NRNP 6635 Week3 Assignment Mood DisordersNRNP 6635 Week 3: Mood Disorders ExamplePatient Information

NRNP 6635 Week3 Assignment Mood Disorders

NRNP 6635 Week 3: Mood Disorders Example

Patient Information:

Patient Initials: N. C                 Age: 17   Gender: Female Race: White American

Subjective:

Chief Complaint (CC): The patient’s mother expressed concern about her daughter’s moodiness during this time of year and requested an evaluation.

History of Present Illness (HPI): Ms. N. C, a 17-year-old White American female, presents with a chief complaint of feeling down and not doing well. Her mother expressed concern about her mood worsening during this time of year. She left the business program at school and is struggling with her academic projects, including a mock company assignment. She has difficulty concentrating, experiencing memory lapses, and has gained weight. Ms. N. C has also been sleeping through some of her classes and has experienced a decline in her social activities. She initially made friends and enjoyed outings, but lately, she has found her friends annoying and feels less motivated to engage in social activities. She dislikes the cold weather and describes the city as dark, grey, and miserable, contributing to her negative mood.

Past Psychiatric History:

• General Statement: The patient has no previous psychiatric history.
• Caregivers (if applicable): N/A
• Hospitalizations: No history of past hospitalizations
• Medication trials:  No previous history of medication trials
• Psychotherapy or Previous Psychiatric Diagnosis: The patient does not have a previous psychiatric diagnosis or history of psychotherapy.
• Substance Current Use and History: She denies any history of substance use for herself, including nicotine, illicit substances (including marijuana), or alcohol. However, she reports taking caffeine daily. The patient does not report any withdrawal complications, such as tremors, delirium tremens, or seizures.

Family Psychiatric/Substance Use History: The patient acknowledges a known history of depression within the family but denies any history of substance use.

Psychosocial History: N.C. is a 17-year-old White American female born and raised in New Orleans, Louisiana. Growing up, N.C. lived with both of her parents and four brothers. However, her residence is a specialty high school dormitory in Chicago, Illinois. Among her siblings, N.C. is the only girl and the youngest. Presently, she is not married and remains single, without any children. Being a full-time high school student, Natalie prioritizes her studies in the business program. In addition to her academic pursuits, she also holds a part-time job at a local coffee shop. She enjoyed socializing and participating in recreational activities in the past, but her interest in them has waned. Notably, N.C. has a clean record with no history or current legal issues.

Medical History: No history of hospital admission

• Current Medications: She takes no medications
• Allergies: NKDA

Reproductive History: She experienced menarche at 14 and continues to have regular menstrual cycles within a 28-day cycle without complications such as dysmenorrhea or menorrhagia. At present, she is unmarried and remains single, without any children. Furthermore, there is no record of her using contraceptives, and she confirms not being sexually active.

Review of Systems (ROS):

GENERAL: Ms. N. C is a 17-year-old White American female with a height of 5’2? and a weight of 192 pounds. She presents with a downcast mood, slouched posture, and signs of decreased engagement, such as a lack of eye contact, reflecting her reported feelings of not doing well and exhibiting a low mood.

HEENT:

• Eyes: She has no loss of vision, double vision, painful eyes, or jaundice.
• Ears, Nose, and Throat: She does not experience any auditory impairments, such as hearing difficulties. Additionally, she is unaffected by symptoms like sneezing, congestion, a runny nose, or a sore throat. Furthermore, no recent nasal polyps, nosebleeds, or sinus infections have occurred. She exhibits no challenges related to chewing or swallowing, and there are no indications of gingivitis or bleeding gums.
• Skin: She denies experiencing any skin rashes or lesions. Her hair appears evenly distributed, showing no signs of hair loss. Additionally, her nails remain intact, and there are no indications of clubbing.
• Cardiovascular: The patient denies experiencing chest discomfort, palpitations, tightness, arrhythmias, or elevated blood pressure. There is also no indication of varicose veins, edema, or claudication.
• Respiratory: No shortness of breath, cough, or sputum.
• Gastrointestinal: The patient denies any presence of abdominal pain, tenderness, distention, or discomfort. There is no reported incidence of heartburn, constipation, diarrhea, or indigestion.
• Genitourinary: She denies dysuria, urinary frequency, urgency, and abnormal vaginal discharge.
• Neurological: She denies experiencing symptoms such as headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. Additionally, there have been no observed alterations in bowel or bladder control.
• Musculoskeletal: No back pain, myalgia, joint pain, or stiffness
• Hematological: No anemia, bleeding, or bruising.
• Lymphatics: No enlarged nodes or splenectomy
• Endocrinologic: She denies sweating, cold, or heat intolerance: no polyuria or polydipsia.

Objective:

Vital signs: Temperature (T): 97.4°F, Pulse (P): 82 beats per minute, Respiration rate (R): 20 breaths per minute, Blood pressure (BP): 128/84 mmHg, Height: 5’2? (62 inches), Weight: 192 lbs.

General: The patient mentions feeling down and not doing well.

Neurological: The patient mentions difficulty concentrating, memory problems, and changes in sleep patterns.

Diagnostic results: Comprehensive psychiatric evaluation, laboratory tests, including a complete blood count (CBC), thyroid function tests, and other relevant investigations, may be recommended to rule out any underlying medical causes for the patient’s symptoms.

Assessment:

Mental Status Examination:

Ms. N. C, a 17-year-old White American female, presents with a slightly overweight appearance, indicated by her weight of 192 lbs and height of 5’2?. During the interview, she appears disinterested and exhibits a passive attitude. Her behavior is characterized by a subdued manner and occasional sighing. Furthermore, her mood remains consistently low, and her affect is congruent with her depressed mood, displaying minimal variability and limited facial expressions.

Regarding speech, Ms. N. C’s responses are brief and lack elaboration. Her thought processes appear slowed, with delayed responses and occasional pauses. She expresses feelings of sadness and states that she is not doing well. Specifically, Ms. N. C reports leaving her program at school and struggling with her coursework, particularly in a special business program where she is required to create a mock company. She describes difficulty concentrating, memory problems, and detachment from her studies. Furthermore, she mentions being late on two projects and expresses frustration with her teachers.

Regarding her perceptions, Ms. N. C does not report any hallucinations, pseudo hallucinations, or illusions during the interview. However, she acknowledges difficulty sleeping, weight gain, and excessive daytime sleepiness. She also reports a decline in her social activities and expresses annoyance toward her friends, whom she finds dull. Additionally, she attributes her dislike for the current time of the year to the dark, grey, and miserable weather, which she believes has changed the city she once loved. She describes the snow in the city as grey and black, contrasting it with her previous expectation of white and beautiful snow.

In terms of cognition, Ms. Crew demonstrates impaired concentration and memory. This is evident in her difficulty remembering what she reads and forgetting the content of her classes shortly after leaving the room. Her insight into her current state is limited, as she attributes her struggles to external factors, such as her teachers and the weather, rather than considering internal emotional or psychological factors. At this time, Ms. Crew denies any suicidal or homicidal ideation. However, given her low mood, decreased interest in activities, social withdrawal, and negative perception of her environment, further exploration of her risk for self-harm is warranted.

Differential Diagnoses:

1.     Major Depressive Disorder (MDD)

The patient’s presentation is consistent with MDD. She exhibits symptoms such as persistent low mood, loss of interest in activities, difficulty concentrating, memory problems, changes in sleep patterns (oversleeping), weight gain, social withdrawal, and negative perception of her environment (Bains & Abdijadid, 2022). A comprehensive psychiatric evaluation is recommended to assess the severity of her depressive symptoms and rule out other possible causes.

2.     Seasonal Affective Disorder (SAD)

The patient’s symptoms worsen during a specific time of the year (winter) and are associated with a dislike for the cold weather and the perception of the city as dark, grey, and miserable. These features suggest the possibility of SAD, a subtype of depression that occurs cyclically with the change in seasons (Munir & Abbas, 2022).

3.     Adjustment Disorder with Depressed Mood

The patient’s symptoms, such as low mood, difficulty concentrating, changes in sleep and appetite, and social withdrawal, maybe a reaction to a specific stressor or life event, such as leaving the business program at school and struggling with academic projects (O’Donnell et al., 2019). If the symptoms are considered to be a direct response to this stressor and do not meet the criteria for a major depressive episode, an adjustment disorder with a depressed mood may be a possible diagnosis.

Reflections:

I agree with my preceptor’s assessment and diagnosis of Major Depressive Disorder (MDD) for this patient. The patient presents with several hallmark symptoms of MDD, which have been present for a significant time, causing impairment in multiple areas of her life. The patient’s family history of depression also supports the possibility of a genetic predisposition. A comprehensive psychiatric evaluation, ruling out other possible medical causes, would be necessary to confirm the diagnosis.

This case taught me the importance of considering seasonal factors in mood disorders, specifically Seasonal Affective Disorder (SAD). The patient’s worsening symptoms during a specific time of the year and her negative perception of the weather and environment indicate the need to explore these factors and assess whether the symptoms meet the criteria for SAD (Munir & Abbas, 2022). Psychosocial factors such as the patient’s adjustment to a new environment and academic stressors must also be evaluated. Legal/ethical considerations, including confidentiality and obtaining appropriate consent for treatment, as well as the patient’s autonomy and involvement in treatment decisions, should be considered.

Social determinants of health, such as the patient’s age, ethnicity, and socioeconomic background, may influence her access to resources, and it is vital to address these factors when developing a treatment plan (Phuong et al., 2022). Health promotion and disease prevention efforts should involve educating the patient and her family about depression, strategies for managing symptoms, and encouraging healthy lifestyle behaviors. Additionally, a more thorough assessment of the patient’s social support network and psychosocial stressors and evaluation of any history of trauma or adverse childhood experiences could provide valuable insights into her current mental state.

NRNP 6635 Week3 Assignment Mood Disorders References

Bains, N., & Abdijadid, S. (2022). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Munir, S., & Abbas, M. (2022, January 9). Seasonal depressive disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568745/

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Phuong, J., Riches, N. O., Madlock?Brown, C., Duran, D., Calzoni, L., Espinoza, J. C., Datta, G., Kavuluru, R., Weiskopf, N. G., Ward?Caviness, C. K., & Lin, A. Y. (2022). Social determinants of health factors for gene–environment: Challenges and opportunities. Advanced Genetics, 3(2), 2100056. https://doi.org/10.1002/ggn2.202100056

Week 3: Mood Disorders

While most people experience the sadness or grief at some point in their lives, it is typically of short duration and may occur in response to some type of loss. Clinically significant depression, on the other hand, is more disruptive and serious. It lasts longer and has more symptoms that interfere with daily functioning.

This week, you will explore the differences among mood disorders such as depressive, bipolar, and related disorders, and you will examine challenges in properly differentiating among them for the purpose of accurately rendering a diagnosis. You also will look at steps that can be taken to increase the likelihood that patients who are diagnosed with these disorders benefit from treatment and refrain from physically harming themselves or others.

Learning Objectives

Students will:

• Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
• Formulate differential diagnoses using DSM-5 criteria for patients with mood disorders across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2013). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm03

American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

• Chapter 8, Mood Disorders
• Chapter 31, Child Psychiatry (Section 31.12 only)

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2015). Bipolar disorders [Video]. Walden University.

Classroom Productions. (Producer). (2015). Depressive disorders [Video]. Walden University.

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00:00:00BEGIN Transcript: 

00:00:00DIAGNOSING MENTAL DISORDERS 

00:00:00DSM-5® AND ICD-10 

00:00:05DEPRESSIVE DISORDERS 

00:00:10JIM HARRIGAN Our mood can often shape our perception of our own situation. The perceptions of our world can influence our overall state of happiness and wellbeing just as much, if not more than the circumstances we find ourselves in. For those people with mood disorders, this can be a harrowing concept, since the individual psychological disorder can make it hard or even impossible for a person to see their circumstances in a favorable light. This is especially true of patients with depressive disorders, a subset of mood disorders, in which the individual experiences episodes of sorrow, lethargy, and even a complete lack of energy and excitement about life. 

Mood is defined as the prolonged emotions that color a person’s perceptions of the world. Within this category of mood disorders, are two groups of disorders. These are depressive disorders, and bipolar and related disorders. Both of these groups share the common trades of mood disorders. However, well, bipolar and related disorders feature manic or hypomanic episodes and symptoms, in which the individual feels elated and energized. Depressive disorders are marked by major depressive episodes or symptoms, in which the individual has difficulty enjoying life. These symptoms can manifest themselves in a variety of disorders, differing in duration, timing, underlying causes, and other more subtle specifics. 

00:02:00DSM-5® AND ICD-10 CODING 

00:02:05JIM HARRIGAN The depressive disorders grouping in the fifth edition of the Diagnostic and Statistical Manual of mental disorders or DSM-5 contains a number of distinct disorders, each given it’s own unique diagnostic code. These codes correspond to the codes used by the World Health Organization in the International Classification of Diseases or ICD. In DSM-5, each disorder is first linked to the coding system from the ICD-9 with the codes for the ICD-10 listed in parenthesis after. Hence, all of the DSM codes crosswalk to the ICD codes, including the newest iteration ICD-10.

For instance, major depressive disorder with a single episode, mild, is assigned the code 296.21 from the ICD-9 and F32.0 in parenthesis from the ICD-10. This is because the ICD-9 system was still in use when DSM-5 was first released. ICD-10 was released in the fall of 2015, in the United States, although it was adopted previously in other countries. However, because ICD-10 is now the standard in the United States, this program will be listing the newer code from ICD-10 first, followed by the ICD-9 codes in parenthesis.

The coding for other specifications of major depressive disorder depends on, if the episode is single or recurrent, and can be further delineated by descriptors to indicate the episode’s severity, if it had psychotic features, the stage of remission that it is in, or if it is unspecified. The appropriate order is, the name of the disorder, if it is a single or recurrent episode, severity psychotic remission specifiers, followed by any additional specifiers. Sometimes, when relevant, we will also delineate the ICD-9 and 10 codes, when we mention a disorder from one of the other chapters of DSM-5. 

For example, to use one of the bipolar and related disorders mentioned earlier in this program, Bipolar I disorder, with the current or most recent episode manic and mild, is coded as F31.11 (296.41), part of the F30 to F39 section of the ICD-10 on mood affective disorders. Organizationally, there are few differences between the layouts of the DSM-5 and the ICD-10. The ICD-10 puts depressive disorders into their larger section on mood affective disorders in their F30 to F39 block. And many of the depressive and bipolar disorders that are separate in DSM-5 are mixed together in the ICD-10. For example, dysthymia, referred to as persistent depressive disorder (Dysthymia) in DSM-5, and cyclothymia, a bipolar related disorder in DSM-5, are both placed in the F34 section of the ICD-10 for persistent mood affective disorders.

While the ICD-10 grouping of all mood disorders into a larger section may seem like a minor organizational difference. It does further illuminate the underlying similarities between depressive and bipolar disorders, which we will highlight throughout this program and in that on bipolar disorders. Two other major differences are with substance or medication-induced depressive disorder. And depressive disorder due to another medical condition. The ICD-10 puts what they call mental and behavioral disorders due to psychoactive substance abuse in the F10 block. And organic, including symptomatic disorders in the F00 to F09, specifically F06, or other mental disorders due to brain damage and dysfunction and to physical disease. In this case, the code is for FO6.3 for organic mood affective disorder. 

00:06:55MAJOR DEPRESSIVE DISORDER 

00:07:00JIM HARRIGAN Major depressive disorder is the most prevalent of the depressive disorders affecting 7 percent of the population. This can be even higher in females, since they experience a 2:1 preponderance to males. However, despite the high prevalence, only one out of three individuals experiencing major depressive disorder seek treatment. An individual with major depressive disorder may experience a depressed mood, loss of pleasure, fatigue, problems with sleeping, weight loss, and more, happening for the majority of time during a specific time period lasting at least two weeks. This is categorized as a major depressive episode, one of three mood episodes, because this episode is such a significant aspect of the diagnosis for major depressive disorder. We will first take a closer look at mood episodes, then major depressive episodes, before further exploring how these episodes tie into a diagnosis of major depressive disorder.

00:08:15SCHIZOPHRENIA 

00:08:15FUNDAMENTAL CHARACTERISTICS 

00:08:20JIM HARRIGAN A mood episode is a specific period of time where an individual feels abnormally energized and elevated, or alternatively depressed. The presence and repetition or lack there of, of these episodes affects the coding of the disorder. But even beyond that, these mood episodes can be considered the basis of some disorders, as they are for major depressive disorder. In addition to depressive episodes, there are manic episodes in which the individual experiences at least a week of increased energy or activity and the less severe hypomanic episodes which feature the same symptoms, but to a less debilitating extent.

For both of these episodes, the individual may experience racing thoughts, a need for less sleep, overly increased self-esteem, distractibility, or excessive poor judgment regarding dangerous activities among other symptoms. While these are worth mentioning to contrast them against a major depressive episode, the presence of a manic or hypomanic episode will change the patient’s diagnosis to a bipolar or a related disorder. And so we will explore them in greater detail in our program on bipolar disorders. 

00:09:50MAJOR DEPRESSIVE EPISODE 

00:09:55JIM HARRIGAN A major depressive episode has a number of characteristic features, which take place most of the day, nearly every day, where relevant. The two main characteristics are a depressed mood, and a noticeably decreased interest in most activities. Other characteristics include trouble sleeping, diminished hunger or pronounced weight loss, trouble concentrating or making decisions, fatigue or loss of energy, recurring suicidal thoughts with or without intent to act on these thoughts, feelings of worthlessness or excessive or inappropriate guilt, psychomotor agitation or retardation, and feelings of low self-worth or pronounced guilt. These symptoms must cause marked distress in the patient’s work or social life. For all of these episodes the clinician should ensure that the symptoms are not better explained by another medical condition or by the affects of a substance. 

00:11:00HANNAH HUFF No, I know, I don’t think that there is a normal response. How are you supposed to get over something like this? He was here and now he’s gone. He’s just not around anymore. This… he was a person who’s, who’s life is just gone. 

00:11:20JIM HARRIGAN For a major depressive episode, the clinician should carefully consider its part in the diagnosis, if the patient has recently experienced a significant loss. While the DSM-4 allowed for a bereavement exclusion, this is absent in the DSM-5. Some clinicians claim this is because depression linked to the death or a loss of a loved one, doesn’t greatly differ from other causes of depression. Still, in these cases, the clinician should factor in cultural norms, the patients history, the severity of the symptoms, and whether or not the patient seems to improve before making their diagnosis. There are ways for the clinician to distinguish between grief and a major depressive episode. Grief decreases over time, and may become more present when thinking of the deceased. A major depressive episode on the other hand, is more constant and persistent, and does not include the ability to experience joy, which is still present throughout the grieving process. 

00:12:30MAJOR DEPRESSIVE DISORDER 

00:12:30FUNDAMENTAL CHARACTERISTICS 

00:12:35JIM HARRIGAN Major depressive disorder involves experiencing a major depressive episode, which causes significant impairment for the individual’s work and social life. These episodes last on average from six to nine months but can go for as long as years in some individuals. A major depressive episode can be quoted as a single episode or recurrent. A single episode means that only one episode occurs during the patient’s lifetime. As always, it is important that the clinician rule out that the condition is not better explained by other disorders. The physiological affects of the substance or another medical condition. If a depressive disorder is induced by another medication, a diagnosis of substance/medication-induced depressive disorder maybe given. And if it is caused by a medical condition, the clinician can give the diagnosis of depressive disorder due to another medical condition. The clinician is also able to specify the presence of psychotic features, the state of remission, and severity, as mentioned previously. 

00:13:45MAJOR DEPRESSIVE DISORDER 

00:13:45SPECIFIERS 

00:13:50JIM HARRIGAN There are numerous specifiers the clinician can add to the diagnosis. These will allow the clinician to include extra detail and information to the diagnosis, which can potentially help future clinicians in understanding the patient. For example, the specifier with anxious distress can indicate that the patient has experienced feelings of foreboding, agitation, or tension, intense worry leading to trouble concentrating, or the feeling that they may lose control of themselves during the majority of their most recent episode. In addition to with anxious distress, other potential specifiers include but are not limited to, with mixed features, with catatonia, with peripartum onset, and with seasonal pattern. 

00:14:45PERSISTENT DEPRESSIVE DISORDER 

00:14:45(DYSTHYMIA) 

00:14:50JIM HARRIGAN Persistent depressive disorder, also referred to as dysthymia, is characterized as a depressed mood that lasts for at least two years. This occurs during the majority of days during this time period. While the possible symptomatology of persistent depressive disorder isn’t quite as extensive as it is for major depressive disorder, patients with dysthymia can experience a range of severity. Many of the characteristics are similar to that of major depressive disorder, difficulty concentrating, problems with sleep, poor self-esteem, poor appetite, low energy, and feeling hopeless. 

00:15:35PERSISTENT DEPRESSIVE DISORDER 

00:15:35SPECIFIERS 

00:15:40JIM HARRIGAN A patient with persistent depressive disorder may or may not have a major depressive episode for all or some of the period of symptoms. In addition to the specifiers available for major depressive disorder, allowing the clinician to indicate severity, the state of remission, and other features, there are also specifiers to signify the role of major depressive episodes in the disorder. A patient who for two years, has not experienced any major episodes can be said to have persistent depressive disorder with pure dysthymic syndrome. If, in the last two years, a patient has met the characteristics for a major depressive episode, then the specifier with persistent major depressive episode can be applied. 

If the patient is currently experiencing a major depressive episode, but has had periods of around two months, without qualifying for a full episode, the clinician should use the specifier with intermittent major depressive episodes, with current episode. And if they aren’t currently experiencing a major depressive episode, but have had one or more in the last two years, the clinician should use with intermittent major depressive episodes, without current episode. The clinician can also indicate if the onset of dysthymia happened early onset or before the age of 21, or late onset if the symptoms happened later than age 21. 

00:17:15DIFFERENTIAL DIAGNOSIS AND COMORBIDITY 

00:17:20JIM HARRIGAN Some alternatives to consider with persistent depressive disorder ar

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