Pediatric Case Study: Matteo Is An 18

Nu665cpediatric Case Studytranscriptscenariomatteo Is An 18 Year Old

Nu665C Pediatric Case Study Transcript Scenario: Matteo is an 18-year-old bisexual adolescent of Latino descent, who has been on and off diets for the past five years. They are in their sophomore year of an accelerated bachelor’s degree program and have been binge eating takeout meals from fast food restaurants on campus late at night. The binge eating episodes have become so expensive that Matteo’s parents have addressed this overspending, which has led Matteo to begin shoplifting and stealing money to support the bingeing. Currently, Matteo has been binge eating at least three times a week over several months. This episode followed the breakup of a stormy relationship with their high school boyfriend.

They are beginning to gain weight even though they restrict food between bingeing episodes and induce vomiting afterward to control weight. In the past, they have used laxatives and diuretics to rid themselves of calories but did not like the side effects of constipation. Matteo’s eating problems became severe when they started college and were living in a dormitory with a self-serve cafeteria. As a child, Matteo had difficulty controlling snacks between meals and would get into arguments with their parents, who threatened to put a lock on the refrigerator. Matteo’s weight has fluctuated by 10 to 20 pounds within several months.

They are secretive about the binge eating, which is difficult to manage because they live in a quad with other students. Matteo plans the late-night episodes and often walks downtown through unsafe neighborhoods to consume food and vomit. Recently, they have been approached by older men who are soliciting them. Their parents found out from one of Matteo’s friends, who was concerned about their judgment. Matteo fears gaining weight because they are on a scholarship with the dance department.

Matteo often goes days without eating. They have begun using methamphetamine with a new acquaintance for the euphoric and appetite-suppressing effects. Matteo has had problems with insomnia for many years but recently reports decreased need for sleep. They have been experiencing headaches, muscle cramps, and fatigue for several days and have not been attending dance practice. They are being seen by the nurse practitioner at the health clinic, who reports that Matteo confides they "feel horrible and need some help."

Physical exam and laboratory tests reveal serum potassium at 3.2 mEq/L, BUN:creatinine ratio greater than 58, signs of volume depletion, scarring on the dorsum of the right hand, dental caries, and enamel erosion.

Paper For Above instruction

The case of Matteo presents a complex clinical picture characterized by multiple intertwined psychiatric and medical conditions, primarily focused on disordered eating behaviors, substance abuse, and their physiological consequences. The goal of this paper is to analyze Matteo’s presentation comprehensively, identify the diagnostic considerations, explore possible comorbidities, discuss the underlying psychological factors, and suggest an integrated treatment approach.

Introduction

Adolescence, especially in the context of college life, is a critical period marked by identity formation, emotional development, and the establishment of behavioral patterns that can significantly influence health. Matteo’s scenario exemplifies the intersecting challenges of eating disorders, substance misuse, and risky behaviors, which necessitate a multidisciplinary and empathetic approach for optimal outcomes.

Clinical Presentation and Diagnostic Considerations

Matteo exhibits hallmark features of bulimia nervosa, including recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, laxative and diuretic misuse, and drastic food restriction. The secretiveness and planning of binge episodes are typical, reflecting shame and concealment often associated with bulimia (American Psychiatric Association, 2013). The electrolyte imbalance indicated by hypokalemia (serum potassium at 3.2 mEq/L), alongside signs of volume depletion and enamel erosion, further supports this diagnosis.

Regarding substance use, Matteo’s recent methamphetamine employment complicates the clinical picture. Methamphetamine is known for its stimulant effects, appetite suppression, and potential to induce dehydration, agitation, and insomnia (Rawson et al., 2012). The combination of disordered eating and stimulant use heightens risks of cardiac arrhythmias, electrolyte disturbances, and psychosis.

The fluctuation in weight, engaged in secretive, late-night bingeing, and history of childhood snack control issues all suggest possible comorbidities such as impulse control disorders, body dysmorphic disorder, or mood disorders (Kessler et al., 2013). The recent emotional stressors, including a breakup, may precipitate or exacerbate these conditions.

Physiological and Psychological Consequences

The physical consequences—dental caries, enamel erosion, scarring, and electrolyte disturbances—are characteristic of bulimic behaviors and reflect chronic physiological harm. The decreased need for sleep coupled with insomnia indicates possible stimulant-induced sleep disruption. Furthermore, head, muscle cramps, and fatigue suggest ongoing dehydration and electrolyte imbalance, elevate risk for cardiac complications (Winters & Naylor, 2017).

Psychologically, Matteo’s secretiveness, shame about behaviors, and engagement with older men who solicit them may point to underlying vulnerabilities including low self-esteem, feelings of despair, and a need for acceptance (Favaro et al., 2014). The involvement with drugs and risky behaviors reflects impulsivity and potential comorbidities such as substance use disorder, which is prevalent in individuals with eating disorders (Mond et al., 2014).

Management Strategies

A comprehensive, multidisciplinary approach is essential for treating Matteo’s complex presenting problems. Psychotherapeutically, cognitive-behavioral therapy (CBT) is evidence-based for bulimia nervosa and can help modify maladaptive thought patterns regarding body image, foster healthier coping mechanisms, and address underlying emotional issues (Spoor et al., 2014). Family therapy may also be beneficial, particularly in addressing early developmental issues and enhancing support systems.

Pharmacologically, selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, have shown efficacy in reducing binge frequency and associated behaviors (Kaye et al., 2005). Given the electrolyte disturbances, hospitalization for stabilization of dehydration and correction of hypokalemia may be necessary, along with close monitoring of cardiac function.

The treatment plan must also address substance use. Referral to addiction specialists, counseling for drug dependence, and harm reduction strategies are pivotal (Marsden & Gossop, 2012). Addressing environmental factors, such as unsafe neighborhood walks and exploitation risks, is also crucial for safety.

Medical management of the physical sequelae includes dental care for enamel erosion, nutritional counseling, and regular medical follow-up to monitor electrolyte balance and overall health status (Sullivan et al., 2008).

Conclusion

Matteo’s case exemplifies the intricate relationship between mental health disorders, behavioral risks, and physiological consequences. An integrated treatment strategy that combines psychological therapy, medical intervention, substance abuse treatment, and social support is vital. Recognizing the signs early and engaging a compassionate, interdisciplinary team will optimize recovery outcomes and address the complex needs of adolescents facing similar challenges.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Favaro, A., Santonastaso, P., & Colombo, G. (2014). The epidemiology of bulimia nervosa. Journal of Psychiatric Research, 48, 17–23.
• Kaye, W. H., et al. (2005). Pharmacotherapy of eating disorders. Journal of Clinical Psychiatry, 66(Suppl 2), 74–82.
• Kessler, R. C., et al. (2013). Prevalence and correlates of binge eating disorder in the National Comorbidity Survey Replication. Biological Psychiatry, 73(9), 805–814.
• Marsden, J., Gossop, M. (2012). Harm reduction and substance misuse: New insights and challenges. Addiction Research & Theory, 20(4), 290–299.
• Mond, J. M., et al. (2014). The comorbidity of eating disorders and substance use disorders. The International Journal of Eating Disorders, 47(7), 675–683.
• Sullivan, P. F., et al. (2008). Medical complications of bulimia nervosa. Journal of the American Medical Association, 280(13), 1158–1162.
• Spoor, P., et al. (2014). Cognitive-behavioral therapy for bulimia nervosa. European Eating Disorders Review, 22(5), 333–339.
• Winters, J. J., & Naylor, J. (2017). Medical complications of eating disorders. Psychiatry Clinics of North America, 40(4), 727–744.