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

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 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.).

RBRIC:

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 • 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 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.

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!), 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).

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.

Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation

CASE STUDY VIDEO WITH CC

Week 7 Schizophrenia and Other Psychotic Disorders; Medication Induced Movement Disorders

Training Title 9

Name: Ms. Nijah Branning

Gender: female

Age: 25 years old

T- 98.4 P- 80 R 18 128/78 Ht 5’0 Wt 120lbs

Background: Raised by parents, lives alone in Santa Monica, CA. Only child. Works in office

supply sales, has a bachelor’s in business degree. Has medical history of hypothyroidism,

currently treated with daily levothyroxine. Guarded and declined to discuss past psychiatric

history. Denied family mental health issues, declined to allow you to speak to parents for

collaborative information. Allergies: medical tape; menses regular

Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-9

Training Title 24

Name: Ms. Jess Cunningham

Gender: female

Age: 28 years old

T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs

Background: Jess is brought for evaluation by her 2 roommates who are concerned with

behaviors that began 12 days after Jess’s younger brother committed suicide in front of her via

GSW after his girlfriend broke up with him. She is estranged from her parents and her brother

was her only sibling. She is only sleeping 1–2 hours/24hrs; she will only canned foods. She

smokes cannabis daily since she was 16, goes out on weekdays 2–3 times with her roommates

and has couple drinks of beer. She was prescribed alprazolam 1mg twice daily as needed by her

PCP for 15 days. She works as a bartender.

Symptom Media. (Producer). (2016). Training title 24 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-24

Training Title 29

Name: Mr. Jay Feldman

Gender: male

Age:19 years old

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

Background: European-American male. He has two younger brothers, one with history of

ADHD, the other with history of anxiety. His mother has anxiety; his father has paranoia

schizophrenia. He is home for spring break. He has no previous medical problems.

Developmental milestones met as child. Appetite is inconsistent and it seems he has lost 18lbs

since first going back to school in the fall. Jason has not acted this way before but did have a

short trial of aripiprazole in the last six months of high school for mild paranoia. He stopped the

medication after graduation as he could not tolerate due to side effects of akathisia. Jason has

several friends but has not kept in touch with them since being back home. He has not been

showering. Sleeping 4–5 hrs.

Symptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-29

Training Title 134

Name: Mrs. Bunny Warren

Gender: female

Age: 33 years old

Background: Bunny was brought in by her best friend, Patty, after the police responded to her

home the fifth time today. The police was threatening to arrest her for misuse of the 911

system, Bunny called you and you informed the police she needed to go the emergency room.

She has been calling 911 saying people are looking in her windows, standing across the street

watching her, stated they are watching for her husband to return home so they can hurt him.

Today, she has a stomachache. She believes there is a snake inside of her stomach which she

would like to have removed. She stopped eating 2 days ago because of this.

During the assessment, the patient seemed on edge, anxious, and paranoid. The patient has

history of scoliosis. This is her third presentation to this hospital, she had one psychiatric

admission 2 years ago. No self-harm behaviors but has been physically aggressive toward

others in the past. She is guarded and refuses to answer questions whether there are memory

or concentration problems. She denies any recent head injuries. She states that she has been

sleeping nightly, one or two hours at a time and waking up throughout the night. Refuses labs,

refuses to have her vital signs obtained.

She obtains SSDI. She lives in Atlanta, GA. Bunny denies ever using any drugs and drinks

occasionally, once a month. She has a sister who is ten years older, both parents deceased in

the last two years. She has no children, her husband is out of town, truck driver. Family history

includes that her father had two previous inpatient psychiatric hospitalizations after bad drug

experiences in the 1970s, for one week each time. Mother had diagnosis and ongoing

treatment for depression. Her paternal grandmother was state hospitalized for several years.

She denies any past history of traumatic experiences, but her friend does say that losing her

parents was hard for her emotionally. No history of military service. No legal issues currently.

Has HS diploma. Allergies: haloperidol

Symptom Media. (Producer). (2018). Training title 134 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-134