To Prepare:

• 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.

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-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.).

Solution: NRNP-6635 Week 7 Assignment

Subjective:

CC (chief complaint): “There’s nowhere that is safe. Don’t pretend like there is” (Symptom Media, 2016)

HPI: PW, a 42-year-old Caucasian woman, was placed under an urgent assessment order after an emergency call from her closest friend Felicia, who reported that PW had shut herself in a closet and had been screaming for more than an hour. She had one mental hospitalization about this time last year, and this was her third visit to the emergency department in the last two weeks. She does not hurt herself, although she has attacked others before. Injury to the brain has not occurred in her past. Her sleep patterns are highly disturbed; she only sleeps for 1-2 hours at a time, six hours a day, and she would not go to sleep at night. Patricia is not cooperative, refuses vital signs, weight, and laboratory tests. Regarding psychiatric symptoms, she exhibits paranoia, believing that the interviewer and “people like them” have eyes and ears planted everywhere and are spying on her. She feels there is nowhere safe and expresses a general distrust of others. The onset of these psychiatric symptoms is unclear, but they appear to have significantly worsened in the past 2 weeks, leading to her third emergency room visit. The frequency and severity of the paranoia, hallucinations, sleep disturbance, and agitation have significantly impacted her functioning, as she is unable to maintain safety and requires emergency intervention. Her background includes a history of psychiatric hospitalizations in her father and mother, as well as a paternal grandmother who received “shock therapy.” She dropped out of high school in 11th grade due to a pregnancy and subsequent abortion. She currently obtains Social Security Disability Income (SSDI) but denies any current legal charges (Symptom Media, 2016).

Past Psychiatric History:

• General Statement: Patient has a history of paranoia and one previous psychiatric hospitalization around 1 year ago for an unclear reason.
• Caregivers (if applicable):  No caregivers involved in her care currently. Lives alone since death of parents recently.
• Hospitalizations: One prior psychiatric hospitalization around 1 year ago for unknown reason.
• Medication trials: No history of previous medication trials provided.
• Psychotherapy or Previous Psychiatric Diagnosis: No history of previous psychotherapy or psychiatric diagnosis provided.

Substance Current Use and History: Patient denies any current drug or alcohol use other than drinking one glass of wine weekly. No history of illicit drug use or problematic alcohol use reported.

Family Psychiatric/Substance Use History: Psychiatric disorders run deep in Patricia’s family tree. Her mother suffered from bipolar disorder, while her dad spent time in a mental institution twice for paranoia. Her paternal grandmother had a history of “shock therapy” (Symptom Media, 2016).

Psychosocial History: She was born in Cameron, Montana and was raised by both parents until their deaths in the past three years. She has one sister who is five years older. She currently lives….Please click purchase button below to get full answer for $10

Related: (Solution) NRNP-6635 Week 8 Assignment