ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635

ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635
Sample Answer for ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635 Included After Question

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.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES
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.).
Submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK7Assgn_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.
A Sample Answer For the Assignment: ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635
Title: ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635
Subjective:

Name: Mr. Harold Feldman Gender: Male Age: 20 years

CC (chief complaint): “My parents called for the appointment.”

HPI: Mr. H.F, a 20-year-old European American male presented for an appointment following a phone call by his parents with allegations of having some difficulty at state college. He is a freshman and has been exhibiting abnormal behavior such as not showering associated with inconsistent appetite and weight loss of about 18 lbs. During the conversation, he reports seeing a microwave oven and claims that the room is spying on them which is consistent with visual hallucinations and delusions respectively. Finally, he appears to hear some voices-“Sssshhhh.” He is also unable to keep his relationships with friends intact.

Past Psychiatric History:
General Statement: A history of risperidone use in the last six months of his high school.
Caregivers (if applicable): None
Hospitalizations: None
Medication trials: risperidone for but ceased due to side effects of oversedation.
Psychotherapy or Previous Psychiatric Diagnosis: Mild paranoia in the final six months of his high school and was on risperidone.

Substance Current Use and History: Weekly cannabis use.

Family Psychiatric/Substance Use History: His father and mother have paranoid schizophrenia and depression respectively. His two younger sisters, one with ADHD, and the other with separation anxiety.

Psychosocial History: Firstborn,  first-year college student, has two sisters. Has numerous friends although not been in contact with them since his arrival from school. Normal developmental milestones during childhood.

Medical History: No previous medical problems

Current Medications: None.
Allergies: Shellfish
Reproductive Hx: Heterosexual.
ROS:
GENERAL: Weight loss but no hotness of the body.
HEENT: No blurring of vision, ear discharge, runny nose, or sore throat
SKIN: No rash
CARDIOVASCULAR: No chest pain, no awareness of heartbeat
RESPIRATORY: No sputum, chest tightness, or shortness of breath
GASTROINTESTINAL: No abdominal distention, diarrhea, or constipation
GENITOURINARY: No dysuria, frequency, or incontinence
NEUROLOGICAL: No dizziness, numbness, or headaches.
MUSCULOSKELETAL: Reports no muscle aches and backaches
HEMATOLOGIC: No bruising
LYMPHATICS: No lymphadenopathy
ENDOCRINOLOGIC: No polydipsia
Objective:
Physical exam:

Vital signs: Temperature- 98.4 F, Pulse- 76 beats per minute, Respiratory rate 18 breaths per minute, BP- 116/74 mmHg, Height 5’6, Weight 120lbs

General- A young European American adult male, well kempt, not in obvious respiratory distress, well hydrated, and of good nutrition status. No cyanosis, pallor, jaundice, peripheral edema, or lymphadenopathy.

HEENT- Normocephalic, no scleral icterus, no conjunctival pallor, pink oral mucosa.

Neck- thyroid gland not palpable

Lung/CVS- Symmetrical chest, vesicular breath sounds, S1, S2 clear and distinct. No murmurs.

Abdomen- Symmetrical, no organomegaly,

Diagnostic results: The patient presents with delusions of paranoia and visual and auditory hallucinations. Additionally, bizarre

ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635

behavior, weight loss, inconsistent appetite, and poor social skills are evident. Hallucinations and delusions are characteristic of psychosis. The most common cause of psychosis in a young adult male is schizophrenia followed by substance-induced psychosis. The DSM-5 criteria can vividly distinguish between these two conditions. For instance, Schizophrenia is diagnosed when two or more of the following symptoms; delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. However, at least one of the symptoms must be from the top three (American Psychiatric Association, 2022). In the second criteria, the symptoms must be present for more than one month with a consistent disturbance for at least six months. Thirdly, symptoms must impair social, occupational, or personal functioning (American Psychiatric Association, 2022). Finally, other mimickers of psychosis such as schizoaffective disorder and mood disorder with psychotic features must be excluded.

Assessment:

Mental Status Examination: He is a 20-year-old European American male well kempt and appropriate for his age. Unable to maintain eye contact although no abnormal motor activity. A coherent, nonspontaneous, loud (with lengthy pauses) and clear speech tone with long pauses. A logical and coherent thought process with occasional thought blocking and neologisms. Low mood and blunted affect. Delusional thinking and flight of ideas along with visual and auditory hallucinations. No suicidal thoughts. Cognitively, he is alert and oriented. Good concentration and memory but poor insight and judgment.

Differential Diagnoses: The most likely diagnosis is schizophrenia. Mr. H.F fulfills the DSM-5 criteria for the diagnosis of schizophrenia. For instance, both auditory and visual hallucinations as well as delusions of paranoia (American Psychiatric Association, 2022). Similarly, he exhibits bizarre behavior such as not showering. These symptoms have significantly impaired her academics. Additionally, the symptoms cannot be attributed to another medical condition. Finally, the duration of symptoms has been more than six months as paranoia started when he was still in high school. Other features suggestive of schizophrenia include the age of onset (20 years), male gender, urban environment, and family history (Wu et al., 2018).

Cannabis-induced psychosis can be considered a diagnosis. He has features of psychosis such as hallucinations and delusions in addition to a history of weekly episodic cannabis use (Pearson & Berry, 2019). However, Mr. H.F does not meet the DSM -5 criteria for cannabis use disorder including; a strong craving to consume cannabis, a large amount of time using cannabis, loss of interest in prior important activities, tolerance, and withdrawal (American Psychiatric Association, 2022).

Schizoaffective disorder: This condition manifests with features of psychosis as well as mood symptoms. From the clinical evaluation, the patient had features of depression suggested by low mood, hypersomnia, inconsistent appetite, weight loss, and poor social relations (Miller & Black, 2019). However, this does not entirely meet the DSM-5 criteria for a schizoaffective disorder which necessitates that mood disorder symptoms should be present for the majority of the disease and psychotic symptoms occur at least once in the absence of mood disorder (American Psychiatric Association, 2022). These criterion has not been met.

Reflections:

If given a chance to conduct this session over, I will request the client’s caregivers to be present to obtain a detailed and collaborative history. I will commence with an introduction and reassurance to ensure a therapeutic alliance and have a more interactive session. Additionally, I will use open-ended questions to allow the client to extensively express himself. From this case assessment, I have learned that clinical history and mental status examination are important aspects of psychiatric evaluation. The risk of individual developing psychopathology is very high if both parents have psychopathology. Ethical and legal considerations while conducting a psychiatric evaluation involve treating all patients equally and showing sympathy for clients with difficult conditions such as schizophrenia (Wan & Zeng, 2020). Similarly, evaluation of the patient’s fitness to give a history and documentation is paramount. Health promotional activities during the evaluation of patients include patient and family education.

ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635 References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Miller, J. N., & Black, D. W. (2019). Schizoaffective disorder: A review. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 31(1), 47–53. https://doi.org/10.3109/10401239109147967

Pearson, N. T., & Berry, J. H. (2019). Cannabis and psychosis through the lens of DSM-5. International Journal of Environmental Research and Public Health, 16(21), 4149. https://doi.org/10.3390/ijerph16214149

Wan, X., & Zeng, R. (2020). Necessity and ethics of history taking. In Handbook of Clinical Diagnostics (pp. 101–101). Springer Singapore. https://doi.org/10.1007/978-981-13-7677-1_35

Wu, Y., Kang, R., Yan, Y., Gao, K., Li, Z., Jiang, J., Chi, X., & Xia, L. (2018). Epidemiology of schizophrenia and risk factors of schizophrenia-associated aggression from 2011 to 2015. The Journal of International Medical Research, 46(10), 300060518786634. https://doi.org/10.1177/0300060518786634

A Sample Answer 2 For the Assignment: ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635
Title: ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635
Subjective:

CC (chief complaint): “My parents requested this appointment.”

HPI: Jay Feldman is a 19-year-old European-American male client on psychotherapy after his parents booked him a psychiatric appointment. When booking the appointment, Feldman’s parents reported that he was having difficulties in school. However, the client states that he is doing fine in school as a freshman pursuing Theoretical physics and advanced calculus. Feldman mentions that the combined courses are mysteries, and the moment he thinks that he has grasped it, it fades away. The client mentions that his roommate at State College brought a microwave. He reports that the purpose of the microwave is to trigger a bleeding degeneration of blood cells and bleed humanity from peoples’ rightful destiny. Feldman also mentions that their room is spying on them. The client has not been showering.

Past Psychiatric History:
General Statement: The client has a psychiatric history of mild paranoia.
Caregivers (if applicable): None
Hospitalizations: None
Medication trials: The patient was on a short trial of Aripiprazole for six months. The medication was stopped due to the side effects of akathisia.
Psychotherapy or Previous Psychiatric Diagnosis: Mild paranoia

Substance Current Use and History: Attempted to smoke marijuana twice at 18 years. He admits to taking vodka 3-4 glasses on weekends. Denies tobacco or other illicit substance use.

Family Psychiatric/Substance Use History: The patient has two younger brothers; one has a history of ADHD and the other a history of anxiety. Feldman’s mother has a history of anxiety, and his father of paranoia schizophrenia.

Psychosocial History:  Feldman is a freshman at State College pursuing a combination of Theoretical physics and Advanced calculus. He plans to pursue a double major in philosophy and physics. He is the firstborn in a family of three and was raised by both parents. He attained all his childhood developmental milestones. He states that he has several friends, but he has not kept in touch with them since he came back home. He sleeps 4–5 hrs per day.

Medical History:
Current Medications: None
Allergies: None
Reproductive Hx: No history of STIs.
ROS:
GENERAL: Reports appetite loss and weight loss. Denies fever, chills, or increased fatigue.
HEENT: Denies visual changes, ear pain/discharge, rhinorrhea, or swallowing difficulties.
SKIN: Denies rashes, discoloration, or bruises
CARDIOVASCULAR: Denies dyspnea, neck distension, or edema.
RESPIRATORY: Denies SOB, wheezing, or productive cough.
GASTROINTESTINAL: Reports having an inconsistent appetite. Denies having nausea, vomiting, abdominal discomfort, diarrhea, or constipation.
GENITOURINARY: Denies urinary symptoms.
NEUROLOGICAL: Denies headache, dizziness, or muscle weakness.
MUSCULOSKELETAL: Denies joint stiffness/pain or muscle pain.
HEMATOLOGIC: Denies bruising.
LYMPHATICS: Denies swollen lymph nodes.
ENDOCRINOLOGIC: Denies excessive sweating, heat/cold intolerance, or acute thirst.
Objective:

Physical exam: T- 98.3 P- 69 R 16 106/72 Ht 5’7 Wt 117lbs

Diagnostic results: None

Assessment:

Mental Status Examination:

The patient is untidy with shaggy hair, long dirty nails, yellow teeth, and a stinking body odor. He is alert but appears fatigued. He maintains minimal eye contact and appears uninterested in the interview. His speech is clear but speaks at a fast rate and high volume. The self-reported mood is “okay,” but he has a flat affect. He makes long pauses before responding to questions. He has a looseness of association, and his speech is difficult to follow. His thoughts are disorganized. The client has odd beliefs and paranoid delusions. No hallucinations, phobias, compulsions, or suicidal/homicidal ideations were noted. Insight is absent.

Differential Diagnoses:

Schizophrenia: Schizophrenia is a psychotic disorder characterized by hallucinations, delusions, and problems with perception, thought, and behavior. The DSM-V criteria for diagnosing schizophrenia require the presence of two or more of the following psychotic features: Delusions, Hallucinations, Disorganized or catatonic behavior, Disorganized speech and Negative symptoms (McCutcheon et al., 2020). Schizophrenia is thus a differential diagnosis based on the patient’s symptoms of odd beliefs, paranoia delusions, looseness of association, and disorganized thoughts and speech. The patient’s symptoms have contributed to impairment in academic and self-care activities.

Bipolar Disorder: Bipolar disorder is diagnosed based on the presence of alternating episodes of mania and profound depression. Mania is manifests with an elevated/irritable mood and increased goal-directed activity. Patients also present with grandiosity, excessive talking, racing thoughts, distractibility, diminished need for sleep, and increased engagement in risky activities (McIntyre et al., 2020). The episodes of profound depression present with a depressed mood, loss of interest, insomnia/hypersomnia, appetite changes, and suicidal ideations (McIntyre et al., 2020). Bipolar disorder is a differential based on the patient’s symptoms of looseness of association, reduced sleep, inconsistent appetite, and altered functioning in school and self-care areas. Nonetheless, the patient has no history of depression which makes Bipolar disorder an unlikely primary diagnosis.

Persecutory Delusional Disorder (PDD): Patients with PDD present with a persistent pattern of unwarrantable distrust and suspicion of others. They interpret others’ motives and actions as spiteful. Besides, individuals perceive that they may be attacked at any time and without reason (González-Rodríguez & Seeman, 2020). The patient’s paranoid delusions are consistent with PPD. The client believes that his roommate has brought a microwave to cause a bleeding degeneration of blood cells and bleed humanity from peoples’ rightful destiny. Besides, he expresses suspicions that they are being spied on in their room. However, the patient has looseness of association, and disorganized thoughts and speech, which are not characteristic of PPD, making it an unlikely primary diagnosis (Joseph & Siddiqui, 2021).

Reflections:

If I were to redo the session, I would assess the patient for depressive and anxiety symptoms, common comorbidities of schizophrenia. I would assess anxiety and depression using screening tools such as the Generalized Anxiety Disorder Assessment (GAD-7) and Patient Health Questionnaire- 9 (PHQ-9). The tools are effective in identifying the symptoms and their severity. Ethical principles to be considered in this patient include beneficence which is a duty to promote good and thus the best patient outcomes (Bipeta, 2019). Nonmaleficence should also be considered by avoiding causing harm to the patient. Health promotion interventions should include educating the patient on lifestyle changes such as increasing the level of physical activity and practicing healthy dietary habits.

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

González-Rodríguez, A., & Seeman, M. V. (2020). Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management. International Journal of Environmental Research and Public Health, 17(12), 4583.

Joseph, S. M., & Siddiqui, W. (2021). Delusional Disorder. In StatPearls. StatPearls Publishing.

McCutcheon, R. A., Reis Marques, T., & Howes, O. D. (2020). Schizophrenia-An Overview. JAMA Psychiatry, 77(2), 201–210. https://doi.org/10.1001/jamapsychiatry.2019.3360

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet (London, England), 396(10265), 1841–1856. https://doi.org/10.1016/S0140-6736(20)31544-0

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.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES
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.

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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.).
Submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK7Assgn_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.
ASSESSING AND DIAGNOSING PATIENTS WITH SCHIZOPHRENIA, OTHER PSYCHOTIC DISORDERS, AND MEDICATION-INDUCED MOVEMENT DISORDERS NRNP 6635 Rubric

NRNP_6635_Week7_Assignment_Rubric

NRNP_6635_Week7_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome 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
20 to >17.0 pts

Excellent

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.

17 to >15.0 pts

Good

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.

15 to >13.0 pts

Fair

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.

13 to >0 pts

Poor

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.

20 pts
This criterion is linked to a Learning Outcome 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.
20 to >17.0 pts

Excellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

17 to >15.0 pts

Good

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

15 to >13.0 pts

Fair

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.

13 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

20 pts
This criterion is linked to a Learning Outcome 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-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.
25 to >22.0 pts

Excellent

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.

22 to >19.0 pts

Good

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.

19 to >17.0 pts

Fair

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.

17 to >0 pts

Poor

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.

25 pts
This criterion is linked to a Learning Outcome 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!), social determinates of health, 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.).
10 to >8.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 to >7.0 pts

Good

Reflections demonstrate critical thinking.

7 to >6.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking.

6 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing.

10 pts
This criterion is linked to a Learning Outcome 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).
15 to >13.0 pts

Excellent

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 prov