NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
Walden University NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders 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 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
Whether one passes or fails an academic assignment such as the Walden University NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders 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 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
The introduction for the Walden University NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders 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.
How to Write the Body for NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
After the introduction, move into the main part of the NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders 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.
How to Write the Conclusion for NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
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 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
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 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
Subjective:
Client initials: P.P
DOB: July 1, 1995
Sex: Female
CC (chief complaint): “I am here for a mental health assessment.”
HPI:
P.P is a 26-year-old female who presented to the psychiatric clinic for a mental health assessment. The client reports that she has a history of taking medications and discontinuing them because she does not think they are beneficial. She feels like the medications crush her. She reports a history of depression which impairs her job productivity at the bookstore. Besides, she experiences episodes of excessive sleepiness 4-5 times yearly, accompanied by a lack of energy and motivation to carry out activities and a reduced interest in creativity. P.P reports that when she feels depressed, she perceives that she is unworthy since her creativity slips away. The depre
ssive episodes transpire after five days of writing, painting, and doing music. The client states that she is not certain whether it is depression, but it is likely exhaustion after working hard.
She gets creativity episodes lasting almost a week before she crashes then develops depression. When she is in the
creativity episodes, she does not like taking medication because they crush her. The creativity episodes are characterized by high energy levels to do many activities, and she can last 4-5 days with minimal sleep. As a result, she gets most activities done, although her friends say she talks excessively and seems scattered. She also hears voices telling her that she is great and wonderfully talented. Besides, she gets too busy to eat in the creative episodes, but when she is crashed and resting, she consumes everything she sees and sleeps 12-16 hours/day.
Substance Current Use: Smokes tobacco 1PPD.
History of alcohol intake, last drink at 19 years.
Used marijuana x1 caused paranoia.
Medical History: History of Hypothyroidism.
- Current Medications: Hormonal pills for Polycystic Ovaries and Levothyroxine for
- Allergies: No drug or food allergies
- Reproductive Hx: History of Polycystic Ovaries.
ROS:
- GENERAL: Low energy levels during depression episodes. High energy levels during creative episodes. Negative for fever, body weakness, or weight changes.
- HEENT: Negative for vision changes, hearing loss, ear discharge, rhinorrhea, hoarseness, or sore throat.
- SKIN: Negative for rashes, lesions, or discoloration.
- CARDIOVASCULAR: Denies palpitations, chest pain, or SOB.
- RESPIRATORY: Denies difficulties in breathing, chest pain, cough, or sputum production.
- GASTROINTESTINAL: Negative for nausea/vomiting, abdominal pain, or diarrhea/constipation.
- GENITOURINARY: Negative for pelvic pain or urinary symptoms.
- NEUROLOGICAL: Denies headache, fatigue, dizziness, or tingling sensations.
- MUSCULOSKELETAL: Negative for muscle or joint pain, joint stiffness, or back pain.
- HEMATOLOGIC: Negative for bruising.
- LYMPHATICS: Negative for enlarged lymph nodes.
- ENDOCRINOLOGIC: History of hypothyroidism. She denies excessive hunger, thirst, or perspiration. Negative for cold/heat intolerance.
Objective:
Diagnostic results: No diagnostic tests were ordered.
Assessment:
Mental Status Examination:
The patient is well-groomed and appropriately dressed for the occasion. She is alert and oriented to person, place, and time. Demonstrates a logical and coherent thought process. No current auditory or visual hallucinations, delusions, or obsessions were noted.
She denies having current suicidal ideations. Her short- and long-term memory is grossly intact. Lacks insight.
Diagnostic Impression:
Bipolar Disorder:
Bipolar disorder presents with episodes of a highly elevated or irritable mood (mania) that alternates with episodes of deep and prolonged depression (Vieta et al., 2018). Bipolar disorder is a differential diagnosis evidenced by the client’s history of experiencing creative episodes characterized by an elevated mood alternated by depressive episodes where the client crashes. The creative episodes are similar to bipolar manic episodes. The patient’s symptoms consistent with mania include very high energy levels, little need for sleep, easy distractibility, excessive talking, and a high engagement in goal-focused activities such as writing, painting, and sexual activity (APA, 2013). Besides, her depressive episodes are similar to those in Bipolar, based on symptoms of depressed mood, lack of motivation, reduced interest, low energy levels, and feelings of worthlessness (Vieta et al., 2018).
Major Depressive Disorder (MDD)
P.P has symptoms consistent with the DSM-V criteria of MDD, making it a differential diagnosis. MDD features present in the patient include depressed mood, diminished interest in previously pleasurable activities, lack of motivation, reduced energy levels, hypersomnia, and feelings of worthlessness (APA, 2013). However, the episodes of depressive symptoms alternate with episodes of mania, ruling out MDD as a primary diagnosis.
Schizophrenia
Schizophrenia presents with features of psychosis, including hallucinations, delusions, disorganized speech, and behavior. There is also diminished interest and drive, lack of motivation, and a reduced emotional range (APA, 2013). The patient’s symptoms consistent with the differential diagnosis of schizophrenia include the history of delusions and auditory hallucination (APA, 2013). P.P reports that during creative episodes, she hears voices telling her she is great and wonderfully talented.
Reflections:
The assignment enlightened me on the differential diagnoses for patients presenting with mood disorders. If I were to conduct the session again, I would utilize mental health screening tools such as the Mood Disorder Questionnaire, which measures the severity of Bipolar disorder and guide in developing a treatment plan (Wang et al., 2020). The PMHNP should adhere to ethical principles of autonomy, beneficence, and nonmaleficence when developing the treatment plan. In the patient follow-up, I would evaluate the patient’s progress by assessing the severity of manic and depressive symptoms. Besides, I would inquire about medication side effects to promote patient safety.
Case Formulation and Treatment Plan:
P.P presented with a history of manic episodes that alternate with depressive episodes. The features are consistent with Bipolar disorder. The patient’s treatment plan will include pharmacotherapy and psychotherapy.
Pharmacotherapy: Lithium 450 mg orally BD. Lithium was selected because it is the gold standard in bipolar disorder treatment. It reduces suicide risk in the long term (Shah et al., 2017).
Psychotherapy: Cognitive-behavioral therapy (CBT): CBT helps decrease the relapse rate of bipolar symptoms. It alleviates depressive and mania symptoms and improves psychosocial functioning (Chiang et al., 2017).
Health education: Treatment compliance, and smoking cessation.
Follow-up: The patient will be scheduled for a follow-up after four weeks to evaluate response to therapy.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849. https://doi.org/10.1371/journal.pone.0176849
Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019-5545.196974
Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Miskowiak, K. W. (2018). Grande. Bipolar disorders. Nat Rev Dis Primers, 4, 18008. https://doi.org/10.1038/nrdp.2018.8
Wang, H. R., Bahk, W. M., Yoon, B. H., Kim, M. D., Jung, Y. E., Min, K. J., Hong, J., & Woo, Y. S. (2020). The Influence of Current Mood States on Screening Accuracy of the Mood Disorder Questionnaire. Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology, 18(1), 25–31. https://doi.org/10.9758/cpn.2020.18.1.25
Sample Answer 2 for NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
Subjective:
CC (chief complaint): ” I have a history of taking medications and stopping them.”
HPI: P.P. is a twenty-five-year-old woman who came to the facility for a mental health assessment. She reports a history of not complying with the previously prescribed psychiatrist medications. She reports that some of the medications interfere with her sense of self and her creativity, which makes her stop using them. She was first hospitalized during her teenage years for not sleeping for four to five days and experiencing auditory hallucinations. She also reports a history of suicide attempts following an overdose of Benadryl. She reports side effects of various medications such as Zoloft, which makes her feel euphoric and suffer racing thoughts and insomnia, while Seroquel causes her weight gain. She also reports periods of heightened energy and creativity, as well as a decreased need for sleep lasting for about one week. She also reports engaging in risky sexual behavior to maintain her mood.
Substance Current Use: The patient reports smoking about a pack of cigarettes per day and shows reluctance to quit smoking. She last drank alcohol at the age of 19. She also tried using marijuana once and stopped using it since it made her feel paranoid. She denies using any other substance.
Medical History:
- Current Medications: She uses unspecified medication for hypothyroidism and birth control pills for polycystic ovarian syndrome.
- Allergies: No reported allergies
- Reproductive Hx: She is currently on birth control pills for PCOS. Reports regular menstrual cycle, with the last one occurring the previous month. No possibility of pregnancy since she reports safe sex. The patient currently lives with her boyfriend, and she has no child yet.
ROS:
- GENERAL: No fever, chills, fatigue, or weight loss. However, she reports fatigue during depressive episodes. Reports fluctuations in appetite during manic and depressive episodes
- HEENT: No headache, vision changes, ear pains, hearing problems. No nasal congestion or sore throat.
- SKIN: No skin lesions, itches, or rashes.
- CARDIOVASCULAR: No chest palpitations, chest pain or edema
- RESPIRATORY: No wheezing, cough, or shortness of breath
- GASTROINTESTINAL: No diarrhea, vomiting, nausea, or abdominal pain. Reports overeating during the depressive episodes.
- GENITOURINARY: No urinary or pregnancy symptoms. Reports regular menstrual cycles. Uses birth control pills.
- NEUROLOGICAL: No focal neurological deficits, seizures, or sensory changes. Reports occasional auditory hallucinations during periods of sleep deprivation.
- MUSCULOSKELETAL: No muscle weakness, joint stiffness, or pain.
- HEMATOLOGIC: No bruising or bleeding was reported
- LYMPHATICS: No swollen lymph nodes.
- ENDOCRINOLOGIC: Reports a history of hypothyroidism. No sweating. No heat or cold intolerance. No polyuria or polydipsia.
Objective:
Vital signs: Temp 98.2 Pulse 90 Respiration 18 B/P 138/88
Diagnostic results: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
Assessment:
Mental Status Examination: P.P. is well-dressed and groomed. She also looks her age. The patient is alert and oriented. She cooperates during the interview. She has a varying mood and a labile effect. She has intact short-term and long-term memory. She exhibits irritability and frustration when discussing her family history and dynamics. Her speech is a bit rapid and pressured. She exhibits a coherent thought process. While she reports a past suicidal attempt, she denies current suicidal thoughts or homicidal ideation.
Diagnostic Impression:
- Bipolar I disorder: This is an illness where a patient experiences a manic episode preceded or followed by a hypomanic episode or a major depressive episode (Ghaemi et al.,2022). P.P. reported manic episodes. She exhibits various symptoms such as extravagance, inflated self-esteem, lack of sleep, too much speaking, and racing thoughts. According to the DSM-V criteria, the patient’s symptoms indicate bipolar I disorder.
- Major depressive disorder: This is a condition where a patient may exhibit different symptoms, such as frequent and persistent feelings of hopelessness and sadness (Flint, 2023). P.P. reported several symptoms, such as feelings of worthlessness, excessive sleep, and low energy. Nonetheless, the symptoms shown by the patient have not been persistent. Hence, this diagnosis is less likely.
- Borderline personality disorder: This is a condition where a patient experiences extreme mood swings and trouble controlling mood swings (Bohus et al.,2021). The patient reports emotional instability and impulsivity. However, she did not exhibit identity disturbance or chronic instability, which then makes this diagnosis less likely.
Reflections: I agree with the assessment and diagnostic impression, especially of Bipolar I disorder being the primary diagnosis. The patient exhibited depressive and manic episodes and a cyclic nature and duration of the symptoms, which aligns with the condition as indicated in the DSM-V criteria (Tondo et al.,2022). One of the things I learned in this case is why it is vital to perform a thorough and systematic assessment during psychiatric evaluations and why sensitivity is important when exploring topics such as past trauma and substance use. Among the things I would do differently is a deeper exploration of the patient’s family history of substance use and mental health and try to understand particular genetic predispositions and environmental factors that may be impacting her condition. It is also important to explore the legal or ethical considerations related to this case. Consent for treatment and confidentiality is vital, especially given the patient’s history of substance use and hospitalization. It is important to ensure informed consent for treatment decisions, especially regarding medication that the patient has been stopping due to their perceived negative impacts. One social determinant of health is her unstable living situation. She depends on her boyfriend and sporadic employment at her aunt’s bookstore, showing possible socioeconomic vulnerabilities (Paro et al.,2021). Therefore, the highlighted factors may negatively impact access to healthcare and adherence to treatment. As part of the health promotion, there should be regular monitoring of their physical health since she has reproductive health concerns, such as polycystic ovary syndrome. She needs to be educated on the risks of smoking and health coping strategies.
Case Formulation and Treatment Plan: The patient needs a comprehensive treatment plan for better outcomes. The necessary laboratory tests have been performed. Therefore, no further laboratory tests are required. Management of Bipolar I disorder will require both psychotherapy and pharmacological approaches. Therefore, the patient should start using lithium carbonate (300 mg) two times a day. She should also start weekly psychotherapy sessions to help deal with the symptoms. In the case of major depressive disorder, the patient should be started on 10 mg of escitalopram once per day. This medication can be integrated with cognitive behavioral therapy. The patient should follow the same plan for borderline personality disorder. The medications may have different side effects. For example, escitalopram may lead to dry mouth, insomnia, headache, and nausea. Besides, lithium carbonate may cause diarrhea, nausea, and weight gain. As part of education, it is important to educate the patient on the importance of adhering to the medication plan and prescription. She should also observe potential adverse reactions and report them as soon as possible.
References
Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., & Lieb, K. (2021). Borderline personality disorder. The Lancet, 398(10310), 1528-1540. https://doi.org/10.1016/S0140-6736(21)00476-1
Flint, J. (2023). The genetic basis of major depressive disorder. Molecular Psychiatry, 28(6), 2254-2265. https://doi.org/10.1038/s41380-023-01957-9
Ghaemi, S. N., Angst, J., Vohringer, P. A., Youngstrom, E. A., Phelps, J., Mitchell, P. B., … & Gershon, S. (2022). Clinical research diagnostic criteria for bipolar illness (CRDC-BP): rationale and validity. International Journal of Bipolar Disorders, 10(1), 23. Doi: 10.1186/s40345-022-00267-3
Paro, A., Hyer, J. M., Diaz, A., Tsilimigras, D. I., & Pawlik, T. M. (2021). Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes. Surgery, 170(6), 1777-1784. https://doi.org/10.1016/j.surg.2021.06.001
Kamal, Z. M., Dutta, S., Rahman, S., Etando, A., Hasan, E., Nahar, S. N., … & Ahmad, R. (2022). Therapeutic application of lithium in bipolar disorders: a brief review. Cureus, 14(9). https://doi.org/10.7759%2Fcureus.29332
Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1), 21. Doi: 10.1186/s40345-022-00268-2
Sample Answer 3 for NRNP 6665 ASSIGNMENT: Assessing, Diagnosing, and Treating Adults With Mood Disorders
Subjective:
CC (chief complaint): ” I have these times when I don’t want to get out of bed. I have no energy, no motivation to do anything, I just can’t feel any interest in my creativity”. ” I have taken medications and discontinued them in the past; I don’t believe I require them.”
HPI: P.P, a twenty-seven-year-old Caucasian female patient, has visited the clinic for a mental health evaluation. She indicates that she has a history of bipolar, anxiety, and depression. She has stopped taking medication since they have done away with her creativity. She has been hospitalized on four occasions, the first of those coming during her teenage days when she was admitted for lacking sleep for up to five years. She also indicated that she has been hearing things. The patient also indicated that she had been admitted to a mental health facility due to recommendations from her mother. The patient also had an overdose of Benadryl, which she took with the intention of committing suicide. Recently, she was also taken in by the police to an emergency room since she was playing guitar and dancing in public while putting on her night dress. P.P also indicates that there are days when she feels completely exhausted, and therefore she struggles to get out of bed and lacks the desire to be creative. These happen after lacking sleep for several days. While there are talks of depression, she is not sure if she is depressed. She sometimes forgets to take her prescribed medications since she feels fatigued from work. The patient also shared that she has a lot of energy; hence she can do several things and can even go up to five days without sleep. She indicates that she is toxic whenever she is creative, something that lasts for seven days. In addition, her friends also say that she looks disorganized and talks too much.
Substance Current Use: the patient smoke a pack (nicotine).
Medical History: the patient has a history of anxiety disorder, bipolar disorder, and depressive disorders. The patient has had a total of four hospitalizations and a suicide attempt by using an excess of Benadryl.
- Current Medications: Zoloft, Seroquel, Risperidone and Klonopin. She uses medications for birth control and hypothyroidism.
- Allergies: no known allergies
- Reproductive Hx: No STIs reported, no children, the patient uses birth control pills, has many sexual partners, and has regular menses.
ROS:
- GENERAL: the patient has no distress; she is presentable and well nourished. She is jovial, though she gets irritated with repetitive questions.
- HEENT: No headaches, no dizziness, no eye or ear pain, no nasal discharge, no blurred vision or vision changes, no reports of swallowing difficulty
- SKIN: No bruising, no lesions, no skin rash
- CARDIOVASCULAR: no chest pain, breath shortness, or chest tightness
- RESPIRATORY: No dyspnea, no cough, no reports of breathlessness
- GASTROINTESTINAL: no constipation, stomach upset and diarrhea
- GENITOURINARY: no frequent or urgent urination, no pain reported.
- NEUROLOGICAL: no numbness, no headache, no ataxia
- MUSCULOSKELETAL: no reports of muscle or joint pain.
- HEMATOLOGIC: no bruising or bleeding
- LYMPHATICS: no pain or swelling reported
- ENDOCRINOLOGIC: reports of hypothyroidism
Objective:
Temp 98.2 Pulse 90 Respiration 18 B/P 138/88
Laboratory Data Available: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
ROS
General: The patient has an appropriate attitude and mood, which are also congruent with each other.
HEENT: no deformities or traumas observed on the head, eyes, ears, and neck are all normal.
SKIN: The skin is warm and dry, with no ulcers, wounds, or rashes observed.
CARDIOVASCULAR: The heart rhythm is normal; no murmurs, no click sounds heard
RESPIRATORY: no shortness of breath, no wheezing, the breathing is non-labored
NEUROLOGICAL: The patient looks alert, oriented, and cooperative
Diagnostic results: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
Assessment:
Mental Status Examination:
The patient is a twenty-seven-year-old Caucasian female. She looks polite and perceptive, well dressed and organized. However, her speech looks forced at times. Her speech tone is appropriate and consistent. The client has had fantasies of becoming famous when he gets a chance to publish her memoirs, apply make-up and sell artwork to movie stars. The client has reported episodes of creativity, a times when she is worried. The patient has lots of energy and sometimes only sleeps three hours per night, yearns for sex with strangers, and talks a lot during such a duration. The week of “creativity” is followed by a week of lack of motivation and energy, where she stays in bed. The patient has no current experiences with sensation, hearing, or vision problems, even though she could hear voices in the past. The long-term and short-term memory is intact. The patient is devoid of impulse control and judgments. Even though she has a history of suicide, she doesn’t have any suicidal thoughts currently. The patient experiences depressive episodes, which make her be away from her Aunt’s bookshop.
Diagnostic Impression:
- Bipolar disorder: the patient has been exhibiting manic behavior, including involvement in potentially harmful activities, possession of racing thoughts and ideas, talking more than usual, lack of sleep in some weeks, inflated self-esteem, and extravagance (Kessing et al., 2021). According to the DSM-V criteria, these symptoms befit bipolar disorder. Indeed, when a patient experiences frequent and several depressive episodes, bipolar I disorder is likely to follow.
- Generalized Anxiety Disorder: There are indications of engaging in impulsive behavior to cope with particularly uncomfortable feelings. Such behavior can easily be misinterpreted as racing thoughts. However, it does not have manic behavior connected to bipolar disorder, hence ruling it out. However, it points to the patient’s reported fatigue, lack of concentration, and restlessness.
- Borderline Personality Disorder: Impulsivity and emotional instability are both common among patients with borderline personality disorder and bipolar disorder (Videler et al.,2019). However, the patient’s symptoms do not meet the full criteria for the diagnosis of this condition according to DSM-V guidelines.
Reflections:
The examination performed on the patient was compressive, and it was appropriate in revealing and addressing the patient medication and medical History. Performing a review of current and past medications is key in coming up with the right treatment and management plan, as a practitioner would know how particular medications made the patient feels. As part of the plan, the patient and the family members should be well educated regarding the medications and their effective use and allow the patient to make appropriate medication choices, led by the presented information. The patient should also get the right direction and education on the disadvantages of using psychotropic medications, their side effects, and potential adverse impacts. Ethical principles should also take center stage when prescribing psychotropic medications to patients (Hunt Grubbe et al.,2020). For instance, non-maleficence should lead the professionals to assess the patient’s safety depending on the patient’s current actions and the possibility of the existence of suicidal ideation or plans. Autonomy should make the practitioner let the patient have a say on the medications to use and the treatment plan and also get the necessary education plan. This client also needs to receive some sex education as she has a sexual relationship with several partners.
Case Formulation and Treatment Plan:
From the guidelines of the DSM-5 criteria, the patient’s symptoms best fit Bipolar Personality disorder. Indeed, the patient has shown a lack of self-control, poor judgment, a diminished need to sleep, bloated self-esteem, and promiscuous character. The patient also has delusional thinking, irrational thought process, racing emotions and opinions, and is also too friendly. The patient also has experiences of hopelessness, lack of desire, diminished interest in activities that she is otherwise used to enjoying, difficulty getting up in the morning, tiredness, and exhaustion.
The patient needs appropriate management to help her cope with the symptoms. The patient can start using Lamictal (25 mg) BID, which will be used until the expected impact is realized. Cognitive behavioral therapy is also indicated for this patient to help her with her racing thoughts. Lamictal is the medication of choice since the previous medication has resulted in weight gain. According to Wang & Osser, 2020 Lamictal has been proven by FDA for treating bipolar disease. The patient has complained of weight gain due to previous medications. Therefore, such a view can negatively impact compliance with the current plan. Therefore, the patient has to be educated that the issue will be addressed, but it may take a few weeks. The patient also needs to be informed of the possible side effects, such as nausea, rash, and dizziness ( Rosenberg et al., 2021).
References
Hunt-Grubbe, H. (2020). Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings. In Ethical Issues in Clinical Forensic Psychiatry (pp. 99-114). Springer, Cham. https://doi.org/10.1007/978-3-030-37301-6_6
Kessing, L. V., González-Pinto, A., Fagiolini, A., Bechdolf, A., Reif, A., Yildiz, A., … & Vieta, E. (2021). DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis–A narrative review from the ECNP bipolar disorders network. European Neuropsychopharmacology, 47, 54-61. https://doi.org/10.1016/j.euroneuro.2021.01.097
Rosenberg, R., Schweitzer, P. K., Steier, J., & Pepin, J. L. (2021). Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management. Postgraduate Medicine, 133(7), 772-783. https://doi.org/10.1080/00325481.2021.1948305
Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Van Alphen, S. P. (2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, 21(7), 1-8. https://doi.org/10.1007/s11920-019-1040-1
Wang, D., & Osser, D. N. (2020). The psychopharmacology algorithm project at the Harvard South Shore Program: an update on bipolar depression. Bipolar Disorders, 22(5), 472-489. https://doi.org/10.1111/bdi.12860