Walden University NRNP 6635 Week 3 Assignment Assessing and Diagnosing Patients With Mood Disorders

 Assessing and Diagnosing Patients With Mood Disorders solved

Patient Initials: C.W.     Age: 57 years         Gender: Male

CC (chief complaint): “everyone says I need treatment, but I don’t think anything’s wrong with me. I just need to get back to my music and get my life together.”

HPI: C.W. is a 57-year-old gay male referred from a homeless shelter for psychiatric evaluation due to mood instability and impaired functioning. He has had a mental illness diagnosis since age 19, with multiple hospitalizations and medication trials. Over the past year, he became homeless after losing his apartment and part-time job. C.W. describes episodes of elated mood with decreased need for sleep, increased energy, grandiosity, and hyperactivity, alternating with periods of depression marked by hopelessness, social withdrawal, impaired concentration, and a history of intentional overdose at age 22. He currently sleeps three to four hours per night without fatigue and denies suicidal or homicidal ideation and hallucinations. Medication adherence is poor due to homelessness, though he reports that lithium previously controlled his symptoms. His psychiatric disorder has led to ongoing functional, social, and occupational impairments.

Past Psychiatric History:

General Statement: C.W. has a longstanding history of severe mental illness, beginning around age 19. He has experienced recurrent mood swings, impaired judgment, multiple psychiatric hospitalizations, and significant psychosocial dysfunction. His treatment adherence is inconsistent, and he shows limited insight into his condition.

Caregivers (if applicable): The patient currently resides in a shelter and lacks a primary caregiver. Does not have support system.  Shelter staff assist with healthcare needs and facilitate access to community resources.

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Hospitalizations: The patient has a history of eight inpatient psychiatric hospitalizations. The most recent hospitalization occurred approximately eight months ago due to worsening mood symptoms, psychotic features, and impaired functioning. Additionally, the patient underwent one inpatient detoxification admission approximately fifteen years ago for problematic alcohol use.

• Medication trials: Previous psychiatric medication trials include:

Lithium – effective for mood stabilization

Valproic acid (Depakote) was discontinued due to gastrointestinal distress.

Aripiprazole was discontinued due to akathisia.

Risperidone was discontinued due to hyperprolactinemia.

Haloperidol was discontinued after a dystonic reaction.

The Quetiapine trial was discontinued prematurely, before therapeutic efficacy could be adequately evaluated. Poor medication adherence was reported during periods of homelessness.

• Psychotherapy or Previous Psychiatric Diagnosis: C.W is Poor historian, no known history or current psychotherapy mentioned.
• Substance Current Use and History: The patient reports drinking about three to six alcoholic drinks per day, usually while playing music in clubs. He denies use of illicit substances like marijuana. He mentioned being admitted to a detox program for alcohol about 15 years ago. He does not have withdrawal symptoms now.

Family Psychiatric/Substance Use History:

• Mother: 
• Father:Unknown
• Sister:Unknown
• Aunt:Hx of Mental treatment, not sure which one.
• Maternal Grandmother: Unknown
• Maternal Grandfather:Unknown
• Paternal Grandmother:Unknown
• Paternal Grandfather:Unknown
• Psychosocial History:
  • W. was born and raised in Peru, Indiana. He holds a Master’s degree in music theory and has worked irregularly in retail and music-related positions. Most recently, he was employed part-time at Home Depot before losing both his job and housing. He has been homeless for about one year and currently lives in a shelter. C.W. is divorced, has no children, and identifies as gay. He maintains minimal contact with family. He shows a strong interest in composing and playing music, which he describes as an important form of communication. C.W. has significant financial instability, limited social support, and ongoing challenges with psychiatric symptoms and employment. He has no legal history.
• Medical History:  Unknown
• Current Medications: Noncompliance with use of prescribed psychiatric medications due to homelessness. Education on importance of prescribed medication compliance is required.
• Allergies:
  • Bee stings
• No known medication allergies.
• Reproductive Hx:The patient identifies as a gay male. Not currently in any relationship but does have casual sex. sexual functioning. Will require routine health screening which includes STIs.

ROS:

GENERAL: Reports sleep 3-4 hours per night. Denies fever, chills, night sweats, or recent weight loss.

• HEENT: Denies headaches, visual disturbances, hearing loss, nasal congestion, or difficulty swallowing.
• SKIN: Denies rashes, lesions, bruising, or itching,
• CARDIOVASCULAR: Denies chest pain, palpitations, orthopnea, or peripheral edema. History of elevated blood pressure noted during assessment.
• RESPIRATORY: Denies cough, wheezing, hemoptysis, or shortness of breath.
• GASTROINTESTINAL: Denies nausea, vomiting, diarrhea, constipation, abdominal pain, or gastrointestinal bleeding.
• GENITOURINARY: Denies dysuria, hematuria, or incontinence.
• NEUROLOGICAL: Reports occasional difficulty concentrating. Denies seizures, weakness, numbness, tremors, dizziness, or history of significant head injury.
• MUSCULOSKELETAL: Denies joint pain, muscle weakness, stiffness, or gait disturbances.
• HEMATOLOGIC: Denies anemia, easy bruising, prolonged bleeding, or clotting disorders.
• LYMPHATICS: Denies swollen lymph nodes or recurrent infections.
• ENDOCRINOLOGIC: Denies heat intolerance, cold intolerance, polyuria, polydipsia, polyphagia, or significant endocrine abnormalities.

Physical exam:

General Appearance: The patient is a 57-year-old male who appears his stated age. He is alert, ambulatory, casually dressed, and has fair hygiene and grooming. Mild psychomotor agitation is observed. He maintains intermittent eye contact and remains cooperative during the examination.

• Vital Signs:Temperature 97.2°F; Blood Pressure 156/88 mmHg; Pulse 94 beats/minute; Respiratory Rate 20 breaths/minute; Height 5’8″; Weight 163 lbs; BMI 24.8 kg/m².
• HEENT:Head normocephalic and atraumatic. Pupils are equal, round, and respond to light and accommodation. EOM intact. External ear canals are open without any discharge. Bilateral intact tympanic membranes and pearly grey. No nasal congestion: nasal mucosa is moist and pink. Oral cavities mosit and pink, no lesions noted. Dentition no decay.
• Neck:Supple with full range of motion. No cervical lymphadenopathy. Trachea midline. Thyroid non-enlarged and without palpable nodules.
• Skin:Warm, dry, and intact. No rashes, lesions, bruising noted
• Cardiovascular:Regular rate and rhythm. S1 and S2 present without murmurs, rubs, or gallops. Peripheral pulses 2+ bilaterally. No jugular venous distention or peripheral edema.
• Respiratory: Lungs clear to auscultation bilaterally. Respirations even and unlabored. No wheezes, rales, or rhonchi.
• Gastrointestinal:Abdomen soft, non-tender, and non-distended. Bowel sounds present in all four quadrants. No hepatosplenomegaly, masses, guarding, or rebound tenderness.
• Genitourinary:No suprapubic tenderness or bladder distention. No costovertebral angle tenderness. Genital examination deferred. Patient denies genitourinary complaints.
• Musculoskeletal:Normal posture and gait. Full active range of motion in all extremities. Muscle strength 5/5 bilaterally. No joint swelling, deformity, or tenderness.
• Neurological:Alert and oriented to person, place, time, and situation. Cranial nerves II-XII grossly intact. Motor and sensory functions intact. Deep tendon reflexes 2+ and symmetrical. No tremors, rigidity, dystonia, or abnormal involuntary movements observed. Coordination and balance intact.
• Lymphatic:No cervical, axillary, or inguinal lymphadenopathy. No evidence of abnormal bruising or bleeding.
• Endocrine:No thyromegaly, tremors, diaphoresis, or other signs of endocrine dysfunction.

Diagnostic results:

• Complete Blood Count (CBC):Evaluate for anemia, infections, or other hematologic abnormalities that may contribute to psychiatric symptoms or affect overall health.
• Comprehensive Metabolic Panel (CMP):Assess renal, liver, electrolyte, and glucose levels before initiating or resuming mental health medications.
• Thyroid Function Tests (TSH and Free T4):Exclude thyroid disorders, as both hyperthyroidism and hypothyroidism may cause symptoms like mania or depression (Norman et al., 2024).
• Urine Drug Screen (UDS): The purpose is to identify substances that may induce or imitate mood or psychotic symptoms and to establish a baseline assessment prior to treatment planning (Paparrigopoulos et al., 2026).

Assessment

Mental Status Examination:

• W. is a 57-year-old male who appears his stated age and is appropriately dressed, though grooming and hygiene are only fair and consistent with recent homelessness. He is alert and oriented to person, place, time, and situation. Behavior is cooperative throughout the interview, with occasional restlessness and mild psychomotor agitation. Eye contact is intermittent. Speech is fluent, spontaneous, and slightly pressured, at times excessively rapid, but maintains normal volume. Affect is expansive, congruent with mood, and sometimes elevated; mood is described as “good.” Thought processes are tangential and circumstantial, requiring frequent redirection to maintain focus on interview questions. Thought content includes grandiose beliefs regarding musical abilities and future success, without evidence of current delusions, obsessions, or phobias. He denies suicidal ideation, homicidal ideation, auditory hallucinations, and visual hallucinations. Attention and concentration are mildly impaired, and recent memory appears slightly diminished, while remote memory remains relatively intact. Insight into psychiatric illness is poor, as he minimizes the severity of symptoms and the need for treatment. Judgment is impaired, as evidenced by poor adherence to medication, suboptimal decision-making regarding treatment engagement, and chronic psychosocial instability. Educational history and vocabulary suggest average to above-average intellectual functioning. Impulse control is adequate during the interview but has been compromised during previous mood episodes.

Differential Diagnoses:

• Bipolar I Disorder, current episode manic, severe, with psychotic features (ICD-10: F31.2): The most likely diagnosis is supported by the patient’s long history of recurrent mood episodes beginning in late adolescence, multiple psychiatric hospitalizations, and documented manic symptoms, including decreased need for sleep, increased energy, pressured and tangential speech, grandiosity, increased goal-directed activity such as music composition, and impaired judgment (Singh et al., 2025). Functional impairment, a history of severe depressive episodes with suicidal ideation, and grandiose beliefs about musical or academic achievements strongly suggest Bipolar I Disorder. His positive response to lithium further supports this diagnosis.
• Schizoaffective Disorder, Bipolar Type (ICD-10: F25.0): This differential diagnosis is important due to prominent mood symptoms, possible psychotic features, and chronic functional impairment. While the patient’s psychotic-like symptoms (grandiosity, disorganized thinking, and possible delusional beliefs) seem closely linked to mood episodes, his poor insight, tangential thought processes, and chronic course suggest that psychotic symptoms may also occur outside of mood episodes (Saadabadi, et al.,2023). According to the American Psychiatric Association [APA] (2022) a diagnosis of schizoaffective disorder is considered when there is evidence of at least two weeks of psychotic symptoms in the absence of prominent mood symptoms.
• Alcohol-Induced Bipolar and Related Disorder / Substance-Induced Mood Disorder (ICD-10: F10.94): Consider a diagnosis of substance-induced mood disorder given the patient’s chronic alcohol consumption, typically 3 to 6 drinks during music performances, previous detoxification admission, and continued alcohol use. According to Tesselaar et al. (2025), Alcohol use can exacerbate mood instability, impulsivity, sleep disturbances, and cognitive deficits, potentially masking or intensifying manic symptoms. Nevertheless, the persistence of symptoms since age 19 and the occurrence of mood episodes independent of substance use suggest that alcohol use is unlikely to be the primary diagnosis, although it may represent a significant contributing factor.

Primary Diagnosis

Bipolar I Disorder, current episode manic, severe, with psychotic features (ICD-10: F31.2).

Diagnostic Reasoning:

• The DSM-5-TR defines Bipolar I Disorder as the occurrence of at least one manic episode, characterized by abnormally elevated or irritable mood and increased energy lasting a minimum of one week, or any duration if hospitalization is necessary. Associated symptoms include decreased need for sleep, grandiosity, pressured speech, and impaired functioning (American Psychiatric Association [APA], 2022).
• This patient meets the criteria, demonstrated by reduced need for sleep without fatigue, increased goal-directed activity in music composition, grandiose beliefs, tangential thinking, and significant functional impairment such as homelessness and job loss. Additional findings include episodic mood disturbance, severe manic symptoms, a history of depression with suicidal ideation, poor insight, and marked psychosocial dysfunction.

Reflections:

• This case illustrates the multifaceted challenges inherent in diagnosing and managing chronic, severe mood disorders in individuals with complex psychiatric histories, especially when patient insight is limited, and collateral information is unavailable. I observed that Bipolar I Disorder often manifests with a distinct episodic pattern throughout the lifespan, but its trajectory is frequently complicated by psychosocial factors such as homelessness, unemployment, and alcohol misuse. These elements tend to intensify symptom severity and impede consistent treatment engagement. The patient’s previous positive response to lithium provides a strong indicator supporting a mood disorder diagnosis and aids in distinguishing it from primary psychotic disorders. In future clinical encounters, I would prioritize early acquisition of collateral information and utilize structured mood rating scales to assess symptom severity and monitor clinical progress more precisely. Economic stability, recognized as a key social determinant of health by Healthy People 2030 (2020), is particularly salient in this context, as the patient’s homelessness and job loss significantly undermined medication adherence, access to care, and psychiatric stability. As an aspiring Psychiatric Mental Health Nurse Practitioner (PMHNP), I acknowledge the importance of integrating case management, housing support, and medication adherence interventions to foster patient stability. Patient education should focus on early recognition of manic and depressive symptoms, the critical role of medication adherence, and strategies to reduce alcohol consumption, as these interventions are essential for preventing recurrent hospitalizations and enhancing long-term functional outcomes.

References

American Psychiatric Association [APA]. (2022). Diagnostic and statistical manual of mental disorders (5th ed.).

Healthy People 2030. (2020). Housing instability. Health.gov. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/housing-instabilityLinks to an external site.

Norman, S. J., Carney, A. C., Algarin, F., Witt, B., Witzel, I. M., Rodriguez, P. M., & Mohyeldin, M. (2024). Thyroid dysfunction and bipolar disorder: A literature review integrating neurochemical, endocrine, and genetic perspectives. Cureus, 16(9), e69182. https://doi.org/10.7759/cureus.69182Links to an external site.

Paparrigopoulos, T., Mellos, E., & Tzagarakis, C. (2026). Substance use disorders and the psychosis spectrum: Assessment, clinical challenges and management. Journal of Clinical Medicine, 15(4), 1562. https://doi.org/10.3390/jcm15041562Links to an external site.

Singh, B., Swartz, H. A., Cuellar-Barboza, A. B., Schaffer, A., Kato, T., Dols, A., Sperry, S. H., Vassilev, A. B., Burdick, K. E., & Frye, M. A. (2025). Bipolar disorder. The Lancet. https://doi.org/10.1016/s0140-6736(25)01140-7Links to an external site.

Tesselaar, D. R. M., Arnt, Homberg, J. R., Booij, J., & Guerrin, C. (2025). Psychiatric comorbidity in substance use disorders, a systematic review of neuro-imaging findings. Neuroscience & Biobehavioral Reviews, 106325–106325. https://doi.org/10.1016/j.neubiorev.2025.106325Links to an external site.

Wy, T. J. P., & Saadabadi, A. (2023). Schizoaffective disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541012/Links to an external site.

Assessing and Diagnosing Patients With Mood Disorders Assignment Instructions

Resources

To Prepare:

• 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-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.
• 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.) Walden university NRNP 6635 Week 3 Assignment Assessing and Diagnosing Patients With Mood Disorders.