NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Essay

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Essay

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders Essay

HPI: Feldman is a 19-year-old European-American male whose parents called for a psychiatric appointment. Feldman’s parents stated that he was having difficulty in school. The client is currently doing Theoretical physics and advanced calculus. He states that the courses are mysteries, and just when he thinks he has understood it, it goes. Feldman states that his roommate at State College put a microwave, which he says will cause a bleeding degeneration of blood cells and to bleed humanity from our rightful destiny. He further states that the room spies on them. The client has not been showering and sleeps 4–5 hrs.

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Past Psychiatric History:

• General Statement: Feldman has a history of mild paranoia.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: He was on a short trial of Aripiprazole for six months, but stopped the drug due to side effects of akathisia.
• Psychotherapy or Previous Psychiatric Diagnosis: History of mild paranoia.

Substance Current Use and History: Denies tobacco, alcohol, or illicit drug use.

Family Psychiatric/Substance Use History:

The client has two younger brothers, one with a history of ADHD and another with a history of anxiety. His mother has a history of anxiety and his father has a history of paranoia schizophrenia.

Psychosocial History:

Jason is in his freshman year at State College pursuing Theoretical physics and advanced calculus. He plans to double major in philosophy and physics. He is the firstborn in a family of three and was raised by both parents. The client met all his childhood developmental milestones. He reports having several friends but has not kept in touch with them since he went back home for the spring break.

Medical History:

 

• Current Medications: None
• Allergies: No drug or food allergies.

• Reproductive Hx: Not applicable.

ROS:

• GENERAL: Positive for loss of appetite and weight loss. Denies fever, chills, or low energy levels.
• HEENT: Negative for eye pain, visual changes, ear pain, ear discharge, sneezing, nasal discharge, or difficulty swallowing.
• SKIN: Denies rashes, discoloration, or bruises.
• CARDIOVASCULAR: Denies palpitations, chest pain, or SOB on exertion.
• RESPIRATORY: Denies chest pain, cough, sputum production, or SOB.
• GASTROINTESTINAL: Positive for inconsistent appetite. Negative for nausea, vomiting, epigastric/abdominal pain, or bowel changes.
• GENITOURINARY: Denies penile discharge, dysuria, or urinary urgency/frequency.
• NEUROLOGICAL: Negative for headache, syncope, dizziness, or tingling sensations.
• MUSCULOSKELETAL: Negative for joint stiffness, muscle pain, or back pain.
• HEMATOLOGIC: Negative for bruising or bleeding.
• LYMPHATICS: Negative for swollen lymph nodes.
• ENDOCRINOLOGIC: Negative for heat/cold intolerance, excessive sweating, or excessive hunger and thirst.

Objective:

Physical exam:

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

Diagnostic results: No diagnostic tests were requested.

Assessment:

Mental Status Examination:

The client is shabby with unkempt hair and dirty nails. He is alert but appears tired. He maintains minimal eye contact and speaks at a fast rate and high volume. The self-reported mood is good but his affect has a flat affect. The client makes long pauses before answering a question. Besides, he demonstrates looseness of association and his speech is difficult to follow. Thoughts are disorganized. He expresses odd beliefs and paranoid delusions. No hallucinations, compulsions, phobias, suicidal/homicidal ideations were noted. He lacks insight.

Differential Diagnoses:

Schizophrenia

Schizophrenia is characterized by delusions, hallucinations, and alterations in perception, thought, and behavior.  The DSM-V diagnostic criteria for schizophrenia include two or more of the following symptoms: Hallucinations, Delusions, Disorganized speech, Disorganized or catatonic behavior, and Negative symptoms (APA, 2013). The symptoms cause impairment in functioning in interpersonal relations, occupation, or self-care (Ganguly et al., 2018). Schizophrenia is a differential diagnosis as evidenced by positive paranoia delusions, odd beliefs, disorganized thoughts and speech, and looseness of association. The symptoms have caused impairment in school and self-care activities.

Persecutory Delusional Disorder (PDD)

PDD presents with a pervasive pattern of unjustifiable distrust and suspicion of others that entails interpreting their motives as malicious. Persons with PPD suspect others and assume they intend to harm or deceive them, despite having no or inadequate justification for these perceptions (APA, 2013). Besides, they feel that they may be attacked at any time and without cause. Due to distrust in others, individuals feel a need to be independent and in control (González-Rodríguez & Seeman, 2020). The patient’s characteristics consistent with a differential of PPD include paranoid delusions. He has odd beliefs that his roommate has kept a microwave to cause a bleeding degeneration of blood cells and bleed humanity from our rightful destiny. He has a suspicion that they are being spied.

Bipolar Disorder

Bipolar disorder is characterized by alternating episodes of mania and depression. The mania episodes are characterized by an elevated or irritable mood with increased goal-directed activity (Vieta et al., 2018). Other symptoms are: Grandiosity; Diminished need for sleep; Excessive talkativeness; Racing thoughts; Distractibility; Increased engagement in risky activities (APA, 2013). Bipolar disorder is a differential based on symptoms of reduced sleep, looseness of association, and impaired functioning in academic and self-care areas. However, it is an unlikely primary diagnosis due to the lack of depressive episodes, and the current symptoms do not fit the criteria for mania.

Reflections:

If I were to conduct the assessment again, I would utilize screening tools for schizophrenia such as the Positive and Negative Syndrome Scale (PANSS) to measure the severity of psychotic symptoms (Kumari et al., 2017). Besides, I would request a urine drug screen to assess substance use. Legal and ethical considerations, in this case, include upholding the ethical principles of doing no harm (nonmaleficence) and promoting overall good (beneficence), particularly when developing the plan of care (Bipeta, 2019). Besides, the confidentiality of the patient’s information should be maintained to avoid legal consequences. Health promotion should focus on healthy lifestyle practices such as healthy dietary habits and regular physical exercise.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

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

Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic management of schizophrenia symptoms using pharmacological and non-pharmacological treatment. Frontiers in public health, 6, 166. https://doi.org/10.3389/fpubh.2018.00166

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.

Kumari, S., Malik, M., Florival, C., Manalai, P., & Sonje, S. (2017). An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS). Journal of addiction research & therapy, 8(3), 324. https://doi.org/10.4172/2155-6105.1000324

Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., … & Suppes, T. (2018). Early intervention in bipolar disorder. American Journal of Psychiatry, 175(5), 411-426. https://doi.org/10.1176/appi.ajp.2017.17090972

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LiNK TO
https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-29 STUDY VIDEO:
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.).