Reference no: EM133649280

Assignment:

An 11-year-old boy, originally from New Zealand, was brought to a pediatric hospital in the United States due to severe food refusal and deteriorating health. He had recently returned from a visit to New Zealand, where he had been with family members, including an uncle suffering from terminal throat cancer. In New Zealand, the boy had complained of stomach discomfort, constipation, and difficulty swallowing. His diet solely consisted of liquid meal supplements. He denied any concerns about his body image but expressed a fear of choking. Additionally, he worried about his parents' health and experienced generalized anxiety. He was described as a shy child with significant performance anxiety, often becoming distressed when separated from his parents.

The patient's parents were of New Zealand origin, while he was born in the United States. They had strong ties to New Zealand culture and frequently visited relatives there.

Upon assessment, the boy's height was approximately 58.7 inches (75th percentile for his age), and he weighed around 73 pounds (10th percentile for his age). His ideal body weight was estimated at 90.4 pounds, making him approximately 80% of his target weight. He presented with a slow resting heart rate of 56 beats per minute. The patient received diagnoses of generalized anxiety disorder, separation anxiety disorder, and Avoidant/Restrictive Food Intake Disorder (ARFID). He was admitted to the pediatric eating disorder unit for weight restoration.

Before his admission, the patient had undergone various medical tests at a community hospital, including swallowing studies, laryngoscopy, and esophagoscopy, which showed no abnormalities. The nature of ARFID being psychological in origin was explained to the patient and his family, but they insisted on finding a physical explanation for his food refusal. Subsequent abdominal x-rays, esophagoscopy, and laryngoscopy also yielded normal results. Although food exposure therapy was offered, the patient refused, claiming a physical issue in his throat prevented him from eating. He declined participation in group therapy and also rejected a trial of fluoxetine to manage his anxiety.

As his food refusal persisted and he failed to gain weight despite a month of hospitalization, nasogastric tube feeding was initiated. The family eventually agreed to commence fluoxetine to address his anxiety symptoms but remained committed to finding a physical cause for his food refusal.

After six weeks in the hospital, the patient and his family returned to the United States, believing that their healthcare needs were better addressed there. He was discharged, weighing around 88 pounds, equivalent to 97 percent of his ideal body weight, and consuming 3000 kilocalories per day.

Provide:

1. Diagnosis

2. 2 Differential Diagnoses and rationale

3. What medications would you use? How would you taper, titrate or cross-titrate medications and why?

4. Explain why or why not Mia might not have responded to quetiapine and or olanzapine.