NRNP 6635 Week 3 Assignment: Diagnosing Patients With Mood Disorders Essay

NRNP 6635 Week 3 Assignment: Diagnosing Patients With Mood Disorders Essay

Subjective:

Name: Ms. Liliana Ball

Gender: Female

Age: 16 years old

CC (chief complaint): “I am not depressed.”

HPI:

Liliana Ball is a 16-year-old female client referred to the psychiatric clinic after her parents reported that she has been depressed in the past week and had no energy. Her parents also reported that she began crying the previous day and mentioned that she never wanted to take part in more school plays. However, the client dismisses her parent’s concerns that she is depressed and states that she was a little bit depressed the previous day because she was in a bad mood. Liliana states that she is happy today. The client further dismisses her parents’ report that she tells them she is worthless for destroying everyone’s lives and wanted to die and states that it is now in the past. She states that whatever her parents said, they had the freedom of expression, and she neither accepts nor denies their report. Furthermore, Liliana’s parents believe she is hiding her medications since the client states that they slow her down and crush her creative art. The client has a history of self-harm by cutting herself.

Past Psychiatric History:

• General Statement: The client first presented for psychiatric evaluation at 7 years when she was diagnosed with Conduct disorder.
• Caregivers (if applicable): None
• Hospitalizations: The client has been in a 3-month teen residential mental health facility due to Cannabis abuse and was discharged one month ago.
• Medication trials: History of taking sertraline which resulted in irritability, aggression, and impulsivity.
• Psychotherapy or Previous Psychiatric Diagnosis: Previously diagnosed with Conduct disorder, Depression, and Substance use Disorder (Cannabis).

Substance Current Use and History: History of Cannabis use.

Family Psychiatric/Substance Use History:  The client’s grandmother has a history of Bipolar disorder. Her mother and maternal aunt have a history of anxiety disorder.

Psychosocial History:

Liliana currently lives with her parents and two younger siblings in Tacoma, WA. She is a second-year high school student. The client is single and states that she is bisexual. The client has a history of domestic violence towards her mother and two younger sisters. She has no current legal issues. She reports sleeping 3 to 4hrs in a day and states that her appetite is great.

Medical History:

 

• Current Medications: The patient was prescribed Lithium 300mg in the morning and 600mg at bedtime, and Aripiprazole 10mg in the morning a month ago.
• Allergies: No known food or drug allergies.

• Reproductive Hx: Currently on Nexplanon implant. She admits to having lots of unprotected sex.

ROS:

• GENERAL: Denies weight loss, chills, fever, or fatigue.
• HEENT: Denies eye pain, blurred/double vision, nasal blockage/discharge, difficulty in swallowing, or hoarseness.
• SKIN: Denies hyperpigmentation, rashes, or bruises.
• CARDIOVASCULAR: Denies chest pain, palpitations, edema, or dyspnea.
• RESPIRATORY: Denies cough, sputum, chest pain, or SOB.
• GASTROINTESTINAL: Denies abdominal pain, nausea, vomiting, or bowel changes.
• GENITOURINARY: Denies urinary symptoms or abnormal PV discharge.
• NEUROLOGICAL: Denies headaches, dizziness, or tingling sensations.
• MUSCULOSKELETAL: Denies joint pain, joint stiffness, or muscle pain.
• HEMATOLOGIC: Denies bruising or hx of anemia.
• LYMPHATICS: Denies hx of enlarged lymph nodes.
• ENDOCRINOLOGIC: Denies excessive perspiration, hunger, thirst, or heat/cold intolerance.

Objective:

Physical exam: T- 97.4 P- 84 R 18 134/88 Ht 5’3 Wt 118lbs

Diagnostic results: Lab results are within normal ranges.

Urine toxicology- negative

Assessment:

Mental Status Examination:

The client is well-groomed and appropriately dressed. She seems less interested in the interview and is distracted. She is alert and oriented to person, place, and time. Her self-reported mood is happy, and her affect is broad. She has rapid and pressured speech and exhibits a flight of ideas. No hallucinations or delusions were noted. She denies suicidal thoughts or ideations. Lacks insight.

Differential Diagnoses:

Pediatric Bipolar Affective Disorder:

Pediatric Bipolar Affective Disorder is characterized by episodes of mania (expansive and elevated mood) and depression. Mania symptoms present for at least one week and include delusions of grandeur, racing thoughts, thoughts being out of control, reduced need for sleep, distractibility, rapid and often pressured speech, reckless and risk-taking behaviors, increased goal-directed activities and hypersexuality (Cichoń et al., 2020). The depressive episodes are characterized by sad/depressed mood, lack of interest, fatigue/low energy levels, decreased/increased appetite, weight changes, sleep disturbances, psychomotor agitation, feelings of worthlessness/inappropriate guilt, indecisiveness, and suicidal ideations (Gautam et al., 2019).

Bipolar Affective Disorder is the presumptive diagnosis based on the patient’s episodes of depressed mood that alternate with elevated mood. The client had a depressive episode characterized by a depressed and tearful mood, diminished interest in school plays, low energy levels, feelings of worthlessness, and suicidal ideations. This alternated with the present manic episode characterized by an elevated mood, flight of ideas, pressure of speech, distractibility, reduced need for sleep, and hypersexuality with potential for dire consequences.

Major Depressive Disorder (MDD):

MDD is a mood disorder that presents with a sad/tearful mood, loss of pleasure/interest, or both for at least two weeks. In addition to the two symptoms, MDD presents with fatigue/low energy levels, decreased/increased appetite, weight changes, sleep disturbances, psychomotor agitation, feelings of worthlessness/inappropriate guilt, indecisiveness, and suicidal ideations (Mullen, 2018). MDD is a differential diagnosis based on the client’s history of depressed mood, tearfulness, lack of interest in school plays, low energy levels, feelings of worthlessness, and suicidal ideations.

Schizophrenia

Schizophrenia is a severe type of psychotic disorder. Schizophrenic symptoms in adolescents are similar to adults and include delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms (Grover & Avasthi, 2019). Adolescents with schizophrenia also present with extreme moodiness and bizarre thoughts and ideas (Grover & Avasthi, 2019). Schizophrenia is a differential diagnosis based on the client’s symptoms of flights of ideas, pressure of speech, and mood swings.

Reflections:

The assignment has enlightened me on the different mood disorders in adolescents. I further learned that Bipolar affective disorder is a mood disorder characterized by alterations in feelings, thoughts, behaviors, and perceptions (Gautam et al., 2019). Ethical and legal factors that should be considered include the patient’s right to autonomy by seeking consent before assessing and initiating treatment (Bipeta, 2019). Beneficence and nonmaleficence should be upheld by implementing treatment interventions established to promote the best patient outcomes with no harm to the patient. Disease prevention strategies that should be considered include avoiding prescribing medications that can trigger acute mania. Besides, the patient should be educated on adjunctive techniques, including meditation, muscle relaxation exercises, and deep breathing exercises to lower stress and anxiety levels (Gautam et al., 2019).

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Cichoń, L., Janas-Kozik, M., Siwiec, A., & Rybakowski, J. K. (2020). Clinical picture and treatment of bipolar affective disorder in children and adolescents. Obraz kliniczny i leczenie choroby afektywnej dwubiegunowej u dzieci i młodzieży. Psychiatria polska, 54(1), 35–50. https://doi.org/10.12740/PP/OnlineFirst/92740

Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian journal of psychiatry, 61(Suppl 2), 294–305. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_570_18

Grover, S., & Avasthi, A. (2019). Clinical Practice Guidelines for the Management of Schizophrenia in Children and Adolescents. Indian journal of psychiatry, 61(Suppl 2), 277–293. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_556_18

Mullen, S. (2018). Major depressive disorder in children and adolescents. The mental health clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

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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 cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder 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.
Selected a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. (I have the selected video and transcript below) 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.
Please
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 rules 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.).

Training Title 150
Name: Ms. Liliana Ball
Gender: female
Age:16 years old
T- 97.4 P- 84 R 18 134/88 Ht 5’3 Wt 118lbs
Background: Currently living with her parents in Tacoma, WA along with two young siblings. She is a sophomore in high school, not currently partnered, reports she is bisexual, lately having lot of unprotected sex that her parents don’t know about. She has been stealing money out of her mom’s purse to buy clothes, makeup, “and just other things.” She has history of treatment since age 7 for conduct disorder, depression, history of taking sertraline which worsened her irritability, aggression, impulsivity. She has been in a 3-month teen residential mental health facility discharged one month ago with lithium 300mg in am and 600mg at bedtime, aripiprazole 10mg in the morning. When discharged, her labs were within normal ranges and urine toxicology negative. She was positive for cannabis upon admission. Her parents believe she is hiding her medication as she has made comments “they slow me down; they crush my creative art.” She has hx of domestic violence toward her mother and 2 younger sisters as juvenile. No current legal issues. Her grandmother has hx of bipolar disorder; her mother and her maternal aunt have anxiety. She is sleeping 3–4hrs/24 hrs. Reports her appetite “is great.” She has no medical issues; has Nexplanon implant; hx of self-harm with cutting.
Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/trianing-title-150

Transcript of the Video
00:00:15 >> Let me ask you about depression.
00:00:15 >> I am not depressed.
00:00:15 I mean, not hardly, no.
00:00:15 >> I see that, but let me ask you about other times.
00:00:20 >> Okay, fine. I’ll tell you what,
00:00:20 you ask, I’ll answer
00:00:20 that’s how it will work.
00:00:25 It will be like a game. Let’s go.
00:00:25 >> Got in the form that your parents filled out,
00:00:25 they were they yesterday many times
00:00:30 in the past week you appeared depressed.
00:00:30 >> Yeah, yesterday I was a little bit depressed but
00:00:35 it was just because I was in a bad mood.
00:00:35 People get in a bad moods all the time.
00:00:35 Don’t you get into bad moods?
00:00:40 I mean, that’s in our nature.
00:00:40 Animals get into bad mood.
00:00:40 >> They also wrote that you started crying
00:00:40 and said that you
00:00:40 never wanted to participate in more school plays.
00:00:40 >> Because bad moods don’t make
00:00:45 you want to sing obviously,
00:00:45 bad moods make you want to,
00:00:50 I don’t know, run,
00:00:50 just run and get away from everything but
00:00:50 that’s not now. Now is the now.
00:00:55 >> They wrote that yesterday you had no energy [inaudible].
00:00:55 >> My God, I’m sorry does it look like I have no energy right now?
00:01:00 Because I really, I am
00:01:05 as happy as a bumblebee in pollen blessed flowers.

00:01:10 >> Were you happy yesterday?
00:01:10 >> Yesterday was yesterday. Today is today.
00:01:15 Maybe depends on string theory, right?
00:01:20 Oh, my god. The art on this wall.
00:01:20 Do you travel a lot? This is amazing.
00:01:25 >> Your parents wrote that you tell them you are
00:01:25 worthless for destroying everyone’s lives,
00:01:25 that you wanted to die.
00:01:30 >> My god, why are you dragging me down with this ancient history?
00:01:30 >> No plans, wanted to die.
00:01:30 >> Ancient history buddy, come on.
00:01:35 Let’s just look.
00:01:35 You have to live in the now.
00:01:35 You can’t leave in the last week.
00:01:40 You can’t live in the last year.
00:01:40 You can’t live in the last century.
00:01:40 All right? Show me your smiley face.
00:01:45The future is bright.
00:01:45 >> Do you agree with what your parents wrote?
00:01:45 >> Look if that’s what they wrote then
00:01:50 that’s their freedom of expression \
00:01:50 and I believe wholeheartedly in freedom of expression,
00:01:55 I do not deny anyone any freedoms. Do you?
00:01:55 This transcript was automatically generated using speech recognition technology. Because this method relies on machine learning algorithms, the quality of transcripts may vary. To request this transcript be improved with enhanced accuracy, please email transcripts@alexanderstreet.com.

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NRNP_6635_Week3_Assignment_Rubric
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
18 (18%) – 20 (20%)
The response thoroughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules 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.
23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
Reflect on this case. Discuss what you learned and what you might do differently. 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.).
9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors