ASSESSING, DIAGNOSING, AND TREATING ADULTS WITH MOOD DISORDERS
It is important for the PMHNP to have a comprehensive understanding of mood disorders 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.
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.
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.
Sample Solution
• Plan: Summarize your treatment plan. What interventions, medications, psychotherapy approaches, and/or referrals do you recommend to best address the patient’s needs? Discuss how your treatment plan will promote recovery and remission. Subjective: The patient is a 24-year-old male who has been experiencing low mood since he was in high school. He describes his mood as “low all the time” and reports difficulty sleeping, loss of appetite,
and feelings of hopelessness. He states that these symptoms have interfered with his work performance by causing him to show up late or miss days entirely due to feeling overwhelmed or unmotivated. The patient expresses difficulty making decisions due to lack of energy and lack of interest in activities or hobbies he used to enjoy. His symptoms have been occurring for at least five years but have recently become more severe within the past two months.
Objective: Upon psychiatric assessment, the patient appeared tearful with slumped posture; reported feelings of guilt without any obvious reason; displayed poor concentration; had impaired memory recall on recent events; stated that physical activities feel difficult even though he exercises regularly; displayed anhedonia (lack of pleasure); experienced difficulties in interpersonal relationships; expressed decreased self-esteem along with suicidal thoughts when asked about them directly; exhibited irritability when discussing current issues related to his job and family life situations.
Assessment: After assessing the information gathered from the subjective history intake and objective observations made during assessment, three possible diagnoses are considered—major depressive disorder (MDD), persistent depressive disorder (PDD), or bipolar II disorder (Bipolar II). MDD criteria includes depressed mood most of the day nearly every day manifested by either sadness or irritability accompanied by at least four other symptoms such as changes in appetite/weight/sleep patterns, fatigue or loss of energy, feelings guilt/worthlessness/inadequate response from others which lasts for at least two weeks duration with evidence from social functioning impairment which is seen here in this case study considering it has been present for 5+ years resulting in missed work days where clearly indicates significant functional impairment due PDD can be a long standing depression lasting over two years characterized by disturbances present across multiple life domains including social occupational academic etc Whereas Bipolar II disorder requires occurrence one major depressive episode along with hypomanic episodes -it does not seem likely given there are no signs indicating mania witnessed during the exam –thus ruling out this diagnosis .When comparing DSM-5 diagnostic criteria ,it appears under both MDD & PDD categories ,person exhibits 4 + core symptoms plus having impactful sociocultural dysfunctioning while ruling out Bipolar II Disorder given absence manic features ; thus suggesting primary diagnosis being Major Depressive Disorder /Persistent Depressive Disorder .Critical Thinking process involves eliminating certain diagnosis based on rule outs obtained from detailed clinical examination which ultimately helps clinician formulating accurate primary diagnosis for specific condition .Pertinent positives noted include depressed mood most part day ,onset 5 years back impacting sociocultural functions ,irritability when discussing current issues related job &family life situatios whereas pertinent negatives noting negative screening tests results regarding presence mania features ruling out Bipolar 2 Disorder
Plan: Treatment Plan should focus on promoting recovery &remission through integration variety interventions including medications psychotherapy approaches referrals etc aimed managing low mood symptomology based upon adequate assessment &differential diagnoses formulation &considering individual's preferences&level functioning .Interventions could involve combination pharmacological treatments like SSRIs SNRIs Atypical Antidepressants MAO Inhibitors Tricyclic antidepressants combined various forms psychotherapies especially Cognitive Behavioral Therapy(CBT) as effective strategies helping person identify potential maladaptive thinking pattern also psychoeducation sessions would helpful educating person about mental health conditions processes such lifestyle modifications improving sleep hygiene involving relaxation techniques exercise mindfulness coupled Family Therapy if relevant addressing environmental factors impacting patient's condition .Referral services may advised seek further specialized care depending severity complicated nature situation if necessary helping restore improved level socio cultural functioning