NRNP 6675 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Walden University Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders 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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Whether one passes or fails an academic assignment such as the Walden University Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders 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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
The introduction for the Walden University Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders 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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
After the introduction, move into the main part of the Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders 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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
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 Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Subjective:
CC (chief complaint): “My sister said that I should come here. These people won’t leave me alone.”
HPI:
Sherman Tremaine is a 53-year-old male patient who says he came to the psychiatric clinic after his sister forced him to have a psychiatric evaluation. The client reports that he is being watched, and the people watching him do not want to leave him. He reports hearing them and seeing their shadows when they are surveilling him. Sherman states that those surveilling think he does not see them, but he can see them on the contrary. The patient further states that the government sent those people watching him, which is why his taxes have increased. Sherman also mentions that he experiences sleeping disturbance
s because the voices of the people watching him are loud, making him remain awake for days. Furthermore, Sherman believes that these people enter his house and poison his food. He also mentions that his sister is planning with the government to change his lifestyle, and his phone has been tapped.
Substance Current Use: The patient states that he smokes tobacco 3PPD and takes alcohol. He previously used marijuana but quit three years ago. However, he denies using other illicit substances.
Medical History:
- Current Medications: Currently on Metformin to manage Diabetes. The patient was previously on Thorazine, Haldol, Risperidone, and Seroquel.
- Allergies: No known allergies.
- Reproductive Hx: Para 0+0. No history of reproductive health disorders.
Family Psychiatric History: Sherman’s father had paranoid schizophrenia, while the mother had an anxiety disorder. There is no history of suicidal attempts in the family.
Social History: Sherman currently lives alone, which has been the case since his parents’ death three years ago.
The patient was raised by his mother and sister. He is single with no children. He studied up to 10th grade and is currently unemployed. The patient has no legal history of arrest or conviction.
ROS:
- GENERAL: Negative for fever, chills, fatigue, or weight changes
- HEENT: Negative for headaches, eye pain, double vision, ear pain/discharge, hearing loss, nasal secretions, or sore throat.
- SKIN: Negative for rashes, discoloration, or bruises.
- CARDIOVASCULAR: Negative for palpitations, SOB, chest pain, or ankle edema.
- RESPIRATORY: Negative for productive/dry cough, chest pain, sputum, or breathing difficulties.
- GASTROINTESTINAL: Negative for nausea, vomiting, abdominal tenderness, flatulence, bowel changes, or rectal bleeding.
- GENITOURINARY: Negative for flank pain, dysuria, urinary frequency/urgency, or abnormal urine color.
- NEUROLOGICAL: Negative for dizziness, headache, muscle weakness, or tingling sensations.
- MUSCULOSKELETAL: Negative for joint pain/stiffness, muscle pain, or back pain.
- HEMATOLOGIC: Negative for anemia or bruising.
- LYMPHATICS: Negative for swollen lymph nodes.
- ENDOCRINOLOGIC: Negative for heat/cold intolerance, excessive thirst or hunger, or increased sweating.
Objective:
General: Male patient in his 50s. He is well-groomed and appropriately dressed. The patient is alert and maintains adequate eye contact. His speech is clear, but the rate and volume vary. He is oriented to person, place, and date but does not know the day of the week.
Diagnostic results: No lab/imaging tests were ordered.
Assessment:
Mental Status Examination:
The patient is neat and appropriately dressed for the function and weather. His self-reported mood is anxious, and his affect is blunted. His speech is clear, but the volume and rate vary. Auditory and visual hallucinations and persecutory delusions are apparent. However, the patient has no obvious suicidal thoughts or ideations. His short- and long-term memory is intact, and judgment is poor. Insight is absent.
Diagnostic Impression:
Schizophrenia: Schizophrenia presents with psychosis, which is a loss of touch with reality. Psychosis is characterized by hallucinations, delusions, disorganized thinking and speech, and bizarre/inappropriate motor behavior that suggest a loss of contact with reality (APA, 2013). Schizophrenic patients also have a flattened affect, cognitive deficits like impaired problem solving and reasoning, and occupational and social impairment (Stępnicki et al., 2018). Schizophrenia is a differential diagnosis based on the patient’s positive symptoms of persecutory delusions, visual and auditory hallucinations, and blunted affect.
Brief Psychotic Disorder: According to the DSM-5, a Brief psychotic disorder should be diagnosed if a patent presents with at least one of the following psychotic symptoms for less than one month: Delusions, Hallucinations, Disorganized speech, and grossly disorganized or catatonic behavior. Patients with Brief psychotic disorder eventually return to their normal premorbid functioning (APA, 2013; Provenzani et al., 2021). Brief psychotic disorder is a differential diagnosis based on positive findings of visual and auditory hallucinations and persecutory delusions. However, if these symptoms have persisted for more than one-month, Brief psychotic disorder would be ruled out as a primary diagnosis.
Delusional Disorder: According to the DSM-5, the key feature when diagnosing Delusional disorder is the presence of one or more delusions that persist for at least a month (APA, 2013). The patient in this case likely has the Persecutory delusional type, characterized by strange and unshakable beliefs that one is being spied, conspired against, cheated on, harassed/followed, or poisoned/drugged (González-Rodríguez & Seeman, 2020). Delusion disorder is a differential diagnosis due to the patient’s irrational belief that people are monitoring her and they enter her house to poison her food. She also has an odd belief that her sister is working with the government to alter her lifestyle and that her phone is tapped.
Reflections:
If I were to conduct the assessment again, I would use screening tools to rate the severity of the patient’s schizophrenia symptoms. I would utilize the Brief Psychiatric Rating Scale (BPRS) since it obtains information about the likely presence and severity of psychiatric symptoms in a patient like depression, hallucinations, anxiety, psychosis, and unusual behavior (Tarsitani et al., 2019). Besides, if I were to follow up with the patient, I would use the BPRS to measure the degree to which the patient’s symptoms have alleviated. The results will determine if additional interventions will be needed in the treatment plan. Legal and ethical considerations include nonmaleficence, beneficence, and autonomy. The treatment interventions should aim to improve patient outcomes without causing harm to the patient. In addition, the patient should be informed of the treatment plan, and the clinician should obtain consent from the patient or caregiver before starting treatment. Health promotion for this patient should center on promoting smoking cessation and reducing alcohol consumption.
Case Formulation and Treatment Plan:
The patient’s presumptive diagnosis is schizophrenia. The plan for psychotherapy is Cognitive behavioral therapy (CBT), which will help change the patient’s irrational thinking and behavioral patterns and ultimately have logical thoughts and behaviors (Stępnicki et al., 2018). Invega Sustenna might be an appropriate pharmacological intervention for this patient for as he keeps on talking about not wanting to take several oral medications in the past, as this is a monthly injection.
A follow-up visit will be scheduled after four weeks to assess the patient’s response to psychotherapy and identify any challenges that could hinder attaining the desired outcomes.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
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. https://doi.org/10.3390/ijerph17124583
Provenzani, U., Salazar de Pablo, G., Arribas, M., Pillmann, F., & Fusar-Poli, P. (2021). Clinical outcomes in brief psychotic episodes: a systematic review and meta-analysis. Epidemiology and psychiatric sciences, 30, e71. https://doi.org/10.1017/S2045796021000548
Stępnicki, P., Kondej, M., & Kaczor, A. A. (2018). Current Concepts and Treatments of Schizophrenia. Molecules (Basel, Switzerland), 23(8), 2087. https://doi.org/10.3390/molecules23082087
Tarsitani, L., Ferracuti, S., Carabellese, F., Catanesi, R., Biondi, M., Quartesan, R., Pasquini, M., & Mandarelli, G. (2019). Brief Psychiatric Rating Scale-Expanded (BPRS-E) factor analysis in involuntarily hospitalized psychiatric patients. Psychiatry Research, 279, 380–381. https://doi.org/10.1016/j.psychres.2019.02.055
Sample Answer for Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Subjective:
CC (chief complaint): “My sister made me come in”
HPI: S.T is a 53-year-old female who reported to the psychiatric unit for evaluation as requested by her sister. The patient thinks that people are watching her most of the time outside the window, and even confirms that she can hear them. She reports that she has been having this experience for weeks. She is also unable to sleep most nights due to loud voices. The patient also claims that when she is watching television, those people in it watch her, and even try to poison her food. She however denies seizures related to intake of drugs or blackouts. No self-injurious behaviors or suicidal ideation were reported.
Past Psychiatric History:
- General Statement: Presents with a history of psychosis.
- Caregivers (if applicable): Currently resides with her sister following their mother’s death.
- Hospitalizations: Hospitalized three times due to psychotic disorders at the age of 29 years.
- Medication trials: Tried Thorazine and Haldol for management of her previous psychotic symptoms, which she hates and claims to be ineffective. She also tried risperidone which led to the enlargement of her breasts. Seroquel is the only drug that she has been taking that has displayed great effectiveness in the management of her symptoms. She is however non-compliant in taking this medication.
- Psychotherapy or Previous Psychiatric Diagnosis: Not reported.
Substance Current Use: She smokes 3 packs of cigarettes every day and drinks about 12 bottles of alcoholic beverages weekly. She stopped taking marijuana after the death of her mother about 3 years ago. She does not take cocaine or any other illicit drug.
Family Psychiatric/Substance Use History: Mother with a history of anxiety. Father with a history of paranoid schizophrenia. No blood relative has ever committed suicide.
Psychosocial History: The patient was living with her mother, but she died three years ago. She moved in with her sister afterward. The highest level of education is the 10th grade. She has no children and has never been married. She is jobless. She has no history of being arrested but has been warned several times. Reports that her father was tough on them before passing on.
Medical History: Reports a history of fatty liver and diabetes
- Current Medications: Metformin to control her blood sugar levels
- Allergies: No allergies
- Reproductive Hx: Attained menopause at the age of 45 years. Heterosexual with no children as she has never been married.
ROS:
- GENERAL: No fatigue, recent changes in body weight, body weakness, nausea, vomiting, or fever.
- HEENT: Head: No headache, or signs of trauma or injuries. Ears: No itchiness, tenderness, tinnitus, or discharge. Eyes: No visual defects, tearing, itchiness, or double vision. Nose: No sinus problems, congestions, stuffiness, redness, or inflammation. Throat & Mouth: No bleeding gums, sore throat, swallowing difficulties, toothache, or bleeding gums.
- SKIN: No itchiness, eczema, rashes, or hives.
- CARDIOVASCULAR: No chest pressure, palpitations, cyanosis, dyspnea, or edema.
- RESPIRATORY: No sneezing, shortness of breath, coughing, wheezing, or chest congestion.
- GASTROINTESTINAL: No changes in bowel movement, heartburn, nausea, vomiting, hernia, or abdominal pain.
- GENITOURINARY: No changes in urine frequency, urgency, burning sensation when urinating, discharge, nocturia, or dysuria.
- NEUROLOGICAL: No changes in vision, headache, dizziness, or loss of consciousness.
- MUSCULOSKELETAL: No joint or muscle pain, stiffness. Full range of muscle movement.
- HEMATOLOGIC: No bleeding problems, or prolonged healing of bruises.
- LYMPHATICS: No enlargement of lymph nodes.
- ENDOCRINOLOGIC: No polydipsia, polyuria, or excessive thirst.
Objective:
Diagnostic results: Metabolic panel and routine blood works ordered, such as CBC, WBC, and MCV. Urine and blood drug tests were ordered to assess for substance use disorder. Renal function tests, LFTs, T4, and T3 were ordered to assess for any complications resulting from previously administered psychotropic agents. Imaging studies such as CT scans and X-rays of the head were ordered to check for any physical abnormalities which might have contributed to her current symptoms. Additional diagnostic tools utilized include Calgary Depression Scale for Schizophrenia, Clinical Global Impression-Schizophrenia (CGI-SCH), Brief Psychiatric Rating Scale (BPRS), SANS and SAPS Tests, Positive and Negative Syndrome Scale (PANSS), and Rorschach (inkblot) test (Jauhar et al., 2018).
Assessment:
Mental Status Examination: The patient is well oriented in time, place, and person. Her attention is limited. She however appears to descent in age-appropriate grooming and clothing. She is suspicious in an awkward manner. She is cooperative during the interview but gets distracted most of the time displaying strange beliefs and delusive behavior such as claiming that a bird is in the examination room. Her speech is not fluent. She displays a sad mood, and fear as she thinks her life is in danger. Her thought process is compromised, with irrelevant and unreasonable thought content. perceptual disturbance noted. Displays impairment in recent and remote memory. Her insight is poor. Confirms hallucinations, nightmares, and delirium. Denies suicidal ideation or self-injurious activities.
Diagnostic Impression:
- Schizophrenia Spectrum and Other Psychotic Disorders: This is a common mental disorder characterized by loss of contact with reality leading to symptoms such as abnormal behavior, disorganized thinking and speech, delusion, and hallucination. To qualify for the diagnosis, the DSM-V requires the patient to display at least two of the above symptoms in addition to catatonic behavior or negative symptoms like nightmares (Palomar-Ciria et al., 2019). The patient in the provided case study displayed most of these symptoms, qualifying for this disorder as the primary diagnosis.
- Bipolar I Disorder with psychotic features: According to the DSM-V, patients with this disorder normally present with manic episodes in addition to psychotic features such as delusion and hallucination (Kesebir et al., 2020). Additional symptoms include increased psychomotor agitation, racing thoughts, inability to sleep, being easily distracted, and inflated self-esteem among others. The patient did not display maniac episodes, which disqualifies this diagnosis.
- Delusional Disorder: According to the DSM-V, this disorder is only applicable to patients who present with delusional symptoms for at least one month, without any other associated psychotic symptoms (Perrotta, 2020). The patient in the provided case study however displayed hallucination, among other psychotic features like nightmares and disorganized thought process.
Reflections:
The PMHNP did an excellent job in evaluating this patient. She uses polite and non-judgmental communication skills while giving the patient ample time to explain herself. The information provided is quite adequate in making a primary diagnosis of schizophrenia. However, it would have been necessary for the clinician to call in the sister to provide additional information regarding the patient’s behavior at home. Additionally, the patient’s thought process is compromised. As such, the patient is unable to make a sound decision concerning her health, especially in the choice of treatment. As such, the sister who is the only available next of kin has the legal obligation of stepping in and helping the patient in making sound decisions to promote effective treatment outcomes (Jauhar et al., 2018).
Case Formulation and Treatment Plan:
Primary diagnosis: Schizophrenia Spectrum and Other Psychotic Disorders
Psychotherapy: Initiate Cognitive Behavioral Therapy to help promote positive thinking and appropriate behavior (El-Mallakh et al., 2019).
Alternative psychotherapy: Assertive community treatment (ACT), cognitive enhancement therapy (CET), coordinated specialty care (CSC) may be considered effective alternatives to CBT.
Pharmacotherapy: Initiate quetiapine (Rx) Extended-release 300 mg orally on day one. Titrate the dose upwards at intervals of 300mg daily to attain an optimum dose between 400 to 800 mg once daily based on the patient outcome (Maroney, 2020). The patient already displayed great effectiveness and tolerance to the medication.
Patient Education: Inform the patient of the importance of being compliant with the medication to promote the treatment outcome, in addition to the associated side effects and how to manage them (Maroney, 2020).
Health Promotion: Quetiapine is associated with moderate weight gain, as such, the patient needs to adopt appropriate life modifications such as physical exercises and consumption of healthy low calorie foods (Maroney, 2020).
Follow up: The patient should report back to the clinic after one week for an evaluation of the treatment outcome, and appropriate dose adjustment.
References
El-Mallakh, R. S., Rhodes, T. P., & Dobbins, K. (2019). The case for case management in schizophrenia. Professional Case Management, 24(5), 273-276. DOI: 10.1097/NCM.0000000000000385
Jauhar, S., Krishnadas, R., Nour, M. M., Cunningham-Owens, D., Johnstone, E. C., & Lawrie, S. M. (2018). Is there a symptomatic distinction between the affective psychoses and schizophrenia? A machine learning approach. Schizophrenia Research, 202, 241-247. https://doi.org/10.1016/j.schres.2018.06.070
Kesebir, S., Koc, M. I., & Yosmaoglu, A. (2020). Bipolar Spectrum Disorder May Be Associated With Family History of Diseases. Journal of Clinical Medicine Research, 12(4), 251. DOI: 10.14740/jocmr4143
Maroney, M. (2020). An update on current treatment strategies and emerging agents for the management of schizophrenia. Am J Manag Care, 26(3 Suppl), S55-S61. DOI: 10.37765/ajmc.2020.43012
Palomar-Ciria, N., Cegla-Schvartzman, F., Lopez-Morinigo, J. D., Bello, H. J., Ovejero, S., & Baca-Garcia, E. (2019). Diagnostic stability of schizophrenia: a systematic review. Psychiatry Research, 279, 306-314. https://doi.org/10.1016/j.psychres.2019.04.020
Perrotta, G. (2020). Psychotic spectrum disorders: definitions, classifications, neural correlates, and clinical profiles. Annals of Psychiatry and Treatment, 4(1), 070-084. https://doi.org/10.17352/apt.000023