NRNP 6635 WEEK 7 Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

The case study presents Ms. Fatima Branning, a 28-year-old woman from Coronado, CA. She has a bachelor’s degree in hospitality and works as an administrative assistant in the car sales department. She presently receives chiropractic therapy for her scoliosis, which she developed in the past. She refutes the existence of familial mental health disorders and reports latex allergies, as well as normal menstruation without the use of birth control. This paper examines the patient’s mental evaluation, differential diagnoses, and analytical reasoning process. This paper also addresses the patient’s symptoms, length, intensity, and life effects while reflecting on future sessions, legal implications, health promotion, and illness prevention.

Subjective:

CC (chief complaint): “Training title 9.”

HPI: F.B., a 28-year-old woman with mental health issues, was admitted to the mental health facility because her employer could fire her. The woman claims her boss’s job is jeopardized because of her supervisor’s affection for her. She disputes any allegations of inappropriate behavior or sexual harassment by her employer. She draws attention by showcasing her strength as a woman. However, her boss insists that she has not been successful in generating any sales over the past three weeks. According to her, the causes include a sluggish month as well as health difficulties, such as a tumor on her neck and lower back discomfort that extends from her back. She contends that the mental strain that she experienced as a result of her employment was the root cause of her health issues, including the development of cancer. In order to treat her history of hypothyroidism, she discloses that she has been taking levothyroxine throughout her treatment.

Past Psychiatric History:

• General Statement: The patient refuses to discuss her prior mental history.
• Caregivers (if applicable): mother
• Hospitalizations: denies any prior history of hospitalization.
• Medication trials: The woman claims she is not taking any medications for mental illness.
• Psychotherapy or Previous Psychiatric Diagnosis: Refuses to disclose her current circumstances to anybody.

Substance Current Use and History: denies abusing alcohol, cigarettes, or any other drug. No history of substance addiction issues exists.

Family Psychiatric/Substance Use History: There is no documented family history of drug addiction or mental health issues.

Psychosocial History: The patient’s home is Coronado, California. Her parents raised her. Her background is in hospitality, and she now works as an administrator’s assistant within the used car sales department. She is receiving chiropractic therapy for her history of scoliosis. She says there are no mental health problems in the family. She thinks that she is about to be fired because her boss loves her.

Medical History: The patient reports having scoliosis in the past.

• Current Medications: The patient gets chiropractic treatment without taking any medications.
• Allergies: the patient records an allergy to latex.

• Reproductive Hx: The patient identifies as heterosexual. The patient says she does not have a history of reproductive issues and that her menstrual periods are regular.

ROS:

• GENERAL: No changes in weight, hunger, pyrexia, weariness, or general weakness have occurred recently.
• HEENT: Head: No signs of cranial trauma or prior concussions. There is no ringing, discharge, itching, soreness, or discomfort in the ears. Eyes: Clear sight without corrective lenses, excessive tearing, diplopia, or pruritus. No erythema, discomfort, obstruction, nasal discharge, or epistaxis. Oral Cavity & Pharynx: No dental pain, pharyngitis, dysphonia, gingival bleeding, or dysphagia.
• SKIN: The complexity of skin differs throughout ethnic groups. No hives, erythema, pruritus, swellings, or dermal eruptions are present.
• CARDIOVASCULAR: Absence of cyanosis, pain, palpitations, edema, or chest tightness.
• RESPIRATORY: Absence of wheezing, chest congestion, cough, sneezing, or dyspnea.
• GASTROINTESTINAL: There is no hernia, discomfort, abdominal distension, constipation, or altered bowel habits.
• GENITOURINARY: Consistent menstrual cycles. No dysuria, nocturnal enuresis, changed urinary frequency, or trouble beginning micturition.
• NEUROLOGICAL: There is no headache, dizziness, blurred vision, or unconsciousness.
• MUSCULOSKELETAL: There are no sore joints or muscles. Joints have a full range of motion without restriction.
• HAEMATOLOGIC: There is no history of slow healing, bruise susceptibility, or hematologic diseases.
• LYMPHATICS: states that there has never been lymphadenopathy.
• ENDOCRINOLOGIC: No signs of excessive thirst, polyuria, or polydipsia.

Objective:

Vitals: Temperature: 98.4°F, Pulse: 82 bpm, Respiratory Rate: 18 breaths/min, Heart Rate: 124/74 mmHg, Height: 5’0″, Weight: 118 pounds

Diagnostic results: A CBC and other vital blood tests are necessary to evaluate the patient’s health and exclude medical conditions. Toxicological analysis, together with urine and blood tests, is essential for identifying chemicals in the patient (Muñoz-Negro et al., 2020).

Assessment:

Mental Status Examination: The 28-year-old female seems to have invested care in her looks and is attired suitably for her age. She has a profound comprehension of temporal, spatial, and interpersonal dynamics. Her discourse is characterized by clarity and intellectual precision. Her intelligence quotient is low, and her reasoning skills are lacking. She asserts that she does not have any suicidal or delusional thoughts or feelings—every one of her memories, whether short-term or long-term, has been kept. Throughout the conversation, she is kind and agreeable, but she is hesitant to discuss her mental health issue in further detail. The look on her face is entirely consistent with how she expresses her sorrow.

Differential Diagnoses:

1. Delusional disorder: Delusional disorder, as delineated by the DSM-V, is characterized by at least one delusional episode persisting for a month or more in persons exhibiting normal behavior (González-Rodríguez et al., 2022). Subgroups such as nihilistic, erotomaniac, grandiose, somatic, persecutory, and referential may be distinguished. In the case study, the patient displays indications of erotomania, convinced of a love relationship with another individual. Given her lack of other psychotic symptoms and her history of hypothyroidism—which is associated with hallucination disorder—this diagnosis is accurate.
2. Delirium disorder: According to the DSM-V, delirium is a condition marked by disturbances in attention, consciousness, and baseline cognitive function (Oldham, 2021). It should also encompass variations in cognitive function during the day and brief intervals of disruption. In the case above study, a patient exhibited disorientation and confusion attributed to her illness, which was misdiagnosed as symptoms of hypothyroidism related to her occupation. Nevertheless, she showed no indications of orientation difficulties or hallucinations, which contradicts the diagnosis.
3. Narcissistic personality disorder: Narcissistic personality disorder is defined by an exaggerated sense of self-importance, a need for excessive admiration, a deficiency in empathy, and challenges in connecting with others (Uriawan et al., 2021). The DSM-V criteria stipulate that a minimum of five traits must be present: grandiose self-worth, delusions regarding significant accomplishments, a craving for praise, feelings of entitlement, and a lack of empathy (Cain & Boussi, 2020). The case study patient asserts that she attracts individuals and receives favorable treatment in her workplace. Although she exhibits empathy, her symptoms frequently do not meet the diagnostic criteria for this condition.

Reflections: The presented case study exemplifies a patient experiencing delusions. She erroneously feels that her boss has sentiments of fondness for her and that she has the power to replace her supervisor. She is firmly persuaded that her job is at risk because of this. To establish the diagnosis, the PMHNP collected sufficient evidence via interviews with the patient’s supervisor and coworkers, with the patient’s cooperation, to obtain insight into her behavior at home. The patient’s parents might act as dependable chroniclers of her symptoms to grasp her condition better. Nonetheless, the patient rejected the chance, posing an ethical issue for the psychiatrist (Pellegrini et al., 2022). The PMHNP must protect the patient’s autonomy and confidentiality about her healthcare decisions, with the exception of circumstances where there is evidence indicating the patient presents a risk of damage to herself or others.

Conclusion

The case study illustrates a young adult female exhibiting signs of a delusional disease characterized by erotomania, as she believes she is in a love relationship with another individual. Her employer thinks she has the power to succeed her boss, jeopardizing her position. The case study emphasizes the need for a psychiatrist to collect information via interviews with her supervisor, coworkers, and parents to get a more thorough comprehension of her condition. The patient rejected the chance, creating an ethical issue. The PMHNP shall respect the patient’s autonomy and confidentiality about her healthcare decisions unless there is evidence indicating self-harm or damage to others.

References

Cain, N. M., & Boussi, A. (2020). Narcissistic Personality Disorder. In Springer eBooks (pp. 3088–3096). https://doi.org/10.1007/978-3-319-24612-3_604

González-Rodríguez, A., Seeman, M. V., Izquierdo, E., Natividad, M., Guàrdia, A., Román, E., & Monreal, J. A. (2022). Delusional Disorder in Old Age: A Hypothesis-Driven review of recent work focusing on epidemiology, clinical aspects, and outcomes. International Journal of Environmental Research and Public Health, 19(13), 7911. https://doi.org/10.3390/ijerph19137911

Muñoz-Negro, J. E., Gómez-Sierra, F. J., Peralta, V., González-Rodríguez, A., & Cervilla, J. A. (2020). A systematic review of studies with clinician-rated scales on the pharmacological treatment of delusional disorder. International Clinical Psychopharmacology, 35(3), 129–136. https://doi.org/10.1097/yic.0000000000000306

Oldham, M. A. (2021). Delirium disorder: Unity in diversity. General Hospital Psychiatry, 74, 32–38. https://doi.org/10.1016/j.genhosppsych.2021.11.007

Pellegrini, R., Negro, J. E. M., Ottoni, R., Cervilla, J. A., & Tonna, M. (2022). The affective core of delusional disorder. Psychopathology, 55(3–4), 244–250. https://doi.org/10.1159/000522344

Uriawan, W., Manaf, K., Syaripudin, U., & Mujiburrahman, M. (2021). Expert system for diagnosing narcissistic personality disorders using certainty factor and forward chaining methods. IOP Conference Series Materials Science and Engineering, 1098(3), 032095. https://doi.org/10.1088/1757-899x/1098/3/032095

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