NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS ESSAY

NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS ESSAY

NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS ESSAY

Week (enter week #): NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS 

Subjective:

CC (chief complaint): “I get moody this time of year, every year.”

HPI: Natalie Crew is a 17-year-old female presenting with a chief complaint of getting moody this time of the year each year. Her mother booked an appointment in the psychiatric clinic because she worried about her mood changes. Natalie mentions that she is not feeling great and feels down and generally not doing well. She mentions that she is in a special business program in school, where she has to create a mock company. However, she is facing challenges because she cannot seem to go through with it. She is late with two of her projects. Natalie also reports difficulty concentrating, weight gain, and sleeping during class.

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Furthermore, she finds her friends annoying and dull, yet she previously found them fun. She states that she does not like being outdoors because of the weather and has always been bothered by fall and winter, and prefers summer. Natalie states that she dislikes how dark, grey, and miserable the city is at this time of the year and loves how it is beautiful and sunny in August and September.

Past Psychiatric History:

• General Statement: No significant psychiatric history.
• Caregivers (if applicable): None.
• Hospitalizations: None
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies using alcohol, drugs, or smoking.

Family Psychiatric/Substance Use History: No history of substance abuse or psychiatric disorders in the family.

Psychosocial History:  The patient is not married and is single. She recently enrolled in an accelerated high school business program in Chicago, Illinois. She has lived in New Orleans with her parents and four brothers. She currently stays in a specialty high school campus dormitory. She is a full-time student and works part-time at a local coffee shop.

Medical History:

• Current Medications: None
• Allergies: None

• Reproductive Hx: None

ROS:

• GENERAL: Reports weight gain and daytime sleepiness. Denies fever, chills, malaise, or fatigue.
• HEENT: Denies vision changes, blurred/double vision, eye pain, ear pain, hearing loss, sneezing, or sore throat.
• SKIN: Denies rashes, bruises, or itching.
• CARDIOVASCULAR: Denies SOB, chest pain, palpitations, or edema.
• RESPIRATORY: Denies sputum, SOB, cough, or wheezing.
• GASTROINTESTINAL: Denies abdominal pain, nausea/vomiting, or bowel changes.
• GENITOURINARY: Denies pelvic pain, urinary symptoms, or vulvar irritation.
• NEUROLOGICAL: Denies dizziness, headaches, muscle weakness, or tingling sensations.
• MUSCULOSKELETAL: Denies muscle pain or joint pain/stiffness.
• HEMATOLOGIC: Denies bruising or bleeding.
• LYMPHATICS: Denies lymph node swelling.
• ENDOCRINOLOGIC: Denies excessive sweating or cold, acute thirst, increased hunger, or polyuria.

Objective:

Physical exam: T 97.4; P-82; R-120; BP-128/84; Ht-5’2”; Wt-192lbs

Diagnostic results: No tests were ordered.

Assessment:

Mental Status Examination:

The patient is a female teenager. She is neat and dressed appropriately. Her eye contact is limited, and she appears dull. Her self-reported mood is low, and her affect is limited. Her speech is goal-directed, but the volume varies from low to average. She has a coherent thought process. No hallucinations, delusions, obsessions, or suicidal thoughts were noted. She is oriented to time, person, place, and event. Her memory is intact, and she demonstrates clear judgment.

Differential Diagnoses:

Major Depressive Disorder with Seasonal Pattern (MDD-SP):  Persons with MDD-SP present with mood changes and symptoms similar to depression. The symptoms usually occur during fall and winter when there is less sunlight and usually abate in spring (Rai et al., 2021). The common features of MDD-SP include fatigue, even excessive sleeping, and weight gain associated with increased appetite and carbohydrate cravings (Fellinger et al., 2022). Natalie reports mood changes during fall and winter, which occurs yearly. She has depressive symptoms like low mood, loss of interest in previously enjoyed activities, like hanging out with friends, weight changes, excessive sleeping, difficulty concentrating, and lack of motivation in school projects.

Major Depressive Disorder (MDD): The patient presents with clinical features of MDD like low mood, diminished interest and motivation in activities, weight gain, excessive sleeping, and concentration difficulties (Filatova et al., 2021). However, the patient’s depressive symptoms are present only at a specific time of year (winter), and full remission occurs after winter. This pattern rules out MDD as the primary diagnosis. 

Bipolar Disorder: Bipolar disorder causes changes in an individual’s mood, energy, and ability to function. Patients with bipolar disorder experience intense emotional states (mood episodes) that usually occur during distinct periods of days to weeks (Baldessarini et al., 2020). The mood episodes are categorized as manic/hypomanic (irritable mood), which alternate with depressive (sad mood) states. Bipolar disorder is a differential diagnosis since the patient’s mood changes from happy to depressed. However, the patient’s mood changes are associated with weather changes and do not fit the criteria for Bipolar disorder.

Reflections:    

 In a different session, I would assess the patient for suicidal thoughts and ideations. This is because patients suffering from seasonal depression are prone to suicide and often require hospitalization during these seasonal times (Fonte & Coutinho, 2021). Besides, I would evaluate the severity of the depressive symptoms using the Patient Health Questionaire-9 (PHQ-9). Ethical considerations, in this case, surround the principles of beneficence and nonmaleficence. The practitioner should implement treatment interventions linked with the best outcomes for patients with seasonal depression without compromising the patient’s safety and quality of life. Health promotion should focus on educating the patient on measures to help alleviate the depressive symptoms during winter, like Dietary modifications, increased physical exercises, Meditation, Sleep hygiene, and taking Vitamin D supplements (Drew et al., 2021).

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

Drew, E. M., Hanson, B. L., & Huo, K. (2021). Seasonal affective disorder and engagement in physical activities among adults in Alaska. International Journal of Circumpolar Health, 80(1), 1906058. https://doi.org/10.1080/22423982.2021.1906058

Fellinger, M., Waldhör, T., Serretti, A., Hinterbuchinger, B., Pruckner, N., König, D., … & Fugger, G. (2022). Seasonality in major depressive disorder: effect of sex and age. Journal of Affective Disorders, 296, 111-116. https://doi.org/10.1016/j.jad.2021.09.051

Filatova, E. V., Shadrina, M. I., & Slominsky, P. A. (2021). Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells, 10(6), 1283. https://doi.org/10.3390/cells10061283

Fonte, A., & Coutinho, B. (2021). Seasonal sensitivity and psychiatric morbidity: study about seasonal affective disorder. BMC psychiatry, 21(1), 317. https://doi.org/10.1186/s12888-021-03313-z

Rai, B., Gupta, R., & Chakravarty, R. (2021). Major Depressive Disorder With Seasonal Pattern or Seasonal Affective Disorder: Diagnostic Issues With Good Response to Agomelatine. The Primary Care Companion for CNS

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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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

LEARNING RESOURCES

Required Readings

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

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 2 -only sections 2.9, “Depressive Disorders and Suicide in Children and Adolescents” 2.10 Early-Onset Bipolar Disorder”, and 2.11 “Disruptive Mood Dysregulation Disorder”

Chapter 6 “Bipolar Disorders”

Chapter 7 “Depressive Disorders”

Document: Comprehensive Psychiatric Evaluation TemplateDownload Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation ExemplarDownload Comprehensive Psychiatric Evaluation Exemplar

Required Media

Classroom Productions. (Producer). (2015). Bipolar disordersLinks to an external site. [Video]. Walden University.

Classroom Productions. (Producer). (2015). Depressive disordersLinks to an external site. [Video]. Walden University.

Classroom Productions. (Producer). (1992). Mood disordersLinks to an external site. [Video]. Walden University.

Classroom Productions. (Producer). (2005). Bipolar disorder in childrenLinks to an external site. [Video]. Walden University.

MedEasy. (2017). Mood disorders (depression, mania/bipolar, everything in between) | USMLE & COMLEXLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=59umGpQyaHs

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2016). Training title 2Links to an external site.[Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-2

Symptom Media. (Producer). (2016). Training title 8Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-8

Symptom Media. (Producer). (2017). Training title 18Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-18

Symptom Media. (Producer). (2016). Training title 28 Links to an external site.[Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-28

Symptom Media. (Producer). (2016). Training title 38Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-38

Symptom Media. (Producer). (2016). Training title 43Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-43

Symptom Media. (Producer). (2018). Training title 118Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-118

Symptom Media. (Producer). (2018). Training title 144Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-144

Symptom Media. (Producer). (2018). Training title 150Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-150

Document: Case History Reports

TO PREPARE:

Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.

Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.

By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

Identify at least three possible differential diagnoses for the patient.

BY DAY 7 OF WEEK 3

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.).

SUBMISSION INFORMATION

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To submit your completed assignment, save your Assignment as WK3Assgn_LastName_Firstinitial

Then, click on Start Assignment near the top of the page.

Next, click on Upload File and select Submit Assignment for review.

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Rubric

NRNP_6635_Week3_Assignment_Rubric

NRNP_6635_Week3_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS

20 to >17.0 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

17 to >15.0 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

15 to >13.0 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

13 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.

20 pts

This criterion is linked to a Learning OutcomeIn the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

20 to >17.0 pts

Excellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

17 to >15.0 pts

Good

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

15 to >13.0 pts

Fair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

13 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

20 pts

This criterion is linked to a Learning OutcomeIn the Assessment section, provide:• Results of the mental status examination, presented in paragraph form.• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.

25 to >22.0 pts

Excellent

The response thoroughly and accurately documents the results of the mental status exam. …Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

22 to >19.0 pts

Good

The response accurately documents the results of the mental status exam. … Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

19 to >17.0 pts

Fair

The response documents the results of the mental status exam with some vagueness or inaccuracy. … Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or inaccuracy.

17 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.

25 pts

This criterion is linked to a Learning OutcomeReflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

10 to >8.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 to >7.0 pts

Good

Reflections demonstrate critical thinking.

7 to >6.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking.

6 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing.

10 pts

This criterion is linked to a Learning OutcomeProvide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

15 to >13.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

13 to >11.0 pts

Good

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

11 to >10.0 pts

Fair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

10 to >0 pts

Poor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

15 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 to >3.5 pts

Good

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 to >3.0 pts

Fair

Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

3 to >0 pts

Poor

No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

Total Points: 100