NRNP-6635 WEEK 3 Assessing and Diagnosing Patients With Mood Disorders

NRNP-6635 WEEK 3 Assessing and Diagnosing Patients With Mood Disorders

Assessing and Diagnosing Patients With Mood Disorders

The assessment of mood disorders requires thorough history-taking. This paper discusses the 19 year old female patient’s psychiatric assessment, focusing on their chief complaint, symptoms, duration, severity, and impact on life. It discusses the patient’s mental status examination results, differential diagnoses, and DSM-5-TR criteria. The paper further contains thoughts on the patient’s situation, legal and ethical issues, health promotion, illness prevention, patient characteristics, past medical history, and risk factors. The goal is to provide a comprehensive understanding of the patient’s condition.

Subjective:

CC (chief complaint): “Mom says I get moody this time of year every year.”

HPI: J.H., a 19-year-old female patient, sought evaluation at a clinic in response to her mother’s worry over her being moody throughout the winter season. She was raised in South Carolina with her family, which consists of a sister and two brothers. Currently, she is enrolled in a distinctive business program. The patient is enrolled as a full-time student and does not engage in any employment activities. Nevertheless, she is lagging on two assignments, struggling with maintaining attention, and experiencing drowsiness in five courses. In addition, she perceives her instructor as a source of annoyance and has gradually lost interest in her companions. The patient has a demonstrated rapid loss of interest, a predisposition towards depression, and a failure to recuperate from past events completely. She has a strong aversion to winter and believes it is a period of significant transformation for society. The patient has impaired attention, concentration, and social disengagement symptoms. She believes that the present circumstances are leading to a decline in her enthusiasm for various activities and preventing her from completely recovering from them.

Past Psychiatric History:

• General Statement: The patient has never had a mental assessment or been diagnosed with a psychiatric disease.
• Caregivers (if applicable): Mother
• Hospitalizations: The patient’s records do not indicate any previous hospitalizations.
• Medication trials: The patient denies having used any medicine for her mental disorder or comparable symptoms in the past.
• Psychotherapy or Previous Psychiatric Diagnosis: The patient has no psychiatric history.

Substance Current Use and History: The patient asserts complete abstinence from alcohol and tobacco and refutes any engagement with other illicit drugs.

Family Psychiatric/Substance Use History: There is no record of drug misuse or mental health problems in the family.

Psychosocial History: The patient is a female patient, aged 19, who is unmarried. She now lives with two female colleagues in a communal living space. She is now unemployed and is enrolled as a full-time student. Her parents brought her up in South Carolina. She resided in the same household as her sister and two brothers during their upbringing.

Medical History:

• Current Medications: None
• Allergies: The patient does not have any documented medication allergies.

• Reproductive Hx: She is single and has not engaged in any sexual activity at this time. Reports a regular cycle of menstruation.

ROS:

• GENERAL Despite displaying signs of anxiety, she responds to inquiries and is aware of her reason for coming to a mental health institution, having gained 10 pounds.
• HEENT: There are no signs of diplopia or any other alterations to her visual acuity. Her auditory perception is excellent. She is devoid of sinuses, and her nostrils are unobstructed. She is not experiencing any discomfort or pain in her throat. She is free from any oral or periodontal injuries.
• SKIN: There has been no change in her skin tone. There is no evidence of bruising or swelling on her skin.
• CARDIOVASCULAR: She does not have any chest pain or discomfort. Absence of edema.
• RESPIRATORY: She is not experiencing coughing. There is an absence of sputum from her.
• GASTROINTESTINAL: She asserts that she has experienced weight gain due to an augmentation in her hunger.
• GENITOURINARY: No cases of dysuria have been reported. She has standard bladder control.
• NEUROLOGICAL: She has exceptional cognitive abilities. Furthermore, she has a keen sense of spatial and temporal awareness. Both her paralysis and seizures are non-existent. There are no reports of experiencing severe numbness or tingling.
• MUSCULOSKELETAL: She has no discomfort in her joints or back.
• HEMATOLOGIC: She is not afflicted with any hematologic disorder. She does not have anemia, and there is no evidence of bleeding.
• LYMPHATICS: There is no evidence of any enlargement in her lymph nodes.
• ENDOCRINOLOGIC: No complaints of excessive sweating. There is no mention of the patient experiencing sensitivity to either heat or cold.

Objective:

Vital signs: T 98.1 P-78 R-18 119/74 5’2″ 184 lbs. T 98.1 P-78 R-18

General: The patient is conscious and provides insightful responses to all queries. She has a robust perception of spatial orientation, temporal awareness, and interpersonal dynamics. She excessively frets and displays an excessive amount of apprehension.

Diagnostic results: No laboratory tests were requested during this consultation.

Assessment:

Mental Status Examination: The patient demonstrates high alertness and exhibits a clear orientation regarding time, place, and person. Her attire is suitable for the occasion. She is very responsive and pays close attention to every question asked. In addition, she possesses a remarkable memory. She demonstrates a cooperative attitude during the evaluation, although her demeanor may be perceived as somewhat distant. Her voice is characterized by its clear and logical nature. Her responses may be slow, but they are thoughtful and straightforward. She seems to be experiencing a sense of sadness and displaying a lack of emotional expression. Her speech is clear and consistent. Her demeanor appears slightly agitated. Her reasoning seems to be sound and logical. There is no indication of any intent to cause harm to oneself or others.

Differential Diagnoses:

1. Seasonal Affective Disorder (SAD): The patient is likely suffering from seasonal affective disorder, a severe form of depression defined by recurring patterns and episodes that are triggered by the onset of a particular season. According to the DSM-V, SAD is associated with a disruption in the brain’s biochemical equilibrium caused by reduced exposure to sunlight (Nevarez-Flores et al., 2023). The symptoms include feelings of despair, fatigue, heightened hunger, desires for carbohydrates, and a rise in body weight. The patient exhibits signs of mood fluctuations, increased body weight, and less motivation toward academic tasks throughout the winter season, but similar symptoms are absent during the summer.
2. Major Depressive Disorder (MDD): MDD is a kind of depression that has adverse effects on mood, behavior, and cognition (Abdoli et al., 2022). It results in cognitive and physical impairments, decreased vitality, weight loss, irregular sleep cycles, and irritability. Common symptoms include diminished academic engagement, social withdrawal, and pervasive fatigue and apathy. These symptoms are more prevalent during the winter season.
3. Bipolar II disorder: Bipolar II illness, as classified by DSM-5, is characterized by less intense periods of depression and hypomania. These episodes are often accompanied by emotions of melancholy, hopelessness, and anxiety (Gitlin & Malhi, 2020). Patients often encounter irregular sleep patterns, heightened appetite, weight gain, impaired concentration, and diminished interest in activities. This illness may be diagnosed in a patient who exhibits symptoms of melancholy, weight gain, difficulties concentrating, and falling asleep during lessons.

Reflections: From this case study, I have gained knowledge that people suffering from mood disorders require a comprehensive evaluation of their medical history in order to make an appropriate diagnosis. Diagnosing patients who are uncooperative in providing answers during the examination might provide a challenge. As a nurse, I establish a conducive atmosphere for patients to share essential information openly. Patients reluctant to reveal severe symptoms should be provided privacy assurances (Bertrand et al., 2021). Prior to doing mental health evaluations, nurses should possess a comprehensive understanding of the legal and ethical dimensions of nursing. In this particular instance, an adolescent patient is undergoing a shift in mood, which may be linked to the difficulties associated with puberty, such as academic demands and aversion to low temperatures. Pharmaceutical treatment is not suitable now. Nevertheless, psychological therapy is necessary. I suggest using cognitive behavioral therapy and implementing health promotion strategies such as regular exercise and a nutritious diet to enhance the patient’s mental and physical well-being (Fonte & Coutinho, 2021). Subsequent meetings should be arranged to investigate other possible variables influencing the patient’s health apart from the weather.

Conclusion

In conclusion, accurately diagnosing a mood illness necessitates evaluating both mental and physical health since one may influence the other. Inquiring about particular aspects of medical and mental history facilitates accurate diagnosis and fosters a constructive treatment connection. It is essential to include intercultural competency in therapeutic experiences such as counseling and communication within the evaluation process.

References

Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2022). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, pp. 132, 1067–1073. https://doi.org/10.1016/j.neubiorev.2021.10.041

Bertrand, L., D’Ortho, M., Reynaud, E., Lejoyeux, M., Bourgin, P., & Geoffroy, P. A. (2021). Polysomnography in seasonal affective disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 292, 405–415. https://doi.org/10.1016/j.jad.2021.05.080

Fonte, A., & Coutinho, B. (2021). Seasonal sensitivity and psychiatric morbidity: study about seasonal affective disorder. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03313-z

Gitlin, M., & Malhi, G. S. (2020). The existential crisis of bipolar II disorder. International Journal of Bipolar Disorders, 8(1). https://doi.org/10.1186/s40345-019-0175-7

Nevarez-Flores, A. G., Bostock, E. C., & Neil, A. L. (2023). The underexplored presence of seasonal affective disorder in the southern hemisphere: A narrative review of the Australian literature. Journal of Psychiatric Research, 162, 170–179. https://doi.org/10.1016/j.jpsychires.2023.05.003

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