| Course | NU674 PMHNP Diagnosis and Management Across the Lifespan Clinical I |
|---|---|
| Unit | Unit 7 |
| Paper type | Comprehensive psychiatric evaluation |
| Length | About 1,110 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU674 Unit 7
Low Since Seventeen, Worse Since the Merger: A Comprehensive Psychiatric Evaluation That Reaches Persistent Depressive Disorder With a Current Major Depressive Episode
[Student Name]
Purdue University Global
NU674: PMHNP Diagnosis and Management Across the Lifespan Clinical I
Unit 7 Comprehensive Psychiatric Evaluation
[Instructor Name]
[Date]
The patient is composite; dates, scores and details are bracketed.
Identifying Data and Source
Ms. [A.], [39], single, lives alone with a cat, works as a producer for a public radio station. Self-referred. Sources: the patient, her prior primary care records, and a phone call with her sister, with consent.
Chief Complaint
"I've always been a gray person. Now I'm black and white, mostly black."
History of Present Illness
Since about age [17], Ms. [A.] describes a low, "gray" mood on most days, with low self-esteem, poor energy and a sense that "joy is for other people." She has functioned throughout: finished college, built a career, kept friendships. She cannot recall more than [three or four] weeks at a time in the past twenty years when she felt well.
Three months ago her station merged with another, her team was reorganized, and she lost the weekly program she had produced for [six] years. Since then her mood has fallen further. She now meets criteria for a major depressive episode: depressed mood nearly every day, marked loss of interest, including in the podcasts she used to listen to constantly, insomnia with early waking at [04:00], fatigue, poor concentration at work, feelings of worthlessness and a passing sense, several times a week, that "nobody would notice if I disappeared." She denies intent or plan. Her PHQ-9 today is [20].
Past Psychiatric History
One episode of worse depression at [26], after a breakup, treated with fluoxetine [20] mg for [four] months; she stopped when she felt "back to gray." No hospitalizations, suicide attempts or self-harm. No history of mania or hypomania, including on fluoxetine; her sister confirms she has never seemed "up" for more than a good day.
Substance Use
Alcohol: since the merger, wine on most weeknights, usually [two or three] glasses, where before it was weekends only. AUDIT-C [5]. No drugs. No tobacco.
Medical History and Medications
Hypothyroidism, treated with levothyroxine [75] mcg; TSH [2.4] mIU/L last month. No other conditions. No other medications.
Family History
Mother with depression, treated for decades. Maternal uncle died by suicide at [52].
Social and Developmental History
Grew up with a father who was often absent and a mother who was often in bed. Describes herself as "the responsible one." College degree in journalism. Long-term relationship ended [two] years ago. Close to her sister and two friends, whom she has recently avoided.
Collateral From Her Sister
Her sister, [two] years older, confirmed the long history. She described Ms. [A.] as "the serious one" since high school, rarely excited and quick to blame herself, but reliable and funny in a dry way with people she trusted. She had noticed a clear change in the past three months: canceled plans, short texts, and a phone call in which Ms. [A.] cried about work, which her sister had not heard in years. She had not noticed any period in which her sister was unusually energetic, talkative or reckless. She was aware of the evening drinking and was worried about it. Collateral was important here because two parts of the diagnosis, the chronic course and the absence of hypomania, depend on history that a person with low mood may understate or forget.
Strengths
She has worked steadily for [15] years, is respected by colleagues, maintains close relationships with her sister and two friends, has good insight, and sought help on her own. She responded partly to an antidepressant before, and she is interested in therapy. These strengths support outpatient care and suggest she is likely to engage. They also give the treatment plan something to build on: her habit of showing up and doing the work can be used in therapy homework, and her sister is willing to be part of the safety plan.
Mental Status Examination
Neatly dressed; sat still with minimal gestures. Speech normal in rate, soft in volume. Mood "black." Affect constricted and tearful twice. Thought process linear. Thought content: hopelessness, passive death wishes without intent or plan; no delusions. No perceptual disturbance. Cognition grossly intact. Insight good. Judgment good.
Differential Diagnosis
1. Major depressive disorder, recurrent, current episode. Accounts for the current episode and the episode at [26], but not for the low mood between episodes, which has lasted most of two decades.
2. Persistent depressive disorder. Requires depressed mood most days for at least two years in adults, with at least two additional symptoms, without a symptom-free interval longer than two months. Her history since [17] meets this.
3. Bipolar II disorder. Excluded by history from her and her sister; no hypomania, including during antidepressant treatment.
4. Depression due to hypothyroidism. Unlikely; her thyroid is treated and her TSH is normal.
5. Alcohol-induced depressive disorder. Her low mood long predates the recent increase in drinking; alcohol may be worsening the current episode.
6. Adjustment disorder. The merger is a clear trigger, but her symptoms meet full criteria for a major depressive episode.
The diagnosis left standing is persistent depressive disorder with a current major depressive episode, because only that label accounts for both the twenty years of gray and the three months of black.
Why the Chronic Course Matters
Chronic low-grade depression is not mild in its consequences. In a five-year prospective study, patients with dysthymic disorder had more symptoms, lower functioning and more suicide attempts and hospitalizations than patients with episodic major depression, and almost all eventually developed superimposed major depressive episodes (Klein et al., 2000). Her family history of suicide adds to the concern.
Assessment Scales
PHQ-9 [20], severe. AUDIT-C [5], above the threshold for women. The PHQ-9 is a validated severity measure suitable for tracking her response (Kroenke et al., 2001). Columbia screen: passive ideation only, no intent, plan or behavior; safety plan completed.
Plan
1. Medication: an SSRI, with the dose raised to a full therapeutic level and continued well beyond remission; her earlier fluoxetine was stopped too soon.
2. Psychotherapy: a structured therapy for chronic depression. A meta-analysis found psychotherapy effective for chronic depression and dysthymia, with combined treatment more effective than either alone, and suggested that at least [18] sessions are needed for optimal effect (Cuijpers et al., 2010).
3. Alcohol: advice to return to weekend-only drinking, with the reasons explained, and rescreening at each visit.
4. Safety: safety plan with her sister as a contact; follow-up in [two] weeks.
5. Measurement: PHQ-9 at each visit.
References
Cuijpers, P., van Straten, A., Schuurmans, J., van Oppen, P., Hollon, S. D., & Andersson, G. (2010). Psychotherapy for chronic major depression and dysthymia: A meta-analysis. Clinical Psychology Review, 30(1), 51-62. https://doi.org/10.1016/j.cpr.2009.09.003
Klein, D. N., Schwartz, J. E., Rose, S., & Leader, J. B. (2000). Five-year course and outcome of dysthymic disorder: A prospective, naturalistic follow-up study. American Journal of Psychiatry, 157(6), 931-939. https://doi.org/10.1176/appi.ajp.157.6.931
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Reading the NU 674 Unit 7 instructions
For Unit 7 you complete a full psychiatric evaluation for a patient you assessed. Prompts usually require every standard section: identifying data and sources, chief complaint, history of present illness, past psychiatric, substance, medical, family and social history, a mental status examination, screening results, a differential diagnosis, a final diagnosis and a plan. Evaluations of five to seven pages are common. Graders reward evaluations in which the history makes the diagnosis clear, the differential rules alternatives in or out with specific evidence, and the plan follows from the diagnosis. Including collateral information, strengths and a safety assessment shows the thoroughness expected at this stage of training.
How the NU 674 Unit 7 example is put together
The evaluation starts with identifying data, three sources and her description of herself as a gray person now black and white. The history separates twenty years of low mood from the three-month worsening, with a PHQ-9 of 20. Past psychiatric, substance, medical, family and social histories follow, then collateral from her sister and a list of strengths. The mental status examination is written in observational terms. Six numbered alternatives are each given a verdict, and a highlighted sentence explains the final diagnosis. A section on the chronic course cites Klein's five-year study, screening scales are reported, and a five-part plan cites the Cuijpers meta-analysis on psychotherapy for chronic depression.
Reading the NU674 Unit 7 grading rubric
Comprehensive evaluations are usually scored on completeness, the quality of the history, diagnostic reasoning, use of collateral and scales, and the plan. Completeness asks whether each standard heading is present and actually filled. The history row rewards clear separation of chronic and acute symptoms and precise onset. Diagnostic reasoning is judged on a differential that addresses bipolar disorder, medical causes, substances and adjustment explicitly. Collateral and scales earn credit when they confirm or challenge the patient's account. The plan row looks for treatments matched to the diagnosis, including duration and intensity suited to a chronic course, together with safety planning and measurement at each visit. Accurate citations complete the marks.
NU674 Unit 7 help from the desk
The most frequent mistake is diagnosing a major depressive episode and missing the chronic low mood underneath it. Another is failing to rule out hypomania with collateral, which changes treatment entirely. Students often treat recent heavy drinking as a separate issue rather than a factor in the current episode. Some evaluations skip strengths, which help shape the plan. Others propose a short medication trial for a condition with a long course, repeating the mistake of her earlier treatment. And an evaluation that lists the diagnosis without saying why each alternative falls short leaves the reader to take the conclusion on trust. Ask for collateral early, since the chronic course and the absence of hypomania both depend on it.
Get an NU674 Unit 7 example written to your instructions
Evaluation templates differ in their headings and in where risk sits, so upload the NU674 Unit 7 template, the rubric and a de-identified case summary. The first evaluation is free and comes back in 24-48h, written on a composite patient under those headings, every section building toward a diagnosis the history has already earned. 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 7 questions, answered
How is persistent depressive disorder different from major depressive disorder?
Persistent depressive disorder requires depressed mood on more days than not for at least two years in adults, without a symptom-free stretch longer than two months. Major depressive episodes can occur within it, and DSM-5-TR specifiers record whether they are present now. An evaluation distinguishes the two through history, which is why the sample dates the baseline so carefully.
How long should a comprehensive psychiatric evaluation be?
Long enough to support its diagnosis and plan, and rarely longer than the template's headings require. Six pages suits a complex outpatient history like this one; a simpler case may need four. Length usually grows in the HPI and social history, where extra detail buries the dates, so cutting there is often the quickest improvement a draft can make.
Does the evaluation need a plan if the course is about assessment?
Yes, in most templates, because a plan shows the evaluation led somewhere. In a first rotation the plan can stay modest: referral, a medication option with doses bracketed, follow-up timing and safety steps. What faculty check is that each element answers something the evaluation found, so a plan that could follow any intake earns less than a short, specific one.
Where can I find a free NU674 Unit 7 sample paper?
The complete NU674 Unit 7 comprehensive psychiatric evaluation is available here, with every section from chief complaint to plan, collateral, strengths, a six-item differential and the final diagnosis, plus three references. A new evaluation can be drafted from the details of your own patient.
What is double depression in NU674 Unit 7?
A major depressive episode superimposed on persistent depressive disorder. Ms. A. had low mood on most days since seventeen and now meets full criteria for a major depressive episode, so both are diagnosed together.