Week 5:Comprehensive Psychiatric Evaluation and Patient Case Presentation
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
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Assignment Due Date

CC (chief complaint): I have been going off on people and getting in arguments, I feel stressed.
HPI: J.B is a 50 years old African American with previous psychiatric history and some medical histories of hypertension, High cholestorol, and Type 2-diabetes. His previous record with the hospital was back in 2009 when he was screened, but not brought into service. He was not on any mental health medication. He reported symptoms of increased anxiety due to situational stressors. Patient stated that his wife is in process of divorcing him. He reports being fraistrated and irritable and been trying to just stay of of the way to avoid getting in trouble. He reports not sleeping as his mind is constantly racing, thinking about things he has no control over. Patient reports that he is still having difficuluty dealing with the death of his daughter that occurred in 1997. Patient is agreeble to evaluation and treatment. His current mood on the scale of 1-10 is 5, He denies nightmales. He indicates he has poor appetite, said he is losing weight, and not getting 3 meals per day. He said he does hear things at night, but would not call it hallucinations and feels others are watching him since he came home from prison. He denies receiving message from TV and radio, or supernatural power. He rates his depression 6 on the rate of 1-10. His anxiety 5 on the scale of 1-10. Denies any symptoms of mania, including euphoria, or grandiosity. He denies reckless or risky behaviors, and denies gamble=ing or excessive spending.
Past Psychiatric History:
• General Statement: Patient entered treatment for his anxiety, depression, and sleep deprievement due to his situational stressors such as his wife trying to divorce him and also the death of his daughter back in 1997.
• Caregivers (if applicable): Self
• Hospitalizations: None
• Medication trials: Low dose Zoloft 50 mg
• Psychotherapy or Previous Psychiatric Diagnosis: He shot himself in the leg in 1991. Patient had two suicidal attempts in 2003 with OD on pills.
Substance Current Use and History: Dips tobacco occasionally, does not smoke or vape. He had a history of cannabis, amphetamines, and crack cocaine, but sober since 2017.
Family Psychiatric/Substance Use History: No none family history of suicide or sudden death before age 30. Also no known family history of mental illness.
Psychosocial History: Patient has one daughter and a son, both grown. He has one older sister and mother. He was raised by his mother. His father died in 2018 from diabetes and kidney failure. He currently stays with his sister because he is currently sepearated with his wife. He is a high school graduate and could not further his education due to his learning disability. “ I was a slow learner, and in special education from 6th -12th grade”. He is currently unemployed, NOT seeking for job right now. He planed to apply for disability “ I can’t see. My vision is bad.” He used to work with his father at farm. He reported he has worked in construction. His longest job held was 2 years.
Medical History: Hypertension, High cholestorol, and Type 2- diabetes

• Current Medications: Amlodipine 10 mg Q AM. Atorvastatin 20 mg Q PM, Metformin 1000 mg BID, and (insulin sliding scale).
• Allergies: NKA
• Reproductive Hx:
ROS:
• GENERAL: Patient reports weight loss. No chills or fever
• HEENT: Reports some vision problems. No hearing loss or congestion.
• SKIN: Denies rash or history rash from medications
• CARDIOVASCULAR: Denies chest pain or edema
• RESPIRATORY: Denies Dyspnea.
• GASTROINTESTINAL: No nausea or vomiting, Denies abdominal discomfort.
• GENITOURINARY: Denies urgency, frequency or dysuria.
• NEUROLOGICAL: No numbness or tingling reported, No paralysis.
• MUSCULOSKELETAL: No muscle pain or weekness reported.
• HEMATOLOGIC: Denies anemia, or bleeding disorders.
• LYMPHATICS: Reports spleen intact. No node problems
• PSYCHITRIC: Reports depression and anxiety . No recent suicidal thoughts

• Physical exam: Weight 183 lbs, HT: 71 inches,
Diagnostic results:
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 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.
Mental Status Examination:
Differential Diagnoses: 1) Major depressive disorder (MDD) will be a priority diagnosis
2) and (3)

Reflections:

References

Comprehensive Psychiatric Evaluation

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Comprehensive Psychiatric Evaluation

Mental Status Examination

The patient is called J.B, a 50-year-old African American male who presented with mental problems. The patient reported experiencing symptoms of anxiety due to situational stressors. The patient reiterated that his wife is the source of stress because she wants to divorce him. The patient reported being frustrated and irritated. Also, he is experiencing trouble sleeping and has difficulty recovering from the death of her daughter in 1997. He rates depression 6 on a scale of 1 to 10. The DSM was critically analyzed to rule out the differential diagnoses based on their diagnostic criteria and comparison with the patient’s symptoms (Perini et al., 2019). The critical analysis helped to arrive at the primary diagnosis.

Primary Diagnosis

Major depressive disorder (MDD)

The primary diagnosis is Major depressive disorder (MDD), also known as depression. Major depressive disorder is a common and disastrous mental illness that has a negative influence on how one thinks and feels. The patient experienced symptoms of depression which made the therapist suspect the condition (Bains & Abdijadid, 2021). According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) five or more of the following symptoms must be present for one to be diagnosed with depression: Depressed mood, lack of or diminished interest in pleasure in most or all actives of the day, significant weight loss or weight gain, and insomnia. Others include agitation or irritability, feeling of worthlessness or guilt, reduced, concentration, and recurrent thoughts (APA, 2013). The symptom must cause distress to any functional area such as relationship, occupation, and any other. The mental problems are not attributed to substance abuse or any other medical condition (Perini et al., 2019). Most of the symptoms are in tandem with most of those indicated in the DSM-5.

Differential Diagnoses

Dysthymia

Dysthymia was selected as a differential diagnosis. It has similar symptoms as major depressive disorder, except that the patient must have suffered the condition for two years. Also, the patient must have at least two (not five as in the case of MDD) of the symptoms used to diagnose MDD (Valadas & Freitas, 2021). This mental disorder was ruled out because the condition has not lasted for at least 2 years. Also, the patient experience more than the symptoms listed in the MDD diagnostic criteria. According to the DSM-5, present for most days for two years (APA, 2013). The symptoms are milder than major depressive disorder but additional symptoms involved in MDD may develop during dysthymia and lead to a diagnosis of MDD.

Cyclothymia

Cyclothymia is a rare mood disorder that causes emotional ups and downs, however, not as extreme as those found in bipolar. Most symptoms of cyclothymia are similar to those of MDD except for manic-like episodes (Bielecki & Gupta, 2021). According to the DSM-5, the illness is diagnosed if, for two years, there have been episodes of hypomanic and depressive experiences which do not meet the full DSM-5 diagnostic criteria for hypomania or major depressive disorder (APA, 2013). The disease was ruled out because the patient did not experience high moods. He only reported low moods, which is a depressing symptom.

In summary, based on the patient’s symptoms and the DSM-5, he was diagnosed with major depressive disorder. The patient manifested symptoms that satisfied the DSM-5 diagnostic criteria for major depressive disorder. The two differential diagnoses include dysthymia and cyclothymia.

References

APA. (2013). Desk reference to the diagnostic criteria from DSM-5. American Psychiatric Association.

Bains, N., & Abdijadid, S. (2021). Major Depressive Disorder. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Bielecki, J., & Gupta, V. (2021). Cyclothymic Disorder. https://www.ncbi.nlm.nih.gov/books/NBK557877/

Perini, G., Ramusino, M. C., Sinforiani, E., Bernini, S., Petrachi, R., & Costa, A. (2019). Cognitive impairment in depression: recent advances and novel treatments. Neuropsychiatric disease and treatment, 15, 1249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520478/

Valadas, M. T., & Freitas, R. M. (2021). Dysthymia through time: A review. European Psychiatry, 64(1), S329-S329. http://dx.doi.org/10.1192/j.eurpsy.2021.883