number of depressed patients respond positively to these antidepressants. SSRIs (Selective Serotonin Re-uptake Inhibitors) are mainly prescribed as they are very effective and can be tolerated as compared to other types of depressive medication. Venlafaxine inhibits serotonin and norepinephrine re-uptake in the central nervous system. It decreases the depressive symptoms although there are expectations of relapses; it as well decreases the instances of panic attacks as well as anxiety. It is per oral administration tablet 75 mg per day in 2-3 divided doses which may be increased with time. It is important to note that if these antidepressants fail, then tricyclic antidepressants, e.g. desipramine 150-200mg per day is often in effect. Also there is Psychotherapy also known as ‘talk therapy’, whereby the cognitive as well as interpersonal therapy is the target, greatly help patients deal with inappropriate negative outlooks about themselves (Uyken, W., Tsivrikos, D. 2008).
  •  Uses the simplest language to make Trina (Natalee’s mother) understand the pharmacological effect of the drugs in order to reduces the depressive symptoms in Natalee.
  • Tell Trina that every drug has its own side effects whereby some are bearable and to some extent may get overwhelmed. In case of severe side effects she should consult the physician. For this case she expects side effects such as; weight gain, diarrhea, nausea and vomiting and also headaches. Also she should be made aware that some of the antidepressants bring about suicidal attempts therefore she should be very keen on Natalee’s behavior and mood just in case she notices unlike behaviors. In case she comes across such, she is then entitled to call the doctor immediately.

References

Uyken, W., Tsivrikos, D. (2008). Mindfulness-based cognitive therapy prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology. 76. Pp. 966-978

Ornstein, G., Wohlreich, M. et al. 2007). Duloxetine efficacy for major depressive disorders in male vs. female patients: Journal of Clinical Psychiatry. 67: Pp.761-770

Eichsenring, F., Rabung, S., Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy a meta-analysis. Journal of the American Medical Association. 300: Pp. 1551-1565

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