Assignment 1: Discussion: iHuman Case Study-Adolescent Depression Case
Discuss the questions that would be important to include when interviewing a
... [Show More] patient with
this issue.
Why are you seeking help today? My mom made me come here because I’m tired all the time.
What is the most distressing symptom for you? I'm tired all the time. I just don't feel like
doing anything.
How does this affect your life?I just can’t focus on school as well as I used to.
When did this start?when school started in September. So, about two months or so ago.
What are the events surroundings the start of fatigue? Maybe just going back to school for
my senior year. They lay on a lot pressure, you know.
Have you been having fevers? No, no fevers or colds or anything like that.
Have you gained or lost weight unintentionally?I’ve put on some weight; maybe 15 pounds or
so since last year
Are you having any difficulty sleeping? Sometimes. The TV helps me go to sleep. I just leave
it on and finally doze off. But not always. Sometimes I just cry at night for no reason.
Is it possible you are pregnant? I'm not pregnant; I've never been pregnant; my periods are like
clockwork; my last one was two weeks ago; and, I certainly don't have those symptoms they drill
into your head in Health. Besides, I don't have a boyfriend, okay?
Do you feel Anxious? Yeah, maybe a bit, I'm worried about getting into college. And other stuff
Do you prefer to stay at home? Yes
Are you crying more than usually?Sometimes over the past month I just cry at night for no
reason at all.
Have you been depressed? I don't know; I guess so, maybe?
Tell me about your family and friends? What's there to tell? You mean like my supposed
girlfriend deciding to go out with my boyfriend. That was pretty bad considering I went to prom
with him last year.
How are your grades in school?Last semester I had a 3.5 GPA. We’ve only had a few tests so
far this fall, and I got C’s on two of them. I just don’t care about my grades as much as I used to.
Are you happy with your body image? Look at these stretch marks! How would you feel?
Have you had any thought of hurting or killing yourself? No, I would never do anything
stupid like that. But sometimes I wish I could just disappear and not have to deal with anything
anymore.
How is your family life? I live with my mother and father, my younger brother who's 10, and
my sister who's 14. I have to share a room with my sister, who is a freshman. I can’t stand the
way she is so excited about high school. My mother's constantly on me about spending more
time on the Internet, rather than being "social," as she calls it. And she's also on me about helping
around the house. And I can't stand my sister. So, is that what you want to know?
Describe the clinical findings that may be present in a patient with this issue.
Depression can change the way teenagers see themselves, their lives, and the people
around them. Teenagers who are depressed usually see everything more negatively and they can't
imagine that any problem or situation can be solved in a positive way (Dyer & Wade, 2012).
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Also, some teenager’s mood may be expressed as sadness, heaviness, numbness, or sometimes
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irritability and mood swings (Carnevale, 2013). They often report a loss of interest or pleasure in
their usual activities, difficulty concentrating, or loss of energy and motivation. Their thinking is
often negative, frequently with feelings of worthlessness, or hopelessness.
Are there any diagnostic studies that should be ordered on this patient? Why?
• Drug toxicology testing, urine-substance abuse disorder
• Thyroid function tests (TFT)- hypothyroidism
• Cortisol, Urine- Cushing’s syndrome
• Heterophile antibody test (mononucleosis spot)-mononucleosis, Epstein virus
• Human chorionic gonadotropin (hCG), urine- pregnancy
• Glycated hemoglobin (HbA1c)- Diabetes
• Complete blood count (CBC)- anemia, mononucleosis,
List the primary diagnosis and three differential diagnoses for this patient. Explain your
reasoning for each.
Primary Diagnoses: Depressive disorder
Angela is a 17-year-old female who has a two-month history of fatigue and lack of
energy associated with insomnia, irritability, and weight gain. Her symptoms have led to a
decline in her school work and lack of participation in her normal activities. She has been crying
on a near daily basis over the past month, elevated BMI, and is noted to have acne.
Angela’s best friend is dating her ex-boyfriend now so this could have triggered the start
of her depression. Angela scoring a 19 out of a possible 27 on the PHQ-A depression scale,
which is consistent with a diagnosis of moderately severe adolescent depression and laboratory
tests ruled out anemia, thyroid dysfunction, mononucleosis, Cushing's syndrome, diabetes
mellitus type 2, pregnancy, and substance use.
Although there is no single known cause of depression it’s likely the results from a
combination of genetic, biochemical, environmental, and psychological factors (Auerbach, Ho,
& Kim, 2014). In some cases, trauma, loss of a loved one, a difficult relationship, or any stressful
situation may trigger a depressive episode (Carnevale, 2013).
Some common signs and symptoms of major depressive disorder are:
• Persistent feelings of sadness, anxiety, or feeling "empty"
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyable
• Decreased energy, fatigue, or feeling "slowed down"
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
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Cushing's syndrome is a debilitating endocrine disorder characterized by excessive cortisol
levels in the blood (Kumar, 2015). Some common signs and symptoms of Cushing’s syndrome
may include the following:
• Weight gain particularly around the midsection and upper back, in the face and between
the shoulders.
• Striae
• Some women also experience irregular menstrual periods
• Can also have headaches, irritability and a chronic feeling of fatigue
Hypothyroidism occurs when a person’s thyroid has been removed or is underactive and does
not produce enough thyroid hormone (Nygaard, 2015). Some common signs and symptoms of
hypothyroidism may include the following:
• Fatigue
• Weakness
• Weight gain or increased difficulty losing weight
• Coarse, dry hair
• Dry, rough pale skin
• Hair loss
• Cold intolerance
• Muscle cramps and frequent muscle aches
• Constipation
• Depression
• Irritability
• Memory loss
• Abnormal menstrual cycles
Anemia
Anemia due to iron deficiency is the most common kind of anemia in the Unite [Show Less]