Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.
Learning Objectives
Students will:
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
- Formulate differential diagnoses using DSM-5-TR criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life span
Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
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.
- 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-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? 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.).
References
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
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
·
General Statement:
·
Caregivers (if applicable):
·
Hospitalizations:
·
Medication trials:
·
Psychotherapy or
Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
·
Current Medications:
·
Allergies:
·
Reproductive Hx:
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination:
Differential Diagnoses:
Reflections:
References
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Assignment week7 Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.
For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such disorders show a range of unique symptoms. This range of symptoms may impede an individual’s ability to function in daily life. As a result, clinicians address a patient’s ability or inability to function in life.
This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.
Learning Objectives
Students will:
· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
· Formulate differential diagnoses using
DSM-5-TR criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life span
Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders
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.
· 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
VIDEO 24 TRANSCRIPT
Video: Training Title 24, In Test Section Index, Episode 24 (Santa Monica, CA: Symptom Media, 2016)
Training Title 24
Top of Form
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERA Your roommates, Rachel and Liz, shared some information with me. They said that you were fine, and that shortly after your aunt died, that you started acting in a different sort of strange way. Started having thoughts and hearing things that others couldn’t hear.
00:00:35JESS 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
00:00:45OFF CAMERA I’m not sure I understand how you can be a movie.
00:00:45JESS Because they listen to our apartment.
00:00:50[Whispers]
00:00:50JESS They listen from next door.
00:00:50OFF CAMERA Who listens?
00:00:55JESS Russian men and whores. They drill all night long. That’s how they send their information back. Drilling.
00:01:05OFF CAMERA Drilling. They send messages by drilling?
00:01:10JESS Doesn’t surprise me. Most people don’t understand.
00:01:15OFF CAMERA Your roommates said that your favorite aunt that died, she’s the one who raised you.
00:01:20JESS Maybe she did. Maybe she didn’t. Who told you? Can you prove it? I can’t.
00:01:30OFF CAMERA Liz and Rachel told me.
00:01:30JESS Good for them.
00:01:35OFF CAMERA And your roommates said you had some new neighbors that moved in. Are these the neighbors you’re talking about?
00:01:45JESS They’re not neighbors. They’re Russians. They don’t answer their door. I tried to banging on their door and they didn’t answer. Figures. I mean they only speak English. They don’t speak English, they speak Russian in code.
00:02:00OFF CAMERA You know, your roommate, Rachel, told me your new neighbors speak Spanish. They speak Spanish.
00:02:10JESS They lie. But what do you expect?
00:02:15OFF CAMERA What do they do? Your neighbors?
00:02:20JESS I don’t want to talk about this any more.
00:02:25OFF CAMERA You know, Jess, I imagine what you are experiencing right now feels very frightening. I hear from a lot of the people who, hear voices that maybe aren’t there, that it’s very frightening. And it’s upsetting. Are you experiencing anything like that?
00:02:40JESS Yes. I hear them talking when no one else can. I mean not Rachel, not Liz. That’s why I went down to my car yesterday. Because if I’m very, very still, the Russians can’t code me.
00:02:55OFF CAMERA What do you mean code you?
00:03:00JESS You know. You act like you don’t know, but you know.
00:03:05OFF CAMERA How long did you stay in your car?
00:03:10JESS Six hours. I watched them move in and out.
00:03:15OFF CAMERA So do you some
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