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

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
[sil.]  00:00:20UNKNOWN Would you prefer I call you Miss Hartford?  00:00:25AMY I go with my middle name Amy.  00:00:25UNKNOWN Amy. Okay, Amy. What’s going on?  00:00:35AMY Sorry, I… I can’t. I don’t… I don’t like… I can’t help but cry. This is just it’s so embarrassing to talk about.  00:00:50UNKNOWN No need to apologize.  00:00:55AMY Everything just… It feels so overwhelming.  00:01:00UNKNOWN Uh-huh. Are you having physical pain?  00:01:00AMY Cramps, intense cramps.  00:01:05UNKNOWN Uh-huh. Do you think this pain is menstrual in nature?  00:01:10AMY Definitely.  00:01:10UNKNOWN Are you having other symptoms with the cramps?  00:01:15AMY Umm… hen I have my period, my breasts become very tenders. So much so that it hurts. If fabric even rests on them.  00:01:25UNKNOWN Uh-huh.  00:01:25AMY And I get bloated, I hold water. So of course, I gain weight. It’s always horrible getting my period.  00:01:35UNKNOWN Do you also become lightheaded?  00:01:40AMY Oh, it’s more like dizziness.  00:01:45UNKNOWN Any headaches?  00:01:45AMY Yes, with back pain that make it impossible to sit and falling apart, right? Everybody says I’m exaggerating and they think I’m fine. But when I am, my period, I’m on my back all day cry.  00:02:05UNKNOWN Well, let’s see if we can figure out what’s going on. Do you also have any bouts of nausea?  00:02:10AMY No.  00:02:10UNKNOWN Food cravings.  00:02:10AMY Oh, God, yes. Not just cravings. I eat more.  00:02:15UNKNOWN Uh-huh. What do you crave and eat?  00:02:20AMY Uh… A mini cookie packs, and some kind of dried fruit nut mix thing they have at work. I always plan to only eat a small amount but then I can’t stop until all of its gone. And one time I went through the entire offices supply for the week, I ate the wrapper so no one would see them and then I ran to Costco during lunch to replace them. I was petrified someone would notice.  00:02:50UNKNOWN Do you have difficulty controlling your impulses to eat?  00:02:55AMY To an embarrassing degree?  00:03:00UNKNOWN How long these symptoms been occurring with your periods?  00:03:05AMY Jeez. Since I was 10 or 11.  00:03:05UNKNOWN Okay.  00:03:10AMY Since my first period, my mother scolded me said that I was overreacting. And then my school counselor told me that I was having normal PMS and I would get used to it. But I knew it wasn’t normal because none of the other girls were sick like I was. And as I became an adult it got worse. Enormously worse after I had kids. You know, I tried to power through but I can’t.  00:03:40UNKNOWN How did it worsen?  00:03:45AMY Level of pain, intensity of the pain. I’m completely zapped of energy. I feel unstable.  00:04:00UNKNOWN What do you mean unstable?  00:04:05AMY My moods jump all over the place. And if my coworkers my friends or even… even my kids say the least little thing I feel totally rejected. I cry at the drop of a hat. Or I just lay there wanting to give up. And other times I’m on edge I’m up and pacing feeling like I want to… I want to throw something or break something. Slam doors, scream at the TV.  00:04:35UNKNOWN When you’re not having these difficult symptoms. Do you feel much stress in your life?  00:04:40AMY All my life is the stress. I am the single mother of two kids so I have to get them up and get them to school. And then most days I don’t have enough energy. I sometimes I feel like I can’t even get myself to work. So I… I call my neighbor and she drives my kids with her kids to school. Thank god she understands. But I don’t know how long that’ll last. And I try my best to force myself but I can’t let these stupid irrational symptoms ruin another job.  00:05:15UNKNOWN Did these difficulties ruin a past previous job?  00:05:15AMY Two jobs. Yeah, I’m a paralegal so work is beyond demanding and I can’t function when I’m like this. I… When I have my period I miss a day or two, maybe three. That’s fine. That’s totally acceptable. But the first job I lost. I heard so bad, I couldn’t even get myself to pick up the phone and call in sick. I just lay there like a blob, being emotional and down. I cannot afford to lose another job.  00:05:55UNKNOWN What’s it like when, as you said emotional and down?  00:06:00AMY Well, I get terribly sad and I snap at people. You know, like kids, you know yell at my coworkers. It doesn’t matter yell at the walls. And I have my period. I know I’m not gonna be able to take care of my kids. So I called my ex to take them and that’s how desperate I could get because we do not get along. Except on issues with the kids.  00:06:35UNKNOWN That’s good.  00:06:40AMY Yeah, but I mean, he had an affair. That’s the reason we divorced.  00:06:45[sil.]  00:06:50AMY Umm… So I started keeping a journal to document my feelings.  00:06:55UNKNOWN That’s smart. What… what have you learned by the doing that by documenting your feelings and symptoms?  00:07:05AMY Umm… Well, I… I learned that I lose track of who I am. When I’m on my period that I become a different person. I don’t know how else to describe it. When I journal it helps me to remember that when I’m like this, it… it’s… it’s not that bad that it will remind me that it will get that I’ll get over it.  00:07:35UNKNOWN So when you’re experiencing this sadness and anger, is it difficult to realize that this is going to end?  00:07:40AMY Well, it’s not just sadness and anger? It’s like everything in the world is different, looks and sounds and feels different. It’s like there’s a… there’s a veil and trying to push it out of the way.  00:08:00UNKNOWN Do you feel like you lose control of your emotions?  00:08:05AMY I’m anything but in control.  00:08:10UNKNOWN Do you ever feel so out of control that you experience hallucinations, seeing or hearing things that are not there?  00:08:15AMY Oh God, no. No, that would really do mean, no.  00:08:20UNKNOWN Is there any history of mental illness in your family?  00:08:25AMY Umm… Depression on my mother’s side.  00:08:30UNKNOWN Okay.  00:08:35AMY I never thought that I had depression. Because when I… when I have these feelings, I snap out of them. And then I’m fine. I mean, it’s not like any depression I’ve ever seen. My uncle killed himself so I know what good looks like and this isn’t like that.  00:08:50UNKNOWN To your symptoms that we get so bad that you think about suicide.  00:08:55AMY I get pretty far down, there no doubt about that but it’s never that bad. I would never do that to my kids, no.  00:09:05UNKNOWN Have you ever seen a psychiatrist or a mental health professional?  00:09:10AMY I did after my divorce. I saw him for several years. He never diagnosed me with clinical depression. I did learn some coping mechanisms because I had anxiety issues. It just normal sadness and anger from the relationship ending but those feelings went away so I stopped seeing him.  00:09:30UNKNOWN Were you ever prescribed any psychiatric medications? anti anxiety medicines, SSRIs for depression, anything like that?  00:09:40AMY None. No.  00:09:45UNKNOWN You mentioned Do you force yourself to go to work? What else do you do to cope?  00:09:50AMY I… I take a lot of ibuprofen, I worry to take too much. I remember… don’t wanna get any long term side effects. But even if I managed to get the pain to subside, I still have the problem that I can’t concentrate. I read and reread depositions and court documents without absorbing any of it. Oh, I heard that some women use birth control for PMS, will that help?  00:10:25UNKNOWN There is medical evidence to support that, we’d have to get some hormonal studies. First, how often would you say these symptoms occur?  00:10:35AMY Every month, like I said with my period.  00:10:35UNKNOWN Are the symptoms that you’re experiencing now are these typical during before or after your period?  00:10:45AMY They start about a week or so before builds. And then as soon as my flow starts, they subside within a day or two.  00:10:55UNKNOWN And then how will you be for the next couple of weeks?  00:11:00AMY Well, I’m fine. In fact, I’m one of the best workers in the office. I laugh at all the office jokes and there are a lot of them. And I can even manage to have fun with my kids when they’re being bratty. You know, they’re pretty clever, they’re funny.  00:11:20UNKNOWN Mm-hmm. I noticed that even though you’re suffering with the symptoms today, uh… you’re able to talk about and remember hold on to the good times.  00:11:25AMY Yeah, that’s… that’s where journaling helps.  00:11:30UNKNOWN Really works for you. Good for you. That’s great. But let me ask you about some other topics, how is your diet?  00:11:35AMY I graze. I mostly eat on the go between work and the kids. It’s hard to find time to cook.  00:11:45UNKNOWN What would be a typical meal?  00:11:45AMY Oh, on the rare dire occasion, it’s fast food. But typically I try for healthier options. There’s a really good chicken place near us. Most of the time, I guess I use a lot of delivery.  00:12:00UNKNOWN Such as.  00:12:05AMY Well, my kids love chicken. They love Turkey and mashed potatoes, love pasta. Oh, they’re picky so that limits me but usually I can fit in a vegetable dish with each order without too many complaints from them.  00:12:20UNKNOWN Good for you, good for you, any dairy?  00:12:25AMY No, my son is lactose intolerance so we don’t buy milk but there’s these cheese and cracker platters they have at work for meetings. That’s typically how I get through my day. I’m embarrassed to admit that.  00:12:40UNKNOWN Any caffeine.  00:12:40AMY Oh, nonstop.  00:12:45UNKNOWN Uh-huh. Besides taking ibuprofen, what else do you do to help with your symptoms?  00:12:55AMY Umm… Basically, I sleep. I curl up on the couch and right out the storm. You know, I tried some over the counter stuff some homeopathic remedies, B6 vitamins, women health supplements but frankly, they don’t seem to do anything.  00:13:20[sil.]  00:13:25END TRANSCRIPT 
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
NRNP_6635_Week3_Assignment_Rubric NRNP_6635_Week3_Assignment_Rubric Criteria Ratings Pts This criterion is linked to a Learning OutcomeCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. 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 20 to >17.0 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. 17 to >15.0 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. 15 to >13.0 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. 13 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, subjective documentation is missing. 20 pts This criterion is linked to a Learning OutcomeIn the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. 20 to >17.0 pts Excellent The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. 17 to >15.0 pts Good The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. 15 to >13.0 pts Fair Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. 13 to >0 pts Poor The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. 20 pts This criterion is linked to a Learning OutcomeIn 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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. 25 to >22.0 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. 22 to >19.0 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. 19 to >17.0 pts Fair The response documents the results of the mental status exam with some vagueness or inaccuracy. … 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 inaccuracy. 17 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, assessment documentation is missing. 25 pts This criterion is linked to a Learning OutcomeReflect 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 taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). 10 to >8.0 pts Excellent Reflections are thorough, thoughtful, and demonstrate critical thinking. 8 to >7.0 pts Good Reflections demonstrate critical thinking. 7 to >6.0 pts Fair Reflections are somewhat general or do not demonstrate critical thinking. 6 to >0 pts Poor Reflections are incomplete, inaccurate, or missing. 10 pts This criterion is linked to a Learning OutcomeProvide 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). 15 to >13.0 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. 13 to >11.0 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. 11 to >10.0 pts Fair Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. 10 to >0 pts Poor Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. 15 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts Excellent A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4 to >3.5 pts Good Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.5 to >3.0 pts Fair Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time. 3 to >0 pts Poor No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. 5 pts This criterion is linked to a Learning OutcomeWritten 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 >3.0 pts Good Contains a few (one or two) grammar, spelling, and punctuation errors 3 to >2.0 pts Fair Contains several (three or four) grammar, spelling, and punctuation errors 2 to >0 pts Poor Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding 5 pts