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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:

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Review this week’s Learning Resources. 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.).

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

 

Case Study

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An Older Woman Living Alone Case Study Assignment Instructions

Refer to the case study information attach below (“An Older Woman Living Alone”). Review the case study patient information in detail. “Miss E” is referred to you by a local community outreach service. The program director believes that Miss E can benefit from a nutritional assessment and possible nutritional therapy. For this Assignment, imagine that you are a clinical nutrition assistant at a private nutrition consulting firm and the supervising dietitian asked you to address the following questions in a formal way:

1. What physical changes have influenced Miss E’s food intake?

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2. What are some socioeconomic or psychological changes that may be influencing her nutrition intake?

3. Could these changes be impacting her overall nutritional status?

4. Which nutrients are likely to be low in her diet? Why?

5. What are your general concerns about her physical condition? What are the implications of her recent weight loss? Are there any particular nutrients she may be deficient or low in?

6. How have her dietary practices and choices impacted her nutrition and health status? (Be specific.)

7. What are your nutrition recommendations? (Include estimated calorie needs, protein needs, menu changes, the recommendation — or not — of an oral supplement, e.g., a vitamin/mineral or oral drink nutrition supplement.)

Requirements: An Older Woman Living Alone Case Study Assignment

· Organize your answers to the above questions into a 3-page essay (estimated word count of essay should be around 750 words). You may include a sample menu if needed. Include a minimum of three APA-style references.

Adult Stages: Older Adult (65 to 85 Years)

Aging in America

The first of the baby boomer generation born between 1946 and 1964 is reaching age 65 and many are facing economic uncertainty and spiraling health care costs. As the older population grows, their personal, social, and health care needs will be felt in all our lives. The young and middle-age adults that we discussed earlier in this chapter will comprise the older population of 2050 and beyond.

Following are some personal characteristics of the older population and their potential impact on health and nutrition services:

• Increase in  life expectancy : Life expectancy is a general measure of the overall health of a population.40 Over the past century, life expectancy at birth rose significantly based on improved sanitation, the discovery of antibiotics, and higher standards of living (Figure 13-4). Better prevention and treatment of heart disease, cancer, and stroke, the most common causes of death in older adults, has contributed to longer life expectancies. Sixty-five-year-olds can expect to live another 19 years, and 85-year-olds another 6 to 7 years.40 Those 85 and older are the fastest growing age cohort in the United States and will double in number over the next 25 years.

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FIGURE 13-4 Life expectancy is increasing among older adults. Men age 65 can expect to live 17 more years and women age 65 can expect to live 20 more years. At age 85, older adults can expect to live another 6 to 7 years. (Data from Federal Interagency Forum on Aging-Related Statistics: Older Americans 2012: key indicators of well-being, Washington, D.C., 2012, U.S. Government Printing Office.)

• Ethnic and racial diversity: Currently, 80% of the population above age 64 is Caucasian, but this will change. By 2050, 42% of the older U.S. population will be Asian, Hispanic, or African American (Figure 13-5).40 Nutrition education programs and meal services will need to adjust to different customs, food patterns, and family roles. Growing diversity is also promoting greater interest in complementary and alternative medicine (CAM). (See the Focus on Culture box, “Cultural and Ethnic Differences in Health Practices” for related discussion.)

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FIGURE 13-5 Percent of persons ages 65 and older according to race and ethnic group. The older population will continue to become more diverse in the coming years. (Data from Federal Interagency Forum on Aging-Related Statistics: Older Americans 2012: key indicators of well-being, Washington, D.C., 2012, U.S. Government Printing Office.)