Assignment task: Assessing and Diagnosing Patients with Mood Disorders
Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.
- 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.
Complete and submit your 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-TR 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.).
Training Title 134 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
FYI: she is very fidgeting during intake interview; avoid eyes contact
00:00:10[sil.]
00:00:15UNKNOWN Hi, Mrs. Warren, nice to see you again. How are you doing?
00:00:20Warren You're with them.
00:00:20UNKNOWN Pardon me.
00:00:25Warren I know you are. But you won't tell me, people like you never do.
00:00:30UNKNOWN I'm not sure that I follow.
00:00:30Warren Sure. They dumb just like everybody else. We're on to you.
00:00:40UNKNOWN Who do you mean by we?
00:00:45Warren Mm-hmm.
00:00:45UNKNOWN You are not going to tell me?
00:00:50Warren I don't need to tell you. You have eyes and ears planted everywhere.
00:00:55UNKNOWN Everywhere meaning other places away from the hospital...
00:01:00Warren Everywhere, enough set.
00:01:00UNKNOWN Let me make sure I understand. Are you saying you feel that I or someone else has been spying on you?
00:01:05Warren I don't feel that. I know it. You and your people had... I don't need to explain it, you already know.
00:01:15UNKNOWN You feel safe here in the emergency department?
00:01:20Warren There's nowhere that is safe. Don't pretend like there is.
00:01:30END TRANSCRIPT