NRNP 6635 Case History Report – Week 3: Mood Disorders Training Title 8: Mrs. Abrianna Tilman Study Notes
Training Title 8
Name: Mrs. Abrianna Tilman
Gender: female
Age: 27 years old
T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs
Background: Recently had her first child two months ago. Currently married; stay at home
mother after working in community library for 5 years. Grew up with her mother after her
parents divorced when she was 16; has two sisters in Troy, Alabama. Completed education
through bachelor’s level, majoring in English Literature. No previous suicidal gestures. Brother
committed suicide via GSW. She denied drugs/alcohol; brother was addicted to
methamphetamines. Hx of HTN-prescribed Trandate 100mg twice daily, admits to missing doses
due to forgetting. No legal hx. Allergies: PCN
Symptom Media. (Producer). (2016). Training title 8 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-8
1. Introduction
Patient: Mrs. Abrianna Tilman, 27‑year‑old female.
Presenting Context: Case study from Symptom Media video (2016).
Clinical Focus: Mood disorders in postpartum women, diagnostic reasoning, treatment planning.
Importance: Postpartum period is a high‑risk time for mood disturbances, requiring careful evaluation of depression, anxiety, and psychosis.
2. Demographics and Background
Age: 27 years old.
Gender: Female.
Vitals: T 98.6, P 88, R 18, BP 154/92 (hypertensive).
Height/Weight: 5’1”, 230 lbs (BMI ~43 → morbid obesity).
Family: Married, recently had first child two months ago. Grew up with mother after parental divorce at age 16. Two sisters in Troy, Alabama.
Education: Bachelor’s degree in English Literature.
Employment: Former community library worker, currently stay‑at‑home mother.
Psychiatric History: No prior suicidal gestures.
Family Psychiatric History: Brother committed suicide via gunshot wound; history of methamphetamine addiction.
Medical History: Hypertension, prescribed Trandate (labetalol) 100 mg twice daily, admits to missing doses.
Allergies: Penicillin.
Substance Use: Denies alcohol or drug use.
Legal History: None.
3. Psychosocial Stressors
Postpartum Adjustment: Caring for newborn, sleep deprivation, hormonal changes.
Family Trauma: Brother’s suicide, history of substance abuse in family.
Medical Issues: Hypertension, obesity, medication non‑adherence.
Social Role Transition: From employed librarian to stay‑at‑home mother.
Support System: Married, but unclear level of spousal/family support.
4. Clinical Presentation (Mood Disorder Features)
Possible Symptoms (from case context):
Sadness, tearfulness, irritability.
Fatigue, low motivation.
Sleep disturbance (common postpartum).
Appetite changes, weight concerns.
Difficulty bonding with infant.
Feelings of guilt or inadequacy.
Risk Factors:
Family history of depression and suicide.
Postpartum period.
Hypertension and obesity.
Psychosocial stressors (role change, trauma).
5. Mental Status Examination (MSE)
Appearance: Overweight, appropriate grooming.
Behavior: Cooperative but possibly withdrawn.
Speech: Normal rate/volume, may show flat 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: Developing, may underestimate severity of symptoms.
6. Differential Diagnosis
Postpartum Depression (PPD): Sadness, fatigue, guilt, difficulty bonding with infant.
Major Depressive Disorder (MDD): ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.
Adjustment Disorder with Depressed Mood: Symptoms linked to postpartum stress and role change.
Postpartum Psychosis: Must rule out if severe symptoms (delusions, hallucinations).
Generalized Anxiety Disorder (GAD): Worry and stress may overlap with depressive symptoms.
Medical Causes: Thyroid dysfunction, anemia, uncontrolled hypertension.
7. Diagnostic Considerations (DSM‑5)
MDD Criteria: ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.
Postpartum Depression: MDD occurring within 4 weeks postpartum (often extended clinically to 12 months).
Adjustment Disorder: Emotional/behavioral symptoms within 3 months of stressor.
Natalie’s Case:
Symptoms consistent with postpartum depression.
Family history of suicide increases risk.
Medical comorbidities complicate presentation.
8. Assessment Tools
Edinburgh Postnatal Depression Scale (EPDS): Screens for postpartum depression.
PHQ‑9: Depression severity.
GAD‑7: Anxiety screening.
Columbia Suicide Severity Rating Scale (C‑SSRS): Suicide risk.
Medical Labs: Thyroid function, metabolic panel, blood pressure monitoring.
9. Treatment Plan
Pharmacological:
SSRIs (sertraline, fluoxetine) → first‑line for postpartum depression.
Monitor for side effects, breastfeeding safety.
Antihypertensive adherence (Trandate).
Psychotherapy:
Cognitive Behavioral Therapy (CBT).
Interpersonal Therapy (IPT).
Family therapy to involve spouse and relatives.
Lifestyle Interventions:
Nutrition counseling, weight management.
Stress management, mindfulness.
Sleep hygiene.
Supportive Measures:
Postpartum support groups.
Coordination with obstetrician and primary care.
Crisis planning given family suicide history.
10. Monitoring and Follow‑Up
Weekly therapy sessions initially.
Medication monitoring every 2–4 weeks.
Suicide risk reassessment.
Blood pressure monitoring.
Collaboration with family and healthcare team.
11. Challenges
Medication adherence: Hypertension treatment missed doses.
Comorbidity: Obesity, hypertension.
Family Trauma: Brother’s suicide, substance abuse history.
Role Transition: Adjustment to motherhood.
Stigma: Mental health stigma in postpartum women.
12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.
Consent: Informed consent for treatment.
Cultural Sensitivity: Address stigma and family dynamics.
Safety: Suicide risk management.
13. Case Summary
Mrs. Abrianna Tilman: 27‑year‑old postpartum woman presenting with depressive symptoms.
Likely Diagnosis: Postpartum depression vs. MDD.
Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, antihypertensive adherence.
Outcome Goal: Symptom reduction, improved functioning, bonding with infant, long‑term resilience.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What is Abrianna’s age? a) 25 b) 27 c) 30 d) 32
What is her BMI category based on height/weight? a) Normal b) Overweight c) Obese d) Morbidly obese
What recent life event is most significant? a) Divorce b) Birth of first child c) Job loss d) Relocation
Which family history is relevant? a) Brother’s suicide and substance abuse b) Mother’s hypertension c) Father’s diabetes d) Sister’s anxiety
Which diagnosis involves depressive symptoms within 4 weeks postpartum? a) Postpartum depression b) Adjustment disorder c) Bipolar disorder d) Schizoaffective disorder
Which tool screens specifically for postpartum depression? a) EPDS b) PHQ‑9 c) GAD‑7 d) MDQ
Which medication class is first‑line for postpartum depression? a) Benzodiazepines b) SSRIs c) TCAs d) MAOIs
Which therapy targets interpersonal role transitions? a) IPT b) CBT c) DBT d) Psychoanalysis
Which antihypertensive is prescribed to Abrianna? a) Lisinopril b) Trandate (labetalol) c) Amlodipine d) Hydrochlorothiazide
Which risk must be monitored given family history? a) Suicide b) Diabetes c) Asthma d) Cancer
Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis
Which lab should be considered for medical causes of depression? a) Thyroid function b) Liver enzymes c) Vitamin D d) All of the above
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