NR 547 Week 8 Diagnostic Case Paper Example

Course	NR 547 Differential Diagnosis in Psychiatric-Mental Health across the Lifespan Practicum
Week	8
Paper type	Diagnostic case paper
Length	About 1,200 words, 2 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP)
Updated	September 2026

Free sample paper for NR 547 Week 8

Diagnostic Case Paper: Bipolar II Disorder, Current Episode Depressed, in a 24-Year-Old Doctoral Student, With Every Element Traceable to the History and Every Excluded Alternative Closed on a Stated Finding

Student Name

College of Nursing, Chamberlain University

NR 547: Differential Diagnosis in Psychiatric-Mental Health Across the Lifespan

Instructor Name

Month Day, Year

What this page is doingThe title names the defended diagnosis and promises that a reader can walk backward from it to the history, which is the test a final diagnostic paper has to pass. Student APA 7 title page.

Identifying Information and Sources

This paper concerns a chemistry doctoral candidate, aged 24 and in the first year of the program, who is single, shares an apartment with a roommate and was sent to psychiatric evaluation by the university health service. Information came from two interviews, a telephone conversation with an older sibling to which the student gave written consent, the health service chart, an advisor's email filed in that chart and three documents the student offered: card receipts, a supervisor's written evaluation from a summer placement and a text message from a friend. Where a statement below depends on a single source, the source is given beside it.

History of the Present Illness

Across the past five weeks the student has described a "flat and heavy" state for most of every day, and the sibling independently noticed messages going unanswered and climbing weekends being called off. The running club has been dropped. Nights now last ten to eleven hours without refreshment, evening eating has increased and the health service scale shows a gain near 3 kg. Reading a full journal article has become impossible, two lab meetings were missed (advisor email) and the student speaks of being "dead weight" to the group, which would, the student believes, do better without them. At times the student has thought that simply not existing would be easier, but reports no plan, no intent and no attempt at any point. The episode began roughly three weeks after the advisor told the student that the opening project was unworkable and must be restarted.

Past Psychiatric and Substance History

The sibling recalled a stretch in July two summers ago lasting about five days, when the student managed on three or four hours of sleep, was unusually talkative, started three ventures including a photography business and spent roughly $1,800 on camera gear. Card receipts fall between July 12 and 16, and the placement supervisor wrote in mid-July that the student was "energetic and full of ideas." A few weeks on, roughly four weeks of flatness followed, which the student put down to a slump. There has been no earlier treatment.

Stimulant use started the following January, half a year after that July, when the student began taking a friend's mixed amphetamine salts, 10 to 20 mg on deadline days two or three times a week; the friend's message fixes the start date. There were four days of use in the opening week of the present episode and none afterward. Alcohol use is several drinks on occasional weekend evenings, and cannabis is used a few times a year.

Family, Social and Medical History

Lithium was prescribed to one parent during that parent's thirties for "highs and lows." The student grew up with both parents and one sibling, did well academically throughout and moved across the country for the doctoral program eight months ago. No significant medical history and no regular medications. Protective factors include a close sibling, a friend the student trusts and no access to firearms.

Mental Status Examination

Unwashed hair, casual clothes, very little movement or gesture. Quiet, slowed speech broken by long gaps. Mood described as "flat and heavy"; affect constricted, lifting for a moment when climbing came up. Thought process linear; no hallucinations or delusions. Passive death wishes without plan or intent. Serial sevens broke down after three correct steps, showing reduced attention. Insight partial; judgment intact.

Assessment Data

Patient Health Questionnaire-9, 17 (moderately severe) (Kroenke et al., 2001). Mood Disorder Questionnaire, 6 of 13 items with some problems reported, positive on items but borderline overall, as is common when hypomania is brief (Hirschfeld et al., 2000). Thyroid-stimulating hormone, complete blood count, ferritin, basic metabolic panel and B12 normal; urine drug screen negative; pregnancy test negative. Neurological examination normal.

Criteria as Anchors

The current episode meets criteria for a major depressive episode on all nine symptoms, with at least five present together for well over two weeks: depressed mood (student and sibling), loss of interest (student and sibling), increased appetite and weight (student and record), hypersomnia (student), observable psychomotor slowing (examiner), fatigue (student), guilt (student), poor concentration (student and advisor email) and passive death wishes (student). Impairment is shown by missed meetings and stalled work (American Psychiatric Association, 2022).

The July stretch satisfies the hypomanic episode criteria: a distinct run of about five days of raised mood and energy with little need for sleep, rapid talk, a burst of new ventures and uncharacteristic spending. Two people outside the student noticed it (sibling and supervisor), and it stopped short of the marked impairment, hospitalization or psychosis that would define mania. No substance can account for it, since it came half a year before the first amphetamine tablet, and no medical cause has been found.

Differential Diagnosis

Major depressive disorder. The present episode alone would support it, but the documented July hypomania rules it out.

Substance-induced depressive disorder. Ruled out: low mood has persisted four weeks past the last stimulant dose, the urine screen is negative and withdrawal would normally have settled by now.

Stimulant-induced bipolar and related disorder. Ruled out: the elevated stretch predates any stimulant exposure, as the receipts, the supervisor's note and the friend's message show.

Bipolar I disorder. Ruled out: no episode has reached manic severity, with no hospitalization, psychosis or marked impairment.

Cyclothymic disorder. Ruled out by the presence of a full major depressive episode.

Medical conditions. Thyroid disease, anemia, B12 deficiency, infection, sleep disorders and neurological disease are set aside on the normal laboratory results and examination (Hage & Azar, 2012).

Diagnosis

Bipolar II disorder, current episode depressed, moderate to severe, without psychotic features.

Nonmedical use of amphetamine, recorded separately, with severity to be assessed; current pattern is in early remission from use.

The diagnosis is consistent with evidence that bipolar disorder is often missed in people presenting with depression, particularly when hypomania is not asked about directly (Angst et al., 2011). Each element above can be traced to a named source.

Implications and Limitations

The diagnosis changes management: antidepressant monotherapy is avoided, treatment options with evidence in bipolar depression are discussed, and stopping the stimulant use becomes a clinical priority, since stimulants can precipitate elevated mood. Suicide risk is monitored at each contact. The student will receive education about the diagnosis, the importance of regular sleep and early signs of elevated mood.

The chief weakness is that the hypomanic episode depends mostly on collateral accounts and documents from two years back, and the student's memory of substance use at that time cannot be checked independently. Because bipolar II is established over time, the label will be revisited should fresh history come to light or should later elevated periods appear only alongside substance use.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Angst, J., Azorin, J.-M., Bowden, C. L., Perugi, G., Vieta, E., Gamma, A., & Young, A. H. (2011). Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: The BRIDGE study. Archives of General Psychiatry, 68(8), 791-798. https://doi.org/10.1001/archgenpsychiatry.2011.87

Hage, M. P., & Azar, S. T. (2012). The link between thyroid function and depression. Journal of Thyroid Research, 2012, Article 590648. https://doi.org/10.1155/2012/590648

Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Jr., Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J., Russell, J. M., Sachs, G. S., & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875. https://doi.org/10.1176/appi.ajp.157.11.1873

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

The Chamberlain NR 547 Week 8 instructions

The final week asks for a comprehensive diagnostic case paper. Typical instructions request identifying information, history of present illness, past psychiatric, substance, medical, family and social history, mental status examination, assessment data, diagnostic criteria, differential diagnosis, the final diagnosis and implications. Name the sources of history and attribute each key statement. Report history before interpreting it, so a reader can disagree using the same facts. Write mental status as observation. Use criteria as anchors for evidence rather than reproducing them. Make the differential a working section that closes each alternative, including medical and substance causes, on a stated finding. State the final diagnosis with specifiers. Discuss implications for treatment and limitations of the evidence. Test that each element can be traced back. Cite sources in APA 7.

How this NR 547 Week 8 example is built

The paper opens by listing all sources of information. The history sections cover the current episode with attributions, the July elevated period with its dating documents, stimulant and alcohol use, family history and protective factors. Mental status is written as observation. Assessment data include screening scores and normal laboratory results. The criteria section anchors each element of the depressive and hypomanic episodes to named sources. The differential closes major depressive disorder, substance-induced depression, stimulant-induced bipolar disorder, bipolar I disorder, cyclothymic disorder and medical causes, each on a finding. The diagnosis follows, with separate recording of stimulant use. A final section covers treatment implications and the reliance on collateral history.

NR 547 Week 8 rubric: what full points look like

Diagnostic case papers are generally evaluated on completeness of history, accurate mental status description, appropriate use of assessment data, correct application of criteria, a thorough differential, a defensible diagnosis and scholarly writing. Traceability, the ability to walk back from each element of the diagnosis to a line of history, is the test graders apply to a long paper. Attributing statements to sources shows careful practice. A differential that actually closes each alternative on evidence reads as rigorous. Criteria used as anchors rather than reproduced show understanding. Implications for treatment connect diagnosis to care. An honest limitation strengthens credibility. Citations placed where claims need them, formatted in APA 7, complete a strong final paper.

NR 547 Week 8 help: mistakes that cost points

Final papers often interpret the history as it is told, so a reader cannot separate the facts from the writer's conclusions. Report first, interpret later. Another weakness is a differential that names alternatives without closing them. Give the finding that excludes each. Some students reproduce criteria in full instead of tying each to evidence. Keep criteria brief and the evidence specific. Avoid unattributed statements, especially when collateral sources are involved. Include medical and substance causes in the differential. State implications for treatment, since that is why the diagnosis matters. Check that every element of the final diagnosis can be found in the history, and name the main limitation rather than implying certainty.

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Send the Week 8 instructions with the rubric and the case your classroom provides, and a custom example is written to that rubric and returned inside 24 to 48 hours. The first one is free. The documentation you complete at your own site remains yours to write and to sign.

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NR 547 Week 8 questions, answered

How long should the paper be?

Whatever your section publishes, and the length is easier to reach honestly than most writers expect. Evidence, exclusions and formulation consume pages quickly once every claim carries its support. Papers that run short are usually the ones that skipped the differential, and papers that pad are usually the ones reproducing criteria the marker already knows by heart.

Can I reuse work from earlier weeks?

Check your section's policy on prior submissions first, since some classrooms treat reused text as a violation even when the work is your own. Reusing the thinking is different from reusing the paragraphs. In practice the final paper needs a fuller account than an earlier week allowed, so rewriting tends to produce the better document anyway.

What if the case has no clear answer?

Then the paper says so and still commits. Give the diagnosis you would carry forward, state the confidence you have in it, name the alternative that stays open, and specify the observation, collateral report or test result that would resolve it. Marking rewards a decision made in the open far more than a survey that ends without one.

Where can I find a free NR 547 Week 8 sample paper?

The traceable bipolar II case paper above is the NR 547 Week 8 sample, available to read end to end. If your final patient is different, share the case with our writers and a diagnostic paper with a closing differential can be drafted.

What is the test of a strong NR 547 Week 8 paper?

Traceability: every element of the final diagnosis can be followed back to a specific, attributed line of history. The sample names sources for each criterion it uses.