Week (enter week #): (Enter assignment title)

Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date

Assignment: Assessing and Diagnosing Patients With Mood Disorders

Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

To Prepare:

Consider the insights they provide about assessing and diagnosing mood disorders.
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 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.
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.).

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Video: Training Title 2, In Test Section Index, Episode 2 (Santa Monica, CA: Symptom Media, 2016)
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00:00:00TRANSCRIPT OF VIDEO FILE:

00:00:00BEGIN TRANSCRIPT:

00:00:15OFF CAMERA Why did your mom feel you should come in and talk with me today?

00:00:20MRS HOUSTON She was worried. Mom says I get moody this time of year, every year. I don’t know. Maybe.

00:00:40OFF CAMERA How are you feeling, when?

00:00:45PATIENT Not great.

00:00:45OFF CAMERA What’s not great?

00:00:50PATIENT Huh. Just down. I’m not doing so well.

00:01:05OFF CAMERA How’s school?

00:01:05PATIENT Ok.

00:01:10OFF CAMERA Just ok?

00:01:15PATIENT Yeah. I left the program at school. I mean I did and… I’m not doing so well.

00:01:25OFF CAMERA Are the courses difficult?

00:01:30[sil.]

00:01:35PATIENT I understand everything. The teachers are getting to be a bit of a pain. The classes aren’t lustrous (Sighs). I’m in this special business program, where you have to come up with a mock company. I just… I just can’t seem to get it done. That, and all my other projects. I’m already late on two of them.

00:02:25OFF CAMERA Are you having difficult concentrating?

00:02:30PATIENT Yeah. I’ll read the headlines in the newspaper and like, five seconds later, I can’t remember what I read. And my classes, when I leave the room, I don’t what we were learning about.

00:02:55OFF CAMERA Are you having any irregular sleeping or eating patterns?

00:03:05PATIENT (Sighs) I’ve gained ten pounds. Umm… I’ve slept through five of my classes this month if that answers your question.

00:03:20OFF CAMERA Have you been able to make any friends?

00:03:25PATIENT [Shrugs] Yeah. Almost immediately. The people are a lot of fun.

00:03:30OFF CAMERA What do you do with them?

00:03:35PATIENT Lately, not so much of anything.

00:03:45OFF CAMERA What happened?

00:03:50PATIENT Well, it was a blast when I arrived in August. I made friends almost immediately. We went to concerts and shows, we hung out. And we had a lot of fun.

00:04:15OFF CAMERA You don’t do any of that now?

00:04:20PATIENT They kind of annoy me a little bit. I mean nothing I can’t get over. They got really dull. They suddenly started playing board games… and then, things also got busy and with the weather, I don’t want to go outside.

00:04:45OFF CAMERA Do you particularly dislike the cold weather?

00:04:50PATIENT It’s not like I have a burning passionate hatred for the cold. I’ve always fretted fall and winter. I’m a summer girl. I like the beach and convertibles. And now…

00:05:10OFF CAMERA You can’t do any of that.

00:05:10PATIENT No. In fact you can’t do anything at all.

00:05:15OFF CAMERA Can you tell me what it is you dislike about this time of the year?

00:05:25PATIENT It’s dark. And grey. And miserable. The whole city changes, it’s not the same city that I loved in August. September was good. It was beautiful. Sunny, crisp days and, the leaves changing at the end of the month and then it just started getting worse and worse. Even… the snow is grey and black. I didn’t know snow got like that, city snow. I thought snow was white and beautiful. But city snow isn’t like that. Everything is grey. It’s miserable.

00:06:30[sil.]

00:06:35SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com

00:06:35END TRANSCRIPT

Please use this table below.
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
• General Statement:
• Caregivers (if applicable):
• Hospitalizations:
• Medication trials:
• Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:

• Current Medications:
• Allergies:
• Reproductive Hx:
ROS:
• GENERAL:
• HEENT:
• SKIN:
• CARDIOVASCULAR:
• RESPIRATORY:
• GASTROINTESTINAL:
• GENITOURINARY:
• NEUROLOGICAL:
• MUSCULOSKELETAL:
• HEMATOLOGIC:
• LYMPHATICS:
• ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination:
Differential Diagnoses:
Reflections:
References


 

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Week (enter week #): (Enter assignment title)

Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date

Assignment: Assessing and Diagnosing Patients With Mood Disorders

Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

To Prepare:

Consider the insights they provide about assessing and diagnosing mood disorders.
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 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.
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.).

Fullscreen
Transcript
Details
Clips

Cite

Search
Video: Training Title 2, In Test Section Index, Episode 2 (Santa Monica, CA: Symptom Media, 2016)
Transcript
Translate

00:00:00TRANSCRIPT OF VIDEO FILE:

00:00:00BEGIN TRANSCRIPT:

00:00:15OFF CAMERA Why did your mom feel you should come in and talk with me today?

00:00:20MRS HOUSTON She was worried. Mom says I get moody this time of year, every year. I don’t know. Maybe.

00:00:40OFF CAMERA How are you feeling, when?

00:00:45PATIENT Not great.

00:00:45OFF CAMERA What’s not great?

00:00:50PATIENT Huh. Just down. I’m not doing so well.

00:01:05OFF CAMERA How’s school?

00:01:05PATIENT Ok.

00:01:10OFF CAMERA Just ok?

00:01:15PATIENT Yeah. I left the program at school. I mean I did and… I’m not doing so well.

00:01:25OFF CAMERA Are the courses difficult?

00:01:30[sil.]

00:01:35PATIENT I understand everything. The teachers are getting to be a bit of a pain. The classes aren’t lustrous (Sighs). I’m in this special business program, where you have to come up with a mock company. I just… I just can’t seem to get it done. That, and all my other projects. I’m already late on two of them.

00:02:25OFF CAMERA Are you having difficult concentrating?

00:02:30PATIENT Yeah. I’ll read the headlines in the newspaper and like, five seconds later, I can’t remember what I read. And my classes, when I leave the room, I don’t what we were learning about.

00:02:55OFF CAMERA Are you having any irregular sleeping or eating patterns?

00:03:05PATIENT (Sighs) I’ve gained ten pounds. Umm… I’ve slept through five of my classes this month if that answers your question.

00:03:20OFF CAMERA Have you been able to make any friends?

00:03:25PATIENT [Shrugs] Yeah. Almost immediately. The people are a lot of fun.

00:03:30OFF CAMERA What do you do with them?

00:03:35PATIENT Lately, not so much of anything.

00:03:45OFF CAMERA What happened?

00:03:50PATIENT Well, it was a blast when I arrived in August. I made friends almost immediately. We went to concerts and shows, we hung out. And we had a lot of fun.

00:04:15OFF CAMERA You don’t do any of that now?

00:04:20PATIENT They kind of annoy me a little bit. I mean nothing I can’t get over. They got really dull. They suddenly started playing board games… and then, things also got busy and with the weather, I don’t want to go outside.

00:04:45OFF CAMERA Do you particularly dislike the cold weather?

00:04:50PATIENT It’s not like I have a burning passionate hatred for the cold. I’ve always fretted fall and winter. I’m a summer girl. I like the beach and convertibles. And now…

00:05:10OFF CAMERA You can’t do any of that.

00:05:10PATIENT No. In fact you can’t do anything at all.

00:05:15OFF CAMERA Can you tell me what it is you dislike about this time of the year?

00:05:25PATIENT It’s dark. And grey. And miserable. The whole city changes, it’s not the same city that I loved in August. September was good. It was beautiful. Sunny, crisp days and, the leaves changing at the end of the month and then it just started getting worse and worse. Even… the snow is grey and black. I didn’t know snow got like that, city snow. I thought snow was white and beautiful. But city snow isn’t like that. Everything is grey. It’s miserable.

00:06:30[sil.]

00:06:35SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com

00:06:35END TRANSCRIPT

Please use this table below.
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
• General Statement:
• Caregivers (if applicable):
• Hospitalizations:
• Medication trials:
• Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:

• Current Medications:
• Allergies:
• Reproductive Hx:
ROS:
• GENERAL:
• HEENT:
• SKIN:
• CARDIOVASCULAR:
• RESPIRATORY:
• GASTROINTESTINAL:
• GENITOURINARY:
• NEUROLOGICAL:
• MUSCULOSKELETAL:
• HEMATOLOGIC:
• LYMPHATICS:
• ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination:
Differential Diagnoses:
Reflections:
References


 

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In many realms of medicine, objective diagnoses can be made: A clavicula is broken. An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015).

Thanks to myriad advances during recent decades, we know that psychopathology is caused by many interacting factors. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

considering the many interacting factors that contribute to the development of psychopathology.
Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.


 

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