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 NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders

NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders

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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; 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.

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NRNP 6635 Assessing/Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic
    NRNP 6635 Assessing Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders

    NRNP 6635 Assessing Diagnosing Patients With Other Psychotic Disorders and Medication-Induced Movement Disorders

CC (Roommates Rachael and Liz state): “J.T is having thoughts that are not true.”

HPI: JT is a 25-year-old white female. She is accompanied by her roommates, Rachael, and Liz, who report that the client has thoughts that are not true. According to her roommates, J.T began exhibiting the symptoms when her favorite aunt, who also raised her, passed away two months ago. The initial symptoms were the client claiming to hear voices, and the symptoms have gradually worsened over time.

The client associates herself with living in a movie and believes this since she watches many movies. She also relates to her neighbors as Russian spies and states that they drill all night long; they drill messages by drilling. The client appears frustrated and says that most people do not understand her. She refers to the Russians as not being people and states that she has knocked on the door loudly and they will not answer. J.T states that the Russians speak Russian in code and that the neighbors are Spanish and speaks Spanish. The client says that they lie and is done talking about it. The client is unsure when she began experiencing this odd belief, and she yells when asked questions.

J.T believes that the voices are real, and she can hear them when no one else can. She states that she goes to her car and remains very still for 6 hours watching the Russians so that they cannot code her. She also states that she finds secret government blueprints scary and that they are all over the wall calling them terrorists. The patient has refused to comply with treatment.

Past Psychiatric History:

  • General Statement: The client has no substantive psychiatric history.
  • Caregivers (if applicable): None
  • Hospitalizations: No history of psychiatric admission.
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: No history.

Substance Current Use and History:

Admits taking alcohol, 3-4 glasses of Vodka 4 times a week. Uses recreational marijuana. Denies tobacco use.

Family Psychiatric/Substance Use History:

Maternal grandmother had Alzheimer’s disease. No known history of substance use in the family.

Psychosocial History:

J.T is a finalist student pursuing Business Management. She currently lives with two roommates, Rachael and Liz. She had a part-time job as an insurance sales agent but stopped after exhibiting paranoia delusions. She was raised by her aunt, who passed away two months ago. Her mother died when she was eight months old due to an RTA. She has never met her father.

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Medical History:

History of Hypothyroidism, Hypertension, and Type 2 Diabetes.

Current Medications:

Synthroid 25 mg daily (hypothyroid)

Atenolol 10 mg daily (HTN)

Metformin 1,000 mg BID (Diabetes type 2)

Allergies: NKDFA

Reproductive Hx: Para 0+0, No Hx of gynecologic disorders.

ROS:

  • GENERAL: Denies chills, fever, weight changes, or fatigue.
  • HEENT: Denies headache, vision changes, hearing loss, nasal congestion, rhinorrhea, or swallowing difficulties
  • SKIN: Denies skin color changes, lesions, or itching
  • CARDIOVASCULAR: Positive history of HTN. Denies palpitations, chest pain, edema, or SOB on exertion.
  • RESPIRATORY: Denies cough, sputum, or SOB.
  • GASTROINTESTINAL: Denies anorexia, nausea, vomiting, abdominal discomfort, or altered bowel patterns.
  • GENITOURINARY: Denies abnormal genital discharge or urinary symptoms.
  • NEUROLOGICAL: Denies headache, dizziness, syncope, or tingling sensations.
  • MUSCULOSKELETAL: Denies limitations in movement.
  • HEMATOLOGIC: Denies easy bruising or bleeding.
  • LYMPHATICS: Denies enlarged lymph nodes.
  • ENDOCRINOLOGIC: Positive history of T2DM and Hypothyroidism.

Diagnostic results:

Positive and Negative Syndrome Scale (PANSS): Positive scale- 42; Negative scale- 38; General psychopathology scale- 88; PANSS Total score- 168.

Assessment

Mental Status Examination:

J.T is sitting in the Psychiatrists office, scanning the room, hugging a pillow, and shaking. Her body hygiene appears good; she is nicely dressed and generally looks well. The self-reported mood is “anxious and scared.” Affect is blunted. Tone and volume of speech vary during the interview, from whispering to yelling and almost jumping out of her chair. The client denies having hallucinations. However, auditory and visual hallucinations are apparent. The client demonstrates paranoia delusions when she states that she remains still in the car so that the Russians cannot code her. Short term memory is impaired, but long term memory is intact. The client is disoriented to place, and person and attention are impaired. Judgment and cognition are grossly impaired. Homicidal ideation present.

Differential Diagnoses:

Schizophrenia

The DSM V diagnostic criteria for Schizophrenia include two or more of the following symptoms, with each presenting for a significant portion of time during a one-month period. The symptoms are Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as flattened affect, alogia, and avolition (APA, 2013). Schizophrenia also presents with cognitive symptoms, such as deficits in attention, memory, organization, and abstract thought (Owen, Sawa & Mortensen, 2016). Schizophrenia is the primary diagnosis for this patient based on the pertinent positive findings of paranoia delusions, auditory and visual hallucinations, disorganized speech, and blunted affect (APA, 2013). Cognitive symptoms are also apparent such as grossly impaired attention, memory, and judgment.

Brief Psychotic Disorder:

Brief psychotic disorder is a type of psychotic disorder in the same class as the schizophrenia spectrum. It is differentiated from schizophrenia by its sudden onset, short duration of less than a month, and the complete return of functioning (Stephen & Lui, 2019). It is marked by an abrupt onset of one or more of the following features: hallucinations, delusions, disorganized speech, and bizarre behavior and posture (APA, 2013). Other associated symptoms include disorientation, impaired attention, affective symptoms, and catatonic behavior.

Brief psychotic disorder is a differential diagnosis based on pertinent positive findings of auditory and visual hallucinations, paranoia delusions, impaired attention, disorientation, and constricted affect. However, the patient’s symptoms had a gradual onset and have lasted for more than a month, which rules out Brief psychotic disorder as the most likely diagnosis.

Persecutory Delusional Disorder (PDD)

Delusional disorder is characterized by having a false belief. The belief is strongly held on inadequate ground and cannot change by educational background, biologic rational evidence, or reasons (Upthegrove, 2018). In PDD, a person experiences a feeling of paranoia. This is an irrational yet unshakable belief that someone is plotting against them or out to harm them (APA, 2013). An individual with PPD is distrustful and suspicious of others. Persons are usually convinced that other people are attempting to harm them.

PPD is a differential diagnosis based on the client’s claim of her neighbors being Russian spies. She exhibits paranoia delusions when she claims that the Russians use coded language, which makes her sit in the car silently for hours so that they cannot code her.  Paranoia delusions are also evident when she reports that she finds secret government blueprints scary and refers to them as terrorists (Upthegrove, 2018). However, the client exhibits other psychotic features such as visual and auditory hallucinations, making PPD an unlikely primary diagnosis.

Reflection

The patient in this assignment was quite challenging due to the presenting symptoms. It was difficult if the patient had Schizophrenia or a delusional disorder from the paranoia delusions. If I were to conduct the session again, I would assess the patient for anxiety and depression, which are comorbidities of psychotic disorders. Legal and ethical considerations related to this patient scenario include upholding the confidentiality of the patient’s medical data and clinical diagnosis. Informed consent must be obtained before examining the client or initiating treatment to avoid legal consequences (Bipeta, 2019). The practitioner must also obtain consent before sharing the patient’s information with other providers. The consent should inform the patient of the extent to which the information will be shared (Bipeta, 2019). Health promotion interventions for this patient will include health education on diet and activity to minimize weight gin associated with psychotropic medications (Owen, Sawa & Mortensen, 2016). Regular physical exercises will be emphasized to boost brain health and prevent relapse of the disease.

 

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Owen, M. J., Sawa, A., & Mortensen, P. B. (2016). Schizophrenia. Lancet (London, England)388(10039), 86–97. https://doi.org/10.1016/S0140-6736(15)01121-6

Stephen, A., & Lui, F. (2019). Brief Psychotic Disorder. In StatPearls [Internet]. StatPearls Publishing.

Upthegrove, R. (2018). Delusional Beliefs in the Clinical Context. In Delusions in Context (pp. 1-34). Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-97202-2_1

 

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