Assignment: Assessing and Diagnosing Patients With Mood Disorders
Subjective: CC (chief complaint): “I can’t stop crying. All the time.” HPI: L.T is a 32-year-old black female who presents for psychiatric evaluation. Patient complains of a depressed mood almost every day since the birth of her child, two months ago. She reports finding it difficult to cope with the new baby and is overwhelmed by the baby’s care. Patient admits to sleeping difficulties, including problems falling asleep after the baby, especially after the baby cries. She also reports reduced appetite, dissatisfaction with her body size and shape, low self-esteem, feelings of guilt and inadequacy, and avoiding contact with friends. She reports an irritable mood stating that “things just upset her.” She also reports lack of interest in activities including writing, which she liked. Patient admits to having thoughts of suicide but has not acted upon them. She denies having thoughts of harming the baby. The patient is not currently prescribed any psychotropic medications.
Past Psychiatric History: General Statement: Patient has never been assessed or treated for mental health disorders Caregivers (if applicable): n/a Hospitalizations: patient was recently hospitalized for normal childbirth Medication trials: None Psychotherapy or Previous Psychiatric Diagnosis: has no history of psychiatric illnesses and has never been treated for mental health conditions
Substance Current Use and History: Patient denied alcohol or drug use Family
Psychiatric/Substance Use History: Her uncle committed suicide using a GSW. Uncle was an opioid abuser
Psychosocial History: patient is currently married and lives with her husband and two children. She is a stay-at-home mother after working in retail for 5 years. She grew up with both parents and has one sister who lives in Omaha, NE. she has a bachelor’s degree in physics. She was employed in research science and worked as a high school teacher 5 years before the birth of her daughter. She had her first child two months ago. Client has no legal history
Medical History: L.T has hypertension
Current Medications: Labetalol 100 mg for HTN; admits to missing doses due to forgetting
Reproductive Hx: Gave birth two months ago and is currently lactating. She is currently not using contraceptives. Patient has not been sexually active since the birth of her child. She reports she has no drive or desire for sex
ROS: General: no weight loss, chills, fever, or fatigue
HEENT: Eyes: no changes in vision, double vision or jaundice. Ears, Nose, Throat: No changes in hearing, congestion, rhinorrhea or sore throat
Skin: No changes in skin color. No rash or itching.
Cardiovascular: No chest discomfort/pain, palpitations or edema
Respiratory: No cough, sputum production or dyspnea
Gastrointestinal: Reports reduced appetite. Reports she wants to lose weight after the pregnancy. No anorexia, vomiting or diarrhea. No abdominal pain
Genitourinary: No burning with urination, hesitancy or urgency. No changes in urine color or odor Neurological: no headaches, seizures, paralysis, numbness or tingling in extremities Musculoskeletal: No back pain, joint pain or stiffness
Hematologic: No bleeding or anemia Lymphatics: No enlarged nodes or history of splenectomy. Endocrinologic: no reports of sweating, heat or cold intolerance. No polydipsia or polyuria
Vital signs: T- 97.6, P- 97, R 22, BP 149/98, Ht 5’3 Wt 245lb
Physical exam: N/A
Diagnostic results: N/A
Mental Status Examination: L.T is dressed appropriately for occasion and weather. She is alert and oriented to person, place, and time. Her memory appears to be intact during the assessment. She is cooperative but seems to be distant during assessment. Her speech is clear and coherent but she speaks in a low tone. Her mood is depressed. Affect is constricted. No delusions or hallucinations (both visual and auditory). Reports having thoughts of suicide or death but she has not acted upon them. Her insight and judgment are good
Differential Diagnoses: Postpartum depression: This refers to an episode of depression with an onset of symptoms four weeks following delivery. It is epitomized by a depressed mood, excessive anxiety, changes in weight, and insomnia (Sadock et al., 2015). Associated stressors often include lack of support (Sadock et al., 2015). People with postpartum depression often present with other signs and symptoms of major depressive disorder including diminished pleasure in activities such as inappropriate guilt or inadequacy, thoughts of death or suicide in addition to thoughts of harming the baby (Sadock et al., 2015). This is the most likely diagnosis considering that the patient meets the diagnostic criteria for major depressive disorder and the symptoms started 4 weeks after childbirth. The client reports a depressed mood and crying almost every day, difficulty sleeping, reduced appetite, low self-esteem, feelings of guilt and inadequacy, lack of interest in pleasurable activities, and thoughts of suicide without a specific plan.
Major depressive disorder: MDD is a mood disorder characterized by depressed mood or diminished pleasure in activities such as depressed mood. This includes feelings of sadness or tearfulness, lack of pleasure or interest in activities, insomnia or hypersomnia, weight loss, loss of energy, feelings of hopelessness or worthlessness, inappropriate guilt, frequent thoughts of suicide or death, loss of energy, and reduced ability to concentrate or indecisiveness (American Psychiatric Association, 2013). Even though the patient presents with most of these symptoms, it is less likely that this is the diagnosis given that the symptoms occurred within four weeks after delivery (APA, 2013).
Postpartum blues: This is a transient mood disturbance that is characterized by low mood and mild depressive symptoms. These depressive symptoms include mood liability, dysphoria, crying, tearfulness, irritability, decreased sleep, and decreased concentration (Mullins, 2021). According to Sadock et al. (2015), the condition affects 30% to 50% of women who give birth. To meet the diagnostic criteria of the condition, the symptoms must occur 2-3 days of delivery and resolve within two weeks. If the symptoms persist for more than 2 weeks, the diagnostic criteria of major depressive disorder are met (Sadock et al., 2015). This is not the likely diagnosis because the symptoms persisted for more than 2 weeks
Reflections Based on the presented case, I have learned the various mood disorders which can portray the same symptoms. Essentially, I have learned about postpartum depression, which is a mood disorder occurring 4-6 weeks after childbirth. I have also learned about other mood disorders, including major depressive disorder and postpartum blues, which mimic the symptoms of postpartum depression. To make an accurate diagnosis, it is essential to analyze factors related to stressors and triggers of the mood disorder (Sadock et al., 2015). A legal factor that should be considered during the treatment of the patient is drug safety, particularly in regards to the infant. The decision for a breastfeeding mother to take medications should involve careful considerations of the potential effectiveness of the drugs and potential risks to the infant. While all medications pass into breast milk, the extent of passage varies between drugs (Frieder et al.,2019). Also, given that patients with postpartum depression experience thoughts of suicide and harming the baby, it is important to ask about such thoughts to help determine if the thoughts are psychotic or obsessional as well as to help ensure the safety of the mother and child (Frieder et al.,2019)
American Psychiatric Association. (2013). DSM 5. American Psychiatric Association, 70. Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy of postpartum depression: current approaches and novel drug development. CNS drugs, 33(3), 265-282.
Mullins IV, C. H. (2021). Postpartum Blues. Patient Education and Counseling.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Sherman, L. J., & Ali, M. M. (2018). Diagnosis of postpartum depression and timing and types of treatment received differ for women with private and Medicaid coverage. Women’s Health Issues, 28(6), 524-529. 7 This study source was downloaded by 100000798758000 from CourseHero.com on 09-16-2021 12:13:21 GMT -05:00 https://www.coursehero.com/file/98069366/WK3Assgn1LinusO-Assessing-and-Diagnosing-Patients-with-Mood-Disorders-editeddocx/ This study resource was shared via Course