| Course | NU674 PMHNP Diagnosis and Management Across the Lifespan Clinical I |
|---|---|
| Unit | Unit 3 |
| Paper type | History of present illness |
| Length | About 660 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU674 Unit 3
Every November, Every April: A History of Present Illness That Lets a Four-Year Calendar Carry the Diagnosis for a 34-Year-Old Greenhouse Grower
[Student Name]
Purdue University Global
NU674: PMHNP Diagnosis and Management Across the Lifespan Clinical I
Unit 3 History of Present Illness
[Instructor Name]
[Date]
The patient is composite; dates and details are bracketed.
Chief Complaint
"It's happening again. It always happens when the clocks change."
History of Present Illness
Ms. [G.], [34], manages a commercial greenhouse and presents in [mid-November] with [three] weeks of low mood, fatigue, oversleeping, increased appetite with craving for bread and sweets, and withdrawal from friends. She describes this as the fifth winter in a row that the same pattern has occurred.
Year 1, [2021]. Symptoms began in [early November], after the end of daylight saving time. She slept [10 to 11] hours a night, gained about [5] kg over the winter, stopped attending her climbing gym and stopped replying to friends' texts. She did not seek help. Symptoms lifted in [April] without treatment.
Year 2, [2022]. The same pattern began in [late October]. She saw her primary care clinician in [January], who started sertraline [50] mg. She took it for [six] weeks, noticed nausea and no benefit, and stopped. Symptoms lifted in [April].
Year 3, [2023]. The pattern began in [November]. She tried a daily walk at lunch, which she thought helped slightly. She missed [nine] days of work between [December] and [February]. Symptoms lifted in [late March].
Year 4, [2024]. The pattern began in [November]. A coworker lent her a light box, which she used for about [15] minutes in the evenings for two weeks, noticed no change and returned. Symptoms lifted in [April].
Current episode, [2025]. Began [late October]. She now sleeps until [10:00] on days off, has missed [two] shifts, craves carbohydrates and says she feels "like a bear that can't hibernate." She denies suicidal thoughts. Her PHQ-9 today is [16].
Between episodes, from [May] to [September] each year, she describes herself as energetic and sociable, sleeping [seven] hours. Asked about summers specifically, she recalls no stretch of unusual energy, little need for sleep or spending sprees.
Placed on one timeline, four winters of the same symptoms and four springs of full recovery make the seasonal pattern visible before any criterion is counted.
Pertinent Negatives and Other History
No history of mania or hypomania; family history of depression in her mother, who "hated winters." Alcohol is limited to [two] glasses of wine on weekends, and she uses no other substances. Thyroid function checked in [January 2023] was normal. No medical conditions. She works indoors in the greenhouse for most of the day, but under diffuse light, and drives to and from work in the dark from [November] to [February].
Treatments Tried, on the Same Timeline
1. Sertraline [50] mg for six weeks in year two: stopped for nausea without benefit; the dose was not increased and the trial was probably not adequate.
2. Lunchtime walks in year three: possible slight benefit.
3. A borrowed light box in year four: used for [15] minutes in the evening, a dose and timing unlikely to be effective.
Summary for the Clinician Reading Next
The history describes recurrent major depressive episodes with a seasonal pattern: onset in autumn, full remission in spring, for four consecutive years, with no episodes at other times and no hypomania. Seasonal affective disorder was first described in patients with this kind of regular autumn-winter onset, oversleeping, increased appetite and carbohydrate craving (Rosenthal et al., 1984). Light therapy has meta-analytic support in seasonal depression, with effect sizes comparable to antidepressants (Golden et al., 2005), and in a randomized comparison light therapy and fluoxetine were similarly effective, with light therapy acting earlier and causing fewer of some side effects (Lam et al., 2006). Her previous light box trial used too short a session at the wrong time of day and should not be counted as a failure.
References
Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., Wisner, K. L., & Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4), 656-662. https://doi.org/10.1176/appi.ajp.162.4.656
Lam, R. W., Levitt, A. J., Levitan, R. D., Enns, M. W., Morehouse, R., Michalak, E. E., & Tam, E. M. (2006). The Can-SAD study: A randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. American Journal of Psychiatry, 163(5), 805-812. https://doi.org/10.1176/ajp.2006.163.5.805
Rosenthal, N. E., Sack, D. A., Gillin, J. C., Lewy, A. J., Goodwin, F. K., Davenport, Y., Mueller, P. S., Newsome, D. A., & Wehr, T. A. (1984). Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry, 41(1), 72-80. https://doi.org/10.1001/archpsyc.1984.01790120076010
Reading the NU 674 Unit 3 instructions
The Unit 3 assignment asks you to write the history of present illness section of a psychiatric evaluation. Prompts usually expect the chief complaint in the patient's words, the onset and course of symptoms, triggers, treatments tried and their results, and pertinent negatives, organized so that a reader can follow the illness over time. Most sections expect one or two pages. The top marks go to histories in which the structure itself reveals the diagnosis, for example a timeline that shows recurrence, rather than a list of symptoms. Stating which past treatments were adequate trials, and which were not, is a mark of careful history-taking that helps the next clinician avoid repeating or dismissing a treatment.
Inside the NU674 Unit 3 example
The chief complaint is quoted, then the current episode is summarized with her PHQ-9 of 16. Four prior winters follow, each as a short dated paragraph that records onset, symptoms, any treatment and when she recovered. The current episode is described with her own image of a bear that cannot hibernate. A section on the months between episodes, including the absence of summer hypomania, follows, and a highlighted sentence explains what the calendar shows. Pertinent negatives and her light exposure at work come next. Treatments are then reviewed on the same timeline, and the summary cites the original description of seasonal affective disorder and the light therapy evidence.
NU674 Unit 3 rubric: what earns full points
History of present illness sections are usually graded on organization, completeness, clinical reasoning, treatment history and clarity. Organization earns full points when the structure makes the course of illness easy to follow and supports the diagnosis. Completeness rewards onset, duration, severity, triggers, associated symptoms and function in each episode. Clinical reasoning is judged on pertinent negatives, especially the absence of hypomania, which changes treatment. Treatment history points go to a clear record of dose, duration and response for each past trial. Clarity covers concise writing, the patient's own words where helpful, and accurate citations when the summary refers to evidence about the condition or its treatments.
NU674 Unit 3 help: mistakes that cost points
The most common error is listing current symptoms without placing them in time, which hides a recurring pattern. Another is omitting what happens between episodes, which is essential for distinguishing seasonal and bipolar patterns. Students often record past treatments as failed without checking the dose, duration and timing, as with a light box used for fifteen minutes in the evening. Some histories skip pertinent negatives. Others include the whole life story rather than what explains this illness and its timing. And a history that never quotes the patient loses the detail, such as her bear image, that makes the pattern memorable to the next clinician. Dates anchor everything, so ask for them.
Get an NU674 Unit 3 example written to your instructions
HPI prompts differ on length and on whether prior treatment belongs here or in its own section, so paste the NU674 Unit 3 instructions along with the rubric and a de-identified sketch of the case. Within 24-48h, a first sample arrives free: a dated composite history, episode by episode, with every trial recorded by dose, duration and ending. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU674 Unit 3 questions, answered
Does prior psychiatric treatment belong in the HPI or in past psychiatric history?
Templates split on this. Many place treatment for the current episode in the HPI and older treatment under past psychiatric history. With a recurrent illness like this one, keeping every trial beside the episode it treated usually reads more clearly. Follow your section's template if it decides the question, and cross-reference rather than repeat when both sections apply.
What makes a seasonal pattern more than a coincidence?
DSM-5-TR asks for a regular link between onset and a time of year, full remission or a switch at a characteristic time, at least two episodes in the past two years fitting the pattern with none outside it, and seasonal episodes clearly outnumbering others over the lifetime. It also excludes timing explained by a seasonal stressor, which is why the history dates onsets against her work.
How much of her life story should the HPI include?
Only what explains this illness and its timing. Her climbing group appears because withdrawing from it marks each onset; her childhood and schooling belong in developmental and social history. A useful test is whether a sentence helps a reader date, describe or explain an episode. If it does none of those, it probably belongs in another section of the evaluation.
Where can I find a free NU674 Unit 3 sample paper?
This page contains the complete NU674 Unit 3 history of present illness, with the chief complaint, four winters and the current episode on one calendar, the treatment history and a summary for the next clinician, plus three references. Send the details of your own case and a history can be laid out the same way.
Why was the earlier light box not counted as a failure in NU674 Unit 3?
She used it for about 15 minutes in the evening for two weeks, a dose and timing unlikely to work. Light therapy has meta-analytic support in seasonal depression and performed as well as fluoxetine in the Can-SAD trial, so a properly timed trial remains an option.