NRNP 6635: Psychopathology and Diagnostic Reasoning
Week 7: Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.
For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such disorders show a range of unique symptoms. This range of symptoms may impede an individual’s ability to function in daily life. As a result, clinicians address a patients ability or inability to function in life.
This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.
Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
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 weeks 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.
· Use case title# 29 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.
For the assignmnet
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 patients 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. 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.).
Learning Resources
Tips for CPE (Comprehensive Psychiatric Evaluation)
Hello All,
Please review the below tips.
1. The CC is a direct quote from the patient or caregiver if from a caregiver include that information.
2. The HPI is a key component that takes practice. It should be clear and concise providing information that is pertinent to the signs and symptoms being presented without excessive information. The HPI should paint a picture of the client and is the foundation for the diagnosis. See the examples below:
Mrs. TP voluntarily presents today with severely depressed mood x 2 months that began after the death of her dog. She feels depressed more days than not, has crying spells 6 out of 7 days. No longer finds pleasure in gardening and has been written up at work due to missing work. She denies SI/HI. Reports feeling anxious daily with difficulty falling and staying asleep. Mrs. TP reports feeling tired daily and fatigue, with psychomotor retardation of just laying in bed. She has had an increase in appetite and gained 15 lbs in last 2 month. When she is having a depressed day she attempts to think about her grandchildren but this has not helped, she has avoided the dog park because it makes her depression worse. She denies previous episodes of depression.
What are the s/s present, what is the trigger/precipitating event, how often and how severe, what makes s/s better what makes it worse? I realize in the case study you may not be given the how often. That is when you insert below the HPI the following information was missing… This demonstrates that you understand the key components of an HPI.
4. The psychosocial history is not just what is in the background document there is more information in that background document than what belongs in the psychosocial assessment you will need to be able to pick out from that background document what belongs in the psychosocial what belongs in the medical history, past history etc..
5. You can not say the Physical exam is Not applicable. A exam of some sort is always applicable. What is the clients v/s, ht/wt, BMI. Every case study had a set of vital signs in the background information. What can you see during the interview? Is the clients skin pale? Was a tremor present? Any acute distress?? Keep in mind when you are practicing many insurance companies require at least 3 points of vital signs for payment of services. It is best to get in the habit of documenting this now.
6. Diagnostic results: If you are given none in the case study tell me what you would order, why, and what evidence supports it. It maybe blood work or CT of the head etc. Additionally, what assessment/screening tool would you use for this patient? Do not give every possible one but what you would order why, and, what evidence supports it. For example, if the patient expresses SI a suicide scale/assessment would be desirable.
7. MSE: you must give the MSE in paragraph form . The exemplar in you course is helpful but page 213 of Kaplan & Saddock gives more detail and helpful information.
8. Differential Diagnosis: I want to see that you can connect the presenting s/s to the diagnostic criteria. You can give background information about the diagnosis but you must demonstration that you can justify the diagnosis with the presentation and criteria. example” Mr.A.W. meets criteria A of depression as evidence by ……..
9. Reflections: Be sure that you are addressing each of the topics in the Assignment directions.
10. Citations. You must have at least 3 peer review scholarly journal and evidence based guidelines published within the last 5 year. Websites directed to patients are not scholarly and should not be used. To review correct APA citation see the Writing Center Citations: Overview.
11. Be sure you start your assignment with Title page and an introduction. The introduction should be a brief paragraph that gives some background information about the diagnosis. Then end with a purpose statement.
12. Writing concise sentences
Use the fewest and most efficient words possible to create information-packed sentences. Imagine that each word costs $20, and you have to budget carefully.
To clean up a wordy sentence:
1. Keep your adjectives in front of your nouns:
Change a person who is lively to a lively person
Change a business that is known to be trustworthy to a trustworthy business
2. Avoid beginning thoughts with it is or there are:
There are some people living in London who enjoy wearing hats could be changed to the following:
Some people in London enjoy wearing hats
3. Avoid redundancy:
I will study the theories, ideas, and models of three theorists could be I will study the ideas of three theorists
