Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
- General Statement:
- Caregivers (if applicable):
- Hospitalizations:
- Medication trials:
- Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
- Current Medications:
- Allergies:
- Reproductive Hx:
ROS:
- GENERAL:
- HEENT:
- SKIN:
- CARDIOVASCULAR:
- RESPIRATORY:
- GASTROINTESTINAL:
- GENITOURINARY:
- NEUROLOGICAL:
- MUSCULOSKELETAL:
- HEMATOLOGIC:
- LYMPHATICS:
- ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination:
Differential Diagnoses:
Reflections:
References
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
- General Statement:
- Caregivers (if applicable):
- Hospitalizations:
- Medication trials:
- Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
- Current Medications:
- Allergies:
- Reproductive Hx:
ROS:
- GENERAL:
- HEENT:
- SKIN:
- CARDIOVASCULAR:
- RESPIRATORY:
- GASTROINTESTINAL:
- GENITOURINARY:
- NEUROLOGICAL:
- MUSCULOSKELETAL:
- HEMATOLOGIC:
- LYMPHATICS:
- ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination: The patient is a 32-year-old who appears older than her age. She is cooperative throughout the session though at some point she raises her tone when explaining a past event that irritated her. Similarly, she breaks down during the interview which shows her hopelessness in dealing with her situation. Sometimes during the interview, she seems lost in thought as she tries to recollect bits of information. She has no signs of hallucinations and has a good concentration and memory span.
Differential Diagnoses:
Based on the patient’s assessment, the differential diagnoses are major depressive disorder, dysthymia, bipolar II disorder, and mood disorder related to another health condition.
Major Depressive Disorder
Major depressive disorder is the first and priority diagnosis for the patient based on her clinical manifestation. According to the DSM-5, for patients to be diagnosed with major depressive disorder, they must show a minimum of five symptoms during the same two weeks. The symptoms should indicate a depressed mood or loss of interest in previously pleasurable things. Some of the symptoms that patients should exhibit include a depressed mood, loss of pleasure, weight gain or loss, insomnia, psychomotor agitation, fatigue, guilt, decreased concentration, or suicidal thoughts (Mullen, 2018). From the interview, the patient shows a depressed mood, is highly and easily irritable, has feelings of guilt, confirms to having trouble falling asleep, is hopeless, feels worthless, and at the same time confirms to have gained a lot of weight. She had been having the above feelings way before she became a mother resulting in relationship issues with her husband. Her symptoms and history, therefore, provide a basis to settle at major depressive disorder as the primary diagnosis.
Dysthymia
Dysthymia is the second diagnosis for the patient. It refers to a chronic, low-grade depression, and irritable mood which lasts for two years. The condition is characterized by symptoms like hopelessness, low-self esteem, sleep changes as well as loss of interest in carrying out activities that one considered pleasurable in the past. From the conversation between the patient and the therapist, one can learn that the patient has an irritable mood to the extent of changing her intonation when the therapist asks her about an instance at home which irritated her. She also is hopeless and believes she is destined to be a stay-at-home mom, is not comfortable with her body and has no energy to work towards achieving the body she desires, and spends most of her time crying. It is equally important to note that from the interview she seems overwhelmed with the baby but cannot afford a nanny and shies off from having the conversation with her husband whom she thinks would feel let down. According to Schramm et al. (2020), dysthymia is usually difficult to diagnose until it later manifests as major depressive disorder.
Bipolar II Disorder
Bipolar II disorder is a type of bipolar disorder where individuals have had at least one major depressive episode and at least one hypomanic episode but never had a manic episode. A depressive episode is usually characterized by five or more of the following symptoms. The symptoms include a depressed mood that entails feeling sad, hopeless, tearful, irritability, a marked loss of interest in activities than one considered pleasurable, fatigue, feelings of worthlessness, insomnia or sleeping too much, and a significant weight loss or weight gain (American Psychiatric Association, 2013). The patient exhibits the above symptoms. However, there is no history of having experienced a hypomania episode.
Mood Disorder related to another Health Illness
Mood disorder related to another health condition would be the fourth differential diagnosis. From the patient’s medical history, she has been put on labetalol 100mg twice daily. The medication is used for managing hypertension. The patient admits to missing doses due to forgetting which possibly accounts for her high blood pressure levels of 149/98. Patients suffering from chronic illnesses have a high risk of suffering from depression-related symptoms.
Reflections:
If I were to see this patient again, I would engage her in relaxation techniques such as breathing exercises which will not only enable her to relax but also gain control of her thought process and her emotions.
If I were to carry out a health promotion initiative with the patient, I would educate her on the importance of complying with medication. I would remind her that missing hypertension drug doses could expose her to adverse events like stroke.
Legal and ethical issues
Based on the patient’s history of non-compliance with drugs, the patient case study attracts an ethical issue regarding compliance with drugs. It would be vital to note that the patient cites forgetfulness as the reason for missing her drugs. It would therefore be vital to get her a support system such as her spouse who she stays with who would be reminding her when to take drugs.
The patient similarly seems overwhelmed with her role as a new mother with no help around her. She cites affordability as a barrier as well as how her spouse would perceive her which communicates the need to establish a link between herself and the spouse to facilitate open communication without fear of being judged harshly.
The patient should return to the clinic after four weeks for follow-up. She will be required to update the therapist on any notable change in her health, her perceptions and even her relationship with the spouse.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Mullen S. (2018). Major depressive disorder in children and adolescents. The mental health clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801-812.