NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Walden University NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology

Whether one passes or fails an academic assignment such as the Walden University NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology

The introduction for the Walden University NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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After the introduction, move into the main part of the NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

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After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRNP 6635 Wk 1 Discussion: Factors That Influence the Development of Psychopathology

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

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. Patient reports she has lost more than one job in direct relation 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 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 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 currently 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

  

  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, nor 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 nor canal swelling was seen. The neck is normal and flexible with the normal and unswollen tonsils. The throat has no swelling, clear and normal.

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

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

Abdomen: 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 well and neatly groomed, has an upright posture, and is capable of maintaining eye contact. Speech is fluid and coherent and thought processes appropriate and within context. Patient exhibits signs of anxiety at times, but is overall able to give an appropriate account of her feelings. 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 with 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 due to mental health conditions such as depression, bipolar disorder, or anxiety get intense some days before the menstrual period. The patient reported having anxiety issues, and 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 end a few days into her menses. She therefore, needs good management to help her have better experience days before her menses. The symptoms showed by the patient largely points to Premenstrual dysphoric disorder as she also experiences bloating, binge eating, and loss of control. This patient would benefit from medications such as antidepressants likey 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 was to conduct another session for the patient again, I would include more mental tests to get a more specific diagnosis as patient is a single mother who is clearly overwhelmed and appears to have psychological issues that become more excacerbated during her period.

References

Appleton, S. M. (2018). Premenstrual syndrome: evidence-based evaluation and treatment. Clinical obstetrics and gynecology, 61(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 Psychiatry, 174(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 Neuroscience, 16(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 services, 55(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 gynaecology Canada, 40(2), 215-223. https://doi.org/10.1016/j.jogc.2017.05.018

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

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Sample Answer 2 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Subjective:

CC (chief complaint): Allegations by the patient’s mother that the patient recurrently gets moody this time of the year every year.

HPI: Ms. Julie Houston is a 19-year-old female who came to the psychiatric clinic for assessment following a recommendation from her mother. The patient presented with allegations by her mother that she recurrently gets moody around this time of the year annually. She reports that she is not feeling great and feels down. She admits to not doing so well, especially with her special business program in school. She reports that she comprehends everything but the classes are boring. She feels the teachers are stressing her with projects such as developing a mock company which she is finding difficult to complete. Two of the projects are already long overdue. The patient reports difficulty concentrating. For instance, she can read newspaper headlines and cannot seem to recall them almost immediately, a similar case with her classes. The patient has recently gained weight approximately ten pounds. She is experiencing excessive daytime sleepiness to an extent of sleeping through five of her classes this month. Initially, the patient was social, and easily made a lot of friends with whom she enjoyed their company. She would attend concerts and shows with them and engage in fun activities. However, lately, she finds them annoying, and dull and avoids their company. She currently prefers staying indoors alone which she partly attributes to the cold weather. She expresses her dislike for fall and winter because she cannot engage in activities such as going to the beach and riding in convertibles which she usually does during summer. She associates winter with darkness, and misery as opposed to beauty during summer.

Past Psychiatric History:

• General Statement: The patient denies any past psychiatric treatment.
• Caregivers (if applicable): Her parents.
• Hospitalizations: The patient has never had any psychiatric admissions.
• Medication trials: She is not on any medication trials.
• Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with any psychiatric disorder or undergone psychotherapeutic interventions.

Substance Current Use and History: The patient denies any history of or current substance abuse or abuse by any member of her family.

Family Psychiatric/Substance Use History: There is no history of any psychiatric condition in her immediate or extended family.

Psychosocial History: The patient grew up in South Carolina and was raised by both her parents. She has three other siblings, two brothers, and one sister. She is currently a full-time student undertaking a business undergraduate program in Boston. She stays with two other female student roommates in off-campus housing. She is unemployed, has never been married, and not dating. She has no history of legal issues or trouble with the authorities.

Medical History: The patient has never been admitted for any medical treatment.

 

• Current Medications: She is not on any prescription medication for any medical condition.
• Allergies: She has no known allergies to drugs or drugs.

• Reproductive Hx: Her menarche was at fourteen years. She experiences a regular menstrual cycle. Her last menstrual period was 20 days ago. She is not currently gravid. She has never used any contraceptives and has no children.

ROS:

• GENERAL: The patient reports no weight loss but a recent weight gain, no fever, and no generalized weakness.
• HEENT: There is no vision loss, hearing loss, dysphagia, sore throat, or nasal congestion.
• SKIN: The patient denies pruritus, skin rash, or abnormal skin changes.
• CARDIOVASCULAR: There are no reported palpitations, easy fatigability, shortness of breath even on exertion, chest pain, or edema.
• RESPIRATORY: There is no difficulty in breathing, no chest pain, and no cough.
• GASTROINTESTINAL: The patient denies experiencing anorexia, abdominal pain, nausea, vomiting, diarrhea, or constipation.
• GENITOURINARY: Patient reports no pain or discomfort on urination, blood in urine, increased frequency, or incontinence.
• NEUROLOGICAL: The patient denies headaches, dizziness, numbness, convulsions, weakness, or paralysis.
• MUSCULOSKELETAL: There are no myalgias, no joint swelling, pain, or stiffness.
• HEMATOLOGIC: The patient denies anemia or excessive bleeding tendency.
• LYMPHATICS: There are no swollen lymph nodes or enlarged spleen.
• ENDOCRINOLOGIC: The patient denies intolerance to heat or cold, polyuria, polydipsia, polyphagia, or excessive sweating.

Objective:

Physical exam:

Vital signs: Temperature 98.1, PR-78, RR-18, BP 119/74 Ht 5’2” Wt 184lbs

General: The patient is in fair general condition, is not in any form of distress, is well nourished and is well-kempt.

HEENT: The head is normocephalic, pupils are equally reactive to light, the oral cavity is of good hygiene and free of inflammatory processes, ear canals are clear, and the nose is not congested.

Neck: The neck is soft with no masses, no cervical lymphadenopathy, no thyroid swelling, and no distended neck veins.

Chest/Lungs: The chest moves with respiration, and expands symmetrically, vesicular breath sounds are heard on auscultation with good bilateral air entry.

Heart/Peripheral Vascular: The precordium has normal cardiac activity, the apex beat is not displaced, and first and second heart sounds were heard with no added sounds or murmurs.

Abdomen: The abdomen is not distended, not tender, with no abnormal masses, hepatomegaly, and no splenomegaly. Bowel sounds are present.

Genital/Rectal: Findings from a digital rectal examination were normal.

Musculoskeletal: There is no limitation in the range of movement in all joints. No swelling, stiffness, deformity, or tenderness was noted.

Neurological: Cranial nerve assessment is normal. Motor examination of bulk, tone, power, and reflexes are normal. Sensory examination is intact.

Skin: The skin has no lesions or abnormal changes.

Diagnostic results:

Complete blood count revealed values of cell counts that were within normal ranges.

A toxicology screen of blood and urine samples was negative for any drug.

No organisms were isolated from blood cultures.

Random blood sugar showed serum glucose levels that were within normal ranges.

Thyroid function tests were within normal values.

Blood urea, nitrogen, and creatinine were within normal levels.

Liver function tests were non-contributory.

A head CT scan detected no cranial pathology.

Assessment:

Mental Status Examination: The patient is a 19-year-old female who looks appropriate to her stated age. She is well-groomed and appropriately dressed. She is alert and fully cooperates with the examiner. There is no evidence of motor agitation. Her orientation to place, person, and time is intact. Her speech is clear, coherent, and of normal tone, rate, and volume. She has a depressed mood which is congruent with her affect. She exhibits no evidence of flight of ideas or looseness of association. She experiences occasional suicidal thoughts but has no intention of harming herself or others. She has no auditory or visual hallucinations, or delusions. Her immediate and recent memory is impaired evidenced by not remembering newspaper headlines five seconds after reading them and not recalling what she learns from her classes. Her remote and long-term memory is intact. Her concentration is poor. She lacks insight into her condition. Her judgment is good.

 

Differential Diagnoses:

1. Bipolar disorder: This is the most likely diagnosis in this patient. This is because the patient exhibits a combination of manic and depressive episodes (Jain et al., 2022). The patient initially experienced a manic episode characterized by elevated mood, increased activity, decreased need for sleep, and increased sociability (Faurholt-Jepsen et al., 2020). During this phase, she could easily make friends and engage in fun activities. The depressive episode that the patient is currently in is characterized by a depressed mood, loss of interest in activities that she initially enjoyed, weight gain, hypersomnia even during classes, reduced concentration, suicidal thoughts, and pessimistic views (Tolentino et al., 2018). The mood disturbance is severe enough to an extent of causing social and functional impairment (Jain et al., 2022). This is evidenced by isolation from her friends whom she initially had cordial relations with. The patient is also having trouble completing her program projects. Bipolar disorder has two incidence peaks of onset the first one being between 15 to 24 years and the second peak occurring between 45 to 54 years (Rowland et al., 2018). The patient is 19 years thus is more predisposed to the first peak. The report by the patient’s mother that the patient gets moody at the same time every year supports the cyclic nature of the condition.

 

2. Depressive disorder: This is the other probable diagnosis. The symptoms that the patient is currently presenting with are typical of depressive illness. This is supported by the aforementioned symptoms such as depressed mood, reduced energy, suicidal thoughts, and sleep disturbance. The risk factors that predispose to depressive illness that are present in this patient include age, female gender, previous episode based on information from the patient’s mother and stress that probably stems from the program projects (Park et al., 2019). This diagnosis does not, however, explain the experience of manic symptoms.

 

3. Borderline Personality Disorder: The patient may also be having a borderline personality disorder. This disorder usually presents with pervasive affective instability, impulsiveness, suicidal thoughts, and unstable interpersonal relationships that were evident from the history (Kulacaoglu et al., 2018). This diagnosis does not explain the presence of other depressive symptoms such as hypersomnia and depressed mood.

Reflections: The examiner in this case scenario was remarkable in eliciting important information from the patient that guided the formulation of the diagnosis. Involving the patient’s mother provided corroborative information that filled any gaps in the psychiatric assessment. Privacy and confidentiality of the patient were maintained by conducting the assessment in a room with minimal personnel flow. The patient has never been on any psychiatric treatment thus the formulation of the treatment plan will require the provision of adequate information for an informed choice. There should be no coercion in decision-making regarding the treatment approach. The patient is a teenager thus the involvement of the parents in shared decisions may be necessary. Medication trials that will be considered should be beneficial to the patient with minimal risks. The patient lacks insight thus the need for psychoeducation and education on the need for adherence to treatment recommendations. The patient expresses suicidal thoughts thus as an examiner, I would have further explored the suicide risk such as enquiring about previous attempts or intent.

References

Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline Personality Disorder. In StatPearls. StatPearls Publishing.

Faurholt-Jepsen, M., Christensen, E. M., Frost, M., Bardram, J. E., Vinberg, M., & Kessing, L. V. (2020). Hypomania/Mania by DSM-5 definition based on daily smartphone-based patient-reported assessments. Journal of affective disorders, 264, 272–278. https://doi.org/10.1016/j.jad.2020.01.014

Jain, A., & Mitra, P. (2022). Bipolar Affective Disorder. In StatPearls. StatPearls Publishing.

Kulacaoglu, F., & Kose, S. (2018). Borderline personality disorder (BPD): Amid vulnerability, chaos, and awe. Brain Sciences, 8(11), 201. https://doi.org/10.3390/brainsci8110201

Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559–568. https://doi.org/10.1056/nejmcp1712493

Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251–269. https://doi.org/10.1177/2045125318769235

Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: Implications for clinical practice. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00450

Sample Answer 3 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Subjective:

CC (chief complaint): “I feel down.”

HPI:

Natalie Crew is a 17-year-old female presenting to the psychiatric clinic with reports of feeling down. Natalie’s mother thought she should visit the counselor because she is worried that she gets moody this time of year, every year. However, Natalie is not sure if the reports are true. She states that she is not great and feels down. Natalie reports that she left school because she is not doing so well. She says the courses were not challenging, but the teachers piss her off. Besides, she seems not to understand how to develop a mock company of a project in a special business program she is undertaking. She is also late on two of her school projects. Natalie also reports difficulty concentrating, gaining 10 pounds, and sleeping during the day in class.

Furthermore, she states that her friends with whom she previously engaged in a lot of fun activities currently annoy her and have become dull. She reports disliking the cold weather because she is a summer girl and prefers the beach and convertibles. The cold weather limits her from going outside, and she cannot do anything. Natalie states that she dislikes this time of the year because it is dark, grey, and miserable, and the entire city changes with grey and black snow.

Past Psychiatric History:

• General Statement: The client has no relevant psychiatric history.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies substance use history.

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

Psychosocial History: Natalie is single. She recently joined an accelerated high school business program in Chicago, Illinois. She grew up in New Orleans her entire life with both her parents and four brothers. She currently resides in a specialty high school campus dormitory. She is a full-time student and works part-time at a local coffee shop.

Medical History: No chronic illnesses.

 

• Current Medications: None
• Allergies: None

• Reproductive Hx: No gynecological disorder.

ROS:

• GENERAL: Positive for weight gain and daytime sleepiness. Negative for fever, chills, malaise, or fatigue.
• HEENT: Negative for vision changes, eye pain, blurred/double vision, ear pain, hearing loss, rhinorrhea, or sore throat.
• SKIN: Negative for rashes, bruises, or discolorations.
• CARDIOVASCULAR: Negative for dyspnea, chest pain, palpitations, or edema.
• RESPIRATORY: Negative for breathing difficulties, cough, or wheezing.
• GASTROINTESTINAL: Negative for abdominal pain, nausea/vomiting, or bowel changes.
• GENITOURINARY: Negative for pelvic pain, dysuria, vulvar irritation, or urine color changes.
• NEUROLOGICAL: Negative for dizziness, headaches, muscle weakness, or loss of consciousness.
• MUSCULOSKELETAL: Negative for muscle pain or joint pain/stiffness.
• HEMATOLOGIC: Negative for delayed wound healing.
• LYMPHATICS: Negative for lymph node swelling.
• ENDOCRINOLOGIC: Negative for acute thirst, hunger, polyuria, or heat/cold intolerance.

Objective:

Physical exam:

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

Diagnostic results: No diagnostic tests were requested.

Assessment:

Mental Status Examination:

Female client in her teenage years. The client is well-groomed and dressed appropriately. She maintains eye contact but appears gloomy. Here the self-reported mood is low, and affect is constricted. Her speech is clear but goes low at times during the interview. She exhibits a logical thought process and has no delusions, hallucinations, or suicidal thoughts. She is oriented and has intact memory and clear judgment.

Differential Diagnoses:

Major Depressive Disorder with Seasonal Pattern (MDD-SP): MDD-SP is diagnosed based on the occurrence and remission of depressive episodes during a specific season of the year. The depressive episodes usually have a seasonal pattern in the past two years (Rai et al., 2021). MDD-SP manifests with depressive episodes that occur yearly at the same time with evident atypical symptoms such as increased appetite, weight gain, hypersomnia, and carbohydrate craving. In addition, many individuals present with diminished interest in usual activities, decreased socialization, reduced sexual interest, lethargy, hopelessness, and suicidal thoughts (Drew et al., 2021).

MDD-SP is the presumptive diagnosis based on the client’s positive symptoms of a low mood, reduced interest in previously enjoyable activities, reduced socialization with her friends, weight gain, and increased sleepiness. The client’s depressive episodes occur during the same time every year during fall, which fulfills the diagnostic criteria for MDD-SP.

Major Depressive Disorder (MDD): MDD manifests with primary features of a sad or low mood and reduced interest in most activities/things. These symptoms are usually accompanied by changes in sleep, changes in appetite and weight, lack of concentration, loss of energy, hopelessness or guilty feelings, changes in movement, and suicidal thoughts (Filatova et al., 2021). MDD is a differential diagnosis based on the patient’s symptoms of a low mood, diminished interest in activities, weight gain, hypersomnia, and diminished concentration in class. However, the patient’s symptoms occur in a recurrent seasonal pattern, which rules out MDD as the primary diagnosis since it occurs in all seasons.

Bipolar Spectrum Disorder:  Bipolar spectrum disorder is a mood disorder characterized by dramatic shifts in mood, energy, and abstract thinking. Individuals with bipolar experience high and low moods (mania and depression), which are different from the usually ups-and-downs most humans experience. The lows of depression in bipolar are usually so impairing that one may be unable to get out of bed (Baldessarini et al., 2020). Affected persons experience difficulties falling and staying asleep, while others have excessive sleep. The patient’s history of a low mood that limits her from getting out of the house and lack of interest in fun activities make Bipolar spectrum disorder a differential diagnosis. However, the patient has no history of manic episodes that alternate with depressive episodes, making Bipolar an unlikely primary diagnosis.

Reflections:

This case has enlightened me on the various types of depressive disorders, including MDD and seasonal affective disorder. I have learned that the various types of depression have common features, including the presence of a sad, empty, or irritable mood, somatic changes, cognitive changes, and a significant impact on the person’s capacity to function (O’Donovan & Alda, 2020). In a different patient encounter, I would use a screening tool like the patient health questionnaire (PHQ-9) to assess the severity of the client’s depressive symptoms. The PMHNP should consider the moral duty to promote good and cause no harm to the patient when handling this patient. Thus, the treatment interventions chosen should have adequate evidence supporting their effectiveness and safety in patients with MDD-SP.

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

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

O’Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500. https://doi.org/10.3389/fpsyt.2020.00500

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 Disorders, 23(3), 32957. https://doi.org/10.4088/PCC.20l02732

Sample Answer 4 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Subjective:

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

HPI:

Natalie Crew is a 17-year-old female client who is on psychiatric assessment after her mother felt that she should see a psychiatrist. Her mother expresses worries about Natalie’s mood changes since she gets moody at this time of year every year. According to Natalie, she does not feel great and feels low. She is having difficulties with the special business school program she enrolled in, where she is required to design a mock company, and is currently running late with two projects. Moreover, the client reports concentration difficulties, sleeping in class, and weight gain. Natalie states that her friends have become annoying and dull and no longer fun like before. She dislikes being outdoors due to the weather. She dislikes fall and winter and loves summer. According to the client, the city is usually dark, grey, and miserable this season but beautiful and sunny during summer.

Past Psychiatric History:

• General Statement: The patient has a history of seasonal mood changes.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies substance use history.

Family Psychiatric/Substance Use History: No family substance use history.

Psychosocial History: Natalie recently enrolled in an accelerated high school business program in Chicago, Illinois. She grew up and has lived her entire life in New Orleans. She was brought up by her both parents alongside four brothers. She is currently living in a specialty high school campus dormitory. She is a full-time student and has a part-time job in a local coffee shop. She is not married and is currently single. No legal history.

Medical History:

• Current Medications: None
• Allergies: NKDA

• Reproductive Hx: None

ROS:

• GENERAL: Positive for weight gain and increased daytime sleepiness.
• HEENT: No vision changes, blurred/double vision, eye pain, ear pain, hearing loss, nasal congestion, or sore throat.
• SKIN: No rashes, bruises, or itching.
• CARDIOVASCULAR: No chest pain, SOB, palpitations, or edema.
• RESPIRATORY: No sputum, cough, or wheezing.
• GASTROINTESTINAL: No abdominal pain, nausea/vomiting, or bowel changes.
• GENITOURINARY: No urinary symptoms, pelvic pain, or irritation.
• NEUROLOGICAL: No dizziness, headaches, paralysis, or tingling sensations.
• MUSCULOSKELETAL: No muscle pain or joint pain/stiffness.
• HEMATOLOGIC: No bruising or bleeding.
• LYMPHATICS: No lymph node swelling.
• ENDOCRINOLOGIC: No heat/cold intolerance, acute thirst, increased hunger, or polyuria.

Objective:

Physical exam:

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

Diagnostic results: No test results.

Assessment:

Mental Status Examination:

Appearance: Female teenager, appears right age; dull-looking.

Grooming: neat and dressed appropriately.

Eye contact: Limited.

Mood: Low

Affect: Limited

Speech: Goal-directed and volume varies.

Though process- coherent

Thought content- No hallucinations, delusions, obsessions, or suicidal thoughts/plans

Cognition- Oriented to time, person, place, and time.

Memory- Short and long-term memory is intact,

Judgment- Clear judgment

Insight- Present

Differential Diagnoses:

Seasonal Affective Disorder (SAD): This is a syndrome characterized by recurrent, seasonal patterns of depressive episodes (Jupe et al., 2023). The DSM-5 diagnostic criteria for SAD include depression present only at a specific time of year, like in the fall or winter, and full remission occurs at a specific time of the year (Rai et al., 2021). SAD is a differential diagnosis based on the patient’s depressed symptoms during specific times of the year (fall and winter). The patient’s symptoms abate during summer.

Major Depression: The DSM-V diagnostic criterion for Major depression requires at least one of the following symptoms: Depressed mood that manifests with feeling sad, low, empty, or hopeless most of the day, nearly every day, OR shed interest or pleasure in all or almost all activities (Marx et al., 2023). The patient has a depressed mood and reports feeling down and not great, as well as losing interest in her studies and friends. She also presents with other Major depression symptoms like weight gain, hypersomnia, and shed ability to concentrate in her studies.

Bipolar Disorder with Seasonal Pattern: This is characterized by depressive episodes in the fall or winter and mania or hypomania in the spring or summer (Rosenthal et al., 2020). The patient has a history of mood changes, with a depressed mood during fall and winter, but reports enjoying summer. However, this cannot be a primary diagnosis since she has no history of mania or hypomania during summer.

Reflections: In a different situation, I would ask the patient about her mood during summer and spring. I would ask her if she is more motivated to undertake school projects and enjoys hanging out with her friends. Legal and ethical considerations for this patient surround the principles of beneficence and nonmaleficence. The clinician should recommend treatment interventions associated with the best outcomes and no harm to persons with SAD. Health promotion should focus on lifestyle measures the patient can adopt during winter and fall to improve her mood like regular physical exercises and Yoga.

References

Jupe, T., Giannopoulos, I., Zenelaj, B., & Myslimi, E. (2023). Treatment of Seasonal Affective Disorder. The efficacy of Light therapy. European Psychiatry, 66(Suppl 1), S604–S605. https://doi.org/10.1192/j.eurpsy.2023.1262

Marx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023). Major depressive disorder. Nature Reviews. Disease Primers, 9(1), 44. https://doi.org/10.1038/s41572-023-00454-1

Rai, B., Gupta, R., & Chakravarty, R. (2021). Major depressive disorder with seasonal pattern or seasonal affective disorder. The Primary Care Companion for CNS Disorders, 23(3). https://doi.org/10.4088/pcc.20l02732

Rosenthal, S. J., Josephs, T., Kovtun, O., & McCarty, R. (2020). Seasonal effects on bipolar disorder: A closer look. Neuroscience & Biobehavioral Reviews, pp. 115, 199–219. https://doi.org/10.1016/j.neubiorev.2020.05.017