Assessing and Diagnosing Patients With Schizophrenia Essay

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.). Include introduction, purpose statement, and conclusion. Assessing and Diagnosing Patients With Schizophrenia Essay

Assessing and Diagnosing Mental Health Patients

Brief psychotic disorder (BPD) as the name suggest is an ephemeral and acute psychiatric condition  that is characterized by an instant onset of psychotic behaviors for a period less than a month (Castagnini & Fusar-Poli, 2017). The identified behaviors are followed by a complete remission with increased chances of a relapse in future. BPD is distinguished from other similar conditions like schizophreniform and schizophrenia by the period of the psychosis. The main psychotic symptoms of BPD include delusions, disorganized speech, hallucinations, catatonic behavior and gross disorganization of an individual (Stephen & Lui, 2019).  This paper is a comprehensive psychiatric assessment of a patient who presented with a brief psychotic episode, differential diagnosis, treatment and reflections based on the information obtained. Assessing and Diagnosing Patients With Schizophrenia Essay

Bio Data

Name: Jess Powell

Sex: Female

Age: 24 years

Race: African American

Occupation: College Student

Marital Status: Single

Contact: 364-923-010

Chief Complaint (CC): Hallucinations, disorganized speech, delusions and catatonic movement.

History of Presenting Illness: Jess a 24-year-old female African-American college student is reported to both visual and auditory hallucinations by her roommates (Rachael and Liz). According to the informants, Jess recently lost an aunt who raised her. Since then, she started exhibiting the “strange” behavior. The client could see and hear things that other people could not see. She strongly believes that their people living next door are Russians who have listened to what Jess and her roommates say. She believed that they have evil plans that are why they drill through her wall. However, her neighbors are not Russians, they speak Spanish. Jess fails to understand why her roommates cannot see and here the things she hears and that’s why she thinks that that both Liz and Rachel think she is living in a movie. During an interview with the patient the patient demonstrated the stated chief complains, she has a severely disorganized speech that the PNP has a hard time following through her conversation. In her statement the Russians drill all day to send and receive information. They code others but they can’t code her since she is very “still” she stayed for six hours in her car. Jess believes that her next-door neighbors are plotting something bad pretending to be tourist. She tried confronting them when she went banging their door but they won’t open since they don’t speak English. She is not amused that people don’t understand the blue print about the government secret but she feels that they will regret later. Assessing and Diagnosing Patients With Schizophrenia Essay

Past Psychiatric History 

General Statement:  Jess has no recorded psychiatric history in the past. However, when her roommates noticed her strange behaviors after the loss of her aunt they took her to a psychiatric setting where she was given drugs to take from home.

Caregivers: Her roommates (Rachael and Liz)

Her aunt who recently passed on

Hospitalization: Jess has never been hospitalized since she was a child.

Medications: No current medication.

Psychotherapy: She never received any psychotherapy.

Substance Use History: Jess has no substance use history. During her interview with the caregiver, she mentioned that her body is a temple and strongly denied used of any mentioned substances.  

Family Psychiatric history: There is no alcohol or substance abuse history in her family, however, her elder sister committed suicide after battling depression for a long time. Assessing and Diagnosing Patients With Schizophrenia Essay

Social History:

Jess was born in Atlanta before moving to Georgia where she grew up raised by her aunt. Her mother passed away shortly after she was born leaving just her and her Elder sister Von. Jess is a jovial lady who interacts effectively with her peers. According to her roommates, she is kind to others and will go out of her ways to ensure everyone is comfortable in the room. She loves swimming and that she sometimes drags both Liz and Rachael for swimming sessions even though they are not good swimmers. Jess also loves music which seams to be a family trait. Her aunt who recently passed on was a music teacher who used to go with her for music festivals since she was little. She used to sing in Sunday school and later joined musical team while in her junior school years. She has a boyfriend who called Kei who is also her childhood friend. They have been together since high school and she believes their love is strong. The two hope to get married in future and get children.

Medical History: Jess remembers having a serious flue twice in her lifetime. The flue was severe that she had to skip school for some days even though she wasn’t hospitalized.

Allergies: She has known allergies.

Reproductive History: The client started receiving her periods at thirteen years, her cycle takes 28 days, and for three days.Assessing and Diagnosing Patients With Schizophrenia Essay

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Review of Systems

Mental Status Assessment

The 24-year-old lady cooperates with the examiner during the psychiatric assessment. She has dressed appropriately for time and season. She is well-groomed and neat. Jess has a disorganized speech. Her ideas when responding to the examiner’s questions are way out of topic. In some cases, she says contradicting statements when she says her next door neighbors who she believes are Russians speak English and they don’t speak English.  The client exhibits abnormal or involuntary motor movements. She has both auditory and visual hallucinations she hears the neighbors drill all day and she can see the government blueprint. She has persecutory delusions about the “Russian” Jess has flight of ideas; she is oriented of time and place. Jess has a dysphoric mood; she is uneasy of the impending harm that her neighbors will do. She denies having suicidal ideations and self-harm activities to herself and others. Her remote and current memory is good. She has no insight of her current mental status. Assessing and Diagnosing Patients With Schizophrenia Essay

Differential Diagnosis

 Brief Psychotic Episode Disorder (BPD)

Jess has brief psychotic disorder which is the first primary diagnosis. She has both auditory and visual hallucination since she sees and hear things that her roommates cannot hear. She talks of a government blueprint that she has covered on her walls. Jess says that her neighbors are Russians who drill and listen to the wall all day. The client has persecutory delusions where she believes that the neighbors are planning something that she the only one who understands. She feels that other people will learn about to when it is late and that’s why they are pretending to be tourist. The client also has an extremely disorganized speech that her thoughts are far from what is questions asked by the caregiver. At some point she says contradicting statements in the same sentence. Jess has catatonic stupor even though she doesn’t recognize it. She says that she waited in her car in a very still mode. All the above symptoms were noticed after she lost her aunt recently.

Schizophrenia

Schizophrenia is the second preferred differential diagnosis of BPD in this case scenario. In both conditions the client present with similar symptoms including hallucinations, delusions, disorganized speech and catatonic movements. However, clients with schizophrenia develop impaired cognitive ability that manifest in various negative symptoms. Those symptoms include reduced attention span, delayed executive function and impaired working memory (Patel et al., 2014). Clients also develop positive symptoms like delusions, suspiciousness and hallucinations (McCarthy-Jones et al, 2017). The other difference between BPD and schizophrenia is that the former is brief while the latter is chronic hence cannot be the primary diagnosis. With effective treatment the client with BPD can achieve premorbid level while in schizophrenia there is no full remission. Assessing and Diagnosing Patients With Schizophrenia Essay

Medical-Induced Movement Disorders     

Medical-induced movement disorders is the third differential diagnosis of BPD. The condition can be caused by both illicit and therapeutic drugs. They could be chronic, sub-acute and acute condition and they all differ in their characteristics.  Acute conditions in this classification occur minutes or days after taking the medical substance. The subacute classification is where changes in movement occur within days or weeks after the patient takes the drugs. The chronic ones mostly occur when the client has already stopped using the drugs. Some of the conditions in this classification include akathisia, tremor, catatonic stupor, serotonin syndrome, acute dystonic reaction, Parkinsonism and Neuroleptic malignant syndrome. Jess has catatonic stupor which is also a symptom of schizophrenia (Duma & Fung, 2019). According to her, the drugs she took were her source of her problems.  The drug could be the first-generation antipsychotic used in management of schizophrenia by blocking dopamine D2 receptors (Rahman & Marwaha, 2020).  One of the side effects of the drugs is producing catatonic behaviors like the one exhibited by Jess when she stays still in her car for six hours (Funayama et al., 2018).

Treatment and Reflection

I agree with the interview that took place between Jess and the care giver. The PNP asks the client questions that are meant to obtained information about her mental health status. Also, the questions try to dig out the contributing factors to her current condition. Thus, the interview in this case was used as an assessment tool. In future I would add more questions that will ensure I obtain information on the impact of the current mental status to her daily activities and social life. I would also mention to her that anything that she tells me is confidential and nobody else including Liz and Rachael will know about it. In the same interview, I would make her understand that she is unwell and she requires treatment to obtain consent.Assessing and Diagnosing Patients With Schizophrenia Essay

Jess management might be complex partly because she lacks insight and partly due to a previous history of non-adherence. Therefore, the initial stage of treatment is making her understand that she is unwell and she requires treatment. The patient also requires pharmacotherapy to manage the positive symptoms she is experiencing. Managing the symptoms in this case is essential so she doesn’t escalate to severe levels where she can hurt others due to the persecutor delusion. In the previous intervention Jess was put on a first-generation antipsychotic drug that resulted into drug induced movement disorder. Therefore, the psychiatric nurse should ensure that the drug administered does not have the offending characteristic. Quetiapine is a drug of choice in this case where she should receive 50mg twice a day. Second generation drugs are preferred in such a case since they have fewer extrapyramidal symptoms (Solmi et al., 2017). The drugs reduced positive symptoms of BPD by blocking D2 dopamine receptors (Maan et al., 2020). Assessing and Diagnosing Patients With Schizophrenia Essay

The client should receive cognitive therapy to help her overcome psychotic symptoms that occur due to the recent loss of her aunt. According to her roommate, her aunt brought her up and she started developing the strange behaviors when she passed on. That indicates that the two had a tight bond, thus the loss affected her severely. Therefore, a combination of cognitive therapy and pharmacotherapy are likely to yield better results than monotherapy (Morrison et al., 2018). The caregiver should also involve her friends in the treatment plan process of Jess. Being roommates, they are likely to experience some challenges dealing with her. The PNP should educate all the parties involved on brief psychotic disorder and its prevention. Prevention in this case would be avoiding risk factors like drugs and substance abuse.  Poor social economic status would also influence the use of drugs thus increasing chances of developing the psychiatric condition. Assessing and Diagnosing Patients With Schizophrenia Essay

References

Castagnini, A. C., & Fusar-Poli, P. (2017). Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. European Psychiatry, 45, 104-113.

Duma, S. R., & Fung, V. S. (2019). Drug-induced movement disorders. Australian prescriber, 42(2), 56.

Funayama, M., Takata, T., Koreki, A., Ogino, S., & Mimura, M. (2018). Catatonic stupor in schizophrenic disorders and subsequent medical complications and mortality. Psychosomatic medicine, 80(4), 370.

Maan, J. S., Ershadi, M., Khan, I., & Saadabadi, A. (2020). Quetiapine. StatPearls [Internet].

McCarthy-Jones, S., Smailes, D., Corvin, A., Gill, M., Morris, D. W., Dinan, T. G., … & Dudley, R. (2017). Occurrence and co-occurrence of hallucinations by modality in schizophrenia-spectrum disorders. Psychiatry research, 252, 154-160.

Morrison, A. P., Law, H., Carter, L., Sellers, R., Emsley, R., Pyle, M., … & Haddad, P. M. (2018). Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility study. The Lancet Psychiatry, 5(5), 411-423.

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. Pharmacy and Therapeutics, 39(9), 638. Assessing and Diagnosing Patients With Schizophrenia Essay

Rahman, S., & Marwaha, R. (2020). Haloperidol. StatPearls [Internet].

Solmi, M., Murru, A., Pacchiarotti, I., Undurraga, J., Veronese, N., Fornaro, M., … & Carvalho, A. F. (2017). Safety, tolerability, and risks associated with first-and second-generation antipsychotics: a state-of-the-art clinical review. Therapeutics and clinical risk management, 13, 757.

Stephen, A., & Lui, F. (2019). Brief Psychotic Disorder. In StatPearls [Internet]. StatPearls Publishing. Assessing and Diagnosing Patients With Schizophrenia Essay