Differential Diagnoses: Reflections: Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education considerations for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

Diagnostic results:

Complete blood count: To test RBC levels to determine the extent of organophosphate poisoning.

Substance and alcohol screening: To rule out drug-induced depression symptoms.

RBC AChE blood test: Recommended and blood drawn before pralidoxime administration to determine organophosphate poisoning. Conducted after treatment to determine response to therapy (Robb & Baker, 2022).

Assessment:

Mental Status Examination: The patient is a 31-year-old African American male who looks his stated age. He appears confused and disoriented after a failed suicide attempt using a pesticide. During the session, he appeared to be in low spirits and did not laugh or smile. The patient started having suicidal thoughts and ideation three months ago after losing his job and breaking up with his girlfriend simultaneously. He highlights that he is feeling hopeless due to joblessness and being single. He is unlucky in love as a divorcee whose current relationship is over. His sister and other family members had been concerned about his tales of how he would like to be buried. He was diagnosed with a major depressive disorder, which he manages using psychotherapy. The mental status examination recognizes that confusion and disorientation are caused by organophosphate poisoning.

Differential Diagnosis (DDx):

Major depressive disorder: According to DSM-5 criteria, patients diagnosed with major depressive disorder present with at least five of the following symptoms in at least a two-week duration: depressed mood, psychomotor agitation, feeling worthless, loss of interest in activities, changes in weight and appetite, sleep disturbance, loss of energy, decreased ability to concentrate, and recurrent suicidal ideation, thoughts, and attempts. DSM-5 highlights that a depressed mood must be seen in a major depressive disorder patient (Bains & Abdijadid, 2022). M.K. has a history of major depressive disorder, suicidal ideation, and suicidal attempts. Additionally, he presents with more than 5 of the outlined symptoms (7 symptoms), which have lasted for three months: insomnia, failed suicide attempt, feeling hopeless, loss of interest in activities such as playing golf and hanging with other people, decreased ability to concentrate, feeling hopeless and worthless and having a depressed mood. Major depressive disorder is the primary diagnosis because of the seven signs and symptoms that have lasted for more than two weeks (three months) seen in the patient and the patient’s psychiatric history.

Bipolar disorder: Patients diagnosed with bipolar disorder experience periods of mania that alternate with periods of depressive mood. DSM-5 outlines that bipolar disorder presents with manic episodes for at least one week and at least three of the criteria signs and symptoms: excess pleasure in activities, grandiosity, decreased need for sleep, distraction, racing thoughts, excessive talking, and increased goal-focused activity (Jain & Mitra, 2022). Bipolar disorder is a differential diagnosis because M.K. presents with a depressed mood and insomnia. However, Before the depressed period, the explained character of M.K. does not show a manic period.

Dysthymic disorder: The DSM-5 criteria for dysthymic disorder include a depressed mood for at least two years in adults. The patient must present with at least two of the following: low self-esteem, hopelessness, low energy, changes in appetite, sleep disorders, and poor concentration (Patel & Rose, 2022). Dysthymic disorder is a differential diagnosis because M.K. presents with a depressed mood that includes insomnia, hopelessness, and poor concentration. Although M.K. has a depressed mood, he has experienced it for about three months only and not two years which is required to diagnose the dysthymic disorder in adults.

Reflections: I concur with M.K.’s assessment and diagnostic impression. M.K. is currently unemployed, which might affect his financial ability to obtain psychotherapy services. Although M.K. has emotional support from his sister and other family members, it is crucial to assess the views on mental health among African Americans. M.K.’s diagnosis of major depressive disorder is currently managed through psychotherapy. Since M.K. has had a failed suicide attempt while continuing with psychotherapy, I would include antidepressants such as SSRIs in his therapy. I would also ensure M.K. is adequately managed for organophosphate poisoning. I would refer M.K. to a rehab facility for advice on the negative impacts of cigarettes and alcohol on his condition. In addition, I learned the importance of ha