A nurse is caring for a client who has depression and states, "A government agency is attempting to capture me." The nurse should identify that the client is experiencing which of the following?

A. Increased cheerfulness, increased energy, helping other nurses on the shift. While mood changes can sometimes indicate a problem, increased cheerfulness and willingness to help others are not specific red flags for substance use disorder. Substance use is more commonly associated with erratic behavior, frequent absences, or medication discrepancies.
B. Increased irritability towards supervisors, outspokenness regarding work issues, increased attendance at staff meetings. Frustration with workplace issues and increased engagement in staff meetings do not necessarily indicate substance use disorder. Behavioral concerns related to substance use often include impaired judgment, frequent errors, or missing narcotics.
C. Volunteering for overtime on a continual basis, avoiding having a witness to wasting narcotics, needing to be alone in the medication room when preparing medications. Consistently seeking extra shifts, avoiding witnesses when handling narcotics, and needing to be alone while preparing medications suggest possible drug diversion. These behaviors align with common patterns seen in healthcare professionals struggling with substance use disorders.
D. Crying, sharing personal details of relationship problems, monopolizing conversations. Emotional distress and oversharing personal issues may indicate stress or burnout rather than substance use disorder. Substance use concerns are more closely tied to inconsistent work performance, medication discrepancies, and altered behavior related to drug access.

A. Cyclothymic disorder: Cyclothymic disorder involves chronic mood instability with alternating hypomanic and depressive symptoms for at least two years. These mood fluctuations occur independently of the menstrual cycle and do not meet the criteria for major mood episodes.
B. Postpartum depression: Postpartum depression occurs within weeks to months after childbirth and presents with persistent sadness, fatigue, and emotional distress. It is unrelated to the menstrual cycle and requires medical treatment such as therapy and antidepressants.
C. Premenstrual dysphoric disorder: Premenstrual dysphoric disorder is marked by mood disturbances, including depressed mood, irritability, and anxiety, occurring in the luteal phase before menstruation. Symptoms resolve after menstruation begins, and treatment may include SSRIs, hormonal therapy, or lifestyle modifications.
D. Bipolar disorder: Bipolar disorder involves episodes of mania and depression that are unrelated to hormonal changes in the menstrual cycle. Manic episodes present with impulsivity and grandiosity, while depressive episodes cause low energy and anhedonia, requiring mood stabilizers.