Assignment: Week 7 Schizophrenia and Other Psychotic Disorders

Assignment: Week 7 Schizophrenia and Other Psychotic Disorders

Assignment: Week 7 Schizophrenia and Other Psychotic Disorders

Subjective:

• CC (chief complaint): ‘Mr. Nehring and Eric want to fire me because they are in love with me’

HPI: Ms. Branning is a 25-year-old female client that has been referred by her supervisor to the clinic for an assessment. Ms. Branning reported having difficulties in her workplace since Mr. Nehring wants to fire her because he is in love with him. The client believes that she is getting in his way, making him want to fire her. The client also believes that Eric, her supervisor, wants to fire her because he is also in love with her. This is despite Eric having a girlfriend. According to Banning bother Eric and Nehring have collaborated to have her fired. When asked why she thinks Eric loves her, she reported that he often gives her easiest assignments, asks her to give her opinion in weekly meetings and walks towards her in a way suggestive that he is in love with her. Ms. Banning acknowledged that both Eric and Nehring have not sexually harassed her. Besides the above, Ms. Banning also thinks that she has cancer because of a heartbreak she underwent. She raises complaints that include neck pain that radiates to the back. She also reports a lump.

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Past Psychiatric History: The client denied to talk about any of her past psychiatric histories. She declined any history of mental health issues in her family.

• General Statement: ‘Mr. Nehring and Eric want to fire me because they are in love with me’
• Caregivers (if applicable): None
• Hospitalizations: The client denied any history of hospitalizations
• Medication trials: The client denied any history of medical trials
• Psychotherapy or Previous Psychiatric Diagnosis: The client denied to talk about any of her psychiatric histories.

Substance Current Use and History: The client denied any history of drug and substance abuse.

Family Psychiatric/Substance Use History: The client denied any family history of psychiatric or substance abuse history.

Psychosocial History: The client lieves alone in Santa Monica, CA. She is the only child in her family. She works in office supply sales. She has a bachelor’s degree in business. She has a boyfriend.

Medical History: The client has a history of hypothyroidism, which is currently treated with daily levothyroxine. She has not history of hospitalization or surgeries.

 

• Current Medications: She currently uses levothyroxine for hypothyroidism
• Allergies: The client reported having allergic reaction to medical tape.

• Reproductive Hx: She has regular menses. He menarche was when she was 16 years old. She has a boyfriend. She denied history of sexually transmitted infections, dysuria, urgency and frequency of urination.

ROS:

• GENERAL: The patient was dressed appropriately for the occasion. She appeared of normal weight for her age. She denied fever, chills, and fatigue.
• HEENT: Head: The head is normocephalic, equal hair distribution, absence of head trauma, and denies headache. Ears: The client denies hearing impairment, tinnitus, ear ache, and drainage. Eyes: The client denies visual changes, eye drainage, and pain. Nose: The client denies nasal flaring, congestion, and rhinorrhea. Throat: The client denies dysphagia, swollen lymphn nodes, and halitosis. Neck: The client denies neck pain, swelling, or limited range of motion.
• SKIN: The client denies skin rashes, color changes, and itchiness.
• CARDIOVASCULAR: The client denies chest pain, palpitation, or edema.
• RESPIRATORY: The client denies chest tightness, cough, sneezing, or wheezing.
• GASTROINTESTINAL: The client denies nausea, vomiting, diarrhea, or abdominal pain.
• GENITOURINARY: The client denies changes in menstrual cycles, dysuria, and increased urgency and frequency.
• NEUROLOGICAL: The client denies numbness, tingling, ataxia, loss of balance, and changes in speech.
• MUSCULOSKELETAL: The client denies muscle or joint pain and limited range of motion.
• HEMATOLOGIC: The client denies anemia and easy bruising
• LYMPHATICS: The client denies lymphadenopathy
• ENDOCRINOLOGIC: The client denies cold or heat intolerance, polyuria, poluydipsia, and polyphagia.

Objective:

Physical exam: A phsycial examination was done to rule out the client’s complaints. The results did not reveal any abnormal findings.

Diagnostic results: Thyroid function test was ordered. The results showed normal T3, T4, and TSH levels.

Assessment:

Mental Status Examination: The patient was dressed appropriately for the occasion. She was oriented to self, others, time, and events. She was delusional. She denied illusions and hallucinations. The client’s speech was of normal rate and volume. The client denied suicidal thoughts, attempts, or plans. The client’s affect and mood were normal.

Differential Diagnoses: Ms. Banning’s primary diagnosis is delusions of erotomania. Erotomania is a type of delusion characterized by an individual believing that another person with a higher status is in love with them (Joseph & Siddiqui, 2021). Ms. Banning believes that Eric and Nehring, who are her supervisors, are in love with her. As a result, she misinterprets any actions that they do towards her.

Ms. Banning’s other diagnosis is persecutory delusions. People with persecutory delusions believe that someone intends to harm them either directly or indirectly. The fear of harm may also extend to people close to the patient. Ms. Bannings believes that Eric and Nehring want to fire her because they are both in love with her. This is an indirect form of harm, hence, he being possibly diagnosed with persecutory delusions (González-Rodríguez & Seeman, 2022; Ricci et al., 2020).

Ms. Banning’s last diagnosis is somatoform disorder. Somatoform disorder is a psychiatric condition characterized by the patient reporting physical symptoms that are not justifiable or negative when physical examinations are undertaken. Ms. Bannings believes that she has cancer attributed to her heartbreak. She also complains of back pain and presence of a lump, which are unjustiable when medical and diagnostic investigations are performed (Mikkelsen & Rosholm, 2018; Piontek et al., 2018). Therefore, she has somatoform disorder, and could be using it to achieve unmet needs.

Reflections: The patient in this case study exhibits delusions of persecution and erotomania. She also has somatoform disorder. I believe that mental health interventions such as psychotherapy and group therapy would help the patient overcome her problem. It would also equip he with knoweldge and skills of identifying and managing any factors that contribute to the development of these symptoms.

References

González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini narrative review. World Journal of Psychiatry, 12(5), 683.

Joseph, S. M., & Siddiqui, W. (2021). Delusional disorder. In StatPearls [Internet]. StatPearls Publishing.

Mikkelsen, M. B., & Rosholm, M. (2018). Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occupational and Environmental Medicine, 75(9), 675–686.

Piontek, K., Shedden-Mora, M. C., Gladigau, M., Kuby, A., & Löwe, B. (2018). Diagnosis of somatoform disorders in primary care: Diagnostic agreement, predictors, and comaprisons with depression and anxiety. BMC Psychiatry, 18(1), 1–9.

Ricci, T. G., de Souza, M. R. S., & da Hora, A. F. (2020). Persecutory Delusional Disorder and Social Anxiety. Psychotic Disorders-E-Book: Comorbidity Detection Promotes Improved Diagnosis And Treatment, 67.

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This week, we will learn about schizophrenia and other psychotic disorders as well and medication-induced movement disorders. You may find that patients in a psychotic state are poor historians. How would you approach this situation?

Please note that the video cases may not have all the necessary information needed for your evaluation. Supplementary case histories are provided. Rather than write “not provided” in your evaluations, be sure to use the fact sheets to fill in gaps. For any information still missing, explain what information is needed and why it is important.

Select one of the videos in resources this week to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis.
Week 7: Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.

For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such disorders show a range of unique symptoms. This range of symptoms may impede an individual’s ability to function in daily life. As a result, clinicians address a patient’s ability or inability to function in life.

This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.

Learning Objectives
Students will:

Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Formulate differential diagnoses using DSM-5-TR criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life spanAssignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Photo Credit: [Hero Images]/[Hero Images]/Getty Images

Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.

For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.

To Prepare:
Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic disorders. Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.
Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient. Rubric Detail

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Name: NRNP_6635_Week7_Assignment_Rubric
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Excellent Good Fair Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
16 (16%) – 17 (17%)
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
14 (14%) – 15 (15%)
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.
0 (0%) – 13 (13%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
20 (20%) – 22 (22%)
The response accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
18 (18%) – 19 (19%)
The response documents the results of the mental status exam with some vagueness or innacuracy.

Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.
0 (0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
8 (8%) – 8 (8%)
Reflections demonstrate critical thinking.
7 (7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking.
0 (0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
12 (12%) – 13 (13%)
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
0 (0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Purpose, introduction, and conclusion of the assignment is vague or off topic.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.
0 (0%) – 3 (3%)
No purpose statement, introduction, or conclusion were provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors
3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors
0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100
Name: NRNP_6635_Week7_Assignment_RubricLearning Resources
Required Readings (click to expand/reduce)

American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 29.2, Medication Induced-Movement Disorders
Chapter 31.15, Early-Onset Schizophrenia
Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Document: NRNP 6635 Final Study Guide

Required Media (click to expand/reduce)

Video Case Selections for Assignment (click to expand/reduce)