Assessing and diagnosing patients with schizophrenia, other psychotic

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Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; in others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms of other psychotic disorders.

To Prepare:

  • Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.

Complete your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis.

  

THE QUESTION

Subjective: 

Ø What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? 

Ø What is the duration and severity of their symptoms? 

Ø How are their symptoms impacting their functioning in life? 

Objective: 

Ø What observations did you make during the psychiatric assessment?  

Assessment: 

Ø Discuss the patient’s mental status examination results. 

Ø What were your differential diagnoses? 

Ø Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. 

Ø Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rule out the differential diagnosis to find an accurate diagnosis. 

Ø 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: 

Ø What would you do differently with this client if you could conduct the session over? 

Ø Include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!).

Ø Also include 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.).

RANSCRIPT OF VIDEO FILE: 

OFF CAMERA Ms. Branning, Mr. Nehring asked suggested you see me. He said your having some issues at work. 

MS. BRANNING You could call them that. 

OFF CAMERA What kind of difficulty are you having at work? 

MS. BRANNING Well Mr. Nehring wants to fire me. 

OFF CAMERA Why do you think Mr. Nehring wants to fire you? 

MS. BRANNING Because Eric is in love with me. And it’s probably getting in the way. And he wants to fire me. 

OFF CAMERA Who is Eric? 

MS. BRANNING Eric is my supervisor. 

OFF CAMERA Are the two of you in a relationship? 

MS. BRANNING No! Eric has his own girlfriend, I have my own boyfriend. But Mr. Nehring got it in his head that this is my fault. And they’ve been ganging up against me. 

OFF CAMERA What happened to make you feel this way? 

MS. BRANNING Eric is lustful for me. Lust. Lustful. 

OFF CAMERA Well has Eric done anything inappropriate? 

MS. BRANNING No, he doesn’t have to. 

OFF CAMERA What do you mean? 

MS. BRANNING Well, he has this way of walking toward me and he gives me the easiest assignments to do and he asks me to voice my opinion a lot in our weekly meetings. And I’m beautiful. I mean, not to be boastful or anything but I’m a strong woman. And people are attracted to that. And others, like Mr. Nehring feel threatened by it. He probably feels I could replace him in a couple years. And I could. 

OFF CAMERA But there have been no instances of sexual harassment. 

MS. BRANNING No. And now they want to fire me, and it’s probably because they don’t want me to get in the way of their day. I’m probably a distraction or something. 

OFF CAMERA According to Mr. Nehring you haven’t made a sale in three weeks. 

MS. BRANNING Oh, it’s been a slow time period. I guess it wouldn’t be bad thing if they fired me. I mean after all of this, all the bad it’s done for my health. You know I should really sue for discrimination; you know the stress and the health problems. 

OFF CAMERA You’ve been having health problems? 

MS. BRANNING Yes. Yes. It keeps getting worse. 

OFF CAMERA Can you describe it for me? 

MS. BRANNING Well you know there’s this pain in my neck, it aches, it spreads to my back, I think there’s a lump, right here. I’m really worried. 

OFF CAMERA And what do you feel is the cause?

 

MS. BRANNING I told you, pain, suffering, broken heart. I think it’s cancer. 

OFF CAMERA: Have you been seen by a doctor? 

MS. BRANNING: No. But it’s probably cancer. And it’s slowly killing me. And it’s all because of them. And Eric’s obsession with me. 

OFF CAMERA Ms Branning, I don’t think you have to worry, a broken heart can’t cause cancer. 

MS. BRANNING: You never know until it happens. 

Training Title 9

Name: Ms. Fatima Branning Gender: female Age: 28 years old T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs

Background: Raised by parents, lives alone in Coronado, CA. Only child. Works as an administrative assistance in car sales, has a bachelor’s in hospitality. Has medical history of scoliosis, currently treated with chiropractic care. Guarded and declined to discuss past psychiatric history. Denied family mental health issues, declined to allow you to speak to parents for collaborative information. Allergies: latex; menses regular, no birth control Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-9 Training

Learning Resources


American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders


American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

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

· Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders

· Chapter 29.2, Medication Induced-Movement Disorders

· Chapter 31.15, Early-Onset Schizophrenia


THE QUESTION

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-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? 

· Include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!).

· Also include 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.).

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