Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example
CC: “I am always sad. I cannot study anymore, and I don’ have the energy to do anything.”
HPI: Natalie is a 17-year-old Caucasian female. Natalie is present for psychiatric evaluation for sadness. Her mother recommended that she come for therapy. “I love summer, winter is dark, and I could not tolerate the school atmosphere. Natalie reports being sad whenever she considers returning to school and anticipates missing her family. “I am disturbed that I cannot feel their presence around me. I started feeling sad the moment I left home for my studies. I felt I could not survive and still feel overwhelmed with the thought of staying far from home and family for a whole semester.” Natalie reports not hanging out with friends since they are boring. They only want to do board games. Natalie reports calling home frequently and asking the family to visit, but the parents had greater work commitments and no time for a proper visit. She feels worthless because her parents have not visited since she enrolled in the high school business program. “I have not been able to concentrate in class or studies. I cannot finish my assignments.” The mother reports, “Natalie is always moody at this time of the year, but this is worse. The mother report, “lately, Natalie cannot do anything for herself. She only eats and sleeps.” “I find it hard to read or revise. I am afraid I will fail, and my father will be mad at me. She reports feeling fatigued after excessive sleep. She loved attending concerts and hanging out, but now she does not.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Past Psychiatric History:
General Statement: The patient entered treatment one month ago for counseling for depression due to homesickness.
Caregivers: N/A
Hospitalizations: None reported.
Medication trials: None reported.
Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric diagnosis.
Substance Use History Denies substance use history.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Family Psychiatric/Substance Use History: No family member has a psychiatric/substance use history.
Social History: She grew up living in New Orleans her whole life. Grew up with both parents and four brothers. Currently lives in a specialty high school campus dormitory. She is married and currently single.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Educational Level: Recently started an accelerated high school business program in Chicago, Illinois.
Hobbies: None reported.
Work History: Currently a full-time student working part-time in the local coffee shop.
Legal history: No trauma history. No legal issues.
Violence Hx: No previous or current for client’s personal, community, home, or sexual safety.
Medical History: No hx of seizures, head injuries, illnesses, or surgeries.
Current Medications: None.
Allergies: NKDA
Reproductive Hx: Not pregnant. Currently not on contraception. Regular menses.
ROS:
GENERAL: Natalie reports no weight loss, fever, chills, weakness, or fatigue.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
HEENT: Eyes: No visual loss, double vision, or blurred vision. Ears, Nose, Throat: No hearing loss, nasal congestion, sneezing, runny nose, or difficulty swallowing.
SKIN: Normal skin turgor. No visible rash or itching.
CARDIOVASCULAR: No chest edema or palpitations, discomfort, chest pain, or pressure.
RESPIRATORY: No breathlessness, wheeze, cough, or sputum.
GASTROINTESTINAL: No abdominal pain. No anorexia or vomiting, No diarrhea or nausea. No abdominal blood.
GENITOURINARY: No dysuria. Standard urine color, frequency, and odor. NEUROLOGICAL: No history of seizures, paralysis, or seizures. Denies tingling in the extremities, numbness, or ataxia.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
MUSCULOSKELETAL: No joint stiffness or pain. No back pain.
HEMATOLOGIC: No ease of bleeding.
LYMPHATICS: No history of splenectomy. No painful or enlarged nodes.
ENDOCRINOLOGIC: No polyuria or polydipsia. No cold or heat intolerance.
Diagnostic results: T 97.4 P-82 R-1 20 128/84 Ht 5’2” Wt 192lbs
Tox Screen: Negative.
Assessment
Assessment Mental Status Examination:
Natalie is a 17-year-old Caucasian female. She is well dressed for the time and occasion. She is calm, cooperative, interactive, and conversant. She does not tolerate the thought of studying far from home and tends to drift away from the topic. She is alert and oriented in all spheres. She does not show abnormal psychomotor activity. Exude clear and coherent speech. She maintains appropriate eye contact, although she appears depressed. Her mood is restricted, and her affect is flat. There is no evidence of flute ideas. The patient denies any form of hallucinations. Denies any form of suicide ideation. The client’s memory, judgment, and insight are grossly intact. (Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Diagnostic Impression:
The symptoms presented by Natalie point to moderate major depression disorder (MDD) coded as 296.22 (F32.1). According to the DSM-5, MDD is characterized by depressed mood, reduced interest in doing things, fatigue, insomnia, psychomotor agitation, feelings of worthlessness, inability to maintain concentration, and thoughts of death that causes a clinically significant impact on an individual’s social, occupational, and other aspects of life (American Psychiatric Association [APA], 2019). Natalie presents more than five of these symptoms, which is significant for MDD. Her symptoms include depressed mood, e.g., sadness, lack of interest in certain activities, e.g., going to concerts, having lost about 10lbs, hypersomnia, loss of energy, and feeling of worthlessness since her parents do not visit while she is in school. These symptoms have affected her learning and social relations.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Natalie’s symptoms suggest adjustment disorder with mixed anxiety and depressed mood coded as 309.28 (F43.23). The disorder is characterized by clinically significant behavioral/emotional symptoms associated with stressors, marked distress, low mood, hopelessness, and impairment of social functions (APA, 2019). Lastly, Natalie’s symptoms suggest generalized anxiety disorder (GAD), coded as 300.02 (F41.1). GAD is characterized by fatigue, excessive worry, irritability, inability to control worry, restlessness, sleep disturbance, and muscle tension occurring for at least six months, with a clinically significant impact on areas of functioning and cannot be explained by other disorders (APA, 2019).(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Reflections:
The client has a concentration problem and, together with the presented primary symptoms, meets the criteria for MDD diagnosis. MDD is the primary diagnosis. Conversely, Natalie present marked distress associated with adjustment disorders. However, the disturbances are better explained by MDD. Therefore, the diagnosis is refuted. Similarly, Natalie’s symptoms are less than six months, she does not show irritability or muscle tension, and MDD better explains her symptoms. Therefore, the GAD diagnosis is refuted.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
MDD is common among teenagers and disproportionally among girls (Maughan et al., 2013). As presented by Natalie, teenage depression causes significant outcomes in life, including problems with social functioning and poor mental health. Since MDD presents differently in adults than adolescents, a further psychiatric assessment is necessary to ascertain the diagnosis. (Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Treatment Plan:
Start Fluoxetine 20 mg PO qDay. Evidence demonstrates that fluoxetine is beneficial in managing depression in children and adolescents (Garland et al., 2016). Fluoxetine is FDA-approved, and further evidence supports its use for MDD and other anxiety disorders with significant improvement in social functions over 12 weeks of treatment (da Costa et al., 2013). (Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Patient referred for cognitive behavioral therapy (CBT). CBT is effective in reducing depressive symptoms, modifying underlying schemas, reducing recurrence, and improving medication adherence (Gautam et al., 2012). CBT works with other medications and provides psychoeducation for the parent to help the client recover completely.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Return to the Clinic: After two weeks.
References
American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders (7th ed.). American Psychiatric Publishing, Inc. (Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
da Costa, C. Z. G., de Morais, R. M. C. B., Zanetta, D. M. T., Turkiewicz, G., Neto, F. L., Morikawa, M., … & Asbahr, F. R. (2013). Comparison among clomipramine, fluoxetine, and placebo for treating anxiety disorders in children and adolescents. Journal of child and adolescent psychopharmacology, 23(10), 687-692.(Assessing and Diagnosing Patients with Mood Disorders Comprehensive Nursing Essay Example)
Garland, E. J., Kutcher, S., Virani, A., & Elbe, D. (2016). Update on using SSRIs and SNRIs with children and adolescents in clinical practice. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 25(1), 4.
Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive-behavioral therapy for depression. Indian journal of psychiatry, 62(Suppl 2), S223. https://doi.org/10.4103%2Fpsychiatry.IndianJPsychiatry_772_19
Maughan, B., Collishaw, S., & Stringaris, A. (2013). Depression in childhood and adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(1), 35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565713/
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