Case Study: Erica Daniels-Dottir

Review the case study and then answer the questions that follow.
Case Study
Erica Daniels-Dottir is a 13-year-old Caucasian female who was admitted today to an inpatient adolescent psychiatric unit for suicidal ideation and reports of severe depression. She has no other significant medical problems. You are at a meeting with Erica and her mothers, Sally Daniels and Thea Sindridottir. Erica has had severe mood swings, irritability, and dangerous and impulsive behavior. This is her third suicide attempt in the past two months.
From your perspective as Erica’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

1. You are assigned to complete a psychiatric evaluation on Erica. Identify the clinical presentation and symptoms you would expect to see if you were to make a diagnosis of Major Depression.
2. What lab tests would you order? Discuss the rationale for each test.
3. Erica’s mothers want to know how their daughter could be depressed enough to require psychiatric hospitalization. What information would you need from Erica’s mothers relative to family, Erica’s current and past functioning, and the rationale for needing inpatient psychiatric treatment rather than outpatient treatment at this time?
4. Erica’s mothers tell you they do not want to medicate her. How do you discuss medication treatment with parents of teenagers and of younger patients? How young is too young? At what age do you consider the child’s opinion? (Optional: Imagine Sally and Thea are divorced, and one of them wants medications and the other does not. How do you mediate that conversation?)
5. Identify pharmacological and non-pharmacological interventions you might recommend. Include a specific recommendation of a psychotropic medication (include starting dose and side effects to monitor). Provide the rationale for these recommendations. Identify how the drug you select is metabolized and its mechanism of action.
6. How would you know when Erica would be ready for a safe discharge relative to symptom presentation and functioning? What are the potential complications if these symptoms are not well managed?

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