NRNP 6635 Week 9 Assignment: Comprehensive Psychiatric Evaluation & Patient Case Presentation for a 29 Year-Old Female with Borderline Personality Disorder and Suicidality

NRNP 6635 Week 9 Assignment: Comprehensive Psychiatric Evaluation & Patient Case Presentation for a 29 Year-Old Female with Borderline Personality Disorder and Suicidality

NRNP 6635 Week 9 Assignment: Comprehensive Psychiatric Evaluation & Patient Case Presentation for a 29 Year-Old Female with Borderline Personality Disorder and Suicidality

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

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For this Assignment, you will document information about a patient that you examined during the last 3 weeks, using the Comprehensive Psychiatric Evaluation Template provided. You will then use this note to develop and record a case presentation for this patient. Be sure to incorporate any feedback you received on your Week 3 and Week 6 case presentations into this final presentation for the course.

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To Prepare
Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
Select a patient that you examined during the last 3 weeks who presented with a disorder for which you have not already conducted an evaluation in Weeks 3 or 6. (For instance, if you selected a patient with OCD in Week 6, you must choose a patient with another type of disorder for this week.) Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor. When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.
Then, based on your evaluation of this patient, develop a video case presentation that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.
Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.
Ensure that you have the appropriate lighting and equipment to record the presentation
Assignment
Record yourself presenting the complex case for your clinical patient. In your presentation:

Dress professionally and present yourself in a professional manner.
Display your photo ID at the start of the video when you introduce yourself.
Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.
Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
Objective: What observations did you make during the interview and review of systems?
Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why?
Reflection notes: What would you do differently in a similar patient evaluation?

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Subjective:

CC (chief complaint): The patient is a 29 year-old female who presents with suicidality by stating that “Iam going to kill myself because nobody cares about me.” She had tied a belt around her neck and was strangling herself with it. She is also agitated and quite aggressive with old scars visible on her skin.

HPI: The patient is a 29 year-old Caucasian female presenting was above in the CC. She admits to a past history of the above symptoms of suicidality and self-mutilation. The onset of her symptoms was a few months ago nd they are psychiatric in origin with aggression and psychosis. The duration of rhe symptoms is all day and they are characteristically persistent and life-threatening. Her symptoms are aggravated by questioning and appear to be relieved by the medication she is getting. The timimng of the symptoms is any time of the day or night. The symptom severity is given as 8/10 by the accompanying person.

Past Psychiatric History:

• General Statement: This is a patient who has an extensive history of suicidal ideation and self-mutilation. She is often psychotic and aggressive and has been put on medications for the same. She is also on a community support program known as the Program for Assertive Community Treatment or PACT. Currently he patient is a danger to herself and to others too due to her psychotic aggression.
• Caregivers (if applicable): Indeed the patient requires to have someone to look after her since she is a suicide risk and m y also be a homicide risk.
• Hospitalizations: The patient has a past history of several hospitalizations for the same symptoms.
• Medication trials: The patient has been tried on psychiatric medications before at present, she is being tried on valproate (Depakote) and risperidone (Risperdal) for the aggression and psychosis respectively (Stahl, 2017).
• Psychotherapy or Previous Psychiatric Diagnosis: Her previous psychiatric diagnosis is Borderline Personality Disorder and she has been tried on several psychotherapeutic modalities to no avail.

Substance Current Use and History: The patient does not have a history of substance use and currently neither smokes nor drinks.

Family Psychiatric/Substance Use History: There is  family history of bipolar disorder on her mother’s side (maternal grandparent) and that of schizophrenia on her paternal great grandparent. Her father was a moderate drinker but smoked heavily his all life.

Psychosocial History: The patient does not have a worthwhile educational achievement. She only competed school up to grade 9 and dropped out due to the mental health issues. At 29 years old she still lives with her parents together with her sister. There is a history on the part of the patient of being sexually abused by a baby sitter and this may have contributed to her mental trauma. She does not seem to have any hobby at the moment and often talks to herself in her delusions and hallucinations.

Medical History:

• Current Medications:

1. Valproate (Depakote) 500 mg orally twice a day
2. Risperidone (Risperdal) 1 mg orally every day

• Allergies: She has no known allergies.

• Reproductive Hx: She identifies as a heterosexual but does not have a boyfriend or a child.  

ROS:

• GENERAL: Denies fever, chills, weight loss, or fatigue.
• HEENT: Negative for bluured vision, photophobia, tinnitus, rhinorrhea, sneeing, otorrhea, or sore throat.
• SKIN: Denies rashes, eczema, or itching.
• CARDIOVASCULAR: Denies palpitations or chest pains/ tightness.
• RESPIRATORY: Denies difficulty in breathing, wheeing, or coughing.
• GASTROINTESTINAL: Negative for a change in bowel habits. Also negative for nausea, vomiting, or diarrhea.
• GENITOURINARY: Denies difficulty urinating or frequency of passing urine. Also denies ny abnormal vaginal discharge.
• NEUROLOGICAL: Negative for paresis, tingling, dizziness, syncope, ataxia, or a loss of bowel and bladder control.
• MUSCULOSKELETAL: Denies myalgia or arthralgia as well as joint stiffness.
• HEMATOLOGIC: Denies any family history of blood and/ or clotting disorders.
• LYMPHATICS: Negative for lymphadenopathy and previous splenectomy.
• ENDOCRINOLOGIC: Denies heat/ cold intolerance. Also denies polydipsia and polyphagia. Negative for excessive diaphoresis and previous hormonal therapy.

Objective:

Physical exam: The patient appears disheveled and poorly groomed. She does not maintain eye contact and fidgets all through the interview. Her speech is coherent but not always clear or goal-oriented.

Vital signs: T 98.3; BP 125/80; HR 75; RR 15; BMI 24.3 kg/m²

Diagnostic results:

1. A magnetic resonance imaging (MRI) scan of the head is negative for traumatic brain injury or raised intracaranial pressure.
2. A chest X-ray reveals no pulmonary pathological process sich as consolidation or infiltration.
3. A full blood count shows no leucocytosis and therefore rules out an infection. Her Hb is 14.3 g/dL.

Assessment:

Mental Status Examination: The patient is a 29 year-old Caucasian female who appears unkempt and disheveled for the occasion. She emits an unpleasant odor and is not very cooperative during the interview. She becomes aggressive when the questioning does not go the way she wants. She is however oriented in time, space, place, person, and event. Her speech is clear but not always coherent or goal-directed. She fidget a lot but aised from that there aqre no other tics or mannerisms observed. Her sef-reported mood is “anxious” and the observed affect is dysphoric; showing that the two are somewhat congruent. Her thought process shows circumstantial and tangential thinking as well as word salad. There is also perseveration and flight of ideas. She has serius suicidal ideation and signs of homicidal ideation. There are also delusions and hallucinations. Her insight an judgment are both clearly impaired. Her diagnosis is 301.83 (F60.3) Borderline Personality Disorder (APA, 2013; Sadock et al., 2015).

Differential Diagnoses

1. Borderline Personality Disorder

This is the primary diagnosis for this female patient, who is 29 years old. Her presentation meets the diagnostic criteria for borderline personality disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5. Increased impulsivity, shaky interpersonal interactions, and a hazy self-image are all symptoms of the disease. Rachel, for example, began feeling the majority of the symptoms at the age of eighteen. The diagnosis is made when at least five of the DSM-5 criteria are met: unjustified fear of abandonment or rejection, distorted self-image and low self-appreciation, unstable interpersonal relationships, impulsivity in at least two areas that are potentially self-damaging, repeated suicidality and self-mutilation, paranoid ideation, affective instability such as depression, and affective instability such as anxiety (APA, 2013; Sadock et al., 2015).

1. Bipolar Disorder with Psychotic Features

In its manic phase, bipolar illness with psychotic features displays symptoms that are similar to those of schizophrenia, making a diagnosis of this feasible but improbabe.

1. Brief Psychotic Disorder

This is a possible diagnosis but it is improbable in the sense that it usually resolves on its own. In the case of ths patient the symptoms remain chronic even after getting medications.

Reflections: The case of this patient required critical thinking and a knowledge of the DSM-5 criteria for diagnosing psychiatric conditions. I used the interviewing algorithm recommended as per Carlat (2017) and made sure that informed consent was obtained before doing anything. This is a major part of autonomy as a bioethical principle (Haswell, 2019). If  were to follow up this patient, I would recommend family therapy for the parents and sister as well as cognitive behavioral therapy for cognitive remodeling of the patient’s thought process.

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Carlat, D.J. (2017). The psychiatric interview, 4^th ed. Wolters Kluwer.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.