A young girl with strange behaviors
BACKGROUND
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Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage and they don’t know what to do.
SUBJECTIVE
Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”
Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.
Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”
During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”
When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”
OBJECTIVE
The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather, and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.
MENTAL STATUS EXAM
Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.
At this point, please discuss any additional diagnostic tests you would perform on Carrie.
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
Assignment 2: Practicum: Decision Tree
Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.
Learning Objectives
Students will:
- Evaluate clients for treatment of mental health disorders
- Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
- Decision #1: Differential Diagnosis
- Which Decision did you select?
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
- Decision #2: Treatment Plan for Psychotherapy
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
- Decision #3: Treatment Plan for Psychopharmacology
- Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
- Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
- Case #3h strange behavior
- **Case Study Analysis: Early Onset Schizophrenia in a Young Girl**
**Decision #1: Differential Diagnosis**
I would select the diagnosis of **Early Onset Schizophrenia** for Carrie. This choice is supported by her reported symptoms of talking to people who aren’t real, believing that TV shows are made just for her, hearing and seeing things that others don’t, and holding delusional thoughts about controlling others’ minds. These symptoms align with the diagnostic criteria for schizophrenia, characterized by delusions, hallucinations, disorganized speech, and impaired cognitive functioning.
Nursing Research and Evidence-Based Practice Essay Assignments – Walden NURS 6052
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I was hoping to achieve an accurate diagnosis that explains Carrie’s unusual behaviors and experiences. Schizophrenia seems to fit her symptom profile, explaining her impaired social functioning, odd beliefs, and cognitive deficits.
The results of Decision #1 aligned with my expectations. Carrie’s reported symptoms are indicative of early onset schizophrenia based on DSM-5 criteria.
**Decision #2: Treatment Plan for Psychotherapy**
For Carrie’s psychotherapy treatment plan, I would recommend **Cognitive Behavioral Therapy for Psychosis (CBTp)**. This approach can help address her delusional beliefs and improve her coping skills. CBTp has shown effectiveness in managing symptoms of schizophrenia by challenging and restructuring irrational thoughts.I was hoping to achieve a reduction in Carrie’s delusional thoughts, improved reality testing, and enhanced coping strategies to manage her symptoms.
The results of Decision #2 were aligned with my expectations. CBTp is a recommended treatment approach for schizophrenia and aims to improve patients’ quality of life.
**Decision #3: Treatment Plan for Psychopharmacology**
For Carrie’s psychopharmacological treatment, I would prescribe **atypical antipsychotic medication**, such as **risperidone**, to target her positive symptoms (hallucinations and delusions). This medication can help alleviate her distressing experiences and support her engagement in psychotherapy.I was hoping to achieve a reduction in Carrie’s positive symptoms and an overall improvement in her functioning and well-being.
The results of Decision #3 were aligned with my expectations. Atypical antipsychotics are commonly prescribed to manage the positive symptoms of schizophrenia and can significantly improve patients’ quality of life.
**Ethical Considerations and Communication**
When working with Carrie and her family, it’s crucial to ensure informed consent, respect for autonomy, and confidentiality. Open and honest communication should be maintained, discussing the diagnosis, treatment options, potential side effects, and the family’s preferences. Additionally, respecting Carrie’s autonomy in treatment decisions, as well as addressing any concerns her parents have about medication, is essential.Dont wait until the last minute.
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Overall, the treatment plan aims to improve Carrie’s symptoms, functioning, and quality of life while considering her individual needs and preferences.