Our Previous Samples

NRNP 6635 Case History Reports Example 2

Week 4: Anxiety Disorders, PTSD, and OCD

Training Title 15

Name: Mr. David Jackson Gender: male

Age:19 years old

T- 98.8 P- 89 R 18 110/62 Ht 5’7 Wt 133lbs

Background: Lives in Minneapolis, MN with both of his parents, only child. Works part time at Starbucks. Not currently partnered. No previous psychiatric history. Symptoms began in the last

1.5 months when he discovered he is being activated with the Navy Reserves. His MOS is SK1 Storekeeper; no medical illnesses Allergies: NKDA; sleeps 6.5 hrs; appetite good

Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-15

Training Title 21

Name: Sergeant Patrick Flanrey Gender: male

Age:27 years old

T- 97.4 P- 84 R 18 B/P134/88 Ht 5’8 Wt 167lbs

Background: He entered the military just after high school and did three long tours of duty in warzones. He separated from active duty in the Marines (MOS 0800 Field Artillery) less than a year ago after eight years of service. He is engaged to be married (no date set) and is currently working as a furniture salesman. He said he grew up poor and would not do much else if

he didn’t go into the military. He denies ever using any drugs and avoids alcohol because his

father was “sloppy drunk.” Father is still alive, unwell (DM, liver disease, HTN), still

drinking. Paternal grandfather was also a veteran and suffered depression at times though he never told anyone except the patient because of their combat connection. Mother is alive and well, still “caring for dad.”  He has one younger and one older sister. He lives in a different state, approximately five hours from his parents and siblings. After the military, he and his fiancé moved because she got a much better opportunity. They want kids someday and hope to marry

in a year or two. Has service-connected asthma, seasonal allergies; no hx of psychiatric or substance use treatment.

Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-21

Training Title 37 Name: Mr. Tony Patelli Gender: male

Age:18 years old

T- 98.8 P- 94 R 20 126/88 Ht 5’4 Wt 131lbs

Background: Lives alone in New York, raised by parents in New Jersey, only child. He is a full- time student at local community college for graphic design. Has a girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of psychiatric treatment; denied drugs or alcohol; Allergies: NKDA; sleeps 7.5 hrs; appetite eats 3 meals/day, likes to keep a routine schedule.

Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-37

Training Title 40

Name: Ms. Barbara Weidre Gender: female

Age: 56 years old

T- 99.0 P- 99 R 24 132/89 Ht 5’4 Wt 168lbs

Background: Lives with her husband in Knoxville, TN, has one daughter age 23. She has never worked. Raised by mother, she never knew her father. Mother with hx of anxiety; no substance hx for patient or family. No previous psychiatric treatment. Has one glass red wine with dinner. Sleeps 10-12 hrs; appetite decreased. Has overactive bladder, untreated. Allergic to Phenergan; complains of headaches, takes prn ibuprofen, has diarrhea once weekly, takes OTC Imodium.

Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-40

Training Title 55 Name: Matilda Johnson Gender: female

Age: 9years old

She refused vitals, ht and wt

Vaccinations are up to date; on target with developmental milestones. Appetite, she is a picky eater per mom. NKDA

Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-55

Training Title 85

Name: Mrs. Carol Holliman Gender: female

Age: 42 years old

T- 98.0 P- 77 R 18 132/72 Ht 5’0 Wt 127lbs

Background: Born and raised in Northern Ireland, parents brought her and her 5 sisters to U.S. when she was 15 to go to U.S. university where she met her husband. They live in Charleston, SC. She obtained her bachelor’s degree in education; no history of mental health or substance use treatment, no family history. Her husband reported a recent school shooting nearby 3 weeks ago “flipped a switch” in her. She is watching the news 24/7, barely sleeping, and even when she does, it is only a few hours, Appetite is decreased. Hx of hysterectomy, NKDA, no legal hx.

Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-85

Training Title 95

Name: Ms. Zahara Williams Gender: female

Age: 23 years old

T- 97.5 P- 86 R 18 112/64 Ht 5’2 Wt 130lbs

Background: Born and raised in Jacksonville, FL with her mother and 2 older brothers; her mother has hx of anxiety, brothers hx of cannabis; no previous mental health treatment, no medications; NKDA; no legal hx;  sleeping 7 hrs; Appetite is good.

She has an associate of arts degree and works for Amazon warehouse. She has DX of diabetes since age 5. She recalls having great difficulty with her medical condition (uncontrolled blood sugar, fighting with mother over needle sticks, “kids want candy, and I was so different because of my diet”). She recalls having a difficult relationship with her mother who was a nurse and

really worked hard to control her daughter’s diabetes. She is not in a relationship, identifies as lesbian but has not come out to the family. Only her closest co-workers know she is gay, and she doesn’t plan to come out in the near future. She stated, “I don’t see why I would, they wouldn’t understand, and this is not important right now.”

Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-95

Week 7 Schizophrenia and Other Psychotic Disorders; Medication- Induced Movement Disorders

Training Title 9

Name: Ms. Nijah Branning Gender: female

Age: 25 years old

T- 98.4 P- 80 R 18 128/78 Ht 5’0 Wt 120lbs

Background: Raised by parents, lives alone in Santa Monica, CA. Only child. Works in office supply sales, has a bachelor’s in business degree. Has medical history of hypothyroidism, currently treated with daily levothyroxine. Guarded and declined to discuss past psychiatric history. Denied family mental health issues, declined to allow you to speak to parents for collaborative information. Allergies: medical tape; menses regular

Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-9

Training Title 24

Name: Ms. Jess Cunningham Gender: female

Age: 28 years old

T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs

Background: Jess is brought for evaluation by her 2 roommates who are concerned with behaviors that began 12 days after Jess’s younger brother committed suicide in front of her via GSW after his girlfriend broke up with him. She is estranged from her parents and her brother was her only sibling. She is only sleeping 1–2 hours/24hrs; she will only canned foods. She smokes cannabis daily since she was 16, goes out on weekdays 2–3 times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg twice daily as needed by her PCP for 15 days. She works as a bartender.

Symptom Media. (Producer). (2016). Training title 24 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-24

Training Title 29 Name: Mr. Jay Feldman Gender: male

Age:19 years old

T- 98.3 P- 69 R 16 106/72 Ht 5’7 Wt 117lbs

Background: European-American male. He has two younger brothers, one with history of ADHD, the other with history of anxiety. His mother has anxiety; his father has paranoia schizophrenia. He is home for spring break. He has no previous medical problems.

Developmental milestones met as child. Appetite is inconsistent and it seems he has lost 18lbs since first going back to school in the fall. Jason has not acted this way before but did have a short trial of aripiprazole in the last six months of high school for mild paranoia. He stopped the medication after graduation as he could not tolerate due to side effects of akathisia. Jason has several friends but has not kept in touch with them since being back home. He has not been showering. Sleeping 4–5 hrs.

Symptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-29

Training Title 134

Name: Mrs. Bunny Warren Gender: female

Age: 33 years old

Background: Bunny was brought in by her best friend, Patty, after the police responded to her home the fifth time today. The police was threatening to arrest her for misuse of the 911 system, Bunny called you and you informed the police she needed to go the emergency room.

She has been calling 911 saying people are looking in her windows, standing across the street watching her, stated they are watching for her husband to return home so they can hurt him. Today, she has a stomachache. She believes there is a snake inside of her stomach which she would like to have removed. She stopped eating 2 days ago because of this.

During the assessment, the patient seemed on edge, anxious, and paranoid. The patient has history of scoliosis. This is her third presentation to this hospital, she had one psychiatric admission 2 years ago. No self-harm behaviors but has been physically aggressive toward others in the past. She is guarded and refuses to answer questions whether there are memory or concentration problems. She denies any recent head injuries. She states that she has been sleeping nightly, one or two hours at a time and waking up throughout the night. Refuses labs, refuses to have her vital signs obtained.

She obtains SSDI. She lives in Atlanta, GA. Bunny denies ever using any drugs and drinks occasionally, once a month. She has a sister who is ten years older, both parents deceased in the last two years. She has no children, her husband is out of town, truck driver. Family history includes that her father had two previous inpatient psychiatric hospitalizations after bad drug experiences in the 1970s, for one week each time. Mother had diagnosis and ongoing treatment for depression. Her paternal grandmother was state hospitalized for several years.

She denies any past history of traumatic experiences, but her friend does say that losing her parents was hard for her emotionally. No history of military service. No legal issues currently. Has HS diploma. Allergies: haloperidol

Symptom Media. (Producer). (2018). Training title 134 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-134

Week 8 Substance-Related and Addictive Disorders

Training Title 82 Name: Lisa Pittman Gender: female Age: 29 years old

T- 99.8 P- 101 R 20 178/94  Ht 5’6 Wt 140lbs

Background: Lisa is in a West Palm Beach, FL detox facility thinking about long term rehab. She has been smoking crack cocaine, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 2–3 alcohol drinks once weekly. She has past drug possession and theft convictions; currently on 2 yr probation with randomized drug screens.

She tries to find the pattern for the calls in order not to test dirty urine. Her admission labs abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. Negative for alcohol or other drugs. BAL 0; other labs within normal ranges. She reports sexual abuse as child ages 5–7, perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Alabama, hx of anxiety, benzodiazepine use. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 4-5 hrs, appetite decreased, prefers to get high instead of eating. Allergies: amoxicillin

She is considering treatment for her Hep C+ but needs to get clean first.

Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-82

Training Title 114 Name: Ally Patel Gender: female Age: 48 years old

Background: Only child, raised by parents in San Francisco, CA. Has PhD in biology and

master’s degree in high school education (8–12). Her supervisor has asked the school EAP

counselor to intervene with concerns regarding potential substance use in effort to facilitate getting her help and be able to retain her.

Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-114-2

Training Title 151 Name: Katarina Bykov Gender: female Age:41 years old

T- 97.4 P- 74 R 120 100/70 Ht 5’8 Wt 117lbs

Background: Moved to Washington State from Russia with her parents when she was 12 years old. She has 2 brothers, 2 sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. Has chronic pain issues. She works part time cashier at Aldi Grocery Store. Dropped out of high school in 11th grade. Sleeps 4–9 hours on average, appetite good.

Symptom Media. (Producer). (2018). Training title 151 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-151

Week 10 Neurocognitive and Neurodevelopmental Disorders

Training Title 48 Name: Sarah Higgins Gender: female

Age: 9 years old

T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs

Background: no history of treatment, developmental milestones met on time, vaccinations up to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does get proper nutrition per PCP.

Symptom Media. (Producer). (2017). Training title 48 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-48

Training Title 50 Name: Harold Griffin Gender: male Age:58 years old

T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs

Background:

Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime.

Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-50

Also Read: NRNP 6635 Case History Reports

NRNP 6635 Case History Reports

Week 3: Mood Disorders

Training Title 2

Name: Ms. Julie Houston Gender: female

Age:19 years old

T 98.1 P-78 R-18 119/74 Ht 5’2” Wt 184lbs

Background: Recently started a business undergraduate program in Boston, MA after growing up and living in South Carolina her whole life. Grew up with both parents, two brothers, and one sister. Currently lives in off-campus housing with two other female roommates. Currently a full-time student, not employed. Not married, currently single. She has no previous psychiatric history; takes no medications. There is no psychiatric or substance use history for her or family. No legal hx NKDA

Symptom Media. (Producer). (2016). Training title 2 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-2

Training Title 8

Name: Mrs. Leslie Tilman Gender: female

Age: 32 years old

T- 97.6 P- 97 R 22 149/98 Ht 5’3 Wt 245lbs

Background: Recently had her first child two months ago. Currently married; stay at home mother after working in retail for 5 years. Grew up with both parents, one sister in Omaha, NE. Completed education through bachelor’s level, studying physics. Previous employment included research science as well as high school substitute teaching for 5 years prior to birth. No previous suicidal gestures; has uncle who committed suicide via GSW. She denied drugs/alcohol; uncle was opioid abuser. Hx of HTN-prescribed labetalol 100mg twice daily, admits to missing doses due to forgetting. No legal hx. Allergies: codeine

Symptom Media. (Producer). (2016). Training title 8 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-8

Training Title 18

Name: Ms. Ashley Domingo Gender: female

Age:20 years old

T-97.9 P-68 R-18 118/82 Ht 5’1 Wt 120lbs

Background: Currently living off-base in California, active duty in the Army, MOS 92M Mortuary Affairs Specialist. Grew up in Houston, TX with both parents and one brother. Completed education through high school. Currently partnered. No children. Mother history of depression; brother hx of cannabis use. No medical history. No legal hx; NKDA

Symptom Media. (Producer). (2017). Training title 18 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-18

Training Title 28

Name: Mrs. Louise Carson Gender: female

Age: 49 years old

T- 98.8 P- 99 R 20 150/88 Ht 5’5 Wt 135lbs

Background: Currently living in Indianapolis, IN, working full-time as a logistics buyer in a medical facility. Has an MBA. Lives with her husband and three children, three boys who are all teenagers. Born and raised in Indianapolis, IN with her mother and two sisters. Father deceased in MVA when she was 2 years old. Sister has depression; mother has history of being a “functioning alcoholic”. Recently informed by her PCP she has a “fatty liver.” Allergies: latex

Symptom Media. (Producer). (2016). Training title 28 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-28

Training Title 38

(same patient in video 43 but presentation of his illness pre-hospitalization) Name: Mr. Will Loman

Gender: male Age:19 years old

T- 98.6 P- 94 R 24 128/78 Ht 5’7 Wt 152lbs

Background: Currently lives with his sister and two parents in Jacksonville, FL. Not currently employed. Completed high school, not currently in school. Hx of treatment for mood disorder began age 15, previous trials of Depakote, Olanzapine off and on, side effects of wt. gain. Has hx of a three-day hospitalization one year ago after found wandering on the side of the freeway, but he signed himself out ‘against medical advice.’ He refused medication due to previous experiences. Not currently partnered. He has been sexually inappropriate with comments to female neighbors; pulled his pants down in the mall. Denies any recent alcohol or substance use. Father has history of bipolar disorder. No history of self-harm behaviors, no

family suicides. Mother reports he has slept 2–3 hours in past week, up spending money buying and playing new video games and says he is writing a book on how others can be a video game master. Appetite is decreased. No medical hx; Hx of trespassing as a juvenile. Has pending court date for indecent exposure. Allergies: PCN

Symptom Media. (Producer). (2016). Training title 38 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-38

Training Title 43 – NRNP 6635 Case History Reports

(same patient in video 38 but presentation of his illness with hospital treatment)

Name: Mr. Will Loman Gender: male

Age:19 years old

T- 98.2 P- 74 R 18 120/70 Ht 5’7 Wt 156lbs

Background: Currently lives with his sister and two parents in Jacksonville, FL. Not currently employed. Completed high school, not currently in school. Hx of treatment for mood disorder began age 15, previous trials of Depakote, Olanzapine off and on, side effects of wt. gain. Has hx of a three-day hospitalization one year ago after found wandering on the side of the freeway, but he signed himself out ‘against medical advice.’ He refused medication due to previous experiences. Not currently partnered. He has been sexually inappropriate with comments to female neighbors; pulled his pants down in the mall. He is currently in hospital admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone 1mg at bedtime. Denies any recent alcohol or substance use. Father has history of bipolar disorder. No history of self-harm behaviors, no family suicides. Mother reports he has slept 2–3 hours in past week, up spending money buying and playing new video games and says he is writing a book on how others can be a video game master. Appetite is decreased. No medical hx; hospital admission labs within normal ranges, UDS negative; Hx of trespassing as a juvenile. Has pending court date for indecent exposure. Allergies PCN

Symptom Media. (Producer). (2016). Training title 43 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-43

Training Title 150 Name: Ms. Liliana Ball Gender: female Age:16 years old

T- 97.4 P- 84 R 18 134/88 Ht 5’3 Wt 118lbs

Background: Currently living with her parents in Tacoma, WA along with two young siblings. She is a sophomore in high school, not currently partnered, reports she is bisexual, lately having lot of unprotected sex that her parents don’t know about. She has been stealing money out of her mom’s purse to buy clothes, makeup, “and just other things.” She has history of treatment since age 7 for conduct disorder, depression, history of taking sertraline which worsened her irritability, aggression, impulsivity.

She has been in a 3-month teen residential mental health facility discharged one month ago with lithium 300mg in am and 600mg at bedtime, aripiprazole 10mg in the morning. When discharged, her labs were within normal ranges and urine toxicology negative. She was positive for cannabis upon admission. Her parents believe she is hiding her medication as she has made comments “they slow me down; they crush my creative art.”

She has hx of domestic violence toward her mother and 2 younger sisters as juvenile. No current legal issues. Her grandmother has hx of bipolar disorder; her mother and her maternal aunt have anxiety. She is sleeping 3–4hrs/24 hrs. Reports her appetite “is great.” She has no medical issues; has Nexplanon implant; hx of self-harm with cutting.

Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-150

Training Title 118 Name: Mr. Oscar Luna Gender: male

Age: 52 years old

T- 98.6 P- 90 R 24 140/84 Ht 5’8 Wt 170lbs

Background: Born and raised in Leopold, IN. Is staying at a shelter after being homeless in MacArthur Park for 1 year in Los Angeles. He lost his apartment and his job working part-time as a dishwasher. Enjoys playing music. He has long hx of mental health treatment since age 14. Previous medication trials include lithium (toxicity), Depakote (wt gain), aripiprazole (akathisia), risperidone (dystonia), haloperidol (didn’t give a fair trial), quetiapine (wt gain), reports in past helpful medication was lurasidone, lamotrigine, olanzapine but states “they really squash my creative song writing though.”

Poor historian. Never married, reports he is gay, no children; estranged from only living sister, parents deceased. He is not sure of his family mental health or substance use history but feels like he is most like his aunt, she has history of mental health treatment “but I’m not sure for what.” States that he got a master’s degree in music theory at Stanford. Admits to 1–3 drinks of alcohol when “playing music in the clubs”, denied illicit drugs, has history of overdose at age 28, history of 3 inpatient psychiatric hospitalization, most recent was 1 year ago. Allergies: doxycycline; hx of rosacea.

Symptom Media. (Producer). (2018). Training title 118 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-118

Training Title 144 Name: Ms. Amy Hartford Gender: female

Age: 32 years old

T- 98.2 P- 74 R 18 120/70 Ht 5’1 Wt 150lbs

Background: Currently lives in Phoenix, AZ, divorced with two children ages 10 and 8. Born and raised in Tucson, AZ with her mother and four sisters NKDA; no legal hx

Symptom Media. (Producer). (2018). Training title 144 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-144

NRNP 6635 Week 3: Assignment

ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS

Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

TO PREPARE:

• Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.
• Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document. 
• By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient. 

BY DAY 7 OF WEEK 3

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 
• Objective: What observations did you make during the psychiatric assessment?? 
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Reflection notes: What would you do differently with this client if you could conduct the session over??Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Video Case Selections for this Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected. 

• Symptom Media. (Producer). (2016). Training title 2.[Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-2
• Symptom Media. (Producer). (2016). Training title 8 https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-8
• Symptom Media. (Producer). (2017). Training title 18. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-18
• Symptom Media. (Producer). (2016). Training title 28.[Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-28
• Symptom Media. (Producer). (2016). Training title 38. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-38
• Symptom Media. (Producer). (2016). Training title 43. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-43
• Symptom Media. (Producer). (2018). Training title 118. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-118
• Symptom Media. (Producer). (2018). Training title 144. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-144
• Symptom Media. (Producer). (2018). Training title 150. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-150
• Document: Case History Reports

NRNP 6635 Case History Reports Week 3: Assessing and Diagnosing Patients with Mood Disorders Example

Subjective:

CC (chief complaint): “Yeah, yesterday I was a little bit depressed, but it was just because I was in a bad mood.”

HPI: Ms. C.L. is an 18-year-old female who presents to the psychiatric clinic for a psychiatric evaluation for depression. She had been admitted to a mental health facility and discharged on lithium 300 mg in the morning and 600 mg during bedtime, and aripiprazole 2.5 mg in the morning. She has a history of taking citaprolam, which worsened her impulsivity, aggression, and irritability symptoms.

The patient agrees that the previous day she left a little depressed, as it is human nature to change moods. The parents reported that she had started crying and said she did not want to participate in more school plays. Additionally, they reported that she had lost her energy and had said she was worthless, thought she was destroying everyone’s life, and wanted to die. She refers to these reports as ancient history. These symptoms had only lasted for almost a week.

Past Psychiatric History:

•       General Statement: She entered treatment for depression and conduct disorder at 9 years. She was also admitted to a residential mental health facility and discharged three months ago.
•       Caregivers (if applicable): N/A
•       Hospitalizations: Residential Mental Health Facility
•       Medication trials: N/A
•       Psychotherapy or Previous Psychiatric Diagnosis: Conduct disorder, depression

Substance Current Use and History: She tested positive for cannabis on admission.

Family Psychiatric/Substance Use History: The grandmother has a history of bipolar disorder. Her mother and aunt have a history of anxiety.

Psychosocial History: The client lives in Locust Grove, Oklahoma, with her parents, two younger sisters, and an older brother.

Medical History:

•       Current Medications: She is on lithium 300 mg in the morning and 600 mg during bedtime, and aripiprazole 2.5 mg in the morning.
•       Allergies: N/A

• Reproductive Hx: She is not partnered and has no children. She is bisexual, and lately, she has been hyper-sexual with increased incidents of unprotected sex.

ROS:

•       GENERAL: No apparent signs of loss of weight, fatigue, chills, or weakness.
•       HEENT: Eyes: No loss of vision, diplopia, or yellowing of the sclera. Ears: No loss of hearing or discharge from ears. Nose & Throat: No sore throat, runny nose, congestion, or sneezing.
•       SKIN: No itching or rash.
•       CARDIOVASCULAR: No reports of chest pressure, chest pain, or chest discomfort. No edema or palpitations.
•       RESPIRATORY: No cough, shortness of breath, or sputum.
•       GASTROINTESTINAL: No reports of nausea, vomiting, diarrhea, abdominal pains, or blood in the stool.
•       GENITOURINARY: No odd urine color, odor, or burning sensation on urination.
•       NEUROLOGICAL: No reports of dizziness, paralysis, ataxia, headache, or tingling sensation of the extremities. Bowel and bladder control has not changed.
•       MUSCULOSKELETAL: No back pains, joint pain, muscle pain, or stiffness of joints.
•       HEMATOLOGIC: No history of bruising, bleeding, or anemia.
•       LYMPHATICS: No history of splenectomy or enlargement of the lymph nodes.
•       ENDOCRINOLOGIC: No reports of heat or cold intolerance. No reports of sweating. No polydipsia or polyuria.

Objective:

Physical exam: N/A

Diagnostic results: Toxicology reports indicates traces of Cannabis sativa

Assessment

Mental Status Examination:

The patient is well-groomed and dressed appropriately for the weather outside. She is clothed appropriately for her age. She has good hygiene. During the interview, the patient had a laid-back and obedient demeanor. She speaks clearly, with enough volume, at a regular tempo, and with a wealth of vocabulary. She seems dysphoric in her overall mood.

Observation reveals that the client is uneasy; she constantly moves and looks around the space. No reported cases of delusion exist. The patient is quickly distracted by other outside occurrences and is not totally engaged in the inquiries. She enquires about the wall decorations and the interviewer’s preference for travel. Her apparent flight of ideas is evidenced by the fact that she swiftly diverts the conversation from the current topic. She does not have any perception issues.

The patient is alert and oriented X4 (to person, time, place, and situation). She is having trouble concentrating; she cannot name the months of the year backward. She mentioned November and December but could not say whether June or July came next. She could recall all the numbers she was asked to repeat: 4, 6, and 9. Her short-term memory is still intact. She answered accurately that she had eaten oats, milk, and pancakes that morning, demonstrating that her memory for the recent past was outstanding. 

She remembered her favorite character from an animation she had watched in the past because her long-term memory was still intact. Her ability to reason abstractly was excellent. She correctly identified the book when asked to choose the odd item from bread, butter, and a book list. The fact that butter and bread were considered foods, while the book was not, was another strong argument for her belief that it was odd. The patient has no understanding of her condition. She made wise decisions. When asked what she would do if she discovered her dog stuck behind a door, she replied that she would contact her parents for assistance in releasing the dog.

Primary diagnosis

Major depressive disorder

The patient has not been happy lately and self-reported that she has been a little depressed. The parents also report that she is uninterested in attending the school plays. She also sleeps an average of 2 to 3 hours in 24 hours, indicating insomnia. The parents also reported that she had a loss of energy. She is also experiencing feelings of worthlessness and recurrent thoughts of death. All these symptoms point to a definite diagnosis of major depressive disorder. 

The DSM V TR requires that five or more of the definite symptoms of MDD exist in the same 2-week period and should indicate a change in functioning. One of the symptoms must be a loss of interest in activities or a depressed mood. The five symptoms that make the diagnosis pertinent are a depressed mood for most of the day, diminished interest, insomnia, loss of energy, feelings of worthlessness, and recurrent thoughts of death (American Psychiatric Association, 2022). All these criteria are indicative of Major Depressive Disorder.

Critical thinking process

My critical thinking considered several important factors while deciding on Major Depressive Disorder as the significant diagnosis. I carefully examined the client’s past, taking note of any history of self-harm or other depressive symptoms, including poor mood, feeling unworthy, and wanting to die. I also looked at the client’s psychosocial issues, such as their history of conduct disorder, drug use, and mental health illnesses in the family.

I could recognize a pattern of symptoms compatible with the diagnosis of Major Depressive Disorder by fusing these pieces of information and contrasting them with the diagnostic standards for this condition. I chose to diagnose the client with major depressive disorder using my critical thinking process to assess their presentation in the context of their psychosocial history and symptoms.

Differential Diagnoses

Substance-induced depressive disorder

Criteria A for this diagnosis requires that the client presents with a persistent and prominent mood disturbance characterized by a depressed mood or a diminished interest in all or almost all activities (American Psychiatric Association, 2022). She presents with a loss of interest in participating in school plays and admits that she is a little depressed, making this differential diagnosis probable. Criteria B requires that the evidence from the findings show that the client developed the symptoms due to withdrawal or after exposure (American Psychiatric Association, 2022). However, the client does not present with withdrawal symptoms despite the toxicology report showing that she had consumed cannabis sativa.

Borderline personality disorder

The client presents with unstable interpersonal relationships; she has a history of domestic violence against her brother and self-harm, which she engaged in 6 months ago. Medications had worsened her impulsivity. Her parents also believe that she has been hiding her medications because she thinks they slow her down and make her not think fast, showing instability in her self-image.

The diagnostic criteria for this condition require a history of identity disturbance and impulsivity in two potentially self-damaging areas; she is engaging in substance abuse and unprotected sex and has a history of self-mutilating behavior (Boland et al., 2022). She also feels empty as she says she is worthless and wants to die. All her symptoms meet the criteria for Borderline personality disorder as a differential diagnosis.

Disruptive mood dysregulation disorder (DMDD)

The client has a history of conduct disorder and domestic violence towards her sibling, probably because of anger outbursts. The history of taking citalopram worsened her irritability, aggression, and impulsivity, making DMDD to be a potential differential diagnosis. Severe recurrent temper outbursts three or more times per week, a hallmark of DMDD, are absent. Although the client has a history of violence, irritability, and conduct disorder, the evidence does not particularly point to severe recurrent temper outbursts as defined by the criteria for DMDD.

Reflection

Working on this case study has taught me more about the intricacy of mood disorders and how they affect a person’s life. This case demonstrated the value of a thorough evaluation that takes the client’s history, family relationships, and consumption of drugs into account. I have also understood the importance of a therapeutic alliance in fostering openness and trust. I would ensure regular interaction and collaboration with the interdisciplinary team to understand the client’s needs comprehensively.

I would prioritize continuing my education in mood disorders, particularly the diagnostic standards and research-supported treatments. To effectively serve the client, I would also focus on developing my therapeutic communication and crisis management abilities. Overall, this experience has highlighted the necessity for a caring and tailored approach to care and the constant learning process.

Working with this client has increased my awareness of the ethical and legal concerns surrounding providing for them. Handling these issues while upholding the client’s dignity, liberty, and privacy is critical. Along with confidentiality and informed consent, it is essential to carefully manage issues like required reporting of domestic abuse and self-harm risk while maintaining the client’s best interests in mind (Ventura et al., 2020).

To provide comprehensive care, it has become essential to comprehend the social determinants of health. Interventions should assist the client’s passage to adulthood and address the educational requirements, given that she is a senior in high school. Their ethnicity may also impact their cultural values and health-seeking habits, necessitating culturally competent treatment to build rapport and successful communication.

Disease prevention and health promotion strategies should be adapted to the client’s risk factors. Substance abuse treatment options, access to contraception, and education about safer sexual practices are all necessary because of substance use and unsafe sexual behaviors. Given the history of conduct disorder, interventions emphasizing anger management and coping mechanisms may be advantageous.

It is crucial to consider any financial limitations that can limit the client’s access to services and treatment while also considering their socioeconomic background. Collaboration with community organizations and social service agencies could offer extra assistance. A supportive atmosphere can be fostered, and family difficulties, such as the reported domestic abuse, can be addressed by including the client’s family in the care process.

Reflecting on this incident, I recognize the need for a thorough, patient-centered strategy. It necessitates a thorough awareness of risk factors, socioeconomic determinants of health, and legal/ethical issues. I may enhance the client’s general well-being and enhance the results of their health therapies by critically assessing these elements.

NRNP 6635 Case History Reports References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Boland, R. J., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2020). Nursing care in mental health: Human rights and ethical issues. Nursing Ethics, 28(4), 096973302095210. https://doi.org/10.1177/0969733020952102

Also Read: Borderline Personality Disorder Sample Paper

feelings of being out of control or anxious

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

 

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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.

_________________________________________________________________ 

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

NRNP-6640-14 Psychotherapy Individuals Week 1-2

Week 1: Foundations of Psychotherapy

While working with a patient in the late 1800s, Sigmund Freud discovered the health benefits of talking about emotions and illnesses. When Sigmund Freud introduced his “talking cure” (fundamental psychotherapy), his efforts were met with considerable skepticism. However, as more and more psychiatrists learned that Freud’s methods brought about change in patients who suffered from a variety of mental health issues, his methods were adopted and refined. Today, psychotherapy is recognized as a viable treatment for a wide variety of mental health issues, many of which are examined throughout this course.

This week, as you explore the foundations of psychotherapy, you consider its biological basis. You also examine the influence of culture, religion, and socioeconomics on psychotherapy treatments.

NRNP-6640-14 Psychotherapy Individuals Week 1-2 Learning Resources

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 1 “Assessment” (pages 44 & 45)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 1, “The Nurse Psychotherapist and a Framework for Practice” (pp. 3–52)

Fournier, J. C., & Price, R. B. (2014). Psychotherapy and neuroimaging. Psychotherapy: New Evidence and New Approaches, 12(3), 290–298. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360/

Holttum, S. (2014). When bad things happen our brains change but psychotherapy and support can help the recovery of our brains and our lives. Mental Health and Social Inclusion, 18(2), 52–58. doi:10.1108/MHSI-02-2014-0006 

Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/psychiatric-and-mental-health-nursing.php

Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

Document: Midterm Exam Study Guide (Word document)

Document: Final Exam Study Guide (Word document)

Required Media

Laureate Education (Producer). (2016). Introduction to psychotherapy with individuals [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player

Laureate Education (Producer). (2015e). Therapies are helpful: Dodo bird conjecture [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

Note: The approximate length of this media piece is 2 minutes.

Accessible player

Credit: Provided courtesy of the Laureate International Network of Universities.

Laureate Education (Producer). (2015f). Therapies change and integrate different approaches over time [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

Note: The approximate length of this media piece is 1 minute.

Accessible player

Credit: Provided courtesy of the Laureate International Network of Universities.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2012). Clinical interview: Intake, assessment, & therapeutic alliance [Video file]. Mill Valley, CA: Psychotherapy.net.

Sommer-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.

Discussion: Does Psychotherapy Have a Biological Basis?

Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis.

Learning Objectives

Students will:

• Evaluate biological basis of psychotherapy treatments
• Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments

To prepare:

• Review this week’s Learning Resources.
• Reflect on foundational concepts of psychotherapy.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.

Biological Basis and Ethical/Legal Considerations of Psychotherapy Example

Psychotherapy is a commonly used intervention in the management of mental health issues. It is often recommended as the first-line treatment before other options, such as psycho-pharmacotherapy in some conditions, such as anxiety. It is a collaborative treatment intervention that relies heavily on the care provider-patient relationship. Various types of psychotherapy include cognitive behavioral therapy and family therapy. Debates on the effectiveness of psychotherapy and the biological basis of psychotherapy exist. This essay evaluates the biological basis of psychotherapy and evaluates individual, group, and family therapy.

Psychotherapy has a biological basis, like psychopharmacological interventions, due to its therapeutic ability. Research affirms that psychotherapy changes brain connectivity and activity. Deits-Lebehn et al. (2020) state that well-perched psychotherapy provides adequate psychological stimulation, promoting new growth, neuron connectivity, and better blood supply. Research also shows that psychotherapy stimulates hormone release, which can be successful in offsetting negative emotions and moderating these emotions, such as over-excitation (arousal) and stress (depression) (Deits-Lebehn et al., 2020). Repeated cycles of psychotherapy assist in many instances, such as depression and anxiety, and anger management. 

Researchers argue that erasing unhelpful schemas and beliefs helps showcase transformational change in psychotherapy (Kramer et al., 2020). For example, psychotherapy has successfully managed bullying behavior in children and adolescents, leading to complete transformation, indicating that psychotherapy could have a biological basis. Cultural, social-economic, and religious practices also affect an individual’s view of the effectiveness of psychotherapy. Some cultures do not encourage speaking up or discussing personal problems, which may limit their perception and acceptance of psychotherapy (Wheeler, 2020). Thus, individual perspectives may embrace or disregard practices, hence the need to be culturally sensitive as a care provider.

Legal and ethical considerations differ in the individual, family, and group therapy settings. Like all other care interventions, individual therapy follows all ethical and legal principles. Informed consent, justice, veracity, fidelity, self-respect, autonomy, beneficence, and non-maleficence are all vital individual therapy (Sanghvi & Pandley, 2019). Despite sharing personal information, group therapy sessions maintain confidentiality in that patients only share the information they are comfortable with (Hahn et al., 2022). 

The group participants voluntarily participate hence altruism and other ethical issues such as justice and confidentiality. Information shared restricts deep-message sharing and entails what is significant to others. In addition, these groups are led by competent professionals who ensure that legal and ethical considerations are duly followed. They help handle group differences and ensure objective achievement despite the differences among group members.  

In family therapy, confidentiality is also vital, and unlike individual therapy, only the information the patient is willing to share is discussed. Family therapy often entails how the family members can promote quality outcomes for the patient or problem (Barnett & Jacobson, 2019). In family therapy, the intervention conceptualizes the origin of a problem as a dysfunctional process. Barnett and Jacobson (2019) note that the focus of family therapy is thus addressing these dysfunctional patterns, especially relationships between family members. Cultural awareness, informed consent, and confidentiality (except when concealed information can lead to family harm) are essential considerations in family therapy.

Conclusion

All these articles used were sourced from current and reputable journals in psychiatry, and most were pulled from the American Psychological Association website. The APA website is a reliable database for sourcing peer-reviewed work. The articles are peer-reviewed and current (produced within the last five years). From the evidence presented above, psychotherapy has a biological basis due to the changes in areas such as memory and behavior and physical brain changes observed after psychotherapy. Understanding the biological basis of psychotherapy helps care providers plan and utilize psychotherapy to achieve the desired outcomes. Ethical and legal issues differ in individual, family, and group therapy. Understanding their differences and similarities can help professionals implement psychotherapy with minimal ethical and legal problems in these groups.

References

Barnett, J. E., & Jacobson, C. H. (2019). Ethical and legal issues in family and couple therapy. In APA handbook of contemporary family psychology: Family therapy and training, Vol. 3 (pp. 53–68). American Psychological Association. https://doi.org/10.1037/0000101-004

Deits-Lebehn, C., Baucom, K. J., Crenshaw, A. O., Smith, T. W., & Baucom, B. R. (2020). Incorporating physiology into the study of the psychotherapy process. Journal of Counseling Psychology, 67(4), 488. https://doi.org/10.1037/cou0000391

Hahn, A., Paquin, J. D., Glean, E., McQuillan, K., & Hamilton, D. (2022). Developing into a group therapist: An empirical investigation of expert group therapists’ training experiences. American Psychologist, 77(5), 691–709. https://doi.org/10.1037/amp0000956

Kramer, U., Beuchat, H., Grandjean, L., & Pascual-Leone, A. (2020). How personality disorders change in psychotherapy: A concise review of process. Current Psychiatry Reports, 22, 1-9. https://doi.org/10.1007/s11920-020-01162-3

Sanghvi, P., & Pandey, S. (2019). Ethical and Legal Constraints in Psychotherapy. Journal of Psychosocial Research, 14(1). https://doi.org/10.32381/JPR.2019.14.01.2

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

Week 2: Assessment and Diagnosis in Psychotherapy

“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use.

Photo Credit: [Wavebreakmedia Ltd]/[Wavebreak Media / Getty Images Plus]/Getty Images

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 3, “Assessment and Diagnosis” (pp. 95–168)
• Chapter 4, “The Initial Contact and Maintaining the Frame” (pp. 169–224)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American Academy of Child and Adolescent Psychiatry. (1995). Practice parameters for the psychiatric assessment of children and adolescents. Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion

Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures

Note: This database may be helpful in obtaining assessment tool information for this week’s Discussion.

Required Media

Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

Note: The approximate length of this media piece is 23 minutes.

Accessible player

Discussion: Assessment Tools

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Learning Objectives

Students will:

• Analyze psychometric properties of assessment tools
• Evaluate appropriate use of assessment tools in psychotherapy
• Compare assessment tools used in psychotherapy

Note: By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide.
• Consider the assessment tool assigned to you by the Course Instructor.
• Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by comparing your assessment tool to theirs.

Also Read: NRNP 6650 Psychotherapy With Groups and Families

NRNP 6645 Week 4 Exploring Psychodynamic Theories

NRNP 6645 Week 4 Exploring Psychodynamic Theories

Contemporary psychodynamic psychotherapy, also referred to as psychoanalytic therapy, is rooted in Dr. Sigmund Freud’s proposal that unconscious thought processes, or thoughts and feelings outside of our conscious awareness, are responsible for mental health issues. This therapeutic approach is unique because its goal is to help patients achieve changes in personality and emotional development.

Like most therapeutic approaches, however, psychodynamic psychotherapy is not appropriate for every patient. In your role as a psychiatric-mental health nurse practitioner, you must be able to properly assess patients to determine whether this therapeutic approach would improve their clinical outcomes.

This week, you explore psychodynamic psychotherapy and examine the application of current literature to clinical practice.

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Learning Resources – NRNP 6645 Week 4 Exploring Psychodynamic Theories

Required Readings (click to expand/reduce)

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

• For reference as needed

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.

• Chapter 8, “Psychoanalytic Family Therapy”

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

• Chapter 5, “Supportive and Psychodynamic Psychotherapy”
  • Review the sections on psychodynamic therapy only.
• Chapter 21, “Psychotherapeutic Approaches with Children and Adolescents”
  • pp. 790–791 only

Required Media (click to expand/reduce)

Alexander Street. (2014, February 24). Jungian play therapy and sandplay with children: Myth, mandala, and meaning [Video]. YouTube. https://www.youtube.com/watch?v=qOj4MPCFiDU

Grande, T. (2016, January 29). Adlerian therapy role-play – “Acting as if” technique [Video]. YouTube. https://www.youtube.com/watch?v=nsp3JZ4uYF4

Grande, T. (2016, February 23). Psychodynamic therapy role-play – Defense mechanisms and free association [Video]. YouTube. https://www.youtube.com/watch?v=z9fF9F5w1cI

PsychotherapyNet. (2018, December 7). Youtube Kernberg psychoanalytic psychotherapy [Video]. YouTube. https://www.youtube.com/watch?v=xkYIdEO4jQg

Optional Resources

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video]. https://waldenu.kanopy.com/video/counseling-and-psychotherapy-theories-contex

• Psychodynamic Therapy (starts at 3 minutes)

Exploring Psychodynamic Theories

When thinking of classic Freudian techniques, what images come to mind? Perhaps the omniscient Freud smoking a pipe, sitting behind a client, passively taking notes—or troubled clients lying sprawled on a couch, speaking about their sexuality or early experiences in dealing with aggression or angst.

Though many associate all psychodynamic theories with well-known images of Freudian psychoanalysis, the works of Jung, Adler, and other prominent psychodynamic theorists took strides to significantly depart from Freud’s theory of personality and therapy. Modern psychodynamic approaches place the therapist across from the patient, actively engaging the patient in the psychotherapeutic process.

During this process, however, therapists place much focus on the unconscious mind and past relationships of the patient—a focus unique to psychodynamic theories.

This week there is no assessment, but you will explore unique interventions and strategies derived from the psychodynamic theoretical approach through the Learning Resources.

NRNP 6645 Week 5 Discussion – Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

To prepare:

•   Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings. 

By Day 3

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply! 

 LEARNING RESOURCES

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

• Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.

• Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

Required Media

• Beck Institute for Cognitive Behavior Therapy. (2018, June 7). CBT for couples. [Video]. YouTube. https://www.youtube.com/watch?v=JZH196rOGsc
• MedCircle. (2019, December 13). What a cognitive behavioral therapy (CBT) session looks like. [Video]. YouTube. https://www.youtube.com/watch?v=8-2WQF3SWwo
• PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241). [Video]. YouTube. https://www.youtube.com/watch?v=A2_NN1Q7Rfg

NRNP 6645 Week 4 Exploring Psychodynamic Theories Optional Resources

• Beck, A. (1994). Aaron Beck on cognitive therapy. [Video file]. Mill Valley, CA: Psychotherapy.net.
• Eysenck, H. (n.d.). Hans Eysenck on behavior therapy. [Video file]. Mill Valley, CA: Psychotherapy.net.
• Psychotherapy.net. (Producer). (2009). Rational emotive behavior therapy for addictions. [Video file]. Psychotherapy.net: Author.
• Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice. [Video]. https://waldenu.kanopy.com/video/counseling-and-psychotherapy-theories-contex
• CBT (starts at 2 hours 27 minutes)

NRNP 6645 Week 4 Exploring Psychodynamic Theories Example 1 – Amanda 

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy in which the therapist utilizes techniques to help to change the mindset and thinking pattern of the client or patient to reduce psychological symptoms of conditions such as anxiety, depression, addictions and other types of mental illness.  The underlying principle is that psychological problems are at least in part due to thought processes which are maladaptive or otherwise unhealthy and that these thought patterns are learned behaviors which can subsequently be unlearned through therapy.  

Once these faulty thought processes are unlearned, they can be replaced with new skills, thought processes and more effective coping mechanisms to use instead (Society of Clinical Psychology, 2017).  Some challenges that present in this type of therapy are the ability to change someone’s mindset from a negative one to a positive one.  When attempting to use the techniques in a group setting the level of difficulty is increased dramatically.  Even when you have a group of people who share a common diagnosis, such as anxiety, there are still many unique contributing factors to each person’s specific symptoms and manifestations of those symptoms. 

Most group CBT success has been seen in the treatment of depression and anxiety as group participants can practice empathy towards others and provide their own personal experiences with symptoms which others in the group can relate (Thimm, 2014).  Some difficulty does lie in the fact that there are differing cultural, religious and socioeconomic views and beliefs that further impact each person’s cognition, outlook and overall emotional functioning and will impact the therapeutic processes.  Understanding how these things can impact the therapeutic processes for each person will help improve the outcome of therapy, but in a group setting it will be harder to modify therapy in a way to fit every participant in the group.  

Nothing in psychotherapy is a one size fits all that works equally for every patient and attempting to gain the same results with multiple people with one standard technique is not a realistic expectation.  Each person in a group therapy session will also have different perspectives and interpretation of their thoughts, emotions and the ramifications of those things on their current symptoms.  Group therapy participants may also drop out of their sessions if they feel they are not effective and the change in group dynamics when someone stops coming to group can negatively impact the remaining participants (Thimm & Liss, 2014). 

There are some benefits to group CBT sessions such as the ability to role play these newly learned CBT techniques and being able to practice things such as empathy (Beck Institute for Cognitive Behavior Therapy, 2018).  Due to these challenges, it may be more effective to utilize individual CBT sessions over group CBT settings to reduce potential setbacks in the therapeutic processes and have the most positive impact on the thought of the patient (Guo, et al, 2021). 

References

Beck Institute for Cognitive Behavior Therapy. (2018, June 7). CBT for couples. [Video]. YouTube. https://www.youtube.com/watch?v=JZH196rOGscLinks to an external site.

Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., and Zhou, X. (2021). Individual      vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and    Adolescents: A meta-analysis of Randomized Controlled Trials. Retrieved from: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.674267/full.

Society of Clinical Psychology. (2017). What is Cognitive Behavioral Therapy?         Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-          families/cognitive-behavioral.

Thimm J & Liss A. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice. BMC Psychiatry. 14(292). Retrieved from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0292-x.

Also Read: Case Study: An Elderly Iranian Man with Alzheimers Disease – NURS 6521

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy

Amelia, a 16-year-old high school sophomore, presents with symptoms of weight loss and a very obvious concern for her weight. She has made several references to being “fat” and “pudgy” when, in fact, she is noticeably underweight. Her mother reports that Amelia is quite regimented in her eating and that she insists on preparing her own meals, as her mother “puts too many fattening things in the food” that she cooks.

After discovering that during the past 3 months Amelia has lost 15 pounds and is well under body weight for someone of similar age/sex/developmental trajectory, the psychiatric-mental health nurse practitioner diagnosed Amelia with anorexia nervosa.

Evidence-based research shows that clients like Amelia may respond well to supportive psychotherapy and interpersonal psychotherapy. So which approach might you select? Are both equally effective for all clients? In practice, you will find that many clients may be candidates for both of these therapeutic approaches, but factors such as a client’s psychodynamics and your own skill set as a therapist may impact their effectiveness.

This week, you continue exploring therapeutic approaches and their appropriateness for clients, focusing on supportive psychotherapy and interpersonal psychotherapy.

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy Learning Objectives

Students will:

• Assess knowledge of concepts, principles, and theories related to psychotherapy with individuals, families, and groups

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy Learning Resources

Required Readings (click to expand/reduce)

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

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.

• Chapter 5, “Strategic Family Therapy”
• Chapter 11, “Solution-Focused Therapy”
• Chapter 12, “Narrative Therapy”

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

• Chapter 3, “Assessment and Diagnosis” (pp. 123–134 only)
• Chapter 5, “Supportive and Psychodynamic Psychotherapy”
  • Review the sections on supportive psychotherapy only.
• Chapter 10, “Interpersonal Psychotherapy”
• Chapter 21, “Psychotherapeutic Approaches with Children and Adolescents” (p. 781 only)

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/ 

Credit: U.S. Department of Health and Human Services/Office for Civil Rights. (n.d.). HIPAA Privacy Rule and Sharing Information Related to Mental Health. HHS.gov. https://www.hhs.gov/sites/default/files/hipaa-privacy-rule-and-sharing-info-related-to-mental-health.pdf

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy Required Media (click to expand/reduce)

IPT Institute. (2015, April 16). IPT Institute lecture demonstration Scott Stuart [Video]. YouTube. https://www.youtube.com/watch?v=TmQYhLiDRE0

MindbyMind. (2016, December 8). Elements of supportive psychotherapy for high impact clinic visits – Episode 2 [Video]. YouTube. https://www.youtube.com/watch?v=i8kj5blYiJk&t=4s

NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy Optional Resource

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video]. https://waldenu.kanopy.com/video/counseling-and-psychotherapy-theories-contex

• Existential Therapy (starts at 58 minutes)

Exam : Midterm Exam – NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this exam. Prior to starting the exam, you should review all of your materials. You are expected to comply with Walden University’s Code of Conduct.

This exam will cover the following topics, which relate to psychotherapy with individuals, families, and groups:

• Biological basis of psychotherapy treatments
• Influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments
• Legal and ethical considerations among individual, family, and group modalities of therapy
• Family assessment
• Group therapy techniques
• Psychodynamic psychotherapy
• Cognitive-behavior psychotherapy
• Supportive and interpersonal psychotherapy

By Day 7

Complete the Midterm Exam. There is a 2-hour and 30-min time limit to complete this 100-question exam. You may only attempt the exam once.

Submission and Grading Information

Grading Criteria

To access your Exam:

Week 6 Midterm Exam

WEEK 7 ASSIGNMENT – COMPARING HUMANISTIC-EXISTENTIAL PSYCHOTHERAPY WITH OTHER APPROACHES

Understanding the strengths of each type of therapy and which type of therapy is most appropriate for each patient is an essential skill of the psychiatric-mental health nurse practitioner. In this Assignment, you will compare humanistic-existential therapy to another psychotherapeutic approach. You will identify the strengths and challenges of each approach and describe expected potential outcomes.

To prepare:

• Review the humanistic-existential psychotherapy videos in this week’s Learning Resources.
• Reflect on humanistic-existential psychotherapeutic approaches.
• Then, select another psychotherapeutic approach to compare with humanistic-existential psychotherapy. The approach you choose may be one you previously explored in the course or one you are familiar with and especially interested in.

In a 2- to 3-page paper, address the following:

• Briefly describe humanistic-existential psychotherapy and the second approach you selected.
• Explain at least three differences between these therapies. Include how these differences might impact your practice as a PMHNP.
• Focusing on one video you viewed, explain why humanistic-existential psychotherapy was utilized with the patient in the video and why it was the treatment of choice. Describe the expected potential outcome if the second approach had been used with the patient.
• Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Comparing Humanistic-Existential Therapy with Other Approaches Example

Psychosocial interventions are vital therapeutic options for a variety of psychiatric illnesses that may be employed alone or in conjunction with pharmacologic agents. Humanistic-existential psychotherapy is a sort of psychosocial intervention that helps patients gain transcendental abilities over their situations. Humanistic-existential therapy promotes comprehension of the human experience rather than symptoms and aims to increase client self-awareness and self-understanding (Schneider, 2019). The goal of this paper is to present an overview of humanistic-existential therapy, followed by a discussion of its differences from cognitive behavioral therapy (CBT), which is also a widespread psychotherapy intervention used in the treatment of mood, anxiety, and psychotic diseases. Furthermore, with reference to a video of a therapy session in progress, the discussion explains why humanistic-existential therapy was chosen as the treatment of choice.

Overview of Humanistic-Existential Psychotherapy and Cognitive Behavioral Therapy

Humanistic-existential therapy is based on a compassionate relationship with patients and focuses on the client’s individual experiences rather than the symptoms. The treatment emphasizes unconditional positive regard as a humanistic value, while freedom and responsibility are stressed as existential virtues (Schneider, 2019). The central constructs of humanistic therapy, of which person-centered therapy is a paragon, include self-actualizing tendency (be all that you can be), self and ideal self, conditions of worth, and relational transparency, in which genuineness, empathy, acceptance, and caring form the therapeutic approach (Grande, 2016). 

The therapist focuses on the client and provides a comfortable setting for positive growth while conducting treatment. In addition, the therapist encourages the client to be open and honest while expressing himself/herself. The therapy session is based on the client’s set objectives. Thus, the name patient-centered therapy, and it also fosters the client’s independence in terms of decision-making (Grande, 2016). The core constructs of existential therapy are phenomenology, ultimate concerns, and defenses. 

Phenomenology refers to the client’s direct or immediate experiences. In contrast, the ultimate concerns are the thoughts that trigger anxiety, such as death, isolation, meaninglessness, and the desperate need to acquire freedom, which creates anxiety and the necessity to act. Defenses are acts that a person does to avoid anxiety. As a result, the treatment embraces worry as a positive force that aids in the achievement of objectives.

CBT is a form of psychotherapy that stresses the significance of thoughts and perception in shaping thoughts and behaviors. People suffering from psychosis, mood, or anxiety disorders may have unpleasant thoughts and perceptions that are harmful to them or others in their immediate surroundings. As a result, CBT employs a problem-solving approach to educate individuals on how to modify their thinking and control their emotions in stressful circumstances (Chand et al., 2022). CBT is extremely educational and employs assignments, homework, and experimenting with new ways of behaving and responding to identities to transform inaccurate or unrealistic ways of thinking, which in turn influences emotions and actions.

The Differences Between Humanistic-Existential Therapy and CBT

The first distinction is that although humanistic-existential treatment emphasizes the relevance of the client’s self-awareness and self-understanding, CBT is based on behavioral traditions. Patient-centered therapy, a type of humanistic-existential therapy, for example, creates an environment in which the therapist forms a therapeutic alliance with the patient, encourages freedom of choice and the potential for meaningful change, and allows therapy to proceed based on the patient’s expectations and goals (Heidenreich et al., 2021). When dealing with individuals suffering from drug addiction problems, for example, promoting their independence and self-awareness may be the first step toward avoiding substance usage. 

Conversely, CBT focuses on tactics for changing a person’s negative beliefs, which ultimately influence their actions and behaviors. The second distinction is the length of treatment. Humanistic-existential therapy may be utilized for short-term treatment of drug misuse problems, but if a lifetime journey and development are necessary, the therapy may be everlasting. On the other hand, CBT requires a short course of 5-20 sessions lasting 30-60 minutes and taking place once a week or every two weeks (Heidenreich et al., 2021). 

The third distinction is that, whereas a therapist’s role in humanistic-existential therapy is to create a positive environment in which a client can develop self-awareness and understanding, a therapist’s role in CBT includes developing client-oriented activities to help shape the client’s thoughts and behaviors (Heidenreich et al., 2021). Understanding the contrasts between the two psychotherapeutic treatments allows a psychiatric mental health nurse practitioner to justify therapy selection when treating a variety of mental health disorders.

Why Humanistic-Existential Therapy was the Treatment of Choice in the Video

Joe is a fictitious name given to the patient being discussed. James Bugental is in a session with a female interviewee, perhaps Joe’s mother. According to the extract, Joe feels “not being alive” and is constricted in his existence. He started treatment two years ago, and his mother believes he needs further help with his illness, which is not indicated in the video excerpt. Humanistic-existential therapy was selected as the treatment of choice to help the patient comprehend his problem better. The treatment would allow the patient to gain self-awareness and self-understanding, rescuing him from a hazy state of mind that he characterizes as “not being alive” and feeling constrained. If CBT had been available, the patient may have formed a positive attitude about his life, which could have led to actions and behaviors that made him feel better.

Conclusion

Humanistic-existential therapy shows promise in the treatment of individuals who have a poor understanding of their ailments and situations. The therapy aims to increase patients’ self-awareness and self-understanding, which will eventually improve their recovery. As a result, humanistic-existential therapists concentrate on making the setting pleasant for patients, promoting their independence, and tailoring the therapy to the patient’s needs and preferences. CBT, in addition to humanistic-existential therapy, is widely utilized in the treatment of mood and anxiety disorders. While the remedies are founded on distinct ideas, when utilized effectively and rationally, they both promote patient recovery from mental health disorders.

References

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2022). Cognitive Behavior Therapy. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/

Grande, T. (2016, January 9). Theories of counseling – Existential Therapy. https://youtu.be/YvAvc2aWup0

Heidenreich, T., Noyon, A., Worrell, M., & Menzies, R. (2021). Existential approaches and cognitive behavior therapy: Challenges and potential. International Journal of Cognitive Therapy, 14(1), 209–234. https://doi.org/10.1007/s41811-020-00096-1

Schneider, K. J. (2019). Existential-humanistic and existential-integrative therapy: Philosophy and theory. In The Wiley World Handbook of Existential Therapy (pp. 247–256). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119167198.ch14

Also Read: NRNP 6645 Week 4 Exploring Psychodynamic Theories

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders

A long-standing debate has roiled over whether addicts have a choice over their behaviors. The disease creates distortions in thinking, feelings, and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.

—Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine

A common misconception is that addiction is a choice, and addicts are often labeled as individuals who lack morals, willpower, or responsibility. However, addiction is a clinical disorder that must be treated with the support of a health care professional. Although many people who are exposed to potentially addictive substances and behaviors continue life unaltered by their experiences, some people are fueled by these experiences and spiral out of control.

In your role as the psychiatric-mental health nurse practitioner, you must be prepared to not only work with these individuals who struggle with addiction but also help them and their families overcome the social stigmas associated with addictive behavior.

This week, you will assess a research article on psychotherapy for clients with addictive disorders. You also examine therapies for treating these clients and consider potential outcomes. Finally, you will discuss how therapy treatment will translate into your clinical practice.

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders
Learning Objectives

Students will:

• Analyze literature on interventions and therapeutic approaches used for treating clients with addictive disorders
• Evaluate the application of current literature on addiction treatment to clinical practice

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders Learning Resources

Required Readings (click to expand/reduce)

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

• For reference as needed

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

• Chapter 9, “Motivational Interviewing”
• Chapter 19, “Psychotherapeutic Approaches for Addictions and Related Disorders”

Required Media (click to expand/reduce)

AllCEUs Counseling Education. (2017, November 4). 187 models of treatment for addiction | Addiction counselor training series [Video]. YouTube. https://www.youtube.com/watch?v=eQkA0mIWx8A

Assignment: NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometimes clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome.

In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families.

To prepare for NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders:

• Review this week’s Learning Resources and consider the insights they provide about diagnosing and treating addictive disorders. As you watch the 187 Models of Treatment for Addiction video, consider what treatment model you may use the most with clients presenting with addiction.
• Search the Walden Library databases and choose a research article that discusses a therapeutic approach for treating clients, families, or groups with addictive disorders.

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders The Assignment

In a 5- to 10-slide PowerPoint presentation, address the following. Your title and references slides do not count toward the 5- to 10-slide limit.

• Provide an overview of the article you selected.
  • What population (individual, group, or family) is under consideration?
  • What was the specific intervention that was used? Is this a new intervention or one that was already studied?
  • What were the author’s claims?
• Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?
• Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.
• Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides.
• Support your response with at least three other peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Provide references to your sources on your last slide. Be sure to include the article you used as the basis for this Assignment.

By Day 7

Submit your Assignment. Also, attach and submit PDFs of the sources you used.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
• Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 8 Assignment

Psychotherapy for Clients with Addictive Disorders Example Approach

Addictive Disorders manifest via deficits in regulating emotions, self-esteem, relationships, and self-care, leading to the inability to abandon detrimental substances or behaviors. Often, causal factors for addictive disorders include biological, psychosocial, cultural, and social factors. According to Khantzian (2020), environmental influences such as traumatic abuse, peer pressure, safety, and parenting may increase individual susceptibility to addiction. With much emphasis regarding addictive disorders resting on substance abuse and gambling, various psychoanalytical psychotherapy is one of the most profound interventions for treating and preventing addiction.

Psychoanalytical Psychotherapy and Addiction Treatment

Psychoanalytical/psychodynamic psychotherapy assumes that essential psychological factors lead to addictive behaviors and activities (Khantzian, 2020). In a retrospective study by Mooney et al. (2019), the researchers evaluate the applicability of psychoanalytical psychotherapy in treating and preventing gambling addiction. Therefore, the research targets patients struggling with compulsive addiction seeking treatment at the National Problem Gambling Clinic (NPGC) in London. According to Mooney et al. (2019), psychodynamic therapy is crucial in exposing unconscious patterns by enabling patients to reflect, clarify, and confront interpersonal conflicts, wishes, and defenses that strengthen addiction.

The research revealed that psychodynamic psychotherapy successfully treated patients’ addiction problems by imparting a sense of intrinsic awareness while reducing depression and anxiety. However, researchers acknowledged that various limitations hampered the study’s precision and validity of the conclusion. For instance, investigators identified a lack of scholarly literature, data disparities, and research model as the major drawbacks for the study. Therefore, it is essential to evaluate scholarly evidence to justify the applicability of psychodynamic psychotherapy in addressing addiction.

Additional Scholarly Evidence

Although insufficient scholarly evidence compromises the determination to render psychodynamic psychotherapy effective in treating addiction, some studies support this approach. Verma & Vijayakrishnan (2018) argue that this therapeutic approach helps patients better understand themselves, their unconscious desires, motivations, and conflicts. On the other hand, Whitman & Olesker (2021) contend that psychoanalytic approaches play a significant role in treating opiate, alcohol, and marijuana dependence patients. Finally, Khantzian (2020) supports the topic by arguing that psychodynamic psychotherapy enables change agents to identify, target, modify and eliminate causal factors for addiction. Undoubtedly, these sources are scholarly because they are peer-reviewed, organized, and published in reputable databases to provide additional insights into the topic.

References

Khantzian, E. (2020). Psychodynamic psychotherapy for the treatment of substance use disorders. Textbook Of Addiction Treatment, 383-389. https://doi.org/10.1007/978-3-030-36391-8_26

Mooney, A., Roberts, A., Bayston, A., & Bowden?Jones, H. (2019). The piloting of a brief relational psychodynamic protocol (psychodynamic addiction model) for problem gambling and other compulsive addictions: A retrospective analysis. Counselling And Psychotherapy Research, 19(4), 484-496. https://doi.org/10.1002/capr.12251

Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders. Indian journal of psychiatry, 60(Suppl 4), S485–S489. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_16_18

Whitman, L., & Olesker, W. (2021). Introduction – Addiction: A ubiquitous problem. The Psychoanalytic Study of The Child, 74(1), 227-233. https://doi.org/10.1080/00797308.2020.1859302

NRNP 6645 Week 8 Assignment Psychotherapy for Clients With Addictive Disorders Rubric Detail

Select Grid View or List View to change the rubric’s layout

 Excellent

90%–100%

Good

80%–89%

Fair

70%–79%

Poor

0%–69%

Develop a 5- to 10-slide PowerPoint presentation on your selected research article discussing a therapeutic approach for treating clients, families, or groups with addictive disorders. •Provide an overview of the article you selected, including: What population (individual, group, or family) is under consideration? What was the specific intervention that was used? Is this a new intervention or one that was already used? What were the author’s claims? 18 (18%) – 20 (20%)

The presentation thoroughly and accurately defines the considered population.

The specific intervention used is fully and accurately described. The description clearly indicates whether the intervention is new or whether it was already studied.

The response includes a thorough and accurate description of the author’s claims.

 16 (16%) – 17 (17%)

The presentation defines the considered population.

The specific intervention used is described. The description indicates whether the intervention is new or whether it was already studied.

The response includes a description of the author’s claims.

 14 (14%) – 15 (15%)

There is an incomplete definition of the considered population.

The specific intervention used is partially or inaccurately described.

The response includes a partial or inaccurate description of the author’s claims.

 0 (0%) – 13 (13%)

There is an incomplete definition of the considered population, or it is missing.

The specific intervention used is partially or inaccurately described, or is missing.

The response includes a partial or inaccurate description of the author’s claims, or is missing.

o Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your clients. If so, how? If not, why? 23 (23%) – 25 (25%)

The presentation includes a thorough and accurate review of the findings of the selected article.

The response fully addresses whether or not the outcomes will translate into practice with clients.

 20 (20%) – 22 (22%)

The presentation includes a review of the findings of the selected article.

The response addresses whether or not the outcomes will translate into practice with clients.

 18 (18%) – 19 (19%)

The presentation includes a somewhat inaccurate or incomplete review of the findings of the selected article.

The response partially or inaccurately addresses whether or not the outcomes will translate into practice with clients.

 0 (0%) – 17 (17%)

The presentation includes an inaccurate and incomplete review of the findings of the selected article, or is missing.

The response partially or inaccurately addresses whether or not the outcomes will translate into practice with clients, or is missing.

• Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. 23 (23%) – 25 (25%)The presentation includes a thorough and accurate explanation of the whether the limitations of the study might impact your ability to use the findings presented in the article. 20 (20%) – 22 (22%)The presentation includes an explanation of the whether the limitations of the study might impact your ability to use the findings presented in the article. 18 (18%) – 19 (19%)The presentation includes a somewhat inaccurate or incomplete explanation of the whether the limitations of the study might impact your ability to use the findings presented in the article. 0 (0%) – 17 (17%)The presentation includes an inaccurate or incomplete explanation of the whether the limitations of the study might impact your ability to use the findings presented in the article, or is missing.•Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides. 9 (9%) – 10 (10%)The Notes function of the presentation is appropriately used to comprehensively expand upon the presentation slides. 8 (8%) – 8 (8%)The Notes function of the presentation is adequately used to expand upon the presentation slides. 7 (7%) – 7 (7%)The Notes function of the presentation is utilized but notes are vague or contain small inaccuracies. 0 (0%) – 6 (6%)The Notes function of the presentation partially or inaccurately expands upon the presentation slides, or is not included.• Support your response with at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is scholarly. References are included on your last slide. PDFs of sources are included with submission. 9 (9%) – 10 (10%)The presentation is strongly supported with at least three peer-reviewed, evidence-based, scholarly sources. References are included on the last slide. PDFs of sources are included with submission. 8 (8%) – 8 (8%)The presentation is supported with at least three peer-reviewed, evidence-based, scholarly sources. References are included on the last slide. PDFs of sources are included with submission. 7 (7%) – 7 (7%)The presentation is supported with two or three peer-reviewed, evidence-based, scholarly sources. Accurate references may not be included on the last slide. PDFs of sources may be missing. 0 (0%) – 6 (6%)The presentation is supported with resources peer-reviewed, evidence-based, scholarly sources, or the sources are missing.Written Expression and Formatting – Style and Organization: Slides are clear and not overly crowded. Sentences in presenter notes are carefully focused—neither long and rambling nor short and lacking substance. 5 (5%) – 5 (5%)Slides are clear, concise, and visually appealing. Sentences in presenter notes follow writing standards for flow, continuity, and clarity. 4 (4%) – 4 (4%)Slides are clear and concise. Sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.5 (3.5%) – 3.5 (3.5%)Slides may be somewhat unorganized or crowded. Sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 0 (0%) – 3 (3%)Slides are unorganized and/or crowded. Sentences follow writing standards for flow, continuity, and clarity < 60% of the time.Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)Contains 1 or 2 grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%)Contains 3 or 4 grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%)Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Total Points: 100

Also Read: NRNP 6645 Week 6 Supportive and Interpersonal Psychotherapy

NRNP 6650 Psychotherapy With Groups and Families

Week 1: Legal and Ethical Considerations for Group and Family Therapy

Members of a cohesive group feel warmth and comfort in the group and a sense of belongingness; they value the group and feel in turn that they are valued, accepted, and supported by other members.

—Irvin D. Yalom, The Theory and Practice of Group Psychotherapy

Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player

Group and family therapy offers a unique sense of community and support that may not be achieved through other therapeutic approaches. As you help clients effect change within themselves, they are able to in turn help others within the group change. Although many clients thrive in this environment, it is important to recognize that group and family therapy is not appropriate for everyone. Like any other therapeutic approach, group and family therapy has limitations that must be considered.

This week, as you begin exploring group and family therapy, you examine legal and ethical considerations of this therapeutic approach.

NRNP 6650 Psychotherapy With Groups and Families Learning Resources

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 5A “Coordination of Care” (page 54)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20-23.

Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400-408.

Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric and Mental Health Nursing, 5(3), 193-196. doi:10.1046/j.1365-2850.1998.00129.x

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.

• Chapter 1, “Introduction Becoming a Family Therapist” (pp. 1–5)
• Chapter 1, “The Evolution of Family Therapy” (pp. 6-22)

U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• Chapter 11, “Group Therapy” (pp. 407–428)

Document: Midterm Exam Study Guide (Word document)

Document: Final Exam Study Guide (Word document)

Required Media

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 32 minutes.

Accessible player

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 32 minutes.

Accessible player

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 3 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 24 minutes.

Accessible player

Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008a). Legal and ethical issues for mental health professionals, volume 1: Confidentiality, privilege, reporting, and duty to warn [Video file]. Mill Valley, CA: Psychotherapy.net. [Kanopy]

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 140 minutes.

Optional Resources

Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008). Legal and ethical issues for mental health professionals, volume 2: Dual relationships, boundaries, standards of care and termination [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 191 minutes.

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

Learning Objectives

Students will:

• Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy
• Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy
• Recommend strategies to address legal and ethical considerations for group and family therapy

To prepare:

• Review this week’s Learning Resources and consider the insights they provide on group and family therapy.
• View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

By Day 6

Respond to at least two of your colleagues by suggesting strategies to address the legal and ethical considerations your colleagues discussed. Support your responses with evidence-based literature.

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .

For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.

Please take the time to review the Appropriate Preceptors and Field Sites for your courses.

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NRNP 6650 Psychotherapy With Groups and Families Week 2: Family Assessment and Phases of Family Therapy

A family’s patterns of behavior influences [sic] the individual and therefore may need to be a part of the treatment plan. In marriage and family therapy, the unit of treatment isn’t just the person – even if only a single person is interviewed – it is the set of relationships in which the person is imbedded.

—American Association of Marriage and Family Therapy, “About Marriage and Family Therapists”

When issues arise within a family unit, the family often presents with one member identified as the “problem.” However, you will frequently find that the issue is not necessarily the “problem client,” but rather dysfunctional family patterns and relationships. To better understand such patterns and relationships and develop a family treatment plan, it is essential that the practitioner appropriately assess all family members. This requires you to have a strong foundation in family assessment and therapy.

This week, as you explore family assessment and therapy, you assess client families presenting for psychotherapy.

Learning Resources

Required Readings

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

L’Abate, L. (2015). Highlights from 60 years of practice, research, and teaching in family therapy. American Journal of Family Therapy, 43(2), 180-196. doi:10.1080/01926187.2014.1002367

Mojta, C., Falconier, M. K., & Huebner, A. J. (2014). Fostering self-awareness in novice therapists using internal family systems therapy. American Journal of Family Therapy, 42(1), 67–78. doi:10.1080/01926187.2013.772870

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.

• Chapter 2, “Basic Techniques of Family Therapy” (pp. 23-39)
• Chapter 3, “The Fundamental Concepts of Family Therapy” (pp. 40-55)

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207-215. doi:10.1111/famp.12025

Papero, D. V. (2014). Assisting the two-person system: An approach based on the Bowen theory. Australian & New Zealand Journal of Family Therapy, 35(4), 386-397. doi:10.1002/anzf.1079

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

• Chapter 12, “Family Therapy” (pp. 429–468)

Document: Group Therapy Progress Note

Required Media

Laureate Education (Producer). (2013a). Hernandez family> Sessions 1—6 [Video file]. Author: Baltimore, MD.

Note: The approximate length of this media piece is 52 minutes.

Psychotherapy.net. (2006c). Tools and techniques for family therapy [Video file].

The approximate length of this media piece is 52 minutes.

Assignment : Hernandez Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Learning Objectives

Students will:

• Assess client families presenting for psychotherapy

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide on family assessment.
• View the Hernandez Family: Sessions 1-6 videos, and consider how you might assess the family in the case study.

Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.

The Assignment

Address in a comprehensive client assessment of the Hernandez family the following:

• Demographic information
• Presenting problem
• History or present illness
• Past psychiatric history
• Medical history
• Substance use history
• Developmental history
• Family psychiatric history
• Psychosocial history
• History of abuse and/or trauma
• Review of systems
• Physical assessment
• Mental status exam
• Differential diagnosis
• Case formulation
• Treatment plan

Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment

Also Read: COUN 5279 Unit 4 Assignment Job Loss Case Study

NRNP 6665 PMHNP Care Across the Lifespan I

NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Name: P.P                DOB: 1/07/1995 Age: 25 yrs Gender: female 

Subjective:

CC (chief complaint): mood cycles between periods of low energy for about 4 to 5 times in a year, and mostly being high for more than a week in a row.

HPI: the patient came for a mental health assessment, and seeking review of her medications after being treated for previous psychiatric symptoms and being started on medications. She has a history of being treated using medications such as Zoloft, Risperidone, Seroquel (quetiapine), and Clonazepam, then stopping due to side effects. She reports getting episodes of low energy, no motivation, disinterest in activities 4 to 5 times a year. During these low periods, she often skips work, and eats too much, and prefers to sleep mostly up to 12 to 16 hours a day. She reports having periods that she is high for over a week, whereby she sometimes has auditory hallucinations. Excessive talking, insomnia for days, increased goal-orientedness, and heightened sexual behavior. The conversation also revealed she has grandiosity and a heightened sense of importance whereby she envisions everything about her future being with celebrity stars.

Past Psychiatric History: history of several admissions or psychiatric symptoms, she has had no suicidal or homicidal ideation since 2017.

Family Psychiatric History: her mother suffered from a psychiatric illness which she thinks was either bipolar and she tried committing suicide once. Her father went to prison for drugs and thinks her brother probably also has been diagnosed with a psychiatric problem before.

Legal History: she has been arrested once for public disturbance, but thinks this was made up because she cannot remember that scene

Substance Current Use: she smokes one packet of cigarettes daily, and has no recent history of other prescription drugs or substance abuse.

Medical History: he has hypothyroidism and polycystic ovarian syndrome (PCOS)

•       Current Medications: takes thyroxines for hypothyroidism and oral contraceptive pills for PCOS
•       Allergies:no known food or drug allergies.

• Reproductive Hx: heterosexual female but has a heightened sexual life at different times which places her at high risk.

Review of systems (ROS):

• GENERAL: no fever, night sweats, or vomiting, but amidst to have gained weight when taking some psychotropic medications
• HEENT: no changes in visual acuity, no diplopia, eye discharge, or photophobia. She has no ear pain, tinnitus, or discharge. No history of nose bleeding, recurrent upper airway infections, she has no denture or teeth problems, and reports of good oral hygiene.
• SKIN: normal hair texture and pigmentation, no nodules, ulcers, or lesions.
• CARDIOVASCULAR: she has no paroxysmal nocturnal dyspnea, intermittent claudication, palpitations or chest pain.
• RESPIRATORY: no exertion or difficulty in breathing, hemoptysis, or coughing.
• GASTROINTESTINAL: she has a good appetite, no changes in bowel habits, no nausea, vomiting, heartburn, dysphagia, yellowness of eyes, or abdominal pain.
• GENITOURINARY: no urinary urgency, incontinence, hematuria, frequency, hesitancy, dysuria, color changes, or decreased urine output.
• NEUROLOGICAL: No changes in memory, convulsions, syncope, lightheadedness, abnormal sensations, or dizziness.
• MUSCULOSKELETAL: no changes in gait or mobility, no joint aches, swelling, fractures, or history of arthritis or gout.
• HEMATOLOGIC: no bloody or dark stool, no easy bruising, or nosebleeding.
• LYMPHATICS: no peripheral edema, or swellings
• ENDOCRINOLOGIC: she has no polyuria, polydipsia, or constant polyphagia. She, however, reports slowness and a history of current treatment for hypothyroidism.

Objective:

Physical Exam 

General: He was well-groomed, seemed overweight, and normal gait.

Vital signs: BP 123/78; pulse 81 regularly regular, temperature 37.5 ear; RR 21; weight: 142lbs; height 5’2; BMI 26 (overweight).

The rest of the systemic examination was normal. 

Diagnostic results: awaiting results of her lipid profile.

Assessment:

Mental Status Examination: 

Appearance: looked like a young adult, and as she walked in she responded to my greetings and sat with normal posture. She was well dressed, despite having the smell of cigarettes she did not look intoxicated. she had no obvious bruises or body scars on exposed areas.

Level of consciousness and Orientation: she was alert and well orientated to time and place, and person.

Behavior: she was charming, had good rapport and attitude despite getting irritable on few occasions, and being too critical of personal questions. However, she was cooperative on kind assurance, with no abnormal movement or compulsions, and didn’t resist being examined.

Concentration and attention: she maintained normal eye contact, and was attentive throughout the assessment.

Speech: her speech was not pressured, with normal volume and tone, with a short latency of speech. She responded to questions adequately, despite admitting to having a history of excessive talking. Mood: currently has a normal mood she often feels high “keep my moods high, high, high”, but also sometimes gets depressed “I feel like I’m not worth anything”

Affect: neutral Appropriate to content and congruent with the mood.

Thought Process: she expressed herself in a logical and meaningful manner. She had no circumstantiality, tangentiality, or flight of ideas, she had no neologisms or thought blocking.

Thought content: she has ideas of grandeur, and pseudo-delusional conviction of importance, but no poverty of thought, and no suicidal and homicidal ideation. She has no phobias or irrational fears, no obsessions or compulsions.

Perceptual Disturbances: she has auditory hallucinations, no illusions, and no episodes of depersonalization or derealization.

Cognition: her Immediate, short-term, and long-term memory were intact. She had good attention, judgment, abstraction, and level 6 insight.

Diagnostic Impression: Bipolar 1 Disorder. 

The patient was otherwise normal on this visit since the mental status examination only tells about the mental status at that moment, but can change at any time. The presenting complaints and information gathered on a further inquiry made me arrive at a primary diagnosis of bipolar 1 disorder. According to Ganti et al., (2018), Bipolar I disorder is diagnosed when one meets the criteria for a full manic episode with or without episodes of major depression, thus also called manic-depression. Often patients have interspersed euthymia, major depressive episodes, or hypomanic episodes between manic episodes (Perrotta, 2019), of which she presented in a euthymic state on this visit. She is mostly in the manic phase due to undertreatment (López-Muñoz et al., 2018), since the euphoria, heightened energy, and goal-orientedness make her skip her medications.

Differential diagnoses: 

Schizoaffective disorder: patients with this disorder, often meet criteria for either a major depressive or manic episode during which psychotic symptoms such as hallucinations and delusions consistent with schizophrenia are also met. Additionally, mood symptoms present for a majority of the psychotic illnesses since some may have atypical features such as flat or blunted affect, anhedonia, apathy, and lack of interest in socialization (Ganti et al., 2018). As such patients often cycle between having a diagnosis between psychotic and mood disorders, thus are given the second generation. antipsychotics such as risperidone to target both psychotic and mood symptoms.

Organic mood disorder due to hypothyroidism: psychiatric symptoms may also be a manifestation of organic disorders such as endocrine or metabolic disorders. Additionally, patients with bipolar also have a high prevalence of psychiatric and medical comorbidities (Grande et al., 2016), such as thyroid disorders or diabetes. She admits to having comorbid hypothyroidism, which could explain the episodes of depression due to undertreatment since she has a history of skipping other medications.

Seasonal affective disorder: This condition is often described as a subtype of recurrent depressive or bipolar disorder. Often patients have recurrent dysregulated mood and affective episodes of regular onset and remission of similar times annually (Pjrek et al., 2016). This condition has been shown to have a high degree of persistence and only about 20 percent of patients get to complete remission after five to eleven years (Nussbaumer-Streit et al., 2018). This is less probable because she described manic symptoms that lasted more than a week (Ganti et al., 2018), thus meeting the criteria for a manic episode.

Case Formulation: this case involves P.P, who is a 25-year-old female with comorbid hypothyroidism and PCOS. Despite having major depressive episodes, where she has anhedonia, hypersomnia, depressed mood, feelings of worthlessness, slowness, loss of energy, and excessive eating, she also experiences manic episodes consisting of grandiosity, inflated self-esteem, increased goal-orientedness, decreased need for sleep, and talkativeness, and excessive involvement in sexual indiscretions despite its negative consequences.

Treatment Plan: most psychiatric conditions require both pharmacotherapy and psychotherapy to have good outcomes. Bipolar patients benefit from mood stabilizers such as lithium, which has been shown to reduce mania and suicide risk, or carbamazepine, especially if the symptoms are rapidly cycling. Most patients have a faster response when mood stabilizers are combined with atypical antipsychotics such as risperidone and quetiapine. Antidepressants are discouraged as monotherapy due to concerns of activating mania or hypomania. I would start her on carbamazepine, at an Initial dose of 200 mg PO q12hr, since it is easier to monitor and make adjustments unlike lithium (Arcangelo et al., 2017). Additionally, I would recommend her to start on Supportive individual therapy, then later enlist her into group therapy to help prolong remission once the acute manic episode has been controlled. I would encourage her to start thinking of quitting smoking and weight reduction since they negatively affect her health.

Reflection notes:

This patient presented minimal challenges since she had good insight into her psychiatric problem. Otherwise, I think I would have explored more on how the symptom cycle between mania and depression and the periods of these symptoms. Additionally asking more about psychotic symptoms such as illusion and delusions would help make a clearer diagnosis with specifiers. If this patient becomes difficult to follow up I would consider referring her to a psychiatrist, and an addiction and wellness counselor

References

• Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. (2017). Pharmacotherapeutics for Advanced Practice (Vol. 4). Philadelphia: Wolters Kluwer.
• Ganti, L. K. (2018). First aid for the psychiatry clerkship. McGraw Hill Professional.
• Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572. https://doi.org/10.1016/s0140-6736(15)00241-x
• López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of bipolar disorder. International Journal of Molecular Sciences, 19(7), 2143. https://dx.doi.org/10.3390%2Fijms19072143
• Nussbaumer-Streit, B., Pjrek, E., Kien, C., Gartlehner, G., Bartova, L., Friedrich, M. E., Kasper, S. & Winkler, D. (2018). Implementing prevention of seasonal affective disorder from patients’ and physicians’ perspectives–a qualitative study. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1951-0
• Perrotta, G. (2019). Bipolar disorder: definition, differential diagnosis, clinical contexts, and therapeutic approaches. Journal of Neuroscience and Neurological Surgery, 5(1), 1-6. DOI: 10.31579/2578-8868/097
• Pjrek, E., Baldinger-Melich, P., Spies, M., Papageorgiou, K., Kasper, S., & Winkler, D. (2016). Epidemiology and socioeconomic impact of seasonal affective disorder in Austria. European Psychiatry, 32, 28-33. https://doi.org/10.1016/j.eurpsy.2015.11.001