NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

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NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders – Step-by-Step Guide

The first step before starting to write the NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders. It is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders Instructions

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. Have a look at NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders.

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.).

Scenario

Name: Mrs. Patricia Warren
Gender: female
Age: 42 years old
Background: Patricia was brought in under a emergency evaluation order after her best friend,
Felicia, after the police for Patricia locking herself in a closet and screaming loudly for over an
hour. EMS was able to calm her with a small dose of Ativan enroute to the emergency
department. This is Patricia’s third presentation to the emergency room in 2 weeks. She had one
psychiatric hospitalization around this same last year.

No self-harm behaviors but has assaulted other in the past. No hx of TBI. Sleeps 1–2-hour increments for total of 6 hrs. daily, refuses to sleep at night. Refused vitals, wt., refuses labs, not cooperative. She obtains SSDI. She lives in Cameron, Montana. She denies ever using any drugs and drinks one glass wine weekly. She has a sister who is five years older, both parents deceased in the last three years.

She has no children, her husband is out of town, truck driver. Family history includes that her father had two previous inpatient psychiatric hospitalizations for paranoia Mother had history of bipolar depression. Paternal grandmother had “shock therapy”. Denies history of trauma experience, but her friend reports parents death was extremely difficulty for Patricia. no current legal charges. dropped out of high school in 11th grade, was pregnant and had abortion. allergies: Clozaril

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients with Schizophrenia, other Psychotic Disorders, and Medication-Induced Movement Disorders Example

Patient Details

  • Name: Mrs. Patricia Warren (Training Title 134)
  • Age: 42 years
  • Sex:  Female
  • Residence: Cameron, Montana
  • Race: White

Subjective:

CC (chief complaint): “I know you are. But you won’t tell me, people like you never do.” (Context: The patient feels like people are spying on her)

HPI: Mrs. Warren is a 42-year-old white female who was admitted under an urgent assessment mandate following an incident involving her closest companion, Felicia, who contacted the authorities due to Patricia’s distressing behavior of barricading herself in a closet and persistently screaming for more than sixty minutes. At the emergency department, Mrs. Warren exhibited a profound sense of fear and suspicion towards a healthcare professional.

She firmly holds the belief that the provider and their colleagues are engaged in covert surveillance, firmly asserting that their presence is omnipresent. Mrs. Warren expresses a pervasive lack of trust, asserting that there is no place that can be deemed safe. This is the third time Patricia has been brought to the emergency room in the last two weeks.

She has a history of disruptive behavior, including assaulting others. Patricia refuses to have her vital signs, weights, and lab work checked, and she displays non-cooperative behavior. The emergency medical team administered a small dose of Ativan during transport, which helped calm her down. Her sleep pattern is disrupted, with 1-2 hour increments, and she only gets a total of 6 hours of sleep per day.

Past Psychiatric History:
  • General Statement: She has had one past hospitalization and two visits in the last two weeks with disruptive behavior.
  • Caregivers (if applicable): She received unknown tranquilizer medications in the emergency department and was discharged home for clinic visits for weeks but was lost to follow-up.
  • Hospitalizations: The patient was admitted to the same hospital last year during the same time as this visit
  • Medication trials: was given Haldol 5mg IM for three days and showed improvement before being discharged but was lost to follow-up thereafter
  • Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History: Patricia refutes any allegations of drug use. She reports to consume only one glass of wine per week. She denies any involvement with illicit substances

Family Psychiatric/Substance Use History: Warren’s father had been admitted to psychiatric hospitals twice in the past due to his paranoia. Her mother had a background of bipolar depression. The paternal grandmother had undergone “shock therapy” in the past. No history of any substance use in the family

Psychosocial History: was diagnosed with acute psychosis during the last hospitalization

Medical History:
  • Current Medications: received lorazepam (Ativan) 2mg IM stat en route to the hospital
  • Allergies: Allergic to clozaril, no food allergies
  • Reproductive Hx:para 1+0, last normal menstrual period was 2nd January 2024. Menses are regular, last 3 days, with no abnormal pain or intermenstrual bleeding. Married with no living child

ROS:

  • GENERAL: No fever, no weakness, no weight loss
  • HEENT: no headache, no history of head trauma, no visual problem, no auditory problems reported,
  • SKIN: No skin itchiness or rashes
  • CARDIOVASCULAR: No feeling of heart racing, easy fatigability, or leg swelling
  • RESPIRATORY: No difficulty in breathing, no cough or chest pain
  • GASTROINTESTINAL: No loss of appetite, no vomiting, no difficulty in swallowing, no diarrhea, or constipation
  • GENITOURINARY: No genital itchiness, discharge, or pain; no change in urinary color, amount, or smell
  • NEUROLOGICAL: No episodes of fainting, no numbness, paralysis, or tingling; able to walk without support or difficulty
  • MUSCULOSKELETAL: No weakness, pain, or stiffness in the joints
  • HEMATOLOGIC: No easy bruising or history of recurrent infections
  • LYMPHATICS: No limb swelling or pain
  • ENDOCRINOLOGIC: No intolerance to heat or cold, no flank pain, no excessive thirst or hunger

Objective:

Physical exam: She is alert and oriented to time, place, and person. No tremors, no parlor, no edema, no jaundice, or lymphadenopathy. Systemic exam is unremarkable.

Diagnostic results: liver function tests and blood urea nitrogen tests are pending in the lab

Assessment:

Mental Status Examination: PW is a 42-year-old white female who looks her stated age. She is well dressed and is seated upright on the chair, does not keep eye contact for long, and keeps wringing her hands on the arms of the chair. No fidgeting. Her speech is of normal rhythm, volume, rate, and articulation. Her subjective mood is euthymic. However, she looks anxious. Her affect is reactive and congruent to the mood. Mrs. Warren shows evidence of delusional perceptions.

She believes that the doctor is part of a group or organization that is out to pursue her. She distrusts her environment and believes there is nowhere safe. Her thought content is logical and shows no flight of ideas. Denies any hallucinations or out-of-body or out-of-world feelings. Denies thought of suicide, self-harm, or harm to others. Attention and concentration are intact. The patient is oriented in time, place, and person. Her judgment is intact. Her remote, recent, and short-term memory are intact. However, she lacks insight.

Differential Diagnoses:

#1: 297.1 (F22) Delusional Disorder, Persecutory Type, Multiple episodes, currently in acute episode

Delusional disorder can manifest in individuals through non-bizarre delusions and/or hallucinations that revolve around themes of being rejected or offending others. The persecutory type of delusion revolves around the individual’s conviction that they are being targeted, deceived, monitored, pursued, poisoned, defamed, harassed, or hindered in their long-term aspirations (American Psychiatric Association., 2013). Minor offenses may be blown out of proportion and become the primary focus of the delusional belief system.

Individuals experiencing persecutory delusions may repeatedly seek redress through legal or legislative means in an effort to find satisfaction (Diaconescu et al., 2019). Those with persecutory delusions often harbor feelings of resentment and anger and may resort to violent actions against those they perceive as causing harm. The persecutory delusion subtype is characterized by a deep-seated sense of victimization and a belief in a malevolent conspiracy against the individual.

Mrs. Warren meets the DSM-5 criteria A-E for diagnosing delusional disorder. Her delusions are persecutory and are based on the belief that there are people out there everywhere to persecute her. This is the third time she has been brought to the facility with similar complaints (Freeman et al., 2019). Her condition has significantly affected her social and personal life.

#2: 300.3 (F42) Obsessive-compulsive disorder

Obsessions of persecution are predominant in the patient’s presentation. These might have compelled her to close herself in her closets, causing distress. Even though she is concerned about her tormentors, she does not have proper insight into whether her persecutors might be true (Cavaco & Ribeiro, 2023). The lack of insights makes this differential less possible in this patient (Palermo et al., 2020). 

#3: (295.90) Schizophrenia, Undifferentiated Type

The presence of delusions makes this patient psychotic and likely to be schizophrenic. However, her delusions are predominated by persecution with no hallucinations. Her speech, mood, and cognition exam elements remain intact, save for insights (Awasthi & Satapthy, 2023). These absent features make schizophrenia less likely in Mrs. Warren.

Reflections:

The case highlights the need for ongoing management of mental health, including understanding specific diagnoses, treatment plans, and responses to medication trials. Social determinants of health, such as disrupted sleep, recent losses, and strained family dynamics, play a significant role in Patricia’s mental health and should be explored for tailored interventions. A patient-centered approach is necessary to address Patricia’s refusal of medical procedures and ensure comprehensive care.

If I were to redo the case, I would incorporate ethical considerations, including the use of emergency evacuation orders, patient autonomy, and less restrictive alternatives, to carefully evaluate Patricia’s case. Patricia’s case underscores the importance of addressing both mental health and physical health in her care plan. Going forward, the management of Patricia’s mental health, including diagnosis, treatment plans, and medication trials, will be carefully monitored and adjusted as needed. To promote long-term well-being, mental health literacy, education, and coping mechanisms should be incorporated into Patricia’s care plan.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental health disorders: Speedy study guides (5th ed.). American Psychiatric Association Publishing.

Awasthi, S., & Satapthy, R. (2023). How do obsessive-compulsive symptoms correlate with other symptoms and quality of life in schizophrenia? A cross-sectional study. Indian Journal of Psychological Medicine, 45(4), 383–389. https://doi.org/10.1177/02537176231174063

Cavaco, T. B., & Ribeiro, J. S. (2023). Drawing the line between obsessive-compulsive disorder and schizophrenia. Cureus, 15(3), e36227. https://doi.org/10.7759/cureus.36227

Diaconescu, A. O., Hauke, D. J., & Borgwardt, S. (2019). Models of persecutory delusions: a mechanistic insight into the early stages of psychosis. Molecular Psychiatry, 24(9), 1258–1267. https://doi.org/10.1038/s41380-019-0427-z

Freeman, D., Morrison, A., Bird, J. C., Chadwick, E., Bold, E., Taylor, K. M., Diamond, R., Collett, N., Černis, E., Isham, L., Lister, R., Kirkham, M., Teale, A.-L., Twivy, E., & Waite, F. (2019). The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors. BJPsych Open, 5(5), e83. https://doi.org/10.1192/bjo.2019.67

Palermo, S., Marazziti, D., Baroni, S., Barberi, F. M., & Mucci, F. (2020). The relationships between obsessive-compulsive disorder and psychosis: An unresolved issue. Clinical Neuropsychiatry, 17(3), 149–157. https://doi.org/10.36131/cnfioritieditore20200302

Symptom Media. (2018). Test Section Index, 134, Training Title 134. Symptom Media (Santa Monica, CA). https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-134