The Psychiatric Assessment Assignment Discussion

The Psychiatric Assessment Assignment Discussion

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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.
Consider patient diagnostics missing from the video:
Provider Review outside of interview:

Temp 98.2 Pulse 90 Respiration 18 B/P 138/88

Laboratory Data Available: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H) The Psychiatric Assessment Assignment Discussion

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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-TR 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: Reflect on this case. 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!), social determinates of health, 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.)The Psychiatric Assessment Assignment Discussion.

Subjective:

CC (chief complaint): History of stopping medications, feeling squashed

HPI: Petunia Park presents with a history of stopping medications and feeling squashed. She reports a tendency to discontinue medications as she feels they suppress her creativity. She experiences periods of high energy and increased productivity, lasting about a week, followed by episodes of depression and decreased motivation. Petunia engages in risky sexual behavior during these high-energy periods. She also mentions occasional periods of feeling depressed, lacking energy, and losing interest in her creative pursuits. Petunia denies significant anxiety or panic symptoms.

Substance Current Use: Nicotine: Smoking approximately one pack of cigarettes per day. Alcohol: Last drink at age 19 due to negative effects experienced. Marijuana: Tried once and experienced paranoia. Cocaine: Never used.

Medical History: hypothyroidism: Receiving medication. Polycystic ovaries: Taking birth control pills.

• Current Medications: Thyroid medication, Birth control pills
• Allergies: None reported

• Reproductive Hx: Regular menstrual cycles, last menstruation was the previous month. No current pregnancy, denies being pregnant. The Psychiatric Assessment Assignment Discussion

ROS:

• GENERAL: Reports occasional periods of feeling depressed, lacking energy, and losing interest in creative pursuits. No significant weight changes or appetite disturbances reported. Sleep patterns are generally disrupted during depressive episodes.
• HEENT: Denies any visual or auditory disturbances, headaches, or sinus issues.
• SKIN: No reported skin abnormalities, rashes, or lesions.
• CARDIOVASCULAR: No history of heart disease, chest pain, palpitations, or edema.
• RESPIRATORY: No complaints of shortness of breath, cough, or wheezing.
• GASTROINTESTINAL: No gastrointestinal symptoms such as abdominal pain, nausea, vomiting, or changes in bowel movements.
• GENITOURINARY: Reports polycystic ovaries and is currently taking birth control pills for management.
• NEUROLOGICAL: Episodes of high energy, increased productivity lasting about a week, followed by episodes of depression and decreased motivation. No reported seizures, loss of consciousness, or focal neurological deficits.
• MUSCULOSKELETAL: No musculoskeletal pain, joint stiffness, or limitations in range of motion reported.
• HEMATOLOGIC: No history of bleeding disorders, easy bruising, or abnormal blood clotting.
• LYMPHATICS: No complaints of swollen lymph nodes or recurrent infections.
• ENDOCRINOLOGIC: Hypothyroidism diagnosed, currently taking prescribed thyroid medication. No other endocrine disorders reported. The Psychiatric Assessment Assignment Discussion

Objective:

Vital signs: Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

Diagnostic results: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

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Diagnostic results:

Assessment:

Mental Status Examination: Petunia Park, a 28-year-old female, exhibited restless behavior and scattered thoughts during the mental status examination. Her speech was rapid and occasionally tangential, and she frequently interrupted the interviewer. Petunia’s mood fluctuated between elation and depression, and her affect sometimes seemed inappropriate. She displayed tangential thinking and racing thoughts during high-energy episodes. While she had a history of a suicide attempt, she denied current perceptual disturbances. Petunia appeared oriented but had compromised attention and concentration. Insight into her mental health condition was limited, and her judgment seemed impaired, as evidenced by risky behaviors and dismissing potential consequences. The Psychiatric Assessment Assignment Discussion

Diagnostic Impression:

1. Bipolar disorder: Petunia’s fluctuating mood, rapid speech, racing thoughts, and periods of elation followed by depression are consistent with bipolar disorder. The DSM-5-TR criteria for bipolar disorder include the presence of manic or hypomanic episodes, which are characterized by elevated or irritable mood, increased energy, and impulsivity. Petunia’s high-energy episodes, racing thoughts, and inappropriate affect align with these criteria. The absence of current perceptual disturbances rules out schizoaffective disorder, a differential diagnosis.
2. Major depressive disorder: Petunia’s history of a suicide attempt, depressive mood, and compromised attention and concentration are indicative of major depressive disorder. The DSM-5-TR criteria for major depressive disorder involve the presence of a depressed mood or anhedonia along with other symptoms, such as changes in appetite, sleep disturbances, and diminished concentration. Petunia’s depressive mood and impaired attention are consistent with these criteria. The absence of sustained periods of elevated mood rules out bipolar disorder as the primary diagnosis.
3. Attention-deficit/hyperactivity disorder (ADHD): Petunia’s restless behavior, scattered thoughts, and difficulty maintaining attention suggest the possibility of ADHD. The DSM-5-TR criteria for ADHD include symptoms such as inattention, impulsivity, and hyperactivity. Petunia’s compromised attention and concentration align with these criteria. However, the presence of distinct manic or hypomanic episodes and fluctuating mood makes bipolar disorder a more likely primary diagnosis. The Psychiatric Assessment Assignment Discussion

The critical-thinking process leading to the primary diagnosis of bipolar disorder involved considering the patient’s symptom presentation, including the presence of both manic and depressive episodes. Petunia’s rapid speech, tangential thinking, racing thoughts, and fluctuating mood were indicative of bipolar disorder, aligning closely with the DSM-5-TR diagnostic criteria. The absence of sustained periods of elevated mood in the absence of depressive symptoms ruled out major depressive disorder as the primary diagnosis. The presence of distinct manic or hypomanic episodes and the pattern of mood fluctuations led to the selection of bipolar disorder as the primary diagnosis.

Reflections:

Reflecting on this case, it highlights the importance of a comprehensive and thorough assessment when evaluating a patient’s mental health. The initial presentation of Petunia Park with symptoms of a suicide attempt, fluctuating mood, racing thoughts, and impaired attention required a systematic approach to arrive at a differential diagnosis. It also underscored the significance of considering various factors such as age, ethnic group, socioeconomic background, and cultural influences when formulating a diagnosis and developing a treatment plan. One important learning from this case is the need for a holistic approach that considers social determinants of health. Factors like socioeconomic status, cultural background, and access to healthcare resources can significantly impact an individual’s mental health. In Petunia’s case, her low-income status and lack of social support may have contributed to her difficulties in managing her symptoms. Recognizing and addressing these social determinants of health is crucial for effective treatment and preventing relapses The Psychiatric Assessment Assignment Discussion.

In terms of what could be done differently, it would have been beneficial to gather more information about Petunia’s personal history, including her childhood experiences and family dynamics. These factors can provide insights into potential trauma or environmental stressors that may have influenced her current mental health condition. Additionally, conducting a thorough assessment of her substance use history would have been important to rule out any potential substance-induced mood symptoms, as substance abuse can mimic psychiatric disorders. Regarding legal and ethical considerations, it is essential to be aware of any mandatory reporting obligations related to suicide attempts or harm to self or others. In this case, if Petunia’s suicide attempt was recent and she remains at risk, it may be necessary to consider involving appropriate authorities or healthcare professionals to ensure her safety. In terms of health promotion and disease prevention, it is crucial to provide Petunia with education and resources for self-management and coping strategies. This may involve psychoeducation about bipolar disorder, support groups, and counseling to enhance her resilience and coping skills. Addressing her socioeconomic challenges by connecting her with community resources and advocating for affordable mental health services is also important for long-term management and prevention of relapses. The Psychiatric Assessment Assignment Discussion

Case Formulation and Treatment Plan:

Case Formulation:

Petunia Park, a 32-year-old African American female, presents with a history of a suicide attempt, alternating periods of elevated and depressed mood, racing thoughts, and impaired attention. Based on the assessment, the primary diagnosis is Bipolar I Disorder, which is supported by the presence of manic and depressive symptoms, as well as a history of a suicide attempt. The differential diagnoses of Major Depressive Disorder and Substance-Induced Mood Disorder were ruled out based on the absence of a clear depressive episode and substance use history. The Psychiatric Assessment Assignment Discussion

Treatment Plan:

1. Psychotherapy:

– Plan: Implement Cognitive-Behavioral Therapy (CBT) with a focus on psychoeducation, mood monitoring, and cognitive restructuring to enhance coping skills and promote self-management.

– Rationale: CBT has shown efficacy in managing bipolar disorder symptoms and reducing relapse rates. It helps the patient identify and challenge negative thinking patterns, develop coping strategies, and improve mood regulation (Novick et al., 2019).

2. Pharmacologic Treatment:

– Plan: Initiate pharmacotherapy with a mood stabilizer, such as lithium or valproate, to stabilize mood fluctuations and prevent future manic and depressive episodes.

– Rationale: Mood stabilizers are considered first-line treatment for bipolar disorder and can help manage manic and depressive symptoms. Regular monitoring of blood levels and side effects will be conducted (Kishi et al., 2020)The Psychiatric Assessment Assignment Discussion.

3. Nonpharmacologic Treatments and Alternative Therapies:

– Plan: Incorporate regular exercise and sleep hygiene practices into the treatment plan.

– Rationale: Exercise has been shown to have mood-stabilizing effects and can help reduce symptoms of bipolar disorder. Improved sleep hygiene, including maintaining a consistent sleep schedule and practicing relaxation techniques, can also contribute to mood stability (Svensson et al., 2022).

4. Follow-Up Parameters:

– Plan: Schedule regular follow-up appointments every 2 weeks initially, then monthly once stability is achieved.

– Rationale: Frequent follow-ups allow for close monitoring of symptoms, medication effectiveness, and side effects. Adjustments to the treatment plan can be made as necessary.

5. Health Promotion Activity: The Psychiatric Assessment Assignment Discussion

– Plan: Encourage Petunia to engage in a support group for individuals with bipolar disorder.

– Rationale: Support groups provide a sense of community, validation, and an opportunity to learn from others who have similar experiences (Strand et al., 2020). It promotes self-advocacy, coping skills, and helps reduce feelings of isolation.

6. Patient Education Strategy:

– Plan: Provide Petunia with educational materials and resources about bipolar disorder, including symptom recognition, medication adherence, stress management techniques, and the importance of regular therapy sessions.

– Rationale: Education plays a vital role in empowering the patient to actively participate in their treatment. It helps increase their understanding of the disorder, enhances treatment adherence, and fosters a sense of control and self-efficacy. The Psychiatric Assessment Assignment Discussion

 References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.

Kishi, T., Ikuta, T., Matsuda, Y., Sakuma, K., Okuya, M., Mishima, K., & Iwata, N. (2020). Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: A systematic review and network meta-analysis of randomized controlled trials. Molecular Psychiatry, 26(8), 4146-4157.

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Novick, D. M., & Swartz, H. A. (2019). Evidence-based psychotherapies for bipolar disorder. FOCUS, A Journal of the American Psychiatric Association, 17(3), 238-248.

Strand, M., Eng, L. S., & Gammon, D. (2020). Combining online and offline peer support groups in community mental health care settings: A qualitative study of service users’ experiences. International Journal of Mental Health Systems, 14(1), 1-12.

Svensson, M., Erhardt, S., Hållmarker, U., James, S., & Deierborg, T. (2022). A physically active lifestyle is associated with lower long-term incidence of bipolar disorder in a population-based, large-scale study. International journal of bipolar disorders, 10(1), 1-9 The Psychiatric Assessment Assignment Discussion