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Seasonal Affective Disorder (SAD) Case Study: Diagnosis and Treatment, Study Guides, Projects, Research of Nursing

A clinical case study of a 20-year-old female diagnosed with major depressive disorder with a seasonal pattern (sad). It includes subjective information gathered from the patient, her history, and a mental status examination. The assessment section details the diagnostic criteria for sad according to dsm-5, along with differential diagnoses such as adjustment disorder and bipolar ii disorder. The plan outlines a comprehensive treatment approach, including light therapy, cognitive behavioral therapy (cbt), and medication (sertraline), with considerations for follow-up appointments and patient education. References to relevant psychiatric literature and resources are also provided, enhancing its educational value for students and practitioners in the mental health field. This case study offers a practical understanding of diagnosing and managing sad, making it a valuable resource for those studying or working in psychiatry and related disciplines.

Typology: Study Guides, Projects, Research

2024/2025

Available from 05/15/2025

dennis-mburu
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MDD with seasonal pattern (F33.9)
Criteria
Clinical Notes
Subjective
CC: “Mom says I get moody this time of year, every year.”
HPI: M.B. is a 20-year-old Caucasian female who presented to the
clinic for evaluation since her mother has been complaining that she
always gets moody during winter time. She reported that recently,
she has been feeling down, fatigued during daytime, oversleeping
during her classes, and gaining 10 pounds weight. She reported that
she has been having difficulties in school where she feels that even
though she understands the material, the classes are not interesting
anymore. She reported that she has a difficult time completing her
school projects, and even running late on two assignments. M.B.
stated that has a difficult time concentrating, being unable to
remember what she has read 5 seconds earlier. Patient stated that
she made a lot of friends when she first started college, in August,
and greatly enjoyed their company but lately she finds them a bit
annoying and dull, and their time spent together decreased
drastically. M.B. reported that she is a summer girl, loves the
sunny ,crips days, enjoys the beach and convertibles, but does not
like this season (winter) because “it’s dark. And gray. And
miserable”. She reported that during the winter the city seems
changed, getting worse and worse, and everything is now grey and
miserable.
Past Psychiatric History:
General statement: Reported that she has never been under
treatment
Current Caregivers: Parents
Hospitalization history: Denies
Medication history: None
Psychotherapy/Previous Pychiatric Diagnosis: M.B. has
never been diagnosed with any psychiatric disorders or been
using psychotherapy.
Include chief
complaint, subjective
information from the
patient, names and
relations of others
present in the
interview, and basic
demographic
information of the
patient. HPI, Past
Medical and
Psychiatric History,
Social History.
Substance Current use: Reports ocassional alcohol use when going
out with friends but denies cigarette smoking, or other illicit drugs.
Family Pyschiatric history: Patient reported that her mother has an
anxiety disorder, and her paternal grandmother had depression.
Reports no other history and denies any history of suicide in the
family.
Social history: M.B. was born in Alameda County, California, and
raised by both parents. She has one one younger sister who lives
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MDD with seasonal pattern (F33.9)

Criteria Clinical Notes Subjective CC : “Mom says I get moody this time of year, every year.” HPI : M.B. is a 20-year-old Caucasian female who presented to the clinic for evaluation since her mother has been complaining that she always gets moody during winter time. She reported that recently, she has been feeling down, fatigued during daytime, oversleeping during her classes, and gaining 10 pounds weight. She reported that she has been having difficulties in school where she feels that even though she understands the material, the classes are not interesting anymore. She reported that she has a difficult time completing her school projects, and even running late on two assignments. M.B. stated that has a difficult time concentrating, being unable to remember what she has read 5 seconds earlier. Patient stated that she made a lot of friends when she first started college, in August, and greatly enjoyed their company but lately she finds them a bit annoying and dull, and their time spent together decreased drastically. M.B. reported that she is a summer girl, loves the sunny ,crips days, enjoys the beach and convertibles, but does not like this season (winter) because “it’s dark. And gray. And miserable”. She reported that during the winter the city seems changed, getting worse and worse, and everything is now grey and miserable. Past Psychiatric History :

  • General statement: Reported that she has never been under treatment
  • Current Caregivers: Parents
  • Hospitalization history: Denies
  • Medication history: None
  • Psychotherapy/Previous Pychiatric Diagnosis: M.B. has never been diagnosed with any psychiatric disorders or been using psychotherapy. Include chief complaint, subjective information from the patient, names and relations of others present in the interview, and basic demographic information of the patient. HPI, Past Medical and Psychiatric History, Social History. Substance Current use : Reports ocassional alcohol use when going out with friends but denies cigarette smoking, or other illicit drugs. Family Pyschiatric history : Patient reported that her mother has an anxiety disorder, and her paternal grandmother had depression. Reports no other history and denies any history of suicide in the family. Social history : M.B. was born in Alameda County, California, and raised by both parents. She has one one younger sister who lives

back home. She moved to NY in August to attend a business program, lives in a dorm with one roommate, and does not have any children. She is a full-time student, no violent or traumatic past. Hobbies: hangs out with friends, traveling and hiking. Past Medical history : Reports no chronic illnesses. Reports regular menses, denies taking any type of contraceptives and denies being sexually active. Past Surgical history : Reports an appendectomy at age 15. Medications : none Allergies : No food/medication allergies. No seasonal allergies. Spiritual history : Catholic but not practicing. Immunizations: All vaccinations are up to date Primary Care Physician : Patient does not see a physician regularly.

ROS :

General : M.B denies fever, generalized weakness, or chills. She has a recent history of 10 lbs weight gain, and fatigue. HEENT: Head, neck, lymph: Denies any pain or discomfort. Nose, sinuses: Denies pain. No epistaxis or rhinorrhea. Throat, mouth, pharynx: Denies pain or difficulty with swallowing. Neuro: Denies dizziness, numbness or tingling. Reports sleeping excessively and difficulty concentrating. Pulm: Denies congestion or dyspnea. Denies cough. Cardio / vascular: Denies chest pain. Denies cough or dyspnea on exertion. Denies any palpitations or heart murmurs. GI / Abdomen: Denies any nausea, vomiting, diarrhea or constipation. Denies any epigastric or abdominal pain. Reports an increased appetite G/U: M.B. denies burning with urination, hematuria, frequency, dysuria, viaginal discharge or incontinence. Objective Vital Signs BP: 112/76 HR: 79 RR: 18 SPO2: 97% T: 98. Pain: 0/ Height: 5’5 Weight: 165 BMI: 27.5 (risk of being overweight) Diagnostic results: HAM-D: 18 moderate depression CBC: normal TSH: normal Blood alcohol content (BAC): normal Vitamin B12: normal Vitamin D: low Mental Status examination M.B. is a young Caucasian female, who seems to be the stated age, This is where the “facts” are located. Include relevant labs, test results, vitals, and Review of Systems (ROS) – if ROS is negative, “ROS noncontributory,” or “ROS negative with the exception of…” Include MSE, risk assessment here, and psychiatric screening

& titration considerations, lab work ordered, referrals to psychiatric and medical providers, therapy recommendations, holistic options and complimentary therapies, and rationale for your decisions. Include when you will want to see the patient next. This comprehensive plan should relate directly to your Assessment. D, light therapy, and psychotherapy (CBT) is recommended. The patient will begin bright-light therapy (provide referral), cognitive behavioral therapy (referral), and give a prescription for 50 mg of oral sertraline daily (may increase to 100 mg based on clinical response if needed). Patient will have a first follow-up appointment in 2 weeks, and then regular follow-up appointments (every 4-6 weeks) to monitor symptoms, medication efficacy, and any side effects are important to adjust treatment as necessary. M.B. will be advised on the benefits of joining support groups (provide recommendations if needed), sleep hygiene, exercising regularly, and maintaining a balanced and healthy diet.

  • Educate patient that the antidepressant Sertaline (Zoloft), is a selective serotonin reuptake inhibitors (SSRIs) and typically takes 4-6 weeks to exert its full therapeutic effect. Inform M.B., that some patients can see improvements in 2 weeks, and that it is essential during this period to monitor any side effects, assess the effectiveness of the medication, and make adjustments if needed. Provide patient with a handout on SSRIs, including instructions, benefits, and expected and serious side effects.
  • Because SAD onset is so predictable, individuals with a history of the disease may benefit from beginning the above- mentioned treatments prior to the fall in order to help prevent or lessen symptoms of depression. Educate M.B. about the predictibility of this condition and how she can avoid it in the future by following up with a pychiatric and medical health care provider. References: American Psychiatric Association. (2022). Diagnostic and statistical Manual of Mental Disorders, text revision (5th ed.). American Psychiatric Association. Carlat, D. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer. National Institute of Mental Health. (2023). Seasonal Affective Disorder. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/seasonal-affective- disorder