The Psychotherapy To Treat Delusional Disorder Assignment

Training Title 9; Ms. Branning; Delusional Disorder – Mixed Subtype

Brief description of the patient

Ms. Branning is raised by her parents and works in an office for supply sales. She has a business degree with a history of hypothyroidism and is currently on daily levothyroxine. Ms. Branning declines to discuss past psychiatric history and denies any psychiatric issues in her family. She has regular menses. The main complaint is that she feels she is going to be fired by her boss because her supervisor is in love with her. Ms. Branning insists of her story despite denials by her supervisor as well as she doesn’t have evidence to back her story. Ms. Branning suspects to be having cancer and blames her bad helath on her broken heart. The Psychotherapy To Treat Delusional Disorder Assignment

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Brief explanation of the presenting symptoms

Ms. Branning has a delusion that she is going to be fired by her boss despite having no evidence to back her story as well as denials by her supervisor. Ms. Branning is having a series of delusions such as being fired at her place of work and also having cancer. The Psychotherapy To Treat Delusional Disorder Assignment

Psychiatric diagnosis supported by the DSM-5

• Non-bizarre delusions (González-Rodríguez & Seeman, 2020)
• There is no evidence to support the criteria for Schizophrenia such as hallucinations

Differential diagnosis from the DSM-5

• Substance induced psychotic disorder; this order pre4sents delusions which can be bizarre. The patient can be alert or even awareness can be impaired.
• Schizophrenia; the patient can present bizarre delusions and is always alert.
• Major depressive episode; delusions are always present and the individual is alert.

Psychiatric tools or scales you used

1. Delusional assessment scale
2. Diagnostic and Statistical Manual (Vahia, 2013)

Medications being ordered

The primary medication ordered in the treatment of delusional disorder is risperidone which is an antipsychotic drug (Kulkarni et al., 2017).

The drug will be prescribed to be taken orally.

Risperidone contraindications include cases of breast cancer, dehydration and overweight.

Non-pharmacological treatments

Psychotherapy

Any labs or medical tests that need to be completed

Blood tests can be done to rule out physical damage to the brain.

References

González-Rodríguez, A., & Seeman, M. V. (2020). Addressing Delusions in Women and men with delusional disorder: Key Points for Clinical Management. International Journal of Environmental Research and Public Health, 17(12), 4583.

Kulkarni, K., Arasappa, R., Zutshi, A., Chand, P. K., Murthy, P., Philip, M., & Muralidharan, K. (2017). Risperidone versus olanzapine in the acute treatment of Persistent Delusional Disorder: A retrospective analysis. Psychiatry Research, 253, 270-273.

Vahia, V. N. (2013). Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian journal of psychiatry, 55(3), 220.

There are two different discussions posted that needs two different responses. Please do not respond to both discussions as one. There needs to be two separate responses and each response needs it own separate references. Thanks.The Psychotherapy To Treat Delusional Disorder Assignment

Discussion 1

What additional considerations should be given when dosing medications for children and seniors and why?
Prior to dosing medications for seniors a thorough history and physical examination should be carried out by the practitioner to gain insight on any past mental health issues, current medications, and any other medical conditions including liver or hepatic disease (Jacobson, 2014). Also, it is important to have the medication instructions in writing and ask the pharmacy to have larger labels on the medication bottles (Jacobson, 2014). Since many seniors are either retired or not working they are usually on a fixed income. Costs of medications can obviously be very expensive and patients should be educated on the costs (Jacobson, 2014). Educating the patient on the dosage, time, and possible side effects are imperative to discuss with the patients. Jacobson (2014) discussed the changing one medication at a time to alleviate confusion and side effects.
Prior to dosing any medication for a child, a complete history and any past medical records should be reviewed by the provider as well as any documents and evaluations (Dulcan et al., 2017). Medications are mainly dosed on a person’s height and weight and the provider should document their recording during each visit. Also, due to the child being under the age of 18 informed consent needs to be documented and education on the medication, dosage, side effects, and compliance is a priority for parents or guardian of the child (Hirsch, 2018)The Psychotherapy To Treat Delusional Disorder Assignment.
What is the Beers Criteria?
The Beers criteria is a set of recommendations for providers when prescribing medication to seniors to prevent adverse effects that can be harmful for this population (Jacobson, 2014). The criteria assists providers in selecting appropriate medications for seniors while providing education to the patient and even their family members (Jacobson, 2014). Also, the Beers criteria have established a list of medications to avoid in patients with certain medical conditions (Jacobson, 2014)

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Any differential diagnoses
Oppositional defiant disorder (ODD). The patient in this case does not appear to have hostility nor negativity to demands as a person would with ODD (American Psychiatric Association, 2013). According to Dulcan et al., (2017) a child with ODD presents with being argumentative and having irritable moods in the past six months. The patient can also be vindictive towards other which does not apply to the patient in question (Dulcan et al., 2017).
Autism spectrum disorder (ASD). Attention deficit hyperactivity disorder (ADHD) and ODD both present with symptoms of “inattention, social dysfunction, and inability to manage behaviors” (American Psychiatric Association, 2013 p 64). The patient for this discussion appears to have normal social interaction with friends and there is no mention of speech deficits or below normal intelligence based on his current grades (Dulcan et al., 2017).
Anxiety disorders. The patient may have some anxiety especially due to the divorce of his parents and the shared custody. The patient is reluctant to discuss the father or step-mother perhaps signaling an anxiety disorder because of the rules established by them if the patient is disobedient. The patient does have difficulty with concentration but no mention of extreme anxiety or worry for the past six months (American Psychiatric Association, 2013)The Psychotherapy To Treat Delusional Disorder Assignment.
Your diagnosis and reasoning
Attention deficit hyperactivity disorder (ADHD). According to the American Psychiatric Association (2013) the patient meets criteria A 1. a, b, c, d, e, f, 2. b, e, f, g, h, i, B, C, D, and E (American Psychiatric Association, 2013). The patient presents with inattention and hyperactivity symptoms described in the scenario. The patient seems to be lacking the ability to maintain the pace of the schoolwork, interrupts students and the teacher, has been disciplined for excessive talking and inability to sit still in class and at home, and demonstrates lack of focus and concentration. The mother does not believe there is a problem with her son. However, Dulcan et al., (2017) states that school and home environments can influence the severity of ADHD symptoms. The patient may have more severe symptoms at his father’s house and school.
Any additional questions you would have asked
Knowing if there is any psychiatric history in the family could assist in the diagnosis. Neither the mother or father was questioned about their medical history. How old was the mother when she gave birth to the patient? Did the mother smoke cigarettes or drink alcohol during pregnancy? Was the child born premature or was he malnourished during infancy? There is a 75%-80% heritability of ADHD (Dulcan et al., 2017). Asking the child questions pertaining to how he feels when he stays at both homes and determine what makes him happy or sad.
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
Prior to prescribing medication or any treatment consent needs to be signed by the parents. For this patient, Adderall 5 mg po q morning before school. Adderall, a stimulant, is a dopamine, norepinephrine reuptake inhibitor stimulant indicated for ADHD that enhances norepinephrine and dopamine in the prefrontal cortex to improve attention and concentration (Stahl, 2020). As with all stimulants, side effects include increase in heart rate, blood pressure, arrythmias, headache, nervousness, nausea, weight loss, loss of appetite, irritability, and dizziness (Stahl, 2020). The black box warning indicates seizures, cardiac palpitations and arrythmias, suicidal thoughts, and sudden death in people with pre-existing cardiac abnormalities (Stahl, 2020). Notify parents and patient to take the medication as prescribed and provide education on onset of action which may be seen immediately or the medication can take several weeks for full effect (Stahl, 2020)The Psychotherapy To Treat Delusional Disorder Assignment. The dose can be titrated by five milligrams each week depending on the effectiveness of the medication.
Any labs and why they may be indicated
Prior to starting a stimulant an electrocardiogram should be ordered to rule out any abnormal cardiac rhythms or disturbances (Stahl, 2020). Blood pressure needs to be taken prior to start of medication and during treatment (Stahl, 2020). Also, it is imperative to measure the patient’s height and weight during treatment. Medications titrations are based on weight of the patient so it is indicative to have accurate measurements. Furthermore, asking the parents if they have any history of cardiac disease is important to assess (Stahl, 2020). Dulcan et al., (2017) states that thyroid and lead levels should be assessed for during the initial examination.
Screener scales or diagnostic tools that may be beneficial
Screening scales such as the NICHQ Vanderbilt Assessment Scale for teachers, parents, or medical professionals to aid in the diagnosis of ADHD by measuring attention and hyperactivity symptoms (Dulcan et al., 2017). The Child Behavior Checklist (CBCL) can be used to monitor a child’s behavior and abilities (Biederman et al., 2021). The CBCL can also monitor changes during treatment. The Teachers Report Form assesses scholastic performance as well as any behavioral problems (Staff et al., 2020).
Additional resources to give (Therapy modalities, support groups, activities, etc.)
With parental consent, the parent or provider can inform the school of the child’s strengths and weaknesses and an Individualized Education Program may be enacted to ensure that the child’s needs are met during school (Dulcan et al., 2017). Also, having teachers regularly report on the child’s behavior and academic performance are crucial for the best results (Dulcan et al., 2017). Cognitive behavioral therapy can be beneficial for the patient to ascertain critical thinking strategies while being able to monitor their achievements (Dulcan et al., 2017). Dulcan et al., (2017) recognizes family therapy as a way to decrease struggles and battles with the child. The Psychotherapy To Treat Delusional Disorder Assignment

DISCUSSION 2

What additional considerations should be given when dosing medications for children and seniors and why?
The brain of children and seniors are both very fragile as the child’s brain is maturing and the seniors’ brain can be deteriorating leading to the need for careful consideration with all medications provided to each age group (Sadock et al., 2014).
What are the Beers Criteria?
(1) potentially inappropriate medications in older adults; (2) potentially inappropriate medications to avoid in older adults with certain conditions; (3) medications to be used with considerable caution in older adults; (4) medication combinations that may lead to harmful interactions; and (5) a list of medications that should be avoided or dosed differently for those with poor renal function (Sadock et al., 2014)The Psychotherapy To Treat Delusional Disorder Assignment.
Group 2: JoAnn Smith
Your diagnosis and reasoning: ADHD (Attention Deficit Hyperactivity Disorder) Predominantly inattentive presentation. From the information provided patient meets criteria 1a. making careless mistakes in school work and other activities, 1b. has difficulty keeping attention on tasks or play activities, 1d. does not follow through on instructions, 1e. difficulty organizing tasks, 1h. easily distracted, and 1i. forgetful in everyday tasks (Dulcan et al., 2018).
Any differential diagnoses: Specific learning disorder- the patient could not be interested or becomes too frustrated to do his work or listen/follow directions (American Psychiatric Association, 2013, p. 73). Depressive disorder-patient could be experiencing poor concentration from a depressive episode related to parents’ divorce and situation (American Psychiatric Association, 2013, p. 74).
Any additional questions you would have asked:
Has any testing been completed at school for attention, learning disability, etc?
Does the patient have a 504 plan or an IEP?
I would want to talk to the patient alone and ask about his feelings about school work? Living arrangements? Friends? Activities?
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
The patient is not failing in his grade or is not in danger of being held back at this time. I would want to send screening tools to the patient’s teachers, have each parent fill out a screening tool, and go over the screening tool with the patient to see how he feels about his performance (Reichenberg & Seligman, 2017). Once all the data was collected, I would then make a decision to start medication or not and discuss all options with all the parents.
Any labs and why they may be indicated: Thyroid function test and or lead screening are the only tests recommended and only if warranted by an abnormality in the physical examination (Dulcan et al., 2018)The Psychotherapy To Treat Delusional Disorder Assignment.
Screener scales or diagnostic tools that may be beneficial:
Child Behavior Checklist and Snap-IV for all parties to fill out and return (Dulcan et al., 2018).
Additional resources to give (Therapy modalities, support groups, activities, etc.)
Patient would benefit from behavioral therapy as he has been getting into trouble at school and also can discuss any thoughts/feelings about his parent’s divorce that can be contributing to his behavior (Sadock et al., 2014).

Module Assignments: CASE STUDY: schizophrenia

For this assignment, you will watch an assigned video clip that depicts a patient needing
psychiatric/mental health treatment. You then will complete a treatment plan for this patient, following
the attached formatting. You are required to follow APA 7, which includes, a title page, your typed
treatment plan, and a references page. Each video case that is assessed should result in a treatment plan
that is a minimum of 2 pages in length, in addition to the title page and references page. This is a
treatment plan, not a research paper. Follow the rubric guidelines for grading criteria.
Just like in practice, there are times when all the preferred information may not be available, yet you still
will need to formulate a treatment plan for the patient. Your treatment plan must include in-text citations
and proper APA 7 formatting.
The following reference materials are required to be utilized and referenced:
– DSM-5
– Course Textbook
– Drug guide of your choice (text or online)
– 1 scholarly peer reviewed journal article, dated within the last 5 years, that supports your
treatment plan. UptoDate is a wonderful site, but it is not considered a scholarly peer
reviewed journal article.
The APA 7 style of writing is required. This includes (but is not limited to):
– Proper grammar and composition, capitalization and sentence structure
– APA 7 approved font (such as 12-point Times New Roman)
– Double spaced paper with 1” margins
– Paragraphs are to be left margin justified only
– Paragraph indentions
– Heading Levels (see APA p. 47-48)
– References that are formatted as per APA 7. See chapter 9 of the APA 7.
How to properly cite and reference the DSM-5.
For electronic versions:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). The Psychotherapy To Treat Delusional Disorder Assignment
https:doi.org/10.1176/appi.books.9780890425596
For printed version:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
American Psychiatric Association.
Basic in-text citation for the DSM-5: (American Psychiatric Association, 2013).

NKU MSN675 | 2022 Treatment Plans, DSM-5, Differentials
Treatment Plan: What to include and how to format the treatment plan
Your Treatment plan should include the following categories:
1. Title page
2. Content of treatment plan (The title of your treatment plan should be on line 1 of page 2).
a. Video # or Discussion Board Prompt #
b. Brief description of the patient
c. Brief explanation of the presenting symptoms
d. Any known medical history, allergies, etc.
e. Your psychiatric diagnosis (supported by the DSM-5).
f. List 3 of the differential diagnosis from the DSM-5, and briefly state why that was
chosen as a differential diagnosis, and not as the main diagnosis. (See course
materials on Differential Diagnosis) (supported by the DSM-5).
g. Suicide and/or homicidal risk assessment (this includes ideation, intent, plan,
means, etc.).
h. What psychiatric tools or scales you used (or that you would use) to help support
your diagnosis (include citations).
i. Medications being ordered
i. Include name of medication(s) and what the med is used for (include
citation)
ii. Include the route, dosage, frequency (include citation)
iii. Include black box warnings or what the pt needs to know/foods to avoid,
etc. (include citation)
j. Non-pharmacological treatments that are being ordered (include citation that
supports these).
k. Any labs or medical tests that need to be completed to rule out organic causes, for
medication monitoring, and so forth (include citation). (include a short line stating
why each lab/test is being ordered)The Psychotherapy To Treat Delusional Disorder Assignment
l. Questions that you would ask to further solidify your diagnosis (brief list)
m. Any further directives/resources for the patient (this would include, follow up with
primary doctor to monitor HTN or diabetes; directives to follow-up with other
members of the comprehensive treatment team; safety plan if you are sending the
pt home and they have suicidal or homicidal thoughts; return for medication
assessment in x number of weeks, etc. This also includes support group and hotline
phone numbers for things like SI and SUD).
3. References Page – include all citations used in the paper, formatted per APA 7, double
spaced and in alphabetical order. References are to include the DSM-5, the course textbook,
a drug book of your choice (text or online), and 1 scholarly journal article reference within
the last 5 years, for each of the videos or discussion board prompts being assessed.
Note:
Direct quotations should be kept to a minimum and properly cited as per the APA 7. It is imperative
that you synthesize the course information into your own words, using minimal direct quotations from scholarly
journal articles to support your treatment plan. Academic integrity is essential as proper citations give credence
and reliability to your treatment plan.

NKU MSN675 | 2022 Treatment Plans, DSM-5, Differentials
DSM-5 & Differential Diagnosis
In order to effectively treat patients, a reliable diagnosis and treatment recommendation is
essential. The DSM-5 provides a definition for each mental health disorder along with diagnostic
criteria that must be met for each diagnosis. These diagnoses are designed to “help clinicians to
determine prognosis, treatment plans, and potential treatment outcomes for their patients”
(American Psychiatric Association, 2013, p. 20). Diagnosis are then made after performing a
clinical interview with the patient, using DSM-5 descriptions, criteria, and using clinician
judgment (American Psychiatric Association, 2013).
1. All psychiatric disorders have a categorical place in the DSM -5. It includes the
symptoms that must be present with specifiers that allow for a more specific
diagnosis that help with the development of a treatment plan. (Example: Major
depressive disorder with psychotic features)The Psychotherapy To Treat Delusional Disorder Assignment.
2. Most psychiatric disorders (and psychiatric emergencies) require a thorough suicide
risk assessment. If the patient in the DB or video requires a suicide risk assessment
you must mention that clearly, as well as giving the side effects of any meds that may
make suicidal thinking worse, as well as a safety plan.
3. Differential diagnoses: A reliable diagnosis is required to effectively treat the patient
and to have positive treatment outcomes. The differentials provide for clinicians and
alternate diagnosis that could be considered if it is proven that the patient does meet
the criteria for the primary diagnosis that was chosen.
A clinician does not randomly come up with a differential diagnosis on their own. The
DSM-5 provides for clinicians, differential diagnosis for each primary diagnosis. They
are listed in the DSM-5 at the end of each diagnosis chapter. The differentials are listed in
order of prevalence. For example, of all the patients diagnosed with Bipolar 1, if that
diagnosis was proven not to be correct, most often the correct diagnosis is found to be
first, major depressive disorder, then second most frequent is the 2nd differential listed,
then the 3rd most frequent is the 3rd differential that is listed. So the differentials should be
alternate diagnosis that you considered or wrestled with as you were determining the
primary diagnosis for the patient.
For example, if you have a patient who appears with a mood disorder, you may be
considering depressive disorder or bipolar 1 disorder. Upon examining the diagnostic

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criteria in the DSM-5 for bipolar 1 (page 123-131) you determine that bipolar 1 is the
diagnosis that the patient meets the criteria for. You must then look to the differential
diagnosis that are listed in the DSM-5 (for bipolar 1 the differentials are on page 131-
132) and you choose 2 or 3 of them that your patient closely matches the criteria for. You
then briefly explain why you chose bipolar 1, as opposed to the differential diagnosis of
major depressive disorder (for example) The Psychotherapy To Treat Delusional Disorder Assignment