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Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

NRNP 6665 Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping

Them because I don’t think I need them. I feel like the medication squashes me.”

HPI:

Petunia Park is a 27-year-old White female who presented for psychiatric assessment with complaints of taking her medications on and off. She stops her medication mostly since she does not perceive that she needs them. Park also states that she feels the drugs squash her. The patient reports getting depressed 4-5 times per year, making her not work at her aunt’s bookstore. During the depressed periods, she has no urge to wake up, lacks motivation, and has minimal motivation. Her creativity also diminishes, making her feel worthless. She experiences depressive periods after she has worked hard for five days o

Assignment Assessing Diagnosing and Treating Adults With Mood Disorders
Assignment Assessing Diagnosing and Treating Adults With Mood Disorders

n her writing, painting, and music work. The patient states that people tell her she is depressed during those periods, but she believes it is just exhaustion from her hard work.

The patient states that she gets creative for about a week and then crushes. She fails to take her medication when creative because they squash her, yet she has a lot of energy. Besides, she sleeps minimally for 4-5 days, engages in many activities, talks excessively, and appears scattered. The patient also states that she likes to explore her body and mind through sexual activity to get pleasure during her creative periods. She is usually too busy to take meals when creative but can feed on anything when crashed. When she is creative, she sleeps about three hours per week but 12-16 hours/day per day when depressed. She further states that she hears voices saying that she is great and very talented when not sleeping adequately.

Substance Current Use: She last took alcohol at 19 years. She smokes nicotine 1PPD. History of using Marijuana (1 episode) stopped due to paranoia.

Medical History: Has Hypothyroidism.

 

  • Current Medications: Levothyroxine to treat Hypothyroidism; On Hormonal pills for Polycystic Ovaries.
  • Allergies: No allergies
  • Reproductive Hx: History of Polycystic Ovaries.

ROS:

  • GENERAL: Reports increased appetite and diminished energy levels during depressive episodes. Reduced appetite and high energy levels on creative episodes. Denies fever, chills, or malaise.
  • HEENT: No changes in vision, rhinorrhea, sneezing, facial pain, or dysphagia.

    Assignment Assessing, Diagnosing, and Treating Adults With Mood Disorders
    Assignment Assessing, Diagnosing, and Treating Adults With Mood Disorders
  • SKIN: Negative for discoloration, rashes, or lesions.
  • CARDIOVASCULAR: Denies chest pain, SOB on exertion, or edema.
  • RESPIRATORY: Denies breathing difficulties.
  • GASTROINTESTINAL: Denies abdominal symptoms.
  • GENITOURINARY: Denies abnormal vaginal discharge or urinary symptoms.
  • NEUROLOGICAL: Denies headaches, black spells, or paralysis.
  • MUSCULOSKELETAL: Negative for limitations in movement.
  • HEMATOLOGIC: No bruises or bleeding.
  • LYMPHATICS: Denies lymph node swelling.
  • ENDOCRINOLOGIC: Denies excessive hunger, urine production, or thirst.

Objective:

Vitals: Temp- 98.2, Pulse- 90, Respiration-18, B/P 138/88

Diagnostic results: Urine drug and alcohol screen- Negative.

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CBC-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 neat and well-groomed. She is alert and oriented to person, place, and time. She maintains eye contact for most of the interview but fidgets on her chair. The patient’s speech is clear and goal-directed. The thought process is coherent and goal-directed. No apparent hallucinations, delusions, phobias, compulsions, or suicidal ideations or plans. Memory is intact, and insight is present.

Diagnostic Impression:

Bipolar Disorder:

Bipolar disorder is the most likely diagnosis based on the presence of DSM-V clinical features in the patient. Bipolar disorder is characterized by episodes of elevated mood, which alternate with a profoundly depressed mood (McIntyre et al., 2020). The patient has a history of creative episodes characterized by an elevated mood alternating with depressive episodes. Besides, the creative episodes are characteristic of manic episodes that occur in Bipolar. The patient’s features of mania include excessive energy levels, diminished need for sleep, increased goal-focused activities, high distraction, and engaging in risky sexual activities (APA, 2013).The mania episodes alternate with episodes of depressed mood, which present with diminished interest in activities, low energy levels, lack of motivation, and feeling of worthlessness.

Major Depressive Disorder (MMD):

The patient presents with symptoms that align with the DSM V diagnostic features of MDD. The symptoms include depressed mood, diminished interest, reduced energy, lack of motivation, hypersomnia, and feeling worthless (APA, 2013). However, the depressed mood is not constant and alternates with episodes of elevated mood, which rules out MDD as a presumptive diagnosis.

Schizophrenia:

Petunia has symptoms that match the DSM-V criteria for schizophrenia. This includes auditory hallucinations where she hears voices. She also has diminished interest and motivation, which are negative symptoms of schizophrenia (McCutcheon et al., 2020). Nevertheless, the patient’s manic and depressive symptoms make schizophrenia an unlikely primary diagnosis.

 

Case Formulation and Treatment Plan:

The patient has bipolar disorder  based on features of mania and depression. The treatment plan will comprise pharmacological and psychotherapy approaches.

Pharmacological: Lithium XR 450 mg per oral twice daily. Lithium is the first-line therapy for acute mania and long-term prophylaxis in bipolar disorder  (Atagü & Oral, 2021).

Psychotherapy: Cognitive behavior therapy (CBT) to train the patient cognitive-behavioral skills that can help her cope with Bipolar and help her identify and address common psychosocial stressors and issues caused by the disorder (Atagü & Oral, 2021).

Follow-up: A follow-up will be scheduled after four weeks to evaluate the patient’s response to treatment, assess for side effects, and modify treatment if necessary.

Reflection:

If I conducted the session again, I would utilize screening tools such as the Young Mania Rating Scale (YMRS), which is used to examine bipolar symptoms and the severity of the disorder (Montes et al., 2021). I would also administer a Patient Health Questionnaire (PHQ-9) to adequately assess MDD symptoms and their severity. Legal/ethical considerations, in this case, include confidentiality for the patient’s health information. The clinician should also seek consent before initiating treatment and uphold autonomy by engaging the patient in decision-making.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Atagün, M. İ., & Oral, T. (2021). Acute and Long-Term Treatment of Manic Episodes in Bipolar Disorder. Noro psikiyatri arsivi58(Suppl 1), S24–S30. https://doi.org/10.29399/npa.27411

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet (London, England)396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0

McCutcheon, R. A., Reis Marques, T., & Howes, O. D. (2020). Schizophrenia-An Overview. JAMA Psychiatry77(2), 201–210. https://doi.org/10.1001/jamapsychiatry.2019.3360

Montes, J. M., Pascual, A., Molins Pascual, S., Loeck, C., Gutiérrez Bermejo, M. B., & Jenaro, C. (2021). Assessment Tool of Bipolar Disorder for Primary Health Care: The SAEBD. International journal of environmental research and public health18(16), 8318. https://doi.org/10.3390/ijerph18168318