NRNP 6635 Comprehensive Psychiatric Evaluation Template: How to Complete It (Gambling Disorder Example)

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template

Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date

Subjective: CC (chief complaint); HPI; Past Psychiatric History (general statement, caregivers if applicable, hospitalizations, medication trials, psychotherapy or previous psychiatric diagnosis); Substance Current Use and History; Family Psychiatric/Substance Use History; Psychosocial History; Medical History (current medications, allergies, reproductive Hx); ROS (general, HEENT, skin, cardiovascular, respiratory, gastrointestinal, genitourinary, neurological, musculoskeletal, hematologic, lymphatics, endocrinologic).

Objective: Physical exam (if applicable); Diagnostic results. Assessment: Mental Status Examination; Differential Diagnoses. Reflections. References.

Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
Student Name • College of Nursing-PMHNP, Walden University • NRNP 6635: Psychopathology and Diagnostic Reasoning • Faculty Name • Due Date

Subjective

CC: “I keep telling myself I’ll win it back, but I’ve lost almost everything.”

HPI: T. N. is a 29-year-old Vietnamese American man referred by his primary care provider after disclosing financial distress and insomnia. He reports placing sports bets on mobile apps daily for 18 months, increasing from $20 to $500 or more per day to feel the same excitement. He has lost about $38,000, including savings and credit card advances, and repeatedly “chases losses.” He becomes restless and irritable when trying to stop and has tried to quit four times. He lies to his fiancée about the amount he bets, has borrowed money from his parents under false pretenses and gambles when stressed. He reports poor sleep, guilt and worry for three months, and his work performance has declined. He denies current suicidal ideation but admits that “a few weeks ago I thought everyone would be better off without me,” with no plan or intent.

Past psychiatric history:

• General statement: no prior psychiatric treatment.
• Caregivers: not applicable.
• Hospitalizations: denies.
• Medication trials: none.
• Psychotherapy or previous psychiatric diagnosis: diagnosed with ADHD in childhood; treated briefly with a stimulant at age 10; no follow-up.

Substance current use and history: drinks 2–3 beers while watching games about three times per week; denies drug use; drinks two energy drinks daily; denies tobacco.

Family psychiatric/substance use history: father had a gambling problem when T. N. was a child; maternal aunt with depression; no known suicides.

Psychosocial history: born in California to parents who immigrated from Vietnam; bilingual (Vietnamese and English); bachelor’s degree in finance; works as a bank analyst. Engaged; lives with fiancée. Reports strong family expectations of financial success and shame about disappointing his parents. Buddhist upbringing; attends temple on holidays. Denies legal problems.

Medical history:

• Current medications: none.
• Allergies: no known drug allergies.
• Reproductive Hx: not applicable; denies sexual health concerns.

ROS:

• GENERAL: fatigue; denies weight change or fever.
• HEENT: denies headaches or vision changes.
• SKIN: denies rashes or lesions.
• CARDIOVASCULAR: occasional palpitations when anxious; denies chest pain.
• RESPIRATORY: denies cough or shortness of breath.
• GASTROINTESTINAL: decreased appetite; denies nausea, vomiting or abdominal pain.
• GENITOURINARY: denies symptoms.
• NEUROLOGICAL: denies seizures, dizziness or numbness.
• MUSCULOSKELETAL: neck and shoulder tension.
• HEMATOLOGIC: denies easy bruising or bleeding.
• LYMPHATICS: denies swollen nodes.
• ENDOCRINOLOGIC: denies heat or cold intolerance or polyuria.

Objective

Physical exam: BP 132/84, HR 92, RR 16, T 98.2°F, BMI 23. Well-nourished; no tremor or physical abnormalities noted. Diagnostic results: Problem Gambling Severity Index (PGSI) score 17 (problem gambling); PHQ-9 score 12 (moderate depressive symptoms; item 9 = 1); GAD-7 score 11 (moderate anxiety); AUDIT-C score 4. CBC, metabolic panel and TSH within normal limits; urine drug screen negative.

Assessment

Mental status examination: T. N. is a 29-year-old man appearing his stated age, neatly dressed, with good hygiene. He is cooperative, makes intermittent eye contact and appears restless, frequently checking his phone. Speech is normal in rate and tone. He describes his mood as “anxious and ashamed”; affect is anxious and congruent. Thought process is logical and goal directed. Thought content includes preoccupation with gambling and debts and passive death wishes three weeks ago; he currently denies suicidal ideation, plan or intent and denies homicidal ideation. No hallucinations or delusions. He is alert and oriented ×4 with intact memory and concentration. Insight is fair; judgment is impaired regarding finances. Columbia Suicide Severity Rating Scale: passive ideation in the past month only, low acute risk; safety plan completed.

Differential diagnoses:

1. Gambling disorder, persistent, moderate (F63.0). Primary diagnosis. The DSM-5-TR requires persistent, recurrent problematic gambling with at least four of nine criteria in 12 months; 6–7 criteria indicate moderate severity (APA, 2022). T. N. meets seven: needs increasing amounts (tolerance), restlessness when cutting down, repeated unsuccessful efforts to stop, preoccupation, gambling when distressed, chasing losses and lying to conceal gambling, and he relies on others for money. Pertinent negatives: no manic episode explains the gambling.

2. Major depressive disorder, single episode, moderate (rule out). He reports guilt, poor sleep, low appetite, fatigue and passive death wishes for three months, with a PHQ-9 of 12. However, the symptoms began after major gambling losses and fluctuate with financial stress. Further assessment is needed to determine whether he meets five of nine criteria for at least two weeks independent of gambling consequences.

3. Bipolar disorder (ruled out). Excessive gambling can occur during manic episodes, and DSM-5-TR excludes gambling disorder when the behavior is better explained by mania (APA, 2022). T. N. denies periods of elevated mood, decreased need for sleep, grandiosity or racing thoughts, and his gambling is persistent rather than episodic, which rules out this diagnosis.

Additional consideration: attention-deficit/hyperactivity disorder history may contribute to impulsivity and should be reassessed, as ADHD commonly co-occurs with gambling disorder.

Reflections

If I conducted the session again, I would assess suicide risk earlier and more directly, because gambling disorder is associated with elevated rates of suicidal ideation and attempts, particularly with high debt. Legal and ethical considerations include the potential for financial crimes such as embezzlement, given his job at a bank, which would require careful discussion of confidentiality limits without assuming wrongdoing; the importance of documenting the safety plan; and respecting his autonomy while encouraging financial safeguards such as self-exclusion from betting apps and handing control of finances to a trusted person. Culturally, family expectations and shame may discourage help-seeking in many Asian American families, so offering bilingual resources and involving family only with his consent is important. Health promotion includes screening for depression and alcohol use, sleep hygiene, reducing caffeine, financial counseling, Gamblers Anonymous or other peer support, and cognitive behavioral therapy, which has the strongest evidence for gambling disorder (Petry et al., 2017).

References

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

Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for problem gambling. Psychology of Addictive Behaviors, 31(8), 951–961. https://doi.org/10.1037/adb0000290