Case Study Mental Health – nursing assignment tutor

1-Please read the following case study and answer questions 2-PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD SUBJECTIVE Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she crashes and has a good nights sleep. She states that sleep will be alright for a few days, even a few weeks, and then she will have a similar issue with sleep. You learn throughout the assessment process that Stefanie has had this problem for years.
She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just pile up at work and she gets this burst of energy to make everything right. She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks.
Stefanie also confesses to problems with being down in the dumps. She states that when she has her episodes in which she endeavors to make everything right, she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels depressed but then states: well, maybe not depressed, but I definitely feel sad and empty. She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel! OBJECTIVE Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable.
Gross neurological assessment is within normal limits. MENTAL STATUS EXAM Stefanie is alert and oriented 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is sad. Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE? Answer Chosen: is Cyclothymic disorder In your write-up of this case, be certain to link specific symptoms presented in the case to DSM5 criteria to support your diagnosis. Please answer the following questions: Decision #1: Differential Diagnosis Which Decision did you select?
Answer Chosen: is Cyclothymic disorder Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Answer Chosen: is Cyclothymic disorder. Explain why you did not choose Bipolar I, current phase, depressed, explain why you did not choose Bipolar II, current phase, hypomanic. In your write-up of this case, be certain to link specific symptoms presented in the case to DSM5 criteria to support your diagnosis. o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? Decision #2: Treatment Plan for Psychotherapy o Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Selected answer is to begin abilify 10 mg orally, explain why you did not select to begin depakote 250 mg daily, explain why you did not select to arrange to see Stephanie every month for a routine check up. o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different? RESULTS OF DECISION POINT TWO Client returns to clinic after four weeks Stefanie reports that her mood is a little more stable, she reported that she has not been sad since taking that medication Decision #3: Treatment Plan for Psychopharmacology o Why did you select this Decision? Support your response with evidence and references to the Learning Resources. The selected answer is maintain current dose of abilify, explain why you did not select to increase abilify to 15 mg, explain why you did not select to discontinue abiliy o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients and their family. Guidance to Student In order to meet the criteria for a major depressive episode, the client needs to have five or more symptoms (refer to DSM5 major depressive episode criteria).
She only demonstrates criteria # 1: depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful); criteria # 6: fatigue or loss of energy nearly every day; and criteria # 8: diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). Thus, Stefanie does not meet the criteria for a major depressive episode as she only has three out of the needed five criteria for the diagnosis of a major depressive episode. In order to meet criteria for a hypomanic episode, the client needs to have a period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. Stefanies symptoms last 3 days.
Additionally, during the period of mood disturbance, the person must have three or more of the qualifying symptoms. Stefanie only has an increase in goal-directed activity and distractibility. Thus, Stefanie does not meet criteria for a hypomanic episode as she only has a decreased need for sleep and an increase in goal-directed activity. Since Stefanie has symptoms of both hypomania and depression (but does not meet the criteria for a major depressive or hypomanic episode), and since these behaviors do not occur in the context of a drug/substance or medical condition, Stefanie meets the diagnostic criteria for cyclothymic disorder.
Some providers will treat cyclothymic disorder with pharmacologic agents used to treat bipolar disorder because individuals with cyclothymic disorder have a higher risk of progression to bipolar disorder. However, there is no consensus in the literature as to the optimal treatment, or if prophylactic psychopharmacologic treatment is beneficial in consideration of the side effects associated with antipsychotics and mood stabilizers. Stefanies symptoms are most consistent with orthostatic hypotension, which is not uncommon when initiating Abilify. At this point, it sounds as if the side effects have subsided. There is nothing to tell us that we should increase the dose. Similarly, there is nothing in the case to tell us that we should discontinue the Abilify. Instead, routine monitoring should occur.