Instruction Please add three referenceAssignment Assessing, Di

Instruction/ Please add three reference
Assignment: Assessing, Diagnosing, and Treating Adults With
Mood Disorders
It is important for the PMHNP to have a comprehensive
understanding of mood disorders in order to assess and
accurately formulate a diagnosis and treatment plan for patients
presenting with these disorders. Mood disorders may be
diagnosed when a patient’s emotional state meets the diagnostic
criteria for severity, functional impact, and length of time.
Those with a mood disorder may find that their emotions
interfere with work, relationships, or other parts of their lives
that impact daily functioning. Mood disorders may also lead to
substance abuse or suicidal thoughts or behaviors, and although
they are not likely to go away on their own, they can be
managed with an effective treatment plan and understanding of
how to manage symptoms.
In this Assignment you will assess, diagnose, and devise a
treatment plan for a patient in a case study who is presenting
with a mood disorder.
To Prepare
Review this week’s Learning Resources. Consider the insights
they provide about assessing, diagnosing, and treating mood
disorders.
Review the Focused SOAP Note template, which you will use to
complete this Assignment. There is also
Review the video, Case Study: Petunia Park. You will use this
case as the basis of this Assignment. In this video,
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 objective data
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 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.).
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP
Psychiatric Evaluation Template
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6665: PMHNP Care Across the Lifespan I
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint):
HPI:
Substance Current Use:
Medical History:
·
Current Medications:
·
Allergies:

·
Reproductive Hx:
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Objective:
Diagnostic results:
Assessment:
Mental Status Examination:
Diagnostic Impression:
Reflections:
Case Formulation and Treatment Plan:
References
© 2021 Walden University

of 3
Case Study: Petunia Park
© 2020 Walden University 1
Program Transcript
[MUSIC PLAYING]
DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I
understanding you're
here for a mental health assessment today?
PETUNIA PARK: That's right.
DR. MOORE: OK. So to make sure I have the right patient and
the right chart, can you
tell me your name and your date of birth?
PETUNIA PARK: Yes. I'm Petunia Park. My birthday is July 1,
1995.
DR. MOORE: And can you tell me what today's date is?
PETUNIA PARK: So it's December 1.
DR. MOORE: Do you know the year?
PETUNIA PARK: 2020.

DR. MOORE: And what day of the week is this?
PETUNIA PARK: It's Tuesday.
[CHUCKLING]
DR. MOORE: And do you know where we are today?
PETUNIA PARK: Yes I am here in the beautiful, sunny office
at the clinic.
DR. MOORE: OK, great. Thank you. So can you tell me a little
bit about why you're here
today? What brings you here today?
PETUNIA PARK: Yes. So I have a history of taking
medications and then stopping
them. I don't think I need them. I really feel like the medication
squashes who I am.
DR. MOORE: OK, OK. So I'm going to be able to help you with
that. But to begin, I'm
going to ask you some questions about your family. I'm going to
ask you some history-
type questions. I'm going to ask you some symptoms that you
might be having. And all
of these questions are going to help me work with you on a
treatment plan, OK? So I
would like to begin with, when was the first time that you ever
had any mental health or
substance use treatment in your life?

PETUNIA PARK: OK. Well, when I was a teenager, my mom
put me in the hospital after
I went four or five days without sleeping. I think I may have
been hearing things at that
time. [CHUCKLES] I think they started me on some medication,
but I'm not sure.
DR. MOORE: Oh, OK so you were hospitalized. How many
times have you been
hospitalized for mental health?
PETUNIA PARK: Oh, I've been hospitalized about four times.
The last time was this
past spring. No detox or residential rehabs, though.
DR. MOORE: OK, good. Were any of these hospitalizations due
to any suicide
gestures?
PETUNIA PARK: One was in 2017. I overdosed on Benadryl,
but I've not had those
thoughts since then.
DR. MOORE: Well, I'm very glad to hear that you've not had
any of those thoughts
since then. And I'm glad that you turned out OK from that
overdose. I'm glad that you're
here today. Can you tell me a little bit about what you've been
diagnosed with during
your past treatments?
PETUNIA PARK: Well, I think depression, and anxiety, had

some even say maybe
bipolar.
DR. MOORE: OK, and what medications have you been tried on
before for those
illnesses? And if you can remember, what was your reactions to
those medications?
PETUNIA PARK: Oh, let's see. Oh, I took Zoloft, and that made
me feel really high.
[CHUCKLES] I couldn't sleep. My mind was racing, and then I
took risperidone. That
made me gain a bunch of weight. Seroquel gave me weight, too.
I took Klonopin, and
that seems to slow me down some.
I really can't remember the others. I think the one I just stopped
taking was helping. It
started with an L, I think. I don't really remember the name, but
it squashed me in
creativity.
DR. MOORE: OK, well, we're going to try to help you find
some medication that doesn't
make you feel squashed or have any of those negative side
effects today. But in order
to do that, I need some more information. And the next
questions I'm going to ask you
are about substances you may have used. And I want you to
know that you don't get in
trouble in here if you've used some of these substances. It really
just helps me to make
sure that what's in your system that could be impacting your
neurochemistry. And when
we do talk about medications, so I don't give you something that
would negatively

interact with something you may be using, OK? So do you--
PETUNIA PARK: OK.
DR. MOORE: --use any nicotine?
PETUNIA PARK: Yes. I smoke about a pack a day, and I'm not
going to quit for you,
either. [CHUCKLES] Oh.
DR. MOORE: That's OK, that's OK. And what about alcohol?
When was your last drink
of alcohol?
PETUNIA PARK: When I was 19 because alcohol and me do
not work well together.
[CHUCKLES]
DR. MOORE: OK, and what about any marijuana? When was
your last use of any
marijuana?
PETUNIA PARK: Oh no. I tried that once and got really
paranoid.
DR. MOORE: OK. What about any last use of cocaine?
PETUNIA PARK: Never.

DR. MOORE: Last use of any stimulants or methamphetamines?
DR. MOORE: What about any huffing or inhalants?
DR. MOORE: OK, have you used anything like Klonopin or
Xanax, any of those
sedative medications?
DR. MOORE: All right, good. What about any hallucinogenics
like LSD, or PCP, or
mushrooms?
PETUNIA PARK: No, never.
DR. MOORE: Wonderful. OK, what about any use of pain pills
or opiate medications?
Anything prescribed or anything you've obtained from the
street?
PETUNIA PARK: No, never.
DR. MOORE: Good. And anything synthetic like Spice, or
ecstasy, Bath Salts, Mollies,
anything like that?

DR. MOORE: Oh, wonderful. Well, I'm glad to hear that. You
know those things aren't
good for your brain. So I encourage you to continue to stay
away from those things.
Have you ever had any blackouts or seizures from drugs or
alcohol? Or seen things that
you weren't sure were there?
DR. MOORE: Good. What about any legal issues or any DUIs?
DR. MOORE: OK. Good, good. All right, so I'm just going to
ask a little bit about your
family right now. Any blood relatives have any mental health or
substance abuse
issues?
PETUNIA PARK: Yeah, well, well, why would you ask that?
It's not your business.
DR. MOORE: Right. I could see where you might find that
wouldn't be any my business.
But really, sometimes these issues can be genetic. They're alarm
behaviors. So my
understanding of your family helps me to understand you.
PETUNIA PARK: Huh. Well, my mother was seen as crazy. I
think they said she had
bipolar or something. And my father went to prison for drugs.

And well, we haven't
heard, or seen, or heard from him in 8 or 10 years. My brother,
while I think he's a little
schizo, but he hasn't ever went to the doctor. Nobody else with
anything.
DR. MOORE: OK. So that sounds like it must be tough growing
up not seeing your
father and having some of those issues in your family. But any
family, blood relatives
commit suicide?
PETUNIA PARK: Well, my mom tried, but nobody really did it,
you know?
DR. MOORE: OK. Have you ever done anything like that, or
anything like cut on
yourself, burn yourself?
PETUNIA PARK: I already told you, I tried to kill myself. Why
ask me that again? No, I'm
not going to kill myself or anyone else, and I don't cut myself.
DR. MOORE: OK. Well, I'm glad to hear that. And I want you
to know that I am here for
you, and we most certainly will make sure you have a crisis like
number at the end of
this session if you do have those thoughts in the future. So I'm
glad to hear that you
don't have those thoughts today. OK. What type of medical
issues do you have?

PETUNIA PARK: Oh, hoo. Let's see. I have a thyroid issue that
I take some medicine
for, that hypothyroidism. And I take a birth control pill for
polycystic ovaries.
DR. MOORE: OK, when was your last menses?
PETUNIA PARK: Oh, well I have a regular one each month. So
let's see. It was last
month sometime.
DR. MOORE: OK, so any chance that you're pregnant?
PETUNIA PARK: [LAUGHS] Lordy, no. I may have a lot of sex
around, but I'm safe.
DR. MOORE: Hm. You "have a lot of sex around." Can you
maybe tell me what that
means?
PETUNIA PARK: Well, it's exciting and thrilling to find new
people to explore sex with. It
helps me keep my moods high, high, high. [CHUCKLES]
DR. MOORE: OK, so that makes you feel really high and kind
of what, OK?
PETUNIA PARK: Oh yeah.
DR. MOORE: So who raised you?
PETUNIA PARK: My mom and my older brother, mainly.

DR. MOORE: And who do you live with now?
PETUNIA PARK: Well, I live with my boyfriend. And
sometimes, stay with my mom
when he gets mad at me for sleeping around some.
DR. MOORE: So that's created some issues in your relationship,
I see. OK. Are you
single, married, widowed, or divorced?
PETUNIA PARK: I've never been married.
DR. MOORE: OK. Do you have any children?
PETUNIA PARK: No.
DR. MOORE: All right. Are you working?
PETUNIA PARK: Yes, I work part time at my aunt's bookstore.
She's more tolerant of
the days I don't come in from feeling too depressed.
DR. MOORE: OK, so I hear some, maybe, feelings of
depressed. OK. What is your
level of education?
PETUNIA PARK: Oh, I'm in vo-tech school right now for
cosmetology. I'm going to do
makeup for movie stars. [CHUCKLES]

DR. MOORE: Oh, that sounds really wonderful. OK, so but
what about now? What do
you do for fun now?
PETUNIA PARK: Well, I am writing my life story, and it's
going to be published. I also
paint like Picasso. I'm going to sell those paintings to movie
stars, too.
DR. MOORE: Well, that's wonderful. Maybe someday you can
show me your paintings
as well. OK, have you ever been arrested or convicted for
anything?
PETUNIA PARK: No. The police did pick me up and take me to
the hospital once. I
didn't have much sleep that week. And they said I was dancing
around in my nightgown
in a field with my guitar. I really don't remember much of that,
though. I think maybe my
mom made up that story against me because she wanted me to
go back to my
boyfriend's house.
DR. MOORE: OK, so that was one of your hospitalizations that
we talked about earlier.
OK, what about any history of trauma with childhood or adult?
Any kind of physical,
sexual, emotional abuse?
PETUNIA PARK: Well, my dad was pretty hard on us when he
was around. But he
didn't really touch us or anything. More just yelled at us a lot.
DR. MOORE: OK. All right, so I've gathered some history here.

Now, I want to get into
more of some of the symptoms that brought you in to see me
today. So you mentioned
before that sometimes your depression keeps you from working
at your aunt's
bookstore. Can you tell me a little bit more about what that
looks like for you?
PETUNIA PARK: Well, about four or five times a year, I have
these times when I just
don't want to get out of bed. I have no energy, no motivation to
do anything. I just can't
feel any interest in my creativity. I feel like I'm not worth
anything because I feel that
creativity slipping away.
So this is usually happening after I've been up for five days
working hard on my works
with my writing, painting, and music. Everyone says I'm
depressed, but I'm not sure. It
could be that I'm just exhausted from working so hard.
DR. MOORE: OK, so I hear you talking about these creativity
episodes right before you
crash. Per se, this depression. Tell me a little bit more about
those episodes. What do
those look like for you?
PETUNIA PARK: Oh, I love those times. Those are the reasons

I don't always take my
medication because I feel like I'm squashed. I have lots of
energy to do a lot of things. I
can go four or five days with very little sleep. I get lots of
things done, but my friends tell
me I talk too much and appear scattered.
[SIGHS] They're just jealous of all the accomplishments I'm
getting done. These are the
times I look to explore my mind and body with feeling good
through sex with other
people.
DR. MOORE: OK, how long do those episodes last typically
when you have them?
PETUNIA PARK: About a week.
DR. MOORE: About a week. OK. So I want to ask a little bit
more about some other
symptoms that maybe we haven't talked about. Do you feel like
you worry a lot or have
any kind of anxiety and panic symptoms?
PETUNIA PARK: No, no no. I'm not a worry.
DR. MOORE: OK, do you do anything that you feel like you
have to do repetitively over
and over? And if you can't do them, you feel like the end of the
world is coming?
Something like maybe count on threes or wash your hands 20
times? Anything like
that?
PETUNIA PARK: [LAUGHS] No, no. I don't have OCD, if
that's what you're asking.

DR. MOORE: OK, what about hearing or seeing things you're
not sure others see or
hear? Anything like that?
PETUNIA PARK: Not right now. It's been a couple of months
since that happened.
Sometimes when I'm not sleeping good, I hear voices telling me
how great and
wonderfully talented I am.
DR. MOORE: OK. So, but no voices right now?
PETUNIA PARK: No.
DR. MOORE: OK, good. What about your appetite? How's your
appetite?
PETUNIA PARK: Well, when I'm really creative, I'm too busy
to eat. And when I'm
crashing and resting, I eat everything in sight.
DR. MOORE: OK, so what about your sleep? On average, how
much time do you think
you sleep in a whole 24-hour period? And do you have any bad
dreams?
PETUNIA PARK: No bad dreams. Most of the time, I get about
five or six hours. When

I'm creative, I'm lucky to get three hours and a whole week.
Ugh. And when I'm crashed,
I sleep about 12 or 16 hours a day.
DR. MOORE: OK, wonderful. So this is great. I have a lot of
information from you that I
think we will be able to come up with a treatment plan and
maybe find some medication
that's going to help you feel better without you feeling so
squashed and having negative
side effects, but really help you be able to function through the
day.
[MUSIC PLAYING]

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