Sample Answer for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Subjective:

Client initials: P.P

DOB: July 1, 1995

Sex: Female

CC (chief complaint): “I am here for a mental health assessment.”

HPI:

P.P is a 26-year-old female who presented to the psychiatric clinic for a mental health assessment. The client reports that she has a history of taking medications and discontinuing them because she does not think they are beneficial. She feels like the medications crush her. She reports a history of depression which impairs her job productivity at the bookstore. Besides, she experiences episodes of excessive sleepiness 4-5 times yearly, accompanied by a lack of energy and motivation to carry out activities and a reduced interest in creativity. P.P reports that when she feels depressed, she perceives that she is unworthy since her creativity slips away. The depressive episodes transpire after five days of writing, painting, and doing music. The client states that she is not certain whether it is depression, but it is likely exhaustion after working hard.

She gets creativity episodes lasting almost a week before she crashes then develops depression. When she is in the creativity episodes, she does not like taking medication because they crush her. The creativity episodes are characterized by high energy levels to do many activities, and she can last 4-5 days with minimal sleep.  As a result, she gets most activities done, although her friends say she talks excessively and seems scattered. She also hears voices telling her that she is great and wonderfully talented. Besides, she gets too busy to eat in the creative episodes, but when she is crashed and resting, she consumes everything she sees and sleeps 12-16 hours/day.

Substance Current Use: Smokes tobacco 1PPD.

History of alcohol intake, last drink at 19 years.

Used marijuana x1 caused paranoia.

Medical History: History of Hypothyroidism.

• Current Medications: Hormonal pills for Polycystic Ovaries and Levothyroxine for
• Allergies: No drug or food allergies

• Reproductive Hx: History of Polycystic Ovaries.

ROS:

• GENERAL: Low energy levels during depression episodes. High energy levels during creative episodes. Negative for fever, body weakness, or weight changes.
• HEENT: Negative for vision changes, hearing loss, ear discharge, rhinorrhea, hoarseness, or sore throat.
• SKIN: Negative for rashes, lesions, or discoloration.
• CARDIOVASCULAR: Denies palpitations, chest pain, or SOB.
• RESPIRATORY: Denies difficulties in breathing, chest pain, cough, or sputum production.
• GASTROINTESTINAL: Negative for nausea/vomiting, abdominal pain, or diarrhea/constipation.
• GENITOURINARY: Negative for pelvic pain or urinary symptoms.
• NEUROLOGICAL: Denies headache, fatigue, dizziness, or tingling sensations.
• MUSCULOSKELETAL: Negative for muscle or joint pain, joint stiffness, or back pain.
• HEMATOLOGIC: Negative for bruising.
• LYMPHATICS: Negative for enlarged lymph nodes.
• ENDOCRINOLOGIC: History of hypothyroidism. She denies excessive hunger, thirst, or perspiration. Negative for cold/heat intolerance.

Objective:

Diagnostic results: No diagnostic tests were ordered.

Assessment:

Mental Status Examination:

The patient is well-groomed and appropriately dressed for the occasion. She is alert and oriented to person, place, and time. Demonstrates a logical and coherent thought process. No current auditory or visual hallucinations, delusions, or obsessions were noted.

She denies having current suicidal ideations. Her short- and long-term memory is grossly intact. Lacks insight.

Diagnostic Impression:

Bipolar Disorder:

Bipolar disorder presents with episodes of a highly elevated or irritable mood (mania) that alternates with episodes of deep and prolonged depression (Vieta et al., 2018). Bipolar disorder is a differential diagnosis evidenced by the client’s history of experiencing creative episodes characterized by an elevated mood alternated by depressive episodes where the client crashes. The creative episodes are similar to bipolar manic episodes. The patient’s symptoms consistent with mania include very high energy levels, little need for sleep, easy distractibility, excessive talking, and a high engagement in goal-focused activities such as writi