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NRNP 6635 week 3 Assignment

NRNP 6635 week 3 Assignment: 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 client’s cultural history, may affect their decision to seek treatment. Bipolar disorders can also be challenging to diagnose correctly. While clients with bipolar or related disorders will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

  • 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 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 rule 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.).

Learning Resources

  • Required Readings (click to expand/reduce)
  • American Psychiatric Association. (2013). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  • doi:10.1176/appi.books.9780890425596.dsm03
  • American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).
  • 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)
  • Document: Comprehensive Psychiatric Evaluation Template
  • Document: Comprehensive Psychiatric Evaluation Exemplar
  • Required Media (click to expand/reduce)

NRNP 6635 week 3 Assignment Sample Solution

 Subjective:

CC (chief complaint): “When I have my periods, I am on my back all day crying. My world is falling apart”.

HPI: Miss H. A, a 32-year-old patient, presents to the clinic complaining of an overwhelming feeling accompanying the intense cramps during her menstrual time. She complains of dizziness, headache, and back pain. She also reports having an increased appetite. She also complains of instability due to mood swings and feels stressed. The patient reports that she has lost more than one job directly related to this problem.

Past Psychiatric History:

  • General Statement: the patient has had issues of anxiety but has never been diagnosed with clinical depression
  • Caregivers (if applicable): the patient has visited a psychiatrist in the past for several years after the divorce but has since stopped since the feelings of anger and sadness due to the divorce have left her
  • Hospitalizations: The patient has no history of hospitalizations
  • Medication trials: The patient uses ibuprofen to relieve her pain, but no other legal medications
  • Psychotherapy or Previous Psychiatric Diagnosis: Anxiety

Substance Current Use and History: no history or current substance use

Family Psychiatric/Substance Use History: The patient’s family from the mother’s side has a history of depression as the uncle killed himself due to depression

Psychosocial history: the patient currently lives in Phoenix with two children but is divorced. The patient was born and raised in Tucson with her mother and four siblings

Medical History:

  • Current Medications: no medications except for ibuprofen which she uses for pain
  • Allergies: The patient has no know allergies
  • Reproductive Hx: The patient is divorced and lives with her two children. The patient reports no history of sexually transmitted diseases.

ROS:

  • GENERAL: The patient has an overwhelming feeling accompanying cramps during her menses. She gets sad

NRNP 6635 Assignment Assessing and Diagnosing Patients With Mood Disorders

and snaps at people.

  • HEENT: The patient’s eyes appear normal. No abnormal discolorization of the sclera was observed. The ears are also normal. No sore throat or scratch. No sneezing and no cough.
  • SKIN: no itchiness noted. The skin has no rashes, and no lesions were noted.
  • CARDIOVASCULAR: No chest discomfort, no chest pressure or pain
  • RESPIRATORY: no congestions nor respiratory issues were noted.
  • GASTROINTESTINAL: No nausea, vomiting, anorexia, diarrhea, or abdominal pain
  • GENITOURINARY: normal passing of urine with no pain
  • NEUROLOGICAL: no numbness. No bowel movement changes or bladder control. Experiences headache and dizziness
  • MUSCULOSKELETAL: experiences back pain. No muscle pain, no stiffness
  • HEMATOLOGIC: No bruises, bleeding, or anemia.
  • LYMPHATICS: has no history of splenectomy and has no swollen lymph nodes
  • ENDOCRINOLOGIC: has bo abnormal sweating or excessive thirst.

Objective:

Physical exam:

Vital signs: T- 98.2 P- 74 R 18 120/70 Ht 5’1 Wt 150lbs.

HEENT: the head is atraumatic and normocephalic. The pupils react well to light and are normal. The ear is normal, and no discharge or canal swelling was seen. The neck is normal and flexible with normal and unswollen tonsils. The throat has no swelling, clear and normal.

Chest/lungs: The breathing sounds were noted to clear upon auscultation.

Heart: no murmurs or abnormal sounds heart as the heart rate was regular and with the expected rhythm.

Abdomen: The abdomen is normal, soft, and non-tender.

Diagnostic results:  Various tools can be essential for screening to obtain the necessary diagnostic results. An example is the use of the Mood-Disorder Questionnaire (Hong et al., 2018).

Assessment:

Mental Status Examination: The patient is nicely and neatly groomed, has an upright posture, and can maintain eye contact. Speech is fluid and coherent, and thought processes are appropriate and within context. The patient exhibits signs of anxiety at times but can give an appropriate account of her feelings overall. The patient’s mood appears unstable, easily irritated, and gets angry. She has a good flow of ideas and compact thoughts. The patient appreciates her current mental struggles as she admits to being stressed and anxious because of the unbearable pain and uncomfortably that comes with her menses. The patient remained focused during the examination, though she appeared bothered by her current condition.

Differential Diagnoses:

  1. Premenstrual syndrome: This condition presents various symptoms such as mood swings in the weeks just before a woman’s menstrual period, with the mood swings presenting as unexplained and sugged mood changes. According to the DSM-5, Patients experiencing this condition may show various symptoms such as anger, anxiety, irritability, and sadness (Appleton, 2018). Ms. Hartford presented with all the symptoms and explained that she experiences those symptoms every month during her menses.
  2. Premenstrual dysphoric disorder: A condition that is similar to the premenstrual except that the symptoms here are worse, and in most cases, emotions are involved. However, only a handful of women experience this condition during their lifetime. The patient reported an unbearable feeling making her even guilty to speak about it. So this is also a possible condition affecting the patient.
  3. Premenstrual exacerbation: this is a condition where the symptoms of mental health conditions such as depression, bipolar disorder, or anxiety get intense some days before the menstrual period. The patient reported having anxiety issues; therefore, it is also possible that its symptoms worsen when close to her periods.

Reflections

This female patient experiences undesirable symptoms and feeling every month, a few days before her menses, extends and ends a few days into her menses. She, therefore, needs good management to help her have better experience days before her menses. The patient’s symptoms largely point to Premenstrual dysphoric disorder as she also experiences bloating, binge eating, and loss of control. This patient would benefit from medications such as antidepressants like sertraline, paroxetine, or fluoxetine (Reid & Soares, 2018). She also needs to undergo stress management techniques such as relaxation techniques. She also needs to consume a healthy diet. If I were to conduct another session for the patient again, I would include more mental tests to get a more specific diagnosis as the patient is a single mother who is overwhelmed and appears to have psychological issues that become more exacerbated during her period.

References

Appleton, S. M. (2018). Premenstrual syndrome: evidence-based evaluation and treatment. Clinical obstetrics and gynecology61(1), 52-61. https://doi.org/10.1097/GRF.0000000000000339

Eisenlohr-Moul, T. A., Girdler, S. S., Schmalenberger, K. M., Dawson, D. N., Surana, P., Johnson, J. L., & Rubinow, D. R. (2017). Toward the reliable diagnosis of DSM-5 premenstrual dysphoric disorder: the Carolina Premenstrual Assessment Scoring System (C-PASS). American Journal of Psychiatry174(1), 51-59. https://doi.org/10.1176/appi.ajp.2016.15121510

Hong, N., Bahk, W. M., Yoon, B. H., Min, K. J., Shin, Y. C., & Jon, D. I. (2018). Improving the screening instrument of bipolar spectrum disorders: weighted Korean version of the mood disorder questionnaire. Clinical Psychopharmacology and Neuroscience16(3), 333. https://dx.doi.org/10.9758%2Fcpn.2018.16.3.333.

Leahy, L. G. (2017). Premenstrual exacerbations: Achieving stability all month, every month. Journal of psychosocial nursing and mental health services55(4), 9-13. https://doi.org/10.3928/02793695-20170330-02.

Reid, R. L., & Soares, C. N. (2018). Premenstrual dysphoric disorder: contemporary diagnosis and management. Journal of obstetrics and gynecology Canada40(2), 215-223. https://doi.org/10.1016/j.jogc.2017.05.018

Training Title 144. . (2018).[Video/DVD] Symptom Media. Retrieved from

https://video.alexanderstreet.com/watch/training-title-144

Also See: NRNP 6635 Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD