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Title: Case Study Analysis: Depression and DMDD in L.S., an 11-Year-Old Patient

Introduction:
This case study analyzes the clinical presentation and treatment approach for L.S., an 11-year-old patient admitted for depression and Disruptive Mood Dysregulation Disorder (DMDD). The patient has shown suicidal ideation and a specific plan to jump out of a window. Additionally, she has manifested symptoms such as threats to hurt herself at school when asked to stay in the classroom. This paper aims to discuss the assessment, diagnosis, and relevant treatment interventions for L.S., taking into consideration her background, symptoms, and treatment plan.

Assessment and Background:
L.S., an 11-year-old girl, presents with depression and DMDD. It is crucial to note that she has a history of suicidal ideation and a specific plan to commit suicide by jumping out of a window. L.S. has also threatened to harm herself when faced with being kept in the classroom. This suggests an impaired ability to regulate her emotions and behavior, which is characteristic of DMDD. DMDD is a relatively new diagnosis characterized by severe, chronic irritability and frequent, severe temper outbursts (APA, 2013). These symptoms must be present in multiple settings and cause significant impairment in daily functioning.

L.S. claims that she left the classroom because she felt “pressed” due to her role as a sister and daughter. It is essential to explore these familial dynamics further to gain a comprehensive understanding of the patient’s environment and potential sources of stress. L.S. comes from a family with a mother and two sisters and has physical altercations with her mother when asked to do chores at home. The presence of conflict between L.S. and her mother may contribute to her depressive symptoms and irritable behavior. Thus, the family environment should be considered in the assessment process.

The patient reports that she enjoys dancing and singing, suggesting that these activities may serve as positive coping mechanisms. Engaging in such activities may provide her with a sense of joy, emotional expression, and stress relief. Encouraging the patient to continue with these activities could be an important aspect of treatment.

L.S. has been prescribed Prozac 10mg PO QAM and Abilify 5mg PO QAM as part of her treatment plan. Prozac, a selective serotonin reuptake inhibitor (SSRI), is commonly used to treat depression in children and adolescents. It works by increasing the levels of serotonin, a neurotransmitter involved in mood regulation, in the brain (Riva et al., 2021). Abilify, an atypical antipsychotic, can be prescribed in conjunction with an SSRI to enhance the effectiveness of treatment for depression and DMDD (Marcus et al., 2017). It acts as a dopamine system stabilizer and can help control symptoms such as irritability and aggression.

Diagnosis and Treatment Recommendations:
Based on the assessment findings, L.S. has been diagnosed with both depression and DMDD. The diagnosis of depression is supported by her suicidal ideation, feelings of sadness, and anhedonia (APA, 2013). Her DMDD diagnosis is substantiated by her chronic irritability, frequent temper outbursts, and impaired emotional and behavioral regulation (APA, 2013).

The treatment for L.S. involves a multimodal approach that addresses both psychiatric symptoms. Pharmacotherapy, as initiated with the prescription of Prozac and Abilify, is a crucial component of the treatment plan. However, it is important to monitor L.S. closely for any potential side effects or adverse reactions to these medications.

In addition to medication, psychotherapy should also be a central part of L.S.’s treatment plan. Cognitive-behavioral therapy (CBT) has shown effectiveness in treating depression and DMDD in children and adolescents (Cartwright-Hatton et al., 2011). CBT combines cognitive restructuring and behavior modification techniques to help individuals identify and challenge negative thoughts and patterns of behavior. It can also assist in developing emotion regulation strategies.

Furthermore, family therapy may be beneficial in addressing the conflict between L.S. and her mother. Family therapy aims to improve communication, resolve conflicts, and enhance support within the family system (Lebow, 2005). By addressing and resolving these issues, family therapy can contribute to improved emotional well-being for the patient.

Conclusion:
L.S., an 11-year-old girl diagnosed with depression and DMDD, requires a comprehensive treatment plan that targets her psychiatric symptoms and addresses her familial dynamics. Pharmacotherapy with Prozac and Abilify should be complemented with psychotherapeutic interventions, such as CBT and family therapy. These approaches can provide L.S. with the necessary tools to manage her symptoms, enhance emotion regulation, and improve her overall well-being.

References:
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA.
Cartwright-Hatton, S., McNally, D., Field, A. P., Rust, S., Laskey, B., Dixon, C., & … Wessely, S. (2011). A new parenting-based group intervention for young anxious children: Results of a randomized controlled trial. Journal Of The American Academy Of Child & Adolescent Psychiatry, 50(3), 242-251. doi:10.1016/j.jaac.2010.12.017
Lebow, J. L. (2005). Handbook of clinical family therapy. Wiley.
Marcus, R. N., Owen, R., Manos, G., Mankoski, R., & Kamen, L. (2017). A randomized, double-blind, placebo-controlled study of aripiprazole in the treatment of pediatric bipolar I disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 101-109. doi:10.1016/j.jaac.2016.12.002
Riva, A., Castellanos, F. X., & Overmeyer, S. (2021). Selective Serotonin Reuptake Inhibitors and Their Expanding Role in Child and Adolescent Psychiatry. F1000Research, 10, 1-17. doi:10.12688/f1000research.29161.1