NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Subjective

CC: “I have been referred to the office for a mental health checkup. I have a history of discontinuing medication”

HPI: P. P. is a 25yo Caucasian female. She reports visiting the office for a mental health assessment. P. P. reports a history of discontinuing medication, stating that she feels like the drug squashes her personality. The patient reports being hospitalized for mental health four times. Was previously diagnosed with anxiety, depression, and bipolar disorder. She is not currently using medications to manage her mental health symptoms. P. P, reports a history of auditory hallucinations and suicidal ideas. She further reports losing interest in various activities, adding that others believe she is depressed. At times, she feels motivated and energized.  She denies taking her medications during these creativity periods and can skill sleeping for five days continuously. P. P. also becomes too talkative during the creative episodes, lasting for about a week.

Substance Current Use: P.P. reports current cigarette smoking. Denies cannabis abuse or alcohol use. Denies use of other illicit substances, including stimulants.

Medical History: P.P. reports polycystic ovaries and hypothyroidism diagnoses.

• Current Medications: Medication for managing hypothyroidism. Oral contraceptive pills for managing her polycystic ovaries.
• Allergies: P. denies a history of known allergies.

• Reproductive Hx: P.P. reports being sexually active. Her L. M. P. was the previous month. P. P. discloses having multiple partners.

ROS:

• GENERAL: P. denies recent weight changes.

HEENT: P. P. denies head deformities, blurred vision, ear pain, nasal discharge, or swallowing difficulties.

• SKIN: P. denies skin bruising.
• CARDIOVASCULAR: P. denies experiencing chest tightness.
• RESPIRATORY: P. denies sputum production.
• GASTROINTESTINAL: P. denies reflux.
• GENITOURINARY: P. denies recent urinary frequency.
• NEUROLOGICAL: P. P. denies ataxia or persistent headaches.
• MUSCULOSKELETAL: P. P. denies muscle stiffness.
• HEMATOLOGIC: P. P. denies an incident of abnormal bleeding.
• LYMPHATICS: P. P. denies painful lymph nodes.
• ENDOCRINOLOGIC: P. P. reports hypothyroidism.

Objective:

Diagnostic results:

Mood Disorder Questionnaire (MDQ): P. P. answered “Yes” in 9 out of 13 questions, confirming bipolar symptoms.

Assessment

Mental Status Examination: P. P. is a 25yo Caucasian female. She appeared appropriate for her age and was well-groomed. P. P. is alert and oriented to time, places, and events. Her affect is bright with an elevated and euthymic mood. She speaks in a pressured speech. P. P. is goal-directed and focused. Suicidal ideations and auditory hallucinations were reported during the psychiatric assessment. She denies visual and auditory hallucinations. NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Diagnostic Impression

Bipolar I Disorder (BID): This form of bipolar disorder is associated with a complete mania symptoms’ set. Persons with BID experience elevated mood accompanied by at least three other symptoms, such as elevated goal-directed activity, a reduced need for sleep, grandiosity, distractibility, pressured speech, racing thoughts, and reckless behaviors. These symptoms persist for a minimum of one week or need hospitalization (Kowalewski et al. (2021). The patient meets the DSM-5 criteria for BID since she was hospitalized for failure to sleep for five consecutive days. P. P. also reported feeling motivated and energized and being too talkative during creative periods, lasting for about a week. Lastly, P. P. answered “Yes” in 9 questions in the MDQ, making BID the most accurate pertinent diagnosis.

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Bipolar II Disorder (BIID): This mood disorder consists of past or current episodes of major depression. The depressive episodes interspersed with hypomanic periods lasting for a minimum of four days (Hategan et al., 2024). P. P. reported feeling energized during creative periods. Moreover, the patient had depressive episodes. She states that other people claimed she was depressed. She also reported losing interest in activities, making BIID a correct current diagnosis.

Major Depressive Disorder (MDD): This mood disorder is primarily characterized by a depressed mood or losing interest in activities lasting for two weeks or more (Fraile-Martinez et al., 2022). P. P. reports losing interest in getting out of bed and losing her motivation and creativity. However, MDD is ruled out since these symptoms had not been experienced two weeks before the psychiatric assessment.

Reflections

The preceptor’s evaluation and diagnostic impression in this scenario are supported. Patients with depressive symptoms are diagnosed with various mood disorders. Besides, I learned that BID can occur together with BIID. A different practice involves asking for P.P.’s discharge reports to collect a detailed mental health history for appropriate diagnosis and treatment. Ethical consideration is nonmaleficence which protects patients from potential harm (Horstkötter & de Wert, 2020). Thus, the mental health provider should not prescribe the patient that might cause undesired side effects. health promotion involves educating P. P. about barrier methods to reduce the risk of sexually transmitted infections since she reports having multiple intimate partners.

Case Formulation and Treatment Plan:

2. P. should be prescribed Depakote 250mg orally twice daily. Depakote is an effective treatment for mood symptoms in adults with bipolar I disorder (Baldessarini et al., 2019). Another recommendable medication is olanzapine 2.5mg orally daily. These medications are recommended since they would be well-tolerated without undesired side effects. As a result, P. P. would adhere to these medication therapies, stabilizing her mood.

References

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217. https://www.nature.com/articles/s41380-018-0044-2

Fraile-Martinez, O., Alvarez-Mon, M. A., Garcia-Montero, C., Pekarek, L., Guijarro, L. G., Lahera, G., … & Ortega, M. A. (2022). Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine. Frontiers in Oncology, 12, 956923. https://doi.org/10.3389/fonc.2022.956923

Hategan, A., Cheng, T., & Saperson, K. (2024). Late-Life Bipolar Disorders. In Geriatric Psychiatry: A Case-Based Textbook (pp. 277-295). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-031-47802-4_11

Horstkötter, D., & de Wert, G. (2020). Ethical considerations (pp. 145-159). Springer International Publishing.

Kowalewski, W., Walczak-Kozłowska, T., Walczak, E., & Bikun, D. (2021). Nursing care in bipolar disorder – case study. Pomeranian Journal of Life Sciences, 67(1). https://doi.org/10.21164/pomjlifesci.772  NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders