Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example

Week (Week 7): Assessing And Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, And Medication-Induced Movement Disorders

Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation

CC (chief complaint): “They think I’m living in a movie. Rachel and Liz. That’s who they think I am. I see a lot of movies. So maybe they’re right. Maybe I am a movie.” (Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

HPI: Ms. JD is a 30-year-old female present for psychiatric evaluation. She had been accompanied by her two roommates, who were apprehensive about her behavior. The client has a history of depression that followed the death of her aunt. Her depression worsened 12 days after witnessing her brother’s death via GSW following a gas station burglary. Ms. JD only sleeps 2 out of 24 hours a day. She prefers eating canned foods. The client has smoked cannabis daily since he turned 17. She goes out with roommates during the weekday and takes s a couple of beers. The roommates reported Ms. JD acting strange following her aunt’s death and started having thoughts and hearing imaginary things.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Past Psychiatric History:

• General Statement: This is the first time the client is entering treatment
• Caregivers (if applicable): NA
• Hospitalizations: None reported.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)
• Medication trials: None reported.
• Psychotherapy or Previous Psychiatric Diagnosis: Has a history of depression. No previous psychiatric

Substance Current Use and History: Denies alcohol and drug abuse.

Family Psychiatric/Substance Use History: No history of family psychiatric or substance use history.

Psychosocial History: The client has parents and one sibling, a brother who is now diseased. The relationship between the client and parents is estranged. She was close to her brother. The client works in a bakery.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Medical History:

• Current Medications: Alprazolam 1mg twice daily for 15 days
• Allergies:Medical tape
• Reproductive Hx:Not reported.

ROS:

• GENERAL: No weight loss, fatigue, chills, or fever.
• HEENT: No double vision. No hearing loss, no runny nose, or difficulty swallowing.
• SKIN: No itches or rushes.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)
• CARDIOVASCULAR: No chest pain, pressure, or discomfort.
• RESPIRATORY: Normal breath sound.
• GASTROINTESTINAL: No nausea, vomiting, or diarrhea. No abdominal pain. No anorexia.
• GENITOURINARY: No urination urgency, burning sensation, hesitancy, or odor.
• NEUROLOGICAL: No history of syncope, numbness, paralysis, or tingling in the extremities. No change in bladder or bowel control.  (Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)
• MUSCULOSKELETAL: No back or joint pain. No muscle stiffness.
• HEMATOLOGIC: No anemia, bleeding, or bruising.
• LYMPHATICS: No enlarged nodes. No history of splenectomy.
• ENDOCRINOLOGIC: No history of cold, sweat, or heat intolerance. No polyuria or polydipsia.

Objective:

Physical exam: NA

Vital Signs: T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs BMI = 23 kg/m²   (Normal)

Diagnostic results:

Lab Findings: WNL

Tox Screen: Negative for Alcohol and Nicotine.

Assessment

Mental Status Examination: Ms. JD is a female aged 30 years who looks her stated age. She seems disoriented. She is inappropriately dressed for the time. She appears to be in acute psychological distress. The client is cooperative and attentive but not conversant. She is depressed, and the mood is congruent with affect. Her thought process is scattered. She has a flight of ideas and is delusional. Experiences inability with abstract thought. Her judgment and insight are poor. Has auditory and visual hallucinations. Her memory is below average, and her concentration is poor. She denies existing plans to hurt herself or other people.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Differential Diagnoses:

1. 295.90 (F20.9), Schizophrenia – Schizophrenia is characterized by delusions, hallucinations, incoherent speech, gross disorganization, and negative symptoms presenting in one month period or less (American Psychiatric Association [APA], 2019). At least delusions, hallucinations, or incoherent speech must be present. These symptoms affect significant areas of functioning, including work, social relations, self-care, or academics, for a considerable portion of the time following onset. Individuals must experience disturbance symptoms for at least six months, with atleast one month of symptoms showing active-phase symptoms that may present as only negative or attenuated symptoms. This is a  primary diagnosis.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)
2. 298.8 (F23), Brief Psychotic Disorder, with marked stressors – Brief psychotic disorder is characterized by delusions, hallucinations, speech, and gross disorganization (APA, 2019). Atleast delusions, hallucinations, and disorganized speech must be present in atleast one day and less than a month as the individual returns to a premorbid functioning level. This is a secondary diagnosis.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)
3. 295.40 (F20.81), Schizophreniform Disorder, with good prognostic features – Schizophreniform disorder is characterized by delusions, hallucinations, disorganized speech, gross disorganization, and negative symptoms (APA, 2019). An individual must present atleast two or more of these symptoms in one month, in which either delusions, hallucinations, or speech disorganization must be present. (Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Reflections:

Schizophrenia is the primary diagnosis. The client presents symptoms that meet Schrizophrenia’s diagnosis criteria, including auditory and visual hallucinations, delusional thought patterns, gross disorganization, and negative symptoms, including diminished emotional expression (Symptom Media, 2016). Schizophrenia has a prevalence of 0.3 – 0.7%, with racial/ethnic, geographic, or gender variation. Season of birth (winter, early spring, or summer), living environment (for children), pregnancy and birth complications (Parental age or hypoxia), and prenatal and perinatal are risk/prognostic factors. (Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

The client also presents symptoms that suggest a brief psychotic disorder with marked stressors. Moreover, the client’s symptoms are in response to marked stressors, i.e., the death of her aunt and brother. However, the diagnosis is refuted since it requires a return to premorbid function after one month, which is not evident in this case. The prevalence of the brief psychotic disorder is 9%, which is more common in developing countries and twice common in females that in males. The onset of the brief psychotic disorder occurs across the lifespan, with an average onset of 30 years. Personality or psychoticism traits predispose individuals to developing brief psychotic disorders (Sadock et al., 2015).(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Although the client presents symptoms associated with schizophreniform disorder, the onset of the prominent psychotic symptoms is not within one month of the first noticeable change (Sadock et al., 2015). Besides, there is no indication of the absence of flat or blunted affect, confusion, or perplexity. The prevalence of schizophreniform disorder is similar to those of schizophrenia in the United States. Moreover, having relatives with the schizophreniform disorder has an increased risk fo developing the condition.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Given a similar case, I would consider cultural variation in the presentation of schizophrenia and other psychotic disorders. When carrying out a psychiatric assessment for Schizophrenia and related psychotic disorders, it is crucial to be sensitive to styles associated with emotional expression, eye contact, and body language (Sadock et al., 2015). Moreover, obtaining additional information from the friends and PCP is necessary to make a definitive diagnosis.(Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

Ethical concerns, in this case, include informed consent and confidentiality. Mental health practitioners are ethically and legally bound to uphold informed consent, i.e., provide the patient with information about the psychiatric process, benefits and risks, and their condition (Bipeta, 2019). Equally, mental health practitioners must uphold confidentiality, i.e., keeping the client’s information secret, unless required by law or particular conditions. In this case, it is crucial to explain the psychiatric process and its importance to the client and assure them that any information shared will be kept confidential. Such an introduction is essential in establishing a therapeutic alliance and getting crucial information from the client to make a definitive diagnosis. (Assessing And Diagnosing Patients With Schizophrenia Comprehensive Nursing Paper Example)

References

American Psychiatric Association (APA). (2019). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian journal of psychological medicine, 41(2), 108-112. https://doi.org/10.4103%2FIJPSYM.IJPSYM_59_19

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry: Behavioral Sciences/Clinical Psychiatry (11th ed.). Wolters Kluwer.

Symptom Media. (Producer). (2016). Training title 24 [Video]. Available at: https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa tch/training-title-24 (Retrieved 15 January 2023)