NRNP 6635: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, And Medication-Induced Movement Disorders Essay

NRNP 6635: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, And Medication-Induced Movement Disorders Essay

NRNP 6635: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, And Medication-Induced Movement Disorders Essay

Subjective:

CC (chief complaint): “My roommates think I’m living in a movie.”

HPI: Jess is a White female on psychiatric evaluation. According to her roommates, Rachel and Liz, Jess was doing well until her aunt died and she started having weird behavior. She has odd thoughts and hears things that are not there.  According to Jess, her roommates think she is living in a movie, probably since she watches a lot of them. She deems their new neighbors as Russian spies who convey information by drilling and Russian code. However, her roommates mention that the neighbors are Spanish. Jess hears the neighbors speaking but her roommates cannot. Last evening she stayed in the car for six hours to avoid the spies from coding her. She denies visualizing things that others cannot perceive, but claims to know things they do not. Besides, Jess claims that the neighbors are terrorists and they possess buildings’ blueprints. As a result, she has covered and marked up the walls to prevent the neighbors from observing them.

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Past Psychiatric History:

• General Statement: History of depression after her aunt’s demise.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: Alprazolam 1mg BD for 15 days (non-compliant).
• Psychotherapy or Previous Psychiatric Diagnosis: Depression

Substance Current Use and History: She has used cannabis since she was 17. Admits to taking takes several beers on weekends.

Family Psychiatric/Substance Use History: None.

Psychosocial History: The client works in a bakery. She currently lives with her roommates. She is estranged from her parents and was raised by her late aunt. She has one brother who was recently murdered through GSW. She sleeps 2 hours/a day and only eats canned foods.

Medical History: No chronic illnesses.

• Current Medications: None
• Allergies: Medical tape

• Reproductive Hx: None

ROS:

• GENERAL: No fever, chills, weight changes, or fatigue.
• HEENT: Denies headache, eye pain, vision changes, ear pain, hearing loss, rhinorrhea, or sore throat.
• SKIN: Denies rash, bruises, or itching.
• CARDIOVASCULAR: Denies palpitations, edema, chest pain, or SOB on exertion.
• RESPIRATORY: Denies cough, sputum, or wheezing.
• GASTROINTESTINAL: Denies anorexia, vomiting, abdominal pain, or constipation/diarrhea.
• GENITOURINARY: Denies vaginal or urinary symptoms.
• NEUROLOGICAL: Denies headache, syncope, muscle weakness, or numbness.
• MUSCULOSKELETAL: Denies muscle/back pain, joint stiffness, or joint pain.
• HEMATOLOGIC: Denies bruising or bleeding.
• LYMPHATICS: Denies enlarged lymph nodes.
• ENDOCRINOLOGIC: Denies increased hunger, thirst, or urination.

Objective:

Physical exam:

Vitals: T- 98.6, P- 86, R-20, BP-120/70, Ht-5’2, Wt-126lbs

Diagnostic results: No tests were ordered.

Assessment:

Mental Status Examination:

The patient is neat and dressed appropriately for the weather. She constantly fidgets, avoids eye contact, and rolls her eyes. She frequently crosses her arms and excessively uses hand gestures. Her tone varies when explaining about Russians and often shouts. She has a coherent and goal-directed thought process. Auditory hallucinations and persecutory delusions were noted. She denies suicidal or homicidal thoughts/ideas. Her memory is intact. Insight is lacking.

Differential Diagnoses:

Brief Psychotic Disorder: Brief Psychotic Disorder is characterized by a sudden onset of at least one of the following psychotic symptoms: hallucinations, delusions, disorganized speech, or catatonic behavior. The symptoms have an abrupt onset and short duration of less than a month and the patient returns to normal functioning (Fusar-Pol, et al., 2022). Jess had an abrupt onset of persecutory delusions and auditory hallucinations and the symptoms have lasted 12 days, making Brief Psychotic Disorder a likely diagnosis.

Schizophrenia: The diagnostic criteria for Schizophrenia require at least two of the following: hallucinations, delusions, disorganized speech, or catatonic behavior (Ruiz-Castañeda et al., 2022). The symptoms should have lasted for at least a month. The patient has auditory hallucinations and persecutory delusions, making Schizophrenia a differential diagnosis. However, the patient’s symptoms have lasted more than a month ruling this as the primary diagnosis.

Bipolar Disorder: Bipolar presents with manic episodes that alternate with depressive episodes. Symptoms of mania include delusions, over-activeness, restlessness, pressure of speech, flight of ideas, excessive planning, reduced need for sleep, poor judgment, and lack of insight (McIntyre et al., 2022). The patient had depression after her aunt’s death. She has manic symptoms like being delusional, minimal sleeping for two hours/day, and lack of insight. However, she does not have an elevated mood or inflated self-esteem to meet the criteria for mania.

Reflections:

The assessment has enlightened me on the different conditions that present with psychotic/symptoms like Brief psychotic disorder and schizophrenia. I have also learned that the two conditions are differentiated by the onset and duration of symptoms. In a different situation, I would use the Brief Psychiatric Rating Scale (BPRS) to assess the severity of the client’s psychotic symptoms (Seiler et al., 2020). Ethical principles of nonmaleficence and autonomy apply in this case. The patient should be involved in developing the treatment plan and her informed consent obtained before initiating treatment. The treatment interventions should promote the best outcomes without harming the patient. Health promotion should seek to improve the patient’s lifestyle habits like dietary and sleeping habits.

References

Fusar-Poli, P., Salazar de Pablo, G., Rajkumar, R. P., López-Díaz, Á., Malhotra, S., Heckers, S., Lawrie, S. M., & Pillmann, F. (2022). Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda. The Lancet. Psychiatry, 9(1), 72–83. https://doi.org/10.1016/S2215-0366(21)00121-8

McIntyre, R. S., Alda, M., Baldessarini, R. J., Bauer, M., Berk, M., Correll, C. U., Fagiolini, A., Fountoulakis, K., Frye, M. A., Grunze, H., Kessing, L. V., Miklowitz, D. J., Parker, G., Post, R. M., Swann, A. C., Suppes, T., Vieta, E., Young, A., & Maj, M. (2022). The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry: official journal of the World Psychiatric Association (WPA), 21(3), 364–387. https://doi.org/10.1002/wps.20997

Ruiz-Castañeda, P., Santiago Molina, E., Aguirre Loaiza, H., & Daza González, M. T. (2022). Positive symptoms of schizophrenia and their relationship with cognitive and emotional executive functions. Cognitive Research: Principles and Implications, 7(1), 1-19. https://doi.org/10.1186/s41235-022-00428-z

Seiler, N., Nguyen, T., Yung, A., & O’Donoghue, B. (2020). Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry and Clinical Neurosciences, 74(4), 226–246. https://doi.org/10.1111/pcn.12966

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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.

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 disordersLinks 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 disordersLinks 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”

 

• Classroom Productions. (Producer). (2016). Schizophrenia and other psychotic disordersLinks to an external site. [Video]. Walden University.
• MedEasy. (2017). Psychotic disorders | USMLE & COMLEXLinks 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 24Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-24

PLEASE USE TRAINING TITLE 24 VIDEO FOR THIS ASSIGNMENT. BELOW IS THE LINK FOR THE VIDEO:

https://video.alexanderstreet.com/watch/training-title-24

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.).

PLEASE USE THE TRAINING TITLE 24 VIDEO FOR THIS ASSIGNMENT. USE THE TEMPLATE, FOLLOW THE RUBRICS AND THE INSTRUCTIONS. USE BOOKS AND REFERENCES NOT MORE TAN FIVE YEARS OLD, APA 7TH FORMAT,  AND INTEXT CITATIONS ARE REQIRED.

THANKS.