Schizophrenia and Other Psychotic Disorders; 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 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.
For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.
- Review the 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.
- video case study to use for this Assignment and “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.
This assignment explores psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.
Objectives
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
- Formulate differential diagnoses using DSM-5 criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life span
“Case History Reports”
Training Title 9
Name: Ms. Nijah Branning
Gender: female
Age: 25 years old T- 98.4 P- 80 R 18 128/78 Ht 5’0 Wt 120lbs
Background: Raised by parents, lives alone in Santa Monica, CA. Only child. Works in office supply sales, has a bachelor’s in business degree. Has medical history of hypothyroidism, currently treated with daily levothyroxine. Guarded and declined to discuss past psychiatric history. Denied family mental health issues, declined to allow you to speak to parents for collaborative information. Allergies: medical tape; menses regular Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-9
TRANSCRIPT OF VIDEO FILE:
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERA Ms. Branning, Mr. Nehring asked suggested you see me. He said your having some issues at work.
00:00:20MS. BRANNING You could call them that.
00:00:20OFF CAMERA What kind of difficulty are you having at work?
00:00:25MS. BRANNING Well Mr. Nehring wants to fire me.
00:00:30OFF CAMERA Why do you think Mr. Nehring wants to fire you?
00:00:30MS. BRANNING Because Eric is in love with me. And it’s probably getting in the way. And he wants to fire me.
00:00:40OFF CAMERA Who is Eric?
00:00:40MS. BRANNING Eric is my supervisor.
00:00:45OFF CAMERA Are the two of you in a relationship?
00:00:45MS. BRANNING No! Eric has his own girlfriend, I have my own boyfriend. But Mr. Nehring got it in his head that this is my fault. And they’ve been ganging up against me.
00:01:00OFF CAMERA What happened to make you feel this way?
00:01:00MS. BRANNING Eric is lustful for me. Lust. Lustful.
00:01:10OFF CAMERA Well has Eric done anything inappropriate?
00:01:10MS. BRANNING No, he doesn’t have to.
00:01:15OFF CAMERA What do you mean?
00:01:15MS. BRANNING Well, he has this way of walking toward me and he gives me the easiest assignments to do and he asks me to voice my opinion a lot in our weekly meetings. And I’m beautiful. I mean, not to be boastful or anything but I’m a strong woman. And people are attracted to that. And others, like Mr. Nehring feel threatened by it. He probably feels I could replace him in a couple years. And I could.
00:01:45OFF CAMERA But there have been no instances of sexual harassment.
00:01:50MS. BRANNING No. And now they want to fire me, and it’s probably because they don’t want me to get in the way of their day. I’m probably a distraction or something.
00:02:00OFF CAMERA According to Mr. Nehring you haven’t made a sale in three weeks.
00:02:05MS. BRANNING Oh, it’s been a slow time period. I guess it wouldn’t be bad thing if they fired me. I mean after all of this, all the bad it’s done for my health. You know I should really sue for discrimination, you know the stress and the health problems.
00:02:25OFF CAMERA You’ve been having health problems?
00:02:25MS. BRANNING Yes. Yes. It keeps getting worse.
00:02:30OFF CAMERA Can you describe it for me?
00:02:30MS. BRANNING Well you know there’s this pain in my neck, it aches, it spreads to my back, I think there’s a lump, right here. I’m really worried.
00:02:55OFF CAMERA And what do you feel is the cause?
00:02:55MS. BRANNING I told you, pain, suffering, broken heart. I think it’s cancer.
00:03:05OFF CAMERA Have you been seen by a doctor?
00:03:10MS. BRANNING No. But it’s probably cancer. And it’s slowly killing me. And it’s all because of them. And Eric’s obsession with me.
00:03:20OFF CAMERA Ms Branning, I don’t think you have to worry, a broken heart can’t cause cancer.
00:03:25MS. BRANNING You never know until it happens.
00:03:30[sil.]
00:03:30END TRANSCRIPT
Complete a Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a 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.).
EXPERT ANSWER AND EXPLANATION
SOAP NOTE for Schizophrenia
Subjective:
CC: The patient was referred to me by her boss Mr. Nehring because she has some issues at work.
HPI: Ms. Nijah Branning is a 25-years-old female of Palestinian origin working as a sales person in in office supply sales in one of the local sales companies. She came to my office after her boss Mr. Nehring suggested that she see me because she has some issues at work. She is not prescribed any psychotic medications at the moment.
Branning says that her boss, Mr. Nehring wants to fire her because Eric her supervisor in in love with her and Mr. Nehring things that Eric is on the way. However, she says that Eric has a girlfriend. The patient says that Eric often walks towards her in a seductive manner. Her thinking is disorganized.
Past Psychiatric History:
- General Statement: The patient has refused to talk about her mental health history.
- Caregivers: The patient has no caregivers.
- Hospitalizations: The patient has never been hospitalized.
- Medication trials: The patient is under no medical trial at the moment.
- Psychotherapy: The patient has refused to discuss her past mental health history; thus it is hard to know whether she has had a prior mental health issue.
Substance Current Use and History: The patient denies using alcohol, tobacco, and illicit drugs.
Family Psychiatric/Substance Use History: The patient notes that there is not mental health problem among her family members. However, she says that her maternal uncle is an alcoholic.
Psychosocial History: The patient is the only child and was born in the US and raised by her parents. Currently, she lives alone in Santa Monica, CA. She is not married but has a boyfriend. The patient has a bachelor’s in business degree. She likes listening to music and having a walk in the park during weekends. She is currently employed as a sales person. She denies any legal issues. No history of trauma. Denies history of violence.
Medical History: The patient has hypothyroidism.
- Current Medications: She takes levothyroxine to treat hypothyroidism.
- Allergies: No allergies.
- Reproductive Hx: No reproductive concerns. Her menstrual cycle is up to date.
ROS:
- GENERAL: No chills, weakness, fatigue, weight change, fever, or tiredness.
- HEENT: Eyes: No yellow sclera, visual loss, double vision, or blurred. Ears, Nose, Throat: No hearing problems, runny nose, sore throat, or sneezing.
- SKIN: No itching or rush.
- CARDIOVASCULAR: No edema, chest pressure, chest pain, palpitations, or chest discomfort.
- RESPIRATORY: No sputum or shortness of breath.
- GASTROINTESTINAL: No vomiting, nausea, diarrhea, or anorexia.
- GENITOURINARY: No urgency on urination or burning on urination.
- NEUROLOGICAL: No paralysis, numbness, headache, ataxia, or dizziness.
- MUSCULOSKELETAL: No musculoskeletal pain.
- HEMATOLOGIC: No bleeding, bruising, or anemia.
- LYMPHATICS: No enlarged nodes.
- ENDOCRINOLOGIC: No polyuria or reports of sweating, heart intolerance, or cold.
Objective:
Physical exam: GENERAL: The patient is welled groomed and wears clothes relevant to the current weather and season of the year. She is also clean and looked like she was from the office. She answers questions correctly and maintains eye contact during the interview process.
Vital Signs: Temp 35.8, Ht. 5’7’’, Wt. 68kgs, HR 68, RR 17, B/P 112/89.
- HEENT: Head: Hair evenly distributed. No deformities Eyes: No abnormal discharge or redness observed. Sclera white and normal sensitivity to light. Ears: No discharge, TM intact, bilateral intact. Nose: Moist mucosa. Throat: No inflammation or swelling.
- Skin: No rash observed.
- Cardiovascular: Capillary refill <3 seconds, no murmurs, regular heart rate.
- Respiratory: Lungs clear. No cracks observed on the chest. No rales or wheezes.
- Neurological: Responds properly to temperature extremes.
- Musculoskeletal: Normal gait. No muscle swelling observed.
Diagnostic results:
- CT Scan-pending
- MRI-pending
- PANSS:
- 40 for the positive symptoms scale
- 20 for the negative symptom scale
- 60 for the general psychopathology scale
Assessment:
Mental Status Examination: The patient is oriented to place, event, person, and time. She is well groomed, appear as stated age, and maintains eye contact during interview. She has calm con concern attitude. Her behavior is cooperative. Speech is clear and within normal rate. Has candid rapport. Self-reported mood is “mild depressed” and affect is blunted. Goal-directed thought process. Delusional thinking noted in the thought content. Insight is fair and judgment is good. No suicidal and homicidal thoughts.
Differential Diagnoses:
Schizophrenia disorder: The primary diagnosis for this case is schizophrenia disorder. The symptoms of schizophrenia disorder include hallucinations, delusions, disorganized thinking, negative symptoms, abnormal or extremely disorganized motor behaviors (Gandal et al., 2018). The DSM-5 notes that for a patient to be diagnosed with schizophrenia disorder, the individual must have two of the five symptoms above. One of the two symptoms must be either disorganized speech, hallucinations, or delusions (American Psychiatric Association, 2013).
This disorder is a primary disorder because the patient has delusions and hallucinations. She believes that her she has cancer. She confesses seeing Eric walking towards her in a seductive manner. The PANSS test results also shows that he has schizophrenia. According to Lim et al. (2021), PANSS can be used to diagnose people with schizophrenia.
Schizoaffective disorder: This disease has been included in the study because it causes symptoms of schizophrenia (Archibald et al., 2019). However, the disorder is a secondary condition because patient does not have symptoms of mood disorder. According to DSM-5, a patient must have a schizophrenia symptom and a mood symptom for them to be diagnosed with schizoaffective disorder (APA, 2013).
Delusional disorder: Delusion disorder has been included in the diagnosis because the patient has delusions (González-Rodríguez et al., 2019). She thinks that Eric and her boss are ganging up on her. She also thinks that she has cancer due to heartbreak. However, this disease has been included as a secondary diagnosis because the patient experiences hallucinations. Hallucinations are not among the symptoms of delusions.
Reflections:
One of the things I have learned in this case is the importance of good communication. The patient had refused to talk about her past mental health history because of poor communication between the patient and the person assessing her. If I was to work on the case again, I would apply communication skills that would help me built trust with the patient. I would show the patient that I am here to help her and not to judge her. An ethical consideration that I include in this case is therapeutic relationship. I will ensure that I have a good and professional relationship with the patient to improve her trust.
References
American Psychiatric Association. (2013). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm02
Archibald, L., Brunette, M. F., Wallin, D. J., & Green, A. I. (2019). Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol research : current reviews, 40(1), arcr.v40.1.06. https://doi.org/10.35946/arcr.v40.1.06
Gandal, M. J., Zhang, P., Hadjimichael, E., Walker, R. L., Chen, C., Liu, S., Won, H., van Bakel, H., Varghese, M., Wang, Y., Shieh, A. W., Haney, J., Parhami, S., Belmont, J., Kim, M., Moran Losada, P., Khan, Z., Mleczko, J., Xia, Y., Dai, R., … Geschwind, D. H. (2018). Transcriptome-wide isoform-level dysregulation in ASD, schizophrenia, and bipolar disorder. Science (New York, N.Y.), 362(6420), eaat8127. https://doi.org/10.1126/science.aat8127
González-Rodríguez, A., Esteve, M., Álvarez, A., Guardia, A., Monreal, J. A., Palao, D., & Labad, J. (2019). What we know and still need to know about gender aspects of delusional disorder: a narrative review of recent work. Journal of Psychiatry and Brain Science, 4(3). https://doi.org/10.20900/jpbs.20190009
Lim, K., Peh, O. H., Yang, Z., Rekhi, G., Rapisarda, A., See, Y. M., … & Lam, M. (2021). Large-scale evaluation of the Positive and Negative Syndrome Scale (PANSS) symptom architecture in schizophrenia. Asian Journal Of Psychiatry, 102732. https://doi.org/10.1016/j.ajp.2021.102732
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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
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
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
- Chief complaint
- History of present illness (HPI)
- Past psychiatric history
- Medication trials and current medications
- Psychotherapy or previous psychiatric diagnosis
- Pertinent substance use, family psychiatric/substance use, social, and medical history
- Allergies
- ROS
- Read rating descriptions to see the grading standards!
In the Objective section, provide:
- Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
- Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
- Read rating descriptions to see the grading standards!
In the Assessment section, provide:
- Results of the mental status examination, presented in paragraph form.
- At least three differentials with supporting evidence. List them from top priority to least 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.
- Read rating descriptions to see the grading standards!
Reflect on this case. Include: Discuss what you learned and what you might do differently. 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.).
(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
EXEMPLAR BEGINS HERE
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:
N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.
Or
P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.
Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.
General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)
Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.
Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.
Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:
Where patient was born, who raised the patient
Number of brothers/sisters (what order is the patient within siblings)
Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?
Educational Level
Hobbies:
Work History: currently working/profession, disabled, unemployed, retired?
Legal history: past hx, any current issues?
Trauma history: Any childhood or adult history of trauma?
Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)
Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.
Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.
Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.
Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns
ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!
You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).
Assessment
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below.
You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical.
There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrating 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 (move to begin on next page)
You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.