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

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

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

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order 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.

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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.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 6, “Bipolar Disorders”

Chapter 2, “Neurodevelopmental Disorders and Other Childhood Disorders”

Section 2.9, “Depressive Disorders and Suicide in Children and Adolescents” (pp. 174-180)

Section 2.10, “Early-Onset Bipolar Disorder” (pp. 181-184)

Chapter 7, “Depressive Disorders”

Chapter 21, “Psychopharmacology”

Chapter 22, “Other Somatic Therapies”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

Chapter 11, “Mood Disorders”

Document: Focused SOAP Note Template

Download Focused SOAP Note Template

Document: Focused SOAP Note Exemplar

Download Focused SOAP Note Exemplar

Required Media

CrashCourse. (2014, September 8). Depressive and bipolar disorders: Crash course psychology #30

Links to an external site. [Video]. YouTube. https://youtu.be/ZwMlHkWKDwM https://www.youtube.com/watch?v=ZwMlHkWKDwM&t=1sLinks to an external site.

Walden University. (2021). Case study: Petunia Park. Walden University Blackboard. https://waldenu.instructure.com

Medication Review

Depression Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation)

agomelatine

amitriptyline

amoxapine

aripiprazole

(adjunct)

brexpiprazole (adjunct)bupropion

citalopram

clomipramine

cyamemazine

desipramine

desvenlafaxine

dothiepindoxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

iloperidone

imipramine

isocarboxazid

ketamine

lithium (adjunct)

l-methylfolate (adjunct)

lofepramine

maprotiline

mianserin

milnacipran

mirtazapine

moclobemide

nefazodone

nortriptyline

paroxetine

phenelzine

protriptyline quetiapine (adjunct)

reboxetine

selegiline

sertindole

sertraline

sulpiride

tianeptine

tranylcypromine

trazodone

trimipramine

venlafaxine

vilazodone

vortioxetine

citalopram

desvenlafaxine

duloxetin

eescitalopram

fluoxetin

eparoxetine

pepexev

sarafe,

sertraline

venlafaxine Bupropion HCL extended-release

Bipolar depression Bipolar disorder (mixed Mania/Depression Bipolar maintenance Mania
lithium (used with lurasidone)

lurasidone

olanzapine-fluoxetine combination (symbyax)

quetiapine

valproate (divalproex) (used with lurasidone) aripiprazole

asenapine

carbamazepine olanzapine

ziprasidone

aripiprazole

lamotrigine

lithium

olanzapine aripiprazole

asenapine

carbamazepine

lithium

olanzapine

quetiapine

risperidone

valproate (divalproex)

ziprasidone

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.

Consider patient diagnostics missing from the video:

Provider Review outside of interview:

Temp 98.2 Pulse 90 Respiration 18 B/P 138/88

Laboratory Data Available: 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)

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-TR 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: Relect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

By Day 7 of Week 4

Submit your Focused SOAP Note.

submission information

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Rubric

NRNP_6665_Week4_Assignment_Rubric

NRNP_6665_Week4_Assignment_Rubric

Criteria Ratings Pts

This criterion is linked to a Learning Outcome Create documentation in the Focused SOAP Note Template about the patient in the case study. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS

15 to >13.0 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

13 to >11.0 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

11 to >10.0 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies.

10 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.
15 pts

This criterion is linked to a Learning Outcome In the Objective section, provide:• Review of Systems (ROS) documentation and relate if pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

15 to >13.0 pts

Excellent

The response thoroughly and accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

13 to >11.0 pts

Good

The response accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are accurately documented.

11 to >10.0 pts

Fair

Documentation of the patient’s ROS is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor inaccuracies.

10 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s ROS. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.

15 pts

This criterion is linked to a Learning Outcome In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least 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.
20 to >17.0 pts

Excellent

The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

17 to >15.0 pts

Good

The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

15 to >13.0 pts

Fair

The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy.

13 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing.

20 pts

This criterion is linked to a Learning Outcome In the Plan section, provide:• Your plan for psychotherapy• 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. • Incorporate one health promotion activity and one patient education strategy.

25 to >22.0 pts

Excellent

The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding. … The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy.

22 to >19.0 pts

Good

The response provides an evidence-based and appropriate plan for psychotherapy for the patient. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided. … The response includes at least one health promotion activity and one patient education strategy.

19 to >17.0 pts

Fair

The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general. … The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy.

17 to >0 pts

Poor

The response provides an incomplete or inaccurate plan for psychotherapy for the patient. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing. … The health promotion and patient education strategies are incomplete or missing.
25 pts

This criterion is linked to a Learning Outcome • Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

5 to >4.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

4 to >3.5 pts

Good

Reflections demonstrate critical thinking.

3.5 to >3.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking.

3 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing.
5 pts

This criterion is linked to a Learning Outcome Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
10 to >8.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

8 to >7.0 pts

Good

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

7 to >6.0 pts

Fair

Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

6 to >0 pts

Poor

Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.
10 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.

5 to >4.0 pts

Excellent

Uses correct APA format with no errors

4 to >3.5 pts

Good

Contains a few (one or two) APA format errors

3.5 to >3.0 pts

Fair

Contains several (three or four) APA format errors

3 to >0 pts

Poor

Contains many (five or more) APA format errors
5 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation

5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.5 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors

3.5 to >3.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

3 to >0 pts

Poor

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts

Total Points: 100

A Sample Of This Assignment Written By One of Our Top-rated writers

 Subjective:

CC (chief complaint): “I have come for a mental health assessment.”

HPI: The video depicts Petunia Park, a 29-year-old female presenting for a mental health assessment. Petunia mentions not being consistent with her prescribed medications because they squash her, and she thinks she does not need them. She has a history of recurrent depression, 4-5 depressive episodes annually, which interferes with her work at the bookstore. During the depressive episodes, she has diminished motivation and energy levels and wants to sleep continuously. She also feels worthless as her creativity diminishes. The depressive episodes usually come after being very active for five days, where she is actively involved in activities she enjoys, like writing, painting, and music. Although others think that she is depressed, Petunia believes that it is just exhaustion.

The client reports that she is usually creative for about a week before crushing and losing interest. On these days, she does not adhere to her meds because they squash her. She also feels very energetic, hardly sleeps, engages in many activities, talks excessively, and is usually all over. Moreover, she engages in sexual activity to explore herself and barely eats, unlike when she is crashed.

Substance Current Use: Smokes 1PPD; Last took alcohol at 19. She has taken marijuana once and had paranoia.

Medical History: Positive for Hypothyroidism.

• Current Medications: Hormonal pills; Levothyroxine
• Allergies: None

• Reproductive Hx: Positive for Polycystic Ovaries.

ROS:

• GENERAL: Decreased energy levels when depressed. High energy when creative.
• HEENT: No vision changes, hearing impairment, sneezing, runny nose, or sore throat.
• SKIN: No bruises, rashes, or itching.
• CARDIOVASCULAR: No dyspnea, palpitations, or edema.
• RESPIRATORY: No cough, wheezing, or difficulties in breathing.
• GASTROINTESTINAL: High appetite when depressed; Reduced appetite when creative.
• GENITOURINARY: Denies pelvic pain or dysuria.
• NEUROLOGICAL: No tingling sensation, muscle weakness, or syncope.
• MUSCULOSKELETAL: No joint pain, stiffness, or muscle pain.
• HEMATOLOGIC: No bleeding or anemia.
• LYMPHATICS: No enlarged nodes.
• ENDOCRINOLOGIC: Reports history of hypothyroidism.

Objective:

Diagnostic results: No tests were ordered.

Assessment:

Mental Status Examination:

The patient is well-groomed and appropriately dressed. She is alert and oriented to person, place, and time. She maintains adequate eye contact and uses appropriate facial expressions. Her speech is clear and goal-directed, with average volume and rate. The thought process is logical and coherent. No delusions, hallucinations, compulsions, obsessions, or suicidal thoughts/ideas were noted. Her recent, recent past, and long-term memory is intact. She lacks insight.

Diagnostic Impression:

Bipolar Disorder: This is a mental disorder that causes extreme mood swings. Patients present with at least one manic episode followed by hypomania or major depressive episode (Jelen & Young, 2020). Symptoms of mania and hypomania include An extremely elevated mood, Racing thoughts, Distractibility, Talkativeness, Increased activity and energy levels, Exaggerated sense of well-being, Poor decision-making, and Engaging in risky pleasurable activities (Goes, 2023). Petunia has episodes of mania lasting a week, during which she is creative and engages in many activities. These episodes are followed by depressive episodes, where she loses interest and has low energy levels. The extreme mood swings seen in the patient make Bipolar disorder a primary diagnosis.

Major Depressive Disorder (MDD): The primary symptoms of MDD, according to the DSM-V diagnostic criteria, include a depressed mood characterized by feeling sad, empty, hopeless, or tearful or a loss of interest or feeling of no pleasure. Other symptoms include significant weight loss or weight gain; Increased or reduced appetite; Insomnia or oversleeping; Restlessness; Fatigue and loss of energy; Suicidal thoughts or plans; Feelings of Thinking and planning suicide worthlessness or guilt (Cui et al., 2024). The patient reports having episodes where she has a depressed mood, lacks interest in her creative works, has low energy levels, overeats, sleeps a lot, and feels worthless. This makes MDD a differential diagnosis.

Schizophrenia: Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, incomprehensive language, and bizarre behavior. Negative symptoms include poverty of speech, lack of motivation, decreased emotional range, and loss of interest (McCutcheon et al., 2020). Petunia has auditory hallucinations as she states that she hears voices telling her she is excellent and wonderfully talented and has delusions of grandeur. She also has episodes where she lacks motivation and interest in her work.

Reflections: From this case, I learned that patients with Bipolar disorder often present with intervals of deep, prolonged, and profound depression that alternate with intervals of mania. Thus, it is vital to establish that a patient has two extreme mood disorders when making the diagnosis (Goes, 2023). Ethical/legal considerations for this patient should entail prescribing treatment that will treat the Bipolar symptoms without compromising the client’s safety (Boland et al., 2022). The clinician should assess SDOH factors that may impact the patient’s utilization of mental health services, like income level and education level.

Case Formulation and Treatment Plan:

Psychotherapy: Weekly Cognitive behavior therapy (CBT) sessions. CBT will impact the client with cognitive-behavioral skills to cope with Bipolar and the associated psychosocial stressors and challenges (Brieler & Keegan-Garrett, 2022).

Pharmacologic treatments: Lithium ER 450 mg PO twice daily.

Alternative therapies: Depakote ER: 250 mg PO once daily.

Follow-up parameter: Follow up after four weeks at the outpatient psychiatry clinic to assess progress.

Health promotion activity and patient education: The patient will be encouraged to exercise regularly, especially during depressive episodes. She should be educated to create a regular daily schedule of major activities. Having exercise and a regular schedule is fundamental to coping with Bipolar (Brieler & Keegan-Garrett, 2022).

References

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Brieler, J. A., & Keegan-Garrett, E. (2022). Diagnosis and Treatment of Bipolar Illness in the Primary Care Office. Missouri Medicine, 119(3), 213–218.

Cui, L., Li, S., Wang, S., Wu, X., Liu, Y., Yu, W., … & Li, B. (2024). Major depressive disorder: hypothesis, mechanism, prevention and treatment. Signal Transduction and Targeted Therapy, 9(1), 1-32. https://doi.org/10.1038/s41392-024-01738-y

Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical Research ed.), 381, e073591. https://doi.org/10.1136/bmj-2022-073591

Jelen, L. A., & Young, A. H. (2020). The treatment of bipolar depression: current status and future perspectives. Current Behavioral Neuroscience Reports, 7(1), 1-14. https://doi.org/10.1007/s40473-020-00200-x

McCutcheon, R. A., Marques, T. R., & Howes, O. D. (2020). Schizophrenia—an overview. JAMA psychiatry, 77(2), 201-210. https://doi.org/10.1001/jamapsychiatry.2019.3360