Study Notes NRNP 6635 Case History Report – Week 3: Mood Disorders Training Title 2: Ms. Natalie Crew
Training Title 2
Name: Ms. Natalie Crew Gender: female Age:17 years old T 97.4 P-82 R-1 20 128/84 Ht 5’2” Wt 192lbs Background: Recently started an accelerated high school business program in Chicago, Illinois after growing up and living in New Orleans her whole life. Grew up with both parents and four brothers. Currently lives in on a specialty high school campus dormitory. Currently a full-time student and works part time in the local coffee shop. Not married, currently single. She has no previous psychiatric history; takes no medications. There is history of depression, denied substance use history for her or family. No legal hx NKDA Symptom Media. (Producer). (2016). Training title 2 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa tch/training-title-2
Training Title 2: Ms. Natalie Crew
1. Introduction
Patient: Ms. Natalie Crew, 17‑year‑old female.
Presenting Context: Case study from Symptom Media video (2016).
Clinical Focus: Mood disorders in adolescents, diagnostic reasoning, treatment planning.
Importance: Adolescents often present with complex psychosocial stressors, requiring careful assessment of mood, functioning, and risk.
2. Demographics and Background
Age: 17 years old.
Gender: Female.
Ethnicity: Not specified.
Vitals: T 97.4, P 82, R 20, BP 128/84.
Height/Weight: 5’2”, 192 lbs (BMI ~35 → obesity).
Family: Grew up with both parents and four brothers.
Education: Recently relocated from New Orleans to Chicago for accelerated high school business program.
Living Situation: Dormitory on specialty high school campus.
Employment: Part‑time at local coffee shop.
Social: Single, not married.
Medical/Psychiatric History: No prior psychiatric treatment, no medications, NKDA.
Family History: Depression present.
Substance Use: Denied personal or family substance use.
Legal History: None.
3. Psychosocial Stressors
Relocation Stress: Transition from New Orleans to Chicago, cultural and environmental adjustment.
Academic Pressure: Accelerated program demands.
Social Isolation: Living away from family, adjusting to dorm life.
Employment Stress: Balancing school and part‑time work.
Body Image/Health: Obesity may contribute to self‑esteem issues and risk for depression.
4. Clinical Presentation (Mood Disorder Features)
Possible Symptoms (from case context):
Slowed speech or slurred affect.
Sadness, irritability, or withdrawal.
Fatigue, low motivation.
Difficulty concentrating.
Sleep or appetite changes.
Academic decline or stress.
Risk Factors:
Family history of depression.
Recent major life changes.
Adolescent developmental stage.
Obesity and possible self‑esteem concerns.
5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, overweight.
Behavior: Cooperative but possibly withdrawn.
Speech: Normal rate/volume, may show slowed or flat tone.
Mood: Reports sadness, stress, or irritability.
Affect: Constricted or flat.
Thought Process: Logical, coherent.
Thought Content: Denies psychosis, denies substance use.
Cognition: Alert, oriented ×3.
Insight/Judgment: Developing, may underestimate severity of symptoms.
6. Differential Diagnosis
Major Depressive Disorder (MDD): Persistent sadness, anhedonia, family history.
Persistent Depressive Disorder (Dysthymia): Chronic low mood ≥2 years.
Adjustment Disorder with Depressed Mood: Symptoms linked to relocation and academic stress.
Bipolar Disorder: Must rule out hypomanic/manic episodes.
Generalized Anxiety Disorder (GAD): Stress and worry may overlap with depressive symptoms.
Medical Causes: Thyroid dysfunction, anemia, obesity‑related metabolic issues.
7. Diagnostic Considerations (DSM‑5)
MDD Criteria: ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.
Adjustment Disorder: Emotional/behavioral symptoms within 3 months of stressor.
Persistent Depressive Disorder: Depressed mood most days for ≥2 years.
Natalie’s Case:
Family history of depression.
Recent stressors (school, relocation).
Symptoms consistent with adjustment disorder or early MDD.
8. Assessment Tools
PHQ‑9: Depression severity.
GAD‑7: Anxiety screening.
Mood Disorder Questionnaire (MDQ): Rule out bipolar disorder.
Columbia Suicide Severity Rating Scale (C‑SSRS): Suicide risk.
BMI and labs: Assess metabolic health.
9. Treatment Plan
Pharmacological:
SSRIs (fluoxetine, sertraline) → first‑line for adolescent depression.
Monitor for side effects (GI upset, suicidality risk in adolescents).
Psychotherapy:
Cognitive Behavioral Therapy (CBT).
Interpersonal Therapy (IPT).
Family therapy to involve parents.
Lifestyle Interventions:
Nutrition counseling, exercise program.
Stress management, mindfulness.
Sleep hygiene.
School/Community Support:
Academic counseling.
Peer support groups.
Coordination with school staff.
10. Monitoring and Follow‑Up
Weekly therapy sessions initially.
Medication monitoring every 2–4 weeks.
Suicide risk reassessment.
Collaboration with family and school.
Adjust treatment based on response.
11. Ethical and Cultural Considerations
Confidentiality: Respect adolescent privacy, involve parents appropriately.
Consent: Assent from patient, consent from guardian.
Cultural Sensitivity: Transition from Southern to Midwestern environment.
Stigma: Address mental health stigma in adolescent populations.
12. Case Summary
Natalie Crew: 17‑year‑old female, presenting with depressive symptoms amid relocation and academic stress.
Likely Diagnosis: Adjustment disorder with depressed mood vs. early MDD.
Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, family involvement.
Outcome Goal: Symptom reduction, improved functioning, resilience building.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What is Natalie’s age? a) 15 b) 17 c) 19 d) 21
What is her BMI category based on height/weight? a) Normal b) Overweight c) Obese d) Underweight
Which family history is relevant? a) Substance abuse b) Depression c) Schizophrenia d) Bipolar disorder
Which recent stressor is most significant? a) Marriage b) Relocation for school c) Divorce d) Legal issues
Which disorder involves ≥5 symptoms for ≥2 weeks? a) MDD b) GAD c) Adjustment disorder d) Cyclothymia
Which diagnosis involves symptoms linked to a stressor within 3 months? a) Adjustment disorder b) Bipolar disorder c) Dysthymia d) Schizoaffective disorder
Which tool screens for depression severity? a) PHQ‑9 b) GAD‑7 c) MDQ d) MMSE
Which medication class is first‑line for adolescent depression? a) Benzodiazepines b) SSRIs c) TCAs d) MAOIs
Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis
Which risk must be monitored with SSRIs in adolescents? a) Weight gain b) Suicidality c) Hypertension d) Diabetes
Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis
Which ethical issue is key in adolescent care? a) Confidentiality and consent b) Profit maximization c) Ignoring family input d) Avoiding cultural sensitivity
Which lab should be considered for medical causes of depression? a) Thyroid function b) Liver enzymes c) Vitamin D d) All of the above
Which diagnosis involves chronic low mood ≥2 years? a) Persistent Depressive Disorder b) Adjustment Disorder c) Bipolar II d) Schizoaffective Disorder
Why are case history reports important in NRNP 6635? a) They emphasize structured assessment and clinical reasoning b) They replace therapy sessions c) They eliminate need for diagnosis d) They focus only on pharmacology
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