Posted: December 6th, 2022
Medication-Induced For Patients with Schizophrenia Disorders
CC (chief complaint): “There’s nowhere that is safe. Don’t pretend like there is.”
HPI: B.W. is a 33-year-old Caucasian woman who comes in with her friend, Patty, for a mental examination. The patient states that she has called 9-1-1 many times because she believes that someone is monitoring her from her windows and awaiting her spouse to hurt him. She says a snake is in her belly, that she has a stomach upset, and that she hasn’t eaten for the last two days.
Past Psychiatric History:
Psychotherapy, according to research, improves patient adherence and satisfaction while also providing the clinician with an insight into how to commence treatment with the patient (Tucci et al., 2017). A clinician’s knowledge of past drug trials may help him, or her determine which treatments are unhelpful. A thorough understanding of a patient’s history of psychotherapy, mental health diagnoses, and prior medications is essential to developing a successful treatment regimen. Medication-Induced For Patients with Schizophrenia Disorders
Substance Current Use and History: Medication-Induced For Patients with Schizophrenia Disorders
Family Psychiatric/Substance Use History:
Neither self-harm nor traumatic events are admitted by the client. A previous history of physical aggressiveness against others may be traced. According to Patty, the patient’s friend, the patient’s parents’ deaths in the previous two years have been extremely challenging for the client. There are no legal concerns with the patient. She presently resides in the city of Atlanta, Georgia. Her husband is a truck driver who is currently out of town. The patient’s younger sister is ten years old. She is a recipient of Social Security Disability Insurance (SSDI). She is a graduate of high school.
Medical History: Scoliosis.
ROS: There is no Review of Systems in this case. This ROS is derived from the information offered in the video and case narrative. ROS is an important element of the mental health assessment since it may assist the clinician in recommending particular diagnostic tests (Hendrickson et al., 2019) Medication-Induced For Patients with Schizophrenia Disorders. Medication-Induced For Patients with Schizophrenia Disorders
Objective: The patient refused to provide vital signs.
Physical exam: This case does not include the performance of a physical examination, which might discount the possibility of physiologic causes for their manifestation (Al-Huseini et al., 2016).
Diagnostic results: Using the 21-item Peters et al. delusions questionnaire, which highlights the multidimensional nature of delusions, comprising levels of anguish, obsession, and conviction, it is possible to diagnose and analyze delusional thoughts more effectively (Wang et al., 2017). In order to rule out substance-induced problems caused by the usage of numerous substances like marijuana, heroin, alcohol, and amphetamines, a urine drug test must be performed on the subject (Wilson et al., 2018). Neuroimaging investigations, like MRI scans, might be performed by healthcare professionals to rule out neurodegenerative illnesses. Medication-Induced For Patients with Schizophrenia Disorders
Mental Status Examination Results:
Patient is a Caucasian female, 33 years old, who seems to be her claimed age. She declined to respond to the interviewer’s inquiries and is being difficult throughout. She is well-groomed and clothed properly for the occasion. Because she is distrustful of the interviewer and continually searches the room, she maintains hypervigilant eye contact with him. At the beginning of the interview, her tone is gentle and reserved, but it becomes louder as the interviewer inquires about her concerns. She seems to be in a flat and confined state of mind, with an agitated and angry demeanor. Owing to apparent thought blockage, her cognitive process seems to be irrational, as she suddenly stops speaking due to a loss of concentration and exhibits greater delay in responding to the interviewer’s inquiries, among other things. There are paranoid ideas of open suspiciousness delusions in her head, and she has delusions that she has a gang of individuals who are spying on her. Because she does not react to internal cues, there is no indication of distorted perception in this patient. Even though her sensorium is clear, her focus and attention are completely devoted to her delusions. The patient does not seem to have any significant memory problems. As seen by her assumption that she is being followed, the patient has a lack of awareness of her situation and poor judgment. Medication-Induced For Patients with Schizophrenia Disorders
The difficulties that clinicians may have while questioning recalcitrant patients should be acknowledged since it may be challenging to get details from a delusional individual who is hesitant. The ethical implications for managing delusional individuals, such as obtaining consent and incorporating them in decision-making processes, should always be recognized by clinicians (Zettl & Sadler, 2020). Because of delusions, it is important for providers to understand that they are still responsible for obtaining their patient’s consent despite the fact that delusions may cloud their judgments (Beck & Ballon, 2020). In order to get informed consent from a patient, it is necessary to establish a bond with them. This indicates that they have faith in the clinician’s ability to deliver appropriate medical treatment. Medication-Induced For Patients with Schizophrenia Disorders
Al-Huseini, S., Al-Madhani, A., Al-Shehhi, A., & Al-Sinawi, H. (2016). Physical examinations of psychiatric patients who presented at the emergency department of a tertiary-care hospital in Oman. Saudi journal of medicine & medical sciences, 4(3), 206. https://doi.org/10.4103/1658-631x.188248
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Beck, N. S., & Ballon, J. S. (2020). Ethical issues in schizophrenia. FOCUS, 18(4), 428-431. https://doi.org/10.1176/appi.focus.20200030
Hendrickson, M. A., Melton, G. B., & Pitt, M. B. (2019). The review of systems, the electronic health record, and billing. JAMA, 322(2), 115. https://doi.org/10.1001/jama.2019.5667
Hias, J., Van der Linden, L., Spriet, I., Vanbrabant, P., Willems, L., Tournoy, J., & De Winter, S. (2017). Predictors for unintentional medication reconciliation discrepancies in preadmission medication: A systematic review. European Journal of Clinical Pharmacology, 73(11), 1355-1377. https://doi.org/10.1007/s00228-017-2308-1
Tucci, V. T., Moukaddam, N., Alam, A., & Rachal, J. (2017). Emergency department medical clearance of patients with psychiatric or behavioral emergencies, Part 1. Psychiatric Clinics of North America, 40(3), 411-423. https://doi.org/10.1016/j.psc.2017.04.001
Wang, Y. Y., Shi, H. S., Liu, W. H., Yan, C., Wang, Y., So, S. H., … & Chan, R. C. (2017). Invariance of factor structure of the 21-item Peters et al. Delusions Inventory (PDI-21) over time and across samples. Psychiatry research, 254, 190-197.
Wilson, L., Szigeti, A., Kearney, A., & Clarke, M. (2018). Clinical characteristics of primary psychotic disorders with concurrent substance abuse and substance-induced psychotic disorders: A systematic review. Schizophrenia Research, 197, 78-86.
Zettl, R. E., & Sadler, J. Z. (2020). Psychiatric ethics. Landmark Papers in Psychiatry, 113, 329 Medication-Induced For Patients with Schizophrenia Disorders.
Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic disorders. 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. 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.)Medication-Induced For Patients with Schizophrenia Disorders.
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:
Place an order in 3 easy steps. Takes less than 5 mins.