Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

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Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

Brief psychotic disorder (BPD) is defined by the DSM-5-TR as a rapid onset of psychotic conduct that lasts no longer than thirty days, and then total recovery with the possibility of future recurrence. Catatonia, delusions, hallucinations, or aberrant speech are some of the signs of an acute but transient, brief psychotic disorder (APA, 2022). It can be distinguished from schizophrenia and schizophreniform sickness based on the duration of the psychosis. The diagnosis is often anticipated or retroactive because the diagnostic requirements necessitate complete recuperation within thirty days. This paper is an evaluation of a client with BPD. Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

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Subjective:

CC (chief complaint): The client is brought by her two roommates with complaints of “strange behaviors” involving delusions and auditory hallucinations. She tells the clinician that “They think I’m in a movie.” When interviewed further, the patient says that “Because they listen to our apartment.”….. “Russian men and whores. They drill all night long. That’s how they send their information back. Drilling.”

HPI: The patient JD is a 30-year-old female who presents with auditory hallucinations and delusions. She admits to a history of depression which happened after losing a significant other. The onset of the current symptoms was about two weeks ago and the location is her thought processes. The duration of symptoms is constant as they are not intermittent. Characteristically, the delusions and hallucinations are persistent and repetitive. They are aggravated by smoking marijuana (which she does), and somewhat relieved when she is in the company of her two roommates. The timing of symptoms is anytime day and night. The two roommates place the severity of her symptoms at 7/10. Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

Past Psychiatric History:

  • General Statement: She has a recent history of depression.
  • Caregivers (if applicable): Currently she has no one, but may require close monitoring by the roommates since she is dysfunctional in areas of self-care, occupation, and interpersonal relationships.
  • Hospitalizations: There is no history of hospitalizations yet for mental illness.
  • Medication trials: She has been put before by her PCP on alprazolam 1 mg BID for 15 days (Stahl, 2020).
  • Psychotherapy or Previous Psychiatric Diagnosis: She has a positive previous diagnosis of depression, but no history of psychotherapy.

Substance Current Use and History: She has been smoking cannabis every day since she was 17 years old. She also uses etoh on most weekdays with her friends.

Family Psychiatric/Substance Use History: There is a family history of etoh abuse and marijuana smoking from her estranged father and only male sibling whom she witnessed being murdered.

Psychosocial History: She had been depressed for some time after her aunt died, but in the subsequent twelve days after her brother’s murder in a gas station criminal activity, her depressive state worsened. Both of her parents are no longer with each other, and her brother was her only sibling. She will only eat canned meals and sleeps for two hours every day. She goes out most weekdays with her housemates, smokes cannabis every day, and has a few beers. Her PCP gave her a 15-day prescription for alprazolam 1 mg twice day as needed to treat her prior symptoms. She is employed at a bakery right now. Her hobbies are smoking cannabis, partying, hiking, and dancing. Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

Medical History:

  • Current Medications: None.
  • Allergies: Medical tape.
  • Reproductive Hx: She currently has no partner and has no children. She identifies as a heterosexual female.

ROS:

  • GENERAL: Denies fever, chills, fatigue, or weight loss.
  • HEENT: Negative for photosensitivity, otorrhea, rhinorrhea, or dysphagia.
  • SKIN: Denies itching, eczema, or rashes.
  • CARDIOVASCULAR: Negative for palpitations, chest tightness/ pain, or peripheral edema.
  • RESPIRATORY: Negative for wheezing, coughing, dyspnea, or phlegm.
  • GASTROINTESTINAL: Denies N/D/V or a change in bowel habits.
  • GENITOURINARY: Negative for abnormal discharge or pelvic pain.
  • NEUROLOGICAL: Denies syncope, paraesthesia, or a loss of bowel/ bladder function.
  • MUSCULOSKELETAL: Denies back pain, muscle pain, or joint pains.
  • HEMATOLOGIC: Negative for bleeding or clotting disorders.
  • LYMPHATICS: Denies lymphadenopathy or a history of removal of the spleen.
  • ENDOCRINOLOGIC: Negative for polyphagia, excessive thirst, excessive sweating, weight loss, cold/ heat intolerance, and a previous history of hormone treatment. Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

Objective:

Physical exam:

Vital signs: T-98.6; P-86; R 20; 120/70; Ht 5’2; Wt 126 lbs.

Diagnostic results:

Labs: Urine toxicology shows high levels of tetrahydrocannabinol in the blood.

Psychometric: The Positive and Negative Syndrome Scale (PANSS) was positive for schizophreniform psychosis, as she scored 76 points (Leucht et al., 2019).

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Assessment:

Mental Status Examination: The client is a 30-year-old female who is alert and oriented to place, time, person, space, and event. She is however well-groomed for the day and occasion. Her speech is clear but not so coherent or goal-oriented. She maintains eye contact and is cooperative. There are no obvious tics or mannerisms. Self-reported mood is “good” and affect is euphoric hence mood-congruent. She displays auditory hallucinations and delusions. There are also flight of ideas, word salad, and tangential thinking. Her abstraction and memory are impaired. She denies suicidal or homicidal ideation. Her insight and judgment are also impaired. Impression: Brief Psychotic Disorder (BPD).      

Differential Diagnoses

  1. Brief Psychotic Disorder: 298.8 (F23)

Delusions, hallucinations, confused speech, severely disordered actions, or catatonic conduct for a minimum of one day but no more than one month are necessary symptoms of brief psychotic disorder. It could be brought on by stress from outside sources. Following the incidents, the person resumes their regular functional capacity (APA, 2022; Boland et al., 2021)Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker.

  1. Substance-Induced Psychotic Disorder: 292.9 (F19.259)

The person under review has a past of substance misuse, including usage of alcohol and marijuana. This disorder meets all the criteria for schizophrenia as defined by the DSM-5-TR. There is no denying that marijuana usage, especially during infancy and the early stages of adulthood, predisposes individuals to developing signs of psychosis in the future (APA, 2022; Boland et al., 2021).

  1. Schizotypal Personality Disorder: 301.22 (F21)

Since this disorder does not fully meet the DSM-5-TR diagnostic criteria for BPD, it presents differently from it (APA, 2022; Boland et al., 2021). However, it shares some similarities with BPD in that it is also a psychosis marked by symptoms such as hallucinations.

Reflections

In this patient’s instance, analytical abilities and acquaintance with the DSM-5-TR diagnostic criteria were required. I made sure that informed permission was obtained before acting and used the interviewing technique that Carlat (2023) advised. This is an important facet of the autonomy principle in bioethics (Haswell, 2019). If I had to follow up this person, I would recommend family therapy for her estranged parents to help them manage, as well as cognitive behavioral treatment or CBT (Wheeler, 2020) to assist the individual to remodel the way they think.

Conclusion

BPD is a psychotic disorder sharing the same classification in the DSM-5-TR with schizophrenia. It manifests by amongst others delusions and hallucinations. The symptoms however usually subside after a day (minimum) or up to a month. This patient meets the criteria for this diagnosis. Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker

References

American Psychiatric Association [APA] (2022). Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5th ed. Author.

Boland, R., Verdiun, M., & Ruiz, P. (Eds) (2021). Kaplan and Sadock’s synopsis of psychiatry, 12th ed. Wolters Kluwer.

Carlat, D.J. (2023). The psychiatric interview, 5th ed. Wolters Kluwer.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Leucht, S., Barabássy, Á., Laszlovszky, I, Szatmári, B., Acsai, K., Szalai, E., Harsányi, J., Earley, W., & Németh, G. (2019). Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: Understanding negative symptom scores in schizophrenia. Neuropsychopharmacology, 44, 1589-1596. https://doi.org/10.1038/s41386-019-0363-2

Stahl, S.M. (2020). Stahl’s essential psychopharmacology: Prescriber’s guide, 7th ed. Cambridge University Press.

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, 3rd ed. Springer Publishing Company, LLC.

Name: Ms. Jess Davies Gender: female Age: 30 years old T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs Background: Jess is brought for evaluation by her 2 roommates who are concerned with behaviors. She had some issues with depression after aunt died but worsened in the 12 days after she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her parents and her brother was her only sibling. She is only sleeping 2 hours/24hrs; she will only eat canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape.

Training Title 24
Name: Ms. Jess Davies
Gender: female
Age: 30 years old
T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs
Background: Jess is brought for evaluation by her 2 roommates who are concerned with
behaviors. She had some issues with depression after aunt died but worsened in the 12 days after
she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her
parents and her brother was her only sibling. She is only sleeping 2 hours/24hrs; she will only eat
canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg
twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape.

Symptom Media. (Producer). (2016). Training title 24 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-24

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 anrd severity of their symptoms? How are their symptoms impacting their functioning in life? 
  • Objective: What observations did you make during the psychiatric assessment? 

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  • 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.). Comprehensive Psychiatric Evaluation of 30-Year-Old Female Cannabis Smoker