Mandy is a 10-year-old who has been brought in by her new foster mother for a well-child exam

Case Scenario 3: Mandy is a 10-year-old who has been brought in by her new foster mother for a well-child exam. The foster mother states that Mandy was removed from her home due to neglect and physical and sexual abuse and expresses concerns Mandy may have an eating disorder.

· What types of abnormal behaviors might Mandy exhibit?

·

· Mandy’s history of severe trauma, including neglect and both physical and sexual abuse, places her at high risk for behaviors such as difficulty forming attachments, extreme mood swings, poor impulse control, and regressive behaviors like bedwetting. She might also show avoidance of specific people or situations, or dissociation. Mandy may also engage in food refusal, poor, eating habits or excessive exercise.

· What physical findings might you find during the physical examination?

· On physical examination, findings could include bruises, scars, or healing fractures. Signs of sexual abuse may include genital irritation or injury and symptoms of urinary tract infections. If Mandy is suffering from an eating disorder, physical signs might include low weight for age, brittle nails, hair thinning, and delayed growth and puberty.

· How should you manage Mandy’s history of abuse?

· A comprehensive, sensitive, and child-centered approach is necessary to manage Mandy’s care. It’s critical to establish a safe and supportive environment for her, both during and after the exam. Psychological evaluation and therapy will also be needed to guide her to move on from the events. If an eating disorder is suspected, Mandy should be referred to a specialist team experienced in pediatric eating disorders for assessment and treatment.

Jacquelin

Part 2: Case Scenario 2

Compare the characteristics of generalized anxiety disorder with obsessive compulsive disorder.

· Both generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) are anxiety related disorders, but they have distinct characteristics. GAD involves excessive and persistent worry about various aspects of life, often accompanied by physical symptoms like restlessness and muscle tension. In contrast, OCD is characterized by intrusive, unwanted thoughts (obsessions) that lead to repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety.

What medications have been approved for managing obsessive compulsive disorder in children her age?

· Regarding medication for managing OCD in children, selective serotonin reuptake inhibitors (SSRIs) are often considered. Fluoxetine (Prozac) and sertraline (Zoloft) are two SSRIs that have been approved for children and adolescents with OCD. SSRIs are typically initiated at a low dose (eg, the equivalent of 25 mg of sertraline) for the first week and titrated up gradually (eg, every two to four weeks) to a therapeutic dose, which is then given a 12-week trial. If the clinical response is not adequate, subsequent gradual adjustments are made to maximize efficacy and minimize toxicity with additional trials of six to twelve weeks (Rosenberg, 2022).

What are the common side effects of these medications?

· Common side effects of SSRIs like fluoxetine and sertraline can include nausea, diarrhea, headache, drowsiness, insomnia, and changes in appetite or weight. Some individuals may experience sexual dysfunction, agitation, or increased anxiety when starting these medications. It’s essential to monitor for any adverse effects and communicate with a doctor if they occur.

How has cognitive behavioral therapy, coupled with a medication, shown to be effective for treatment in the pediatric population?

· Cognitive behavioral therapy (CBT) coupled with medication has been shown to be effective in treating pediatric OCD. CBT helps individuals identify and challenge negative thought patterns while gradually exposing them to anxiety-inducing situations. This exposure and response prevention (ERP) component helps them learn to manage their compulsive behaviors. Combining CBT with medication can provide a comprehensive approach to managing OCD symptoms, addressing both psychological and neurological aspects of the disorder. However, the specific treatment plan should be tailored to each individual’s needs and discussed with a mental health professional.

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