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NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders
Sample Answer for NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders Included After Question
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; with 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 for other psychotic disorders.
For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.
To Prepare:
- Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychoticdisorders. Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.
- Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
- By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
- Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 7
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 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 diagnostic criteria for each differential diagnosis and explain what DSM-5 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.).
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
- Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders Grading Criteria
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A Sample Answer For the Assignment: NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders
Title: NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders
Subjective:
CC (chief complaint): “I am having difficulty at work”
HPI: Ms. Fatima Branning is a 28-year-old female who presents for psychiatric evaluation after his boss suggested she get evaluated since she is having difficulties at work. She states that Mr. Nehring (his boss) wants to fire her because Eric (his supervisor) is in love with her, which is likely getting in the way. Branning denies being in a relationship with Eric, and she states that Eric has a girlfriend, and she also has a boyfriend. She states that Mr. Nehring thinks it is her fault, and they are joining together against her to fire her. Besides, Branning thinks that Eric is lustful for her. This is because he walks towards her differently, assigns her the easiest tasks, and asks for her opinion in the weekly meetings. Branning perceives herself as beautiful, strong, and attractive, which makes people like Mr. Nehring feel threatened. She denies any cases of sexual harassment at work. Furthermore, she reports being worried since she has neck pain radiating to the back and thinks she has a lump. She perceives the cause as pain, suffering, and a broken heart and thinks she has cancer.
Past Psychiatric History:
- General Statement: The patient is guarded and refuses to discuss past psychiatric history.
- Caregivers (if applicable): None.
- Hospitalizations: No history of hospitalization.
- Medication trials: None.
- Psychotherapy or Previous Psychiatric Diagnosis: Refused to discuss past psychiatric history.
Substance Current Use and History: Denied alcohol use or smoking.
Family Psychiatric/Substance Use History: Denied family mental health issues.
Psychosocial History: The patient was raised by her parents and is the only child. She lives alone in Coronado, CA. She is an administrative assistant in car sales and has a bachelor’s in hospitality.
Medical History: She has a medical history of scoliosis. She is currently being treated with chiropractic care.
- Current Medications: None.
- Allergies: Allergic to Latex.
- Reproductive Hx: She has regular menses and is on no birth control.
ROS:
- GENERAL: Denies weight changes, fever, or fatigue.
- HEENT: Denies head injury, eye pain, visual changes, rhinorrhea, or sore throat.
- SKIN: Denies bruises or rashes.
- CARDIOVASCULAR: Denies chest pain, palpitations, or edema.
- RESPIRATORY: Denies SOB, sputum, or wheezing.
- GASTROINTESTINAL: Denies abdominal pain, vomiting, nausea, or bowel changes.
- GENITOURINARY: Denies dysuria or pelvic pain.
- NEUROLOGICAL: Denies headaches, syncope, loss of consciousness, or muscle weakness.
- MUSCULOSKELETAL: Denies joint pain/stiffness or muscle aches.
- HEMATOLOGIC: Denies bleeding or anemia.
- LYMPHATICS: Denies enlarged lymph nodes.
- ENDOCRINOLOGIC: Denies excessive sweating, polyuria, polydipsia, or polyphagia.
Objective:
Physical exam: if applicable
Vitals: T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs
Diagnostic results: No lab tests were ordered.
Assessment:
Mental Status Examination:
The patient is neat and appropriately dressed. She is alert and oriented but appears nervous. Her speech is clear and goal-oriented. The thought process is logical and coherent. The patient has delusions of something being physically wrong with her and that her boss is plotting against her. No hallucinations, obsessions, compulsions, or suicidal thoughts/ideas were noted. She has an intact memory and cognition. Minimal insight and impaired judgment about the delusions.
Differential Diagnoses:
Delusional Disorder – Mixed Subtype: This is characterized by two or more delusion types. The patient presents with delusions of persecutory and somatic type. She falsely believes that her boss is plotting to fire her, which falls under persecutory delusion (Rootes-Murdy et al., 2022). She also believes that something is physically wrong with her body and that she has cancer slowly killing her even though she has not had a medical checkup.
Delusional Disorder- Persecutory Type: This is characterized by an irrational and unshakable belief by an individual that someone is plotting against them or wishes to harm them (Bell et al., 2021). The patient has an irrational belief that her boss is ganging up against her to fire her. This is probably because the boss feels the patient could replace him soon. She falsely believes that the boss does not want her to get in the way of their day and thus wishes to see her gone.
Delusional Disorder- Somatic Type: This presents with a belief that something is physically wrong with the individual. The delusion may involve a medical condition, illness, or perceived deformity (Cohen et al., 2019). The patient is deluded to having cancer, yet she has not seen a doctor. This is based on neck pain radiating to the back, and she thinks she has a lump. She also has a false belief that the cancer is slowly killing her.
Reflections: In this assessment, I have learned of the indicators of a delusion, one of them being a patient expressing an idea or belief with unusual persistency or force. The idea usually appears to exert undue difference in the patient’s life (González-Rodríguez & Seeman, 2022)). In a different situation, I would assess the emotional distress related to the patient’s delusions, like irritability, anger, and resentment. Legal and ethical considerations for this patient should surround principles of beneficence and nonmaleficence. The clinician should identify therapeutic interventions for this patient to help alleviate the delusions but not compromise the patient’s occupational and social well-being, especially in the workplace (Boland et al., 2022). The clinician should avoid confrontation of the delusional symptoms to improve the patient’s possibility of treatment compliance and response. Health promotion for this patient should focus on recognizing and managing comorbid psychiatric conditions.
References
Bell, V., Raihani, N., & Wilkinson, S. (2021). Derationalizing Delusions. Clinical Psychological Science: a journal of the Association for Psychological Science, 9(1), 24–37. https://doi.org/10.1177/2167702620951553
Boland, R., Verduin, M. L., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Cohen, J. L., Vu, M. T., Beg, M. A., Sivaraman, S., & Birur, B. (2019). Successful Resolution of Prominent Somatic Delusions Following Bi-temporal Electroconvulsive Therapy in a Patient with Treatment-Resistant Schizoaffective Disorder. Psychopharmacology Bulletin, 49(2), 52–56.
González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini-narrative review. World journal of psychiatry, 12(5), 683–692. https://doi.org/10.5498/wjp.v12.i5.683
Rootes-Murdy, K., Goldsmith, D. R., & Turner, J. A. (2022). Clinical and Structural Differences in Delusions Across Diagnoses: A Systematic Review. Frontiers in integrative neuroscience, p. 15, 726321. https://doi.org/10.3389/fnint.2021.726321
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NRNP_6635_Week7_Assignment_Rubric
Excellent | Good | Fair | Poor | |||
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide: |
18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. |
16 (16%) – 17 (17%)
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. |
14 (14%) – 15 (15%)
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. |
0 (0%) – 13 (13%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. |
||
In the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. |
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. |
16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. |
14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. |
0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. |
||
In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 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. |
23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. |
20 (20%) – 22 (22%)
The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. |
18 (18%) – 19 (19%)
The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. |
0 (0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. |
||
Reflect on this case. Discuss what you learned and what you might do differently. 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.). | 9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking. |
8 (8%) – 8 (8%)
Reflections demonstrate critical thinking. |
7 (7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking. |
0 (0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing. |
||
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old). | 14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. |
12 (12%) – 13 (13%)
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. |
11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. |
0 (0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. |
||
Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided. |
||
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors |
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors |
3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors |
0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding |
||
Total Points: 100 | ||||||
As we begin this session, I would like to take this opportunity to clarify my expectations for this course:
Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).
Course Room Etiquette:
- It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
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Late Policy and Grading Policy
Discussion questions:
- I do not mark off for late DQ’s.
- I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
- I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
- Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.
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- Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
- Any activity or assignment submitted after the due date will be subject to GCU’s late policy
- Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
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- Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
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- A substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do notmeet the active engagement expectation.
- Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
- I do expect outside sources as well as class materials to formulate your post.
- APA format is not necessary for DQ responses, but I do expect a proper citation for references.
- Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
- I will not accept responses that are from Wikipedia, Business com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
- Stay away from the use of personal pronouns when writing.As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.
Plagiarism
- Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
- This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
- Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
- Please review your LopesWrite report prior to final submission.
- Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).
Plagiarism includes:
- Representing the ideas, expressions, or materials of another without due credit.
- Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
- Failing to document direct quotations without proper citation and referencing.
- Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
- If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
- We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.
LopesWrite
- All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
- Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.
Assignment Submissions
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Grade of Incomplete
- The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
- The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
- Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.
Grade Disputes
- If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with mepersonally for further clarification.
- While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.
- However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedurewhich is outlined in the GCU Catalog and Student Handbook.