DOCUMENT 7

Week Seven: Schizophrenia

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

Subjective:

CC (chief complaint): The patient presents in the healthcare facility with complaints of paranoia, inconsistent appetite, lack of enough sleep, and withdrawal.

HPI: J.F., a 19-year-old European-American male, presents at the healthcare facility for psychiatric evaluation of paranoia schizophrenia. He is currently not under any psychotropic medications but he had been administered with aripiprazole for the last six months for mild paranoia. His parents booked the hospital appointment for him to get the psychiatric test done. The patient has an inconsistent appetite which has resulted in the loss of weight, inadequate sleep of four to five hours, and paranoia. The patient denies any feelings of suicide ideation.

Past Psychiatric History:

· General Statement: It is the second time that the patient is seeking treatment for a psychological disorder.

· Hospitalizations: The patient has not been hospitalized. He indicates that it is his second time to present to a healthcare facility with a psychological issue.

· Medication trials: The patient was on a six-month trial for aripiprazole for mild paranoia but the patient indicates he stopped taking the medicine due to akathisia.

· Psychotherapy or Previous Psychiatric Diagnosis: Mild paranoia

Substance Current Use and History: The patient denies any history of substance abuse and alcohol.

Family Psychiatric/Substance Use History: The patient has two younger brothers. One of the brothers has a history of anxiety whereas the other brother has a history of ADHD. His father has paranoia schizophrenia and his mother has anxiety.

Psychosocial History: The patient currently studies Theoretical physics and advanced calculus at State College. He indicates that he is thinking of majoring in physics and philosophy. The patient indicates that he took advanced placement courses in high school. He has several friends at home. However, since he came home for the spring break, he has not been in touch with them.

Medical History: Mild paranoia

· Current Medications: Currently not taking any medications

· Allergies: The patient has no known latex, drug, or food allergies

· Reproductive Hx: He is heterosexual.

ROS:

· GENERAL: The patient has lost 18 lbs. His temperature is normal. The patient has an inconsistent appetite and he gets inadequate sleep.

· HEENT: The patient denies any visual loss, double vision, or blurred vision. Denies any pain or discomfort in the ears and throat. The patient does not have any pain in his neck.

· SKIN: The patient denies any skin problems.

· CARDIOVASCULAR: The patient denies any discomfort or pain in his chest. He does not have a history of cardiovascular illnesses or conditions.

· RESPIRATORY: The patient denies any breathing difficulties and also denies having coughs.

· GASTROINTESTINAL: The patient denies any abdominal pain. He also denies feeling nauseated, vomiting, or diarrhea. However, he has an inconsistent appetite.

· GENITOURINARY: The patient does not have any history of STIs. He is heterosexual.

· NEUROLOGICAL: The patient feels paranoid wherever he is. He seems to be having delusions and hallucinations.

· MUSCULOSKELETAL: The patient denies back pains, muscle pains or joint pains, and stiffness.

· HEMATOLOGIC: No history of transfusion, lesion removal, skin cancer, and bleeding disorders.

· LYMPHATICS: No enlarged nodes

· ENDOCRINOLOGIC: No reports of heart intolerance.

Objective:

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

Diagnostic results: To diagnose schizophrenia according to the DSM-IV 2, a patient should portray the following five symptoms; disorganized speech, negative symptoms, delusions, disorganized or catatonic behavior, and hallucinations. 

Assessment:

Mental Status Examination: The patient looks like his stated age. He was not cooperative alert during the interactions with the psychiatric healthcare practitioner. He seems to be disturbed and he portrays some of the delusions during the interview. He is neatly groomed and has dressed appropriately according to the weather. The patient’s speech was affected and it is not easily understood. He denied suicidal ideation. The patient has a below-average concentration as he was struck by thoughts as he was talking thus reducing his concentration. 

Differential Diagnoses: 

Paranoia schizophrenia - This is a psychotic disorder that has positive symptoms of schizophrenia such as hallucinations and delusions. It creates a blur between what is real and what is not real (Krzystanek et al., 2017). The diagnosis was supported by the signs and symptoms that the patient presented. It was supported by delusions, paranoia, inconsistent appetite, and lack of enough sleep. 

Schizoaffective disorder - This is a chronic mental illness that is characterized by the signs and symptoms of schizophrenia. It is also characterized by the signs and symptoms of a mood disorder such as depression and mania. Hus, that was the reason it was ruled out (Miller & Black, 2019).

Bipolar I Disorder - This is a mental disorder characterized by manic episodes for at least seven days of manic symptoms that are very severe. This diagnosis was ruled out due to lack of intense moods and hyperactivity which is one of the symptoms of bipolar I disorder (Cloutier, et al., 2018).

Psychotic depression - This is a serious mood disorder that occurs as a subtype of major depression. It is characterized by sins and symptoms such as hallucinations and delusions. However, it was ruled out due to a lack of signs and symptoms of depression (Dubovsky, et al., 2021). 

Reflections: I agree with the preceptor’s diagnostic impression and assessment. The assessment uses the data that is collected from the patient to make an informed diagnosis. If I would do the assessment again, I would ensure that a full body assessment of the patient is conducted. That can help to identify other areas that may be affected by the issue. Ethical considerations were made during the assessment. The patient data that was collected was maintained at high levels of confidentiality. Additionally, the patient was involved in the diagnostic process.

References

Cloutier, M., Greene, M., Guerin, A., Touya, M., & Wu, E. (2018). The economic burden of bipolar I disorder in the United States in 2015. Journal of affective disorders, 226, 45-51.

Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic depression: diagnosis, differential diagnosis, and treatment. Psychotherapy and Psychosomatics, 90(3), 160-177.

Krzystanek, M., Krysta, K., & Skałacka, K. (2017). Treatment compliance in the long-term paranoid schizophrenia telemedicine study. Journal of technology in behavioral science, 2(2), 84-87.

Miller, J. N., & Black, D. W. (2019). Schizoaffective disorder: A review. Annals of clinical psychiatry: official journal of the American Academy of Clinical Psychiatrists, 31(1), 47-53.