Assignment Guide: Comprehensive Psychiatric Evaluation for Mood Disorders – NRNP 6635 Week 3

Accurately diagnosing depressive and bipolar disorders requires a systematic approach that integrates patient history, clinical presentation, and evidence-based diagnostic criteria, a skill central to the Week 3 Assignment for Walden University’s NRNP 6635 course. This guide provides a detailed framework for completing the Comprehensive Psychiatric Evaluation, including differential diagnosis, critical thinking, and reflection, while incorporating current best practices and verifiable sources.

Comprehensive Psychiatric Evaluation: Assessing and Diagnosing Patients with Mood Disorders

Mood disorders present unique diagnostic challenges due to their episodic nature, symptom overlap, and the influence of psychosocial stressors on presentation. The Week 3 Assignment for NRNP 6635: Psychopathology and Diagnostic Reasoning requires students to demonstrate clinical reasoning by conducting a comprehensive psychiatric evaluation on a selected video case study.

Assignment Overview

The assignment requires students to select one video case study from the provided list, review the corresponding case history report, and complete the Comprehensive Psychiatric Evaluation Template. The evaluation must include subjective and objective data, a mental status examination, at least three differential diagnoses with supporting evidence, and a primary diagnosis based on DSM-5-TR criteria. Students must also include reflection notes addressing legal and ethical considerations, health promotion, and disease prevention tailored to the patient’s unique factors.

Sample Answer Excerpt: Major Depressive Disorder Case Analysis

Subjective:

CC (chief complaint): “Yeah, yesterday I was a little bit depressed, but it was just because I was in a bad mood.”

HPI: Ms. C.L. is an 18-year-old female who presents for a psychiatric evaluation following discharge from a residential mental health facility. She was prescribed lithium 300 mg in the morning and 600 mg at bedtime, along with aripiprazole 2.5 mg in the morning. Her parents report that she has experienced a depressed mood, loss of energy, feelings of worthlessness, and recurrent thoughts of death over the past week, though the patient minimizes these symptoms as “ancient history.” She also reports sleeping only 2 to 3 hours per night, indicating significant insomnia.

Past Psychiatric History: The patient has a history of conduct disorder and depression dating back to age 9, with a previous residential treatment admission three months ago. She has a history of cannabis use, positive on admission toxicology.

Family Psychiatric History: Her grandmother has bipolar disorder; her mother and maternal aunt have anxiety disorders.

Objective:

Mental Status Examination: The patient is well-groomed, alert, and oriented to person, place, time, and situation. Her speech is clear with a regular tempo and adequate volume. However, she appears dysphoric, exhibits psychomotor agitation (constant movement, looking around the room), and demonstrates flight of ideas, frequently diverting conversation to unrelated topics. She has difficulty with concentration, unable to recite the months of the year backward, though short- and long-term memory remain intact.

Assessment:

Primary Diagnosis: Major Depressive Disorder (MDD)

The patient meets DSM-5-TR criteria for MDD, with five or more symptoms present during the same two-week period representing a change from previous functioning. These include depressed mood (subjective report and observed by parents), diminished interest in activities (refusing to participate in school plays), insomnia (2–3 hours of sleep per night), loss of energy, feelings of worthlessness, and recurrent thoughts of death. The symptoms cause clinically significant distress and impairment in social and occupational functioning. There is no history of manic or hypomanic episodes, ruling out bipolar disorder.

Differential Diagnoses:

Substance-Induced Depressive Disorder: While the patient has a history of cannabis use and presents with depressive symptoms, there is no evidence that the symptoms developed during or shortly after intoxication or withdrawal, as required by DSM-5-TR criteria. The toxicology report was positive upon admission, but the depressive symptoms persisted beyond the expected duration of substance effects.

Borderline Personality Disorder (BPD): The patient exhibits unstable interpersonal relationships, impulsivity (substance use, unprotected sex), and a history of self-harm, which are features of BPD. However, the episode of depressed mood and anhedonia, along with the clear temporal onset and duration of symptoms, better supports a primary mood disorder diagnosis. The DSM-5-TR requires a pervasive pattern of instability in interpersonal relationships, self-image, and affects, which is not fully demonstrated in this case.

Disruptive Mood Dysregulation Disorder (DMDD): Although the patient has a history of conduct disorder and irritability, DMDD requires severe recurrent temper outbursts occurring three or more times per week, which are not reported in the current presentation. The absence of these outbursts rules out DMDD as a primary diagnosis.

Reflection:

This case highlights the complexity of diagnosing mood disorders in adolescents with comorbid substance use and family history of psychiatric illness. A thorough evaluation must consider cultural background, socioeconomic factors, and the patient’s developmental stage. Legal and ethical considerations include mandatory reporting of domestic violence (history of violence toward family members) and assessing suicide risk. Health promotion strategies should address substance abuse treatment, safer sexual practices, and medication adherence, given the patient’s reported noncompliance. Engaging the family in treatment and collaborating with community resources can support the patient’s recovery and reduce barriers to care.

Why This Matters in Practice

Accurate diagnosis of mood disorders is essential for effective treatment planning and improving patient outcomes. PMHNPs must be proficient in applying DSM-5-TR criteria, conducting thorough psychiatric evaluations, and considering biopsychosocial factors that influence presentation. The CANMAT 2023 guidelines emphasize a personalized, collaborative approach to managing MDD, highlighting the importance of shared decision-making and evidence-based treatments. Mastery of these skills ensures that patients receive appropriate interventions, reducing the risk of misdiagnosis and improving quality of life.

Frequently Asked Questions

What are the key DSM-5-TR criteria for diagnosing Major Depressive Disorder, and how do they apply to the case studies in this assignment? The DSM-5-TR requires five or more symptoms present during the same two-week period, including depressed mood or loss of interest or pleasure. Additional symptoms include significant weight change, insomnia or hypersomnia, psychomotor changes, fatigue, feelings of worthlessness, diminished concentration, and recurrent thoughts of death. These symptoms must cause clinically significant distress or impairment and not be attributable to substance use or another medical condition. In the sample case, the patient meets criteria with depressed mood, anhedonia, insomnia, fatigue, worthlessness, and suicidal ideation, supporting a primary diagnosis of MDD.

• Submit a 5–7-page Comprehensive Psychiatric Evaluation for Walden University NRNP 6635, including subjective and objective data, mental status exam, differential diagnoses, and reflection on legal/ethical considerations.

Research, Writing, Citation & Referencing

For this assignment, students should integrate current, peer-reviewed sources to support their diagnostic reasoning. The following references provide authoritative guidance on mood disorder assessment and diagnosis:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Boland, R. J., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Lam, R. W., Kennedy, S. H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., … & Milev, R. V. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults. Canadian Journal of Psychiatry, *69*(9), 641. https://doi.org/10.1177/07067437241245384[reference:19]

Lee, K., & Ha, T. H. (2026). Diagnosis of bipolar disorder and differential diagnosis from other conditions: A narrative review. Journal of the Korean Medical Association, *69*(3), 187. https://doi.org/10.5124/jkma.25.0140[reference:20]

Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2020). Nursing care in mental health: Human rights and ethical issues. Nursing Ethics, *28*(4), 096973302095210. https://doi.org/10.1177/0969733020952102

Next Assignment Preview: Week 4 – Assessing and Diagnosing Patients with Schizophrenia and Other Psychotic Disorders

For Week 4, students will complete a Comprehensive Psychiatric Evaluation for a patient presenting with symptoms of schizophrenia or another psychotic disorder. The assignment will require selecting a video case study from the provided list, reviewing the case history, and applying DSM-5-TR criteria to formulate a primary diagnosis with differentials. Students must also address the impact of cultural factors, substance use, and medical comorbidities on presentation and treatment planning.