Assessing And Diagnosing Patients With Mod Disorder Assignment

Assessing And Diagnosing Patients With Mod Disorder Assignment

Subjective:

CC (chief complaint): depressed mood, difficulty with concentration and memory, and decreased energy.

HPI: L.N is a 34-year old Caucasian male who reports experiencing episodes of both depression and mania, with the most recent episode of mania occurring approximately two weeks ago. During this episode, L.N reported increased energy, racing thoughts, and impulsive behavior. He has also reported experiencing periods of depression, with symptoms including depressed mood, difficulty with concentration and memory, and decreased energy. Assessing And Diagnosing Patients With Mod Disorder Assignment

Past Psychiatric History:

• General Statement: L.N has a history of bipolar disorder and has been diagnosed with the condition for the past 10 years.
• Caregivers (if applicable L.N lives with his parents, who provide support and assistance with managing his condition.
• Hospitalizations: L.N has been hospitalized for bipolar disorder in the past, but it is unclear how many times this has occurred.
• Medication trials: L.N has previously tried several medications to manage his bipolar disorder, including mood stabilizers and antipsychotics.
• Psychotherapy or Previous Psychiatric Diagnosis: L.N has participated in individual therapy in the past and reports some benefit from this treatment. Assessing And Diagnosing Patients With Mod Disorder Assignment
  

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Substance Current Use and History: L.N reports no current substance use and has a history of limited substance use in the past.

Family Psychiatric/Substance Use History: L.N reports no family history of psychiatric conditions or substance abuse.

Psychosocial History: L.N is currently unemployed and has a limited social support system outside of his family. He reports feeling isolated and struggling with motivation to engage in activities he used to enjoy

Medical History:

• Current Medications: L.N is currently taking a mood stabilizer and an antipsychotic to manage his bipolar disorder.
• Allergies: no known allergies.

• Reproductive Hx: N/A

ROS:

• GENERAL: Denies fever, chills, fatigue, or weight loss
• HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae reported. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat reported.
• SKIN: No rashes, lumps, sores, or abnormal skin changes reported.
• CARDIOVASCULAR: No chest pain, palpitations, shortness of breath, or edema reported.
• RESPIRATORY: No cough, shortness of breath, or chest pain reported.
• GASTROINTESTINAL: No abdominal pain, nausea, vomiting, diarrhea, or constipation reported.
• GENITOURINARY: No urinary frequency, incontinence, or dysuria reported. Assessing And Diagnosing Patients With Mod Disorder Assignment
• NEUROLOGICAL: No tremors, weakness, numbness, or tingling reported.
• MUSCULOSKELETAL: No joint pain, swelling, stiffness, or weakness reported.
• HEMATOLOGIC: No easy bruising, bleeding, or anemia reported.
• LYMPHATICS: No swelling of lymph nodes reported.
• ENDOCRINOLOGIC: No changes in appetite, thirst, or weight reported.

Objective:

Physical exam: No significant findings on physical exam

Diagnostic results: No diagnostic testing has been performed at this time

Assessment:

Mental Status Examination: On mental status examination, L.N appears well-groomed and alert. His mood is euthymic and his affect is appropriate. His thought process is logical and coherent, and he reports no suicidal or homicidal ideation. His insight and judgment are intact. Assessing And Diagnosing Patients With Mod Disorder Assignment

Differential Diagnoses:

Bipolar disorder: L.N’s reported symptoms, including depressed mood, difficulty with concentration and memory, decreased energy, and periods of mania with increased energy, racing thoughts, and impulsive behavior, are consistent with the DSM-5 criteria for bipolar disorder (Bobo, 2017). Additionally, L.N has a history of being diagnosed with and treated for bipolar disorder in the past. The DSM-5 criteria for bipolar disorder includes the presence of both manic and depressive episodes, with periods of normal mood in between (American Psychiatric Association, 2013). This criteria rules out major depressive disorder, as major depressive disorder is characterized by the presence of a single episode of depression without any manic or hypomanic episodes. Assessing And Diagnosing Patients With Mod Disorder Assignment

Major depressive disorder: L.N’s reported symptoms of depressed mood, difficulty with concentration and memory, and decreased energy are consistent with the DSM-5 criteria for major depressive disorder. However, L.N has also reported experiencing periods of mania, which is not consistent with the DSM-5 criteria for major depressive disorder. The DSM-5 criteria for major depressive disorder requires the presence of a single episode of depression without any manic or hypomanic episodes. Therefore, this diagnosis is less likely than bipolar disorder.

Schizoaffective disorder: L.N’s reported symptoms of racing thoughts and impulsive behavior are consistent with the DSM-5 criteria for schizoaffective disorder (Wy & Saadabadi, 2019). However, L.N has not reported any symptoms of psychosis, such as delusions or hallucinations, which are required for a diagnosis of schizoaffective disorder according to the DSM-5 criteria. In addition, L.N’s reported symptoms of depressed mood and difficulty with concentration and memory are more consistent with a mood disorder like bipolar disorder or major depressive disorder than with schizoaffective disorder. Therefore, this diagnosis is less likely than bipolar disorder. Assessing And Diagnosing Patients With Mod Disorder Assignment

Reflections: L.N’s reported symptoms are consistent with those of bipolar disorder and he has a history of the condition. Further evaluation, including diagnostic testing and a comprehensive psychiatric evaluation, may be necessary to confirm the diagnosis and determine the most appropriate treatment plan.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bobo, W. V. (2017, October). The diagnosis and management of bipolar I and II disorders: clinical practice update. In Mayo Clinic Proceedings (Vol. 92, No. 10, pp. 1532-1551). Elsevier. https://www.mayoclinicproceedings.org/article/S0025-6196(17)30544-X/pdf

Wy, T. J. P., & Saadabadi, A. (2019). Schizoaffective Disorder. https://europepmc.org/article/nbk/nbk541012

Bipolar patient
Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking. Assessing And Diagnosing Patients With Mod Disorder Assignment