PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Walden University PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Whether one passes or fails an academic assignment such as the Walden University PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
The introduction for the Walden University PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
After the introduction, move into the main part of the PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Subjective:
CC (chief complaint): “I know I am pregnant but they think I am not”.
HPI: TK is a 40-year-old AA female referred by her psychiatrist. The patient was dx. with schizophrenia 14 years ago and reports she was in an altercation with her mother and ended up being admitted to the hospital. Hospital notes indicate the patient has been stalking the family of a man who died 15 years ago for about 2 years, saying she is 6 months pregnant with his baby and they are trying to prevent him from seeing her. She even claims to have spoken with him a week ago. When asked whether she had done a pregnancy test, she responds that all her pregnancies are never negative until she is over 6 months pregnant. The patient’s mother’s attempt to bring her to reality led to this altercation where the patient become uncontrollable and had to be hospitalized.
Past Psychiatric History:
- General Statement: The patient is a 40-year-old AA female who is convinced she is 6 months pregnant with the baby of a deceased man.
- Caregivers (if applicable): Currently lives with her aunt.
- Hospitalizations: The patient was diagnosed with schizophrenia 14 years ago and hospitalized in June 2022 for 5 days
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: schizophrenia, 2008
Substance Current Use and History: The patient reports smoking marijuana when she was in her 20s. Denies smoking tobacco or use of any other illicit drug of abuse.
Family Psychiatric/Substance Use History: The patient reports no family history of substance use or psychosis.
Psychosocial History: The patient is a single mother of 2 children aged 17 and 14 years who are
currently in the custody of her mother. The patient has not worked in over 2 years due to her disability and currently lives with her aunt. The patient reports that she only has one year of a college education. She was jailed for one 1 week in 2014.
Medical History: The patient has a history of a Benign cyst that was removed from her breast when she was 24 years of age.
- Current Medications: Haldol, Risperdal, Invega Sustenna
- Allergies: No allergies reported.
- Reproductive Hx: The patient is heterosexual with 2 children. She has a history of 2 Abortions. She reports her last monthly periods were 4 to 5 months ago.
ROS:
CONSTITUTIONAL: No fever, weight gain, weight loss, chills, fatigue, or general body weakness.
EYES: No changes in visual acuity or blurred vision. Puts on corrective lenses only when reading. Lat eye exam was done a year ago.
EARS, NOSE, THROAT: No hearing problems, tinnitus, or ear pain. No epistaxis. No bleeding gums, sore throat, or toothache.
CARDIOVASCULAR: No chest pain, palpitations abnormal heartbeat, or decreased exercise intolerance.
RESPIRATORY: No breathing difficulties or dyspnea. Denies coughing, congestions, or hemoptysis.
GASTROINTESTINAL: No constipation, diarrhea, hernia, or abdominal tenderness. Denies changes in bowel movement.
GENITOURINARY: Denies hesitation, polyuria, dysuria, oliguria, dribbling, or incontinence.
HEMATOLOGIC/LYMPHATIC: No anemia, easy bruising, or any other blood disorder.
ENDOCRINE: Denies heat or cold intolerance, sweating, changes in appetite, or hair loss.
NEUROLOGIC: No paralysis, syncope, dizziness, or headache.
PSYCHIATRIC: The patient has a compromised perception of reality. She believes to be pregnant with a dead man’s child.
Objective:
The patient is alert and oriented x 4, the abdomen is distended, respiration even and unlabored, pitting edema to BLE.
Diagnostic results:
Assessment:
Mental Status Examination: The patient is well-groomed and appropriately dressed for the weather. She is alert and maintains adequate eye contact in the interview but becomes evasive and defensive when asked about her pregnancy and the father of her baby. Speech is clear with normal tone, rate, and volume. The thought process becomes non-coherent and illogical as the interview progresses. The patient states she has been speaking to the father of her unborn baby, but cannot recall when she saw him last. No obsessions, compulsions, or hallucinations were noted, delusions of pregnancy need to be confirmed through a pregnancy test or ultrasound. She is oriented to person, place, and time. She demonstrates good abstract thought and judgment. Insight is present.
Differential Diagnoses:
- Pseudocyesis: Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. It is the conviction of a non-pregnant woman that she is pregnant Vazifdar & Gavali (2022). This is the most applicable primary diagnosis for the patient as she demonstrably presents with pregnancy signs such as menstrual disturbance, and abdominal swelling. However, the diagnosis of this disorder is based on ruling out a viable pregnancy by carrying out a pelvic examination, urine pregnancy test, or ultrasound.
- Delusion of pregnancy: Delusional pregnancy usually occurs among female patients during the state of psychosis. Delusions, a core symptom of psychosis, are false beliefs that are rigidly held with strong conviction despite contradictory evidence (Baker et al., 2019). In delusional pregnancy, there might be abdominal distension and menstrual period cessation, but with no additional outward signs just like the patient in the provided case study.
- Schizophrenia: This disorder occurs when an individual interprets reality abnormally. The patient presents with a previous diagnosis of schizophrenia, and continued use of antipsychotics in the management of this disorder. Antipsychotic medications act by inhibiting the secretion of dopamine hence raising prolactin levels which leads to amenorrhea, and breast tenderness in addition to the somatic experience of pregnancy (Seeman, 2014).
Reflections:
This was a very interesting and complex case. The patient presented as pregnant, her abdomen was distended, and her entire physiology presented as any 6-month pregnant woman would, but this case becomes complex as the patient is convinced, she is pregnant for a man who is confirmed to have been deceased for over 15 years. The patient has been under this illusion for about 2 years and it is consuming her entire life. The patient needs professional help to resolve her delusion preferably psychodynamic and supportive psychotherapy.
Case Formulation and Treatment Plan:
According to Vazifdar & Gavali (2022), the management of pseudocyesis is multidisciplinary, including psychiatrists, gynecologists, and psychologists. The goal of treatment is to help patients perceive the meaning of their symptoms and to help resolve the associated stressors. This patient has had her children taken away from her as she is not in a position to take care of them due to her mental illness. Feeling that she is pregnant and expecting a child may be a coping mechanism. On the other hand, Marzieh & Forouzan (2017), note that the available psychiatric literature on pseudocyesis is mostly associated with disorders such as schizophrenia, anxiety disorders, and mood disorders. A pregnancy test and more so an ultrasound needs to be done to confirm or rule out pregnancy and if negative, Psychiatric procedures that can be used in these patients include supportive, cognitive, behavioral, and psychoanalytical psychotherapy that focuses on problem-solving. Therapy might focus on helping the patient perceive the meaning of the symptoms and help resolve the stressors that were partly responsible for the condition’s onset (Marzieh & Forouzan, 2017).
Diagnostic studies: Pelvic examination, urine pregnancy test, or an ultrasound.
Referrals: Psychiatrists, gynecologists, and psychologists
Psychotherapy: Cognitive behavioral therapy
Pharmacotherapy: Advise the patient to continue taking Haldol, Risperdal, and Invega Sustenna for the management of previously diagnosed schizophrenia.
Education: Advise the patient to take an active role in therapy and stay compliant with the treatment regimen for a positive outcome.
Follow-up: The patient should report back to the clinic after one month for a review of the treatment outcome and adjustment of the care plan.
References
Baker, S. C., Konova, A. B., Daw, N. D., & Horga, G. (2019). A distinct inferential mechanism for delusions in schizophrenia. Brain: a journal of neurology, 142(6), 1797–1812. https://doi.org/10.1093/brain/awz051
Marzieh, A., & Forouzan, E. (2017). Biopsychosocial view to pseudocyesis: a narrative review. Pesquisa.bvsalud.org, 535–542. https://pesquisa.bvsalud.org/portal/resource/pt/emr-191450
Seeman, M. V. (2014). Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion. World Journal of Clinical Cases: WJCC, 2(8), 338. https://doi.org/10.12998/wjcc.v2.i8.328
Vazifdar, S., & Gavali, U. (2022). Impregnated With Delusion: A Case of Pseudocyesis. Indian Journal of Case Reports, 30–32. https://doi.org/10.32677/ijcr.v8i2.3257
Sample Answer 2 for PRAC 6645 WEEK 4 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Subjective:
CC (chief complaint): “My son has constantly been disobedient.”
HPI:
W.E. is an 8-year-old Hispanic-American male client who presented for family psychotherapy alongside her mother and her elder brother. The mother reported that her son has been constantly disobedient. W.E. had been referred for psychiatric evaluation by the primary care provider since he exhibited a consistent pattern of rejecting adult authority. He often argued with authority figures, including his teachers, mother, elder brother, and adults. His mother reported that the boy exhibited the behavior since he was six years old, and it worsened when his father separated from his mother. The boy had numerous indiscipline cases in school due to his refusal to comply with school rules and requests from his teachers. He had a tendency to blame his classmates for his mistakes and poor behavior in school. Besides, his classmates avoided interactions since he would get easily annoyed and get them in trouble. The mother had been given a warning letter that if the child’s behavior persisted, he would be expelled from the school.
The patient’s brother reported that he had a tendency to deliberately annoy others, including adults in the neighborhood. He frequently defended him when he got into trouble. The mother reported that he rarely gave attention to the boy’s behavior and often felt the teachers were against the child since they were Hispanics. In recent months, she has tried using harsh punishments such as canning when she has noted the defiant behavior, but they seem ineffective.
Past Psychiatric History:
- General Statement: The patient first presented for psychiatric evaluation because of disruptive behavior.
- Caregivers (if applicable): Mother
- Hospitalizations: None
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: None
Substance Current Use and History: No exposure to alcohol, tobacco, or illicit substances.
Family Psychiatric/Substance Use History: The mother has a history of generalized anxiety disorder and has been on psychotherapy.
Psychosocial History: W.E lives with his mother, brother, and maternal uncle. His parents separated about three years ago, and his mother is the sole provider. The patient has achieved his developmental milestones. He is in 2nd grade but had a poor academic performance. He reports having few friends due to his defiant behavior. He sleeps 8-10 hours a day.
Medical History: The patient has no history of chronic illnesses. He had undergone surgery when he was six months old due to cryptorchidism. His immunizations are up-to-date.
- Current Medications: None
- Allergies: No known allergies
- Reproductive Hx: None
Objective:
Diagnostic results:
HR- 88; RR-20; Temp-98.6
Clinician-Rated Severity of Oppositional Defiant Disorder- Moderate
Assessment:
Mental Status Examination:
The patient is well-groomed and appropriately dressed. He is alert and oriented to person, place, and time. His self-reported mood is ‘good,’ and his affect is congruent. His speech is clear and goal-directed with normal rate and volume. He has a coherent and goal-directed thought process. No delusions, hallucinations, obsessions, compulsions, or phobias were noted. The patient denies having suicidal thoughts or ideations. His short and long-term memory is intact, and he exhibits good judgment.
Differential Diagnoses:
Oppositional Defiant Disorder (ODD): ODD is a type of disruptive behavior disorder that occurs in children. The DSM V defines ODD as a recurrent pattern of irritable or angry mood, argumentative or defiant behavior, or vindictiveness lasting for at least six months. The patient exhibits features of ODD with symptoms from both Angry/irritable mood and Argumentative/Defiant behavior categories (Arias et al., 2021). Positive findings in the patient include being easily annoyed, arguing with authority figures and adults, intentionally annoying others, and blaming others for his mistakes and undesirable behaviors.
Conduct Disorder: The DSM-V diagnostic criteria for Conduct Disorder require the presence of at least three of the following symptoms in the past six months from each category. The first category includes aggression toward people and animals, such as fighting, bullying, threatening, and being physically cruel to individuals or animals. The second category is the destruction of property by fire or other means. The third category is being deceitful (Colins et al., 2021). The last category includes serious violations of rules, such as ignoring parents’ orders and being truant in school. The patient has a history of violating rules at school and ignoring rules from his mother and teachers.
Disruptive Mood Dysregulation Disorder (DMDD): DMDD is a childhood disorder characterized by a constant and severe irritable mood that is out of proportion in intensity and duration alongside frequent temper outbursts (Benarous et al., 2020). Children with DMDD have severe temper outbursts, verbal or behavioral, with an average of three or more temper outbursts per week. The disorder results in severe impairment that necessitates clinical attention (Hendrickson et al., 2020). DMDD is a differential based on the patient’s getting into arguments with authority figures, including his teachers, mother, and elder brother, and with adults.
Reflections: In a similar patient evaluation, I would assess how the patient’s mother’s history of GAD affected her relationship with her son. I will also ask the mother if she has difficulties regulating her emotions when dealing with her son. Structural factors, including education, occupation, and income, are linked with mental health problems in children. Enelamah et al. (2023) explain that children whose parents have a low income and education level are at more risk of developing emotional and behavioral health disorders like ODD. Thus, this could have influenced the development of disruptive behavior in the child. Health promotion should focus on training the child’s parent on measures to change her behaviors and thus alter the boy’s problematic behavior at home.
Case Formulation and Treatment Plan: Oppositional Defiant Disorder
Psychotherapy: The psychotherapy plan will include individual psychotherapy and family intervention involving direct parent training.
Child individual CBT will be used to teach the patient anger management and social- and cognitive problem-solving skills. Training children with ODD on social problem-solving measures enhances their emotion-regulatory skills and leads to decreased irritability (Helander et al., 2023).
Parent Management Training (PMT) was recommended to teach the patient’s mother parenting strategies to help alleviate disruptive behavior (Helander et al., 2023).
Follow-up: A visit was scheduled after four weeks to assess the patient’s progress with psychotherapy.
Referrals: The patient will be referred to a child psychiatrist for medication review if he does not improve with psychotherapy alone.
I confirm the patient used for this assignment is a patient that was seen and managed by the student at their Meditrek approved clinical site during this quarter course of learning.
References
Benarous, X., Bury, V., Lahaye, H., Desrosiers, L., Cohen, D., & Guilé, J. M. (2020). Sensory processing difficulties in youths with disruptive mood dysregulation disorder. Frontiers in Psychiatry, 11, 164. https://doi.org/10.3389/fpsyt.2020.00164
Arias, V. B., Aguayo, V., & Navas, P. (2021). Validity of DSM-5 oppositional defiant disorder symptoms in children with intellectual disability. International Journal of Environmental Research and Public Health, 18(4), 1977. https://doi.org/10.3390/ijerph18041977
Colins, O. F., Fanti, K. A., & Andershed, H. (2021). The DSM-5 limited prosocial emotions specifier for conduct disorder: Comorbid problems, prognosis, and antecedents. Journal of the American Academy of Child & Adolescent Psychiatry, 60(8), 1020–1029. https://doi.org/10.1016/j.jaac.2020.09.022
Enelamah, N. V., Lombe, M., Yu, M., Villodas, M. L., Foell, A., Newransky, C., Smith, L. C., & Nebbitt, V. (2023). Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children. Children (Basel, Switzerland), 10(7), 1100. https://doi.org/10.3390/children10071100
Helander, M., Enebrink, P., Hellner, C., & Ahlen, J. (2023). Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial. Child Psychiatry and Human Development, 54(4), 1112–1126. https://doi.org/10.1007/s10578-021-01306-3
Hendrickson, B., Girma, M., & Miller, L. (2020). Review of the clinical approach to the treatment of disruptive mood dysregulation disorder. International Review of Psychiatry (Abingdon, England), 32(3), 202–211. https://doi.org/10.1080/09540261.2019.1688260