NR 547 Week 5 Case Study; Kristin is a 26-year-old client

Casual attire, well-groomed, no motor abnormalities. Cooperative, good eye contact. Alert and oriented x 3. Speech is clear, normal rate and volume. Mood is depressed, irritable, and angry. Affect is appropriate, congruent to mood. Does not appear to respond to external stimuli. Memory grossly intact, fair concentration and attention. Thought processes are coherent with average intellectual functioning. Thought processes appear organized and content is appropriate to subject. Denies suicidality or homicidality. Insight and judgment are fair. 1. Application of Knowledge: The student post demonstrates the application of knowledge. a. Select an appropriate screening tool for Kristin and provide a score for the tool. An appropriate tool for screening Kristin would be- Mood Disorder Questionnaire (MDQ). According to the scenario presented above (episodes of goal-directed activity- crafting “all day and all night” for 3-4 days, impulsive/excessive spending and irritable/depressed mood), Kristin is most likely to screen positive on the MDQ with an estimated score of 7 or 8/13, “yes” to responses and maternal history of depression. It involves questions about 13 aspects of mania, symptom duration, functional impairment, and family history of bipolar disorder (Mundy et al., 2023). MDQ is widely utilized due to its high specificity (0.90) for identifying Bipolar Disorder (BD) in psychiatric consultations, although it is more sensitive to bipolar I than bipolar II (Dines et al. 2025). According to the MDQ scale- a positive screen requires >=7 “yes” items, co- occurrence of symptoms, at least a moderated level of impairment, and family history- all criteria is met my Kristin. b. Provide a rationale for the screening tool you selected: Diagnosing bipolar disorder is essential to guide the treatment in the right direction, therefore MDQ was selected over a depression scale only tool, like PHQ-9. Kristins reported symptoms are relating to mania including decreased need for rest, impulsive behavior, like spending all her savings, goal-directed activities in addition to her current depressive episode. It is imperative to use a scale that would capture both poles of her mood presentation, rather than one that would identify depressive symptoms alone and risk missing an underlying bipolar spectrum disorder. According to Mundy et al. (2023), identifying “hidden” bipolar disorder patients can aid clinicians in earlier diagnosis and prescribing of correct medication (e.g., mood stabilizer) which reduces the risk of antidepressants induced mania, rapid cycling, and the cost associated with delayed treatment. c. Determine the most likely diagnosis for Kristin based on the available information: The most likely diagnose for Kristin would be- Bipolar Disorder II, current episode depressed. This diagnosis is selected based on the supportive evidence- • Current major depressive episode: Kristin’s statements like “not liking myself”, decreased sleep, lack of concentration are her presenting which helps reduce mood cycling in bipolar disorder. IPSRT implemented during acute phase in BD was found to decrease the number of subsequent episodes (Menon et al. 2026). Fourth- Baseline labs (CBC, CMP, TSH, fasting glucose/lipid panel, a pregnancy test)- Rules out medical contributors (thyroid dysfunction) and establishes a baseline prior to starting psychotropic medication.