NRNP 6635 Case History Report – Week 3: Mood Disorders Training Title 18: Ms. Rosario Campbell
Training Title 18
Name: Ms. Rosario Campbell
Gender: female
Age:25 years old
T-97.7 P-70 R-18 118/72 Ht 5’3 Wt 123lbs
Background: Currently living off-base in El Paso, Texas, active duty in the Army, MOS 92M
Mortuary Affairs Specialist. Grew up in McAllen TX with both parents and one brother.
Completed education through high school. Currently partnered. No children. Mother history of
depression; brother hx of cannabis use. No medical history. No legal hx; allergy: cipro previous
medication trials: sertraline, fluoxetine both with good effects when taking.
Symptom Media. (Producer). (2017). Training title 18 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-18
1. Introduction
Patient: Ms. Rosario Campbell, 25‑year‑old female.
Context: Case study from Symptom Media video (2017).
Clinical Focus: Mood disorders in young adults, diagnostic reasoning, treatment planning.
Importance: Military service members face unique stressors that increase risk for depression, anxiety, and trauma‑related disorders.
2. Demographics and Background
Age: 25 years old.
Gender: Female.
Vitals: T 97.7, P 70, R 18, BP 118/72 (normal).
Height/Weight: 5’3”, 123 lbs (BMI ~21.8 → normal).
Occupation: Active duty Army, MOS 92M Mortuary Affairs Specialist.
Living Situation: Off‑base in El Paso, Texas.
Family: Grew up in McAllen, TX with both parents and one brother. Currently partnered, no children.
Education: High school graduate.
Medical History: None reported.
Psychiatric History: Previous medication trials with sertraline and fluoxetine, both effective.
Family Psychiatric History: Mother with depression; brother with cannabis use.
Legal History: None.
Allergies: Ciprofloxacin.
3. Psychosocial Stressors
Military Role: Mortuary Affairs Specialist → exposure to death, trauma, grief.
Occupational Stress: Demanding, emotionally taxing duties.
Family History: Depression and substance use increase vulnerability.
Relationship Stress: Partnered but no children; possible isolation.
Transition Stress: Living off‑base, balancing military and personal life.
4. Clinical Presentation (Mood Disorder Features)
Possible Symptoms (from case context):
Sadness, irritability, fatigue.
Difficulty concentrating.
Sleep disturbance.
Loss of interest in activities.
Feelings of guilt or hopelessness.
Risk Factors:
Family history of depression.
Military occupational stress.
Prior depressive episodes requiring SSRIs.
Young adult developmental stage.
5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, normal weight.
Behavior: Cooperative, may appear withdrawn.
Speech: Normal rate/volume, possibly slowed tone.
Mood: Reports sadness, stress, irritability.
Affect: Constricted or flat.
Thought Process: Logical, coherent.
Thought Content: Denies psychosis, denies substance use.
Cognition: Alert, oriented ×3.
Insight/Judgment: Fair, recognizes benefit from prior medications.
6. Differential Diagnosis
Major Depressive Disorder (MDD): Persistent sadness, anhedonia, fatigue, family history.
Persistent Depressive Disorder (Dysthymia): Chronic low mood ≥2 years.
Adjustment Disorder with Depressed Mood: Symptoms linked to occupational stress.
Post‑Traumatic Stress Disorder (PTSD): Given military role, must rule out trauma‑related symptoms.
Generalized Anxiety Disorder (GAD): Worry and stress may overlap with depressive symptoms.
Medical Causes: Thyroid dysfunction, anemia (though vitals and history normal).
7. Diagnostic Considerations (DSM‑5)
MDD Criteria: ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.
Persistent Depressive Disorder: Depressed mood most days for ≥2 years.
Adjustment Disorder: Emotional/behavioral symptoms within 3 months of stressor.
PTSD: Exposure to trauma with intrusive symptoms, avoidance, hyperarousal.
Rosario’s Case:
Prior positive response to SSRIs suggests recurrent MDD.
Occupational stress may contribute to adjustment disorder features.
8. Assessment Tools
PHQ‑9: Depression severity.
GAD‑7: Anxiety screening.
PCL‑5: PTSD screening.
Columbia Suicide Severity Rating Scale (C‑SSRS): Suicide risk.
Medical Labs: Thyroid function, CBC if indicated.
9. Treatment Plan
Pharmacological:
SSRIs (sertraline, fluoxetine) → effective in past, safe first‑line.
Consider SNRIs if partial response.
Monitor for side effects (GI upset, sexual dysfunction).
Psychotherapy:
Cognitive Behavioral Therapy (CBT).
Interpersonal Therapy (IPT).
Trauma‑focused therapy if PTSD symptoms present.
Lifestyle Interventions:
Stress management, mindfulness.
Sleep hygiene.
Physical activity.
Supportive Measures:
Military mental health services.
Peer support groups.
Coordination with primary care and psychiatry.
10. Monitoring and Follow‑Up
Weekly therapy sessions initially.
Medication monitoring every 2–4 weeks.
Suicide risk reassessment.
Collaboration with military healthcare team.
Adjust treatment based on response.
11. Challenges
Occupational Stress: Mortuary Affairs role is emotionally taxing.
Stigma: Military culture may discourage mental health disclosure.
Family History: Depression and substance use increase vulnerability.
Medication Adherence: Must ensure consistent use.
Risk of PTSD: Exposure to trauma requires vigilance.
12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy within military system.
Consent: Informed consent for treatment.
Cultural Sensitivity: Address stigma in military populations.
Safety: Suicide risk management.
13. Case Summary
Ms. Rosario Campbell: 25‑year‑old Army Mortuary Affairs Specialist presenting with depressive symptoms.
Likely Diagnosis: Major Depressive Disorder, recurrent, with occupational stressors.
Treatment: Combination of psychotherapy, SSRI, lifestyle interventions, military support services.
Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of relapse.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What is Rosario’s age? a) 23 b) 25 c) 27 d) 30
What is her military occupation specialty (MOS)? a) Infantry b) Mortuary Affairs Specialist c) Medic d) Logistics
Which family history is relevant? a) Mother with depression, brother with cannabis use b) Father with diabetes c) Sister with anxiety d) Uncle with hypertension
Which prior medications were effective? a) Sertraline and fluoxetine b) Lithium and valproate c) Risperidone and quetiapine d) Bupropion and mirtazapine
Which diagnosis involves ≥5 symptoms for ≥2 weeks? a) MDD b) GAD c) Adjustment disorder d) PTSD
Which tool screens for depression severity? a) PHQ‑9 b) GAD‑7 c) PCL‑5 d) MMSE
Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis
Which risk must be monitored in military populations? a) Suicide b) Diabetes c) Asthma d) Cancer
Which antidepressant class is first‑line for Rosario? a) SSRIs b) TCAs c) MAOIs d) Benzodiazepines
Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis
Which diagnosis involves trauma exposure with intrusive symptoms? a) PTSD b) MDD c) GAD d) Adjustment disorder
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 challenge is unique to Rosario’s occupation? a) Exposure to death and trauma b) Financial stress c) Parenting stress d) Academic pressure
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