CC (chief complaint): The patient complains of stomachaches and headaches and will not go to school or attend the majority of other social occasions.
HPI: When attending classes, the patient has been experiencing symptoms like headaches and stomachaches. Prior to this point, the patient had been receiving medical treatment from her pediatrician, Dr. Ferguson, who is responsible for her care. The patient finds it “scary” to attend school and worries that she may be kidnapped, despite the fact that there is no reason to support her beliefs in this regard. The patient’s mother denies that her child has any sleeping problems. The patient states that they only are able to fall asleep when they are accompanied by a carer and, reports nightmares. The patient’s parents having an accident is reported in the nightmares, without any previous records of accident history in the patient’s family. The patient felt disturbed during the assessment because her carer was absent.
Past Psychiatric History: the patient has no prior psychiatric history
- General Statement:
- Caregivers (if applicable): not applicable
- Hospitalizations: not applicable
- Medication trials: not applicable
- Psychotherapy or Previous Psychiatric Diagnosis: not applicable
Substance Current Use and History: not applicable
Family Psychiatric/Substance Use History: not applicable
Psychosocial History: The patient is a nine-year-old child who is currently in the third grade. The patient is in the context of the family support system. Both of the parents are currently present.
Medical History:
- Current Medications: no current medications
- Allergies: no known drug allergy
- Reproductive Hx: not applicable
ROS:
- GENERAL: There was no loss of weight, fever, chills, weariness, or fatigue. The patient’s nightmares disrupt their otherwise restful sleep. Occasional headaches and stomachaches. All vaccinations are current, and they are on track with the child’s developmental milestones. According to the mother, there are no abnormalities in the patient’s appetite, although the patient is a picky eater.
- HEENT: not applicable
- SKIN: chickenpox (three years ago)
- CARDIOVASCULAR: not applicable
- RESPIRATORY: not applicable
- GASTROINTESTINAL: Patient reports stomachaches
- GENITOURINARY: not applicable
- NEUROLOGICAL: Patient reports headaches
- MUSCULOSKELETAL: not applicable
- HEMATOLOGIC: not applicable
- LYMPHATICS: not applicable
- ENDOCRINOLOGIC: not applicable
Objective: Matilda Johnson, female. Age: 8 years old. T-98.0 P 70 R 24 B/P 110/68 Ht 45 inches Wt 57lbs
Physical exam: not applicable
Diagnostic results: The patient’s severe anxiety is a result of her mother’s impending departure or the anticipation of her departure. Based on attachment theory, this idea is an adaptive response that keeps the child close to the caregiver and so guarantees the continuum of care (Elbay et al., 2021). If the patient’s anxiety continues to worsen over time and disrupts their development, it is likely that they have a separation anxiety disorder (SEPAD).
Assessment: The symptoms are typical of a childhood anxiety disorder condition. Anxiety, sleeplessness, social and academic difficulties, and physical symptoms are just some of the ways in which SEPAD disrupts the lives of both the kid and their caretaker (Vaughan et al., 2017). The patient also has occasional trouble controlling their rage and has frequent intrusive thoughts. For infants and toddlers, separation anxiety is a natural part of development; however, it is considered a disorder if it persists through the toddler years, as in the case of this patient.
Mental Status Examination: The speaker makes sense but simply provides brief responses without going into further detail. The effect is tense, and the mood is generally low. During the mental status evaluation, the patient experiences an increase in anxiety in response to certain questions, and this is especially the case when the caregiver is not there. The patient claims they are not experiencing any auditory or visual hallucinations. No signs of suicidal or homicidal ideation.
Differential Diagnoses:
- Generalized Anxiety Disorder
- Phobias
- Posttraumatic Stress Disorder
Reflections: It is recommended that the patient follows through with appropriate anxiety treatment and child therapy sessions. There is a correlation between the prevalence of psychiatric problems in early life and the likelihood of those disorders persisting into adulthood, as well as an increased risk of comorbidities. Depression, mood disorders, and other mental illnesses have been linked to separation anxiety disorder in several studies (Mohammadi et al., 2020). A significant decline in the patient’s psychosocial functioning is likely to occur without treatment.
References
Elbay, R. Y., Görmez, A., Kılıç, A., & Avcı, S. H. (2021). Separation anxiety disorder among outpatients with major depressive disorder: Prevalence and clinical correlates. Comprehensive Psychiatry, 105, 152219. Web.
Mohammadi, M. R., Badrfam, R., Khaleghi, A., Hooshyari, Z., Ahmadi, N., & Zandifar, A. (2020). Prevalence, comorbidity and predictor of separation anxiety disorder in children and adolescents. Psychiatric Quarterly, 91(4), 1415–1429. Web.
Vaughan, J., Coddington, J. A., Ahmed, A. H., & Ertel, M. (2017). Separation anxiety disorder in school-age children: What health care providers should know. Journal of Pediatric Health Care, 31(4), 433–440. Web.