Natalee Williams and Alejandro Escobar-Vega Case Study

You have been seeing Natalee Williams for about a year. She comes in today with her mother, Trina, as usual for a regular appointment. Now 11, this African American girl originally came in with reports of depression and irritability, including a rapid decline in her schoolwork. You diagnosed her with depression, and she has been taking sertraline 12.5 mg PO q day. Since you last saw her two months ago, she started her period. Trina and Natalee are concerned that her medication is no longer working with her change in hormones. Both report that her “mood has gone downhill.” She has been having trouble again in school and with her friends.

Recall that there is a history of depression in the family, as Natalee’s maternal grandmother and maternal aunt both have had major depression. Her maternal grandmother was hospitalized for psychiatric care 20 years ago for depression and a suicide attempt by an overdose of Tylenol.

From your perspective as Natalee’s psychiatric nurse practitioner, answer the following questions. Include at least two peer-reviewed, evidence-based references.

What screening tools would you use during this interview?
Would you keep the same diagnosis?
Are there any symptoms that would make you consider a different diagnosis? On what evidence/symptoms do you base your diagnosis?
What medication changes would you prescribe for Natalee and why? Please note the medication(s), initial dose, and dosing schedule.
Include the American Psychiatric Association Standards of Care conclusions for each medication.
How do you educate and inform Trina about how this medication will work? How do you include Natalee in your conversation?
How do you discuss with Trina the side effects and risks for a child of this age with taking this medication?

Sample Solution

prevalent form of communication tool used by presidents were public speeches delivered in-person to an audience of spectators who received the speech. An example of this would be Abraham Lincoln’s Gettysburg Address, which demonstrates a key aspect of early Presidential communications: the need to be seen to be communicating directly to the people. Indeed, this helps explain the character of American presidential campaigns in the latter-half of the 19th century: the whistle-stop train tour was done in order to be seen to be directly communicating with Americans.
The second communications tool used by Presidents was the newspaper. During the years between 1869 and 1928 newspapers were the prime source of the American public’s news and political information (Gentzkow et al. 2981). The newspaper was the physical embodiment of the spreading of information across the country. Newspapers were the way that the American public could keep up with the president and his dealings, and presidential public images were strongly influenced by the portrayal of presidents in newspapers. At the same time, Presidents could use newspapers to recreate the historic need to directly interact with Americans, but with newspapers the interaction was mediated by both the staff of the newspaper and the staff of the President. Nonetheless, newspapers permitted some semblance of interaction between the President and the public, albeit at a distance. It was through newspapers that presidents tried to introduce his plans for the country. For this reason, the newspaper was a key factor in political campaigns for the presidency; “in the years 1869-1928, one additional newspaper increases presidential turnout by 0.3 percentage points” (Gentzkow et al. 2981). Thus, newspapers were an immensely important factor from which presidents sought to secure support, if not indeed control, because they mediated the relationship between the president and the public in a way that could build support for the Presidency. Newspapers built and maintained the infrastructure of information in the United States and held on to this position for close to 70 years. “The opening or closing of newspapers has long been linked to the health of democracy” (Gentzkow et al. 2980) and they maintained the relationship between the people and the president.
In the 1920s the introduction of new technologies brought with it new communications tools that would change how people received, interacted and discussed information. The introd

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