Assessing, Diagnosing, And Treating Adults with Mood Disorders

Assessing, Diagnosing, And Treating Adults with Mood Disorders

Subjective:

CC (chief complaint): Petunia Park, a 28-year-old female patient (25 years old as of the time of the interview), presents to the clinic with a history of mental health issues, including bipolar, depression, and anxiety, with a complaint that she tends to stop taking her medications as she feels that the medications squash who she really is. Get in touch with us at eminencepapers.com. We offer assignment help with high professionalism.

HPI: Ms. Park, 25 years presented herself and reported that she has a history of taking medications and then stopping them. She thinks that she does not need the medications and that they squash who she is. Ms. Park has reported experiencing recurrent episodes characterized by heightened creativity, increased energy, reduced need for sleep, and engagement in impulsive behaviors, including promiscuity. These recurrent high-energy periods are short-lived, followed by periods of low energy, depressive feelings, and increased need to sleep more. She reports that she has a long history of mental issues that have made her get hospitalized four times. She notes that, as a teenager, she had issues with sleeping and went for five days without sleep. This made her have some auditory illusions and hallucinations. She reports that she has been diagnosed with what she thinks are depression and probably bipolar. She has been put on medication on all occasions. Ms. Park also mentions experiencing hypothyroidism, taking medication for it, and using birth control pills for polycystic ovaries. She, however, notes she has never had detoxification or residential rehab.

Substance Current Use: The patient reports that she has a history of nicotine abuse. she notes that she smokes approximately one pack per day and is unwilling to stop any time soon. She also says that when she was 19 years old, she tried drinking, but she was unable to continue since it did not sit well with her body. She further reports she tried smoking and using marijuana once but stopped as she started experiencing paranoia. She denies using any other substances, currently or in the past, including stimulants, inhalants, sedatives, hallucinogens, or any other synthetic substances. She denies having any experiences of blackouts and seizures from her past or current substance use.

Medical History: Ms. Park reports she has hypothyroidism, for which she is currently using medications. She was diagnosed with polycystic ovaries, which she is currently treating and managing using birth control pills. The patient also reports regular menstruation and has never had a pregnancy despite having a very active sex life involving multiple sex partners. She denies having any symptoms related to anxiety, panic disorder, or obsessive-compulsive behaviors. She once had auditory but no visual hallucinations. She has had suicidal ideation and even attempted suicide in 2017 by overdosing on Benadryl. However, she has never had any other suicidal gestures since then. She has highly fluctuating sleep patterns based on moods and can sleep for 3 hours. She has depressive episodes which affect her work life. Her family has a history of mental health issues and substance and drug abuse, especially her father. She mentions her mother to have been described as crazy and has probable bipolar. Her mother has also attempted suicide. She describes her brother as schizophrenic, although not yet medically diagnosed. Ms. Park does not report any past, current, or future cases of self-harm or intention to harm herself.

Current Medications: Ms. Park reports that she is currently using some medications to treat her thyroid and a birth control pill for polycystic ovaries. She also mentions she has used Zoloft, which made her feel really high and lose sleep, risperidone and Seroquel, which made her gain weight, and Klonopin, which slows her down. She mentions that there are other medications, but she cannot remember the names, including one with a name starting with L, which made her lose her creativity.

• Allergies: No mentioned or known allergies.

• Reproductive Hx: The patient reports that she has never got pregnant. She has regular menstrual periods. She is sexually active with a boyfriend and other random multiple-sex partners.

ROS:

• GENERAL: The patient reports that she has episodes of feeling high with energy and others of having low energy and depression. She reports being less creative during her depressive episodes and more creative during her high-energy episodes. She denies having any fever, chills, or weight loss. She gained some weight while using some medications in the past.
• HEENT: Park denies having headaches or dizziness. She has no reported visual disturbances or hearing loss, although she reported having some auditory hallucinations some time back, having any pain or sore throat, or issues with swallowing. Her breathing is normal, and she denies any current nasal congestion or any nose-related issues. She does not report any visual issues.
• SKIN: She has no rashes, scratches, or markings on her skin. She denies any skin issues.
• CARDIOVASCULAR: The patient does not report having any past or current chest pain or irregular heartbeats. No edema.
• RESPIRATORY: No reported shortness of breath, cough, wheezing, or difficulties breathing.
• GASTROINTESTINAL: Ms. Park has not mentioned any type of abdominal pain, nausea, vomiting, or changes in her bowel habits.
• GENITOURINARY: The patient has not reported any urinary issues or symptoms experienced. She notes she has no notable changes in urination patterns.
• NEUROLOGICAL: Ms. Park mentions having episodes of racing thoughts with heightened creativity. She does not report of any history of seizures or notable neurologic deficits.
• MUSCULOSKELETAL: The patient has not mentioned any bone, joint, or muscle pain or issues of concern.
• HEMATOLOGIC: The patient has not mentioned any history or family history of blood and bleeding disorders. No report of easy bruising.
• LYMPHATICS: Patient The patient does not report any lymphatic issues, including painful, swollen, or enlarged lymph nodes.
• ENDOCRINOLOGIC: Ms. Park reports that she has thyroid issues and polycystic ovaries. She mentions she uses medication for hypothyroidism and birth control pills for polycystic ovaries.

Objective:

Diagnostic results:

Vital Signs:

• Temperature: 98.2°F
• Pulse: 90 bpm
• Respiration: 18 breaths per minute
• Blood Pressure: 138/88 mmHg

Laboratory Data:

• Urine drug and alcohol screen: Negative
• CBC: Within normal ranges
• CMP: Within normal ranges
• Lipid panel: Within normal ranges
• Prolactin Level: 8
• TSH Level: 6.3 (high, indicating hypothyroidism).

Assessment:

Mental Status Examination:

Ms. Petunia Park, a (25)-year-old female patient, presents herself to the clinic following a prolonged period of having mental issues and recently feeling she has developed a tendency to adhere to her medications. She is well-groomed and appropriately dressed for the occasion and weather. She was cooperative and engaged throughout the assessment and provided well-reasoned and detailed responses to questions of the mental status examination. Ms. Park’s moods and behavior alternate between periods of high energy, impulsivity, and increased speech during her creative episodes and periods of low energy, depressive symptoms, and increased sleep during her depressive episodes. She experiences episodes of elevated moods and high energy as well as low energy, depression, and less creativity with a matching effect for each of the high and low episodes. Her speech is clear and unpressured throughout the interview. Her thoughts are formal and well organized, while her thought content is congruent to the topic. She has no signs of cognitive deficits or difficulties with memory or attention. Ms. Park is aware of her mental issues and the potential consequences of related behaviors. She acknowledges her previous suicide attempt but denies any current suicidal ideation. She has no self-harming or homicidal thoughts. She has no current auditory or visual hallucinations.

Diagnostic Impression:

Based on the assessment of Petunia Park, the possible major diagnostic impression is Bipolar II Disorder. Other possible diagnostic impressions are bipolar I disorder, Major Depressive Disorder, and substance-induced mood disorder, specifically medication-induced depressive disorder.

Bipolar II Disorder is the main diagnostic impression as Ms. Park has a history of depressive and hypomanic episodes, which form the basis of differentiating bipolar II from bipolar I (Gitlin & Malhi, 2020). The pertinent positives in the case include the alternating periods of elevated mood, increased energy, impulsivity, and creativity, which are hypomanic episodes, then subsequent episodes of depressive episodes characterized by low energy, increased sleep, and loss of interest in creativity. However, such mood fluctuation can be influenced by her thyroid issues. Hypothyroidism is associated with the development of depressive symptoms (Hirtz et al., 2021).

Bipolar I Disorder is a possible diagnosis due to depressive episodes. However, it can be ruled out as Ms. Park does not report any full-blown manic episodes or psychotic symptoms during her hypomanic episodes common in Bipolar I disorder (Marzani & Neff, 2021).

Major Depressive Disorder (MDD) is possible due to recurrent depressive episodes, loss of interest in creative activities, and feelings of hopelessness as major symptoms of MDD (Gutiérrez-Rojas et al., 2020). However, it can be ruled out as the patient has hypomanic episodes.

Substance-Induced Mood Disorder (medication-induced depressive disorder) is possible, as per Ms. Park’s history. However, it can be ruled out as urine drug and alcohol screens are negative.

Reflections

Managing Petunia Park’s case has been a great learning experience. The major diagnostic impression of Bipolar II Disorder is well-considered and is based on the patient’s reported history of alternating hypomanic and depressive episodes. However, I would not fully settle on that diagnosis as she has mentioned having thyroid issues and that she has been under several medications which combined can significantly affect her moods. Before she can start on medications, it is important that further diagnostic tests are conducted on Ms. Park to determine her hypothyroidism and if it is related to her mood fluctuations. This case has helped me know how to thoroughly assess a patient without passing any personal and biased judgments. It has also taught me how to consider various factors to develop multiple diagnostic impressions and then support or rule out each impression based on available evidence that supports or rules out each diagnostic impression. Regardless, besides understanding the need to maintain confidentiality and consent for treatment when dealing with mental health patients, it is important to consider personal biases, experiences, legal perspectives, and the patient’s views in developing a treatment plan. Additionally, it is essential to consider other factors outside of the patient, such as their home and social-economic environment, and how it can contribute to the symptoms manifested as well in the development of the care plan.

Case Formulation and Treatment Plan:

The patient, Petunia Park, presented with a history of multiple mental issues and alternating hypomanic and depressive episodes, which indicate possible Bipolar II Disorder. Her lab tests show an elevated TSH level, which indicates hypothyroidism. All other tests, CBC, CMP, lipid, and prolactin levels are within the normal ranges, which indicates that she has no significant underlying medical conditions or abnormalities in organ function. Ms. Park’s treatment plan will include further diagnostic assessment for thyroid function to confirm the hypothyroidism and develop a new management plan. She will also be provided with a diary to monitor and track her moods for a set period and be provided with education on how to manage her moods and reduce the risks of medication side effects and hypothyroidism. She will also be educated on the health risks she gets exposed to due to her multiple sex partners. No medications will be prescribed or adjusted until the thyroid function test is done. In the meantime, Ms. Park will be referred to an endocrinologist and a therapist for testing and further assessment and provided mental support.

References

Gitlin, M., & Malhi, G. S. (2020). The existential crisis of bipolar II disorder. In International Journal of Bipolar Disorders (Vol. 8, Issue 1). https://doi.org/10.1186/s40345-019-0175-7

Gutiérrez-Rojas, L., Porras-Segovia, A., Dunne, H., Andrade-González, N., & Cervilla, J. A. (2020). Prevalence and correlates of major depressive disorder: a systematic review. Brazilian Journal of Psychiatry, 42(6), 657–672. https://doi.org/10.1590/1516-4446-2020-0650

Hirtz, R., Föcker, M., Libuda, L., Antel, J., Öztürkb, D., Kiewert, C., Munteanu, M., Peters, T., Führer, D., Zwanziger, D., Hebebrand, J., Thamm, M., & Grasemann, C. (2021). Increased Prevalence of Subclinical Hypothyroidism and Thyroid Autoimmunity in Depressed Adolescents: Results From a Clinical Cross-Sectional Study in Comparison to the General Pediatric Population. The Journal of Clinical Psychiatry, 82(2), 27973. https://doi.org/10.4088/JCP.20M13511

Marzani, G., & Neff, A. P. (2021). Bipolar Disorders: Evaluation and Treatment. American Family Physician, 103(4), 227–239. https://www.aafp.org/pubs/afp/issues/2021/0215/p227.html

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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 an 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 presents 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.
• 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)

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