Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample
Mood Disorders
Patient: E.L.
Age: 18 years
Gender: Male
CC: “I experience a significant shift in mood, behavior, and energy. At one moment, I feel very energetic and happy, while the next moment, I feel sad, afraid, irritated, and depressed.”(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Subjective (S):
HPI: E.L. is an 18-year-old male who presents to the clinic with a history of mood disorder. He currently lives with his sister but is unemployed, although he has completed school. Currently, the patient is not in school. He was previously treated for a mood disorder, beginning at age 15. He participated in previous risperidone and quetiapine trials, though on and off, because they caused weight gain. He was hospitalized for six days a year ago after being found wandering in the mall parking lot naked. The patient refused medication because of experience. He is currently single. His comments to female neighbors have been sexually inappropriate. He once pulled his pants down in the mall. Father has a history of bipolar disorder. The patient has no history of self-harm or family suicides. The mother reports 4-5 hours of sleeping in the previous week and using money to buy new video games. He says he is writing a book to help people become game masters. He has decreased appetite. Has no medical history. However, the patient was previously in juvenile due to vandalism. The patient has a pending court date for indecent exposure. The patient has no medical history and has a latex allergy. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Social Hx: The patient currently lives with his sister, but he is not employed, although he completed house school. The patient is not in school and is currently single. Father has a history of bipolar disorder.
Legal Hx: the patient has a history of vandalism as a juvenile. He is yet to go to court for indecent exposure.
Medical Hx: Patient refused medication due to previous experiences.
Surgical Hx: Denied
Psychiatric Hx: Patient was previously treated for a mood disorder, beginning at age 15. He participated in previous risperidone and quetiapine trials, though on and off, because they caused weight gain.
Psychiatric medication use: No medication Hx. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Substance Abuse History: Patient denies any recent alcohol or substance use.
MSE: Mr E.L. was seen for psychiatric evaluation. Patient has dressed appropriately for the occasion and time of year. He was seated throughout the interview; he was compliant, though hyperverbal, but did not appear to be in obvious distress. Patient denied insomnia, auditory/visual hallucinations, suicidal/homicidal ideations, and paranoid thoughts but reported decreased appetite.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Hospitalization Hx: Patient was hospitalized for six days a year ago after being found wandering in the mall parking lot naked.
ROS:
General: Reports weight loss. Denies fever, chills, weakness, or fatigue.
HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
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: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. Appetite is decreased.
Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Denies difficulties concentrating and paying attention.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Musculoskeletal: Denies muscle, back pain, joint pain, or 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.
Allergies: latex
Objective (O):
Vitals: T- 98.3 P- 93 R 22 118/68 Ht 5’7 Wt. 149lbs
General appearance: the patient appears healthy looking and well-nourished. He interacts and usually converses with the medical care team but is hyperverbal.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Cardiovascular: heart rates and rhythm are regular, and murmurs and extra sounds can be heard from the patient’s chest. Has a normal pulse rate throughout, and capillaries refill in 2 seconds.
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: patient appropriately converses with the psychiatrist, indicating awareness of place, situation, and self. Patient ignores detail.
Neuropsychological testing: the patient does not indicate appropriate attention and concentration.
Assessment:
Mental status examination: The patient is an 18-year-old white male presenting with a history of mood disorder. The patient wants to know more about the psychiatrists and seems uncomfortable talking about his sister and the ACT she underwent, siting, “it was a disaster.” The patient is worrisome and does not indicate appropriate attention to detail, does not sustain attention to activities, and seems not to listen continuously when spoken to directly.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample) The patient follows through on conversation but fails to organize tasks and activities appropriately and is reluctant to engage in questions or talk about his past mental state examination because of the bad experience. The patient is aware of extraneous stimuli, indicates good memory, talks too much, and engages in appropriate turn-taking. The patient does not display delusional thinking and denies suicidal or homicidal ideation. The patient is alert and oriented, his short-term memory is intact, and his insight is good. The patient indicates disturbing thoughts. The patient appears delusional regarding writing a book to help people become video game masters.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Primary Diagnosis
Bipolar Disorder
Bipolar disorder is a mood disorder in the same category as depression. Patients with bipolar disorder indicate unpredictable and erratic mania, often appearing garishly dressed, showing social propriety negligence, with boundary violation, agitation, and other inappropriate behaviors (Jain & Mitra, 2022). The patients indicate issues with mood and affect, mostly elevated or euphoric in mania. Patients indicate heightened effect and extreme lability. A sad or elegiac mood indicates a depressive state. The patient also indicates pressured speech and rapid or consistent speech production with interpretation difficulties. Patients can also lack concentration, attention to detail, and easy distractibility (Jain & Mitra, 2022). Patients can also indicate impaired judgment and unreliability in information. E.L. presents with boundary violations and other inappropriate behaviors. E.L. has problems with mood and affect, pressured speech, hyperverbal, and impaired judgment of the interviewer. These indications confirm the bipolar disorder. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Differential Diagnosis
Depression
Depression is categorized as a mood disorder, similar to bipolar disorder. It affects the mood, causing persistent sadness and loss of interest. Patients experiencing depression report extreme sadness, emptiness, and irritable mood, coupled with somatic and cognitive changes that affect an individual’s ability to function appropriately (Chand et al., 2021). The patient reports previous mood disorder treatment. The patient reports disturbed sleep patterns (4-5 hours), interest reduction in other things besides video games, energy changes, attention and concentration impairment, appetite and weight changes, and depressed mood. The patient denies suicidal thoughts or a family history of suicide. Depression is refuted because, although mood and affect impairments are shared with bipolar disorder, inappropriate behavior, boundary violations, pressured speech, inattentiveness to detail, and episodes of euphoria and heightened energy indicate bipolar disorder. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
F90.9. Attention-deficit/hyperactivity disorder (ADHD):
Attention deficit/hyperactivity disorder (ADHD) is a long-term mental health problem that often worsens as people age. Hyperactivity, impulsive conduct, and problems maintaining attention are all persistent symptoms of ADHD. Low self-esteem, problematic relationships, and poor involvement are common problems for ADHD patients, especially children (Magnus et al., 2017). Adult ADHD symptoms include impulsivity, disorganization, difficulty prioritizing, poor time management, difficulty focusing, difficulty multitasking, excessive activity and restlessness, poor planning, and a low threshold for irritation. The DSM-5 diagnostic criteria for adults with ADHD include five or more inattention symptoms, several of which were present before the age of 12, several of which were present in two settings, evidence that the symptoms interfere with or degrade social, academic, or occupational functioning, and symptoms which do not only manifest in the context of another psychotic disorder. ADHD is refuted because of a lack of a previous diagnosis before age 12.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
F41.9. Generalized Anxiety Disorder
The hallmarks of a generalized anxiety disorder (GAD) include excessive, exaggerated anxiety and worry over everyday events without any discernible cause (Munir et al., 2021). Although it can start at any point in the lifespan and manifest gradually, the risk is most significant between childhood and middle age. Although the specific etiology of GAD is unknown, biological factors, family history, life experiences, and other stressors play a role (Toussaint et al., 2020). General anxiety disorder can be diagnosed by looking for signs such as excessive, persistent worry and tension, unrealistic views of problems, restlessness or a sense of being “edgy,” difficulty focusing, quickly becoming exhausted, increased crankiness or irritability, trouble sleeping, and muscle tension. People with GAD frequently see calamity coming and worry excessively about everyday occurrences like going to work. GAD is identified when a person has uncontrollable worrying.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Plan (P): Address the patient’s bipolar disorder by first confirming the mania and hypomania diagnosis and defining the client’s mood state due to the different treatment approaches for different patient types. The primary goal will be to ensure patient safety and attain clinical and functional stabilization with minimal adverse effects.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Therapeutics:
Pharmacological Interventions: Mood stabilizers and antipsychotics will help manage bipolar mania and depression. Mood stabilizers are the primary treatment approach, especially in maintaining the mania phase (Jain & Mitra, 2022). Patients are often prescribed lithium to reduce mania. Other mood stabilizers include carbamazepine and valproic acid, which can help with acute mania episodes (Jain & Mitra, 2022). Antipsychotics like olanzapine, ziprasidone, and quetiapine can help stabilize the patient’s mood. Antidepressants are used to treat depression (Jain & Mitra, 2022). FDA-approved antipsychotics like cariprazine and lurasidone are also effective treatments for depression. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Therapy: A combination of mood stabilizers and therapy is preferred, indicating greater effectiveness than medication or therapy alone (Jain & Mitra, 2022). The patient will undergo electroconvulsive therapy to treat mania and reduce depression symptoms. (Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Education:
- Educate about potential side effects of medication therapy and when to report any complications or undesired effects.
- Educate the patient about when the medication will work and the need to adhere to prescription guidelines.
- Advise patient to join a support group or group therapy to help deal with anxiety(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
- Engage the patient in skills training.
- Encourage the patient to make time for exercise every day.
- Teach the patient to accept himself and his limitations and interact with people who accept him.
Further assessment is to develop a comprehensive care plan.
Consultation/follow-up: The patient should return to the clinic in two weeks for further assessments.
Reflection
The patient is an adolescent, only 18 years of age. Assessing the patient was challenging because some symptoms, like energy changes, inappropriate behavior, and sexual comments, can be associated with adolescence. This assessment enhances understanding of mood disorders and differences in various mood disorders that inform specific or accurate diagnoses. A family history of bipolar disorder is a risk factor in this case, but it does not confirm the diagnosis. Bipolar disorder emerged as the confirmed diagnosis followed a though patient evaluation of behavior, mental state, and mania indicative of the disorder. Bipolar disorder is in many ways similar to depression, but most patients, although present with depressive symptoms like extreme sadness, and feelings of emptiness and worthlessness, often maintain appropriate behavior. The patient still needs further assessment to develop a comprehensive treatment plan. If given another chance with the patient, I would inquire more about the patient personal life and engage family members to understand better how the mood disorder impacts the patient daily living and normal functioning.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
References
Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing).(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Jain, A., & Mitra, P. (2022). Bipolar affective disorder. In StatPearls [Internet]. StatPearls Publishing.(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD).
Munir, S., Takov, V., & Coletti, V. A. (2021). Generalized Anxiety Disorder (Nursing). StatPearls [Internet].(Comprehensive Psychiatric Evaluation on Mood Disorders Nursing Essay Sample)
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