Pediatric Anxiety and OCD Comprehensive Nursing Paper Example
Summary
According to the case study, the patient was born normal with no complications at birth. She has demonstrated normal growth and development, meeting every milestone in the first three years. She interacted normally with her older sister and parents but became anxious around the babysitter. In her initial schooling in the nursery, she experienced difficulty but adjusted well to make friends and feel comfortable at the particular school, encouraging her parents to enroll her in kindergarten in the same school. Cora’s mother was diagnosed with lupus, making tuition at the school challenging, prompting her parents to enroll her at the public elementary school in the neighborhood. This change, together with Cora’s mother’s illnesses, triggered symptoms that were atypical of her, forcing her parents to make an appointment with the PCP, who did not find any physical abnormalities and referred Cora’s parents to a family PMHNP. Her mother has experienced panic disorder before, her father has undergone ADHD treatment with medications, and her cousin has Asperger’s syndrome.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Provisional and Differential Diagnoses
Based on the subjective data, the provisional diagnosis is Separation Anxiety Disorder (F93. 0). These symptoms align with DSM-5 Criteria for Separation Anxiety Disorder. DSM-5 includes symptoms such as; developmentally inappropriate and extreme anxiety about separation from home and those attached (Abuse & Administration, 2016). An individual must exhibit at least three of the following in the DSM-5 criteria; recurrent extreme distress during separation from home or primary attachment figure happens or is expected, Constant and excessive worry about losing or potential harm to a major attachment figure, persistent and extreme worry that an untold event would lead to a separation from the primary attachment figure, constant reluctance or refusal to go to school or anywhere fearing separation, continuous and extreme fear or reluctance to be alone or without the major attachment figure at home, persistence reluctance or refusal to sleep without being close to a major attachment figure or sleep away from home, repeated nightmares fearing separation, and constant complaints of physical symptoms such as headaches, stomachaches, nausea, or vomiting when anticipating a separation. Cora exhibits all these symptoms, confirming Separation Anxiety Disorder as the provisional diagnosis.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Differential Diagnoses
Phobia Anxiety Disorder (F40.9)
A child experiencing phobia feels unpredictable and has an unwarranted period of extreme fear or discomfort. The child may experience panic attacks and exhibits symptoms such as dizziness, shortness of breath, lightheadedness, shaking, fear of losing control, and abnormal heartbeat, with symptoms lasting for hours (Abuse & Administration, 2016). Sometimes the child can have tightness in the chest and experience sweating. Although Cora has excessive fear triggered by her mother’s illness and change of school, most symptoms do not align with DSM-5 criteria for phobia, refuting this diagnosis.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Panic Disorder (F41.0)
A child experiencing panic disorder exhibits symptoms such as a racing heart, sweating, chills, trembling, difficulty breathing, weakness or dizziness, chest pain, and tingly or numb hands. The child may experience periods of shortness of breath or feeling smothered (Abuse & Administration, 2016). The patient must experience recurrent panic attacks, with one or more attacks preceded by a month of fear of another panic attack. Cora experiences extreme fear and anxiety, but she does not exhibit physical symptoms associated with panic disorder, refuting the diagnosis.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Cora is not too young to be diagnosed with separation anxiety disorder, a common issue among children, but most grow out of it with age. Specific events like the fear that something bad might befall a primary caregiver, for instance, Cora’s mother’s illness, can trigger the disorder in older children. A trained therapist should perform such a diagnosis.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Psychiatric Scales and Assessment Tools
Tools, including the Children’s Separation Anxiety Scale (CSAS) and APA’s Severity Measure for Separation Anxiety Disorder (SMSAD), can be used to assess Cora.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Children’s Separation Anxiety Scale (CSAS)
CSAS is used to evaluate separation anxiety symptoms in children. It measures factors such as worry about separation, distress from separation, opposition to separation, and calm at separation (Méndez et al., 2014). This is a 20-item scale assessing the frequency of the disorder’s symptoms on a 5-point scale: 1= never or almost never, 2= sometimes, 3= often, 4= very often, 5= always or almost always.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Severity Measure for Separation Anxiety Disorder (SMSAD)
SMSAD can help measure separation anxiety disorder symptoms in childhood. The 10-item scale measures the severity of separation anxiety disorder symptoms (Craske et al., 2015). Each item requires the child, guardian, or parent to rate the severity of their separation anxiety disorder in the past 7 days. Each item is scored or rated on a 5-point scale: 0=Never; 1=occasionally; 2=Half of the time; 3=Most of the time, and 4=All of the time.
Treatment Plan for Medication
Antidepressants and antianxiety medicine can help the child feel calmer. The child can be prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), including paroxetine and escitalopram, to bolster the levels of the brain’s chemical serotonin. SSRIs reduce anxious thoughts and physiological symptoms of anxiety, including sleep difficulty and headaches (Chu & Wadhwa, 2022). SSRIs impact the brain chemistry and slow the reabsorption of the neurotransmitter serotonin, which helps regulate mood and anxiety. Increasing serotonin levels helps improve sleep and reduce anxiety. The parent should be concerned about potential side effects of SSRIs such as drowsiness, dry mouth, nausea, and diarrhea, which often go away after 4-8 weeks.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
School-Based Treatment Plan
The parent should inform the teachers about Cora’s mental health condition to involve them in her care. The teachers should be informed about interventions to address any occurrence of symptoms during school time. The parent should share contacts of all parties, including the parents and the PMHNP the teachers can call in case Cora experiences symptoms.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Implications for the Families of Children and Adolescents with These Diagnostic Pictures
Families of children and adolescents with these diagnostic pictures should understand the importance of early diagnosis, medication adherence, and following treatment plans. Evaluation should be done immediately after noticing the signs because early treatment can lessen symptoms and improve the child’s normal development and quality of life. Parents and guardians should be proactive and keep all appointments with the care provider, provide reassurance and support to the child, recognize situations that trigger symptoms, and maintain adherence to the treatment plan. (Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Impact of Mother’s Health on Cora’s Diagnosis
Separation Anxiety Disorder primarily affects children who fear separation from a major attachment figure. Cora’s mother’s illness prompted the family to change her school and enroll her in a public school. Cora was already comfortable at the previous school and developed relations with friends and teachers, who were student-centered in their teaching approach. Additionally, Cora feared she would be separated from her mother if she died of her illness. The fear triggered separation anxiety, and she did not want to go to school away from her mother. She never stopped worrying about her mother dying and experiencing sleeping difficulties. Her mother’s illness is the primary trigger of her separation anxiety. (Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Possible Therapy
Cognitive behavioral and family therapy can help Cora and her family manages her anxiety. Cognitive behavioral therapy can help Cora and her family learn better ways of handling her anxiety and master situations that trigger her separation anxiety symptoms (Giani et al., 2021). Family therapy makes everyone involved in Cora’s care. It will help improve communication and ensure family members work together to help Cora manage her anxiety.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Resources for Patients/Families with This Diagnosis
The parents can reach out for support from local community service resources, websites, advocacy, and treatment resources. The parents should be in touch with families of children with similar pictures. The NAMI Connection Recovery Support Group in Northwest City can connect Cora’s parents with other parents with a similar issue. Organizations such as the AMITA Health Saint Francis Hospital Evanston, Midwest Asian Health Association’s Community Mental Health Clinic, and North Shore Pediatric Therapy can provide treatment and therapy resources. (Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Worries
Cora is 6 years old and cannot understand her mental health condition at the level of her parents. Therefore, she needs utmost support and guidance from her parents to adhere to the treatment plan, communication, medication adherence, and safety implications of her behavior. However, her mother is also ill with a serious and life-threatening condition, and she needs optimal care and support from the family. This situation might overwhelm the father and the older sister, impacting effectiveness in anxiety management and threatening Cora’s relapse. The family might require help from an external caregiver.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
References
Abuse, S., & Administration, M. H. S. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].
Abuse, S., & Administration, M. H. S. (2016). Impact of the DSM-IV on DSM-5 Changes on the National Drug Use and Health Survey.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Chu, A., & Wadhwa, R. (2022). Selective serotonin reuptake inhibitors. In StatPearls [Internet]. StatPearls Publishing.
Craske, M,, Wittchen, U., Bogels, S., Stein, M., Andrews, G., & Lebeu, R. (2015). Severity Measure for Separation Anxiety Disorder. American Psychiatric Association. (Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-Measure-For-Separation-Anxiety-Disorder-Child-Age-11-to-17.pdf
Giani, L., Caputi, M., Forresi, B., Michelini, G., & Scaini, S. (2021). Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: A Systematic Review of Randomized Controlled Trials. International Journal of Cognitive Therapy, 1-24.(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
Méndez, X., Espada, J. P., Orgilés, M., Llavona, L. M., & García-Fernández, J. M. (2014). Children’s separation anxiety scale (CSAS): psychometric properties. PloS one, 9(7), e103212. https://doi.org/10.1371/journal.pone.0103212(Pediatric Anxiety and OCD Comprehensive Nursing Paper Example)
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