NRNP6635 Week 7 : ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS ASSIGNMENT PAPER

NRNP6635 Week 7 : ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS ASSIGNMENT PAPER

NRNP6635 Week 7 : ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS ASSIGNMENT PAPER

Introduction

H.F. is a 20-year-old freshman in college who was referred for psychiatric evaluation due to academic difficulties. He is currently on spring break and exhibits weight loss, poor hygiene, social isolation, irregular appetite, and excessive sleep. He has a family history of mental illness and a personal history of moderate paranoia. In high school, he was enrolled and took part in a brief trial of risperidone for a mild form of paranoia, which he discontinued due to sedation adverse effects. H.F. has not showered since returning from school in the autumn and has lost 18 pounds. He confesses to using cannabis weekly. This case study is intended to assess H. F’s physical and mental health, identify any underlying medical conditions, and provide a diagnosis based on his symptoms and medical history.

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Purpose Statement

The aim of this case study is to assess Mr. HF.’s physical and mental health and to determine a possible diagnosis based on his current symptoms and medical history. To enhance H. F’s quality of life, this study will also investigate potential treatment options and management strategies for the diagnosed condition. The assessment of H. F’s symptoms will guide the determination of whether he suffers from depression, anxiety, or substance use disorders. These symptoms indicate the possibility of a debilitating and life-altering mental disorder. Mr. Feldman requires a comprehensive evaluation to rule out these disorders and determine the most appropriate treatment plan. Further evaluation is advised to determine whether medication, therapy, or both are required.

Subjective:

CC (chief complaint): “I do not know why my parents called for an appointment.”

HPI:  H.F., a 20-year-old European-American male, arrives for an evaluation scheduled by his parents during spring vacation. When quizzed about the purpose of the appointment, he was unable to provide an answer because he was unaware of why his parents had requested it. The clinician discovered through H. F’s parents that he was experiencing some trouble in school after speaking with them. H.F. is currently at home enjoying his spring vacation, and he reports that he has shed 18 pounds since he returned to school in the fall. He has not been taking showers and has been sleeping for more than 14 hours per day. He has been admitted to weekly episodic cannabis use. He has had no contact with his high school friends since being back home. He has a family history of depression, paranoia, schizophrenia, ADHD, and separation anxiety.

Psychiatric Review of Symptoms

– Onset: not reported

– Duration: not reported

– Frequency: Every day

Impact: school difficulties, weight loss, reduced hygiene, social isolation, increased sleep, and occasional cannabis use.

H.F. presents with school difficulties, weight loss, decreased hygiene, social isolation, excessive sleep, and cannabis use on occasion.

Past Psychiatric History:

• General Statement: Short trial of risperidone for a mild form of paranoia during the final half-year of high school; discontinued after graduation due to sedation adverse effects. As a child, he reached all of his developmental milestones.
• Caregivers (if applicable): The patient’s father suffers from paranoid schizophrenia, and his mother suffers from depression.
• Hospitalizations: None reported
• Medication trials: Harold took part in a risperidone trial for minor paranoia. He stopped taking the drug after graduating because the over-sedation side effects were too great.
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Caffeine, nicotine, and alcohol use were not reported. Weekly cannabis uses on an episodic basis.

Family Psychiatric/Substance Use History: H. F’s father suffers from paranoid schizophrenia, while his mother suffers from depression. Both of his younger sisters have a history of separation anxiety, and one of them has ADHD. No family suicides reported

Psychosocial History: Birthplace not reported. Raised by unknown. Has two younger sisters, one with ADHD and the other with separation anxiety. He is a freshman at State College. Harold is now spending spring vacation at home. He has not remained in touch with his many friends from high school since returning home.

Medical History: No illnesses, surgeries, seizure episodes, or head injuries reported

• Current Medications: None
• Allergies: Shellfish

• Reproductive Hx: None

ROS:

• GENERAL: Weight loss reported of 18lbs, no fever, chills, weakness, fatigue, or night sweats
• HEENT: No headache, no vision loss, blurred vision, no hearing loss, sneezing, congestion, runny nose, or sore throat.
• SKIN: No rash or itch
• CARDIOVASCULAR: no chest pain, palpitations, fatigability, orthopnea, paroxysmal nocturnal dyspnea.
• RESPIRATORY: No shortness of breath, dyspnea, wheezing, or cough.
• GASTROINTESTINAL: loss of appetite, no nausea and vomiting, diarrhea, or constipation.
• GENITOURINARY: No pain on urination, hesitancy, odor, or urine color change
• NEUROLOGICAL: No dizziness, fainting, paralysis, numbness, or tingling. No change in bowel and bladder control.
• MUSCULOSKELETAL: No muscle stiffness, back, or joint pains.
• HEMATOLOGIC: No bleeding or bruising
• LYMPHATICS: No history of splenectomy
• ENDOCRINOLOGIC: No excessive sweating, cold, or heat intolerance. No increased thirst or hunger.

Objective:

Physical exam: if applicable

T- 98.4, P- 76, R- 18, BP- 116/74, Ht- 5’6, Wt- 120lbs

Diagnostic results:

Assessment:

Mental Status Examination: H.F. is a young man who appears thin with poor grooming and hygiene. Generally, he appears cooperative with the examiner, although he occasionally is distracted and disoriented. However, his thought processes are disorganized and hard to follow. He mentions taking advanced courses in theoretical physics and advanced calculus and professes a desire to major in both philosophy and physics. There are no obvious symptoms of depression or anxiety present in H. F’s demeanor. However, he exhibits some peculiar characteristics, such as discussing the “mysteries of life” and “the bleeding degeneration of blood cells.” He denies experiencing any auditory or visual hallucinations or delusions.

In terms of cognition, the patient appears alert and oriented, with intact memory and good concentration. However, his insight is questionable, as he makes statements that are difficult to comprehend and have little relevance to the discussion at hand. His belief that a microwave in his room is related to a “bleeding degeneration of blood cells” is an example of his impaired judgment.

Differential Diagnoses:

In major depressive disorder (MDD), an individual has a persistently low mood, lack of energy, reduced interest in fun activities, poor concentration, feeling worthless, disturbed sleep, changes in appetite, agitation, or suicidal tendencies (Bains & Abdijadid, 2022). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines MDD as five symptoms, one of which is depression or anhedonia that impairs social or occupational functioning (American Psychiatric Association, 2022). MDD requires ruling out manic or hypomanic episodes. H.F. displays major depressive disorder (MDD) symptoms such as excessive sleep, poor hygiene, social withdrawal, and weight loss. These symptoms are compatible with the diagnosis of MDD. H.F. has a family history of mental disorders, such as melancholy, and MDD and anxiety disorders frequently co-occur. A review of H.F.’s medical history reveals that he stopped taking risperidone for moderate paranoia, which may indicate a history of depression. H.F. also admits to using cannabis, which may exacerbate depressive symptoms.

Substance/medication-induced mental disorders are characterized by the emergence of psychotic, depressive, manic, or anxiety symptoms from the abuse of drugs or pharmaceuticals. It may occur while using, becoming intoxicated, or undergoing withdrawal (Revadigar & Gupta, 2021). Substance-induced disorders may manifest during either withdrawal or intoxication. Individuals with substance-induced affective disorders will exhibit symptoms similar to those of patients with independent mood disorders, regardless of the presence or absence of concomitant substance use disorders. H.F. also meets the criteria for a substance-induced mood disorder, which can be caused by the use of psychoactive substances such as marijuana. It is well known that cannabis use has both immediate and long-term effects on mood, including psychosis, melancholy, and anxiety. H.F.’s weekly cannabis consumption is consistent with this diagnosis. H.F. exhibits symptoms of substance-induced emotional disorders, including weight loss, poor sanitation, social isolation, irregular appetite, and excessive sleep.

Schizophrenia is a psychotic disease characterized by delusions, hallucinations, and alterations in thought, perception, and behavior. To establish a clinical diagnosis of schizophrenia, it is necessary to obtain a complete psychiatric history and rule out other potential causes of psychosis (Hany et al., 2019). An individual must exhibit two or more of the symptoms for at least half a month to meet the DSM-5 diagnostic criteria: negative symptoms, gross disorganization, disorganized speech, hallucinations, or negative symptoms (American Psychiatric Association, 2022; Boland et al., 2022). In addition, there must be social or occupational dysfunction, as well as at least six months of signs preceding at least one month of symptoms. The patient’s personal history of moderate paranoia and withdrawal from risperidone, as well as his family history of paranoid schizophrenia, suggest that schizophrenia is a possible differential diagnosis. H.F.’s current symptoms of social withdrawal, cognitive distortion, and diminished self-care may be early indicators of schizophrenia. The DSM-5 includes delusions, hallucinations, impaired speech, and negative symptoms as criteria for schizophrenia. To validate this diagnosis, additional convincing evidence, such as the presence of positive symptoms and evidence of ongoing functional impairment, would be required.

Primary Diagnosis: Major Depressive Disorder (MDD) with concurrent substance abuse disorder is the primary diagnosis in this case. This diagnosis is supported by H.F.’s symptoms, including weight loss, poor sanitation, social isolation, irregular hunger, and excessive sleep, as well as his own and his family’s histories of mental illness. Cannabis consumption can exacerbate depressive symptoms and may have accelerated the onset of his current condition. H.F. has also discontinued treatment for minor paranoia, which may be an indication of underlying depression. It is recommended that additional testing be performed to corroborate this diagnosis and determine the best course of action.

Reflections: As a healthcare provider, you must approach this case with compassion, understanding, and openness to all possible diagnoses and treatments. Depression, anxiety disorders, substance use disorders, and even psychotic diseases such as schizophrenia are all plausible diagnoses alongside H.F. It is necessary to perform a thorough evaluation of his physical and mental health, taking into account his family history and other personal factors. To alleviate H.F.’s symptoms and improve his quality of life, it may be necessary to employ a multifaceted treatment strategy that combines medication and psychotherapy. Given H.F.’s history of adverse reactions to risperidone, it is essential to proceed with caution and consider the possibility of adverse drug effects. The family of H.F. should be consulted because they are more knowledgeable about his history and can provide emotional support during treatment.

Conclusion

1. F’s case demonstrates the significance of a comprehensive medical evaluation that includes a thorough medical history and physical examination. His symptoms, which include school difficulties, weight loss, decreased sanitation, social isolation, and sporadic cannabis use, indicate the possibility of mental health disorders such as depression, anxiety, or substance use disorders. To determine the most appropriate treatment plan, it is necessary to rule out any underlying medical conditions that could be contributing to his symptoms through a comprehensive evaluation. It is suggested that Mr. Feldman should be referred to a psychiatrist for further evaluation and management. Mr. Feldman may achieve improved health outcomes and a higher quality of life with an individualized treatment plan that addresses his physical and mental health requirements. The ultimate objective of H. F’s treatment is to enhance his overall health and alleviate his symptoms.
2. References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), 5(5). https://doi.org/10.1176/appi.books.9780890425787

Bains, N., & Abdijadid, S. (2022, June 1). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/

Boland, R., Verduin, M., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry. Www.wolterskluwer.com. https://www.wolterskluwer.com/en/solutions/ovid/kaplan–sadocks-synopsis-of-psychiatry-2253

Hany, M., Rehman, B., & Chapman, J. (2019). Schizophrenia. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539864/

Revadigar, N., & Gupta, V. (2021). Substance induced mood disorders. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555887/#:~:text=Substance%2Fmedication%2Dinduced%20mental%20disorders%20refer%20to%20depressive%2C%20anxiet

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NRNP6635 Week 7 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.

LEARNING RESOURCES

Required Readings

• American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disordersLinks to an external site.(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders
• American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site.(5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum
• Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry(12th ed.). Wolters Kluwer.
  • Chapter 5, “Schizophrenia Spectrum and Other Psychotic Disorders”
  • Chapter 2 only section 2.14, “Early-Onset Schizophrenia”

Required Media

Classroom Productions. (Producer). (2016). Schizophrenia and other psychotic disordersLinks to an external site. [Video]. Walden University.

MedEasy. (2017). Psychotic disorders | USMLE & COMLEXLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=BdB6MgWAP1k

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Training Title 29

Transcript Provided below

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00:00:00TRANSCRIPT OF VIDEO FILE:

00:00:00______________________________________________________________________________

00:00:00BEGIN TRANSCRIPT:

00:00:00[sil.]

00:00:15OFF CAMERA Mr. Feldman? I understand you called us last week for an appointment.

00:00:20MR. FELDMAN My parents.

00:00:25OFF CAMERA Excuse me?

00:00:25MR. FELDMAN My parents called for the appointment.

00:00:25OFF CAMERA Oh. Do you know why your parents called for an appointment?

00:00:30MR. FELDMAN No.

00:00:35OFF CAMERA When your parents called me they said you were having some difficulty in school. Where are you in school?

00:00:50MR. FELDMAN State College.

00:00:50OFF CAMERA How long have you been at State College?

00:00:55MR. FELDMAN My freshman year.

00:01:00OFF CAMERA And how is it going?

00:01:05MR. FELDMAN Fine.

00:01:10OFF CAMERA What courses are you taking at State?

00:01:15MR. FELDMAN In high school I took advanced placement courses. Theoretical physics, advanced calculus is what I’m taking now. Although I’m thinking about double majoring in philosophy and physics.

00:01:35OFF CAMERA That’s an interesting combination.

00:01:35MR. FELDMAN Yes, the mysteries of life. The courses are mysteries, and just when you think you’ve understood it, it’s gone.

00:01:45OFF CAMERA Gone?

00:01:50MR. FELDMAN The totality of life precludes us from repeating it. I mean what’s the point?

00:02:00OFF CAMERA Do you have a roommate at state?

00:02:05MR. FELDMAN You could call him that.

00:02:10OFF CAMERA Can you tell me about him?

00:02:15MR. FELDMAN Oh no.

00:02:15OFF CAMERA Why not?

00:02:20[sil.]

00:02:25MR. FELDMAN He put a microwave in there, but I know what that means. But I won’t tell. Not a word..

00:02:35OFF CAMERA A microwave oven?

00:02:40MR. FELDMAN They had them in here too, in this building. But they’ll spare me, and they’ll spare you too, because you are with me, and what that’s about a bleeding degeneration of blood cells, bleeding the humanity from our rightful destiny… but this room spies on us.

00:03:05OFF CAMERA I don’t understand what you mean.

00:03:10MR. FELDMAN It’s in the eyes. You can hold of forever if you know how.

00:03:20OFF CAMERA Mr. Feldman, did you come here with anyone else today?

00:03:25[sil.]

00:03:30MR. FELDMAN Sssshhhh.

00:03:35OFF CAMERA Mr. Feldman, I think I may need to contact your parents.

00:03:45SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com

00:03:45END TRANSCRIPT

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-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.).

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Rubric

NRNP_6635_Week7_Assignment_Rubric

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