NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
Week 7: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
Subjective:
CC (chief complaint): “Mr. Nehring wants to fire me”
HPI: Fatima Branning is a 28-year-old female client who has come to the facility to be seen for some issues at work. Ms. Branning’s supervisor suggested she come to the facility to be seen. According to her, Mr. Nehring wants to fire her because Eric is in love with her and is getting in the way. Branning denied being in a relationship with Eric. Branning also reports that both Eric and Nehring are ganging up against her because of their lust. She denies any inappropriate behaviors from Eric and Nehring. According to Branning, Eric has been giving her the easiest assignments to do. He also lets her voice her opinions in their weekly meetings. Branning believes that she is beautiful and strong, which threatens Mr. Nehring since he thinks that she will replace him in a couple of years. Ms. Branning reports neck pain, which spreads to the back, and has a neck lump, which is untrue. She believes that she has cancer caused by a broken heart.
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Past Psychiatric History:
General Statement: Mr. Nehring wants to fire me
Caregivers (if applicable): None
Hospitalizations: Ms. Branning has no history of hospitalization
Medication trials: Branning has no history of medication trials
Psychotherapy or Previous Psychiatric Diagnosis: Brannings declined to discuss past psychiatric history
Substance Current Use and History: Ms. Brannings denied current or a history of substance use or abuse
Family Psychiatric/Substance Use History: Ms. Brannings denied family psychiatric or substance use history
Psychosocial History: Ms. Branning lives alone in Coronado, CA. She is the only child in her family. She works as an administrative assistant in car sales. She has a bachelor’s degree in hospitality.
Medical History: Ms. Branning has a medical history of scoliosis, currently treated with chiropractic care.
Current Medications: none
Allergies: She has a latex allergy
Reproductive Hx: Ms. Branning reports a regular menstrual cycle. She is not on any birth control method.
ROS:
GENERAL: Ms. Branning is dressed appropriately for the clinical visit. There is no evidence of weight loss. She denies fever, chills, or fatigue.
HEENT: Eyes: Ms. Branning is not wearing corrective lenses. She denies eye pain, drainage, or blurred vision. Ears, Nose, Throat: Ms. Branning denies ear pain, drainage, nasal flaring, congestion, or a sore throat.
SKIN: Ms. Branning denies skin color changes, rashes, or itching.
CARDIOVASCULAR: Ms. Branning denies chest pain, palpitations, or discomfort.
RESPIRATORY: Ms. Braning denies cough, wheezing, or shortness of breath.
GASTROINTESTINAL: Ms. Branning denies nausea, vomiting, diarrhea, or abdominal pains.
GENITOURINARY: Ms. Branning denies urgency, frequency, or dysuria.
NEUROLOGICAL: Ms. Branning denies headaches, dizziness, or loss of balance
MUSCULOSKELETAL: Ms. Branning denies joint or muscle pain, joint stiffness, or bone pain.
HEMATOLOGIC: Ms. Branning denies bleeding
LYMPHATICS: Ms. Branning denies lymphadenopathy or splenectomy
ENDOCRINOLOGIC: Ms. Branning denies cold or heat intolerance, body weight changes, polyuria, or polydipsia.
Objective:
Vitals: T 98.4, P 82, RR 18, BP 124/74, Ht 5’0, Wt 118lbs
Physical exam:
Respiratory system: No wheezing, coughing, crackles, or nasal flaring
Cardiovascular: Presence of S1 and S2 heart sounds. No adventitious heart sounds.
Diagnostic results: None
Assessment:
Mental Status Examination: Ms. Branning is dressed appropriately for the clinical visit. She is alert and oriented to others, time, and events. Ms. Branning’s thought process and content are intact. She maintains a normal eye contact during the assessment. Her insight and affect are appropriate. She denies anxiety or a depressed mood. She has delusions of grandiosity. She denies suicidal thoughts, plans, attempts, hallucinations, or illusions. She does not show any abnormal mannerisms such as tremors or tics during the assessment. Her speech is appropriate and has a normal tone and rate.
Differential Diagnoses:
Delusions of grandiosity (F 22): One of the diagnoses that should be considered is delusions of grandiosity. Delusions of grandiosity refer to a mental health disorder where an individual believes that they are exceptionally wealthy, famous, or have considerable abilities. Patients usually have an inflated sense of self-importance and self-esteem. They also appear disconnected from reality (Isham et al., 2021, 2022). Ms. Branning believes that she is beautiful and a strong woman. She believes that Mr. Nehring wants to fire her because of her abilities, which she can use to replace her in years to come. This makes delusions of grandiosity one of her primary diagnoses.
Delusions of persecution (F 22): Delusion of persecution is the other primary diagnosis to be considered for Ms. Branning. Patients with delusions of persecution believe that others want to harm or harass them. They constantly think that others have bad intentions toward them. They also distrust others and are always suspicious (Pahuja et al., 2020; Ritunnano et al., 2022). Ms. Branning believes that Eric and Mr. Nehring want to fire her because they are in love with her. This feeling of being harmed by others makes persecutory delusions the other primary diagnosis to consider for Ms. Branning.
Erotomanic delusions (F 22): Erotomanic delusion is the other diagnosis that should be considered for Ms. Branning. Patients with erotomanic delusions believe that another person loves them (Jamaluddin, 2021). Ms. Branning believes that Eric and Mr. Nehring are in love with her. This is despite them not showing any inappropriate behaviors or sexual advances toward Ms. Branning. This makes erotomanic disorder the other diagnosis to consider for Ms. Branning.
Somatoform disorder (F 45.9): Ms. Branning also has somatoform disorder. Somatoform disorder is a mental health disorder where a patient reports symptoms of a physical disorder but no organic findings support them. The complaints have a psychological basis rather than pathophysiological changes in body functions (Agarwal et al., 2020; Rossetti et al., 2021). Ms. Branning believes that she has cancer due to a broken heart. She also reports neck pain radiating to the back, which has no pathophysiological basis. As a result, somatoform disorder is a diagnosis that should be considered in the case study.
Reflections:
I agree with my preceptor that Ms. Branning has a delusional disorder, with subtypes including persecution, grandiosity, and erotomania. I also agree with her that Ms. Branning has somatoform disorder. The assessment reveals that Ms. Branning has delusions, which affect her social and occupational functioning. I learned from this case study the possibility of co-existence of multiple diagnoses in a patient’s complaint. The coexistence influences treatment decisions that mental healthcare providers make in their practice. I would prescribe antipsychotics such as risperidone instead of psychotherapy alone should I encounter a similar case in the future (Muñoz-Negro et al., 2020). Ms. Branning has the right to make informed decisions related to her care needs. Mental health nurse practitioners must consider their preferences, values, and beliefs in the treatment to ensure autonomous care and patient empowerment.
References
Agarwal, V., Nischal, A., Praharaj, S. K., Menon, V., & Kar, S. K. (2020). Clinical Practice Guideline: Psychotherapies for Somatoform Disorders. Indian Journal of Psychiatry, 62(Suppl 2), S263. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_775_19
Isham, L., Griffith, L., Boylan, A.-M., Hicks, A., Wilson, N., Byrne, R., Sheaves, B., Bentall, R. P., & Freeman, D. (2021). Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 94(1), 119–140. https://doi.org/10.1111/papt.12260
Isham, L., Loe, B. S., Hicks, A., Wilson, N., Bird, J. C., Bentall, R. P., & Freeman, D. (2022). The meaning in grandiose delusions: Measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland. The Lancet Psychiatry, 9(10), 792–803. https://doi.org/10.1016/S2215-0366(22)00236-X
Jamaluddin, R. (2021). Same Gender Erotomania: When the Psychiatrist Became the Delusional Theme—A Case Report and Literature Review. Case Reports in Psychiatry, 2021, e7463272. https://doi.org/10.1155/2021/7463272
Muñoz-Negro, J. E., Gómez-Sierra, F. J., Peralta, V., González-Rodríguez, A., & Cervilla, J. A. (2020). A systematic review of studies with clinician-rated scales on the pharmacological treatment of delusional disorder. International Clinical Psychopharmacology, 35(3), 129. https://doi.org/10.1097/YIC.0000000000000306
Pahuja, E., Manjunatha, N., Kumar, C. N., Bada Math, S., Rajmohan, P., & Salam OK, A. (2020). Repetitive superficial self harm as an acting out on delusion of persecution: A case report and mini review. Asian Journal of Psychiatry, 48, 101904. https://doi.org/10.1016/j.ajp.2019.101904
Ritunnano, R., Kleinman, J., Oshodi, D. W., Michail, M., Nelson, B., Humpston, C. S., & Broome, M. R. (2022). Subjective experience and meaning of delusions in psychosis: A systematic review and qualitative evidence synthesis. The Lancet Psychiatry, 9(6), 458–476. https://doi.org/10.1016/S2215-0366(22)00104-3
Rossetti, M. G., Delvecchio, G., Calati, R., Perlini, C., Bellani, M., & Brambilla, P. (2021). Structural neuroimaging of somatoform disorders: A systematic review. Neuroscience & Biobehavioral Reviews, 122, 66–78. https://doi.org/10.1016/j.neubiorev.2020.12.017
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Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
Learning Resources
Required Readings
American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders
Links to an external site. (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
Links to an external site. (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
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Chapter 5, “Schizophrenia Spectrum and Other Psychotic Disorders”
Chapter 2 only section 2.14, “Early-Onset Schizophrenia”
Document: Comprehensive Psychiatric Evaluation Template
Download Comprehensive Psychiatric Evaluation Template
Document: Comprehensive Psychiatric Evaluation Exemplar
Download Comprehensive Psychiatric Evaluation Exemplar
Document: NRNP 6635 Final Study Guide
Download NRNP 6635 Final Study Guide
Required Media
Classroom Productions. (Producer). (2016). Schizophrenia and other psychotic disorders
Links to an external site. [Video]. Walden University.
MedEasy. (2017). Psychotic disorders | USMLE & COMLEX
Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=BdB6MgWAP1k
Video Case Selections for Assignment
Select one of the following videos 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.
Symptom Media. (Producer). (2016). Training title 9
Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-9
Symptom Media. (Producer). (2016). Training title 24
Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-24
Symptom Media. (Producer). (2016). Training title 29
Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-29
Symptom Media. (Producer). (2018). Training title 134
Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-134
Document: Case History Reports
Download Case History Reports
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.
By Day 7 of Week 7
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment??
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest 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.
Reflection notes: What would you do differently with this client if you could conduct the session over??Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), 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.).
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
To submit your completed assignment, save your Assignment as WK7Assgn_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.
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Rubric
NRNP_6635_Week7_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome 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 |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome 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. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome 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.). |
|
10 pts | ||||
| This criterion is linked to a Learning Outcome 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). |
|
15 pts | ||||
| This criterion is linked to a Learning Outcome 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 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation |
|
5 pts | ||||
| Total Points: 100 | ||||||