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

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

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

Name: Mr Jay Feldman

Gender: Male

Age: 19 years old

Race: European-American

Subjective:

CC (chief complaint): “My parents requested this appointment.”

HPI: Jay Feldman is a 19-year-old European-American male client on psychotherapy after his parents booked him a psychiatric appointment. When booking the appointment, Feldman’s parents reported that he was having difficulties in school. However, the client states that he is doing fine in school as a freshman pursuing Theoretical physics and advanced calculus. Feldman mentions that the combined courses are mysteries, and the moment he thinks that he has grasped it, it fades away. The client mentions that his roommate at State College brought a microwave. He reports that the purpose of the microwave is to trigger a bleeding degeneration of blood cells and bleed humanity from peoples’ rightful destiny. Feldman also mentions that their room is spying on them. The client has not been showering.

Past Psychiatric History:

• General Statement: The client has a psychiatric history of mild paranoia.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: The patient was on a short trial of Aripiprazole for six months. The medication was stopped due to the side effects of akathisia.
• Psychotherapy or Previous Psychiatric Diagnosis: Mild paranoia

Substance Current Use and History: Attempted to smoke marijuana twice at 18 years. He admits to taking vodka 3-4 glasses on weekends. Denies tobacco or other illicit substance use.

Family Psychiatric/Substance Use History: The patient has two younger brothers; one has a history of ADHD and the other a history of anxiety. Feldman’s mother has a history of anxiety, and his father of paranoia schizophrenia.

Psychosocial History:  Feldman is a freshman at State College pursuing a combination of Theoretical physics and Advanced calculus. He plans to pursue a double major in philosophy and physics. He is the firstborn in a family of three and was raised by both parents. He attained all his childhood developmental milestones. He states that he has several friends, but he has not kept in touch with them since he came back home. He sleeps 4–5 hrs per day.

Medical History:

• Current Medications: None
• Allergies: None

• Reproductive Hx: No history of STIs.

ROS:

• GENERAL: Reports appetite loss and weight loss. Denies fever, chills, or increased fatigue.
• HEENT: Denies visual changes, ear pain/discharge, rhinorrhea, or swallowing difficulties.
• SKIN: Denies rashes, discoloration, or bruises
• CARDIOVASCULAR: Denies dyspnea, neck distension, or edema.
• RESPIRATORY: Denies SOB, wheezing, or productive cough.
• GASTROINTESTINAL: Reports having an inconsistent appetite. Denies having nausea, vomiting, abdominal discomfort, diarrhea, or constipation.
• GENITOURINARY: Denies urinary symptoms.
• NEUROLOGICAL: Denies headache, dizziness, or muscle weakness.
• MUSCULOSKELETAL: Denies joint stiffness/pain or muscle pain.
• HEMATOLOGIC: Denies bruising.
• LYMPHATICS: Denies swollen lymph nodes.
• ENDOCRINOLOGIC: Denies excessive sweating, heat/cold intolerance, or acute thirst.

Objective:

Physical exam: T- 98.3 P- 69 R 16 106/72 Ht 5’7 Wt 117lbs

Diagnostic results: None

Assessment:

Mental Status Examination:

The patient is untidy with shaggy hair, long dirty nails, yellow teeth, and a stinking body odor. He is alert but appears fatigued. He maintains minimal eye contact and appears uninterested in the interview. His speech is clear but speaks at a fast rate and high volume. The self-reported mood is “okay,” but he has a flat affect. He makes long pauses before responding to questions. He has a looseness of association, and his speech is difficult to follow. His thoughts are disorganized. The client has odd beliefs and paranoid delusions. No hallucinations, phobias, compulsions, or suicidal/homicidal ideations were noted. Insight is absent.

ORDER A PLAGIARISM FREE-PAPER HERE

Differential Diagnoses:

Schizophrenia: Schizophrenia is a psychotic disorder characterized by hallucinations, delusions, and problems with perception, thought, and behavior. The DSM-V criteria for diagnosing schizophrenia require the presence of two or more of the following psychotic features: Delusions, Hallucinations, Disorganized or catatonic behavior, Disorganized speech and Negative symptoms (McCutcheon et al., 2020). Schizophrenia is thus a differential diagnosis based on the patient’s symptoms of odd beliefs, paranoia delusions, looseness of association, and disorganized thoughts and speech. The patient’s symptoms have contributed to impairment in academic and self-care activities.

Bipolar Disorder: Bipolar disorder is diagnosed based on the presence of alternating episodes of mania and profound depression. Mania is manifests with an elevated/irritable mood and increased goal-directed activity. Patients also present with grandiosity, excessive talking, racing thoughts, distractibility, diminished need for sleep, and increased engagement in risky activities (McIntyre et al., 2020). The episodes of profound depression present with a depressed mood, loss of interest, insomnia/hypersomnia, appetite changes, and suicidal ideations (McIntyre et al., 2020). Bipolar disorder is a differential based on the patient’s symptoms of looseness of association, reduced sleep, inconsistent appetite, and altered functioning in school and self-care areas. Nonetheless, the patient has no history of depression which makes Bipolar disorder an unlikely primary diagnosis.

Persecutory Delusional Disorder (PDD): Patients with PDD present with a persistent pattern of unwarrantable distrust and suspicion of others. They interpret others’ motives and actions as spiteful. Besides, individuals perceive that they may be attacked at any time and without reason (González-Rodríguez & Seeman, 2020). The patient’s paranoid delusions are consistent with PPD. The client believes that his roommate has brought a microwave to cause a bleeding degeneration of blood cells and bleed humanity from peoples’ rightful destiny. Besides, he expresses suspicions that they are being spied on in their room. However, the patient has looseness of association, and disorganized thoughts and speech, which are not characteristic of PPD, making it an unlikely primary diagnosis (Joseph & Siddiqui, 2021).

Reflections:

If I were to redo the session, I would assess the patient for depressive and anxiety symptoms, common comorbidities of schizophrenia. I would assess anxiety and depression using screening tools such as the Generalized Anxiety Disorder Assessment (GAD-7) and Patient Health Questionnaire- 9 (PHQ-9). The tools are effective in identifying the symptoms and their severity. Ethical principles to be considered in this patient include beneficence which is a duty to promote good and thus the best patient outcomes (Bipeta, 2019). Nonmaleficence should also be considered by avoiding causing harm to the patient. Health promotion interventions should include educating the patient on lifestyle changes such as increasing the level of physical activity and practicing healthy dietary habits.

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

González-Rodríguez, A., & Seeman, M. V. (2020). Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management. International Journal of Environmental Research and Public Health, 17(12), 4583.

Joseph, S. M., & Siddiqui, W. (2021). Delusional Disorder. In StatPearls. StatPearls Publishing.

McCutcheon, R. A., Reis Marques, T., & Howes, O. D. (2020). Schizophrenia-An Overview. JAMA Psychiatry, 77(2), 201–210. https://doi.org/10.1001/jamapsychiatry.2019.3360

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet (London, England), 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0

ORDER A PLAGIARISM FREE-PAPER HERE

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.
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.
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.).

TRANSCRIPT OF VIDEO FILE: TRAINING TITLE 29
00:00:00
00:00:00 BEGIN TRANSCRIPT:
00:00:00 [sil.]
00:00:15 OFF CAMERA Mr. Feldman? I understand you called us last week for an appointment.
00:00:20 MR. FELDMAN My parents.
00:00:25 OFF CAMERA Excuse me?
00:00:25 MR. FELDMAN My parents called for the appointment.
00:00:25 OFF CAMERA Oh. Do you know why your parents called for an appointment?
00:00:30 MR. FELDMAN No.
00:00:35 OFF CAMERA When your parents called me they said you were having some difficulty in school. Where are you in school?
00:00:50 MR. FELDMAN State College.
00:00:50 OFF CAMERA How long have you been at State College?
00:00:55 MR. FELDMAN My freshman year.
00:01:00 OFF CAMERA And how is it going?
00:01:05 MR. FELDMAN Fine.
00:01:10 OFF CAMERA What courses are you taking at State?
00:01:15 MR. FELDMAN In high school I took advanced placement courses. Theoretical physics, advanced calculus is what I’m taking now. Although I’m thinking about double majoring in philosophy and physics.
00:01:35 OFF CAMERA That’s an interesting combination.
00:01:35 MR. FELDMAN Yes, the mysteries of life. The courses are mysteries, and just when you think you’ve understood it, it’s gone.
00:01:45 OFF CAMERA Gone?
00:01:50 MR. FELDMAN The totality of life precludes us from repeating it. I mean what’s the point?
00:02:00 OFF CAMERA Do you have a roommate at state?
00:02:05 MR. FELDMAN You could call him that.
00:02:10 OFF CAMERA Can you tell me about him?
00:02:15 MR. FELDMAN Oh no.
00:02:15 OFF CAMERA Why not?
00:02:20 [sil.]
00:02:25 MR. FELDMAN He put a microwave in there, but I know what that means. But I won’t tell. Not a word..
00:02:35 OFF CAMERA A microwave oven?
00:02:40 MR. FELDMAN They had them in here too, in this building. But they’ll spare me, and they’ll spare you too, because you are with me, and what that’s about a bleeding degeneration of blood cells, bleeding the humanity from our rightful destiny… but this room spies on us.
00:03:05 OFF CAMERA I don’t understand what you mean.
00:03:10 MR. FELDMAN It’s in the eyes. You can hold of forever if you know how.
00:03:20 OFF CAMERA Mr. Feldman, did you come here with anyone else today?
00:03:25 [sil.]
00:03:30 MR. FELDMAN Sssshhhh.
00:03:35 OFF CAMERA Mr. Feldman, I think I may need to contact your parents.
00:03:45 Symptom Media Visual Learning for Behavioral Health www.symptommedia.com
00:03:45 END TRANSCRIPT

Training Title 29
Name: Mr. Jay Feldman
Gender: male
Age:19 years old
T- 98.3 P- 69 R 16 106/72 Ht 5’7 Wt 117lbs
Background: European-American male. He has two younger brothers, one with history of
ADHD, the other with history of anxiety. His mother has anxiety; his father has paranoia
schizophrenia. He is home for spring break. He has no previous medical problems.
Developmental milestones met as child. Appetite is inconsistent and it seems he has lost 18lbs
since first going back to school in the fall. Jason has not acted this way before but did have a
short trial of aripiprazole in the last six months of high school for mild paranoia. He stopped the
medication after graduation as he could not tolerate due to side effects of akathisia. Jason has
several friends but has not kept in touch with them since being back home. He has not been
showering. Sleeping 4–5 hrs.
Symptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-29

ORDER A PLAGIARISM FREE-PAPER HERE

RUBRIC
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
18 (18%) – 20 (20%). The response thoroughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
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.
18 (18%) – 20 (20%). The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
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 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.
23 (23%) – 25 (25%). The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
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!), 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.).
9 (9%) – 10 (10%). Reflections are thorough, thoughtful, and demonstrate critical thinking.
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).
14 (14%) – 15 (15%). The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
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 (5%) – 5 (5%). A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation
5 (5%) – 5 (5%). Uses correct grammar, spelling, and punctuation with no errors