Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Assignment

Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Assignment

Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Assignment

Patient Details:

Name: J.D

Gender: Female

Age: 30-year-old

Race: Caucasian

Subjective:

Chief Complaint: “Started having thoughts and hearing things that others couldn’t hear. They think I’m living in a movie.”

History of Presenting Illness: J.D is a 30-year-old Caucasian female who presented in the company of her two roommates for a psychiatric evaluation as they are concerned about her strange behavior from the recent past. She reports no chronic medical condition. She works in a bakery. She lives with two roommates with whom she goes out regularly even on weekdays to take alcohol. In the past, she had issues with depression which started when her aunt whom she had lived died. These symptoms worsened when she witnessed her brother die in a gas station burglary 12 days after her aunt. She currently presents with symptoms where she hears things that others cannot hear. She also presents with delusions as she believes that she is in a movie, and her neighbors are Russians spying yet corroborative history shows that her neighbors are US citizens. She is also accusatory to both her neighbors and her friends for being liars. She denies having visual hallucinations. She has a restricted appetite only for canned food. She has sleep disturbance as she can only sleep for 2 hours.

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Past Psychiatric History: J.D is a 30 years old presenting with bizarre behavior. Her past psychiatric history is not clear. There is no reported past hospitalizations or caregivers. She is currently on Alprazolam. No reported episodes of psychotherapy. J.D’s past psychiatric history is unknown as she has declined to discuss her past psychiatric history and she also declined to consult with roommates for a collaborative history.

Substance Current Use and History: J.D currently smokes cannabis. She has smoked cannabis every day since she was 17 years old at the time of evaluation. She also uses alcohol several days a week when she goes out to drink with her friends. She takes the beer.

Psychosocial History: J.D’s family is currently dysfunctional as she is estranged from both of her parents. She was raised by her aunt. There is no mention of a family history of mental illness, diabetes, hypertension, or malignancies. J.D is estranged from her parents. She has one sibling; a brother whom she witnessed killed in a burglary. She works in a bakery. Her educational qualifications are not mentioned. She suffered the early social trauma of separation from her parents. The reasons for this are not mentioned.

Medical History:

There is no mention of any medical or surgical treatment for any other illnesses.

• Current Medications: J.D is currently on Alprozalam 1mg twice daily dose prescribed by her primary care physician for the management of her symptoms.
• Allergies: J.D reports an allergy to medical tape. She does not mention any allergies to food or medications.
• Reproductive History: She does not report having any children, she does not mention anything on her menses, contraceptive use, or any history of treatment for sexually transmitted illnesses. she has regular menses, she has no history of the use of contraceptives, and she has no history of treatment for any STIs.

ROS:

GENERAL: No fever, no feeling of general body malaise, no increased sweating

• HEENT: she is normocephalic, with no masses or lesions on the head, her hair is not brittle, no pain in the eye, normal visual acuity, no diplopia, no haziness of vision, no dizziness, no ear pain, no ear discharge, no external ear masses, no problems in hearing. No rhinorrhea, no epistaxis, no phonation problems, no polyp growths. There is no throat pain reported, and no change in voice reported.
• Skin: no skin eruptions or masses, there is no skin color change, and no brittleness of the skin is reported.
• Cardiovascular: there are no palpitations, difficulty in breathing while lying down, no generalized body swelling, and no skin pallor.
• Respiratory: No labored breathing, no chest pains, no chest tightness, no cough.
• Gastrointestinal: no hematemesis, no melena, no diarrhea, no vomiting, no abdominal pains, no abdominal swelling, no change in color over any part of the skin of the abdomen, she has loss of appetite.
• Genitourinary: There is no reported urgency, increased frequency, or urinary incontinence, no genital eruptions, swellings, or masses, and no anogenital warts.
• Neurological: She experiences on-and-off headaches, there is no weakness in any of the muscle groups.
• Musculoskeletal: There are no joint pains, no joint swelling, redness, or pain in joint movement.
• Hematologic: She reports no bleeding tendencies, fatiguability on slight exertion, or any history of recurrent infections reported.
• Lymphatics: there is no splenomegaly, no lymphadenopathy, or unilateral swelling of a limb.
• Endocrinologic: no increased sweating of the skin, she reports feeling depressed, and no intolerance to cold or hyperthermia reported.

Objective:

Physical exam: vital signs: Temperature- 98.6, Pulse rate- 86, Respiratory rate 20, Blood Pressure 120/70 mmHg, Height 5’2 Weight 126 lbs.

Diagnostic results: Liver function tests, Renal function tests, electrolytes, complete blood count, and thyroid function tests are all normal.

Assessment:

Mental Status Examination: J.D 30-year-old Caucasian female. She is of athletic build and she looks older than her age. She is generally untidy. She is seated comfortably on the chair. She does not maintain adequate eye contact. She is evasive in her manner and distractible. She is mildly agitated. She has a pressured speech and is marginally hyper talkative She is incoherent in speech. Her articulation is clear. Her mood is labile with a constricted range, blunted intensity with a sad, depressed, and anxious affect. Subjectively, she has a depressed mood. She is delusional; mainly persecutory delusions. She has no suicidal ideations, no obsessions, and seems to be anxious. She has a hallucinatory perceptual disturbance; she has auditory hallucinations but no visual hallucinations. She is alert and well-oriented to the dimensions of time place and person. She has poor judgment and lacks insight.

Primary Diagnosis: DSM-5 295.9 (F20.9) Schizophrenia is the Primary diagnosis for J.D. She meets almost the whole of the diagnostic criteria for the diagnosis of Schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). J.D has visual hallucinations as she can hear voices speaking. She has persecutory delusions of the “Russians” spying on her. She has grossly disorganized behavior and incoherent speech. These symptoms have been there for a long and are precipitated into acute episodes by adverse life experiences. She does not meet the criteria for both bipolar illness and depression. She also experiences the supporting features of schizophrenia-like sleep disturbance, anxiety, and depressive conscience discussed by Lin & Lane, (2019). According to Lysaker et al., (2018), precipitating factors for schizophrenia include substance use, adverse life events like the death of a family member, and genetic predisposition among others. J.D has a myriad of precipitating features such as substance use, and the death of her aunt and brother which occurred in quick succession.

Differential Diagnoses: 295.40 (F20.81) Schizophreniform Disorder, 305.20 (F12.10) Mild Cannabis Use Disorder, and 295.70 (F25.1) Schizoaffective Disorder Depressive type all qualify as possible differential diagnoses. The diagnostic demarcation between schizophrenia and schizoaffective disorder is a thin one that rests on the presence of a concurrent mood disorder in the course of the psychotic illness (American Psychiatric Association, 2013). Although J.D presents with some features and triggers of depression, she does not meet the criteria for a depressive illness. Cannabis use disorder is another plausible differential diagnosis. Cannabis use disorder rests on the pathological pillars of psychological dependence, lack of control of use, risky behavior, and impairment of social fabrics. These are rather not explicitly shown in J.D,s case although she has smoked cannabis for many years. There is no dependence depicted but it can be assumed she is. Again, there is no temporal association between the use of cannabis and symptomatology. Schizophreniform disorder and brief psychotic episodes are also possible differential diagnoses. The American Psychiatric Association, (2013) describes the difference in diagnostic criteria to be only the timelines of illness. For schizophreniform disorder, symptoms last less than 6 months while in a brief psychotic episode they last less than a month (López-Díaz et al., 2020). Schizophrenia lasts more than 6 months. The duration of the illness is not exactly elicited but it tends to look like a chronic, relapsing illness. This rules out Brief Psychotic episodes and Schizophreniform disorders.

Reflections: J.D presents with the classic symptoms of psychosis which are delusions, hallucinations, and disorders in speech among others. The diagnosis of Schizophrenia is the preferred diagnosis in this case and has ruled out the other disorders. If I were to do this case again, I would stress the timelines of the illness to find the appropriate diagnosis that rests on the illness’s timelines. Family history in mental illness is crucial. It shows the level of genetic predisposition to illness and may be an important prognosticator (Díaz-Castro et al., 2021). In this patient’s management, providing insight is a key tenet. The presence of insight in patients improves the treatment strategies outlined (Buchman-Wildbaum et al., 2020). The management of this patient also entails cutting down the precipitants like cannabis use among others. Psychotherapy and medical therapy are complementary to each other in the treatment of this patient.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Buchman-Wildbaum, T., Váradi, E., Schmelowszky, Á., Griffiths, M. D., Demetrovics, Z., & Urbán, R. (2020). The paradoxical role of insight in mental illness: The experience of stigma and shame in schizophrenia, mood disorders, and anxiety disorders. Archives of Psychiatric Nursing, 34(6), 449–457. https://doi.org/10.1016/j.apnu.2020.07.009

Díaz-Castro, L., Hoffman, K., Cabello-Rangel, H., Arredondo, A., & Herrera-Estrella, M. Á. (2021). Family History of Psychiatric Disorders and Clinical Factors Associated With a Schizophrenia Diagnosis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 004695802110607. https://doi.org/10.1177/00469580211060797

Lin, C.-H., & Lane, H.-Y. (2019). Early Identification and Intervention of Schizophrenia: Insight From Hypotheses of Glutamate Dysfunction and Oxidative Stress. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00093

López-Díaz, Á., Ayesa-Arriola, R., Ortiz-García de la Foz, V., Crespo-Facorro, B., & Ruiz-Veguilla, M. (2020). M97. predictors of transition to schizophrenia in brief psychotic disorder: Findings from a 3-year longitudinal study in the pafip cohort. Schizophrenia Bulletin, 46(Supplement_1), S171–S172. https://doi.org/10.1093/schbul/sbaa030.409

Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018). Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry, 17(1), 12–23. https://doi.org/10.1002/wps.20508

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Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

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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.
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 and Grading Information