NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

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NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders – Step-by-Step Guide

The first step before starting to write the NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders Instructions

Assessing and Diagnosing Patients with Mood Disorders

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. 
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. 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. 

BY DAY 7 OF WEEK 3

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-TR 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.). Have a look at NRNP 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD. 

Case Scenario

Name: Mrs. Abrianna Tilman
Gender: female
Age: 27 years old
T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs

Background: Recently had her first child two months ago. Currently married; stay at home
mother after working in community library for 5 years. Grew up with her mother after her
parents divorced when she was 16; has two sisters in Troy, Alabama. Completed education
through bachelor’s level, majoring in English Literature. No previous suicidal gestures. Brother
committed suicide via GSW. She denied drugs/alcohol; brother was addicted to
methamphetamines. Hx of HTN-prescribed Trandate 100mg twice daily, admits to missing doses
due to forgetting. No legal hx. Allergies: PCN

NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders Example 1

Subjective:

CC (chief complaint): “I do not think I need to be here.”

HPI: Mrs. Tilman is a 33-year-old African American woman, presents for a psychiatric evaluation driven by her husband’s expressed concerns. Despite acknowledging her husband’s worries, Mrs. Tilman questions the necessity of her visit, having never sought psychiatric help previously and doubting its current need. Her primary complaints center around significant sleep disturbances, attributed to the frequent awakenings by her two-month-old daughter, Jessica, and a profound dissatisfaction with her postpartum physical appearance and overall well-being.

Mrs. Tilman describes a cycle of sleep challenges exacerbated by the baby’s needs, alongside a persistent desire to lose weight gained during pregnancy, which compounds her stress and self-critical perspective. Despite recognizing her physical and emotional struggles, Mrs. Tilman has not shared these feelings with her husband, Rick, fearing disappointment.

Her situation is further complicated by feelings of isolation and a shift in social dynamics, as her current responsibilities towards her daughter have significantly limited her ability to engage in previous hobbies and social interactions. This transition has left Mrs. Tilman feeling stuck, overwhelmed, and questioning her identity beyond motherhood, with a noted impact on her marital relationship and personal satisfaction.

Past Psychiatric History:

  • General Statement: Tilman reports no prior engagement with psychiatric services before her current presentation. She mentions experiencing occasional “blue periods” during college, which she managed without seeking professional help, attributing these episodes to the normal stresses of academic and social life.
  • Caregivers (if applicable): Not applicable, as Mrs. Tilman has not previously sought psychiatric care or had a caregiver for mental health concerns.
  • Hospitalizations: No history of psychiatric hospitalizations. Mrs. Tilman has never been admitted to a hospital for mental health issues, indicating that any past mental health challenges were managed outside of inpatient settings.
  • Medication Trials: Tilman has not been prescribed psychotropic medication in the past. Her lack of formal engagement with psychiatric services means she has not undergone medication trials for mental health conditions.
  • Psychotherapy or Previous Psychiatric Diagnosis: Despite her occasional feelings of depression during college, Mrs. Tilman has never undergone psychotherapy nor received a psychiatric diagnosis. She considered counseling during particularly stressful times but ultimately never pursued these services.

Substance Current Use and History: Mrs. Tilman denies current use of tobacco, alcohol, or illicit substances. She reports occasional wine consumption before pregnancy but ceased all alcohol intake upon learning of her pregnancy. There is no history of substance abuse or dependence.

Family Psychiatric/Substance Use History: Her family history reveals that her mother suffered from depression, though it was never formally diagnosed or treated. On her father’s side, there is a history of alcohol use disorder. Mrs. Tilman has an uncle who was treated for bipolar disorder. There are no known substance abuse issues in her immediate family.

Psychosocial History: Mrs. Tilman describes a generally supportive relationship with her husband, Rick, though she notes recent strains due to her emotional and physical health postpartum. She graduated from college with a degree in English Literature and worked as a high school teacher until deciding to stay home following her daughter’s birth. She enjoys writing and reading but expresses that she has had little time for these activities recently. Socially, she feels isolated since becoming a mother, stating that her friendships have diminished as she struggles to find time and energy to connect with others.

Medical History:

  • Current Medications: Prenatal vitamins continued postpartum; no other medications reported.
  • Allergies: No known drug allergies. Mrs. Tilman mentions a mild allergy to shellfish, resulting in hives.
  • Reproductive Hx: This is Mrs. Tilman’s first pregnancy and childbirth, with no complications reported during pregnancy. Her daughter, Jessica, was born full-term and healthy. Mrs. Tilman is currently not using any birth control methods, citing a preference to discuss family planning options at her postpartum follow-up.

ROS:

  • GENERAL: Reports feeling constantly fatigued, regardless of sleep quantity, and experiences a significant lack of energy.
  • HEENT: Mentions frequent headaches, which she attributes to stress and sleep disruption.
  • SKIN: Describes increased sensitivity and dryness.
  • CARDIOVASCULAR: Occasionally experiences palpitations.
  • RESPIRATORY: No significant issues reported. However, mentions feeling short of breath during anxiety attacks, which are new since giving birth.
  • GASTROINTESTINAL: Reports decreased appetite and occasional episodes of nausea.
  • GENITOURINARY: denies urinary frequency
  • NEUROLOGICAL: Experiences difficulty concentrating and memory lapses, contributing to her feelings of inadequacy and frustration.
  • MUSCULOSKELETAL: Complains of persistent lower back pain and general body aches, which she has not addressed due to focusing on her child’s needs over her own.
  • HEMATOLOGIC: No specific complaints. However, she has not had a recent check-up to rule out anemia, which could contribute to fatigue.
  • LYMPHATICS: No known issues. No reports of swollen glands or lymph nodes.
  • ENDOCRINOLOGIC: Expresses concerns about her thyroid function, wondering if it might relate to her mood, weight changes, and energy levels, but has not been evaluated.

Objective:

Physical exam:
  • General Appearance: Tilman appears tired but is well-groomed and appropriately dressed for the season. She makes direct eye contact and is cooperative, though occasionally seems distracted or distant during the exam.
  • Vital Signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, and BMI 25.
  • HEENT (Head, Eyes, Ears, Nose, Throat): The head is normocephalic and atraumatic. Eyes: Pupils are equal, round, and reactive to light and accommodation. No scleral icterus or conjunctival pallor. Ears: Tympanic membranes intact, with no signs of infection. Nose: Mucosa is moist, and septum is midline. Throat: Oropharynx is clear without erythema or exudate.
  • Cardiovascular: Heart rhythm is regular, with no murmurs, rubs, or gallops detected upon auscultation. Peripheral pulses are 2+ and symmetrical in both upper and lower extremities.
  • Respiratory: Lungs are clear to auscultation bilaterally, with no wheezes, rales, or rhonchi. Chest wall is non-tender.
  • Gastrointestinal: Abdomen is soft, non-distended, and non-tender upon palpation. No hepatosplenomegaly or masses felt. Bowel sounds are normoactive in all quadrants.
  • Musculoskeletal: Full range of motion in all extremities, with no joint swelling or tenderness. Muscle strength is 5/5 in all major muscle groups.
  • Neurological: Cranial nerves II-XII are intact. Sensation intact to light touch. Reflexes are 2+ and symmetrical in biceps, triceps, patellar, and Achilles. Coordination is normal with no evidence of ataxia.
  • Skin: No rashes, lesions, or significant scars noted. Mild dryness observed, but no eczema or psoriasis plaques.
  • Psychiatric: Tilman exhibits a flat affect with minimal facial expression variation. She is oriented to person, place, and time. Speech is coherent but sometimes hesitant. Thought process appears linear but burdened by depressive thoughts.

Diagnostic results: N/A

Assessment:

Mental Status Examination:

Mrs. Tilman’s mental status examination reveals a complex picture indicative of a woman struggling significantly in the postpartum period. Her appearance is disheveled, with signs of fatigue visible on her face, suggesting a lack of sleep and personal neglect. Her attitude towards the evaluation is cooperative, albeit with some initial reluctance, as evidenced by her statement, “I don’t think I need to be here.”

This hesitance may indicate a mixture of denial about her condition and societal stigma surrounding mental health. Her behavior during the session is mostly calm, but moments of tearfulness when discussing her feelings and the challenges of motherhood indicate fluctuating emotional states. Mrs. Tilman’s speech is coherent and goal-directed, although her rate of speech slows noticeably when she discusses her self-image and relationship issues, suggesting these topics are particularly distressing for her.

Affectively, Mrs. Tilman presents as markedly dysphoric, with her mood congruent with her affect, displaying sadness and hopelessness, especially when discussing her physical appearance and the perceived impact on her marital relationship. She describes her mood as “terrible,” with a profound sense of dissatisfaction with her life since the birth of her daughter. Her thought process is logical, but the content reveals a preoccupation with her inadequacies as a mother and spouse.

She expresses irrational beliefs about her failure in these roles, indicative of distorted thinking likely fueled by her depressive state. There are no indications of psychosis; however, she admits to thoughts of suicide, though denies any intent or plan, which highlights a significant risk and an urgent need for intervention. Cognitively, Mrs. Tilman appears oriented to time, place, and person. Her attention and concentration are intact, as she can follow the conversation and respond appropriately.

However, she reports difficulty concentrating on tasks at home, which may be more reflective of her depressive symptoms rather than a primary cognitive deficit. Insight into her condition seems limited; she acknowledges her struggles but seems to minimize the severity or potential for improvement through treatment. Her judgment is impaired, as evidenced by her reluctance to seek help and discuss her feelings with her husband, which could lead to further isolation and exacerbation of her symptoms.

Differential Diagnoses:

  1. Major Depressive Disorder, with Peripartum Onset (Postpartum Depression):

Mrs. Tilman displays significant signs of depression, including marked sadness, tearfulness, feelings of inadequacy, disturbed sleep, and significant preoccupation with her perceived failures as a mother and wife. Notably, these symptoms have occurred in the postpartum period, aligning with the DSM-5-TR criteria for Major Depressive Disorder with Peripartum Onset (Batt et al., 2020).

For a diagnosis of Major Depressive Disorder, five or more symptoms must be present for at least two weeks, representing a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure. Mrs. Tilman’s presentation meets these criteria, with additional symptoms including significant weight concern, sleep disturbance, feelings of worthlessness, and recurrent thoughts of death. The specificity of the postpartum period, along with the absence of manic or hypomanic episodes, rules out Bipolar Disorder.

  1. Adjustment Disorder with Depressed Mood:

This diagnosis considers the possibility that Mrs. Tilman’s depressive symptoms are a reaction to the significant life change and stressor of becoming a new mother. Her difficulty adapting to this new role, along with her expressed unhappiness and struggle to adjust, could suggest Adjustment Disorder. Emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor. These symptoms or behaviors are clinically significant, as evidenced by marked distress that is out of proportion to the severity or intensity of the stressor (Shusharina et al., 2023). The severity and duration of Mrs. Tilman’s symptoms, alongside her significant preoccupation with feelings of inadequacy and thoughts of death, exceed what might be typically observed in Adjustment Disorder, suggesting a more severe underlying mood disorder.

  1. Generalized Anxiety Disorder (GAD):

Mrs. Tilman exhibits excessive worry, particularly regarding her capabilities as a mother and her baby’s well-being, which could suggest GAD. Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities. The individual finds it difficult to control the worry. While Mrs. Tilman does present with worry and anxiety, the predominant features of her presentation are more aligned with depressive symptoms rather than the pervasive anxiety and worry central to GAD (Cui et al., 2020). Additionally, her symptoms are more acutely linked to the postpartum period rather than a general, ongoing pattern of anxiety.

Critical-Thinking Process:

The primary diagnosis of Major Depressive Disorder, with Peripartum Onset, is supported by the temporal association of symptoms with the postpartum period, the severity and range of depressive symptoms, and the significant impact on Mrs. Tilman’s functioning (Batt et al., 2020). The critical differentiation from Adjustment Disorder lies in the intensity and duration of symptoms, which are more severe and persistent than typically seen in response to an identifiable stressor.

While Generalized Anxiety Disorder was considered, the lack of pervasive, non-situational anxiety and the presence of significant depressive symptoms, including thoughts of death, directed the diagnosis towards a mood disorder primarily. The diagnosis process underscores the importance of a thorough evaluation, recognizing the profound impact of peripartum mood changes and the need for targeted, evidence-based interventions.

Reflections:

Reflecting on the session with Mrs. Tilman, revisiting the approach could significantly enrich the therapeutic encounter. A more empathetic listening and validation of her feelings would encourage openness, offering a secure space for Mrs. Tilman to share her struggles without fear of judgment. Delving deeper into her past psychiatric history and exploring potential familial patterns of mental health issues could unveil crucial insights, tailoring the intervention more effectively. Acknowledging the profound impact of socioeconomic and cultural backgrounds is pivotal, as these factors shape experiences and access to support, influencing Mrs. Tilman’s perception of her situation and available resources.

The mention of suicidal thoughts by Mrs. Tilman brings to the forefront the delicate balance between ethical obligations towards confidentiality and the imperative to protect her and her child. This scenario necessitates a nuanced approach, evaluating the risk of harm while respecting her autonomy. Additionally, the discussion around health promotion and disease prevention should encompass postpartum care, emphasizing the normalcy and treatability of postpartum depression and anxiety, and the importance of community support and self-care strategies. Enhancing awareness and providing practical resources could foster a supportive environment, encouraging her to engage in proactive steps towards recovery, thus embodying a holistic and patient-centered care model.

References

Batt, M. M., Duffy, K. A., Novick, A. M., Metcalf, C. A., & Epperson, C. N. (2020). Is postpartum depression different from depression occurring outside of the perinatal period? A review of the evidence. Focus, 18(2), 106-119. https://doi.org/10.1176/appi.focus.20190045

Cui, Q., Sheng, W., Chen, Y., Pang, Y., Lu, F., Tang, Q., & Chen, H. (2020). Dynamic changes of amplitude of low‐frequency fluctuations in patients with generalized anxiety disorder. Human Brain Mapping, 41(6), 1667-1676. https://doi.org/10.1002/hbm.24902

Shusharina, N., Yukhnenko, D., Botman, S., Sapunov, V., Savinov, V., Kamyshov, G., & Voznyuk, I. (2023). Modern methods of diagnostics and treatment of neurodegenerative diseases and depression. Diagnostics, 13(3), 573. https://doi.org/10.3390/diagnostics13030573

NRNP 6635 Week 3 Assignment: Assessing and Diagnosing Patients with Mood Disorders Example 2

Patient Information:

Patient Initials: N. C                 Age: 17   Gender: Female Race: White American

Subjective:

Chief Complaint (CC): The patient’s mother expressed concern about her daughter’s moodiness during this time of year and requested an evaluation.

History of Present Illness (HPI): Ms. N. C, a 17-year-old White American female, presents with a chief complaint of feeling down and not doing well. Her mother expressed concern about her mood worsening during this time of year. She left the business program at school and is struggling with her academic projects, including a mock company assignment. She has difficulty concentrating, experiencing memory lapses, and has gained weight. Ms. N. C has also been sleeping through some of her classes and has experienced a decline in her social activities. She initially made friends and enjoyed outings, but lately, she has found her friends annoying and feels less motivated to engage in social activities. She dislikes the cold weather and describes the city as dark, grey, and miserable, contributing to her negative mood.

Past Psychiatric History:

  • General Statement: The patient has no previous psychiatric history.
  • Caregivers (if applicable): N/A
  • Hospitalizations: No history of past hospitalizations
  • Medication trials:  No previous history of medication trials
  • Psychotherapy or Previous Psychiatric Diagnosis: The patient does not have a previous psychiatric diagnosis or history of psychotherapy.
  • Substance Current Use and History: She denies any history of substance use for herself, including nicotine, illicit substances (including marijuana), or alcohol. However, she reports taking caffeine daily. The patient does not report any withdrawal complications, such as tremors, delirium tremens, or seizures.

Family Psychiatric/Substance Use History: The patient acknowledges a known history of depression within the family but denies any history of substance use.

Psychosocial History: N.C. is a 17-year-old White American female born and raised in New Orleans, Louisiana. Growing up, N.C. lived with both of her parents and four brothers. However, her residence is a specialty high school dormitory in Chicago, Illinois. Among her siblings, N.C. is the only girl and the youngest. Presently, she is not married and remains single, without any children. Being a full-time high school student, Natalie prioritizes her studies in the business program. In addition to her academic pursuits, she also holds a part-time job at a local coffee shop. She enjoyed socializing and participating in recreational activities in the past, but her interest in them has waned. Notably, N.C. has a clean record with no history or current legal issues.

Medical History: No history of hospital admission

  • Current Medications: She takes no medications
  • Allergies: NKDA

Reproductive History: She experienced menarche at 14 and continues to have regular menstrual cycles within a 28-day cycle without complications such as dysmenorrhea or menorrhagia. At present, she is unmarried and remains single, without any children. Furthermore, there is no record of her using contraceptives, and she confirms not being sexually active.

Review of Systems (ROS):

GENERAL: Ms. N. C is a 17-year-old White American female with a height of 5’2″ and a weight of 192 pounds. She presents with a downcast mood, slouched posture, and signs of decreased engagement, such as a lack of eye contact, reflecting her reported feelings of not doing well and exhibiting a low mood.

HEENT:

  • Eyes: She has no loss of vision, double vision, painful eyes, or jaundice.
  • Ears, Nose, and Throat: She does not experience any auditory impairments, such as hearing difficulties. Additionally, she is unaffected by symptoms like sneezing, congestion, a runny nose, or a sore throat. Furthermore, no recent nasal polyps, nosebleeds, or sinus infections have occurred. She exhibits no challenges related to chewing or swallowing, and there are no indications of gingivitis or bleeding gums.
  • Skin: She denies experiencing any skin rashes or lesions. Her hair appears evenly distributed, showing no signs of hair loss. Additionally, her nails remain intact, and there are no indications of clubbing.
  • Cardiovascular: The patient denies experiencing chest discomfort, palpitations, tightness, arrhythmias, or elevated blood pressure. There is also no indication of varicose veins, edema, or claudication.
  • Respiratory: No shortness of breath, cough, or sputum.
  • Gastrointestinal: The patient denies any presence of abdominal pain, tenderness, distention, or discomfort. There is no reported incidence of heartburn, constipation, diarrhea, or indigestion.
  • Genitourinary: She denies dysuria, urinary frequency, urgency, and abnormal vaginal discharge.
  • Neurological: She denies experiencing symptoms such as headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. Additionally, there have been no observed alterations in bowel or bladder control.
  • Musculoskeletal: No back pain, myalgia, joint pain, or stiffness
  • Hematological: No anemia, bleeding, or bruising.
  • Lymphatics: No enlarged nodes or splenectomy
  • Endocrinologic: She denies sweating, cold, or heat intolerance: no polyuria or polydipsia.

Objective:

Vital signs: Temperature (T): 97.4°F, Pulse (P): 82 beats per minute, Respiration rate (R): 20 breaths per minute, Blood pressure (BP): 128/84 mmHg, Height: 5’2″ (62 inches), Weight: 192 lbs.

General: The patient mentions feeling down and not doing well.

Neurological: The patient mentions difficulty concentrating, memory problems, and changes in sleep patterns.

Diagnostic results: Comprehensive psychiatric evaluation, laboratory tests, including a complete blood count (CBC), thyroid function tests, and other relevant investigations, may be recommended to rule out any underlying medical causes for the patient’s symptoms.

Assessment:

Mental Status Examination:

Ms. N. C, a 17-year-old White American female, presents with a slightly overweight appearance, indicated by her weight of 192 lbs and height of 5’2″. During the interview, she appears disinterested and exhibits a passive attitude. Her behavior is characterized by a subdued manner and occasional sighing. Furthermore, her mood remains consistently low, and her affect is congruent with her depressed mood, displaying minimal variability and limited facial expressions.

Regarding speech, Ms. N. C’s responses are brief and lack elaboration. Her thought processes appear slowed, with delayed responses and occasional pauses. She expresses feelings of sadness and states that she is not doing well. Specifically, Ms. N. C reports leaving her program at school and struggling with her coursework, particularly in a special business program where she is required to create a mock company. She describes difficulty concentrating, memory problems, and detachment from her studies. Furthermore, she mentions being late on two projects and expresses frustration with her teachers.

Regarding her perceptions, Ms. N. C does not report any hallucinations, pseudo hallucinations, or illusions during the interview. However, she acknowledges difficulty sleeping, weight gain, and excessive daytime sleepiness. She also reports a decline in her social activities and expresses annoyance toward her friends, whom she finds dull. Additionally, she attributes her dislike for the current time of the year to the dark, grey, and miserable weather, which she believes has changed the city she once loved. She describes the snow in the city as grey and black, contrasting it with her previous expectation of white and beautiful snow.

In terms of cognition, Ms. Crew demonstrates impaired concentration and memory. This is evident in her difficulty remembering what she reads and forgetting the content of her classes shortly after leaving the room. Her insight into her current state is limited, as she attributes her struggles to external factors, such as her teachers and the weather, rather than considering internal emotional or psychological factors. At this time, Ms. Crew denies any suicidal or homicidal ideation. However, given her low mood, decreased interest in activities, social withdrawal, and negative perception of her environment, further exploration of her risk for self-harm is warranted.

Differential Diagnoses:

1.     Major Depressive Disorder (MDD)

The patient’s presentation is consistent with MDD. She exhibits symptoms such as persistent low mood, loss of interest in activities, difficulty concentrating, memory problems, changes in sleep patterns (oversleeping), weight gain, social withdrawal, and negative perception of her environment (Bains & Abdijadid, 2022). A comprehensive psychiatric evaluation is recommended to assess the severity of her depressive symptoms and rule out other possible causes.

2.     Seasonal Affective Disorder (SAD)

The patient’s symptoms worsen during a specific time of the year (winter) and are associated with a dislike for the cold weather and the perception of the city as dark, grey, and miserable. These features suggest the possibility of SAD, a subtype of depression that occurs cyclically with the change in seasons (Munir & Abbas, 2022).

3.     Adjustment Disorder with Depressed Mood

The patient’s symptoms, such as low mood, difficulty concentrating, changes in sleep and appetite, and social withdrawal, maybe a reaction to a specific stressor or life event, such as leaving the business program at school and struggling with academic projects (O’Donnell et al., 2019). If the symptoms are considered to be a direct response to this stressor and do not meet the criteria for a major depressive episode, an adjustment disorder with a depressed mood may be a possible diagnosis.

Reflections:

I agree with my preceptor’s assessment and diagnosis of Major Depressive Disorder (MDD) for this patient. The patient presents with several hallmark symptoms of MDD, which have been present for a significant time, causing impairment in multiple areas of her life. The patient’s family history of depression also supports the possibility of a genetic predisposition. A comprehensive psychiatric evaluation, ruling out other possible medical causes, would be necessary to confirm the diagnosis.

This case taught me the importance of considering seasonal factors in mood disorders, specifically Seasonal Affective Disorder (SAD). The patient’s worsening symptoms during a specific time of the year and her negative perception of the weather and environment indicate the need to explore these factors and assess whether the symptoms meet the criteria for SAD (Munir & Abbas, 2022). Psychosocial factors such as the patient’s adjustment to a new environment and academic stressors must also be evaluated. Legal/ethical considerations, including confidentiality and obtaining appropriate consent for treatment, as well as the patient’s autonomy and involvement in treatment decisions, should be considered.

Social determinants of health, such as the patient’s age, ethnicity, and socioeconomic background, may influence her access to resources, and it is vital to address these factors when developing a treatment plan (Phuong et al., 2022). Health promotion and disease prevention efforts should involve educating the patient and her family about depression, strategies for managing symptoms, and encouraging healthy lifestyle behaviors. Additionally, a more thorough assessment of the patient’s social support network and psychosocial stressors and evaluation of any history of trauma or adverse childhood experiences could provide valuable insights into her current mental state.

References

Bains, N., & Abdijadid, S. (2022). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Munir, S., & Abbas, M. (2022, January 9). Seasonal depressive disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568745/

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Phuong, J., Riches, N. O., Madlock‐Brown, C., Duran, D., Calzoni, L., Espinoza, J. C., Datta, G., Kavuluru, R., Weiskopf, N. G., Ward‐Caviness, C. K., & Lin, A. Y. (2022). Social determinants of health factors for gene–environment: Challenges and opportunities. Advanced Genetics, 3(2), 2100056. https://doi.org/10.1002/ggn2.202100056