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Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders Photo Credit: Monkey Business / Adobe Stock It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms. In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder. To Prepare Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders. Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations. Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar. Consider what history would be necessary to collect from this patient. Consider what interview questions you would need to ask this patient. The Assignment Develop a Focused SOAP Note, 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 symptomatology 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 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. Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy. Reflection notes: What would you do differently with this client if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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 that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY If you are struggling with the format or remembering what to include, follow the Focused SOAP Note Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide. 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 Read rating descriptions to see the grading standards! In 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. Read rating descriptions to see the grading standards! In 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 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 . · Read rating descriptions to see the grading standards! Reflect on this case. Include: 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 !), 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.). (The FOCUSED SOAP psychiatric evaluation is typically the follow-up visit patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) EXEMPLAR BEGINS HERE Subjective: CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim ofNRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template Week (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6665: PMHNP Care Across the Lifespan I Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: Substance Current Use: Medical History: · Current Medications: · Allergies: · Reproductive Hx: ROS: · GENERAL: · HEENT: · SKIN: · CARDIOVASCULAR: · RESPIRATORY: · GASTROINTESTINAL: · GENITOURINARY: · NEUROLOGICAL: · MUSCULOSKELETAL: · HEMATOLOGIC: · LYMPHATICS: · ENDOCRINOLOGIC: Objective: Diagnostic results: Assessment: Mental Status Examination: Diagnostic Impression: Reflections: Case Formulation and Treatment Plan:  References © 2021 Walden University Page 1 of 3Case Study: Petunia Park © 2020 Walden University 1 Case Study: Petunia Park Program Transcript [MUSIC PLAYING] DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding youre here for a mental health assessment today? PETUNIA PARK: Thats right. DR. MOORE: OK. So to make sure I have the right patient and the right chart, can you tell me your name and your date of birth? PETUNIA PARK: Yes. Im Petunia Park. My birthday is July 1, 1995. DR. MOORE: And can you tell me what todays date is? PETUNIA PARK: So its December 1. DR. MOORE: Do you know the year? PETUNIA PARK: 2020. DR. MOORE: And what day of the week is this? PETUNIA PARK: Its Tuesday. [CHUCKLING] DR. MOORE: And do you know where we are today? PETUNIA PARK: Yes I am here in the beautiful, sunny office at the clinic. DR. MOORE: OK, great. Thank you. So can you tell me a little bit about why youre here today? What brings you here today? PETUNIA PARK: Yes. So I have a history of taking medications and then stopping them. I dont think I need them. I really feel like the medication squashes who I am. DR. MOORE: OK, OK. So Im going to be able to help you with that. But to begin, Im going to ask you some questions about your family. Im going to ask you some history- type questions. Im going to ask you some symptoms that you might be having. And all of these questions are going to help me work with you on a treatment plan, OK? So I would like to begin with, when was the first time that you ever had any mental health or substance use treatment in your life? Case Study: Petunia Park © 2020 Walden University 2 PETUNIA PARK: OK. Well, when I was a teenager, my mom put me in the hospital after I went four or five days without sleeping. I think I may have been hearing things at that time. [CHUCKLES] I think they started me on some medication, but Im not sure. DR. MOORE: Oh, OK so you were hospitalized. How many times have you been hospitalized for mental health? PETUNIA PARK: Oh, Ive been hospitalized about four times. The last time was this past spring. No detox or residential rehabs, though. DR. MOORE: OK, good. Were any of these hospitalizations due to any suicide gestures? PETUNIA PARK: One was in 2017. I overdosed on Benadryl, but Ive not had those thoughts since then. DR. MOORE: Well, Im very glad to hear that youve not had any of those thoughts since then. And Im glad that you turned out OK from that overdose. Im glad that youre here today. Can you tell me a little bit about what youve been diagnosed with during your past treatments? PETUNIA PARK: Well, I think depression, and anxiety, had some even say maybe bipolar. DR. MOORE: OK, and what medications have you been tried on before for those illnesses? And if you can remember, what was your reactions to those medications? PETUNIA PARK: Oh, lets see. Oh, I took Zoloft, and that made me feel really high. Medication Review Review the FDA approved use of the following medicines related to treating mood disorders. Depression Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation) agomelatine amitriptyline amoxapine aripiprazole (adjunct) brexpiprazole (adjunct)bupropion citalopram clomipramine cyamemazine desipramine desvenlafaxine dothiepindoxepin duloxetine escitalopram fluoxetine fluvoxamine iloperidone imipramine isocarboxazid ketamine lithium (adjunct) l-methylfolate (adjunct) lofepramine maprotiline mianserin milnacipran mirtazapine moclobemide nefazodone nortriptyline paroxetine phenelzine protriptyline quetiapine (adjunct) reboxetine selegiline sertindole sertraline sulpiride tianeptine tranylcypromine trazodone trimipramine venlafaxine vilazodone vortioxetine citalopram desvenlafaxine duloxetin eescitalopram fluoxetin eparoxetine pepexev sarafe, sertraline venlafaxine Bupropion HCL extended-release Bipolar depression Bipolar disorder (mixed Mania/Depression Bipolar maintenance Mania lithium (used with lurasidone) lurasidone olanzapine- fluoxetine combination (symbyax) quetiapine valproate (divalproex) (used with lurasidone) aripiprazole asenapine carbamazepine olanzapine ziprasidone aripiprazole lamotrigine lithium olanzapine aripiprazole asenapine carbamazepine lithium olanzapine quetiapine risperidone valproate (divalproex) ziprasidone Medication ReviewWAL_NRNP6665_04_A_EN-DL.m4a