Review the video, Case Study: Sherman Tremaine. You will use this case as the basis of this Assignment
Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
NRNP 6675 ASSIGNMENT WEEK 5 Assignment 1
Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.
For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder.
To Prepare
- Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating schizophrenia spectrum, other psychotic, and medication-induced movement disorders.
Photo Credit: Getty Images/Wavebreak Media
- Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
- Review the video, Case Study: Sherman Tremaine. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
The Assignment
Develop a focused SOAP note, 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, and list them 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.
- Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
- Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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.).
- Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
EXPERT ANSWER AND EXPLANATION
SOAP Note for Schizophrenia
Patient Initials: Sherman Tremaine Age: 53 years Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC): “He was made to come in by his sister.”
History of Present Illness (HPI): Sherman Tremaine is a 53-years-old African American male who visited my office saying that he was made to come in by his sister. Sherman notes that people have been watching him for weeks and his taxes have raised. He says that the government sent these people to watch him. The patient’s symptoms alleviate when he listens to music.
Medical trials and Current Medications:
No medical trials but reports using Haldol, Thorazine, and Seroquel previously. Takes metformin for diabetes.
Allergies: Denies food, environmental, or drug allergies.
Past Medical History: The patient was diagnosed with diabetes and fatty liver.
Past Psychiatric/Physical History (PMH): Have been in the hospital three times though when he was 20.
Past Surgical History (PSH): No past surgeries.
Personal/Social History: The patient smokes three packets a day, drunks 12 packets of alcohol a week, and used marijuana last three years ago. Denies substance abuse.
History of Violence: His dad was abusive.
Immunization History: The patient does not remember immunization dates.
Significant Family History: The patient is single, never married, and has no children. The patient’s mother had anxiety and father had paranoid schizophrenia.
Lifestyle: The patient has his sister has his main social support.
Review of Systems:
General: Denies fatigue, fever, weight changes, or weakness.
Respiratory: No shortness of breath, sputum, or cough.
Cardiovascular/Peripheral Vascular: No chest pain or chest discomfort.
Psychiatric: Positive for sleeping problems.
Neurological: No headache or other neurological problems.
Skin: No sores, dryness, or rashes.
OBJECTIVE DATA:
Physical Exam:
Vital signs: Wt. 180lbs, Ht. 5’8’’, T 36.4, HR 76, HH 18, BP 134/98
General: Sherman is oriented to place, date, and people. However, the patient does not know whether today is Wednesday or Thursday. The patient is well groomed and wears clothes that conforms to weather of the day and climate of the year. The patient answers most questions correctly.
Chest/Lungs: Regular heart rhythm and rate. No murmurs.
Heart/Peripheral Vascular: Lungs clear. No wheezes, chest cracks, or rhonchi.
Psychiatric: The patient experiences hallucinations and delusions. He says that there are people outside his window watching him. He notes that these people were sent by the government. He says that he hears loud voices and also notes that people from his TV want to poison him but he tricks them.
Diagnostic Tests
MRI-Pending
DSM-5-Schizophrenia
PSYRATS – Hallucinations Subscale-Positive for hallucinations.
PSYRATS – Delusions Subscale-Positive for delusions
ASSESSMENT:
- Schizophrenia-Primary disorder for this case.
- Brief Psychotic Disorder
- Schizoaffective Disorder
- Delusional Disorders
The primary diagnosis for this case is schizophrenia. According to Ng et al. (2019), symptoms of schizophrenia include disorganized speech, delusions, catatonic behavior, negative symptoms, and hallucinations. According to DSM-5, one must experience at least two of the five symptoms for them to be said to have schizophrenia (American Psychiatric Association, 2013). The patient has hallucinations and delusions, making the disorder a primary diagnosis. The diagnosis has also been supported by PSYRATS, a mental health tool used to assess patients’ mental status (Chong et al., 2020).
PLAN:
Treatment Plan: I would recommend that the patient be prescribed Invega Sustenna 234 mg intramuscular X1. The medication can improve the patient’s heath by improving his judgment, thinking, and mood (Pesa et al., 2017). Apart from medication, the patient will also be advised to go for talk therapy once a week. Galbusera et al. (2018) note that a combination of talk therapy and medication can highly improve the mental health of schizophrenic patients.
Health Promotion: The patient should avoid smoking and alcohol.
Follow-Up: The patient should come for re-evaluation and check-up after four weeks.
REFLECTION:
If I was given another chance to work on the case, I would have recommended that the patient be taken to a psychologist for counseling. A combination of medication and therapy can improve the health of the patient.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Publishing.
Chong, B., Wahab, S., Muthukrishnan, A., Tan, K. L., Ch’ng, M. L., & Yoong, M. T. (2020). Prevalence and Factors Associated with Suicidal Ideation in Institutionalized Patients with Schizophrenia. Psychology research and behavior management, 13, 949–962. https://doi.org/10.2147/PRBM.S266976
Galbusera, L., Finn, M. T., & Fuchs, T. (2018). Interactional synchrony and negative symptoms: An outcome study of body-oriented psychotherapy for schizophrenia. Psychotherapy Research, 28(3), 457-469. https://doi.org/10.1080/10503307.2016.1216624
Ng, Q. X., Soh, A. Y. S., Venkatanarayanan, N., Ho, C. Y. X., Lim, D. Y., & Yeo, W. S. (2019). A systematic review of the effect of probiotic supplementation on schizophrenia symptoms. Neuropsychobiology, 78(1), 1-6. https://www.karger.com/Article/Abstract/498862
Pesa, J. A., Doshi, D., Wang, L., Yuce, H., & Baser, O. (2017). Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment. Current Medical Research and Opinion, 33(4), 723-731. https://doi.org/10.1080/03007995.2016.1278202
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FAQs
What is one of the first signs of schizophrenia?
Schizophrenia is a complex mental health condition that affects millions of people worldwide. While the full spectrum of symptoms can vary from person to person, there are certain early signs and symptoms that are often considered among the first indications of this disorder. In this article, we will delve into the world of schizophrenia, exploring the first signs and symptoms that individuals, their friends, and family should be aware of. It’s important to note that early recognition and intervention can significantly improve the prognosis for those diagnosed with schizophrenia.
Introduction
Schizophrenia is a chronic brain disorder that affects a person’s thinking, feeling, and behavior. It can cause a range of symptoms that make it difficult for individuals to distinguish between what is real and what is not. This article will explore the early signs of schizophrenia to help individuals and their loved ones recognize the condition and seek timely help.
Understanding Schizophrenia
Before we dive into the early signs, it’s crucial to understand the basics of schizophrenia. This mental illness is characterized by a range of symptoms that affect different aspects of a person’s life. These symptoms typically emerge in late adolescence or early adulthood.
The Complexity of Schizophrenia Diagnosis
Diagnosing schizophrenia can be challenging, as its symptoms may overlap with other mental health conditions. It’s essential to consult with a mental health professional for an accurate assessment.
Early Warning Signs
Social Withdrawal
One of the early signs of schizophrenia is social withdrawal. Individuals may start isolating themselves, showing a reduced interest in social activities and relationships. They may become increasingly reclusive and prefer solitude.
Unusual Behavior
Schizophrenia can manifest in unusual behaviors. People with the condition may exhibit eccentric actions that are difficult to comprehend. This can be alarming for friends and family.
Cognitive Changes
Cognitive changes are also common early signs. Individuals may experience difficulties in concentrating, thinking logically, or remembering things. They may find it challenging to carry out daily tasks.
The Role of Hallucinations
Schizophrenia often involves hallucinations. These are sensory experiences that others do not perceive. Auditory hallucinations, in which individuals hear voices, are a hallmark of this condition.
Paranoia and Delusions
People with schizophrenia may experience paranoia and delusions. They might believe that they are being watched, persecuted, or that they possess special powers. These thoughts can be distressing and irrational.
Emotional Changes
Emotional changes are another sign. Individuals with schizophrenia may exhibit sudden mood swings, emotional flatness, or heightened emotions, often without an apparent cause.
Physical Symptoms
Schizophrenia can also manifest in physical symptoms. These may include insomnia, changes in appetite, and a lack of personal hygiene.
Family History and Genetic Factors
A family history of schizophrenia can increase the risk of developing the condition. Genetic factors are known to play a role in its onset.
Substance Abuse and Schizophrenia
Substance abuse, particularly drug abuse, can exacerbate the symptoms of schizophrenia. It is essential to recognize and address any co-occurring issues.
Diagnosing Schizophrenia
Consultation with a Professional
If someone exhibits early signs of schizophrenia, it’s crucial to consult a mental health professional. They can provide a comprehensive evaluation.
Evaluation and Assessment
Evaluation and assessment help rule out other conditions that may mimic schizophrenia. This is a crucial step in ensuring an accurate diagnosis.
Treatment Options
There are various treatment options for schizophrenia, including medications and psychotherapy. Early intervention is key to managing the condition effectively.
Coping Strategies for Schizophrenia
Individuals with schizophrenia can benefit from learning coping strategies to manage their symptoms effectively.
The Importance of Support
A robust support system is crucial for individuals with schizophrenia. Friends and family can make a significant difference in their journey towards recovery.
Conclusion
In conclusion, recognizing the early signs of schizophrenia is vital for timely intervention and effective management of this complex mental health condition. If you or someone you know is experiencing these symptoms, seek professional help. With the right treatment and support, individuals with schizophrenia can lead fulfilling lives.
5 Unique FAQs
- Can schizophrenia be prevented?
- Schizophrenia cannot be entirely prevented, but early intervention and treatment can help manage the condition effectively.
- What causes schizophrenia?
- The exact cause of schizophrenia is unknown, but it is believed to result from a combination of genetic, environmental, and neurochemical factors.
- Is schizophrenia curable?
- Schizophrenia is a chronic condition, but it can be managed with treatment and support. There is no known cure, but many individuals lead productive lives with proper care.
- Do all individuals with schizophrenia experience hallucinations and delusions?
- No, not all individuals with schizophrenia experience hallucinations and delusions. The symptoms can vary from person to person.
- What can friends and family do to support someone with schizophrenia?
- Friends and family can provide emotional support, encourage treatment adherence, and educate themselves about the condition to offer meaningful assistance to their loved ones.
What is a Brief Psychotic Disorder?
Brief Psychotic Disorder is a mental health condition that affects an individual’s thoughts, feelings, and behaviors. It is characterized by a sudden onset of one or more psychotic symptoms, such as delusions, hallucinations, disorganized thinking, and grossly disorganized or abnormal motor behavior. This disorder typically lasts for a short duration, usually less than a month, and often follows a significant stressor or trigger. In this article, we will explore the nature of Brief Psychotic Disorder, its causes, and its key symptoms.
Definition and Characteristics
Brief Psychotic Disorder is a brief but severe mental illness that may resemble other psychotic disorders, such as schizophrenia. It is characterized by the following features:
Sudden Onset
One of the defining characteristics of Brief Psychotic Disorder is its abrupt onset. Individuals who previously showed no signs of psychosis can suddenly develop symptoms. This sudden onset often occurs in response to stressors or triggers.
Psychotic Symptoms
The disorder is marked by the presence of one or more psychotic symptoms. These symptoms can include delusions, which are false beliefs that are firmly held despite evidence to the contrary, and hallucinations, which are sensory experiences without a real stimulus.
Short Duration
Brief Psychotic Disorder is, as the name suggests, brief in duration. Symptoms usually last for less than a month, with many individuals experiencing relief from their symptoms within two weeks.
Return to Normal Functioning
After the brief episode, most individuals with Brief Psychotic Disorder return to their normal level of functioning and do not experience long-term impairment.
Subtypes of Brief Psychotic Disorder
There are two subtypes of Brief Psychotic Disorder:
With Marked Stressor
This subtype is associated with a clearly identifiable stressor or trigger that precedes the onset of symptoms. The stressor can be a traumatic event, loss of a loved one, or a major life change.
Without Marked Stressor
In this subtype, no apparent stressor or trigger is evident. The onset of psychotic symptoms seems to occur spontaneously, without an external cause.
What Causes Brief Psychotic Disorder?
The exact causes of Brief Psychotic Disorder are not fully understood, but it is believed to result from a complex interplay of various factors. Let’s explore some of the key contributing factors:
Triggers and Stressors
Stressful life events or traumatic experiences can trigger Brief Psychotic Disorder in susceptible individuals. These stressors can include the loss of a loved one, relationship problems, financial crises, or legal issues.
The Role of Genetics
Genetic factors may play a role in the development of Brief Psychotic Disorder. If a close family member has a history of psychotic disorders, the risk of developing the condition may be higher.
Brain Chemistry and Psychotic Disorders
Imbalances in brain chemistry, particularly in neurotransmitters like dopamine, have been associated with psychotic disorders, including Brief Psychotic Disorder. These imbalances can affect an individual’s perception and thinking.
An Example of Brief Psychotic Disorder
To better understand this disorder, consider the following hypothetical example:
Sarah, a 25-year-old woman, has been experiencing extreme stress due to her demanding job and ongoing relationship problems. One evening, she begins to believe that her coworkers are conspiring against her and that her partner is an impostor. She also starts hearing voices that are not there. Sarah’s family notices her bizarre behavior and seeks help. After a thorough evaluation, she is diagnosed with Brief Psychotic Disorder.
Diagnosis and Evaluation
Diagnosing Brief Psychotic Disorder involves a comprehensive assessment by a mental health professional. This evaluation includes a thorough review of the individual’s symptoms, medical history, and any recent stressors or triggers.
Treatment Options
Treatment for Brief Psychotic Disorder aims to alleviate symptoms, reduce distress, and prevent future episodes. The following treatment options are commonly used:
Medications for Managing Symptoms
Antipsychotic medications may be prescribed to alleviate delusions, hallucinations, and other psychotic symptoms. These medications can help individuals regain their connection to reality.
Psychotherapy and Counseling
Individual or group therapy can be beneficial in helping individuals understand and manage their symptoms. It provides a safe space to explore thoughts and emotions.
Coping Strategies for Individuals and Families
Learning coping strategies can help individuals manage stress and reduce the risk of future episodes. Families can also benefit from education and support.
The Importance of a Support System
Having a strong support system is crucial for individuals with Brief Psychotic Disorder. Friends and family can provide emotional support and assist in the individual’s recovery.
Conclusion
Brief Psychotic Disorder is a complex mental health condition characterized by a sudden onset of psychotic symptoms, typically in response to stressors or triggers. While its causes are not fully understood, it is clear that a combination of genetic, environmental, and neurological factors plays a role. Early diagnosis and appropriate treatment can help individuals recover and lead fulfilling lives.
FAQs
1. Can Brief Psychotic Disorder recur?
Yes, it is possible for individuals to experience recurrent episodes of Brief Psychotic Disorder, especially if they continue to face significant stressors.
2. Are there any long-term effects of Brief Psychotic Disorder?
Most individuals with Brief Psychotic Disorder do not experience long-term impairment and can return to their normal functioning after an episode.
3. Can Brief Psychotic Disorder be prevented?
Preventing the disorder can be challenging, but managing stress, seeking support, and early intervention can reduce the risk of developing it.
4. What is the difference between Brief Psychotic Disorder and schizophrenia?
The key difference lies in the duration and impact. Brief Psychotic Disorder is of short duration and typically follows a stressor, while schizophrenia is a chronic condition with more pervasive symptoms.
5. How can I support a loved one with Brief Psychotic Disorder?
Offer emotional support, encourage treatment, and educate yourself about the disorder. A strong support system can make a significant difference in their recovery.