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

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

NRNP 6665 ASSIGNMENT Assessing Diagnosing and Treating Adults With Mood Disorders
NRNP 6665 ASSIGNMENT Assessing Diagnosing and Treating Adults With Mood Disorders

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

NRNP 6665 ASSIGNMENT Assessing, Diagnosing, and Treating Adults With Mood Disorders
NRNP 6665 ASSIGNMENT Assessing, Diagnosing, and Treating Adults With Mood Disorders

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.

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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 one12(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 psychiatry59(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 Primers4, 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 Neuropsychopharmacology18(1), 25–31. https://doi.org/10.9758/cpn.2020.18.1.25