NRNP 6635 Week3 Assignment Mood Disorders

NRNP 6635 Week 3: Mood Disorders Example

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.

NRNP 6635 Week3 Assignment Mood Disorders 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

Week 3: Mood Disorders

While most people experience the sadness or grief at some point in their lives, it is typically of short duration and may occur in response to some type of loss. Clinically significant depression, on the other hand, is more disruptive and serious. It lasts longer and has more symptoms that interfere with daily functioning.

This week, you will explore the differences among mood disorders such as depressive, bipolar, and related disorders, and you will examine challenges in properly differentiating among them for the purpose of accurately rendering a diagnosis. You also will look at steps that can be taken to increase the likelihood that patients who are diagnosed with these disorders benefit from treatment and refrain from physically harming themselves or others.

Learning Objectives

Students will:

Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Formulate differential diagnoses using DSM-5 criteria for patients with mood disorders across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2013). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm03

American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 8, Mood Disorders

Chapter 31, Child Psychiatry (Section 31.12 only)

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Required Media (click to expand/reduce)

NRNP 6635 Week3 Assignment Mood Disorders

Classroom Productions. (Producer). (2015). Bipolar disorders [Video]. Walden University.

Classroom Productions. (Producer). (2015). Depressive disorders [Video]. Walden University.

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00:00:00BEGIN Transcript:

00:00:00DIAGNOSING MENTAL DISORDERS

00:00:00DSM-5® AND ICD-10

00:00:05DEPRESSIVE DISORDERS

00:00:10JIM HARRIGAN Our mood can often shape our perception of our own situation. The perceptions of our world can influence our overall state of happiness and wellbeing just as much, if not more than the circumstances we find ourselves in. For those people with mood disorders, this can be a harrowing concept, since the individual psychological disorder can make it hard or even impossible for a person to see their circumstances in a favorable light. This is especially true of patients with depressive disorders, a subset of mood disorders, in which the individual experiences episodes of sorrow, lethargy, and even a complete lack of energy and excitement about life.

Mood is defined as the prolonged emotions that color a person’s perceptions of the world. Within this category of mood disorders, are two groups of disorders. These are depressive disorders, and bipolar and related disorders. Both of these groups share the common trades of mood disorders. However, well, bipolar and related disorders feature manic or hypomanic episodes and symptoms, in which the individual feels elated and energized. Depressive disorders are marked by major depressive episodes or symptoms, in which the individual has difficulty enjoying life. These symptoms can manifest themselves in a variety of disorders, differing in duration, timing, underlying causes, and other more subtle specifics.

00:02:00DSM-5® AND ICD-10 CODING

00:02:05JIM HARRIGAN The depressive disorders grouping in the fifth edition of the Diagnostic and Statistical Manual of mental disorders or DSM-5 contains a number of distinct disorders, each given it’s own unique diagnostic code. These codes correspond to the codes used by the World Health Organization in the International Classification of Diseases or ICD. In DSM-5, each disorder is first linked to the coding system from the ICD-9 with the codes for the ICD-10 listed in parenthesis after. Hence, all of the DSM codes crosswalk to the ICD codes, including the newest iteration ICD-10.

For instance, major depressive disorder with a single episode, mild, is assigned the code 296.21 from the ICD-9 and F32.0 in parenthesis from the ICD-10. This is because the ICD-9 system was still in use when DSM-5 was first released. ICD-10 was released in the fall of 2015, in the United States, although it was adopted previously in other countries. However, because ICD-10 is now the standard in the United States, this program will be listing the newer code from ICD-10 first, followed by the ICD-9 codes in parenthesis.

The coding for other specifications of major depressive disorder depends on, if the episode is single or recurrent, and can be further delineated by descriptors to indicate the episode’s severity, if it had psychotic features, the stage of remission that it is in, or if it is unspecified. The appropriate order is, the name of the disorder, if it is a single or recurrent episode, severity psychotic remission specifiers, followed by any additional specifiers. Sometimes, when relevant, we will also delineate the ICD-9 and 10 codes, when we mention a disorder from one of the other chapters of DSM-5.

For example, to use one of the bipolar and related disorders mentioned earlier in this program, Bipolar I disorder, with the current or most recent episode manic and mild, is coded as F31.11 (296.41), part of the F30 to F39 section of the ICD-10 on mood affective disorders. Organizationally, there are few differences between the layouts of the DSM-5 and the ICD-10. The ICD-10 puts depressive disorders into their larger section on mood affective disorders in their F30 to F39 block. And many of the depressive and bipolar disorders that are separate in DSM-5 are mixed together in the ICD-10. For example, dysthymia, referred to as persistent depressive disorder (Dysthymia) in DSM-5, and cyclothymia, a bipolar related disorder in DSM-5, are both placed in the F34 section of the ICD-10 for persistent mood affective disorders.

While the ICD-10 grouping of all mood disorders into a larger section may seem like a minor organizational difference. It does further illuminate the underlying similarities between depressive and bipolar disorders, which we will highlight throughout this program and in that on bipolar disorders. Two other major differences are with substance or medication-induced depressive disorder. And depressive disorder due to another medical condition. The ICD-10 puts what they call mental and behavioral disorders due to psychoactive substance abuse in the F10 block. And organic, including symptomatic disorders in the F00 to F09, specifically F06, or other mental disorders due to brain damage and dysfunction and to physical disease. In this case, the code is for FO6.3 for organic mood affective disorder.

00:06:55MAJOR DEPRESSIVE DISORDER

00:07:00JIM HARRIGAN Major depressive disorder is the most prevalent of the depressive disorders affecting 7 percent of the population. This can be even higher in females, since they experience a 2:1 preponderance to males. However, despite the high prevalence, only one out of three individuals experiencing major depressive disorder seek treatment. An individual with major depressive disorder may experience a depressed mood, loss of pleasure, fatigue, problems with sleeping, weight loss, and more, happening for the majority of time during a specific time period lasting at least two weeks. This is categorized as a major depressive episode, one of three mood episodes, because this episode is such a significant aspect of the diagnosis for major depressive disorder. We will first take a closer look at mood episodes, then major depressive episodes, before further exploring how these episodes tie into a diagnosis of major depressive disorder.

00:08:15SCHIZOPHRENIA

00:08:15FUNDAMENTAL CHARACTERISTICS

00:08:20JIM HARRIGAN A mood episode is a specific period of time where an individual feels abnormally energized and elevated, or alternatively depressed. The presence and repetition or lack there of, of these episodes affects the coding of the disorder. But even beyond that, these mood episodes can be considered the basis of some disorders, as they are for major depressive disorder. In addition to depressive episodes, there are manic episodes in which the individual experiences at least a week of increased energy or activity and the less severe hypomanic episodes which feature the same symptoms, but to a less debilitating extent.

For both of these episodes, the individual may experience racing thoughts, a need for less sleep, overly increased self-esteem, distractibility, or excessive poor judgment regarding dangerous activities among other symptoms. While these are worth mentioning to contrast them against a major depressive episode, the presence of a manic or hypomanic episode will change the patient’s diagnosis to a bipolar or a related disorder. And so we will explore them in greater detail in our program on bipolar disorders.

00:09:50MAJOR DEPRESSIVE EPISODE

00:09:55JIM HARRIGAN A major depressive episode has a number of characteristic features, which take place most of the day, nearly every day, where relevant. The two main characteristics are a depressed mood, and a noticeably decreased interest in most activities. Other characteristics include trouble sleeping, diminished hunger or pronounced weight loss, trouble concentrating or making decisions, fatigue or loss of energy, recurring suicidal thoughts with or without intent to act on these thoughts, feelings of worthlessness or excessive or inappropriate guilt, psychomotor agitation or retardation, and feelings of low self-worth or pronounced guilt. These symptoms must cause marked distress in the patient’s work or social life. For all of these episodes the clinician should ensure that the symptoms are not better explained by another medical condition or by the affects of a substance.

00:11:00HANNAH HUFF No, I know, I don’t think that there is a normal response. How are you supposed to get over something like this? He was here and now he’s gone. He’s just not around anymore. This… he was a person who’s, who’s life is just gone.

00:11:20JIM HARRIGAN For a major depressive episode, the clinician should carefully consider its part in the diagnosis, if the patient has recently experienced a significant loss. While the DSM-4 allowed for a bereavement exclusion, this is absent in the DSM-5. Some clinicians claim this is because depression linked to the death or a loss of a loved one, doesn’t greatly differ from other causes of depression. Still, in these cases, the clinician should factor in cultural norms, the patients history, the severity of the symptoms, and whether or not the patient seems to improve before making their diagnosis. There are ways for the clinician to distinguish between grief and a major depressive episode. Grief decreases over time, and may become more present when thinking of the deceased. A major depressive episode on the other hand, is more constant and persistent, and does not include the ability to experience joy, which is still present throughout the grieving process.

00:12:30MAJOR DEPRESSIVE DISORDER

00:12:30FUNDAMENTAL CHARACTERISTICS

00:12:35JIM HARRIGAN Major depressive disorder involves experiencing a major depressive episode, which causes significant impairment for the individual’s work and social life. These episodes last on average from six to nine months but can go for as long as years in some individuals. A major depressive episode can be quoted as a single episode or recurrent. A single episode means that only one episode occurs during the patient’s lifetime. As always, it is important that the clinician rule out that the condition is not better explained by other disorders. The physiological affects of the substance or another medical condition. If a depressive disorder is induced by another medication, a diagnosis of substance/medication-induced depressive disorder maybe given. And if it is caused by a medical condition, the clinician can give the diagnosis of depressive disorder due to another medical condition. The clinician is also able to specify the presence of psychotic features, the state of remission, and severity, as mentioned previously.

00:13:45MAJOR DEPRESSIVE DISORDER

00:13:45SPECIFIERS

00:13:50JIM HARRIGAN There are numerous specifiers the clinician can add to the diagnosis. These will allow the clinician to include extra detail and information to the diagnosis, which can potentially help future clinicians in understanding the patient. For example, the specifier with anxious distress can indicate that the patient has experienced feelings of foreboding, agitation, or tension, intense worry leading to trouble concentrating, or the feeling that they may lose control of themselves during the majority of their most recent episode. In addition to with anxious distress, other potential specifiers include but are not limited to, with mixed features, with catatonia, with peripartum onset, and with seasonal pattern.

00:14:45PERSISTENT DEPRESSIVE DISORDER

00:14:45(DYSTHYMIA)

00:14:50JIM HARRIGAN Persistent depressive disorder, also referred to as dysthymia, is characterized as a depressed mood that lasts for at least two years. This occurs during the majority of days during this time period. While the possible symptomatology of persistent depressive disorder isn’t quite as extensive as it is for major depressive disorder, patients with dysthymia can experience a range of severity. Many of the characteristics are similar to that of major depressive disorder, difficulty concentrating, problems with sleep, poor self-esteem, poor appetite, low energy, and feeling hopeless.

00:15:35PERSISTENT DEPRESSIVE DISORDER

00:15:35SPECIFIERS

00:15:40JIM HARRIGAN A patient with persistent depressive disorder may or may not have a major depressive episode for all or some of the period of symptoms. In addition to the specifiers available for major depressive disorder, allowing the clinician to indicate severity, the state of remission, and other features, there are also specifiers to signify the role of major depressive episodes in the disorder. A patient who for two years, has not experienced any major episodes can be said to have persistent depressive disorder with pure dysthymic syndrome. If, in the last two years, a patient has met the characteristics for a major depressive episode, then the specifier with persistent major depressive episode can be applied.

If the patient is currently experiencing a major depressive episode, but has had periods of around two months, without qualifying for a full episode, the clinician should use the specifier with intermittent major depressive episodes, with current episode. And if they aren’t currently experiencing a major depressive episode, but have had one or more in the last two years, the clinician should use with intermittent major depressive episodes, without current episode. The clinician can also indicate if the onset of dysthymia happened early onset or before the age of 21, or late onset if the symptoms happened later than age 21.

00:17:15DIFFERENTIAL DIAGNOSIS AND COMORBIDITY

00:17:20JIM HARRIGAN Some alternatives to consider with persistent depressive disorder are those along the schizophrenia spectrum and other psychotic disorders. There are depressive symptoms associated with psychotic disorders, such as schizophrenia and delusional disorder. So a diagnosis of dysthymia is not made if the depressive symptoms only coincide with the psychotic disorder. Persistent depressive disorder can also coexist with personality disorders, though care must be taken to determine whether the individual truly qualifies for two disorders.

00:18:00PREMENSTRUAL DYSPHORIC DISORDER

00:18:05JIM HARRIGAN Premenstrual dysphoric disorder affects up to 5 percent of menstruating women. It involves mood symptoms that occurs repeatedly during the premenstrual phase of the menstrual cycle, and alleviate shortly after menstruation commences. Characteristics include changes in mood or appetite, trouble concentrating or sleeping, feelings of being out of control or anxious, irritability, lethargy, depressed mood, and decreased interest in activities, as well as physical characteristics, such as bloating, weight changes, and breast sensitivity or other pain. These symptoms should cause the patient significant distress in their daily life and not be solely a heightening of the symptoms from another disorder.

00:19:00DISRUPTIVE MOOD DYSREGULATION DISORDER

00:19:05BRETT DUGGAN I want to.

00:19:05ABBEY GRACE Give me your phone.

00:19:10BRETT DUGGAN Mom, it’s my phone.

00:19:10ABBEY GRACE I know it’s your phone, but I bought it.

00:19:10BRETT DUGGAN No.

00:19:15JIM HARRIGAN Beginning before the child is ten years old and affecting adolescence between six and eighteen years of age, disruptive mood dysregulation disorder is used to diagnose children with continuous extreme verbal and behavioral outbursts. These outbursts are incongruous when considering the circumstances and out of character for the individual’s developmental level. And even when the individual isn’t having a mood outburst, they are on edge or angry the majority of the time. The characteristics are present in multiple settings, such as at home, at school, or with peers.

00:19:55ABBEY GRACE So, I’m not bad in that.

00:19:55BRETT DUGGAN No, I want to.

00:20:00ABBEY GRACE I don’t care that you don’t want to…

00:20:00BRETT DUGGAN I don’t want to.

00:20:00JIM HARRIGAN It is also important to distinguish these symptoms from other mental disorders. The symptoms should not meet the characteristics of a manic or hypomanic episode. And they should not occur exclusively during a major depressive episode. While it can co-exist with conditions, such as major depressive disorder, attention-deficit/hyperactivity disorder, and conduct disorder, the diagnosis can not co-exist with oppositional defiant disorder, intermittent explosive disorder, and bipolar disorder. If the patient persists with characteristics of both disruptive mood dysregulation disorder and oppositional defiant disorder, only the diagnosis for disruptive mood dysregulation disorder should be given.

Because these depressive mood symptoms can affect the very lens through which individuals view their lives. Those with these disorders can feel helpless, like they have no hope of ever feeling happy or whole again. While being diagnosed with a mental disorder can be upsetting to the patient, it can also offer a source of comfort for the individual. It can let them know that their mood isn’t their fault, but is instead the product of a mental disorder, one that can be managed and even treated. Though diagnosing a mental disorder is only the first step in this treatment process, it can put the patient on the path to recovery, to help them live a more balanced happy life.

00:21:40Produced by

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00:21:40Dr. Mathew Macaluso, DO

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00:21:40Written by

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00:21:40Pandora Suderman

00:21:40Production Coordinator

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00:21:40Field Production

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00:21:40Featured Cast

00:21:40Anatasha Blakely

00:21:40Ross Crain

00:21:40Siobhan Doherty

00:21:40Brett Duggan

00:21:40Abbey Grace

00:21:40Zach Hallett

00:21:40Jim Harrigan

00:21:40Sean Harrigan

00:21:40Kristen Henley

00:21:40Hannah Huff

00:21:40Merlin Huff

00:21:40Dennis Hurley

00:21:40Jason Ko

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00:21:40Narration

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00:22:05END TranscriptION

Classroom Productions. (Producer). (1992). Mood disorders [Video]. Walden University.

Classroom Productions. (Producer). (2005). Bipolar disorder in children [Video]. Walden University.

MedEasy. (2017). Mood disorders (depression, mania/bipolar, everything in between) | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=59umGpQyaHs

Video Case Selections for Assignment (click to expand/reduce)

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2016). Training title 2 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-2

Symptom Media. (Producer). (2016). Training title 8 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-8

Symptom Media. (Producer). (2017). Training title 18 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-18

Symptom Media. (Producer). (2016). Training title 28 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-28

Symptom Media. (Producer). (2016). Training title 38 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-38

Symptom Media. (Producer). (2016). Training title 43 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-43

Symptom Media. (Producer). (2018). Training title 118 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-118

Symptom Media. (Producer). (2018). Training title 144 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-144

Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-150

Document: Case History Reports

NRNP 6635 Assignment: 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 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.).

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

NRNP 6635 Week3 Assignment Mood Disorders Rubric Detail

	Excellent	Good	Fair	Poor
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.	16 (16%) – 17 (17%) The response 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.	14 (14%) – 15 (15%) The response 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, but is somewhat vague or contains minor inaccuracies.	0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of 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. Or, subjective documentation is missing.
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.	16 (16%) – 17 (17%) The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.	14 (14%) – 15 (15%) Documentation of the patient’s physical exam is somewhat vague or contains minor inaccuracies. Diagnostic tests and their results are documented but contain minor inaccuracies.	0 (0%) – 13 (13%) The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
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.	20 (20%) – 22 (22%) The response 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 an accurate justification for each of the disorders selected.	18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or inaccuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or inaccuracy.	0 (0%) – 17 (17%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
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.	8 (8%) – 8 (8%) Reflections demonstrate critical thinking.	7 (7%) – 7 (7%) Reflections are somewhat general or do not demonstrate critical thinking.	0 (0%) – 6 (6%) Reflections are incomplete, inaccurate, or missing.
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.	12 (12%) – 13 (13%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.	11 (11%) – 11 (11%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.	0 (0%) – 10 (10%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
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%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided.
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.	4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors	3 (3%) – 3 (3%) Contains several (three or four) grammar, spelling, and punctuation errors	0 (0%) – 2 (2%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Total Points: 100

Major Depressive Disorder Discussion Sample

The patient is a 75-year-old patient who lost her husband 10 months ago and presents with complaints of insomnia. The questions I might ask the patient are:

Can you tell me how I may be of assistance today? This is an open-ended question that can serve to create rapport and encourage the patient to give me a lot of information about herself with the knowledge that the doctor is ready to listen and help her.
Do you live with someone at home? By asking this question, I will understand the type of support system the patient has at home and know which support to prescribe for the patient.
Are you following your regimen correctly? This will help me know if the patient is compliant to her medication and whether the support at home is helping the patient follow her regimen correctly.
How would you describe a well-rested sleep? This open-ended question would give me information regarding the patient’s expectations of enough sleep and this would be useful in designing an effective goal for her personal treatment plan.

The people in the patient’s life that I would need to speak to are her children, her close friends and neighbors. I could also speak to her aide if she has one. these people will help me know the severity of the patient’s problem. Some of the questions I will ask them are;

Based on your personal experience with her, can you describe her as a mother or friend or neighbor? This question will help me understand how the patient usually is so as to easily identify any anomalies from the subsequent history taken.

Has the patient been behaving more differently recently or experiencing worse symptoms of depression since her husband’s death? This question will help me understand the changes that the people close to her have noticed and whether they have noticed if she is depressed or not.
Does the patient complain about her medication or treatment regimen? This question will allow me to assess whether the patient is compliant or know the side effects the patient experiences, if any.
Has the sleeping patterns changes recently? This question will help me understand the severity of insomnia.

The physical exams appropriate for this patient include heart rhythm, respiratory rate, pulse rate, and oxyhemoglobin saturation. This is done because anxiety disorders can affect the findings of these parameters.

Tests such as Complete Blood count and Blood chemistry. Thyroid function tests assess possible contributing factors to her depression. Thyroid dysfunction can play a role in the pathogenesis of depression. Kidney function tests which test the ability of the kidney to eliminate waste from the body. These tests will include the urea, electrolytes and creatinine, and the GFR tests. Liver function tests which assess the liver enzymes. LFTs and KFTs test how well the body can metabolize and eliminate medications to be prescribed.

The diagnostic tests for this patient include polysomnography and actigraphy tests that are used to measure the patient’s sleep patterns. The actigraphy alone measures sleep efficiency, sleep latency, and total sleep time. The polysomnography will diagnose sleep disorders (Niel et al., 2020). Depression screening tests can also be done using different questionnaires to assess the level of her depression.

The patient’s differential diagnoses include:

Generalized Anxiety Disorder (GAD),
Major Depressive Disorder (MDD),
Restless Leg Syndrome.

Major depressive disorder (MDD) is the most likely disease that could explain why the patient is experiencing insomnia. MDD usually presents clinically as insomnia, difficulty concentrating, loss of appetite, and hopelessness. The patient lost her husband of 41 years and it is possible that this contributed to her depression, which has also affected her sleeping pattern. Bennabi et al. (2019) states that patients with MDD are at risk of experiencing sleeping disorders. Since the patient is responding to grief, her chances of developing MDD are high.

The pharmacologic agents that would be appropriate for the patient’s therapy are:

Selective serotonin uptake inhibitor (SSRIs). An example is Prozac. The required dose is 10 mg given PO qDay. The mechanism of action of SSRIs is by inhibiting the serotonin transporter (SERT) at the presynaptic axon terminal to prevent serotonin re-uptake. Inhibition of SERT results in an increased amount of serotonin in the synaptic cleft which then increase the serotonin levels, activity and effect in the brain.
Tricyclic antidepressants (TCAs) are used to treat MDD. An example is Amitriptyline. The required dosage is 10-25 mg given PO qHS. The mechanism of action of TCAs is blocking the reuptake of both serotonin and norepinephrine neurotransmitters consequently increasing the levels of norepinephrine and serotonin levels in the brain.

In terms of treating MDD, both TCAs and SSRIs show equivocal efficacy. However, SSRIs are the preferred drug for treatment of MDD because of fewer and milder side effects associated with this type of antidepressant drug. TCAs cause more adverse effects because of their anticholinergic effect. Also, when considering the patient’s age, SSRIs are the preferred drug (Bauer et al., 2017). TCAs on an elderly client might result in adverse cardiovascular effects such as dysrhythmias or orthostatic hypotension that may lead to dizziness, falls, and fractures.

Various research has shown that other races such as Asians and African Americans resort to using other alternative medication to treat their depression and these medications require lesser drug dosages to achieve the desired effect. SSRI use for the white race is always on standard prescription values with regards to its dosage and schedule. Administering these drugs to elderly patients however warrant that a modification is done. This is done through dose adjustment to minimize the side effects and polypharmacy considerations for drug-drug interactions (Salehi, 2019). The drug contraindicates in the patients taking selective serotonin reuptake inhibitors are mirtazapine, and other vasoconstrictors and analgesics.

After administering these drugs, the patient will be assessed after a four-week interval to determine if the symptoms have improved. If the symptoms have not improved after four weeks, Prozac will be increased by 10-20 mg for four weeks until a maximum of 80 mg, which is the maximum recommended dose per day. If the symptoms improve within the first four weeks, the regimen will be maintained until the patient completes the dose.

After completing the dose, the patient will sleep well and the symptoms of depression will be well managed. Once the desired outcome has been achieved the patient Prozac daily should be discontinued and started on Prozac weekly after one week. The patient should be closely monitored for any changes in behavior and suicidal tendencies within the first 4- 8 weeks. Prozac may also interfere with glycemic control as it may cause hypoglycemia especially in diabetic patients (DiVall & Woolley, 2019)

I have learnt that depression is a major illness that affects many patients and details in the history of a patient should be carefully examined to make the appropriate diagnosis and commence the proper treatment modalities.

References

Bennabi, D., Charpeaud, T., Yrondi, A., Genty, J. B., Destouches, S., Lancrenon, S., & Haffen, E. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC Psychiatry, 19(), 262. https://doi.org/10.1186/s12888-019-2237-x
Bauer, M., Severus, E., Möller, H. J., Young, A. H., & WFSBP Task Force on Unipolar Depressive Disorders. (2017). Pharmacological treatment of unipolar depressive disorders: summary of WFSBP guidelines. International Journal Of Psychiatry In Clinical Practice, 21(3), 166-176. https://doi.org/10.1080/13651501.2017.1306082
DiVall, M. V., & Woolley, A. B. (2019). CHAPTER Pharmacologic Agents. Acute Care Handbook for Physical Therapists E-Book, 431.
Niel, K., LaRosa, K. N., Klages, K. L., Merchant, T. E., Wise, M. S., Witcraft, S. M., Hancock, D., Caples, M., Mandrell, B. N., & Crabtree, V. M. (2020). Actigraphy versus polysomnography to measure sleep in youth treated for craniopharyngioma. Behavioral sleep medicine, 18(5), 589-597. https://doi.org/10.1080/15402002.2019.1635133
Salehi, M., Hadizadeh, H., Chang, A., & Grados, M. A. (2019). Recommendations for prescribing SSRIs. Contemporary Pediatrics, 36(11), 24-27.

Also Read: Academic Success and Professional Development Plan Part 6: Finalizing the Plan

NRNP 6635 Week3 Assignment Mood Disorders

NRNP 6635 Week3 Assignment Mood Disorders

NRNP 6635 Week 3: Mood Disorders Example

Patient Information:

Subjective:

Past Psychiatric History:

Review of Systems (ROS):

HEENT:

Objective:

Assessment:

Mental Status Examination:

Differential Diagnoses:

1. Major Depressive Disorder (MDD)

2. Seasonal Affective Disorder (SAD)

3. Adjustment Disorder with Depressed Mood

Reflections:

NRNP 6635 Week3 Assignment Mood Disorders References

Week 3: Mood Disorders

Learning Objectives

Learning Resources

NRNP 6635 Assignment: Assessing and Diagnosing Patients With Mood Disorders

To Prepare:

By Day 7 of Week 3

Submission and Grading Information

NRNP 6635 Week3 Assignment Mood Disorders Rubric Detail

Major Depressive Disorder Discussion Sample

References

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