NRNP PRAC Assignment: Comprehensive Psychiatric Evaluation of Psychotic Disorders (Schizophrenia)

NRNP PRAC Assignment: Comprehensive Psychiatric Evaluation of Psychotic Disorders (Schizophrenia)

NRNP PRAC Assignment: Comprehensive Psychiatric Evaluation of Psychotic Disorders (Schizophrenia)

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.

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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 diagnostic criteria for each differential diagnosis and explain what DSM-5 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.).

A Sample Of This Assignment Written By One Of Our Top-rated Writers

 Comprehensive Psychiatric Evaluation of Psychotic Disorders (Schizophrenia)

Subjective:

CC (chief complaint): Aggressiveness, insomnia and loss of appetite are the chief complaints with which the 30 year-old Caucasian female was brought with. She has already assaulted her mother causing her physical injury and and is also noncompliant with medication.

HPI: She is a 30 year-old White woman who presents with the above complaints. She admits to a revious history of the symptoms and psychiatrc illness in general. The curren symptoms commenced several months ago and she has already even been admitted for the same. The symptoms are constant and characteristically unending. The symptoms are aggravated by being close to other people but somewhat relieved by weariness. These symptoms are present all the time and are rated 7/10 n severity by the historian. 

Past Psychiatric History:

• General Statement: The patient has a long psychiatric history and entered treatment at an early age. She is however not adhering to her treatment regime all the time and that may explain her lack of progress.
• Caregivers (if applicable): She requires to have caregivers at home because she is dysfunctional in all areas. She also cannot take care of her activities of daily living (ADLs) without being reminded and assisted to do so.
• Hospitalizations: She has severally been admitted to psychiatric facilities and involuntarily in all cases. The last admission was six months ago.
• Medication trials: She has been on several medications before and these include aripiprazole (Abilify) and clozapine (Clozaril). She has however never fully cmplied with these medications and so it is difficult to comment about their efficacy or otherwise.
• Psychotherapy or Previous Psychiatric Diagnosis: This patient has indeed received psychtherapy for a psychotic disorder before. However, because she erratically attends sessions, they are unable to state whether the therapy was helpful or not.

Substance Current Use and History: She uses and smokes cannabis as revealed by the laboratory test. She also abuses benzodiazepines which are prescription medications.

Family Psychiatric/Substance Use History: There is a history of psychiatric illness (psychosis) in first class relatives on the side of the mother. A number of her uncles are also users of banned substances and also take etoh and cigarettes.  

Psychosocial History: She only went to school up to the eleventh grade and did not continue after that due to bizarre behavior. She has never been married. However, she is a mother of two children bu still lives with her birth family. Because of her current dysfunction, her two children are living with her sister. She gets a monthly stipend of 900 USD from the social services for her disability and need for an income.

Medical History:

• Current Medications: The client is at present on the following medications:
• Aripiprazole 25 mg PO OD
• Clozapine 50 mg PO OD (Stahl, 2017).
• Allergies: She denies any history of allergies that are known.

• Reproductive Hx: She professes heterosexuality and is the mother of two children who are both alive.

ROS:

• GENERAL: She claims to be free of fever, chills, lethargy, weight loss, and malaise.
• HEENT: Headaches, photophobia, tearing, otorrhea, tinnitus, rhinorrhea, sneezing, and sore throat are all negative.
• INTEGUMENTARY: She has no rashes, eczema, or itching on her skin.
• CARDIOVASCULAR: She claims she has no chest aches or discomfort, and no peripheral edema.
• RESPIRATORY: Dyspnea, wheezing, and coughing are not present.
• GASTROINTESTINAL: She denies having any bowel movements that are irregular. She doesn’t have any symptoms of nausea, vomiting, or diarrhea.
• GENITOURINARY: No vaginal discharge or lesions have been found. She also denies urinary retention, hesitation, micturition frequency, or murky urine passing.
• NEUROLOGICAL: She denies paraesthesia, bladder and bowel control loss, hemiparesis, and hemiplegia.
• MUSCULOSKELETAL: She denies having myalgia or arthralgia, claiming that her joints have a full range of motion.
• HEMATOLOGIC: Her blood and clotting problems are negative. She also denies that she has any strange injuries on her body.
• LYMPHATICS: Lympadenopathy and splenectomy are not present.
• ENDOCRINOLOGIC: Excessive diaphoresis, polydipsia, pyphagia, heat sensitivity, cold intolerance, and hormone therapy are all denied.

Objective:

Vital Signs: T 98.4°F; BP 115/75 regular cuff, sitting; HR 75, regular; RR 16, non-labored.

Diagnostic results: Positive and negative symptom scale or PANSS tool shows that the patient has moderate to severe schizophrenia with a score of ten (Leucht et al., 2019). The other test was an MRI of the head that showed no abnormality such as a traumatic brain injury, space-occupying lesion (SOL), midline shift, or morphological changes.    

Assessment:

Mental Status Examination: She is a 30 year-old White woman who is only oriented to persons but disoriented in place, space, time, and event. Speech is unclear, incoherent, and definitely not goal-directed. She is unkempt with monotonous speech and avoids eye contact. There is flight of ideas and word salad but no mannerisms or tics. Self-reported mood is “fantastic” but affect is euthymic suggesting incongruence of the two. There are clear delusions and hallucinations and judgment and insight are impaired. She however shows no signs of suicidal or homicidal ideation. She is diagnosed with 295.90 (F20.9) schizophrenia (APA, 2013; Sadock et al., 2015).   

Differential Diagnoses: The differential diagnoses are schizophrenia, substance-induced psychotic disorder (292.9 [F19.259]), and bipolar disorder with psychotic features (APA, 2013; Sadock et al., 2015). The client meets the diagnostic criteria for schizophrenia in that she has delusions, hallucinations, language and cognitive impairment. She also has disorientation of speech that qualifies as a negative symptom. Because she has been abysing cannabis for a while, the differential diagnosis of substance-induced psychotic disorder is also plausible. Lastly but not least, bipolar disorder with psychotic features in its manic phase also has symptoms that imitate those of schizophrenia and therefore would be possible.

Reflections: Loking back at the interview and assessment I think I would repeat the same were I to be given another opportunity. The reason is that I followed the laid down protocols for psychiatric interviews and assessments (Carlat, 2017). Autonomy was granted as well as the other bioethical principles of beneficence and fidelity (Haswell 2019). Confidentiality was also observed. Patient and family education centered on coping and psychosocial support as well as adherence to medications and therapy appointments.

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

Leucht, S., Barabássy, Á., Laszlovszky, I, Szatmári, B., Acsai, K., Szalai, E., Harsányi, J., Earley, W., & Németh, G. (2019). Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: Understanding negative symptom scores in schizophrenia. Neuropsychopharmacology, 44, 1589-1596. https://doi.org/10.1038/s41386-019-0363-2

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.