class response

PRAC_This criterion is linked to a Learning OutcomeResponses	85 to >76.0 ptsExcellentResponses exhibit synthesis, critical thinking, and application to practice settings.... Responses provide clear, concise opinions and ideas that are supported by at least two scholarly sources.... Responses demonstrate synthesis and understanding of Learning Objectives.... Communication is professional and respectful to colleagues.... Presenters' prompts/questions posed in the case presentations are thoroughly addressed.... Responses are effectively written in standard, edited English. 76 to >67.0 ptsGoodResponses exhibit critical thinking and application to practice settings.... Responses provide clear, concise opinions and ideas that are supported by 2 or more credible sources.... Communication is professional and respectful to colleagues.... Presenters' prompts/questions posed in the case presentations are addressed.... Responses are effectively written in standard, edited English. 67 to >59.0 ptsFairResponses are on topic and may have some depth.... Responses may lack clear, concise opinions and ideas, and only one or no credible sources are cited.... Responses posted in the Discussion may lack effective professional communication.... Presenters' prompts/questions posed in the case presentations are inadequately addressed. 59 to >0 ptsPoorResponses may not be on topic and lack depth.... No credible sources are cited.... Responses posted in the Discussion lack effective professional communication.... Responses to colleagues’ prompts/questions are missing.	85 pts
This criterion is linked to a Learning OutcomeParticipation	15 to >13.0 ptsExcellentMeets requirements for participation by responding at least twice to each colleague who presented this week. Responses are carried out over multiple days between Days 4 and 7. 13 to >11.0 ptsGoodMeets requirements for participation by responding at least twice to each colleague who presented this week, over at least 2 days. 11 to >10.0 ptsFairParticipants respond at least twice to each colleague who presented this week, but responses may occur all in 1 day. 10 to >0 ptsPoorDoes not meet requirements for participation by responding at least twice to each colleague who presented this week.	15 pts

Total Points: 100

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Week #4 Complex Case Study Presentation

Mirna Gomez

College of Nursing-PMHNP, Walden University

PRAC 6675: PMHNP Care Across the Lifespan II

Demesia Brown

Assignment Due: March 18, 2026

Subjective:

CC (chief complaint): “My mother called 911 after she found a residue that looked like cocaine on a credit card.”

HPI: X.V. is a 28-year-old single, unemployed African-American male with a past psychiatric history significant for ADHD which was diagnosed as an adult, no history of previous psychiatric hospitalizations and currently not in outpatient treatment or on medications, who presented to Newark Beth Israel Medical Center as an involuntary psychiatric aadmission, transfered from Clara Maas Medical Center after the patient presented there brought in by EMS. The patient reportedly had not slept in 8 days and was found to have a residue, possibly cocaine, on a credit card. Per the chart review, the patient had been acting bizarrely, with an abnormal increase in energy and a lack of sleep. Believing that people were hacking his phone, he reported that his brother and his ex-girlfriend were involved in pornography and were having an affair. Patient was admitted involuntarily to unit D5 and evaluated today. The patient spoke at length about his phone being hacked, as evidenced by the deletion of messages. Patient reported feeling good. Had no psychiatric complaints. Sleep and appetite were reported as good. Patient denied not sleeping for 8 days. The patient also denied the other reports obtained from collateral information in the emergency room from his mother, who reported that the patient was presenting bizarre behavior at home prior to coming to the hospital, as evidenced by the patient being naked in the living room with only his laptop covering his private parts. His mother reported that the patient showed her a pornography video where two people were having sex, whom the patient strongly believed were his brother and ex-girlfriend—denied auditory or visual hallucinations. Denied suicidal ideations, intent, or plan and denied homicidal ideations. Patient denied any history of suicide attempts, self-injurious behaviors, or history of violence. Patient admitted to smoking cannabis, but firmly denied using cocaine. The patient’s urine toxicology was positive for cocaine and cannabis.

Substance Current Use: Cocaine and cannabis.

Medical History: No chronic medical problems

· Current Medications: Start Risperdal 2 mg twice daily for psychosis

· Allergies: No known medication allergies

· Reproductive Hx: Patient is single and was recently involved in a relationship

ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

Objective:

Diagnostic results: Urine Drug Screen (UDS) is positive for Cocaine and cannabis.

Assessment:

Mental Status Examination:

X.V. is dressed casually in street clothing with fair hygiene. Makes fair good eye contact. Speech was coherent, logical, and relevant, with a slightly increased rate, normal volume, and increased productivity. Eye contact was fair. Mood was good, and affect was somewhat expansive. Thought process exhibited slight flight of ideas. Denied suicidal or homicidal ideations. The patient is currently unable to care for himself. Denied auditory or visual hallucinations. Patient presents as paranoid and delusional. Insight and judgment were limited.

Diagnostic Impression:

Bipolar 1 disorder, most recent episode manic with psychotic features.

As per the DSM-5, for a patient to meet the criteria for this diagnosis, the patient has to have a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day. Collateral information from X’s mother indicates that he is experiencing an abnormal increase in energy and a lack of sleep. Bipolar I disorder is among the most chronic, prevalent, and disabling mental health conditions (Kaur et al., 2026).

Attention Deficit Hyperactivity Disorder (ADHD)

X.V. was only diagnosed with ADHD as an adult. His hyperactivity and excess energy are consistent with the DSM-5 criteria for ADHD. Many adult patients being evaluated for ADHD have never had a diagnosis of the disorder when they were children or adolescents. This poses difficulties for the diagnostic process because the disorder's diagnostic criteria require the onset of impairing symptoms in childhood. In the absence of a childhood diagnosis, documenting childhood onset can be challenging due to the age-dependent decline in symptoms of ADHD

(Hutt Vater et al., 2024).

Substance-induced psychotic (SIP) disorder:

According to the DSM-5, substance-induced psychosis (SIP) is defined as a brief psychotic syndrome that occurs during or following psychoactive substance use, but that is not explained based on acute intoxication alone and does not form part of a withdrawal state (Jeyapalan et al.,

2024). X.V. has recently started consuming cocaine and has admitted to using marijuana.

Reflections:

X.V.’s new onset of bizarre behavior has raised a red flag for his family, which is why they decided to have him receive psychiatric medical attention. The primary diagnosis of Bipolar 1 disorder, most recent episode manic with psychotic features, chosen for this case, is justified by the bizarre behavior of X.V., manifested by an abnormal increase in energy and a lack of sleep, which is the manic part, together with psychotic behavior as evidenced by patient believing that people were hacking his phone, he also reported that his brother and his Ex girlfriend were involved in pornography and were having an affair. His hyperactivity is consistent with the new diagnosis of adult ADHD. Lastly, the SIP disorder is clearly presented with symptoms of paranoia and delusion, as he believes that his phone is being hacked, and that his ex-girlfriend and his brother are having an affair (Jeyapalan et al., 2024). The legal and ethical considerations in X.V.’s case are based on the fact that he is not able to care for himself and to make decisions in life utilizing good judgment. X.V. is committed against his will to receive involuntary psychiatric treatment ordered by a judge.

Case Formulation and Treatment Plan:

1. Admit to involuntary psychiatry as the patient presents manic, psychotic and is unable to care for self. Patient is currently not voluntary for admission

2. Patient does not need one-to-one observation as the patient’s C-SSRS score is no risk, the patient denies any history of suicide attempts or self-injurious behaviors, and denies current suicidal ideations, intent, or plan. The patient may be maintained safely on every 15-minute observation

3. Start Risperdal 2 mg twice daily for psychosis

4. Follow-up on results of new onset psychosis workup

5. Encourage group participation

6. Refer to appropriate outpatient psychiatric services upon stabilization and discharge

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: ________________________

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Chloe Hutt Vater, Maura DiSalvo, Alyssa Ehrlich, Haley Parker, Hannah O’Connor, Stephen V.

Faraone, & Joseph Biederman. (2024). ADHD in Adults: Does Age at Diagnosis Matter? Journal of Attention Disorders, 28(5), 614–624. https://doi.org/10.1177/10870547231218450

Jeyapalan, J., Sassi, P., Mittendorfer Rutz, E., Tiihonen, J., Taipale, H., & Niemelä, S. (2024).

Characteristics of incident substance-induced psychosis compared to first-episode psychotic disorders: A nationwide register-linkage study from Sweden. Schizophrenia Research, 264, 526–533. https://doi.org/10.1016/j.schres.2024.01.033

Kaur, G., Miglani, M., Upadhyay, P., Kaur, M., Kumar, P., & Mishra, B. P. (2026). The Interconnection

Between Social Skills, Functional Impairment, and Theory of Mind in Bipolar I Disorder. Journal of Pharmacy & Bioallied Sciences, 18, S93–S95. https://doi.org/10.4103/jpbs.jpbs_711_25