Assessing, Diagnosing, and Treating Adults With Mood Disorders
Assignment: Bipolar disorder
The PMHNP needs to have a comprehensive understanding of mood disorders to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time.
Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.
In this Assignment, you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.
To Prepare
- Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
- Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
- Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
The Assignment: Develop a Focused SOAP Note, 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 symptomatology 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 to lowest priority. Compare the DSM-5 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.
Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: What would you do differently with this client if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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 that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Solution
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6665: PMHNP Care Across the Lifespan I
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint): Patient P.P presents to the clinic with a history of taking medications and then stopping with no apparent reason.
HPI: The 25-year-old Caucasian female presents to the office with a history of taking medications and stopping taking them for no reason. She highlights that she has both high and low episodes. High episodes are characterized by increased activity and insomnia while low episodes are characterized by long hours of sleep, feelings of hopelessness, loss of interest in pleasurable activities. She also has a history of attempted suicide by overdosing Benadryl.
Substance Current Use: Patient P.P admits to using nicotine.
Medical History:
- Current Medications: Birth control pills
- Allergies: No reported allergies
- Reproductive Hx: The patient has polycystic ovaries
ROS:
- GENERAL: No increase or a reduction of weight, no chills or fever or fatigue
- HEENT: No vision changes, no eye pain or redness, no vertigo, no sour taste or heartburn, no runny nose, no sorethroat, no sneezing or congestion
- SKIN: Skin is warm to touch, no rash or itching
- CARDIOVASCULAR: No palpitations or chest pressure, denies chest pain, or edema
- RESPIRATORY: Denies cough or sputum, no shortness of breath, or wheezing
- GASTROINTESTINAL: No diarrhea, no constipation. No anorexia or abdominal pain, Appetite varies with the mood
- GENITOURINARY: No changes in the urine pattern, no incontinence, no color
- NEUROLOGICAL: Denies dizziness, tingling on the extremities, no headache, no syncope or paralysis, no tingling or weakness, or even confusion
- MUSCULOSKELETAL: No weakness or pain in the joints, no stiffnness
- HEMATOLOGIC: Has no history of anemia, leeding or bruising
- LYMPHATICS: Has no swollen lymph nodes. Has no history of splenectomy
- ENDOCRINOLOGIC: Has hyperthyroidism
Objective:
Vitals: Temp 98.2, Pulse 90, Respiration rate 18, B/P 138/88
Diagnostic results: Screening with The Mood Disorder Questionnaire indicates that the patient has bipolar disorder having scored 9 yes or no questions positively.
Laboratory results: Urine drug and alcohol screen negative. CBC within normal ranges. CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
Assessment:
Mental Status Examination: She is a 25-year old Caucasian female who appears her age. She cooperates during the session. She is oriented to time and place. She presents with bright vibrant colored clothing and heavy makeup. She has disheveled long hair which is unkempt. She has normal motor activity during the interview. She uses incorrect facial expressions, gestures, and body movements. She has no signs of hallucinations. Despite acknowledging having suicidal thoughts in the past, she has a good memory and concentration span.
Diagnostic Impression: The diagnostic impression for the patient is bipolar disorder. The differential diagnoses are major depressive disorder and schizophrenia.
Bipolar disorder is a health condition that is characterized by episodes of manic highs and depressive lows. Individuals experiencing manic episodes are characterized by high energy, insomnia as well as a loss of touch with reality. The depressive lows are indicated by low energy and motivation levels, loss of interest in pleasurable activities and at times individuals could experience suicidal thoughts (McCormick et al. 2015). Bipolar disorder is the primary diagnosis since the patient’s symptoms align with the diagnostic criteria for the condition. The patient has been having both manic and depressive episodes and most importantly, her mother has a history of bipolar which could be inherited.
The second differential diagnosis is a major depressive disorder. The DSM-5 diagnostic criteria indicate that a patient must present with five or more symptoms for at least two weeks. The symptoms include insomnia, depressed mood, loss of pleasure in activities that one enjoyed, weight gain or loss as well as agitation or retardation (Mullen, 2018; American Psychiatric Association, 2013).
The third differential diagnosis is schizophrenia a disorder that affects one’s ability to think and behave freely. The condition is characterized by thoughts and experiences which are out of reality, hallucinations, delusions, and disordered thinking which could alter daily functioning.
Reflections:
If I were to conduct the session again I would ask the patient questions related to how her mental health condition has affected her social and work life. The questions would enable her to understand the importance of adherence to medications based on her history of stopping to take medications in the course of her treatment. Some of the ethical and legal implications that would affect this particular case would be related to patient autonomy, privacy, and confidentiality as stipulated by the Health Insurance Portability and Accountability Act (Bipeta, 2019). Based on her medical history it would be necessary to educate her on the importance of adherence to treatment as a way of health promotion.
Case Formulation and Treatment Plan:
The treatment plan that I would design for the patient would be a combination of therapy and medications. The goal of therapy and medications would be to lower the prevalence of the symptoms while at the same time boost the patient’s coping mechanisms. The most effective therapy would be cognitive behavioral therapy which facilitates the restructuring of thoughts thus resulting in behavior and thought modification (Wheeler, n.d). Apart from therapy, I would also recommend mood stabilizers such as lithium which will enable the patient to manage her manic and depressive episodes (Volkmann et al., 2020).
I would advise the patient to continue with therapy and medication as instructed to lower the possibility of a relapse and most important adverse events which may be associated with abrupt discontinuation of medications. Some of the side effects that the patient may experience include headache, dizziness, dry mouth, hand tremors, nausea, and increased thirst.
The patient should seek immediate medical attention if she develops allergic reactions after taking the medication.
I looked at hospital records to facilitate collaboration.
The patient was allowed to ask questions. She seemed to understand the discussion.
The patient was required to go back to the clinic after four weeks for follow-up.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
McCormick, U., Murray, B., & McNew, B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 27(9), 530–542. https://doi.org/10.1002/2327-6924.12275
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
Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Frontiers in psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377
Wheeler, K. (Ed.). Psychotherapy for the advanced practice psychiatric: A how-to guide for evidence-based practice (2nd ed.). New York: Springer Publishing Company