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University of North Texas Pediatric Anxiety and OCD Case Study Questions

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University of North Texas Pediatric Anxiety and OCD Case Study Questions – Description

Cora is a seven-year-old girl, the second  of two children of a middle-class family living in a suburban area of a  northwest city. Cora has one sister that is two years older than her.  Her mother’s pregnancy was normal, with no complications and Cora’s  birth was normal. Cora had colic the first three months, cried  extensively, and was difficult to comfort. After three months she became  passive and cried very little with comfort from her mother. Her growth  and development appeared to be normal. She met all the developmental  milestones in her first three years. She interacted normally with her  sister and parents, except that she would become tearful and anxious  when her parents would get a babysitter. 
At age four, she was in nursery school and  appeared to function normally except during the first month when Cora  had difficulty when her father would drop her off at school. The nursery  school was a small private school with a lot of personal attention  given to each child. Although shy, she made friends and liked going to  nursery school after she became adjusted to the new setting. Her parents  liked the school so much that they decided to keep Cora in kindergarten  at this school with her same teachers and friends. However, tuition at  the school became a problem after Cora’s mother became sick with lupus  and was unable to work. 
At age six, Cora’s parents enrolled her in  first grade at the public elementary school in their neighborhood. For  the last two weeks, she has refused to go to school and has missed six  school days. She began routinely brushing her hair before bed and  insisted on making sure each side was brushed with an even number of  strokes.  She also had her mother tuck her in bed on the right side and  her father come after on the left side each night.  She would become  very tearful and upset if the routine was not followed.  She is awake  almost all night worrying about going to school and asks the same  questions over and over about the environment, teachers, and other  students. As the start of the school day approaches, she cries and  screams that she cannot go, chews holes in her shirt, pulls her hair,  digs at her face, punches the wall, throws herself on the floor, as well  as experiences headaches, stomachaches, and vomiting. Over the past two  weeks, she has become gloomy, has stopped reading for fun, and  frequently worries about her mother’s Lupus and that she may die.  She  asks her every night if she has dreamed about her funeral. In addition,  Cora is phobic of dogs, avoids speaking and writing in public, and wets  the bed every night. 
Her parents immediately made an  appointment to see her PCP. Her doctor conducted a thorough physical  exam, found no physical abnormalities, and then referred her to you, a  Family PMHNP. 
Family history of mental health includes  the following: mother has a history of panic disorder; her father has a  history of treatment with medications for ADHD as a child, and she has a  cousin diagnosed with Asperger’s syndrome. 
Instructions
For your assignment, write a paper that addresses the following prompts using evidence-based references to support your answers: 
Summarize the case.  
What is your provisional diagnosis, as well as the possible differentials?  
Justify your answer with DSM-5 criteria (be short, brief, and to the point).  

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

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

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:  

Target symptoms  

Receptors affected  

Psychiatric and system effects  

Possible parental concerns  

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

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

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?  

Identify resources for patients/families with  this diagnosis in the form of community groups, web-sites, advocacy, as  well as treatment resources available in your service area.  

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

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