Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Diagnosing and Treating Adults with Mood Disorders

Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders

Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders

Patient Initials: P.P.

Gender: Female

DOB: July 1, 1995

SUBJECTIVE:

CC: ” I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am.”(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

HPI: The patient, a 27-year-old female, presents at the clinic with complaints of failing to adhere to the medication treatment plans due to negative effects. The patient reports experiencing amnesia, weight gain, low mood, and sometimes feeling high because of the medications. The patient reports depressive symptoms sometimes, which affects her ability to work. She does not go to work when depressed, and her aunt tolerates her absenteeism. The patient reports feeling depressed about four to five times every year. During these episodes, she does not feel like getting out her bed and has no energy or motivation to do anything. She reports losing interest in her creative work and feels worthless because her creativity is deteriorating. Often, she experiences these episodes after working for extended periods on her writing, painting, and music. People tell her she is depressed, but she is unsure and thinks it is only exhaustion from hard work. The patient has creativity episodes which she loves before she crashes. During these episodes, she does not take her medications because they squash her, experiences increased energy to do many things and goes four to five days without enough sleep. Her friends say she talks excessively and appears scattered during the creativity episodes. Additionally, during these episodes, she likes to explore her mind and body by having sex with other people. Typically, the episodes last about a week. The patient denies any OCD. The patient denies hearing voices or seeing things others cannot for the last two months. However, it happens when she does not have enough sleep when she hears voices telling her she is great and wonderfully talented. The patient reports being too busy to eat, but during her depressive episodes or resting, she eats everything in sight. She denies any bad dreams and reports sleeping an average of 5-6 hours a night. She sleeps about 3 hours a day in her creative episodes and 12-16 hours a day during her depressive episodes.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Social History: The patient was raised by her mom and older brother. Currently, the patient lives with her boyfriend and sometimes with her mother. The patient is in a relationship but has never been married. P.P. has no children. The patient likes to write for fun, and currently, she is writing her life story and intends to publish it. She also paints and intends to sell her painting to movie stars.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Education and Occupation History: She works part-time at her aunt’s bookstore. She reports being absent on days she feels depressed. Her aunt is tolerant of her absenteeism. The patient is currently in vo-tech school studying cosmetology. She aspires to be a makeup artist for movie stars.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Substance Current Use and History: The patient reports smoking a pack daily and has no plans to quit. The patient reports taking alcohol when she was 19, but not anymore because of the negative effects. The patient denies using marijuana, but she tried once and became paranoid. She also denies using cocaine, stimulants, or methamphetamines. She denies huffing, inhalants, Klonopin, Xanax, hallucinogenic, or mushrooms. P.P. denies using pain pills or opiate medications and any other medications prescribed from the street. She denies using anything synthetic. The patient denies experiencing blackouts or seizures from using drugs or alcohol.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)   

Legal History: The patient denies any legal history or DUIs. The patient reports being picked up by police and taken to a hospital after they found her dancing in her nightgown in a field with her guitar. She reports not having adequate sleep that week. However, she cannot remember these events and thinks her mom made up the story against her to force her to go back to her boyfriend’s house.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Family Psychiatric/Substance Use History: The patient reports her mother was perceived as crazy and might have been suffering from bipolar. Her father was incarcerated for drugs, and has not interacted with him for about 8-10 years. The patient reports her brother as schizophrenic, although he has never seen a doctor. The patient states that her dad was hard on them but never abusive.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Past Psychiatric History:

General Comment: The patient reports previous diagnoses of depression, anxiety, and bipolar disorder.

Hospitalization: She was hospitalized as a teenager after going for days without sleep because she was hearing things. The patient has been hospitalized four times; the last was past spring. The patient reports being hospitalized for attempted suicide after overdosing on Benadryl.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Medication: The patient reports taking medication after four days but cannot remember the name. The patient reports taking Zoloft, which made her feel high, lose sleep, and experience a racing mind. She also took risperidone and Seroquel, which made her gain weight. The patient also took Klonopin, which slowed her down. She cannot remember the other medications.

Psychotherapy or Previous Psychiatric Diagnosis: Reports previous depression, anxiety, and bipolar disorder evaluation.

Medical History: The patient has a thyroid issue/hypothyroidism she takes medication for. She has polycystic ovaries she takes a birth pill.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

  • Current Medications: The patient did not name current medication for hypothyroidism. She takes birth control for polycystic ovaries.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)
  • Allergies: Denies any allergies.
  • Reproductive Hx: The patient has regular menses each month; the last was the previous month. The patient reports being sexually active but using protection. The patient engages multiple sex partners to maintain a high mood.

ROS:

General: P.P. denies fever, weight loss, or feelings of weakness and fatigue.

HEENT: Eyes: Patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: The patient reports diet changes, eating too much when depressed or resting, and little in her creativity episodes; denies feelings of nausea and vomiting. Denies diarrhea. No abdominal pain or blood. Denies constipation.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, and odd color.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Neurological: The patient denies headaches, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

Musculoskeletal: The patient denies muscle pain and weakness. Denies back pain and muscle or joint stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating. No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 98.8F

            B.P.: 120/65

            P: 84

             R.R.: 18

             O2: Room air

             Pain: 0/10

             Ht: 5’8 feet

             Wt: 135 lbs

             BMI: 20.5

             BMI Range: Healthy weight

LABS:

Lab findings WNL

Tox screen: Negative

Alcohol: Negative

Physical Exam:

General appearance: The patient appears well-fed and nourished. The patient is well-groomed and appears her age. The patient addressed the interviewer politely and regularly most of the time. The patient seemed irritated by the question about his family’s mental health history. The patient was also irritated by repetitive questions, particularly whether she tried hurting herself or committing suicide.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: The patient’s heartbeat and rhythm are normal. The patient’s heart rate is normal, and capillaries refill within two seconds.

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities. Muscle and back pain rated 3/10.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear.

Psychiatric: The patient has a depressed mood, irritability, insomnia and experiences creativity and depression episodes four to five times a year, lasting about one week each. Creativity episodes come before depression episodes.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Neuropsychological testing: Emotional functioning is impaired.

Behavior/motor activity: The patient’s behavior was appropriate and constant most of the time, but she demonstrated irritability towards particular questions that seemed too personal, like about her family’s psychiatric history.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Gait/station: Stable.

Mood: Depressed mood.

Affect: The patient’s mood was depressed.

Thought process/associations: comparatively linear and goal-directed.

Thought content: Thought content was appropriate.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Attitude: the patient was uncooperative at times(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Orientation: Oriented to self, place, situation, and general timeframe.

Attention/concentration: Good

Insight: Good

Judgment: Good.

Remote memory: Fair

Short-term memory: Good

Intellectual /cognitive function: Good

Language: clear speech, with a tone assessed to be normal

Fund of knowledge: Good.

Suicidal ideation: The patient reports attempted suicide after overdosing on Benadryl in 2017. The patient denies current suicidal ideation.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

The 27-year-old female patient complained of a history of taking and stopping medications because they squash her. She is oriented to self, place, situation, and general timeframe. Her insight is good, her judgment is good, her short-term memory is good, her long-term memory is fair, her fund of knowledge is good, and her speech is clear. The patient was occasionally uncooperative and appeared irritated by the question about his family’s mental health history. The patient was also irritated by repetitive questions, particularly whether she tried hurting herself or committing suicide. The patient had a depressed appearance. She admits to suicidal ideation and attempt, but negative now. She denies thoughts or actions to harm herself or others and denies any thoughts of homicide.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Differential Diagnosis:

  1. F31 Bipolar I Disorder:

The patient indicates signs of bipolar disorder. She experiences creativity episodes and depressive episodes. She loves her creativity episodes, which come before the depression episodes. During these episodes, she does not take her medications because they squash her, experiences increased energy to do many things and goes four to five days without enough sleep. Her friends claim she talks excessively and appears scattered during the creativity episodes. Additionally, during these episodes, she likes to explore her mind and body by having sex with other people. Typically, the episodes last about a week. During her depression episodes, she does not feel like getting out her bed and has no energy or motivation to do anything. She reports losing interest in her creative work and feels worthless because her creativity is deteriorating. Often, she experiences these episodes after working for extended periods on her writing, painting, and music. People tell her she is depressed, but she is unsure and thinks it is only exhaustion from hard work.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Per DMS-5, patients with bipolar I disorder report manic episodes and depressive episodes. During manic episodes, patients report increased energy feeling high, elated, or severely irritated or touchy, feeling more active than normal, jumpy or wired, having reduced need to sleep, talking fast about various things or experiencing a flight of idea, having racing thoughts, feeling they can do many things concurrently without getting tired, experiencing increased appetite for food, drinking, sex, and other pleasurable activities, and feeling unusually important, powerful, or talented (Sekhon & Gupta, 2023). During depressive episodes, patients report feeling down, sad, anxious, slowed down, restless, having sleeping difficulties or sleeping too much, talking extremely slowly, and unable to construct anything useful to say (NIMH, 2022). The patient also forgets a lot, has trouble concentrating and making decisions, cannot do simple tasks, loses interest in almost all activities, and feels hopeless, worthless, and suicidal. These symptoms align with P.P.s reported ones. She fits the DMS-5 criteria for bipolar I disorder, hence confirming the diagnosis.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

  1. 9 Major Depressive Disorder:

Depression is marked by apathy and persistent melancholy. The sorrow, emptiness, irritability, and physical and psychological changes that characterize all depressive disorders severely limit the patient’s capacity to carry out daily responsibilities. For most of the day, very much every day, depressed patients exhibit noticeably diminished excitement or interest in practically all activities. The DMS-5 criteria state that to diagnose someone with depression, five of the following symptoms must be present: trouble sleeping, loss of interest or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, difficulties concentrating or paying attention, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood (Chand et al., 2021). P.P. experiences depressive episodes, during which she does not feel like getting out her bed and has no energy or motivation to do anything. She reports losing interest in her creative work and feels worthless because her creativity is deteriorating. Often, she experiences these episodes after working for extended periods on her writing, painting, and music. People tell her she is depressed, but she is unsure and thinks it is only exhaustion from hard work. These episodes occur 4-5 times a year for about one week, which does not fit DMS-5 criteria for MDD; hence the diagnosis was refuted.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

  1. 3 Borderline Personality Disorder:

The patient indicates signs of borderline personality disorder. Hypersensitivity to rejection and the instability of interpersonal relationships, self-image, mood, and conduct defines borderline personality disorder (BPD), a cluster B disorder. Significant disability and distress are caused by borderline personality disorder, which also has several physical and mental health co-morbidities (Chapman et al., 2022). Five or more of the following describe a generalized pattern of interpersonal connections, self-image, affective instability, and noticeable impulsivity that starts by early adulthood and manifests in a range of contexts: A pattern of intense and unstable relationships marked by switching between extremes of idealization and devaluation; a substantially and continuously unstable self-image or sense of self; impulsivity in a minimum of two domains that have the potential to be self-destructive; frantic attempts to avoid real or imagined abandonment; a marked reactivity of mood, persistent feelings of emptiness, inappropriately intense anger, or difficulty controlling anger, such as frequent outbursts of rage, constant agitation, or frequent physical altercations, and brief paranoid thoughts or severe dissociative symptoms (Chapman et al., 2022). Bipolar disease patients may experience periods of stable mood between episodes of mania and depressive states, similar to borderline personality disorder patients who experience significant mood swings. This diagnosis was refuted because the patient did not fit the criteria for BPD.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Reflection:

This activity is a great learning opportunity regarding assessing mood disorders per the comprehensive patient assessment. The activity allowed the identification of symptoms and potential diagnostic impression per these symptoms. It also allowed the use of DMS-5 criteria to confirm the diagnosis, which is a standard practice in mental health practice. Assessing a mock-up patient offers a hands-on experience of a real-life scenario, building confidence and improving comprehensive patient assessment skills. The patient was mostly cooperative but appeared irritated by personal questions, which requires great interpersonal skills. This activity offers insights into approaching such situations while maintaining professionalism and giving the patient assurance. Given another chance with this patient, I would require the presence of a caregiver, the mother or big brother, for a detailed assessment of the patient and the development of a robust care plan.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Working with bipolar patients requires high ethical standards and sensitivity due to the challenges the patient experience with everyday activities and social relationships. The physician has to promote autonomy, beneficence, and non-maleficence during the assessment to ensure the patient feels heard and valued and that no activity or questions lead to emotional or psychological harm. These highly vulnerable patients should be treated with extreme sensitivity, love, and compassion.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Case Formulation and Treatment Plan:

(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Combining pharmacotherapy and psychotherapy would significantly alleviate symptoms.

Safety Risk/Plan:

The patient says she had suicidal ideation and attempted to kill herself once, but currently, she has no such thoughts or plans. She has no homicidal ideation and does not have any current plans. Despite increased arguments and irritation, the patient is not a threat to other people. Admission is not necessary.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Pharmacological Interventions:

Mood stabilizers like lithium and atypical antipsychotics like risperidone and olanzapine can help address manic episodes and symptoms. Prescribing quetiapine or lurasidone or combining olanzapine and fluoxetine can help address depressive symptoms (Sekhon & Gupta, 2023). Lithium is highly recommended, with a starting dosage of 300 milligrams two-three times a day.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Psychotherapy:

The patient can benefit from mindfulness-based cognitive therapy (MBCT) and acceptance therapy, which will help ease mood symptoms and prevent relapse. Interpersonal therapy is also recommended to address interpersonal problems and role transitions, for instance, with the mother, who the patient feels is against her. Cognitive-behavioral therapy will help improve impaired and dysfunctional cognitions and attitudes contributing to depressive episodes (Sekhon & Gupta, 2023). Dialectical behavioral therapy involves mindfulness and can help improve distress tolerance and emotional regulation.   (Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Education:

  1. Educate the client on medication side effects, potential complications, and the need for medication adherence.
  2. Advise the client on the need to follow up with therapy sessions.
  3. Regularly evaluate withdrawal symptoms to avoid relapse.(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)
  4. Educate the client on healthy lifestyle choices, such as balanced diets and routine physical activity.
  5. Encourage the client to work with the healthcare team and seek help anytime.  

Consultation/follow-up: Follow-up is in one week for further assessment. 

Referral: See endocrinologists for thyroid assessment

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.

Sekhon, S., & Gupta, V. (2023). Mood disorder. In: StatPearls [Internet]. Treasure Island (F.L.). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558911/(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)

Chapman, J., Jamil, R.T., & Fleisher, C. (2022). Borderline Personality Disorder. In: StatPearls [Internet]. Treasure Island (F.L.). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/

NIMH. (2022). Bipolar disorder. National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/bipolar-disorder(Comprehensive Essay Example on Diagnosing and Treating Adults with Mood Disorders)