NRNP 6635 Assessing and Diagnosing Patients With Mood Disorders Essay

NRNP 6635 Assessing and Diagnosing Patients With Mood Disorders Essay

NRNP 6635 Assessing and Diagnosing Patients With Mood Disorders Essay

Week (enter week #): (Enter assignment title)

Psychopathology and Diagnostic Reasoning

Subjective:CC (chief complaint): Depression: According to the information provided by the patient’s parents, the patient appeared to be depressed, lacking energy, crying,expressing a desire to die and feeling worthless for destroying everyone’s lives.

HPI: The client is a sixteen-year-old female from Tacoma, Washington. She has been engaging in a lot of unprotected sex recently. Additionally, she has been stealing money from her mother’s purse to purchase clothing, makeup, and “other things.” She recently got discharged from a three-month teen residential mental health facility on a medication regimen consisting of Lithium 300 mg in the morning and 600 mg at bedtime, as well as Ariprazole 10 mg druing the morning hours.She has issues with medication compliance according to the statements that she made to her parents. Recent laboratory results were within normal ranges, and this included a negative urine toxicology test. However, the client tested positive for cannabis four months ago upon admission to the teen residential program. Sleep is reduced to three to four hours per day. Appetite “is fantastic.” The client is on birth control with an implant of Nexplanon.

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Past Psychiatric History:

• General Statement: The patient has a history of conduct disorder, depression, and aggression/violence directed at his mother as well as the two younger sisters during his childhood.
• Caregivers (if applicable):
• Hospitalizations: Three months in a residential mental health facility for adolescents last month
• Medication trials: Sertraline – irritability, impulsivity, and aggression are exacerbated
• Psychotherapy or Previous Psychiatric Diagnosis: Since the age of seven, I’ve struggled with conduct disorder and depression.

Substance Current Use and History: Cannabis – unknown quantity, frequency, and duration of use. Four months ago, prior to entering residential treatment, a urine toxicology test revealed a positive result for Cannabis.

Family Psychiatric/Substance Use History: Grandmother – history of bipolar disorder

Mother – history of anxiety

Maternal aunt – similar to mother

Psychosocial History: Client resides with her parents and two younger sisters in Tacoma, Washington. She is a sophomore in high school but is single at the moment. She identifies as bisexual. As a child, she engaged in domestic violence against her mother and two younger sisters. Client tested positive for Cannabis four months ago during his admission to a three-month teen residential psychiatric mental facility. Additionally, the client has a history of self-harm through cutting. Denies any legal ramifications.

Medical History:

• Current Medications: Lithium 300 mg in the morning, Lithium 600 mg at bedtime, and Aripiprazole 10 mg in the morning.
• Implantable Nexplanon.
• Allergies: None were reported.

• Reproductive Hx: Client engages in sexual activity with partners of both genders.

ROS:

• GENERAL: alert, hyperactive, hyperverbal, and not in acute distress
• HEENT: the provider should have conducted an examination.
• SKIN: the provider should have conducted an examination.
• CARDIOVASCULAR: the provider should have conducted an assessment
• RESPIRATORY: the provider should have conducted an assessment
• GASTROINTESTINAL: the provider should have conducted an assessment
• GENITOURINARY: the provider should have conducted an assessment
• NEUROLOGICAL: the provider should have conducted an assessment
• MUSCULOSKELETAL: the provider should have conducted an assessment
• HEMATOLOGIC: the provider should have conducted an assessment
• LYMPHATICS: the provider should have conducted an assessment
• ENDOCRINOLOGIC: the provider should have conducted an assessment

Objective:

Physical exam: if applicable

Temperature: 97.4

Pulse – 84

Respirations – 18

Blood Pressure – 134/88

Ht – 5’3

Wt – 118 lbs

BMI – 20.9

 

Diagnostic results: Laboratory values are within the normal range.

Urine toxicology results were negative.

Assessment:

Mental Status Examination:

Client is well-groomed and dressed appropriately for her age, the weather, and the occasion.

Fair eye contact

 

Hyper-verbal, pressed, and obnoxious speech.

 

Hyperactive behavior.

 

Psychomotor: agitated.

 

Euphoric mood.

 

Elated, consistent with mood

 

The Process of Thought: the flight of ideas

 

No delusions.

There are no suicidal, homicidal, or self-harming thoughts.

 

No response to external or internal stimuli.

 

Concentration/Attention: easily distracted.

 

Cognition: Aware, focused X 4.

 

Short- and long-term memory are both intact.

 

Poor insight

 

Poor judgment

 

Knowledge Base: Average.

 

Average intelligence.

Differential Diagnoses:

Bipolar disorder

Attention Deficit and Hyperactivity disorder

Major Depressive Disporder

Reflections:

Due to the patient’s mania, impulsivity, and excessive involvement in activities with a high risk of painful consequences, it appears necessary to admit her to an inpatient treatment facility. According to Malhi et al. (2018), more than 1% of the world’s population suffers from chronic Bipolar disorder, which typically begins in childhood. Bipolar disorder is one of the leading causes of disability worldwide, particularly among the younger population. Prompt and appropriate treatment can help avoid permanent damage caused by this disorder (Malhi et al., 2017). Bipolar disorder is a multifaceted disorder that necessitates compassionate care and painstaking ethical decision-making that takes the patient’s goals into account (Aref-Adib et al., 2019). When a provider is treating bipolar disorder, he or she must strike a balance between the principles of truthfulness, beneficence, and autonomy.

References

Aref-Adib, G., McCloud, T., Ross, J., O’Hanlon, P., Appleton, V., Rowe, S., … & Lobban, F. (2019). Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review. The Lancet Psychiatry, 6(3), 257-266. https://doi.org/10.1016/S2215-0366(18)30302-X

Malhi, G. S., Morris, G., Hamilton, A., Outhred, T., & Mannie, Z. (2017). Is “early intervention” in bipolar disorder what it claims to be?. Bipolar disorders, 19(8), 627-636. https://doi.org/10.1111/bdi.12576

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WEBSITE FOR FOR VIDEO CASE STUDY
https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/bipolar-disorders
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.

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.).