ASSESSING AND DIAGNOSING PATIENTS WITH MOOD DISORDERS
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 patients 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.).
Sample Solution
Comprehensive Psychiatric Evaluation for K.Y. (Employee Health Nurse Practitioner)
Due to limitations as a large language model, this evaluation cannot provide a specific diagnosis. However, the following template demonstrates a comprehensive psychiatric evaluation process for K.Y.:
Subjective:
Unfortunately, without a direct interview with K.Y., details about her chief complaint and symptomology are unavailable. However, given the nature of her work and the age group she sees (middle-aged adults), we can speculate on potential concerns she might raise:
- Stress: High workload, long hours, and dealing with employee health issues could contribute to job-related stress.
- Burnout: Constant emotional strain and exposure to others' problems might lead to burnout.
- Compassion fatigue: Continuously providing support and witnessing employee struggles could lead to compassion fatigue.
- Secondary traumatic stress: Exposure to traumatic employee experiences might lead to secondary traumatic stress.
Objective:
Since a direct assessment cannot be conducted, objective observations are unavailable. However, some potential observations during a future evaluation might include:
- Appearance: Noticeable signs of fatigue, dishevelment, or changes in weight.
- Speech patterns: Rapid speech, pressured talking, or difficulty concentrating.
- Affect: Depressed mood, irritability, or anxiety.
- Psychomotor activity: Restlessness, fidgeting, or withdrawal.
Assessment:
Mental Status Examination (MSE) Results (Hypothetical):
- Mood: Depressed or anxious (depending on the primary diagnosis).
- Thought process: May be racing or difficulty concentrating if stressed or burnt out.
- Perception: No gross abnormalities expected.
- Attention and concentration: May be impaired if experiencing stress or burnout.
- Insight and judgment: Presumed intact unless a more severe mental health condition is present.
- Reliability: Information provided by K.Y. is assumed to be reliable in the absence of contradictory evidence.
Differential Diagnoses:
- Adjustment Disorder: This is the most likely diagnosis if K.Y.'s symptoms are a recent reaction to work-related stress and haven't been present for longer than 6 months.
- Major Depressive Disorder: This would be considered if K.Y. experiences persistent depressed mood, loss of interest or pleasure in activities, and other core depressive symptoms for at least two weeks, impacting her daily life.
- Burnout: While not an official diagnosis in the DSM-5, burnout is characterized by emotional exhaustion, cynicism, and reduced sense of accomplishment. It can be a precursor to other mental health conditions.
Rationale for Differential Diagnoses:
- Adjustment Disorder: The middle-aged clientele K.Y. sees could be a significant stressor. Symptoms would likely be recent and related to work.
- Major Depressive Disorder: The nature of the symptoms (depressed mood, loss of interest) and their duration (at least two weeks) would be crucial in differentiating it from adjustment disorder.
- Burnout: While burnout isn't a formal diagnosis, its symptoms (emotional exhaustion, cynicism) could be present in K.Y.'s case.
Critical Thinking Process:
The critical thinking process would involve:
- Understanding K.Y.'s specific stressors: Are there specific workplace factors contributing to her distress?
- Evaluating the duration and severity of symptoms: How long has she been experiencing these symptoms, and how significantly are they impacting her life?
- Ruling out medical causes: Physical health issues can sometimes mimic mental health symptoms.
Based on this evaluation, Adjustment Disorder would be the most likely diagnosis if K.Y.'s symptoms are recent and primarily work-related. However, a more in-depth assessment is needed for a definitive diagnosis.
Pertinent Positives:
- K.Y. is employed as a healthcare professional, suggesting a potential for insight and self-awareness.
- Her role involves helping others, indicating a caring and empathetic nature.
Pertinent Negatives:
- The lack of a specific interview limits a more precise understanding of K.Y.'s symptoms and their impact on her life.
Reflection Notes:
If possible, conducting the session in a relaxed and private setting would be ideal.
Legal/Ethical Considerations:
- Confidentiality: Maintaining client confidentiality is paramount.
- Duty to Warn: If K.Y. expresses suicidal ideation or poses a danger to herself or others, a duty to warn may arise.
- Self-care: Educate K.Y. about the importance of self-care for healthcare professionals to prevent burnout and compassion fatigue.