NRNP 6635 Week (): Assessing And Diagnosing Patients with Mood Disorders Essay

NRNP 6635 Week (): Assessing And Diagnosing Patients with Mood Disorders Essay

 

Assessing And Diagnosing Patients with Mood Disorders

Subjective:

CC (chief complaint): “Gets moody around this time of the year, every year.”

HPI: Ms. Natalie Crew, a 17-year-old White female, is brought to the facility by her mother to complain of getting moody around this time of the year. She reports being moody and states that her symptoms had worsened since the beginning of winter when she lost interest in activities she once liked, could not go out, and often felt miserable. She admits to having trouble concentrating in school and has a poor memory. She currently has a low mood. The patient also reports having added weight; ten pounds

Past Psychiatric History:

• General Statement: The patient has a history of depression which was managed, and is currently not on any medication
• Caregivers (if applicable): The patient lives with her parents and her four brothers
• Hospitalizations: Has never been hospitalized
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: Positive history of depression

Substance Current Use and History: The patient denies any current or past substance use

Family Psychiatric/Substance Use History: The patient denies a family history of psychiatric illness

Psychosocial History: The patient was raised and lived in New Orleans her whole life. She recently started an accelerated high school business program in Chicago, Illinois. The patient lives with two parents and four brothers. The patient is single and has no children. She is a high-school student. She used to enjoy partying and playing games, which she has found annoying lately.

Medical History: The patient has a history

• Current Medications: The patient is not on any current medications
• Allergies: The patient has no history of allergies

• Reproductive Hx: The patient is nulliparous with no history of pregnancies. LMP 2         weeks ago, not pregnant, sexually inactive

ROS:

• GENERAL: The patient reports a recent weight loss of ten pounds. Denies any weakness, fever, chills, or fatigue
• HEENT: Eyes: Denies visual changes, pain, or discharge. Ears: Denies hearing loss/changes. Nose: Denies bleeding, pain, or drainage. Throat: Denies pain swallowing, itchiness, or dryness.
• SKIN: Denies skin itchiness, rashes, or lesions
• CARDIOVASCULAR: Denies chest pain, tightness, discomfort, peripheral edema, and palpitations
• RESPIRATORY: Denies shortness of breath, cough, or sputum production
• GASTROINTESTINAL: nausea, vomiting, diarrhea, blood in stool
• GENITOURINARY: Denies burning on micturition blood in the urine
• NEUROLOGICAL: Denies headache, dizziness, numbness, tingling sensation
• MUSCULOSKELETAL: Denies muscle, joint, or back pain or stiffness
• HEMATOLOGIC: Patient denies easy bruising, bleeding, or anemia
• LYMPHATICS: Patient denies lymphadenopathy or splenectomy history
• ENDOCRINOLOGIC: Patient denies cold or heats intolerance and excess urination, thirst, and hunger

Objective:

Physical exam:

Vital Signs T: 97.4 P-82 RR-20 BP 128/84 Ht 5’2

HEENT: Head: Normocephalic and atraumatic. Eyes: sclera white, no drainage. Ears: Clear canal, TM pearly, and atraumatic. Nose: Pink atraumatic nasal membrane. Throat: Atraumatic, pink membrane

Neck: No palpable cervical lymph nodes, edema, or movement restriction

Chest: symmetrical rising with breathing. Apical pulse 82. S1 and S1 with no murmurs

Abdomen: Globular shape, Normoactive bowel sounds in all quadrants, no engorged veins, no pain on deep or light palpation

Extremities: Bilaterally symmetrical. Peripheral pulses 82. No limited ranges of motion, and all muscles have appreciable strength/tone

Genital: Not Done

Diagnostic results: C-reactive protein (inflammation marker is depression) and Vitamin B12 level (Kennis et al., 2020). Head CT to understand the brain structure and function.

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Assessment: SAD- Patient subjective and objective data

Mental Status Examination: The client is a 17-year-old White Female who is well-groomed and appears the stated age. The patient is cooperative and answers all questions from the examiner. She reports her mood to be great (euthymic). Her affect is flat and incongruent. She looks dull and emotionless as she seems sad throughout the encounter. She maintained an appropriate posture but avoided eye contact throughout the encounter. The speech is coherent, audible, and fluent. There is a poverty of speech with mostly one-word answers. She denies any auditory or visual hallucinations or illusions. She denies any suicidal ideations or behaviors. The patient is alert and well-oriented. She has poor immediate retention and recall memory and admits to forgetting all learned materials. She admits having poor concentration and expresses concerns regarding her projects that she does not know what to do and is already behind in two areas. However, her recent and remote memory is intact. The patient has some insight into her condition. She accepts having ‘mood changes” as her mother’s concerns but blames other people and factors for her changes. For example, she blames her teachers for her failure in class and the weather and the games her friends play for her loss of interest in activities. She has good judgment

Differential Diagnoses:

Seasonal Affective Disorder (SAD)

A possible diagnosis for this patient is SAD. The DSM criteria for SAD requires a patient to have persistent low mood and loss of interest in activities an individual once loved for based on seasonal changes (DSM, 2022). Another change is weight gain, where the patient has gained 10 pounds over the last few months (Galima et al. 2020). She has difficulty concentrating, lost interest in activities she once loved, and is almost indoors. She also reports low energy since winter began. The patient reports that she parties a lot and loves cars, but she cannot do any of that now, and games with friends are boring. The patient changes have been majorly affected by seasonal changes. Thus, the patient meets the diagnostic criteria for SAD.

Major Depressive Disorder

Major depression is a major psychiatric/mental health illness that causes marked mood changes and anhedonia (APA, 2020). The diagnostic criteria require the patient to have experienced a change in function for over two weeks and at least five or more symptoms of depressed mood or loss of pleasure (Kennedy, 2022). The patient presents with a low mood, decreased interest in activities, has increased more than 5% body weight, has low energy, and is often inattentive, meeting the criteria for diagnosis. The symptoms cause severe social and school functioning changes, as seen in decreased interaction with friends and declining performance in school. Thus, the patient meets the diagnostic criteria for major depression. However, the patient reports that mood changes occur around the same time of the year, based on seasonal changes, ruling out the diagnosis.

Bipolar Disorder

The patient reports different experiences and changes with the seasons. The patient explains that she parties and has fun a lot in the summer, but now she cannot do any of that. She paints a picture of a joyful youth, but her current situation is a persistent depressed mood. American Psychiatric Association (2022) states that a diagnosis of bipolar disorder requires a patient to have experienced a manic or hypomanic episode besides the depressive mood symptoms. Yeom et al. (2021) note that the disorder is also associated with SADs, and most patients with BD present with SAD. However, episodes of mania have not been properly documented, ruling out the disease.

Reflections: This session was a success, and I gathered much information from the patient. In future sessions, I will allow the patient to express their emotions more and give as many details as they want when asked questions. Allowing the client to talk without cutting them off much makes them open and allows the care provider to capture information on aspects such as judgment, insight, and factors affecting their health, which could have been impossible to capture after restricting the conversation. Lastly, I will maintain an empathetic tone instead of an interrogative tone with recognition of the problem of weaknesses to encourage cooperation and the development of a therapeutic relationship. In addition, it is important to understand the cultural background revolving around sexuality and the relationship between the patient and the family and the patient and the community. Behavior that conflicts with societal expectations may be considered abnormal, while it is normal in other communities. Thus, understanding the clients’ cultural backgrounds helps in their management. Another ethical issue is offering treatment interventions that are most plausible and offer the greatest degree of freedom to the patient. It is also important to consider the economic background when prescribing medications and other interventions due to their affordability. Considering these ethical-legal issues will thus help promote better patient outcomes while maintaining a cordial and therapeutic patient-care provider interaction.

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References

American Psychiatric Association. (2022). Bipolar and related disorders. In the Diagnostic and statistical manual of mental disorders

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). Author.

Galima, S. V., Vogel, S. R., & Kowalski, A. W. (2020). Seasonal affective disorder: common questions and answers. American family physician, 102(11), 668-672.

Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/shkennedy

Kennis, M., Gerritsen, L., van Dalen, M., Williams, A., Cuijpers, P., & Bockting, C. (2020). Prospective biomarkers of major depressive disorder: a systematic review and meta-analysis. Molecular psychiatry, 25(2), 321-338. https://doi.org/10.1038/s41380-019-0585-z

Yeom, J. W., Cho, C. H., Jeon, S., Seo, J. Y., Son, S., Ahn, Y. M., & Lee, H. J. (2021). Bipolar II disorder has the highest prevalence of seasonal affective disorder in early‐onset mood disorders: Results from a prospective observational cohort study. Depression and Anxiety, 38(6), 661-670. https://doi.org/10.1002/da.23153

COURSE TEXT
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
Note: This required text is available for purchase. It is also accessible through the Walden Library.
Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
RECOMMENDED TEXT
American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). Author.

LEARNING RESOURCES
Required Readings
American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders

Links to an external site.
(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders
American Psychiatric Association. (2022). Depressive disorders. In Diagnostic and statistical manual of mental disorders

Links to an external site.
(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x04_Depressive_Disorders
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 8, Mood Disorders

Chapter 31, Child Psychiatry (Section 31.12 only)
ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS
Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

I have uploaded four files: a video to use for the assignment, a case history for the video, a template, and an exemplar template.

Please use the template and be mindful of plagiarism.