Training Title 144
Name: Ms. Amy Hartford
Gender: female
Age: 26 years old
T- 98.2 P- 70 R 18 128/76 Ht 5’0 Wt 152lbs
Background: Currently lives in Scottsdale, AZ, divorced with two children a daughter age 8 and
son age 4. Born and raised in Mesa, AZ with her mother and two sisters Works as paralegal, has
an associate degree; no legal hx; allergic to dicyclomine; history of rosacea
Symptom Media. (Producer). (2018). Training title 144 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-144

1. Introduction
Patient: Ms. Amy Hartford, 26‑year‑old female.

Context: Case study from Symptom Media video (2018).

Clinical Focus: Mood disorders in young adult women, diagnostic reasoning, treatment planning.

Importance: Mood disorders in women of child‑bearing age often intersect with psychosocial stressors such as divorce, parenting responsibilities, and occupational demands.

2. Demographics and Background
Age: 26 years old.

Gender: Female.

Vitals: T 98.2, P 70, R 18, BP 128/76 (normal).

Height/Weight: 5’0”, 152 lbs (BMI ~29.7 → overweight).

Family: Divorced, lives in Scottsdale, AZ with two children (daughter age 8, son age 4).

Childhood: Born and raised in Mesa, AZ with mother and two sisters.

Education/Occupation: Associate degree, works as paralegal.

Medical History: Rosacea.

Allergies: Dicyclomine.

Legal History: None.

3. Psychosocial Stressors
Family Responsibilities: Parenting two young children as a single mother.

Marital Stress: Divorce, possible custody or financial challenges.

Occupational Stress: Paralegal role, balancing work and family.

Health Concerns: Rosacea, overweight status.

Social Support: Limited information, but likely strained due to divorce.

4. Clinical Presentation (Mood Disorder Features)
Possible Symptoms (from case context):

Sadness, irritability, fatigue.

Sleep disturbance.

Difficulty concentrating.

Loss of interest in activities.

Feelings of guilt or hopelessness.

Risk Factors:

Divorce and single parenting.

Family stress.

Occupational demands.

Medical comorbidity (rosacea, overweight).

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, overweight.

Behavior: Cooperative, may appear fatigued.

Speech: Normal rate/volume, possibly slowed tone.

Mood: Reports sadness, irritability, stress.

Affect: Constricted or flat.

Thought Process: Logical, coherent.

Thought Content: Denies psychosis, denies substance use.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes stressors but may minimize psychiatric symptoms.

6. Differential Diagnosis
Major Depressive Disorder (MDD): Persistent sadness, anhedonia, fatigue, impaired functioning.

Persistent Depressive Disorder (Dysthymia): Chronic low mood ≥2 years.

Adjustment Disorder with Depressed Mood: Symptoms linked to divorce and family stress.

Generalized Anxiety Disorder (GAD): Worry and stress may overlap with depressive symptoms.

Postpartum Depression: Must consider history, though children are older.

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.

Amy’s Case:

Symptoms consistent with MDD or adjustment disorder.

Family and occupational stressors increase risk.

8. Assessment Tools
PHQ‑9: Depression severity.

GAD‑7: Anxiety screening.

C‑SSRS: Suicide risk assessment.

Medical Labs: Thyroid function, metabolic panel.

Collateral Information: Family input may clarify functioning.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, fluoxetine) → first‑line for depression.

Monitor for side effects.

Consider weight‑neutral options given BMI.

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Interpersonal Therapy (IPT).

Family therapy to support parenting.

Lifestyle Interventions:

Nutrition counseling, weight management.

Stress management, mindfulness.

Sleep hygiene.

Supportive Measures:

Parenting support groups.

Coordination with primary care for medical issues.

Crisis planning for suicide risk.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with family and healthcare team.

11. Challenges
Medication Adherence: Must balance psychiatric and medical treatments.

Family Stress: Parenting two children alone.

Occupational Stress: Demanding paralegal role.

Stigma: Mental health stigma in young mothers.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma and family dynamics.

13. Case Summary
Ms. Amy Hartford: 26‑year‑old paralegal, divorced mother of two, presenting with depressive symptoms amid family and occupational stressors.

Likely Diagnosis: Major Depressive Disorder vs. Adjustment Disorder.

Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, medical monitoring.

Outcome Goal: Symptom reduction, improved functioning, resilience building, long‑term health management.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Amy’s age? a) 24 b) 26 c) 28 d) 30

What is her occupation? a) Teacher b) Paralegal c) Nurse d) Librarian

Which family stressor is relevant? a) Divorce and single parenting b) Father with diabetes c) Sister with anxiety d) Uncle with hypertension

What medical condition does Amy have? a) Diabetes b) Rosacea c) Asthma d) Thyroid disease

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) AUDIT‑C d) MMSE

Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis

Which risk must be monitored in young mothers? a) Suicide b) Diabetes c) Asthma d) Cancer

Which antidepressant class is first‑line for Amy? 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 chronic low mood ≥2 years? a) Persistent Depressive Disorder b) Adjustment Disorder c) Bipolar II d) Schizoaffective Disorder

Which lab should be considered for medical causes of depression? a) Thyroid function b) Liver enzymes c) Metabolic panel d) All of the above

Which challenge is unique to Amy’s case? a) Parenting stress as divorced mother b) Substance abuse c) Financial stress only d) Legal issues

Which ethical issue is key in Amy’s care? a) Confidentiality b) Profit maximization c) Ignoring culture d) Withholding information

Why are case history reports important in NRNP 6635? a) They emphasize structured assessment and clinical reasoning b) They replace therapy sessions c) They eliminate need for diagnosis d) They focus only on pharmacology

Answer Key:
1‑b, 2‑b, 3‑a, 4‑b, 5‑a, 6‑a, 7‑a, 8‑a, 9‑a, 10‑a, 11‑a, 12‑d, 13‑a, 14‑a, 15‑a