NRNP PRAC 6635 Week 3: Assessing and Diagnosing Patients with Mood Disorders: The Case of Major Depressive Disorder Assignment

Assignment: Assessing and Diagnosing Patients With Mood Disorders

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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.

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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 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.).

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Assessing and Diagnosing Patients with Mood Disorders: The Case of Major Depressive Disorder

Subjective:

CC (chief complaint): The patient presents with a complaint of having a depressed mood, feeling “down”, “not feeling so well”, feeling drained of energy, and lonely for most of the day most of the time. She is also forgetting things easily and is unable to concentrate must of the time.

HPI: She is a 19 year-old Caucasian female presenting with depressed mood as above. There is no previous history of the symptoms according to her. The symptoms first occurred after she enrolled into college for undergraduate studies. The symptoms are recalcitrant and constant, tormenting her all the time. When she is alone the symptoms are aggravated but during times such as summer she feels a bit better. She rates the symptom severity at 7/10.

Past Psychiatric History:

General Statement: She is single and studies in Boston MA. She has no psychiatric history.
Caregivers (if applicable): She can take care of her activities of daily living or ADLs.
Hospitalizations: She has no history of hospitalizations.
Medication trials: She has never taken part in medication trials.
Psychotherapy or Previous Psychiatric Diagnosis: She is negative for previous history of a psychiatric diagnosis.

Substance Current Use and History: She denies any previous substance use history.

Family Psychiatric/Substance Use History: No one in her family has a history of substance use.

Psychosocial History: She comes from a family of six from South Carolina and she has three siblings (a sister and two brothers). She stays outside campus with some college colleagues but she feels they do not engage in activities that she likes. She has no boyfriend or children.

Medical History:

Current Medications: She is not on any medications.
Allergies: She has no known allergies to anything.

Reproductive Hx: She is a heterosexual female but has no partner at the moment.

ROS:

GENERAL: Denies fatigue, fever, weight loss, or chills.
HEENT: Denies headache, photophobia, tearing, tinnitus, rhinorrhea, painful gums , or sore throat.
SKIN: Negative for rashes, eczema, hives, or itching.
CARDIOVASCULAR: Denies chest pains, chest tightness, edema, or palpitations.
RESPIRATORY: She denies coughing, wheezing, or difficulty in breathing.
GASTROINTESTINAL: Negative for diarrhea, vomiting, or nausea. She also denies a change in bowel habits.
GENITOURINARY: Denies hesistancy, frequency of micturition, dysuria, or vaginal discharge.
NEUROLOGICAL: Negative for paraesthesia, tingling, hemiparesis or loss of bladder/ bowel control.
MUSCULOSKELETAL: Denies joint pains or myalgia.
HEMATOLOGIC: Negative for blood and clotting disorders.
LYMPHATICS: Negative for lymphadenopathy and splenectomy.
ENDOCRINOLOGIC: Negative for polydipsia, polyphagia, or excessive diaphoresis. Also negative for heat or cold sensitivity and previous hormonal therapy.

Objective:

Physical exam: She is alert and oriented in place, person, space, and event. Her grooming is appropriate and suitable for the time of day and weather. Her speech is coherent.

Vital signs: BP 120/75 regular cuff and sitting; P 68, regular; T 98.3°F; RR 15, non-labored; BMI 24.3 kg/m² (normal weight to height).

Diagnostic results: Positive for depression on assessment using the Patient Health Questionnaire or PHQ-9.

Assessment:

Mental Status Examination: She is a 19 year-old Caucasian female oriented in all aspects. Her grooming is appropriate for the time of the day. Her speech is normal, understandable, and goal-oriented. She has not displayed any mannerisms, tics, or gestures whatsoever. She states that she is “depressed” and this denotes her mood. The affect that is observed is dysphoria and is thus congruent with the reported mood. She displays no suicidal or homicidal ideation. There is no paranoia, delusions, or even hallucinations. Her judgment and insight are intact. She is dignosed with major depressive disorder or MDD whose DSM-5 diagnostic code is 296.22 (F32.1) (APA, 2013; Sadock et al., 2015).

Differential Diagnoses:

Major depressive disorder (MDD) – Diagnostic code 296.22 (F32.1)

This is the primary and mosr likely diagnosis. This patient fulfillsthe diagnostic criteria for MDD as stated in the DSM-5. These include constant anxiety, a feeling of depressed mood, sadness, fatigue, disinterest, lack of concentration, solitude, and non-enjoyment of activities that were previously enjoyed (APA, 2013).

Dysthymia – Diagnostic code 300.4 (F34.1)

This condition shares quite a number of DSM-5 diagnostic criteria it is also known as persistent depressive disorder and has symptoms that include insomnia, depressed mood, poor concentration, poor appetite, and low self-esteem a mongst others (APA, 2013). The absence of a number of criteria that are present for MDD makes it only second likely as a diagnosis in this case.

Bipolar Disorder – Diagnostic code 296.52 (F31.32)

This is the thid diferential and is the least likely of the three. The DSM-5 criteria for diagnosis is a period of elevated mood characterized by inflated self-esteem and distractibility. I also sows with marked impairment in social, occupational, and self-care functioning (APA, 2013). These are the symptoms that set it aside from MDD and dysthymia because these two do not have elevated moods. The symptoms are also clearly not attributable to substance use.

Reflection:

In the case of this patient, I flowed the laid down psycgiatric interview process and treated the patient with dignity (Carlat, 2017; Haswell, 2019). I sought infrmed consent before I did anything or asked anything (Entwistle, 2019). Ethically, I know that I mus keep the patient’s information confidential and I assured her of the same. Legally, I knew that I would not be able to disclose her disgnosis to her parents without her consent. I advised her on the importance of adherence to treatment and honoring appointments. She has no risk factors so I only encouraged her to kep away from stressful environments and toassociate with those whose company she enjoys.

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Carlat, D.J. (2017). The psychiatric interview, 4^th ed. Wolters Kluwer.

Entwistle, J.W.C. (2019). Noninformed consent and autonomy. The Annals of Thoracic Surgery, 108(6), 1610. https://doi.org/10.1016/j.athoracsur.2019.08.006

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.