NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment

Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

When treating patients with psychotic illnesses, practitioners must be aware of the symptomatic patterns that could impair a patient ‘s ability to function in daily life. Psychosis may present in a variety of ways depending on the individual patient. Symptoms such as delusions or hallucinations may be more pronounced in some people, while symptoms like these may be barely perceptible in others. A 25-year-old woman has just had a psychotic episode, and the purpose of this study is to assess her and determine possible diagnoses NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment.

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Subjective:

CC (chief complaint): difficulty at work and pain in the neck

HPI: Ms. Branning is a 25-year-old woman who comes to the facility with a coworker who mentions that Ms. Branning’s output at work has been lower than usual. The patient reports that she is experiencing problems at work and feels that the supervisor is in love with her, which is leading her to fear that her employer is planning to fire her. Additionally, the patient complains of experiencing pain in her neck, which radiates to her back and continues to worsen. She is under the impression that the pain is the result of cancer, which is brought by the agony, heartbreak, and suffering that she undergoes at the hands of her coworkers. She asserts that she has not been subjected to sexual assault in the workplace.

Past Psychiatric History:

  • General Statement: refused to share past psychiatric diagnoses and treatments
  • Caregivers (if applicable): N/A
  • Hospitalizations: None
  • Medication trials: Unknown
  • Psychotherapy or Previous Psychiatric Diagnosis:Unknown

Substance Current Use and History:Unknown

Family Psychiatric/Substance Use History: Denies mental health issues in her family

Psychosocial History: Ms. Branning lives alone in Santa Monica, California. She is her family’s only child, having been brought up by her mother and father. She states that she is not married, but she is open about the fact that she has a boyfriend. She has a bachelor’s degree in business and is currently employed in the office supplies sales sector. She blames the escalating level of neck pain she has been experiencing on the lack of sales she has made in the past three weeks NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment.

Medical History: Hypothyroidism

  • Current Medications: levothyroxine
  • Allergies: medical tape
  • Reproductive Hx:Regular menstrual cycle. Never been pregnant.

ROS: In this particular case, a Review of Systems is not included. From the details provided in the case, one may derive the ROS as shown below. ROS is an essential component of the psychiatric evaluation since it provides the practitioner with information that may be helpful when making recommendations for diagnostic testing (Okland al., 2017).

  • GENERAL: Denies fever, chills, fatigue, or weight changes
  • HEENT: Denies hearing problems, vision changes, or headaches.
  • SKIN: Denies rash, itching, lesons, or discoloration
  • CARDIOVASCULAR: Denies edema, chest tightness, palpitations, and chest pain.
  • RESPIRATORY: Denies cough, wheezing, or breathing problems
  • GASTROINTESTINAL: Denies constipation, vomiting, nausea, diarrhea, and abdominal pain.
  • GENITOURINARY: Denies frequent urination, hesitancy, or pain on urination
  • NEUROLOGICAL: Denies dizziness, numbness or tingling, vertigo, or headaches.
  • MUSCULOSKELETAL: Reports neck pain that radiates to her back.
  • HEMATOLOGIC: Denies bleeding or history of anemia
  • LYMPHATICS: Reports a lump located in her neck. Denies history of splenectomy
  • ENDOCRINOLOGIC: Denies excessive urination, excess thirst, or heat or cold intolerance.

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

Physical exam: In this case, a physical examination is not performed, which could have assisted in determining the likelihood of physiological factors contributing to the client’s health condition.

Diagnostic results: In this specific case, the Peters et al. Delusions Inventory, needs to be ordered so as to help in the identification and evaluation of delusional thoughts. Using this test, one may see the many facets of delusional thinking, like the severity of emotional distress (Matheson al., 2020) NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment. On the other hand, in order to get a more precise diagnosis of neck pain, the practitioner may think about employing x-rays, MRI, and CT scans.

Assessment:

Mental Status Examination: The patient appears well-dressed, well-groomed and well-nourished.  She was difficult with the interviewer at times, and she refused to address questions that were asked. The client exhibits some mild motor agitation as she repeatedly points to her neck, which is the location of the pain that she is reporting. She has a                                                                         watchful eye contact, which demonstrates her heightened level of vigilance in light of the fact that she is suspicious of the interviewer and is always looking around the place. When the interviewer asks her about her health concerns, her normally subdued tone of voice suddenly becomes more assertive. Her mood is irritable with a flat affect. She exhibits illogical thought process, thought obstruction, and and a lack of thought pattern. Delusions are noted in her thought content. Her cognition and memory are intact. She demonstrates impaired judgment and lack of insight into her health condition. Patient has no auditory or visual hallucinations, suicidal or homicidal ideations.

Differential Diagnoses:

  1. Delusional Disorder- Delusional disorder is a kind of mental disease that is distinguished from other forms of psychosis by the presence of delusions over a period of at least one month but not other psychotic indications (González-Rodríguez & Seeman, 2022). According to the DSM-5-TR, the specific criteria for delusional disorder include the existence of one or more delusions that have lasted for at least one month, nonfulfilment of schizophrenia’s diagnostic criteria, the functionality of the patient has not significantly deteriorated, and that there is not other mental condition that more adequately explains the problem. This is most likely the correct diagnosis for the patient in question taking into consideration her delusional symptoms.
  2. Schizophrenia- Schizophrenia is a severe mental condition in which a person has aberrant perceptions of the world around them. Schizophrenia may be the cause of a variety of symptoms, including delusions, hallucinations, and profoundly disorganized thought and behavior, all of which interfere with everyday functioning and have the potential to be incapacitating (Stępnicki et al., 2018)NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment. The DSM-5 specifies that in order to diagnose schizophrenia, a patient must have at least two of the following five primary symptoms: hallucinations, delusions, disordered or incoherent speech, fragmented or odd movements, and adverse symptoms. It is probable that this patient is suffering from Schizophrenia as a result of the intense delusions that she has been experiencing.
  3. Bipolar Disorder with Psychotic Features- A condition characterized by recurrent periods of extreme shifts in mood, which may range from depressed lows to manic highs. Delusions and hallucinations may occur at any time throughout a manic or hypomanic episode in someone who has bipolar illness with psychotic features (APA, 2013). It is improbable that this diagnosis is correct for the patient given that she does not exhibit any manic or depressed symptoms.

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Reflections:

It is important to constantly note the challenges that medical personnel may confront while conducting interviews with patients who are unwilling to cooperate. This is due to the fact that getting information from a delusional person who is reticent might be difficult to accomplish. When dealing with individuals who suffer from delusions, practitioners have a duty to be cognizant of the ethical considerations involved, which include having patients included in the decision-making process and getting their consent (Bartels & Ryan, 2018). Individuals who suffer from delusions may have poor judgment, but this does not absolve a professional of his or her obligation to get their informed consent. It is crucial to build a connection with clients in order to obtain their informed consent because doing so will make them have faith in the professional’s capacity to provide appropriate medical treatment NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Bartels, J., & Ryan, C. J. (2018). How should physicians use their authority to name a stigmatizing diagnosis and respond to a patient’s experience?. AMA Journal of Ethics, 20(12), 1119-1125. https://doi.org/10.1001/amajethics.2018.1119

González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini narrative review. World Journal of Psychiatry, 12(5), 683-692. https://doi.org/10.5498/wjp.v12.i5.683

Matheson, G. J., Plavén-Sigray, P., Louzolo, A., Borg, J., Farde, L., Petrovic, P., & Cervenka, S. (2020). Dopamine D1 receptor availability is not associated with delusional ideation measures of psychosis proneness. Schizophrenia Research, 222, 175-184. https://doi.org/10.1016/j.schres.2020.06.001

Okland, T. S., Gonzalez, J. R., Ferber, A. T., & Mann, S. E. (2017). Association between patient review of systems score and Somatization. JAMA Otolaryngology–Head & Neck Surgery, 143(9), 870. https://doi.org/10.1001/jamaoto.2017.0671

Stępnicki, P., Kondej, M., & Kaczor, A. A. (2018). Current concepts and treatments of schizophrenia. Molecules, 23(8), 2087. https://doi.org/10.3390/molecules23082087

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.).NRNP 6635: Psychopathology and Diagnostic Reasoning Essay Assignment