Week 7: Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders

At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.  NRNP 6635 Week 7 Medication-Induced Movement Disorders Assignment

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.

This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.

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.

Learning Objectives

Students will:

  • 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

Learning Resources

Required Readings (click to expand/reduce)

American  Psychiatric Association. (2013). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 709–714). Author.

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

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders
  • Chapter 29.2, Medication Induced-Movement Disorders
  • Chapter 31.15, Early-Onset Schizophrenia

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Document: NRNP 6635 Final Study Guide

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2016). Schizophrenia and other psychotic disorders [Video].Walden University.

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(dot)ezp(dot)waldenulibrary(dot)org/watch/training-title-9
Reading Resources:
American Psychiatric Association. (2013). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., pp. 709–714). Author.
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
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 29.2, Medication Induced-Movement Disorders
Chapter 31.15, Early-Onset Schizophrenia

____________________________________________________________________________ 

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? NRNP 6635 Week 7 Medication-Induced Movement Disorders Assignment

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 

MedEasy. (2017). Psychotic disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=BdB6MgWAP1k

Video Case Selections for Assignment (click to expand/reduce)

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-9

Symptom Media. (Producer). (2016). Training title 24 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-24

Symptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-29

Symptom Media. (Producer). (2018). Training title 134 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-134

Document: Case History Reports


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

Photo Credit: [Hero Images]/[Hero Images]/Getty Images

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.

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 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.).

Submission and Grading Information – NRNP 6635 Week 7 Medication-Induced Movement Disorders Assignment

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 7

To participate in this Assignment:

Week 7 Assignment

NRNP 6635 Week 7 Medication-Induced Movement Disorders Assignment Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NRNP_6635_Week7_Assignment_Rubric

ExcellentGoodFairPoor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.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
18 (18%) – 20 (20%)The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.16 (16%) – 17 (17%)The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.14 (14%) – 15 (15%)The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.0 (0%) – 13 (13%)The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
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.
18 (18%) – 20 (20%)The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.16 (16%) – 17 (17%)The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.14 (14%) – 15 (15%)Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.0 (0%) – 13 (13%)The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
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.
23 (23%) – 25 (25%)The response thoroughly and accurately documents the results of the mental status exam.Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.20 (20%) – 22 (22%)The response accurately documents the results of the mental status exam.Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.18 (18%) – 19 (19%)The response documents the results of the mental status exam with some vagueness or innacuracy.Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.0 (0%) – 17 (17%)The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Reflect on this case. 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.).9 (9%) – 10 (10%)Reflections are thorough, thoughtful, and demonstrate critical thinking.8 (8%) – 8 (8%)Reflections demonstrate critical thinking.7 (7%) – 7 (7%)Reflections are somewhat general or do not demonstrate critical thinking.0 (0%) – 6 (6%)Reflections are incomplete, inaccurate, or missing.
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).14 (14%) – 15 (15%)The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.12 (12%) – 13 (13%)The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.11 (11%) – 11 (11%)Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.0 (0%) – 10 (10%)Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity.A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.3.5 (3.5%) – 3.5 (3.5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.Purpose, introduction, and conclusion of the assignment is vague or off topic.0 (0%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors4 (4%) – 4 (4%)Contains a few (one or two) grammar, spelling, and punctuation errors3 (3%) – 3 (3%)Contains several (three or four) grammar, spelling, and punctuation errors0 (0%) – 2 (2%)Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100

Name: NRNP_6635_Week7_Assignment_Rubric

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