NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

CC (chief complaint): I am Patti, a lady from Iran who is forty years old. Constant discomfort from my recent surgery has rendered me jobless, and I’m already struggling with depressive symptoms and feelings of powerlessness. My children’s drive for independence compounds the difficulty caused by a clash of Iranian cultural standards.

HPI: Patti, a lady of Iranian heritage in her forties, says she has been depressed since her children left home but has not sought help for it. While Patti is independent, she does wish her children would honor Iranian tradition and help take care of her. No mental hospitalizations have ever occurred in Patti’s life. No one in the family has ever participated in a medical trial. Even though Patti and her family have been going to therapy for the last 18 months, Shirleen, the youngest daughter, still refuses to join in. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

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Past Psychiatric History:

General Statement: At thirty years of age, she sought help for the depression that had its roots in a troubled divorce by enrolling in therapy. Attempts to traverse cultural differences and family pressures in the United States have defined my mental health journey since then.

Caregivers: She has no caregiver as of her case.

Hospitalizations: No mental hospitalizations were made, and no histories of self-harm or acts of suicidality or homicide have been identified.

Medication Trials: She has not taken psychiatric and has no trial for psychotropic medications.

Psychotherapy or Previous Psychiatric Diagnosis:  There is no previous psychiatric diagnosis. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

 Substance Current Use and History:

She has no history of substance use of marijuana and alcohol.Top of Form

Family Psychiatric/Substance Use History:

There is no indication of any issues related to drug abuse or suicides in the family. Shireen’s departure from the home might suggest a major disturbance in the family dynamic.

Psychosocial History:

Patti was born in Iran. She divorced her husband after an abusive marriage. She has lived with her two boys, ages 18 and 15, in the United States for the last twelve years. She may have hit a professional wall after her recent jobless due to surgery. After eighteen months of treatment, Patti is still reeling from a tangled web of emotions. She finds comfort in her pastimes, which include self-care, watching television, and having long phone talks. Recent surgery has affected her employment history, making her physically unable to work and, hence, unemployed. Patti has a long and troubled history of trauma, including sexual assault, marital violence, and the devastating experience of abandoning a kid in Iraq. She still feels helpless, depressed, and in continual agony because of these events. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Medical History:

Current Medications: Patti’s is not on medications.

Allergies: No known food and drug allergies. Information about allergies is provided for Patti. Reproductive Hx: her menstrual history, pregnancy status, lactation, and contraceptive use are not provided.

Illnesses and Surgeries: she had a recent surgery that led to physical limitation as well as limited work and, thus, unemployment.

System Review (ROS):

General: Patti has been complaining of persistent pain and exhaustion ever since her operation. The patient did not experience any notable changes in weight, fever, or night sweats.

HEENT (Head, Eyes, Nose, Throat): No complaints were reported of any issues with their hearing, vision, or headaches. No throat pain and nasal congestion were reported.

SKIN: No changes, rashes, or lesions observed on the skin.

Cardiovascular: No complaints of chest discomfort, palpitations, or swelling.

Respiratory: No complaints of difficulty breathing, coughing, or wheezing.

GASTROINTESTINAL: she does not complain of nausea, vomiting, or changes in their bowel patterns.

GENITOURINARY: No urinary urgency, frequency, or hematuria reported.

NEUROLOGICAL: Patti’s movement is hindered by chronic pain, according to her neurological evaluation. There is no mention of seizures, localized neurological impairments, or cognitive abnormalities. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

MUSCULOSKELETAL: No particular musculoskeletal issues were noted except for the stated persistent pain.

HEMATOLOGIC: There is no indication of a history of abnormal bleeding, excessive bruising, or blood problems.

LYMPHATICS: There has been no mention of lymph node swelling or pain.

ENDOCRINOLOGIC: No changes in weight, appetite, or excessive thirst.

Physical exam: if applicable

General Appearance: She appears fatigued.

Musculoskeletal System: Upon palpation, there is tenderness on the surgical incision site.

Neurological Examination: Patti does mention experiencing tingling in her leg. Although the reflexes remain unaffected, the right side’s muscular strength is significantly diminished, particularly in the legs.

Skin Examination: The area around the surgical incision does not seem to be infected or dirty. But you may notice some little redness and swelling around the wound that sometimes itches.

Cardiovascular Examination: Blood pressure and heart rate are regular.

Respiratory Examination: there is no respiratory distress noted on her.

Abdominal Examination: Not applicable.

Head, Eyes, Ears, Nose, Throat (HEENT): There are no anomalies detected in the area of the face or head.

Genitourinary Examination: Not applicable

Lymphatic Examination: There is no visible abnormality, such as enlarged or painful lymph nodes. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Diagnostic results:

The lab tests. Normal Thyroid Function Evaluations in which thyroid dysfunction may cause emotional problems and symptoms that are similar to depression (Duval, 2018). An evaluation of cortisol levels also may reveal how the body reacts to stress.

Imaging techniques like X-rays or MRIs could be used to find any structural abnormalities and underlying physical reasons for the persistent pain. Inflammatory processes, musculoskeletal disorders, or nerve impingements may be better understood with the use of these diagnostic procedures (Gatti et al., 2016). In order to get a full picture of the patient’s physical and mental health, pain management experts and clinicians doing clinical assessments work together to review the patient’s medical records and symptoms before deciding whether or not to order imaging.

The use of validated depression rating instruments, such as the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HAM-D), is very beneficial. Clinicians may more accurately evaluate their patients’ emotional well-being with the use of these evaluation tools, which provide measurable indicators of the intensity of depression symptoms. Incorporating these measures provides for a deeper comprehension of the complex relationship between mental and physical health, which is especially important for those dealing with chronic pain (Ballard et al., 2018). In addition, these rating scales provide a methodical way to monitor the progression of symptoms of depression over time, which allows for continuous evaluation and the customization of treatment plans to meet the unique requirements of every client within the given diagnostic framework. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Assessment

Mental Status Examination:

A 40-year-old lady of Iranian heritage named Patti comes in for a mental health assessment. She kept a cooperative attitude and looked her declared age throughout the session. Patti does not exhibit any unusual motor activity and is well-groomed. Her voice is at a typical level, and her discourse is intelligible and clear. There is no indication of free association or idea flight in the thought processes, which are goal-oriented and rational.

In her mood, she is distressed, which is a reflection of her pessimism and powerlessness. Her demeanor is noticeably sorrowful, reflecting her emotional state. A quiet look characterizes her personality; however, there are moments of engagement. Patti is honest about the difficulties she has and admits that she tries to hide her feelings of sadness by smiling falsely.

In exploring her thought content, she claims she has never had visual or aural hallucinations. There is no sign of hallucination. By stating that her emotional issues were caused by a complicated interaction of cultural norms and family relationships, Patti demonstrates a genuine comprehension of her situation. Throughout the evaluation, Patti did not exhibit any signs of having thoughts of self-harm or harming others. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Cognitively, she shows signs of being awake and oriented. Her capacity to remember and articulate events from the past suggests that her short-term and long-term memory are both unimpaired. As a result of the effects of her emotional pain on her cognitive performance, Patti has trouble concentrating and sometimes wanders off-task during sessions. On the insight, she is honest about her feelings and admits she needs therapy. She shows that she has insight into her illness. However, her cultural background colors her views on family duties and her expectations, so her understanding is limited. Patti freely participates in treatment, showing a dedication to taking care of her mental health, and her judgment is unimpaired.

Differential Diagnoses
First, the primary diagnosis is Major Depressive Disorder (MDD) (F32), which is notable because of her perpetual emotions of despair and helplessness as well as the effect of her chronic pain on her ability to move about and do her job. In line with the criteria for MDD, she exhibits a persistently low mood and little affect; relevant positives include this, while relevant negatives include the lack of manic or hypomanic episodes (Fellinger et al., 2022). This choice is rooted in the fact that Patti’s depressed symptoms are long-lasting, she has not shown any signs of adjusting to a stressor, and her mental anguish deeply affects her day-to-day functioning. The clinical picture is augmented by cultural adjustment stress as well as chronic pain syndrome. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Secondly, Patti has the possibility of Adjustment Disorder (F43.2) since her emotional discomfort is clearly related to certain life stresses, such as family relationships, difficulties with immigration, and cultural changes. Timely admission of Sharleen’s history of abuse is one of the major stresses that have coincided with her symptoms. Important positives are the stress-depression onset association and the cultural elements that impact adjustment issues. Signs that go beyond the usual manifestations of adjustment disorder are relevant negatives (Gradus et al., 2014).

Also, Persistent Depressive Disorder (F34.1) could be a possible diagnosis because Patti describes feeling depressed when her children become independent. Symptoms of this condition include an ongoing sense of despair and extreme exhaustion. A relevant positive would be the lack of a clear history of a prior serious depressive episode, whereas a relevant negative would be the presence of a persistently low mood that has persisted for years with no signs of improvement (Taurines & Wewetzer, 2014). NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

The importance of persistent pain in Patti’s perspective suggests that Chronic Pain Syndrome, along with mood-related disorders, may be contributing to her unhappiness. The fact that her discomfort greatly interferes with her everyday activities and is a source of great unhappiness lends credence to this diagnosis. It is important to note that chronic pain cannot rule out the possibility of a co-occurring depressive illness and that persistent, nonmalignant pain that substantially impacts everyday living is a relevant negative (Reddi & Curran, 2014).

Case Formulation and Treatment Plan:

Patti will begin weekly individual psychotherapy sessions to address the long-term effects of her depression. In order to improve emotional health, deal with negative thinking patterns, and learn new coping mechanisms, cognitive-behavioral therapy (CBT) will be the main approach. Educational materials on persistent depressive illness are also available, with an emphasis on the need for psychotherapy for the long-term treatment of symptoms. Mood monitoring and recognizing depressive episode triggers will be part of the homework. Included in this evaluation should be the local crisis lines as well as emergency services contact information. In the event that Patti has increased discomfort or has an urgent issue, she should make sure she can reach out for help right away. Included in the list of emergency numbers is the number for the national suicide prevention hotline. Working together with Patti’s other doctors, especially her primary care physician, to compile a complete medical history that includes all drugs, any pertinent diagnoses, and any other pertinent information that could affect treatment I important. For a thorough understanding, it is recommended to study hospital and therapy records if they are accessible. To make sure Patti gets the treatment plan, I should give her plenty of opportunities to ask questions and get her responses. There should be an establishment of a schedule of follow-up sessions to evaluate the success of your therapy and make any necessary adjustments to your treatments. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

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There should be a collaborative management of pain management as well as the antidepressant prescription. It might be wise to think about prescribing analgesics to alleviate her discomfort and tricyclic antidepressants (TCAs) to treat her depression. Starting with a modest dosage and closely monitoring side effects as well as a therapeutic response are the best ways to use the medicine. The specific reaction and tolerance of Patti will determine if a change in kind or dose is required. Additionally, it is crucial to educate Patti about the expected results, possible negative effects, and the need to follow her prescription regiment. She should feel comfortable asking questions or expressing reservations about pharmaceutical therapies in an open discussion. The prescribing psychiatrist, as well as Patti’s psychotherapist must work together effectively. This is to ensure a holistic understanding of her process and adjust the pharmacological interventions when needed.  Finally, the psychiatric provider will arrange frequent follow-up sessions to evaluate side effects, assess the effectiveness of pharmacological management, and then implement any required revisions to the treatment plan (Huffman et al., 2014). In order to provide a thorough and personalized approach to Patti’s well-being, medication will be included to treat the neurological aspects of her ongoing depression symptoms. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Reflections:

In reviewing this case, I concur with my preceptor’s diagnostic observations and evaluation. Since Patti’s depression symptoms have persisted over time, the main diagnosis of Major Depressive Disorder fits her symptoms well. The significance of intact families and cultural competency in mental health evaluation and treatment were both highlighted in this instance. Mental as well as physical well-being are inextricably linked, as the example shows. For Patti, the effects of chronic pain on her mental health were substantial. Working together with a pain management expert and using medication to treat the psychological and neurological components demonstrated the interdependence of the two.

Regarding mental health in an environment of cultural diversity, I would prioritize early intervention as well as psychoeducation in future situations even more. For a more seamless transition and better-coping mechanisms, it may be helpful to anticipate and manage the stresses associated with immigration as well as cultural adjustment. Further possibilities for community resource cooperation that are sensitive to cultural and language demands should be investigated. A more all-encompassing and patient-centred approach might be achieved by incorporating community support networks and improving cultural competency in treatment. Dedication to patient autonomy is also shown by routinely checking in with patients to see whether their treatment plan is still suitable and by providing continuing informed consent. It is crucial to address the socioeconomic variables impacting Patti’s mental health, which includes taking into account her cultural background and immigrant experience. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

A more comprehensive and culturally aware strategy may be developed via partnerships with community organizations that are familiar with the specific difficulties encountered by immigrant groups. Lastly, I would like to emphasize that comprehensive health promotion encompasses more than just mental health; it also aims to improve people’s physical and emotional health. A key component in avoiding the worsening of mental health issues might be health education that is culturally specific and that promotes resilience across the family unit.

References

Ballard, E. D., Yarrington, J. S., Farmer, C. A., Lener, M. S., Kadriu, B., Lally, N., … & Zarate Jr, C. A. (2018). Parsing the heterogeneity of depression: An exploratory factor analysis across commonly used depression rating scales. Journal of Affective Disorders, 231, 51-57. https://doi.org/10.1016/j.jad.2018.01.027

Duval, F. (2018). Thyroid hormone treatment of mood disorders. Current Treatment Options in Psychiatry, 5, 363-376. https://doi.org/10.1007/s40501-018-0155-z

Fellinger, M., Waldhoer, T., Serretti, A., Hinterbuchinger, B., Pruckner, N., Koenig, D., … & Fugger, G. (2022). Seasonality in major depressive disorder: effect of sex and age. Journal of Affective Disorders, 296, 111-116. https://doi.org/10.1016/j.jad.2021.09.051

Gatti, D., Rossini, M., & Adami, S. (2016). Management of patients with complex regional pain syndrome type I. Osteoporosis international, 27, 2423-2431. https://doi.org/10.1007/s00198-016-3531-9

Gradus, J. L., Bozi, I., Antonsen, S., Svensson, E., Lash, T. L., Resick, P. A., & Hansen, J. G. (2014). Severe stress and adjustment disorder diagnoses in the population of Denmark. Journal of traumatic stress, 27(3), 370-374.https://doi.org/10.1007/978-3-7091-1501-5_14

Huffman, J. C., Niazi, S. K., Rundell, J. R., Sharpe, M., & Katon, W. J. (2014). Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the academy of psychosomatic medicine research and evidence-based practice committee. Psychosomatics, 55(2), 109-122.

Reddi, D., & Curran, N. (2014). Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgraduate medical journal, 90(1062), 222-227. https://doi.org/10.1136/postgradmedj-2013-132215

Taurines, R., & Wewetzer, C. (2014). Depressive disorders. In Psychiatric Drugs in Children and Adolescents: Basic Pharmacology and Practical Applications (pp. 405-416). Vienna: Springer Vienna. https://doi.org/10.1007/978-3-7091-1501-5_14 NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

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Case Study
Patti, a 40-year-old woman of Iranian descent, arrived in the United States via a medical visa a dozen years ago, a decision precipitated by domestic abuse that compelled her to leave one of her children behind. She was married at the age of 14, has two sons and three daughters, and currently lives with her 18 and 15-year-old sons. Following surgery, she is no longer employed due to physical limitations. Patti has no legal issues, is no longer with her abusive husband, and enjoys lengthy phone conversations, television, and self-care.
HPI: Sandi, a therapist specializing in family dynamics, introduces the compelling case of Patti, a 40-year-old woman, and her 23-year-old daughter Sharleen, both hailing from Iran. They have come forward for a psychotherapeutic evaluation, seeking assistance amidst a turbulent history encompassing domestic abuse, sexual trauma, and the complex trials of immigration. Patti expresses feelings of helplessness, depression, hopelessness, and constant pain, affecting her mobility and work. After undergoing surgery, she was directed to a psychiatrist for evaluation and therapy. A challenging dynamic exists between the mother and daughter, stemming from different expectations. The turmoil began when Shirleen moved to the USA two years ago, revealing the abuse she endured from her father, including sexual abuse and being called in derogatory names. Resistant to attend therapy, Shirleen sought to support herself financially. Household chaos ensured as the daughters sought independence, leading to conflicts. Patti believes her children should care for her due to her condition, while they desire autonomy in American culture, causing her to feel out of control and resulting in family tension and anxiety. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment

Important information.
Patti mentions experiencing depression as her children have become independent, but she hasn’t pursued any treatment or medications. Patti takes care of herself but hopes her children will follow Iranian cultural norms and look after her. Patti has never been hospitalized for psychiatric reasons. No medical trials have been conducted within the family. Patti and her family have engaged in therapy for the past eighteen months, but Shirleen, her youngest daughter, refuses to participate.
NB: Please rewrite the HPI to avoid plagiarism.

Comprehensive Psychiatric
Document the following for the family in the video, using the Comprehensive Evaluation Note Template:
• Chief complaint
• History of present illness
• Past psychiatric history
• Substance use history
• Family psychiatric/substance use history
• Psychosocial history/Developmental history NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment
• Medical history
• Review of systems (ROS)
• Physical assessment (if applicable)
• Mental status exam
• Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria
• Case formulation and treatment plan
• Include a psychotherapy genogram for the family
Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.

Note :
Choosing Differential Diagnoses:
Major Depressive Disorder (MDD) (F32)
Adjustment Disorder (F43.2)
Persistent Depressive Disorder (F34.1)

Use this information for the psychotherapy genogram for the family.
Patti, a 40-year-old woman of Iranian descent and a mother, grapples with depression, experiencing profound feelings of hopelessness and persistent fatigue. She migrated to the United States 12 years ago from Iran.
Sheila, 24-year-old daughter. First born.
Sharleen, a 23-year-old, daughter, with Patti in session.
Shireen, 21 years old, daughter, was left behind in Iraq at 8 years.
18-year-old son
15-year-old son. NRNP 6645-Psychopathology and Diagnostic Reasoning Assignment