Assignment: Assessing and Diagnosing Patients with Mood Disorders
Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.
Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 3
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 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 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.).
CC (chief complaint):
Past Psychiatric History:
- General Statement:
- Caregivers (if applicable):
- Medication trials:
- Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
- Current Medications:
- Reproductive Hx:
Physical exam: if applicable
Mental Status Examination:
Expert Answer and Explanation
A Comprehensive Assessment of Sarah
CC: “My daughter forgets and losses things easily.”
HPI: Sarah Higgins is a 9-year-old African American female who comes to the office accompanied by her mother for psychiatric evaluation and treatment. The mother says that Higgins has been having attention problems and poor memory since kindergarten. She does not remember school assignments. She has bad sitting behaviors in school and at home. She squirms in sits and fidgets. For instance, she hardly sits when eating. She cannot organize her work. She avoids hard tasks and hardly finishes her homework or chores. She cannot wait her turn in a group. Recently, there has been a complaint that she intimidates others during plays. She also reports feelings of anxiety when she is wrong. She gets restless and frustrated when she is wrong. Her anxiety is often triggered by being wrong.
Past Psychiatric History:
- General Statement: No history of psychiatric conditions.
- Caregivers (if applicable): Not applicable.
- Hospitalizations: No hospitalizations.
- Medication trials: No medical trials.
- Psychotherapy or Previous Psychiatric Diagnosis: No psychiatric diagnosis or treatment.
Substance Current Use and History: No drug, tobacco, or alcohol use.
Family Psychiatric/Substance Use History: No family history of mental problems or substance abuse.
She was born and raised by both parents in Washington, D.C. She is the only child and is in grade four. She loves art and visiting museums. She also likes video games. She denies a history of violence or trauma. She denies legal issues.
Medical History: No major medical issues. Vaccinations are up-to-date.
- Current Medications: No medications.
- Allergies:No allergies.
- Reproductive Hx:No Menstrual cycle. Not sexually active.
- GENERAL: Positive for weight loss.
- HEENT: Noncontributory.
- SKIN: No rash.
- CARDIOVASCULAR: No chest problems.
- RESPIRATORY: No cough or difficulty breathing.
- GASTROINTESTINAL: No nausea, abdominal pain, or diarrhea.
- GENITOURINARY: No UTI or urinary problems.
- NEUROLOGICAL: No change in bowel movements, dizziness, or headache.
- MUSCULOSKELETAL: Denies muscle and joint swelling, stiffness, or pain.
- HEMATOLOGIC: No bleeding.
- LYMPHATICS: No swelling of glands.
- ENDOCRINOLOGIC: No endocrinologic problems.
Vital Signs: Ht. 4’5, Wt. 63lbs, R 14, P 62, T 97, BP 95/60
- HEENT: No scars on her head. Vision intact. Hearing intact. Normal nasal mucosa. No sore throat.
- Skin: No rash
- Cardiovascular: No murmurs. Regular heart rate and rhythm.
- Respiratory: Chest clear. Lungs clear. No wheezes.
- Neurological: Cranial nerves II- XII intact.
- Functional Magnetic Resonance Imaging (fMRI): fMRI is more accurate and valid in diagnosing people with ADHD and autism (Sen et al., 2018). The test shows that the patient has lower connectivity between the posterior and precuneus cingulate cortex and anterior cingular cortex, indicating the presence of ADHD (Sen et al., 2018).
- Behavior Assessment System for Children (BASC-3)– The tool was used to assess the patient’s behavior because it is valid in diagnosing AHDH (Tan et al., 2021).
Mental Status Examination: She is not well-nourished. She appears her age. She has poor attention but is oriented. She was cooperative during the interview. Speech is slow and polite. She reports a happy mood and positive affect. Thought content and process are intact. She has memory problems. She denies delusions, illusions, or hallucinations. She also denies suicidal thoughts.
- Attention-Deficit/Hyperactivity Disorder-predominantly inattentive type (ADHD-I). 314.00 (F90. 0) Primary disorder
- Anxiety disorder, unspecified. Code.9
- 81 (F91.1) Conduct Disorder, Childhood-Onset Type
ADHD-I is the primary disorder impacting the mental health of this patient. According to Ayano et al. (2019), ADHD-I occurs when inattention is recorded at a higher level. The DSM-5 also notes that ADHD-I when a patient has six or more symptoms of inattention. The patient is forgetful, inattentive, loses things easily, hardly finishes her homework and chores, cannot organize their tasks, and engages in challenging activities. She has been experiencing the symptoms since kindergarten. Based on the American Psychiatric Association (2013) ‘s DSM-5 criteria, the patient has ADHD. The diagnosis is also supported by fMRI and BASC-3 results.
The second diagnosis is anxiety disorder-unspecified. Anxiety disorder is known for causing restlessness and extreme worries or anxiety feelings (Adwas et al., 2019). This patient often feels anxiety when she is wrong. She also reports restlessness. However, the patient’s symptoms do not meet DMS-5’s criteria for anxiety disorder, making the disease a secondary diagnosis. The last diagnosis is conduct disorder, a childhood-onset type. This diagnosis was made because the patient intimidates others when playing (Fairchild et al., 2019). She does not wait for her turn. However, the disease is a secondary disorder because it does not meet DSM-5 criteria. According to APA (2013), conduct disorder, childhood-onset type, can be confirmed if the patient has experienced at least a symptom in 12 months.
I agree with the diagnosis. The patient’s symptoms meet the DSM-5 criteria for ADHD, inattentive type. I have learned in this case that neurological disorders are related to conduct and anxiety disorders. The feelings of a patient with a neurological disorder should also be examined. If I handled the case again, I would include ADHD hyperactive type because the patient also shows hyperactive symptoms. The ethical consideration, in that case, is informed consent. The child’s mother has the explicit right to decide whether she should take drugs or not.
Adwas, A. A., Jbireal, J. M., & Azab, A. E. (2019). Anxiety: Insights into signs, symptoms, etiology, pathophysiology, and treatment. East African Scholars Journal of Medical Sciences, 2(10), 580-591. http://www.easpublisher.com/easjms/
American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm01
Ayano, G., Yohannes, K., & Abraha, M. (2020). Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis. Annals of General Psychiatry, 19(1), 1-10. https://doi.org/10.1186/s12991-020-00271-w
Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., … & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 1-25. https://www.researchgate.net/profile/Graeme-Fairchild/publication/337992065_Fairchild_et_al_2019_Conduct_disorder_primer/links/5df93d94299bf10bc3634c98/Fairchild-et-al-2019-Conduct-disorder-primer.pdf
Sen, B., Borle, N. C., Greiner, R., & Brown, M. R. (2018). A general prediction model for the detection of ADHD and Autism using structural and functional MRI. PloS One, 13(4), e0194856. https://doi.org/10.1371/journal.pone.0194856
Tan, A. T. S., Kraska, J., Bell, K., & Costello, S. (2021). Confirmatory factor analyses of the Behavior Assessment System for Children–Third Edition among an Australian sample. The Educational and Developmental Psychologist, 1-12. https://doi.org/10.1080/20590776.2021.1907181
Write a fully developed and detailed APA essay addressing each of the following points/questions. There is no required word count; be sure to completely answer all the questions for each question in detail.