The Case of Major Depressive Disorder Essay Paper

1. Assessing and Diagnosing Patients with Mood Disorders: The Case of Major Depressive Disorder

Subjective:

CC: The patient complains of being in a sad mood, feeling “down,” “not feeling well,” being drained of energy, and feeling lonely for the majority of the day. She also has a tendency to forget things and is unable to concentrate for the majority of the time. The Case of Major Depressive Disorder Essay Paper

HPI: The patient is a 19-year-old Caucasian woman who is depressed for the reasons stated above. According to her, the symptoms have never occurred before. After she entered in college for undergraduate studies, she began to have symptoms. The symptoms are obstinate and persistent, plaguing her at all times. When she is alone, her symptoms worsen, yet she feels better during certain seasons, such as summer. She gives an 8 out of 10 rating to the intensity of the symptoms.

Past Psychiatric History:

• General Statement: This patient has no psychiatric history.
• Caregivers: She does not require a caretaker.
• Hospitalizations: She has no history of hospitalizations.
• Medication trials: She has not been prescribed any psychotropic medications.
• Psychotherapy or Previous Psychiatric Diagnosis: She has had no previous psychiatric diagnosis.

Substance Current Use and History: She denies using drugs, substances, or even alcohol and cigarettes.

Family Psychiatric/Substance Use History: There is no history of substance use in her family.

Psychosocial History: She is the youngest of three siblings in a family of six from South Carolina. She has two elder brothers. She lives off campus with several college friends, but she believes they do not participate in activities that she enjoys. She doesn’t have a partner or any children.

Medical History:

• Current Medications: None.
• Allergies:

• Reproductive Hx: She identifies herself as a heterosexual female.

ROS:

• GENERAL: Denies fatigue, fever, weight loss, or chills.
• HEENT: Denies headache, photophobia, tearing, tinnitus, rhinorrhea, painful gums , or sore throat.
• SKIN: Negative for rashes, eczema, hives, or itching.
• CARDIOVASCULAR: Denies chest pains, chest tightness, edema, or palpitations.
• RESPIRATORY: She denies coughing, wheezing, or difficulty in breathing.
• GASTROINTESTINAL: Negative for diarrhea, vomiting, or nausea. She also denies a change in bowel habits.
• GENITOURINARY: Denies hesitancy, frequency of micturition, dysuria, or vaginal discharge.
• NEUROLOGICAL: Negative for paraesthesia, tingling, hemiparesis or loss of bladder/ bowel control.
• MUSCULOSKELETAL: Denies joint pains or myalgia.
• HEMATOLOGIC: Negative for blood and clotting disorders.
• LYMPHATICS: Negative for lymphadenopathy and splenectomy.
• ENDOCRINOLOGIC: Negative for polydipsia, polyphagia, or excessive diaphoresis. Also negative for heat or cold sensitivity and previous hormonal therapy.  The Case of Major Depressive Disorder Essay Paper

Objective:

Physical exam: She is aware of where she is, who she is with, where she is going, and what is going on. Her grooming is appropriate for the time of day and weather conditions.

Vital signs: BP 115/70 regular cuff and sitting; P 73, regular; T 98.7°F; RR 16, non-labored; BMI 22.3 kg/m² (normal weight to height).

Diagnostic results: Patient Health Questionnaire or PHQ-9 test positive for depression.

Assessment:

Mental Status Examination: The client is a 19-year-old Caucasian woman who is goal-oriented in every way. Her grooming is in keeping with the time of day. Her communication is normal, intelligible, and directed toward a certain purpose. She hasn’t shown any sort of quirks, tics, or motions. She expresses her mood by saying she is “sad.” The observed affect is dysphoria, which is consistent with the reported mood. She does not have any suicidal or homicidal thoughts. There are no hallucinations, delusions, or paranoia. Her insight and judgment are unaffected. The diagnosis is major depressive disorder or MDD with the diagnostic code of 296.22 (F32.1) (APA, 2013; Sadock et al., 2015).

Differential Diagnoses:

1. Major depressive disorder (MDD): 296.22 (F32.1)

This is the most common and primary diagnosis. According to the DSM-5, this patient meets the diagnostic criteria for MDD. Constant anxiety, a low mood, melancholy, exhaustion, apathy, lack of attention, loneliness, and non-enjoyment of previously enjoyed activities are examples (APA, 2013; Sadock et al., 2015).

2. Dysthymia: 300.4 (F34.1)

Several DSM-5 diagnostic criteria apply to this disease. Insomnia, gloomy mood, poor attention, poor appetite, and low self-esteem are some of the symptoms of this illness, which is also known as chronic depressive disorder (APA, 2013). Because a number of criteria for MDD are missing in this case, it is only the second most likely diagnosis.

3. Bipolar Disorder: 296.52 (F31.32)

This is the third and least likely of the three differential diagnoses. A period of heightened mood characterized by inflated self-esteem and distractibility meets the DSM-5 criteria for diagnosis. I also suffer from significant impairments in social, occupational, and self-care functions (APA, 2013). These are the characteristics that distinguish it from MDD and dysthymia, both of which do not induce heightened moods. The symptoms are also unquestionably unrelated to substance abuse.

Reflection:

In this situation, I followed the established psychiatric interview procedure and treated the patient with respect (Carlat, 2017; Haswell, 2019). Before I did or asked anything, I sought informed consent (Entwistle, 2019). I realize that I have an ethical obligation to keep the patient’s information private, and I informed her of this. I knew I wouldn’t be able to tell her parents about her diagnosis without her permission. I counselled her on the significance of sticking to her treatment plan and keeping appointments. She has no risk factors, so I merely advised her to avoid stressful situations and associate with people she enjoys being around.  The Case of Major Depressive Disorder Essay Paper

1. Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD

Anxiety disorders manifest themselves when a person experiences excessive fear and/or anxiety in response to real or imagined threats. When someone is worried about something, they are worried that it will happen to them. The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, has recognized various anxiety disorders whose diagnostic criteria have been identified and placed in the fifth and most recent edition. Agoraphobia, claustrophobia, and social anxiety disorder are among the conditions (APA, 2013). In this case study, the patient is a 19-year-old Caucasian boy who is gay but has not yet come out. He is ready to be deployed on a military mission, but he is worried about what would happen if his squad discovers out he is gay. He is a patient that works part-time as a storekeeper when he is not in the military. He is an only child who lives in Minneapolis with both of his parents. The purpose of this article is to conduct a thorough mental health assessment in order to arrive at a diagnosis.

Subjective

CC: He’s worried about what the other members of his military unit would say if they find out he is gay.

HPI: The client is a 19-year-old Caucasian man who is concerned about his sexual orientation. He claims he has never experienced the current symptoms before. According to him, his symptoms began when he learned that he was going to be activated for a Navy Reserve deployment. His ailments are psychological in nature and originate in his thoughts. His symptoms are intermittent in nature and last for a short period of time. When he starts to worry about his approaching activation and deployment, they turn on and off. These anxiety symptoms are typically long-lasting. They’re made worse by thoughts of military service and made better by social activities that distract him from the impending deployment. He does not specify when he first detects the symptoms. They can appear in the morning, afternoon, evening, or late at night. He gives his symptoms a 6/10 severity rating on a scale of 1 to 10.

Past Psychiatric History:

• General Statement: Patient has no past psychiatric history.
• Caregivers: He does not need a caretaker.
• Hospitalizations: He has never been admitted to hospital.
• Medication trials: He has never been given psychotropic medications.
• Psychotherapy or Previous Psychiatric Diagnosis: He has never been to therapy before.

Substance Current Use and History: The patient has no prior history of substance abuse. He is also not misusing any drugs or chemicals at the moment. He doesn’t drink or smoke.

Family Psychiatric/Substance Use History: There is no mental history on his mother’s side of the family. There is no history of substance abuse in the family.

Psychosocial History: The patient is a one-of-a-kind child. He has always lived with his parents, and he still does in Minneapolis, where he was born. Outside and inside the military, he has buddies. On weekends, he socializes with them and occasionally invites them to their home. Because he resides in another state, he has a boyfriend whom he sees on occasion. His parents and he have a solid working relationship.

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Medical History:

• Current Medications: None.
• Allergies:

• Reproductive Hx: He identifies himself as a gay male.

ROS:

• GENERAL: Denies fever, malaise, fatigue, and chills.
• HEENT: Denies headaches. Denies photophobia, diplopia, and blurred vision. Also denies tinnitus, earache, and otorrhea. Negative for rhinorrhea and sneezing. Denies having a sore throat or difficulty in breathing.
• SKIN: Negative for rashes and itching.
• CARDIOVASCULAR: Denies chest pain and chest discomfort. Also denies palpitations and chest tightness. There is no pedal edema.
• RESPIRATORY: Negative for dyspnea and wheezing. Denies breathlessness on exertion.
• GASTROINTESTINAL: Negative for nausea, vomiting, and diarrhea. Reports having bowel movements that are regular. Latest bowel movement before he came to the clinic.
• GENITOURINARY: Denies frequency, urgency, and pain on micturition. Denies having contracted any form of sexually transmitted infection or STI.
• NEUROLOGICAL: Negative for pins and needles. Denies dizziness and feeling faint. Bowel and bladder control intact.
• MUSCULOSKELETAL: Denies arthralgia and myalgia. Also denies back pain.
• HEMATOLOGIC: Denies blood and clotting disorders in the family history.
• LYMPHATICS: Negative for lymphadenopathy and a history of splenectomy.
• ENDOCRINOLOGIC: Denies ever having any form of hormonal therapy. Denies polydipsia and polyphagia. Also denies heat or cold intolerance as well as excessive sweating. The Case of Major Depressive Disorder Essay Paper

Objective

Physical exam: Vitals: T 98.3; P 75; RR 16; BP 130/78

Diagnostic results: Hamilton Anxiety Rating Scale (HAM-A) is positive.

MSE

The patient is a 19-year-old young man. In time, space, location, person, and event, he is aware and oriented. He’s dressed appropriately for the time of day and the weather. He speaks in a clear, cogent, and goal-oriented manner. There were no noticeable tics or mannerisms to be found. The observed affect was euthymic, whereas the self-reported mood was “anxious.” As a result, the mood and affect were out of sync. He said he had no suicidal or homicidal thoughts. His judgment and intuition were also unblemished. GAD, or Generalized Anxiety Disorder, is the diagnosis.

Assessment  

Differential Diagnoses

Generalized Anxiety Disorder (GAD)

Because he meets the diagnostic criteria specified in the DSM-5, this is the most likely diagnosis for this patient. Excessive anxiety, inability to control worry, restlessness, weariness, irritability, insomnia, and functional impairment are among the requirements for diagnosis (Sadock et al., 2015; APA, 2013).

Social Anxiety Disorder

According to the DSM-5 diagnostic criteria, this is the second most likely diagnosis. It’s also referred to as social phobia. Its diagnostic criteria include, among other things, severe fear or anxiety, fear prompted by social circumstances, and avoidance of social events due to dread.

PTSD

The final differential diagnosis is posttraumatic stress disorder. It’s possible that the events that occurred the last time he was deployed have left this patient traumatized. Flashbacks and nightmares are among the symptoms that might be used to diagnose PTSD (APA, 2013).

Reflections

If I had another chance to analyze this patient, I would do exactly what I did in this circumstance. First, all processes for taking a history and doing a physical examination were followed (Ball et al., 2019; Bickley, 2017). Second, the patient was treated with respect and his or her autonomy was preserved because informed consent was sought for each procedure and the same was described to the patient (Haswell, 2019; Entwistle, 2019).

III. Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Subjective:

CC: The 30 year-old Caucasian girl was brought in with aggressiveness, sleeplessness, and a loss of appetite as her main symptoms. She has already assaulted her mother, causing severe bodily harm, and she refuses to take her medication.

HPI: The patient is a 30-year-old Caucasian woman with the symptoms listed above. She admits to having experienced the symptoms before, as well as psychological disorders in general. Her current problems began some months ago, and she has already been admitted to the hospital for them. The signs and symptoms are persistent and never-ending. Being with other people aggravates the symptoms, yet fatigue helps to alleviate them. The historian rates the severity of these symptoms at an 8 out of 10 on a scale of one to ten.

Past Psychiatric History:

• General Statement: The patient has a significant past psychiatric history.
• Caregivers: She needs a caretaker as she cannot look after herself on her own.
• Hospitalizations: She has been admitted to hospital on a number of occasions.
• Medication trials: Previous psychotropic medications include aripiprazole (Abilify) and clozapine (Clozaril).
• Psychotherapy or Previous Psychiatric Diagnosis: She has been diagnosed with mental illness and put on therapy before.

Substance Current Use and History: The laboratory test confirmed that she uses and smokes cannabis. Benzodiazepines, which are prescribed drugs, are also abused by her.

Family Psychiatric/Substance Use History: On the mother’s side of the family, there is a history of psychiatric disease, particularly psychosis. Several of her uncles are also consumers of prohibited substances, including etoh and cigarettes.

Psychosocial History: She only attended school till the eleventh grade and then dropped out owing to strange conduct. She’s never been married before. Despite the fact that she is the mother of two children, she continues to live with her birth family. Her two children are living with her sister because of her current dysfunction. For her disabilities and need for cash, she receives a 900 USD monthly stipend from social services.

Medical History:

• Current Medications:

1. Aripiprazole 25 mg PO OD
2. Clozapine 50 mg PO OD (Stahl, 2017).

• Allergies: NKDA.

• Reproductive Hx: She identifies herself as heterosexual female and has two children.

ROS:

• GENERAL: She denies fever, chills, lethargy, weight loss, and malaise.
• HEENT: Headaches, photophobia, tearing, otorrhea, tinnitus, rhinorrhea, sneezing, and sore throat are all negative.
• INTEGUMENTARY: She has no rashes, eczema, or itching on her skin.
• CARDIOVASCULAR: She claims she has no chest aches or discomfort, and no peripheral edema.
• RESPIRATORY: Dyspnea, wheezing, and coughing are not present.
• GASTROINTESTINAL: She denies having any bowel movements that are irregular. She doesn’t have any symptoms of nausea, vomiting, or diarrhea.
• GENITOURINARY: No vaginal discharge or lesions have been found. She also denies urinary retention, hesitation, micturition frequency, or murky urine passing.
• NEUROLOGICAL: She denies paraesthesia, bladder and bowel control loss, hemiparesis, and hemiplegia.
• MUSCULOSKELETAL: She denies having myalgia or arthralgia, claiming that her joints have a full range of motion.
• HEMATOLOGIC: Her blood and clotting problems are negative. She also denies that she has any strange injuries on her body.
• LYMPHATICS: Lymphadenopathy and splenectomy are not present.
• ENDOCRINOLOGIC: Excessive diaphoresis, polydipsia, polyphagia, heat sensitivity, cold intolerance, and hormone therapy are all denied.  The Case of Major Depressive Disorder Essay Paper

Objective:

Vital Signs: T 99.0°F; BP 130/80 regular cuff, sitting; HR 80, regular; RR 17, non-labored.

Diagnostic results: With a score of ten on the Positive and Negative Symptom Scale, or PANSS instrument, the patient has moderate to severe schizophrenia (Leucht et al., 2019). An MRI of the skull revealed no abnormalities, including a traumatic brain injury, a space-occupying lesion (SOL), a midline shift, or morphological changes.

Assessment:

Mental Status Examination: This is a 30-year-old White woman who is solely aware of people but not of place, space, time, or events. Speech is muddled, confusing, and not at all goal-oriented. She is untidy, speaks in a monotone, and avoids eye contact. There is a lot of word salad and a lot of flight of ideas, but no mannerisms or tics. Although self-reported mood is “great” affect is euthymic, implying a misalignment between the two. There are evident delusions and hallucinations, as well as impaired judgment and insight. She, on the other hand, displays no evidence of suicide or homicidal intent. The diagnosis is schizophrenia whose code is 295.90 (F20.9) (APA, 2013; Sadock et al., 2015).

Differential Diagnoses: Schizophrenia, substance-induced psychotic disorder, and bipolar disorder with psychotic symptoms are the differential diagnosis (APA, 2013; Sadock et al., 2015). The client has delusions, hallucinations, linguistic impairment, and cognitive impairment, which all fulfil the diagnostic criteria for schizophrenia. She also exhibits speech disorientation, which is a bad indication. The differential diagnosis of substance-induced psychotic illness is also possible because she has been misusing cannabis for some time. Finally, bipolar illness with psychotic traits in its manic phase has symptoms that resemble those of schizophrenia, making a diagnosis of schizophrenia probable.

Reflection: Evaluating the interview and the patient assessment, I believe I would do the same if given another chance to redeem myself. The explanation for this is that I followed the established psychiatric interview and assessment standards (Carlat, 2017). Autonomy, as well as the bioethical norms of beneficence and faithfulness were granted (Haswell 2019). It was also noted that there was a high level of confidentiality. Patient and family education focused on coping strategies and psychosocial support, as well as medication and treatment appointment compliance.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.

1. Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental Disorders: Attention-Deficit/ Hyperactivity Disorder or ADHD

Subjective:

CC: The patient presented with difficulty to concentrate, distractibility, and restlessness. The Case of Major Depressive Disorder Essay Paper

HPI: The client is a 9-year-old female who is unable to concentrate for long periods of time. She also exhibits impulsive conduct and is having difficulty with her schoolwork. Although the youngster is claimed to have met all of his developmental milestones, there is a history of these behaviors. The symptoms began to appear at the start of the school year. These symptoms do not come and go, but are always there. They are persistent and consistent, and they are exacerbated by authority persons’ reprimanding behaviors. Isolation alleviates the symptoms, which are noticeable throughout the day. The historian gives the symptoms a 7 out of 10 on a scale of 1 to 10.

Past Psychiatric History:

• General Statement: The patient is a child with no history of mental illness.
• Caregivers: At the moment she does not need a caretaker.
• Hospitalizations: She has never been hospitalized.
• Medication trials: She has not been given any psychotropic prescription.
• Psychotherapy or Previous Psychiatric Diagnosis: She has not had any form of therapy.

Substance Current Use and History: The client is still a minor below ten years old.

Family Psychiatric/Substance Use History: There is no substantial mental history in her family. Similarly, her family does not have a history of substance abuse.

Psychosocial History: She is the second of five children and lives with her parents. They reside in a relatively pleasant neighborhood with all of the necessary amenities. Her parents are able to provide her with whatever she desires, and they vacation at least once a year. She, on the other hand, does not have neighborhood friends like other kids and prefers to be alone.

Medical History: The patient has no history of hospitalizations.

• Current Medications: None.
• Allergies:

• Reproductive Hx: The patient is a child under ten.

ROS:

• GENERAL: She denies fatigue, malaise, fever, chills, and weight loss.
• HEENT: She is negative for headaches. Denies photophobia and double vision. Denies otorrhea and tinnitus. Negative for rhinorrhea and sneezing. Denies a sore throat and dysphagia.
• SKIN: Denies rashes and itching.
• CARDIOVASCULAR: Denies chest tightness and discomfort as well as edema.
• RESPIRATORY: Negative for coughing and difficulty in breathing.
• GASTROINTESTINAL: Denies nausea, vomiting, diarrhea, and abnormal bowel movements.
• GENITOURINARY: Denies pain on micturition, oliguria, and polyuria.
• NEUROLOGICAL: Negative for paraesthesia, dizziness, syncope, paresis, and loss of bowel/ bladder control.
• MUSCULOSKELETAL: Negative for arthralgia and myalgia. Also denies back pain.
• HEMATOLOGIC: Denies history of blood and clotting disorders.
• LYMPHATICS: Negative for palpable lymph nodes as well as a history of splenectomy.
• ENDOCRINOLOGIC: Negative for hormonal therapy. Denies polydipsia and polyphagia. Denis heat or cold intolerance.

Objective:

Vital signs: T- 98.2; P- 60; R 12; BP 100/55; Ht 4’2; Wt 66 lbs

General: The patient is properly attired, with clothing that is appropriate for the time of day and weather. Her communication is hurried and rushed, yet it is clear, intelligible, and goal-oriented. She is aware and focused in terms of time, space, people, and events.

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Physical exam:

HEENT: The shape of the head is normal. Both pupils are the same size, circular, and react to light and accommodation in the same way (PERRLA). Extraocular muscles are unaffected (EOMI). There is no otorrhea. Pinna and tragus are free of defects. Both sides of the tympanic membranes are intact. The turbinates in the nose are not inflamed, and there is no exudate in the throat.

Diagnostic results: Normal BC count, Hb, and ESR. No abnormalities on radiologic examinations too. The Case of Major Depressive Disorder Essay Paper

Assessment:

Mental Status Examination

The patient is a 9-year-old girl who looks to be developmentally appropriate for her age. She speaks in a rushed, yet clear, coherent, and goal-oriented manner. Her attire is suited for the season and the weather. In terms of time, place, person, and event, she is aware and oriented. There are no tics or mannerisms to be found. Her self-reported mood is “good,” but her observed affect is euthymic, which means the two are out of sync. She denies having hallucinations or delusions, as well as having homicidal or suicidal thoughts. Her judgment and intelligence are both lacking. She has shown a lack of ability to pay attention and concentrate. The diagnosis made is attention-deficit/ hyperactivity disorder (ADHD) (APA, 2013; Sadock et al., 2015; Walden University, n.d.).

Differential Diagnosis

1. ADHD with a Combined Presentation: 314.01 (F90.2)

This is the most likely cause of the 9-year-old girl’s neurodevelopment issue. Specific diagnostic criteria from the fifth version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, must be met in order to make this diagnosis. These criteria include having a pattern of hyperactivity and impulsivity combined with inattention that affects the child’s functioning, the symptoms appearing before the age of twelve, the symptoms appearing in at least two settings (for example, at home and at school), objective evidence that these symptoms interfere significantly with the child’s functioning at school and at home, and the symptoms not occurring in the course of another psychiatric condition (Wender & Tomb, 2017; APA, 2013).

2. Oppositional Defiant Disorder: 313.81 (F91.3

This is the second most likely cause of your symptoms. The DSM-5 criteria for diagnosis are that the child has been in an irritable, argumentative, and defiant mood for at least six months, that the behavioral disturbance causes distress and interferes with the child’s social, interpersonal, and academic functioning, and that the symptoms are not caused by another psychiatric disorder (Wender & Tomb, 2017; APA, 2013).

3. Intermittent Explosive Disorder: 312.34 (F63.81

Given her symptoms, intermittent explosive disorder is the second most plausible differential diagnosis for this youngster. Recurrent failure to manage outbursts from the kid as evidenced by temper tantrums or property destruction, aggressive behavior disproportionate to the provocation, lack of premeditation of the outbursts, and patient age of at least six years are all DSM-5 criteria for diagnosis (Wender & Tomb, 2017; APA, 2013).

Reflection

Given a second opportunity, I would not change anything about the evaluation I conducted for this 9-year-old child. All of the actions were scientific and evidence-based. By obtaining informed agreement from the adult accompanying the girl, the bioethical principle of autonomy was safeguarded. Every other activity was taken with the girl’s therapeutic benefit in mind. This was kindness (Haswell, 2019). Parents’ understanding of the girl and participation in her therapy and rehabilitation would be the focus of health education.

References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Walden University (n.d.). Attention-deficit/ hyperactivity disorder: A young girl with ADHD. https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_09/index.html

Wender, P.H. & Tomb, D.A. (2017). ADHD: A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults, 5^th ed. Oxford University Press.

The Case of Major Depressive Disorder Essay Paper