Evaluating and Diagnosing Individuals With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Evaluating and Diagnosing Individuals With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Psychotic disorders and schizophrenia pose significant diagnostic challenges within the DSM. Symptoms associated with psychotic disorders can manifest in varying degrees of severity among patients. Furthermore, these symptoms often exhibit overlaps across different disorders. For instance, specific manifestations, such as neurocognitive impairments, social difficulties, and perceptual distortions, may be present in individuals with schizophrenia while also serving as contributing factors to other psychotic disorders.

In the context of the Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders, you will engage in the analysis of a case study related to either schizophrenia, another form of psychotic disorder, or a medication-induced movement disorder.
To Prepare:

– Examine the Learning Resources for this week and consider the insights they offer regarding the assessment and diagnosis of psychotic disorders. Reflect on whether experiences of symptoms related to psychosis are always indicative of a schizophrenia diagnosis, and contemplate alternative diagnostic possibilities for symptoms associated with psychosis.
– Download the Comprehensive Psychiatric Evaluation Template, which will be used for the completion of this Assignment. Additionally, review the Comprehensive Psychiatric Evaluation Exemplar to gain an understanding of a completed evaluation document.
– By the first day of this week, select a specific video case study for use in this Assignment from the provided options in the Learning Resources. View the assigned video case and review any supplementary data found in the “Case History Reports” document, keeping in mind the requirements outlined in the evaluation template.
– Deliberate on the patient’s history that needs to be collected during the assessment. Consider what interview inquiries would be essential when interacting with this patient.
– Identify at least three potential differential diagnoses applicable to the patient.

By the seventh day of Week 7

Complete and submit your Comprehensive Psychiatric Evaluation, incorporating your differential diagnosis and the thought process underlying your primary diagnosis.

Integrate the following components into your responses within the template:

– Subjective: Elaborate on the information provided by the patient regarding their primary complaint and symptomatology, which contributed to the formulation of your differential diagnosis. Provide insights into the duration and severity of the symptoms and discuss how these symptoms are affecting the patient’s daily functioning.
– Objective: Outline the observations made during the psychiatric assessment.
– Assessment: Examine the outcomes of the mental status examination conducted with the patient. Present a minimum of three potential diagnoses with supporting evidence, arranging them in order of priority from highest to lowest. Compare each differential diagnosis with the diagnostic criteria outlined in the DSM-5-TR, elucidating the criteria that eliminate specific differentials and facilitate the identification of an accurate diagnosis. Describe the critical thinking process that led to your selection of the primary diagnosis, and include pertinent positive and negative findings specific to the patient’s case.
– Reflection Notes: Reflect on what you would do differently if you were to conduct the session with this client again. Additionally, delve into discussions concerning legal and ethical considerations beyond confidentiality and informed consent, health promotion, and disease prevention, taking into account patient-specific factors (e.g., age, ethnicity), past medical history, and other risk factors (e.g., socioeconomic status, cultural background).

Submission and Grading Information

To submit your completed Assignment for review and grading, follow these steps:

– Save your Assignment using the following naming convention: “WK7Assgn+last name+first initial.(extension)”.
– Access the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
– Click on the Week 7 Assignment link, where you can also view the grading rubric.
– In the “Attach File” section, click on the “Browse My Computer” button. Locate the document you saved as “WK7Assgn+last name+first initial.(extension)” and click “Open”.
– If applicable, check the box for “I agree to submit my paper(s) to the Global Reference Database” in the Plagiarism Tools section.
– Click “Submit” to finalize your submission.

Subjective Section

CC: The patient reports neck pain that radiates to their back and expresses concerns about a lump. Additionally, the patient mentions anxiety related to work and suspicions about coworkers plotting against them.

HPI: A 28-year-old woman named Ms. Fatima presents with anxiety about potential job termination, as her work performance has declined recently. She believes her boss wants to fire her because he perceives her as a threat due to the supervisor’s interest in her. She expresses thoughts that her coworkers are conspiring to have her fired. She also mentions physical symptoms, including neck pain that extends to her back and the suspicion of a lump, which she believes could be cancer. Ms. Fatima attributes her deteriorating health to the stress caused by work-related problems and her coworker Eric’s obsession with her.

Past Psychiatric History

– General Statement: The patient lives alone and denies any previous psychiatric history or family history of mental illness.
– Caregivers (if applicable): The patient lives alone.
– Hospitalizations: There are no known hospitalizations.
– Medication trials: No previous medication trials are reported.
– Psychotherapy or Previous Psychiatric Diagnosis: The patient declines to discuss any prior psychotherapy or psychiatric diagnoses.

Substance Use History

The patient has no known history of substance use.

Family Psychiatric/Substance Use History

The patient denies any family history of mental health issues.

Psychosocial History

Ms. Fatima was raised by her parents and currently lives alone in Coronado, CA. She is an only child with a degree in hospitality but works as an administrative assistant in car sales.

Medical History

Ms. Fatima has a history of Scoliosis and is currently undergoing chiropractic treatment for it.

Current Medications

The patient is currently receiving chiropractic care for Scoliosis.

Allergies

The patient is allergic to latex.

Reproductive History

Ms. Fatima experiences regular menses and does not use birth control pills.

Review of Systems (ROS)

– General: The patient denies significant weight changes but reports neck pain extending to her back and emotional distress.
– HEENT: The patient denies dizziness, headache, ear or eye pain, dysphagia, nasal discharge, or blurred vision.
– SKIN: No reports of bruises or skin rashes.
– CARDIOVASCULAR: No complaints of chest pain, chest tightness, or shortness of breath.
– RESPIRATORY: The patient does not experience dyspnea, cough, or nocturnal dyspnea.
– GASTROINTESTINAL: No signs of stomach cramps, vomiting, upset stomach, or diarrhea.
– GENITOURINARY: The patient denies urinary frequency, urgency, or painful urination.
– NEUROLOGICAL: There is no reported numbness or ataxia.
– MUSCULOSKELETAL: The patient denies joint or muscle pain.
– HEMATOLOGIC: No signs of bruising or abnormal bleeding.
– LYMPHATICS: No reports of painful or swollen lymph nodes.
– ENDOCRINOLOGIC: The patient reports no signs of hypothyroidism.

Objective Section

Vitals: T- 98.4, P- 82, R 18, BP 124/74, Height 5’0, Weight 118 lbs

Diagnostic Results: Urine and drug tests returned negative results.

Assessment Section

Mental Status Examination: Ms. Fatima is a 28-year-old female referred for psychiatric assessment due to work-related stress and declining performance. During the assessment, she appears well-groomed and well-oriented. She maintains good eye contact, speaks with pressured speech, and displays spontaneity. However, she exhibits confusion and delusional thoughts. No abnormal psychomotor movements are observed, and she denies auditory or visual hallucinations. No suicidal or homicidal ideations are present, but she demonstrates poor judgment.

Differential Diagnoses:

1. Schizophrenia (Primary Diagnosis): Ms. Fatima presents with delusions related to her boss’s intentions and disorganized speech. Her work performance has significantly declined, meeting criteria for reduced achievements in one or more significant areas. This aligns with the DSM-5-TR diagnostic criteria for Schizophrenia (American Psychiatric Association, 2022).

2. Substance/Medication-Induced Psychotic Disorder (SMIPD): Although SMIPD is a potential diagnosis, there is no evidence of substance/medical use based on negative urine and drug test results. Thus, it does not meet criteria for this disorder (American Psychiatric Association, 2022).

3. Brief Psychotic Disorder: While brief psychotic disorder includes symptoms like hallucinations and delusions, it typically lasts for a short duration and is not consistent with the prolonged decline in work performance observed in this case. Therefore, it is a less likely diagnosis.

The Relationship Between Evidence-Based Practice and the Quadruple Aim in Healthcare

Reflection:

If conducting this session again, I would prioritize establishing a strong rapport with the patient to encourage them to share more information, including their psychiatric and medical history. Additionally, obtaining consent to communicate with family members for additional details could provide valuable insights. In terms of legal considerations, hospitalizing a patient with Schizophrenia against their will can be challenging. Clinicians must balance legal concerns with the patient’s best interests, which can lead to ethical dilemmas.

Group therapies could be beneficial for health promotion in this community. Such interventions can reduce social isolation, enhance cohesion, and improve reality testing among individuals with psychotic disorders (Sadock et al., 2015).

References

American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.