Name: Case Study Title: Briefly What happened? Provide the article title, URL and a one sentence summary of the case. Key Stakeholders and how were they negatively impacted: [This does not need to be a complete list, just several major stakeholders (not stockholders, though the stockholders may be stakeholders). Briefly explain the relationship with the company – why they are stakeholders What was the final outcome? [prison, fines, termination, and for how many individuals] Describe why you feel the actions were morally wrong? [Be sure to use keywords describing your moral base (consequentialist, care, duty, act utilitarian, prima facie duties, etc.) and why your compass would justify classifying the action as morally wrong. Alternatively, discuss why you may feel the action was morally acceptable.] Put yourself in a position of leadership and describe what you would put in place that would have prevented this in the first place or keep it from happening again. Or, alternatively what rules would you implement to justify the action: NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template Assignment Instructions: Answer with minumun 2 paragraphs each the following questions based in the bellow clinical case: 1. What other additional differential diagnosis is applicable based on the presention symptoms? explain 2. What additional history is required to confirm the diagnosis? 3. What other medications would be applicable in her situation? ** At least 2 references per question** Subjective CC (chief complaint): “I need help, I feel empty and overwhelmed by sadness”. HPI: Client MM is a 33-year-old Caucasian female who was referred from the women center after she lost a term pregnancy of twins 13 months ago. She presented for a psychiatric evaluation with her husband in attendance. They both looked very sad. She reported that the reason for referral was because she was very depressed after losing her pregnancy and was having suicidal thoughts. She was started on Zoloft 50 mg pod once a day at the women center. She currently denies any suicidal or homicidal ideation. She is feeling intense sadness. Admits to having rumination thoughts. She is still grieving the loss of her pregnancy. Admits that she has not been able to get back to work after the burying her babies remain. She said she has lost interest in doing things she enjoys doing. Admits to have lost her appetite and is skipping meals. She has poor memory and concentration. Denies any distractibility. She has poor sleep, sleeps 4 to 5 hours per night. Patient endorse hopelessness, helplessness and worthlessness, however, she said she is not suicidal at this time. Reports to be anxious. Admits to racing thoughts and mood swing. Admits to nightmares. Denies paranoia, delusions and hallucination. PHQ-9 score 24. Past psychiatric history: Denies any previous psychiatric history. Social histor.

1. Name:
Case Study Title:
Briefly What happened? Provide the article title, URL and a one
sentence summary of the case.
Key Stakeholders and how were they negatively impacted: [This
does not need to be a complete list, just several major
stakeholders (not stockholders, though the stockholders may be
stakeholders). Briefly explain the relationship with the company
– why they are stakeholders
What was the final outcome? [prison, fines, termination, and for
how many individuals]
Describe why you feel the actions were morally wrong? [Be
sure to use keywords describing your moral base
(consequentialist, care, duty, act utilitarian, prima facie duties,
etc.) and why your compass would justify classifying the action
as morally wrong. Alternatively, discuss why you may feel the
action was morally acceptable.]
Put yourself in a position of leadership and describe what you
would put in place that would have prevented this in the first
place or keep it from happening again. Or, alternatively what
rules would you implement to justify the action:

2. NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP
Psychiatric Evaluation Template
Assignment Instructions:
Answer with minumun 2 paragraphs each the following
questions based in the bellow clinical case:
1. What other additional differential diagnosis is applicable
based on the presention symptoms? explain
2. What additional history is required to confirm the diagnosis?
3. What other medications would be applicable in her situation?
** At least 2 references per question**
Subjective
CC (chief complaint): “I need help, I feel empty and
overwhelmed by sadness”.
HPI: Client MM is a 33-year-old Caucasian female who was
referred from the women center after she lost a term pregnancy
of twins 13 months ago. She presented for a psychiatric
evaluation with her husband in attendance. They both looked
very sad. She reported that the reason for referral was because
she was very depressed after losing her pregnancy and was
having suicidal thoughts. She was started on Zoloft 50 mg pod
once a day at the women center. She currently denies any
suicidal or homicidal ideation. She is feeling intense sadness.
Admits to having rumination thoughts. She is still grieving the
loss of her pregnancy. Admits that she has not been able to get
back to work after the burying her babies remain. She said she
has lost interest in doing things she enjoys doing. Admits to
have lost her appetite and is skipping meals. She has poor
memory and concentration. Denies any distractibility. She has
poor sleep, sleeps 4 to 5 hours per night. Patient endorse
hopelessness, helplessness and worthlessness, however, she said
she is not suicidal at this time. Reports to be anxious. Admits to

3. racing thoughts and mood swing. Admits to nightmares. Denies
paranoia, delusions and hallucination. PHQ-9 score 24.
Past psychiatric history: Denies any previous psychiatric
history.
Social history: She was born and brought up in New York, they
moved to Florida when she was young and went to school in
Florida. She is a college graduate. Reports that her childhood
was good and had very supportive parents and extended family.
She is the first born in a family of four two sisters and one
brother. The rest of her sibling lives with their parents. The two
sisters work at the post office and the brother who is the
youngest is in the navy. She is married and lives with her
husband, they have no children together. She reports to have
had two previous miscarriages. Reports that they are
experiencing marital issues but she does not want to discuss
more on that. She works as a technician in a phone company.
Her husband is a teacher. Her parents are alive and well.
Family history of Psychiatric illness: Denies any psychiatric
illness in her family.
Substance Current Use: Admits to drinking 2 cups of coffee
daily, Denies alcohol, tobacco, recreational drug, narcotic pain
medication, or steroids use.
Medical History: Hypothyroidism
·
Current Medications: Zoloft 50 mg p.o o.d
Synthroid 50 mcg
p.o o.d

4. ·
Medication trials: none
·
Allergies:
No know drug allergies
·
Reproductive Hx:
LMP 12/01/2022 She is para 0 Gravida 3
ROS:
· GENERAL: 138 pounds has lost 40 pounds unintentionally.
Height 5’5. No fever, no chills. Admits to feeling weak and
fatigued.
· HEENT: Reports to be having occasional headaches, denies
any changes with her eye sight, denies any loss of hearing, No
sneezing no nasal congestion no sir throat and enlarged thyroid
gland.
· SKIN: No skin discoloration and itching
· CARDIOVASCULAR: Denies any chest pain, tightness, or
discomfort.
· RESPIRATORY: no shortness of breath
· GASTROINTESTINAL: no anorexia
· GENITOURINARY: no burning, hesitancy, urgency or
abnormal color.
· NEUROLOGICAL: admits to having frequent headache
· MUSCULOSKELETAL: Denies any muscle, back, joint pain
· ENDOCRINOLOGIC: denies sweating, cold or hot
intolerance.
Objective:
1.
By the end of this presentation the participant will be
able to identify the three differential diagnosis this client is
presenting with.

5. 2.
By the end of this presention the participant will be
able to identify the key symptoms from the mental status
examination the lead to the differential diagnosis.
3.
By the end of this presention the participatants will
understand the side effects of Zoloft.
Diagnostic results:
· Thyroid function tests: to retrieve result
· Complete metabolic panel: to retrieve result
· Complete blood count to retrieve result
Assessment:
Mental Status Examination:
Client MM is a 33-year-old Caucasian female, who appears
older than the stated age. She was dressed in an oversize T shirt
and long pants. She was very tearful with red eyes. She had
long black hair held in a pony tail. She looked flushed. Had
poor eye contact and her eyes were mostly down cast. She
appeared underweight. She was restless and kept changing
sitting position. Mood was described as depressed. Affect was
flat. Her speech was barely audible and slow. Thought process
goal directed but with flight of ideas. Thought content: deny
any fixed delusion. Perception: Denies auditory and visual
hallucinations. Denies any suicidal or homicidal thoughts at the
moment. Cognition: short term memory is poor. Had poor
abstract reasoning.
Diagnostic Impression:
1. F43.8 Prolonged grief disorder. According to DSM 5-TR, the
patient must have experienced the death of a close relation for
at least 12 months to meet the criteria for this diagnosis. Client

6. MM lost her term twin pregnancy 13 months ago and is still
mourning the loss (American Psychiatric Association, 2022).
She is in intense emotional death. She is unable to revenge in
her relationship with her husband or engagement; she reports
that she has not been able to report back to work. She reports
being emotionally numb. Her duration of mourning exceeds the
expected social norms. Mechanism of responding to the stress of
loss, there is an increased risk of a mental or physical disorder
that requires treatment(Simon et al., 2020).
2. F32.2 Major Depressive disorder severe. According to DSM-
5-TR, for patient to meet the classification of Major depressive
disorder, they must meet the following five or more of the
following symptoms, Depressed mood most of the day,
diminished interest in doing things one loved doing, weight
loss, Insomnia or hypersomnia nearly every day, psychomotor
agitation, Fatigue or lack of energy, Diminished ability to think,
and recurrent thoughts of death (American Psychiatric
Association, 2022). Client MM has more than six of the above
symptoms. The symptoms have also caused significant
impairment in her social and occupational functioning. She
reports that she has not been able to report to work for 13
months since losing her pregnancy.
3. F41.1 generalized anxiety disorders. The diagnostic criteria
for GAD, according to DSM-5 TR, is excessive anxiety and
worry happening more days than not for over six months
(American Psychiatric Association, 2022). Client MM admits to
excessive worry and anxiety for over six months. She also
admits to having difficulty controlling worry. Admits to
restlessness, being tired all the times, difficulty concentrating,
and sleep disturbance which are some of the symptoms of GAD
in DSM -5-TR
Reflections

7. Client MM is a 33 year old female; she is grieving the loss of
her term twin pregnancy. She is a para 0 gravida 3. She has lost
a term twin pregnancy. She is feeling hopeless. A lot must be
bothering her. Her current situation might even affect her
marriage? Will the husband want to be in childless marriage?
She is anxious about conceiving and experiencing another
miscarriage. She seems lost in thought. Her desire is to feel
better.
Case Formulation and Treatment Plan:
Discussed with the client available treatment and non treatment
options and the benefits of combining psychopharmacology with
psychotherapy. Advised the client on the benefits of taking
medication as prescribed and not stopping the treatment
abruptly. Agreed to increase the dose of Zoloft and monitor
after two weeks.
Patient education on the side effects of Zoloft. Zoloft is an
antidepressants. Some of the minor side effects include
drowsiness, feeling tired, syncope, anxious, abdominal
discomfort, nausea, diarrhea, xerostomia, confusion, female
sexual disorder, rhinitis and poor appetite (singh & Saadabadi,
2022). It can also cause adverse side effects like convulsions,
headache, confusion, memory problems, severe weakness,
racing thoughts (singh & Saadabadi, 2022). Discussed with
client MM on using a reliable family planning method to
prevent getting pregnant when using Zoloft as it has serious
effect on the unborn child, in case of pregnancy or planning to
get pregnant to contact the provider. Call and report any adverse
reaction.
Increased the dose for Zoloft 100 mg p.o o.d
To try Melatonin 10mg for sleep, if no adequate sleep may try
other hypnotic agents.
Psychotherapy individual and family
Marital counseling
Review after two weeks
Instructed to call 911 or 988 suicide and crisis lifeline or go to
ER if she experiences a danger to self or others

8. References
American Psychiatric Association. (2022). Depressive disorder.
In American psychiatric association (Ed.),
Diagnostic and statistical manual of mental disorders
Fifth edition text revision DSM-5-TR (5th ed., pp. 177–214).
American Psychiatric Association.
Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y.
(2021). Major depressive disorder: Validated treatments and
future challenges.
World Journal of Clinical Cases,
9(31), 9350–9367.
https://doi.org/10.12998/wjcc.v9.i31.9350
Simon, N. M., Shear, M., Reynolds, C. F., Cozza, S. J., Mauro,
C., Zisook, S., Skritskaya, N., Robinaugh, D. J., Malgaroli, M.,
Spandorfer, J., & Lebowitz, B. (2020). Commentary on evidence
in support of a grief related condition as a DSM diagnosis.
Depression and Anxiety,
37(1), 9–16.
https://doi.org/10.1002/da.22985
singh, H. K., & Saadabadi, A. (2022).
Sertraline. Statpearls publishing.
https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK547689
/
© 2021 Walden University
Page 5 of 6