DB1:400 words without references included. 2-3 references peer review articles within 5 years of publications in the U.S.A. Discuss the specifics of polypharmacy in the child and adolescent population and how to deprescribe. DB2: 400 words without references included. 2-3 references peer review articles within 5 years of publications in the U.S.A. 1. According to Keltner & Steele (2015), the consensus of scholars and clinical experts is that there are multiple factors that cause and/or contribute to development and maintenance of an eating disorder such as Bulimia Nervosa or Anorexia Nervosa. Please choose from many factors that are listed (e.g., biologic, cognitive and behavioral, family) one that is of particular interest to you, and discuss its impact on BN or AN. 2. Case study: 200 words without reference included-2-3 references Eating disorder: Hx Present Illness: A 16 y/o girl is brought to the ER by her soccer coach and a few teammates. Her coach told the doctor that during a routine practice that afternoon, the girl suddenly collapsed on the field. Her friends mentioned that following previous practices she c/o "feeling sort of dizzy" but never mentioned "passing out". Her friends explained that she has been spending less time with them lately; often going straight home after practice instead of going out for a snack with her teammates, as she used to do. The pt. states that she hads a "weird pain in her chest, felt dizzy and then just passed out". She describes several episodes of chest pain lately and apparently has been feeling more dizzy than usual. These feelings occur throughout the day and not associated only with physical exercise. When the girls mother arrived at the ER, she was visibly frantic. "What happened?" I told you that you were practicing too much--it's no wonder you passed out.--You play soccer more than 4 hrs a day". Mother corroborates the absence of any past physical or psychiatric Hx but states that the pt "has not been herself lately--spending most of the weekend lying in bed instead of going out with her friends. I know she is not sleeping well-just last night I found her looking through the frig at 3 am." Physical Exam: Pt is a slight girl , 65 inches tall, weighing 135 lbs. Resting pulse 48 beats/min in a regular rhythm. B/P 115/60 seated and 120/67 standing. She appears well nourished and hydrated. She is clearly anxious and states that she feels "nervous" being in the hospital. The HEENT exam is significant for enlarged parotid glands bilaterally. The remainder of the physical is unremarkable. LABS: Sodium-138; K-2.7; Cl-82; Bicarb-35; Venous blood gasses=7.5 pH. All other labs WNL. with exception of Mg = 1.0. The ekg showed prominent U-waves and a prolonged QT interval. What is her Diagnosis? How does the medical workup confirm it? DB3: 400 words without references included. 2-3 references peer review articles within 5 years of publications in the U.S.A. This discussion board is related to the Case study of the 9-year-old girl who has threatened her teacher at school. Please consider and write about the following: (Provide references) 9 yr. old girl threatening teacher HISTORY OF PRESENT ILLNESS: A 9 year- old girl is brought to the psychiatry office for evaluation because the school counselor reports the patient’s behavior has become increasingly out of control. Today the patient threatened to harm her teacher, stating, “I will get you, just you watch”, after she was asked to climb down from the classroom windowsill. The girl is described as disrespectful toward this teacher and other school staff, frequently yelling, arguing, and cursing at them. Any limit setting, such as being told to complete one task and move on to the next task, seemingly triggers these disruptive episodes. She is described by the school counselor as “sneaky and full of excuses”, always quick to blame others for her behaviors. The mother reports that at home she is disrespectful and rarely follows rules, explaining, “Everything is an argument.” The mother reports that it seems as though the patient “really knows how to push my buttons”, and seems at times to be deliberately annoying her. The mother denies that the patient has threatened or become violent toward her. There is no history of stealing, fire setting, hurting animals or destruction of property. The patient is sleeping and eating well and is reported to be able to focus during activities that interest her. PAST PSYCHIATRIC HISTORY: Since the age of 4 years, the patient has exhibited disruptive behaviors, noted first as an inability to follow rules of bedtime routine. The pt. attended regular education classes until 1 year ago, when she was changed to special education because of her behavior problems. She has been seeing the school counselor for almost 2 years. Despite the school’s recommendation that the pt. be evaluated by psychiatry, until now no evaluation has been done. The pts. father is incarcerated for assault, and the patient has had sporadic, minimal contact with him throughout her life. Her mother is a single parent with 3 other children who currently live with their grandmother out of state. The mother recently got a new government clerical job, leaving the patient under the supervision of a neighbor after school. PAST MEDICAL HISTORY: The patient was born full term; there were no complications of pregnancy or delivery. She achieved all developmental milestones on time. During routine screening at age 2, she was noted to have elevated lead levels and microcytic anemia. After treatment with iron supplementation, monitoring of lead levels, and home inspection for sources of lead, the problem resolved and no further treatment was needed. MENTAL STATUS EXAM: The patient is well- groomed, pleasant, well-related girl who appears her stated age. She makes good eye contact and answers all questions in a matter-of-fact tone. Her mood is reported as good and her affect is full-range and mood congruent but inappropriately bright at times. She sits calmly in her chair, playing with her hair throughout the interview. She denies any suicidal thoughts or perceptual disturbances. She reports that she no longer wants to harm her teacher and denies any other homicidal thoughts. She is alert and oriented. When asked simple computational math problems, she becomes frustrated, her affect appeared angry and her tone was disrespectful as she told the interviewer that these questions and the interviewer were “stupid”. DIAGNOSTIC TESTING: Neuropsychiatric testing from school records reveal a normal IQ. Routine lab screening tests are normal. 1. What is this child’s diagnosis? 2. What are the differential diagnosis? 3) Are there any environmental factors (especially in the home) that could be contributing to her behaviors at school, and what information would be important to know (and that you want to obtain) if you were the NP evaluating this child? 4) What are your thoughts about a diagnosis? Differential diagnosis? 5) Any other thoughts about this case? 
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