WORK30

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Comprehensive Psychiatric Evaluation for Patients With Mood Disorders

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COMPREHENSIVE PSYCHIATRIC EVALUATION 2

Comprehensive Psychiatric Evaluation for Patients With Mood Disorders

CC (chief complaint): “I can’t sleep much”

HPI: The patients is a 24-year old female, Mrs. Tilmam, who came to the clinic after

experiencing trouble falling asleep because of the constant crying of her 2 month old baby.

Although she says she loves her baby and does not regret giving birth,she is does not want o be a

bad mother, and she finds herself crying a lot and yelling. She reports no health problems as the

time of examination, however she mentioned that she is distigusted with her body and her

weight. She feels stuck with her baby all day and cannot catch a break from the baby’s crying

and needs. She also has reports to have suicidal idealition so that she can get out, but she has not

acted on them because she feels guilty doing that to her daughter and husband. Additionally, the

patient mentions that she is unmotivated to do anything because she is going to be interrupted by

the baby and she feels like her life is never going to go out and have a social life. She mentions

wanting to run to lose weight, but she can never have time as they cannot afford a nanny to take

care of the baby. She has no desire for sexual activity. And she is easily upset by the baby and her

husband. Further, the patient said her appetitie is not big and she feels isolated from her friends

and other social activities. Mrs. Timam is not on any medication and she was referred by her

husband, who was worried about her.

Past Psychiatric History:

 General Statement: The patient has never been to a shrink before.

 Caregivers (if applicable): None

 Hospitalizations: None

 Medication trials: No medication history

 Psychotherapy or Previous Psychiatric Diagnosis: No previous diagnosis

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COMPREHENSIVE PSYCHIATRIC EVALUATION 3

Substance Current Use and History: No record of substance abuse and history

Family Psychiatric/Substance Use History: Negative history for mental illnesses in the family

Psychosocial History: The patient is married and had been in business for four years. There is

no record of her birth place or ethnicity. She has a 2-month old baby, Jessica and quit her job so

that she could take of the baby. She lives with her husband and her daughter at home. She used

to like writing , but not anymore. There is no historyof childhood or adult trauma and she has no

issues or concerns about her safety of that of her family. She also used to hang out wit her

friends, but she can never get the time to do so after her daughter was born.

Medical History:

 Current Medications: No medication

 Allergies: No knowne allergies

 Reproductive Hx: Sexually inactive since the baby was born 2 months ago. The patient

is nursing. No mention of contraceptives or menstrual history.

ROS:

 GENERAL: No mention of weight loss, fever, or fatigue in the patient.

 HEENT: No mention of visual loss,ears, nose throat of sore throat

 SKIN: No mention of skin problems

 CARDIOVASCULAR: No record given

 RESPIRATORY: No record given

 GASTROINTESTINAL: She feels bloated and her appetite is not big

 GENITOURINARY: No record given

 NEUROLOGICAL: No record given

 MUSCULOSKELETAL: No record given

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COMPREHENSIVE PSYCHIATRIC EVALUATION 4

 HEMATOLOGIC: No record given

 LYMPHATICS: No record given

 ENDOCRINOLOGIC: No record of heat intolerance or sweating given.

Physical exam: if applicable

The patient is well oriented and aswers questions appropriately. From her response she shows

discomfort being at a shrink’s office. The patient cries a lot but responds with head nodes and

words appropriately.

Diagnostic results: Diagnostic results are not documented in the case study.

Assessment

Mental Status Examination:

The patient is a 24-year old female who shows cooperation with the examiner. Although she

mentions discomfort being at the examiner’s office, she stays and answers all questions

appropriately. Her speech is also clear, normal coherent and the examiner can hear her well. Her

thought process is also goal directed and logical as she says her responses logically and in a

language that the examiner can understand. Her mood seems to be tranquil as she responds in a

manner that shows stability in her mental state. There are no auditory or visual hallucinations

mentioned in the interview, nor is there an indication of delusional thinking. She admits that she

does have suicidal ideation, but she has never acted on it. She does seem alert in her repsinses

and her concentration is good because she waits for the examiner to complete the question before

she can answer. Sometimes, the patient responds in incomplete sentences because she is crying,

this making her responses incomplete.

Differential Diagnoses:

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COMPREHENSIVE PSYCHIATRIC EVALUATION 5

Post-Partum depression

From the patient’s symptoms she could be suffering from postpartum depression(PPD). The

patient shows symptoms that are consistent with PPD such as feeling angry, annoyed, hopeless

and resentful. She explains instances where she yells at her husband for no reason and gets easily

upsent by his actions. Also, the patient cries a lot for no reason, which is one of the main

symptoms of PPD. Since she just gave birth a few months ago, the patient could be suffering

from PPD as she is trying to adjust to the new realities of taking care of the baby all day.

According to Field (2017), PPD affects new mothers who have given birth withint he first 4

weeks to 30 weeks of giving birth. Further the articl reveals that mothers who experience PPD

show manifestations of symptoms such as crying spells, anxiety, insomnia, lost of interest in

doing things, changes in appepite, and suicidal thoughts. These symptoms are consistent with the

patient’s case, especially sicne she cannot seem to get much sleep or rest because of the baby

(Field, 2017). Furthermore, the patient is exposed to risk factors of PPD such as being in a

relationship and financial problems as they cannot afford to pay for a nanny to help her with the

baby (Friedman & Resnick, 2009). These symptoms are also consistent with the the Diagnostic

and Statistical Manual of Mental Disorders(DSM-5), which shows that PPD is consistent with

depression except for the fact tht is happens within the perinatal period. The diagnostic tool

shows that mothers with PPD must experience atlest five of the nine symptoms such as

decreased concentrations, suicidal thoughts, depressed mood, loss of interest, changes is sleep

patterns and appetite. While the patient says she doesn’t regret giving birth, she is not sure why

she feels that she is not a good mother (Friedman & Resnick, 2009).

Post Partum anxiety

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COMPREHENSIVE PSYCHIATRIC EVALUATION 6

The other possible diagnosis for the patient is post partum anxiety. Although the DSM-s tool

does not classify this as its own mental disorder, it differs from PPD because post partume

anxiety makes mothers feel tht they are always agitated and worries about their a lot of things.

Such mothers hae trouble sleeping or staying still to find some calm. Although the patient shows

some of these symptoms, she does not report any intrusive thoughts anout bad things happening

to the baby or constantly monitoring the baby so that bad things do not happen to them.

Nevertheless, the patient can have both PPD and post partum anxiety (MGH Center for Women's

Mental Health, 2015).

Insomnia

Another possible diagnosis so the patient is insomnia. Insomnia is experienced when an

individual has trouble sleeping or staying awake. Although the patient does not specify how

many hours she sleeps, she makes it clear that she has trouble falling asleep after the baby wakes

her up. This could be a possible diagnosis except fo the fact tht the patient has other symptoms

such as loss of appetite, self-esteem issues, loss of pleasure in doing things, suicidal thoughts,

and isolation from others. In that case, treating insomnia will not be enough to help her with her

other symptoms, especially since insomnia is a symotoms for PDD. To avoid the aspect of

polypharmacy, it will be prudent to being with the diagnosis with the most symptoms such as

PDD (Creti et al., 2017).

Reflections:

From the case, I agree that the patient could be experiencing PDD because she meets the criteria

as described under the DSM-5 diagnostic tool. I however think that there was an overreliance on

subjective data due to limitation in objective data. One thing that I could have done differently

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COMPREHENSIVE PSYCHIATRIC EVALUATION 7

was to ask the patient what they thought was the cause of their symptoms. I would also ask if the

patient had any coping mechanisms that had worked for her and her support systems in terms of

her family and friends. Asking these questions could have helped me understand the patient’

view abouther condition and provide adequate phycotherapeutic and paharmacologicl options ot

help her cope and manage her condition. Some ethical consideration that I would ovbserve

include ensuring that patient-clinet confidentiality was observed. I would also encourage the

patient to be open about her feelings and make her feel that she is ina safe space. More

importantly, I would educate the patient about the importance of seeking medical assistance and

provide her with all available options while explaining the side effect and contraindications of

each phamarcological options.

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COMPREHENSIVE PSYCHIATRIC EVALUATION 8

References

Creti, L., Libman, E., Rizzo, D., Fichten, C., Bailes, S., Tran, D., & Zelkowitz, P. (2017). Sleep

in the Postpartum: Characteristics of First-Time, Healthy Mothers. Sleep Disorders, 2017, 1-

10. https://doi.org/10.1155/2017/8520358

Field, T. (2017). Postpartum Depression Effects, Risk Factors and Interventions: A

Review. Clinical Depression, 03(01). https://doi.org/10.4172/2572-0791.1000122

Friedman, S., & Resnick, P. (2009). Postpartum Depression: An Update. Women's Health, 5(3),

287-295. https://doi.org/10.2217/whe.09.3

MGH Center for Women's Mental Health. (2015). Is It Postpartum Depression or Postpartum

Anxiety? What’s The Difference? - MGH Center for Women's Mental Health. MGH Center

for Women's Mental Health. Retrieved 15 December 2020, from

https://womensmentalhealth.org/posts/is-it-postpartum-depression-or-postpartum-anxiety-

whats-the-difference/.

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