Assessing, Diagnosing, and Treating Adults with Mood Disorders

Assessing, Diagnosing, and Treating Adults with Mood Disorders

 Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am.”

HPI: P.P. is a 29-year-old Caucasian Female patient seeking mental examination regarding her ongoing mental health concerns and medication adherence issues. She has taken medications before but stopped because it is suppressing the real her. She has not been taking any medications currently. This patient was referred by her primary care physician, who expressed concern about the inconsistencies in this patient’s use of prescribed psychiatric medications and their possible effects on her mental health and overall functioning. The individual in question claims she has been hospitalized four times for behavioral difficulties. The patient states that her mom admitted her to a medical facility as a young woman after she went for four to five days with no sleep. In 2017, the individual in question went to the hospital for a suicide attempt after overdosing on Benadryl, during which she experienced hearing voices. The person in question went to the hospital when cops discovered her dancing in a field while wearing a night gown and playing guitar. She believes her mom fabricated this narrative to get her to return to her lover.

The person in question previously received diagnoses for anxiety, depression, and bipolar illness. Previously on Zoloft, she experienced a “high” sensation and difficulty sleeping due to racing emotions. Risperdal and Seroquel caused her to acquire bodyweight, which she disliked. She reported that Klonopin slowed her down, which she didn’t enjoy. The client experiences bouts of exhaustion, lack of drive, lack of fascination, and feelings of worthlessness four to five times per year.

She is not currently betrothed and had no kids of her own. She working a part-time at the aunt’s bookstore but misses job because of despair. She is presently studying cosmetics at an educational institution and aspires to work as a makeup professional for celebrities. She adores composing her entire history and aims to publicize it. She also paints like Picasso and hopes to market her work to famous actors.

History of Mental Illness

 Hospitalizations – 4 times, with the most current one occurring in 2020 springtime.

 Overdosing on Benadryl during a 2017 attempt to commit suicide

 Diagnosed with bipolar illness, depression and anxiety.

Trials of Medication

 Zoloft: “Gave me a very euphoric feeling. My thoughts were speeding up and I was having trouble falling asleep”.

 Risperidone and Seroquel resulted in a notable increase in bodyweight.

 Klonopin: “I feel like I’m slowing down.”

 “I abruptly discontinued a prescription that started with the letter “L,” which assisted but it stifled my imagination.

Family History: Mom of the individual in question tried and failed to end her life. She believes that her mom was given a bipolar disorder diagnosis. Dad served time in jail for narcotics offenses. The individual in question claims that she hasn’t seen her father in nearly a decade. The client states that although his brother has behavioral problems, he has never asked for help or received a diagnosis.

Substance Current Use: She smokes one pack of cigarettes daily. She denied current or past use of any illicit substances, claims to have tried marijuana one time, but she didn’t enjoy it because it made her anxious. disputes consuming alcohol; last sip was at age 19.

Medical History: Hypothyroidism and polycystic ovarian syndrome.

• Current Medications: The patient is currently birth control pill and a medication for her thyroid problem but cannot remember the name.
• Allergies: The patient reports no known allergy. There is no documentation of food allergies.
• Reproductive Hx: None reported

ROS:

• GENERAL: Disputes weakness, cold, a high temperature, decrease in weight, or exhaustion.
• HEENT: Denies migraines, or injuries to the head. Disputes visual changes, double vision, or eye pain. Denies hearing loss, ear pain, nasal congestion, or sore throat.
• SKIN: Denies any irritation or blemishes.
• CARDIOVASCULAR: Denies any heart rate fluctuations, chest discomfort, or swelling in the legs.
• RESPIRATORY: Denies breathing difficulties or dyspnea.
• GASTROINTESTINAL: Disputes stomach pain, bloating, loose stool or vomiting.
• GENITOURINARY: Denies dysuria, pressure, frequency, or hematuria.
• NEUROLOGICAL: Denies experiencing any tingling, shifts in coordination, convulsions, fainting, convulsions, or paralysis.
• MUSCULOSKELETAL: Denies Absence of edema, muscular weakness, or tenderness in the joints.
• HEMATOLOGIC: Disputes history of hemorrhage, bruising, or shortage of blood.
• LYMPHATICS: Denies enlarged lymph lobes or history of lymphatic disorders.
• ENDOCRINOLOGIC: The patient’s thyroid-stimulating hormone (TSH) level was elevated at 6.3. The prolactin level was normal at 8. Further, the CBC, CMP, and lipid panel showed no abnormalities indicative of endocrine disorders such as diabetes or dyslipidemia.

Objective:

ROS:

• GENERAL: The individual in question is tidy, polished, and properly dressed. The state of mind and attitude are suitable and compatible.
• HEENT: The head is normal in shape and shows no signs of trauma or malformation.
• SKIN: Lack of moisture warm, and free of visible wounds, irritation, or blemishes.
• CARDIOVASCULAR: No chest pain nor palpitation noted. Assessing, Diagnosing, and Treating Adults with Mood Disorders
• RESPIRATORY: There are no noticeable wheezes or loss of breath.
• NEUROLOGICAL: The individual in question is friendly, accommodating, and four times as focused as usual.
• MUSCULOSKELETAL: Capable of effortlessly moving all limbs.

Vital Signs: Temp. 98.2, Pulse 90, RR 18, BP 138/88, O2 Sat 98%, Weight 166lbs., Height 5ft 7”.

Diagnostic results: For this patient, diagnostic testing would include thyroid function tests that may explain her elevated TSH to contribute to mood instability similar to the symptoms of bipolar disorder. Such tests may help in distinguishing primary mood disorders from underlying medical conditions such as hypothyroidism and allow for complete management based on needs. The structured interviews for the psychiatric evaluation would be necessary for the establishment and refining of the diagnosis of bipolar disorder since she reported manic episodes characterized by symptoms of impulsivity and depressive episodes characterized by suicidal ideation. These tests will arrive at a proper diagnosis and adequately plan for treatment, stressing that it is necessary to couple medical and psychiatric assessments in the management of complex mood disorders.

Assessment:

Mental Status Examination: PP is well-groomed and appropriately dressed. She sits calmly, with steady eye contact throughout the interview. Her motor behaviour does not show any abnormalities. During the interview, she was cooperative and engaged. She expresses an entire spectrum of feelings—from sadness while describing recent depressive episodes to optimism when talking about more stable periods in her life. Her affect is generally congruent to her mood, appropriately variable, tearful while describing distressing events, and brightening when describing her supportive relationships and future goals. PP’s speech is fluent and coherent, with no evidence of pressured speech or tangentiality. The rate, volume, and rhythm were within normal limits. She is logical and goal-directed in thought processes, reflecting deeply on the triggers and patterns of mood episodes; there is no evidence of delusions or disorganized thinking. The content of thought is well-focused, principally preoccupied with concerns about future mood swings and their consequences in her private and professional life.

She denies suicidal or homicidal ideation and paranoid thoughts or perceptual disturbances such as hallucinations or illusions. Cognitive functions seem grossly intact;. She appears to be aware of the moment, the place, and the individuals. There is excellent devote and focus, and recollection is unharmed. She has good insight regarding her illness, realizing how it had been impairing her functioning and expressing willingness to comply with treatment recommendations. The assessment indicates that there are no safety concerns regarding self-harm or harm to others at this moment, as Petunia denies any current suicidal intent or risk. Assessing, Diagnosing, and Treating Adults with Mood Disorders

Diagnostic Impression: Bipolar II Disorder, Hypomanic Episode

PP came with a joyful mood, increased energy, pressure of speech, grandiosity, and decreased need for sleep—some hallmarks of a hypomanic episode. The diagnosis that best fits these symptoms is Bipolar II Disorder because hypomania is less severe than full-blown mania but significantly impacts functioning (McIntyre et al., 2020). A lack of current psychotic symptoms, such as hallucinations or delusions in conjunction with a history of prior depressive episodes, more likely confirms this diagnosis over other mood disorders or psychotic disorders.

Differential Diagnosis

Major Depressive Disorder (MDD): Considered in the differential diagnoses initially given PP’s history of depressive episodes (Abdoli et al., 2022). Still, the current presentation with an elevation of mood, increase in energy, and grandiosity is more suggestive of a hypomanic rather than a depressive episode.

Generalized Anxiety Disorder: Is characterized by too much stress, agitation, nervousness, and difficulty sleeping lasting at least a half-year. The above signs might cause anguish and negatively impact interpersonal and vocational performance. The person in question experiences significant difficulties with sleep, including trouble sleeping and excessive sleepiness.

Substance-Induced Mood Disorder: Ruled out due to insufficient evidence of recent substance use that could explain the current symptoms.

Schizoaffective Disorder: Although grandiosity and forced speech are also hallmarks of bipolar disorder and schizoaffective disorder, no psychotic symptom was elicited upon assessment for PP; therefore, the probability of schizoaffective disease is considerably reduced (Dennison et al., 2021).

Reflections:

The PP case has, in some measure, enlightened the understanding of the complexities involved in diagnosing and treating Bipolar II Disorder. The differentials at the beginning, when she had been feeling low and could not concentrate, were multiple major depressive illnesses or adjustment disorders. This diagnosis of bipolar II disorder, however, was made in the light of a clear clinical history provided by PP with hypomanic episodes marked with high energy and goal-directed conduct. This, therefore, emphasizes the critical role of good assessment in arriving at a correct diagnosis by carefully evoking variations in mood and functional impairment during many phases of this illness.

Cultural sensitivity in healthcare was a core ethical responsibility above informed consent and confidentiality protections. Confidentiality words have to be defined because this is  professionals’ ethical and legal obligations. The individual in question deserves to be aware of her medical plan alternatives before making a selection. Maintaining the patient’s autonomy is critical in the treatment bond involving physician and patient. It is important that the patient completely knows all possible therapies to choose from the potential hazards and benefits of each therapy choice, and the sort of surveillance that might be required for certain therapeutic alternatives. Establishing trust and respect for PP’s ethnic background and beliefs significantly improved communication and the working relationship (Stubbe, 2020). Two of the more pertinent barriers to PP’s treatment plan include minimizing the stigma associated with mental illness within her culture and educating her about Bipolar II Disorder. Furthermore, the identified social determinants of health—socioeconomic class and access to healthcare services—implored the necessity of care planning. Health promotion strategies include lifestyle modifications and stress management techniques that would help improve the overall well-being of PP and prevent relapses.

Case Formulation and Treatment Plan:

For this reason, my plan for PP’s psychotherapy is the integration of cognitive behavioural therapy as a primary modality. CBT can be beneficial in the management of Bipolar II Condition by attending to maladaptive thoughts and behaviors that are associated with mood swings and how one can identify and alter them (Özdel et al., 2021). Sessions will address psychoeducation about the nature of bipolar disorder, identifying triggers for mood episodes, and developing coping strategies on stress management techniques and regulating emotions. Moreover, we will target the stabilization of daily routines and sleep patterns through interpersonal and social rhythm therapy IPSRT, which is one of the essential strategies in the prevention of mood swings.

For pharmacologic treatment, it would be proper to initiate lamotrigine (Lamictal), whose efficacy in mood stabilization and prevention of depressive episodes in Bipolar II Disorder has been well established (Haenen et al., 2024). The low starting dose and gradual titration according to response and tolerability will be very important for this medication. Liver function tests and tracking dermatologic reactions will give guidelines for dosing adjustment and safety monitoring. These will be supplemented with non-pharmacologic approaches, including regular exercise, sleep hygiene, and mindfulness-based practices, to support well-being and resilience while the patient is under medication management. Assessing, Diagnosing, and Treating Adults with Mood Disorders

An alternative therapy to consider is light therapy, particularly during the winter months when PP may experience seasonal affective disorder (SAD). Light therapy can help regulate circadian rhythms and improve mood by simulating natural sunlight exposure (Gitlin & Malhi, 2020). It will be crucial to first set up follow-up parameters on a weekly basis to track drug compliance, symptom reaction, and any negative effects. By the time PP is stabilized, these follow-up intervals can be extended to monthly visits to assess the effectiveness of treatment, make any further therapy adjustments, and provide support for psychoeducational components.

An appropriate health promotion activity for PP would be initiating regular exercise programming based on activities she enjoys or can do. Aerobic exercise enhances physical well-being in general but also improves mood due to increased endorphins and reduced stress hormones. Assistance with joining community-based exercise opportunities will help ensure socialization and support beyond the clinical environment.

I will provide information and resources on Bipolar II Disorder, its symptoms, and treatment options, as well as how one might manage the disorder. Stressing the value of taking prescriptions as prescribed, seeing early indicators of mood disorders, and applying buffering mechanisms during stressful times can help empower PP in her treatment journey. Moreover, the role of social support networks and ways to effectively communicate with loved ones about her condition will be discussed to decrease stigma and increase overall well-being.

References

Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2022). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, pp. 132, 1067–1073.

Dennison, C. A., Legge, S. E., Hubbard, L., Lynham, A. J., Zammit, S., Holmans, P., … & Walters, J. T. (2021). Risk factors, clinical features, and polygenic risk scores in schizophrenia and schizoaffective disorder depressive-type. Schizophrenia Bulletin, 47(5), 1375–1384.

Gitlin, M., & Malhi, G. S. (2020). The existential crisis of bipolar II disorder. International Journal of Bipolar Disorders, 8(1), 5.

Haenen, N., Kamperman, A. M., Prodan, A., Nolen, W. A., Boks, M. P., & Wesseloo, R. (2024). The efficacy of lamotrigine in bipolar disorder: A systematic review and meta‐analysis. Bipolar Disorders.

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., … & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.

Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S66.

Stubbe, D. E. (2020). They practice cultural competence and humility when caring for diverse patients. Focus, 18(1), 49-51.