Posted: January 12th, 2023
Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
Subjective:
CC (chief complaint): “Well, you know there is a pain in my neck, it aches, it spreads to my back; I think there is a lump there. I am really worried.” “And it’s slowly killing me, and it’s all because of them and Eric’s obsession with me”.
HPI: Ms. Fatima is a 28-years-old lady presenting with the chief complaint of being worried about being fired by her boss. She has been referred to a psychiatrist by her boss due to having difficulties at work. According to her boss, she has not made any sales for the last three weeks. She claims the boss wants to fire her from work because he feels threatened by the fact that the supervisor wants her. “They have ganged up to fire me because they don’t want me to get in their way; I’m probably a distraction.” She claims it wouldn’t be bad if they fired her because all these problems worsened her health. She complains of pain, suffering, and a broken heart. “Well, you know there is a pain in my neck, it aches, it spreads to my back; I think there is a lump there Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders. I am really worried.” Although she has not seen a doctor, she thinks it’s cancer. “And it’s slowly killing me, and it’s all because of them and Eric’s obsession with me.
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Past Psychiatric History:
- General Statement: Lives alone and denies any past psychiatric history and family mental illness issues.
- Caregivers (if applicable): Lives alone.
- Hospitalizations: No known hospitalizations.
- Medication trials: No known medication trials.
- Psychotherapy or Previous Psychiatric Diagnosis: Denies to discuss.
Substance Current Use and History: No known history or current substance use.
Family Psychiatric/Substance Use History: The patient denied any family mental health issues.
Psychosocial History: Ms. Fatima was raised by her parents and lives alone in Coronado, CA. She is the only child. She has a hospitality degree but works as an administrative assistant in car sales.
Medical History: Has a medical history of Scoliosis and is currently treated with chiropractic care.
Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
- Current Medications: Has a scoliosis history and is undergoing chiropractic treatment at the moment.
- Allergies: The patient is allergic to latex.
- Reproductive Hx: Receives regular menses and uses no birth control pills.
ROS:
- GENERAL: The client denies losing or gaining weight; however, she reports neck pain stretching to her back and a broken heart.
- HEENT: The patient denies dizziness, headache, or ear or eye ache signs. She also denies dysphagia, nasal discharge, and blurred vision.
- SKIN: reports no bruises or abnormal skin rashes.
- CARDIOVASCULAR: Denies chest pain, chest tightness, and shortness of breath.
- RESPIRATORY: the patient reports no dyspnea, cough, or nocturnal dyspnea.
- GASTROINTESTINAL: Reports no signs of stomach cramps, vomiting, stomach upset, or diarrhea.
- GENITOURINARY: The patient reports no signs of urinary frequency, urgency, or pain when urinating.
- NEUROLOGICAL: The patient denies numbness or ataxia
- MUSCULOSKELETAL: The client denies joint or muscle pain.
- HEMATOLOGIC: No signs of bruising or abnormal bleeding
- LYMPHATICS: Reports no painful or swollen lymph nodes
- ENDOCRINOLOGIC: The client reports zero signs of hypothyroidism
Objective:
Vitals; T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs
Diagnostic results: Urine and drug tested negative
Assessment:
Mental Status Examination: Ms. Fatima is a 28-year-old female who has been referred for psychiatric assessment by her boss. She is well groomed for the interview and well-oriented X4. She appears at her stated age and maintains good eye contact throughout the interview. She has pressured speech and is spontaneous. She looks confused with delusional thoughts. No signs of abnormal psychomotor movements. She denies auditory or visual hallucinations. No suicidal or homicidal ideations were noticed. She has poor judgment.
Differential Diagnosis
Schizophrenia (Primary Diagnosis): The DSM 5 diagnosis for Schizophrenia requires the client to present delusion, hallucinations, disorganized speech, and grossly disorganized and negative symptoms (American Psychiatric Association, 2022). Criterion B also requires the patient to have experienced reduced achievements in one or significant areas, e.g., the workplace. Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders The client expresses delusions by assuming her boss wants to fire her because of her love affair. The patient also exhibits disorganized speech. When asked why she thinks Mr. Nehring and Eric have ganged up against her, she responds to a different topic by saying Eric is lustful. The client also meets criterion B, having made no sale for the previous three weeks. Zero sales implicate the reduced performance in her workplace.
Substance/Medication-Induced Psychotic Disorder (SMIPD): SMIPD diagnosis is characterized by solid delusions and hallucinations attributed to the substance’s/physiological dosage effects. Even though this diagnosis met criteria A, there lacked medical and physical history, laboratory findings, or physical examination evidence that the above symptoms are caused by substance/ medical use (American Psychiatric Association, 2022). The urine and drug laboratory test proved negative.
Brief Psychotic Disorder: The diagnosis of brief psychotic disorder includes two out of the following symptoms: hallucinations, disorganized speech, delusions, or grossly abnormal psychomotor behavior occurring in at least one day in at least a month. However, for Schizophrenia, the disorder has shown consistency in declined work performance.
Reflections:
If I were to conduct this session, I would create a strong rapport with patients to ensure they disclose sufficient information to make a diagnosis. This information includes psychiatric past medical history and consent to allow for communication with parents to obtain necessary, crucial details. One legal issue when dealing with Schizophrenia is hospitalizing a patient against their will. A clinician might fail to hospitalize a patient for fear of legal action. A clinician acting for their legal safety other than the client’s best interest poses legal and ethical dilemmas. Conducting group therapies can help in health promotion. Through these therapies, the community will reduce social isolation (Sadock et al., 2015), enhance cohesiveness and improve reality testing Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders.
References
American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
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.
For this Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders 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. Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
- 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 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders. 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.).
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
- Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Rubric Detail
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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 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
• ROS—
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.—
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-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.—
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!), social determinates of health, 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.).—
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).— Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
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.—
Correct grammar, mechanics, and punctuation—
| Total Points: 100 |
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