The writer of my last paper (SOAP NOTE) did a good job. I do not know whether the number is 3315 or not. But the important thing is giving the paper to a professional psychiatric mental health nursing paper writer that is knowledgeable at mental health nursing paper writing. Write on any psychiatric illness you can write very well with accurate APA citations. I lost points on APA format in my last SOAP NOTE paper, and I do not want it to repeat again. Diagnostic Assessment and Plan of Care Essay Example

Diagnostic Assessment and Plan of Care: The Case of a 10 Year-Old Boy with Major Depressive Disorder (MDD)

Depression – or more precisely major depressive disorder (MDD) – is a mental health condition that results in one isolating themselves and shunning pleasurable activities that they previously enjoyed. It is a fairly common condition but which is also sadly grossly underdiagnosed and undertreated. For instance, it is appalling that statistics show that one in every two adults suffering from depression has never received any form of treatment for the condition. (WHO, 2020; Olfson et al., 2016). According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, suicidal ideation is a major complication and characteristic of depression. For this reason alone, depression should be properly identified, diagnosed, and treated as it is a life-threatening condition. Available data from the WHO (2020) shows that close to 800,000 people who are diagnosed with depression globally die from suicide each year. That depression is a fairly common mental health condition is undeniable given that it affects about 264 million people at any given time all over the world. Of these, the majority are young adults and adolescents. The patient forming the basis of this paper’s subject is a 10 year-old boy who was seen at the clinic brought by the mother and diagnosed with depression. From the subjective information presented, it was found that the boy had been avoiding his peers in school and also displaying levels of sadness that could not immediately be explained. Depression screening by the Children’s Depression Scale (CDRS) showed that the boy had significant depression and required treatment. He was positive for suicidal ideation during the mental status examination (MSE) and his affect was also blunt and in congruence with hi mood which he stated was “sad”. Laboratory tests and other investigations definitively confirmed that the patient was not having any physical medical problems that his symptoms could be attributed to. The purpose of this paper is therefore to discuss the diagnostic assessment of depression and its plan of care in the context of the 10 year-old patient presented above and seen by the psychiatric-mental health nurse practitioner (PMHNP) in the clinic.

Pathophysiology of Major Depressive Disorder

There is a genetic component to the susceptibility to depression. One must be genetically predisposed for the environmental triggers or stressors to produce symptoms of depression in them. However, biologically there are also biochemical changes that take place in the patient’s brain especially with regard to neurotransmitters. But that is not all as subtle anatomical changes have also been observed after the post-mortem and neuro-imaging studies of deceased depression patients. Concerning the biochemical changes in the brain, dopamine plays an important part in the brain’s reward system and pathway. It is active in the mesolimbic pathway and it has been found that its dysfunction in this area of the brain is partly responsible for the pathophysiology of depression. The dysfunction results in a lack of pleasure and increased sadness as is characteristic of MDD in its symptomatology (Fekadu et al., 2017). Norepinephrine and serotonin have also been implicated in the pathophysiology of depression. Specifically, the fact that antidepressants known as serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) are effective in treating depression is proof. Examples of these medications are venlafaxine (Effexor) and sertraline (Zoloft) respectively (Stahl, 2017).    Diagnostic Assessment and Plan of Care Essay Example

The changes in the brain’s anatomy have been shown through confirmed morphological alterations in areas such as the hippocampus and the prefrontal cortex. Specifically, the density of the glia and the quantity of grey matter has been shown to decrease in these particular areas of the brain (Fekadu et al., 2017). As far as heredity is concerned, no single gene has been identified as being responsible for predisposing one to develop depression. However, a collection of closely-related genes have been found to put one at risk of developing depression when they are exposed to stressful factors within the immediate socio-cultural environment.

Etiology of Depression

The etiology of depression is rooted in the fact that individuals that are genetically at risk and exposed to conforming psychosocial factors within their environment will develop depressive symptoms. As explained in the pathophysiology, biological and biochemical changes will also often play a significant part in the development of the depression. It is instructive that the first episode of depression occurs at different ages. This demonstrates that there are varying causal factors for the development of depressive symptoms. Generally, however; an early onset of depression has a positive correlation with chronicity, a higher degree of impairment, and a higher possibility of recurrence (Stahl, 2015; APA, 2013). Apart from genetics, the other biological factors that are etiologically significant in the development of major depression include neuro-endocrinological and hormonal factors. A number of etiologically significant environmental triggers to depression have been recognized. They include childhood exposure to adverse childhood events (ACEs), traumatic life occurrences, and adversity. Lastly but not least, the presence of comorbidities that may be either medical or psychological in nature also plays an important part in the etiology of depression. Any of these conditions co-occurring with depression will exacerbate its manifestations and make it harder to treat (Stahl, 2015; APA, 2013).

The Incidence and Prevalence of Depression

The incidence of major depression in the United States is about 7.1% according to the National Institutes of Health or NIH (n.d.) that cites data from the year 2017. The data refers to adults from the age of 18 years onwards. Amongst the female population in the US, the prevalence of depression was higher at 8.7% compared to that in males which was 5.3%. What the data by the NIH shows is also that young adults and those who are biracial or of mixed race are more affected. Specifically, the prevalence of depression among young adults aged 18-25 years was 13.1% in 2017. In the same year, it was found that mixed race individuals also showed the highest prevalence of major depression at 11.3% (NIH, n.d.).

Determinants of Health

The factors that impact the health status of a population or particular population demographic are referred to as social determinants of health (SDOH). They include socio-economic status, access to quality healthcare, living conditions, and educational achievement (Powell, 2016). With regard to major depression, the most significant social determinants of health would be access to quality healthcare, socio-economic status, and educational achievement. To begin with, it is a fact that the US is one of the most expensive countries in terms of healthcare costs (Sultz & Kroth, 2018). For this reason, many Americans of modest income are not able to afford the cost of treatment for chronic conditions such as depression. The matter is worsened by the other fact that the US does not have universal healthcare coverage or UHC. The only semblance of UHC is the Patient Protection and Affordable Care Act of 2010 or ACA 2010. However, the ACA 2010 does not go far enough to offer complete coverage for the poor and marginalized in terms of mental healthcare coverage (Kominski et al., 2017).

The SDOH of socio-economic status as far as depression is concerned is linked to the first one of access to quality healthcare services. Because of the high cost of healthcare in the United States, the majority of persons suspected of suffering from depression cannot access secondary prevention offered by screening tools. These screening tests can only be done by exert professionals such as PMHNPs and psychologists. Even if the diagnosis were confirmed in the first instance, the repeated visits required for psychotherapy and even the cost of pharmacotherapy will be beyond the reach of many citizens (. The most affected are the poor and marginalized minority communities such as Hispanics and African Americans.

Lastly but not least is the SDOH of educational achievement. With regard to depression, it can be argued that a person with a high degree of educational achievement would be better placed to cope with the challenges brought about by depression. It would be easier for them to understand the causes of their condition and what needs to be done for them to get better. That level of comprehension will not be possible for a patient who is illiterate or semi-literate.

Diagnostic Assessment of Depression

The hallmark of diagnostic assessment for any mental health condition is the Diagnostic and Statistical Manual of Mental Disorders or DSM-5. This is the resource that contains all the diagnostic criteria that must be fulfilled for a positive diagnosis of a mental health disorder to be made (APA, 2013). But before a diagnosis is attempted, screening for depression is often the first step towards recognizing that a patient has a problem and needs to be evaluated further. Some of the evidence-based screening tools for depression are the Beck Depression Inventory or BDI-II and the Patient Health Questionnaire (PHQ-9). These are tools that have been tried and tested for use in identifying those patients who have the highest probability of suffering from depression.

Apart from screening, the task of arriving at the correct diagnosis involves correctly matching the presenting symptoms to the diagnostic criteria for major depressive disorder in the DSM-5 (Sadock et al., 2015; APA, 2013). These diagnostic criteria for depression that must be fulfilled for the diagnosis to be made include the following:

• Feelings of sadness, hopelessness, and emptiness that persists most of the day.
• A noticeably lower interest in activities that initially brought one pleasure.
• Disturbances in the person’s patterns of sleep that is unusual.
• Significant loss/ increase of appetite accompanied by unexplained weight loss or gain in the absence of dieting or binge eating.
• Overactivity or lethargy as observed both subjectively and objectively by others.
• Reduced ability to focus and inability to make decisions.
• Repeated thoughts about death and dying accompanied by suicidal ideation with or without a plan for actualizing it.
• Having feelings of guilt that cannot be explained and also feeling worthless.

Differential Diagnosis

1. Attention-Deficit/ Hyperactivity Disorder (ADHD)

Children with ADHD are often irritable and frequently withdraw from their peers preferring to keep to themselves. They do not concentrate on what is being taught in the school or what is being said at home. At other times, they become hyperactive and all this ends up making them fall into trouble. These symptoms can occur in a child with either depression or ADHD. For this reason, this 10 year-old boy must be assessed for symptoms that are only present in MDD and absent in ADHD for the diagnosis of the former to be made. The distinction between irritability on the one hand and sadness with loss of interest is crucial if the diagnosis of ADHD is not to be missed by wrongly diagnosing MDD in the boy (APA, 2013).

2. Bipolar I Disorder

The irritable mood of depression is not clinically easy to distinguish from the manic episodes of bipolar disorder. For this reason, it is essential that the PMHNP evaluates this boy extensively to rule out any possibility that they might be suffering from bipolar disorder (APA, 2013). This will require other diagnostic aids such as the mental status examination or MSE.

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3. Posttraumatic Stress Disorder (PTSD)

For the differential diagnosis of PTSD to be made, there must be a history of trauma as narrated by the child or the mother. These are adverse childhood experiences (ACEs) that have a lasting traumatic impact on the psychological and physical health of the child. Similarities between PTSD and MDD include that a PTSD patient also isolates themselves from society and have changes in their sleep patterns in terms of insomnia or hypersomnia (APA, 2013). The PTSD patient avoids company, just like the patient with depression who actively avoids both company and activities that would prompt them to engage in interpersonal communication. Diagnostic Assessment and Plan of Care Essay Example

Plan of Care

The plan of care for this 10 year-old boy will include both pharmacotherapy and psychotherapy. For the pharmacotherapy, off-label prescription of antidepressants will be undertaken as is supported by evidence-based practice. This is because there are no effective agents that are FDA-approved to treat depression in children. In this case, an off-label prescription of sertraline (Zoloft) will be made. An initial dose of 25 mg will be administered orally daily. This is a selective serotonin reuptake inhibitor that is however FDA-approved for the treatment of depression in adults. It has been proven by scholarly evidence to be effective in treating depression in children when used off-label (Vijay et al., 2018; Allen et al., 2018). The other part of the plan of care will involve therapy with cognitive behavioral therapy (CBT) and family therapy. The former will help the boy change his thoughts and eventually modify his behavior; while the latter will be attended by the mother too and will be aimed at helping the family cope (Corey, 2017).

Desired Outcomes and Evaluative Methods

For the treatment of this 10 year-old boy for his depression, the desired outcomes include the complete remission of symptoms within twelve weeks after commencing treatment; and the prevention of a relapse thereafter by maintaining therapeutic interventions. This may be achieved by taking the boy for sporadic evaluation and maintaining low-dose sertraline (Stahl, 2017). For the evaluation methods; they are supposed to provide an indication of whether the evidence-based interventions have succeeded in treating the boy. These methods will be the initial screening tools for depression in the form of the Beck Depression Inventory or BDI-II and the Patient Health Questionnaire (PHQ-9). These will be able to show if the child is still depressed or not after treatment.

Conclusion

Depression or major depressive disorder is a mental health condition whose ramifications are dire because of the characteristic of suicidality. It has a high prevalence in the United States and around the world. However, its diagnosis and treatment is still not satisfactory because of unfavorable social determinants of health such as poor access to quality healthcare and low socio-economic status. This paper has discussed the diagnostic assessment and plan of care for depression in the context of a 10 year-old boy seen in the clinic and diagnosed with depression. 

The writer of my last paper (SOAP NOTE) did a good job. I do not know whether the number is 3315 or not. But the important thing is giving the paper to a professional psychiatric mental health nursing paper writer that is knowledgeable at mental health nursing paper writing. Write on any psychiatric illness you can write very well with accurate APA citations. I lost points on APA format in my last SOAP NOTE paper and I do not want it to repeat again.

Diagnostic Assessment and Plan of Care Submission

Directions

PMHNP’s must synthesize information and communicate it in the oral and written word. In this assignment, you will choose a patient you have interacted with during your clinical experience and provide a comprehensive overview to fully describe the encounter and the treatment/plan of care. The focus of the assignment will be on the psychiatric-mental health diagnosis, although your patient may have comorbid medical conditions that should be included in the paper.

DO NOT INCLUDE ANY IDENTIFYING PATIENT INFORMATION ON YOUR ASSIGNMENT.

Purpose: The purpose of this assignment is to facilitate the learner’s ability to synthesize clinical information and comprehensively present assessment, diagnostic, and treatment information.

Assignment outcome:  At the conclusion of this assignment, the learner will be able to:

• Introduce the reader to the patient seen
• Provide fully assessment information
• Provide a diagnostic differential
• Provide a psychiatric-mental health diagnosis (with rationale)
• Describe the treatment and plan of care for this patient
• Discuss your preceptor’s diagnosis/treatment/plan of care, and provides evidence for why student agrees or disagrees with such
  

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Directions:

Create an APA formatted paper that follows the rubric below. Turn this assignment into Turnitin and upload your PDF results from Turnitin into the appropriate dropbox in Moodle

Your paper should be 9-10 pages (without the cover page and reference page), double spaced, which is approximately 2250-2500 words.

Diagnostic Assessment and Plan of Care Essay Example