response
wk 4 response due tomorrow night
3 months ago 20
wk4.docx
Wk4Assgn2_Auletta_H1.pdf.pdf
wk4.docx
BY MULTIPLE DAYS BETWEEN DAYS 4 AND 7
Respond at least 2 times each to all colleagues who presented this week (should be 2-3 presenters each week). The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
X.V.’s Case: Objectives and Questions
Objective #1.
By the end of this presentation, the participants will understand the importance of obtaining collateral information to arrive at the correct diagnosis for the patient.
Objective #2.
The participants will be able to understand when a patient meets the criteria for an involuntary psychiatric hospitalization.
Objective #3.
The participants will know the difference between Substance-Induced Psychosis (SIP) and psychosis produced by schizophrenia or any other mental illness.
Questions:
#1. Why is it so important to obtain collateral information before diagnosing a patient?
#2. What were the symptoms that X.V. had that made him a candidate for an involuntary admission?
#3. What is the difference between Substance-Induced Psychosis (SIP) and psychosis produced by schizophrenia or any other mental illness?
Wk4Assgn2_Auletta_H1.pdf.pdf
Week 4: Patient Case Study
Hester Auletta
College of Nursing-PMHNP, Walden University
PRAC 6675: PMHNP Care Across the Lifespan II
Dr. Demesia Brown
March 18, 2026
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
Subjective:
CC (chief complaint): “My mom thinks I need residential treatment, but I don’t want to go. I think I just have ADHD.”
HPI: The patient is an 8th-grade female presenting for psychiatric evaluation and medication management due to concerns raised by her adoptive mother regarding worsening academic performance, inconsistent treatment adherence, and consideration for residential treatment placement. The patient is currently failing multiple classes and has a pattern of school absenteeism. Historically, she performed better in a private school setting but experienced bullying and social isolation, limiting peer interaction. She expresses frustration with current expectations and strongly opposes residential placement, preferring to remain at home and continue her education.
The patient attributes her primary difficulties to attention deficits consistent with ADHD and reports some overall emotional improvement. However, she acknowledges ongoing challenges with completing schoolwork. Medication adherence has been inconsistent, as she previously discontinued sertraline liquid due to a dislike of the formulation. She is currently prescribed lisdexamfetamine by another provider. She denies suicidal ideation, homicidal ideation, hallucinations, or delusions. Sleep and appetite are reported as adequate. Symptoms have been present throughout the current school year and have progressively worsened, significantly impairing academic functioning and family relationships.
Substance Current Use: The patient denies use of alcohol, tobacco, or recreational substances.
Medical History: The patient has a history of attention difficulties and academic impairment consistent with a prior diagnosis of ADHD.
● Current Medications: The patient is currently taking lisdexamfetamine
(Vyvanse) 20 mg chewable daily and sertraline (Zoloft) 25 mg daily, initiated with titration from 12.5 mg.
● Allergies: No Known Drug Allergies ● Reproductive Hx: Not Discussed
ROS:
GENERAL: The patient denies fatigue, fever, or weight changes.
HEENT: No headaches or vision changes reported.
SKIN: No rashes or lesions reported.
CARDIOVASCULAR: No chest pain or palpitations reported.
© 2022 Walden University Page 2 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
RESPIRATORY: Denies shortness of breath.
GASTROINTESTINAL: No nausea, vomiting, or abdominal pain reported.
GENITOURINARY: No complaints reported.
NEUROLOGICAL: Reports attention and concentration difficulties.
MUSCULOSKELETAL: No pain or weakness reported.
HEMATOLOGIC: No bleeding or bruising concerns reported.
LYMPHATICS: No lymph node swelling reported.
ENDOCRINOLOGIC: No endocrine symptoms reported.
Objective: The patient attended an in-person visit and appeared alert and oriented to person, place, and time. Her behavior was initially guarded and resistant, with frequent phone use and limited engagement. Affect ranged from irritable to cooperative during discussion of academic concerns and treatment options. Speech was coherent and organized, and thought processes were logical and goal-directed. There was no evidence of psychosis, suicidal ideation, or homicidal ideation. Insight into her academic challenges was partial. Interaction with her guardian suggested potential family dynamic concerns, as the mother appeared somewhat passive in behavioral management.
Diagnostic results: No laboratory testing or formal rating scales were completed during this visit. Prior clinical history supports a diagnosis of ADHD. Previous cognitive testing (Creyos) supports probable ADHD but no other significant cognitive deficits.
Assessment:
Mental Status Examination: The patient is an age-appropriate adolescent female with guarded and resistant behavior. Speech is normal in rate and tone. Mood is irritable with an aligned affect. Thought processes are logical and goal-directed, with no evidence of delusions or hallucinations. Insight is partial, and judgment is fair. She is alert and oriented to person, place, and time, with intact memory but impaired attention and concentration. She denies suicidal and homicidal ideation.
Diagnostic Impression: The primary diagnosis is Attention-Deficit/Hyperactivity Disorder (ADHD), predominantly inattentive presentation. This diagnosis is supported by persistent attention deficits, academic impairment, difficulty completing tasks, and functional impairment in educational performance across settings, consistent with DSM-5-TR diagnostic criteria (American Psychiatric Association, 2022). Evidence-based literature supports the association between ADHD and academic
© 2022 Walden University Page 3 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
dysfunction, as well as the effectiveness of stimulant medication and behavioral interventions in improving outcomes (Peterson et al., 2024; Ogundele & Ayyash, 2023). Differential diagnoses include Oppositional Defiant Disorder (ODD), as the patient demonstrates irritability and resistance to authority; however, these behaviors may be secondary to academic frustration rather than a persistent pattern of defiance. Adjustment Disorder with mixed disturbance of emotions and conduct is also considered, given the history of bullying, school transition, and psychosocial stressors contributing to emotional dysregulation. Additionally, alternative and adjunctive treatments, including behavioral therapy and lifestyle interventions, may support symptom improvement in pediatric ADHD populations (Leon et al., 2024).
Reflections: If this session were conducted again, additional time would be dedicated to building rapport to reduce resistance and improve engagement. Utilizing motivational interviewing techniques may enhance the patient’s willingness to participate in treatment and improve medication adherence. Future care should emphasize a collaborative, patient-centered approach to increase treatment acceptance.
Case Formulation and Treatment Plan:
The patient presents with ADHD complicated by academic failure, psychosocial stressors, and inconsistent treatment adherence. A multimodal treatment approach is indicated. Psychotherapy will include initiation of cognitive behavioral therapy targeting emotional regulation and academic engagement. Family therapy is recommended to improve communication, parental involvement, and boundary setting.
Pharmacologic treatment will continue with lisdexamfetamine 20 mg daily and initiate sertraline 12.5 mg daily for one week, increasing to 25 mg daily. This approach aims to address emotional dysregulation and comorbid anxiety symptoms that may exacerbate ADHD-related impairment.
Non-pharmacologic interventions will include structured routines, academic planning, reduced phone use during schoolwork, and collaboration with school personnel. Recommendations include school counseling services and evaluation for academic accommodations such as a 504 plan or IEP.
Alternative therapies such as mindfulness practices, physical activity (e.g., structured exercise like Muay Thai), and omega-3 supplementation may provide adjunctive benefits. Follow-up is scheduled in four weeks to reassess medication adherence, symptom progression, and academic performance. Consideration of higher levels of care will depend on treatment response.
© 2022 Walden University Page 4 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
PRECEPTOR VERIFICATION:
I confirm the patient used for this assignment is a patient that was seen and managed by the student at
their Meditrek approved clinical site during this quarter course of learning.
Preceptor signature:
Date: 3/18/2026
© 2022 Walden University Page 5 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Leon, L., Tran, T., Navadia, M., Patel, J., Vanderveen, A., Cruz, M. I., Le, T., Assuah, F. B., Prager, V., & Costin, J. M. (2024). Alternative treatments to pharmacological therapy in pediatric populations with attention-deficit/hyperactivity disorder (ADHD): A scoping review. Cureus, 16(3), e55792. https://doi.org/10.7759/cureus.55792
Ogundele, M. O., & Ayyash, H. F. (2023). ADHD in children and adolescents: Review of current practice of non-pharmacological and behavioural management. AIMS Public Health, 10(1), 35–51. https://doi.org/10.3934/publichealth.2023004
Peterson, B. S., Trampush, J., Maglione, M., Bolshakova, M., Rozelle, M., Miles, J., Pakdaman, S., Brown, M., Yagyu, S., & Motala, A. (2024). Treatments for ADHD in children and adolescents: A systematic review. Pediatrics, 153(4), e2024065787. https://doi.org/10.1542/peds.2024-065787
© 2022 Walden University Page 6 of 6
wk4.docx
BY MULTIPLE DAYS BETWEEN DAYS 4 AND 7
Respond at least 2 times each to all colleagues who presented this week (should be 2-3 presenters each week). The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
X.V.’s Case: Objectives and Questions
Objective #1.
By the end of this presentation, the participants will understand the importance of obtaining collateral information to arrive at the correct diagnosis for the patient.
Objective #2.
The participants will be able to understand when a patient meets the criteria for an involuntary psychiatric hospitalization.
Objective #3.
The participants will know the difference between Substance-Induced Psychosis (SIP) and psychosis produced by schizophrenia or any other mental illness.
Questions:
#1. Why is it so important to obtain collateral information before diagnosing a patient?
#2. What were the symptoms that X.V. had that made him a candidate for an involuntary admission?
#3. What is the difference between Substance-Induced Psychosis (SIP) and psychosis produced by schizophrenia or any other mental illness?
Wk4Assgn2_Auletta_H1.pdf.pdf
Week 4: Patient Case Study
Hester Auletta
College of Nursing-PMHNP, Walden University
PRAC 6675: PMHNP Care Across the Lifespan II
Dr. Demesia Brown
March 18, 2026
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
Subjective:
CC (chief complaint): “My mom thinks I need residential treatment, but I don’t want to go. I think I just have ADHD.”
HPI: The patient is an 8th-grade female presenting for psychiatric evaluation and medication management due to concerns raised by her adoptive mother regarding worsening academic performance, inconsistent treatment adherence, and consideration for residential treatment placement. The patient is currently failing multiple classes and has a pattern of school absenteeism. Historically, she performed better in a private school setting but experienced bullying and social isolation, limiting peer interaction. She expresses frustration with current expectations and strongly opposes residential placement, preferring to remain at home and continue her education.
The patient attributes her primary difficulties to attention deficits consistent with ADHD and reports some overall emotional improvement. However, she acknowledges ongoing challenges with completing schoolwork. Medication adherence has been inconsistent, as she previously discontinued sertraline liquid due to a dislike of the formulation. She is currently prescribed lisdexamfetamine by another provider. She denies suicidal ideation, homicidal ideation, hallucinations, or delusions. Sleep and appetite are reported as adequate. Symptoms have been present throughout the current school year and have progressively worsened, significantly impairing academic functioning and family relationships.
Substance Current Use: The patient denies use of alcohol, tobacco, or recreational substances.
Medical History: The patient has a history of attention difficulties and academic impairment consistent with a prior diagnosis of ADHD.
● Current Medications: The patient is currently taking lisdexamfetamine
(Vyvanse) 20 mg chewable daily and sertraline (Zoloft) 25 mg daily, initiated with titration from 12.5 mg.
● Allergies: No Known Drug Allergies ● Reproductive Hx: Not Discussed
ROS:
GENERAL: The patient denies fatigue, fever, or weight changes.
HEENT: No headaches or vision changes reported.
SKIN: No rashes or lesions reported.
CARDIOVASCULAR: No chest pain or palpitations reported.
© 2022 Walden University Page 2 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
RESPIRATORY: Denies shortness of breath.
GASTROINTESTINAL: No nausea, vomiting, or abdominal pain reported.
GENITOURINARY: No complaints reported.
NEUROLOGICAL: Reports attention and concentration difficulties.
MUSCULOSKELETAL: No pain or weakness reported.
HEMATOLOGIC: No bleeding or bruising concerns reported.
LYMPHATICS: No lymph node swelling reported.
ENDOCRINOLOGIC: No endocrine symptoms reported.
Objective: The patient attended an in-person visit and appeared alert and oriented to person, place, and time. Her behavior was initially guarded and resistant, with frequent phone use and limited engagement. Affect ranged from irritable to cooperative during discussion of academic concerns and treatment options. Speech was coherent and organized, and thought processes were logical and goal-directed. There was no evidence of psychosis, suicidal ideation, or homicidal ideation. Insight into her academic challenges was partial. Interaction with her guardian suggested potential family dynamic concerns, as the mother appeared somewhat passive in behavioral management.
Diagnostic results: No laboratory testing or formal rating scales were completed during this visit. Prior clinical history supports a diagnosis of ADHD. Previous cognitive testing (Creyos) supports probable ADHD but no other significant cognitive deficits.
Assessment:
Mental Status Examination: The patient is an age-appropriate adolescent female with guarded and resistant behavior. Speech is normal in rate and tone. Mood is irritable with an aligned affect. Thought processes are logical and goal-directed, with no evidence of delusions or hallucinations. Insight is partial, and judgment is fair. She is alert and oriented to person, place, and time, with intact memory but impaired attention and concentration. She denies suicidal and homicidal ideation.
Diagnostic Impression: The primary diagnosis is Attention-Deficit/Hyperactivity Disorder (ADHD), predominantly inattentive presentation. This diagnosis is supported by persistent attention deficits, academic impairment, difficulty completing tasks, and functional impairment in educational performance across settings, consistent with DSM-5-TR diagnostic criteria (American Psychiatric Association, 2022). Evidence-based literature supports the association between ADHD and academic
© 2022 Walden University Page 3 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
dysfunction, as well as the effectiveness of stimulant medication and behavioral interventions in improving outcomes (Peterson et al., 2024; Ogundele & Ayyash, 2023). Differential diagnoses include Oppositional Defiant Disorder (ODD), as the patient demonstrates irritability and resistance to authority; however, these behaviors may be secondary to academic frustration rather than a persistent pattern of defiance. Adjustment Disorder with mixed disturbance of emotions and conduct is also considered, given the history of bullying, school transition, and psychosocial stressors contributing to emotional dysregulation. Additionally, alternative and adjunctive treatments, including behavioral therapy and lifestyle interventions, may support symptom improvement in pediatric ADHD populations (Leon et al., 2024).
Reflections: If this session were conducted again, additional time would be dedicated to building rapport to reduce resistance and improve engagement. Utilizing motivational interviewing techniques may enhance the patient’s willingness to participate in treatment and improve medication adherence. Future care should emphasize a collaborative, patient-centered approach to increase treatment acceptance.
Case Formulation and Treatment Plan:
The patient presents with ADHD complicated by academic failure, psychosocial stressors, and inconsistent treatment adherence. A multimodal treatment approach is indicated. Psychotherapy will include initiation of cognitive behavioral therapy targeting emotional regulation and academic engagement. Family therapy is recommended to improve communication, parental involvement, and boundary setting.
Pharmacologic treatment will continue with lisdexamfetamine 20 mg daily and initiate sertraline 12.5 mg daily for one week, increasing to 25 mg daily. This approach aims to address emotional dysregulation and comorbid anxiety symptoms that may exacerbate ADHD-related impairment.
Non-pharmacologic interventions will include structured routines, academic planning, reduced phone use during schoolwork, and collaboration with school personnel. Recommendations include school counseling services and evaluation for academic accommodations such as a 504 plan or IEP.
Alternative therapies such as mindfulness practices, physical activity (e.g., structured exercise like Muay Thai), and omega-3 supplementation may provide adjunctive benefits. Follow-up is scheduled in four weeks to reassess medication adherence, symptom progression, and academic performance. Consideration of higher levels of care will depend on treatment response.
© 2022 Walden University Page 4 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
PRECEPTOR VERIFICATION:
I confirm the patient used for this assignment is a patient that was seen and managed by the student at
their Meditrek approved clinical site during this quarter course of learning.
Preceptor signature:
Date: 3/18/2026
© 2022 Walden University Page 5 of 6
NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Leon, L., Tran, T., Navadia, M., Patel, J., Vanderveen, A., Cruz, M. I., Le, T., Assuah, F. B., Prager, V., & Costin, J. M. (2024). Alternative treatments to pharmacological therapy in pediatric populations with attention-deficit/hyperactivity disorder (ADHD): A scoping review. Cureus, 16(3), e55792. https://doi.org/10.7759/cureus.55792
Ogundele, M. O., & Ayyash, H. F. (2023). ADHD in children and adolescents: Review of current practice of non-pharmacological and behavioural management. AIMS Public Health, 10(1), 35–51. https://doi.org/10.3934/publichealth.2023004
Peterson, B. S., Trampush, J., Maglione, M., Bolshakova, M., Rozelle, M., Miles, J., Pakdaman, S., Brown, M., Yagyu, S., & Motala, A. (2024). Treatments for ADHD in children and adolescents: A systematic review. Pediatrics, 153(4), e2024065787. https://doi.org/10.1542/peds.2024-065787
© 2022 Walden University Page 6 of 6