Assessing and Diagnosing Patients with Mood Disorders

Assessing and Diagnosing Patients with Mood Disorders

History of Present Illness (HPI): C.W. is a 57-year-old male who presents to the facility with hallucinations. He is escorted to the facility by a  nurse who volunteers at the shelter where C.W. currently stays. The nurse highlights that according to C.W.’s behavior, she suspects he is hallucinating; therefore, she sees a need for a psychiatric evaluation. The nurse reports that for the past two months since C.W. moved into the shelter, he has been telling other individuals in the shelter that he is a celebrity who is well-known globally. He believes that his famous concerts are on youtube and Google, but the nurse has not found any details about his fame on the internet. C.W. reports he sleeps for less than three hours every night. The nurse states that C.W. has not been given any medications to manage his hallucinations. C.W. has, however, undergone a few counseling sessions conducted by a therapist who volunteers at the shelter. There has not been any significant change in his hallucinations. Is your assignment devastating you ? Get in touch with us at eminencepapers.com. Our homework help will save you tons of time and energy required for your assignment papers.

Past Psychiatric History: C.W. was first diagnosed with a mental health condition at the age of 19 years. He currently lives in a shelter where a volunteer nurse monitors him. He has been hospitalized eight times in an inpatient psychiatric hospital; his last psychiatric hospitalization was eight months ago. C.W. was hospitalized once for detox 15 years ago. He has a history of an intentional drug overdose at the age of 22 years. His previous psychotropic medications include lithium, aripiprazole (akathisia), quetiapine, haloperidol (dystonia), Depakote (gastric upset), and risperidone (hyperprolactinemia). Lithium was very effective, while quetiapine did not give a fair trial. C.W. lost his medical records during the move from his apartment to the shelter and did not recall his previous diagnosis.

Substance Use History: C.W. reports that he takes 3 to 6 drinks of alcohol when playing music in the club. He does not use illicit drugs.

Family Psychiatric/Substance Use History: C.W. is not sure of family substance use and psychiatric history. He, however, recalls that he has the same behavioral traits as his aunt, who was on treatment for a mental health condition whose name he doesn’t remember.

Social History: C.W. was born and raised in Peru, Indiana. He previously lived in an apartment in Los Angeles. He lost his apartment in Los Angeles and moved to MacArthur Park for a year. He is currently living in a shelter. He also lost his job, where he worked part-time at a Home Depot. He holds a master’s degree in music theory from Stanford. He is divorced and does not have any children. He has a sister, although they are estranged. His parents are deceased, and he has no brother. He enjoys playing and listening to music. He is currently unemployed after losing his part-time job at home depot. He underwent emotional turmoil after losing his job and house.

Past Medical History (PMH): C.W. has a history of mental health conditions from 19 years, dystonia, akathisia, gastric upset, intentional drug overdose at 22 years, and hyperprolactinemia. C.W.’s immunization status is up to date. He received the Moderna vaccine for covid 19 on 9/17/2021.

Current Medications: Risperidone 2mg Nocte

Allergies: No known drug allergy. No known food allergy. Bee stings.

Reproductive history: Homosexual.

ROS:

General: Denies chills, fever, headache, day sweats, fatigue, daytime sleepiness, weight loss, or weight gain.

HEENT/Neck: Denies difficulty swallowing and rhinorrhea. Denies vision, oral, nasal, hearing and dental problems.

Skin: Denies rashes and itching.

Cardiovascular: Denies chest pains, lightheadedness, numbness in extremeties, paroxysmal nocturnal dyspnea, leg edema, slow wound healing, palpitations, arrhythmias, dyspnea, slow wound healing, or orthopnea.

Respiratory: Denies cough, choking when swallowing, shortness of breath, holding breath during sleep, difficulty breathing, wheezing, or sputum production.

Gastrointestinal: Denies indigestion, vomiting, heartburn, nausea, choking during sleep, loss of appetite, diarrhoea, acid reflux, constipation, abdominal pain, or difficulty swallowing.

Genitourinary: Denies urinary incontinence, painful urination, decreased stream, frequent urination, dribbling, and blood in the urine.

Neurological: Reports changes in memory and memory loss. Denies loss of consciousness, headache, seizures, difficulty balancing, numbness, tingling sensation, confusion, spells of blindness,  or dizziness.

Musculoskeletal: Denies stiffness, and muscle, joint and back pain.

Hematologic: Denies easy bruising, exposure to HIV, swollen glands, anaemia, and bleeding problems.

Lymphatics: Denies swollen lymph nodes or splenectomy.

Endocrinology: Denies weight gain, weight loss, hair loss, hot flashes, and frequent urination.

Psychiatric: Positive history of mental health conditions, suicidal thoughts, and changes in sleep pattern. C.W. currently sleeps for less than 3 hours at night. He underwent an intentional drug overdose at the age of 22 years and has been hospitalized eight times in an inpatient psychiatric unit. He was last hospitalized in a psychiatric unit eight months ago. He had a detox admission 15 years ago.

Objective:

Physical Exam:

Vital signs: BP 156/88 mmHg, HR-94 bpm, SPO2- 97% on room air, Temp 97.2, RR-20 bpm, Height- 5’8, Weight- 163lbs, BMI 24.7.

General: The patient is comfortable, cooperative, hygienic, and well-dressed. He is unaware of his surroundings and does not positively identify the date, year, and day of the week.

HEENT: Clear oronasophaynx, PERRLA, normocephalic head, no visual acuity issues.

Neck: Neck has normal symmetry, no palpable lymph nodes, a full range of motion, and normal length.

Respiratory: No tenderness or palpable mass, no chest deformities, normal breath sounds without wheezing or audible breath sounds.

Heart/Peripheral Vascular: Normal heart size, normal heart rate, normal heart location, no murmurs, and normal rhythm. Normal extremities.

Abdomen: No abdominal pain. The liver and spleen are of normal size, consistency and tenderness.

Genital/Rectal: This exam was not conducted.

Lymphatic: No swollen lymph nodes.

Musculoskeletal: Symmetric muscle development. Muscle power of 5/5 on extremities. No deformities or swelling on joints.

Neurological:  Intact deep tendon reflexes and cranial nerves.

Psychiatric: He is unaware of context and not oriented to place and time.

Skin: His skin tone is appropriate to his ethnicity.

Diagnostic results:

Complete blood count: To rule out any underlying disorders that cause hallucinations.

Substance and alcohol screening: To rule out drug-induced delusions and hallucinations.

Assessment:

Mental Status Examination: The patient is a fifty-seven-year-old male who looks his stated age. The patient’s speech is clear, coherent, and normal in tone and volume. He is neatly dressed and hygienic. He smiled and even laughed during the session, highlighting that he taught farmers how to farm. He found it hilarious that farmers do not know how to farm. He appears delusional and believes he performs concerts worldwide, including in New York and Atlantic City. The patient has had a history of mental health conditions since he was 19. He has been hospitalized eight times in a psychiatric inpatient facility, whereby his last hospitalization was eight months ago. He experienced an intentional drug overdose when he was 22 years old and had one detox admission 15 years ago.

Differential Diagnosis (DDx):

Schizoaffective disorder: This is a mental illness with signs and symptoms of schizophrenia and a mood disorder (Wy & Saadabadi, 2022). The patient’s medication history includes lithium which turned out to be highly effective. Lithium is a mood stabilizer; therefore, its use in the patient shows that the patient has a mood disorder. According to DSM-5 criteria, schizoaffective disorder is characterized by hallucinations that occur for more than two weeks without a mood disorder. The patient’s history of presenting illness shows that he has experienced hallucinations for more than one month without a mood disorder. The presence of hallucinations without a mood disorder and the history of the effectiveness of lithium shows that schizoaffective disorder is the primary diagnosis.

Bipolar disorder: According to DSM-5 criteria, patients diagnosed with bipolar disorder present at least three of the following symptoms: the decreased need for sleep, increased levels of goal-focused activity, grandiosity, racing thoughts, excessive talking, excessive pleasurable activity, and a clear level of distractibility. Additionally, bipolar disorder patients experience manic episodes characterized by irritability, elation, or expansiveness for at least one week and depressive episodes (Jain & Mitra, 2022). The patient has no history of depressive and manic episodes. However, he has decreased need for sleep, highlighting that he sleeps for less than 3 hours per night. He shows grandiosity by believing he can teach experienced farmers how to farm, yet he is not a farmer. He has racing thoughts and excessive talking during the interview and doesn’t give the interviewer a chance to speak. He finds extreme pleasure in music and is focused on success.

Schizophrenia: DSM-5 criteria highlight that patients diagnosed with schizophrenia must have at least two of the following symptoms: hallucinations, negative symptoms, delusions, disorganized speech and disorganized behavior. The patient’s hallucination can be classified as a positive symptom of schizophrenia (Hany et al., 2022). He is estranged from his only living sister, which can be classified as a cognitive symptom of schizophrenia where a patient cannot maintain relationships (Hany et al., 2022). He has more than two of the outlined symptoms.

Reflections:  I concur with C.W.’s assessment and diagnostic impression. C.W. lives in a shelter and is unemployed. His current living and financial situation can lead to a lack of basic needs and finances required to acquire any prescribed medication and therapy sessions. I would refer C.W. to organizations that offer free therapy and medications at a subsidized amount. C.W. is estranged from his only living sister, which shows the lack of a family support system. I would refer C.W. to support groups for emotional support. The patient has a blood pressure of 156/88 mmHg, which signifies stage 1 hypertension. Accordingly, I would refer the patient for the management of hypertension. I learned the importance of genetics and family history in mental health disorders. The patient’s legal rights were respected.

References

Hany, M., Rehman, B., Azhar Y, et al. (2022). Schizophrenia. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539864/.

Jain, A., & Mitra, P. (2022). Bipolar Affective Disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/.

Wy, T. J. P., & Saadabadi, A. (2022). Schizoaffective Disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541012/.

Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.

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Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also, review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.

By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

Identify at least three possible differential diagnoses for the patient.

Complete and submit your Comprehensive Psychiatric Evaluation, 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 symptomology 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 priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rule 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.

Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).