PRAC 6645 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Walden University PRAC 6645 Wk 7 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 Wk 7 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 Wk 7 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 Wk 7 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 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
The introduction for the Walden University PRAC 6645 Wk 7 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 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
After the introduction, move into the main part of the PRAC 6645 Wk 7 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 Wk 7 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 Wk 7 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 Wk 7 Assignment 2: Comprehensive Psychiatric Evaluation Note and Patient Case Presentation
Subjective:
CC (chief complaint): ‘My child is behaving abnormally. He is violates the rights of others and bullies his peers. He is getting out of control.’
HPI: A.A is a 13-year-old client that came to the unit as a referral by his physician. He was referred for psychiatric assessment because the physician felt that his deviant behaviors were likely to be attributed a mental disorder. The mother of the client reported that A.A has been acting abnormally for the last six months. He has been aggressive and often violates the rights of children of his age. The violation of rights were reported to include aspects such as bullying others, threating to harm, engaging in fights frequently, and used a stick to hit his friend when they disagreed. The mother also reported that A.A was recently accused of stealing a book from his friend in his school. The mother noted that she has tried talking and taking A.A for counseling but they have been unsuccessful. She also noted that the frequency of his involvement in deviant behaviors are getting out of hand. She took him to their family physician, where they were referred to the unit for psychiatric assessment.
Past Psychiatric History:
- General Statement: ‘My child is behaving abnormally. He is violates the rights of others and bullies his peers. He is getting out of control.’
- Caregivers (if applicable): A.A’s mother
- Hospitalizations: The client does not have any history of hospitalizations.
- Medication trials: The client does not have any history of medication use or medication trials.
- Psychotherapy or Previous Psychiatric Diagnosis: The mother reports that she has taken A.A for counseling services, which have not been effective.
Substance Current Use and History: A.A denied any history of substance abuse
Family Psychiatric/Substance Use History: The mother reported that her father died at the age of 65 years with a history of depression. She also reported that her husband’s father lives with Alzheimer’s disease. She denied any history of drugs and substance abuse in the family.
Psychosocial History: A.A is a the first born in a family of three. He lives with his parents in a healthy environment. He has a brother and a sister. He is in junior highschool. He reports that his hobbies includes playing with peers and watching the television. He has no history of childhood trauma or violence. He also has no history of involvement with the legal system.
Medical History:
- Current Medications: A.A is currently not on any medications.
- Allergies: A denied any history of food, drug, or environmental allegies.
- Reproductive Hx: A.A denied any history of increase in urinary urgency and frequency. He is not sexually active.
Objective:
Diagnostic results: Physical examination and history taking are the most effective diagnoses recommended for
A.A. The information obtained from physical examination and history taking can help rule out whether the client has a conduct disorder or is suffering from another rmedical condition. Laboratory investigations such as blood test may be conducted to determine if the client has abnormal biomarkers or changes in the electrolyte levels. Tests such as thyroid function tests may be performed to rule out thyroid disorders, which may have some of the symptoms that the client presented with to the hospital. In rare cases, neuroimaging investigations such as scan of the brain may be performed to determine if the client has any brain pathologies such as changes in the prefrontal and frontal complex, which are contributing to the symptoms.
Assessment:
Mental Status Examination: A.A is a 13-year-old client who appears appropriately dressed for the occasion. He does not show any signs of fatigue or abnormal movements such as tremors and tics. The client is oriented to place, time, events, and space. His insight is intact with absence of depressed mood. The client denies illusions, delusions, and hallucinations. He also denied suicidal thoughts, attempts, and plans. His thought content is future oriented. He also has normal speech in terms of rate and volume.
Differential Diagnoses:
Conduct disorder: Conduct disorder is the primary diagnosis for the client in this case study. According to DSMV, patients with conduct disorder present to the hospital with a number of symptoms. The symptoms involve disruptive and impulsive behaviors. They include repetitive pattern of behaviors that violate societal norms and rights of others for the past 12 months with at least the following symptoms in the last six months. The symptoms include bullying, initiating physical fights, using weapon to harm others, crueal to people and animals, stealing, forcing others into sexual activity, destruction of property, and commiting arson (Rolon-Arroyo et al., 2018). The other symptoms include destroying other people’s properties deliberately, breaking into other peoples’ properties, violation of rules, staying out of night despite prohibition by parents, and running away from home (Fairchild et al., 2019). A.A has the majority of the above symptoms, hence, making conduct disorder his primary diagnosis.
Attention Deficit Hyperactive Disorder (ADHD): ADHD is the secondary diagnosis that should be considered for A.A. According to DSMV, individuals with ADHD present to the hospital with symptoms that include inattention and hyperactivity or impulsivity. The symptoms of inattention include failing to pay attention to details, not listening when spoked to directly, failing to follow instructions, and dislikes activities that need mental effort. The symptoms of hyperactivity include fidgeting, engaging in inappropriate behaviors for the age, failing to engage in leisure activities, talking excessively, and lack of patience (CDC, 2020). ADHD is the least likely diagnosis for A.A since he has destructive behaviors that violate social norms and rights of others.
Oppositional defiant disorder: The other secondary diagnosis to consider for the client is oppositional deviant disorder. According to DSMV, individuals with oppositional deviant behaviors present with symptoms that include irritable mood, argumentative behaviors, and vindictiveness. The symptoms of irritable mood include losing temper, being easily annoyed, and angry or resentful. The symptoms of argumentative behavior include arguing with authority figures and others, defying requests, and annoying others deliberately. The symptom of vindictiveness includes being spiteful at least two times in the last two months (Burke & Romano-Verthelyi, 2018). Oppositional deviant disorder is the least likely diagnosis for A.A because he engages in activities that harm others and violates the social norms and rules.
Reflections: Conduct disorder is a common problem in children and adolescents. They demonstrate behaviors that contradict the social norms and violate the rights of others in the society. I agee with the diagnosis that was reached in this case study. I also agree with the use of cognitive behavioral therapy to facilitate the management of the symptoms of the disorder. I learnt the importance of comprehensive examination and history taking from this experience. I also learned about the importance of significant others in history taking. One of the things that I would do differently in the future is incorporating family therapy to the treatment to improve the family dynamics of the client (Caldwell et al., 2021).
Case Formulation and Treatment Plan:
A.A has been diagnosed with conduct disorder. Diagnostic investigations were not ordered due to the accuracy of the subjective data that guided the development of the diagnosis. The client was initiated on behavior modification therapy. The therapy aimed at helping him overcome impulsive and intrusive symptoms of the disorder (Fairchild et al., 2019). The client was scheduled for a follow-up visit after four weeks to determine his response to treatment.
References
Burke, J. D., & Romano-Verthelyi, A. M. (2018). 2—Oppositional defiant disorder. In M. M. Martel (Ed.), Developmental Pathways to Disruptive, Impulse-Control and Conduct Disorders (pp. 21–52). Academic Press. https://doi.org/10.1016/B978-0-12-811323-3.00002-X
Caldwell, D. M., Davies, S. R., Thorn, J. C., Palmer, J. C., Caro, P., Hetrick, S. E., Gunnell, D., Anwer, S., López-López, J. A., French, C., Kidger, J., Dawson, S., Churchill, R., Thomas, J., Campbell, R., & Welton, N. J. (2021). School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: A systematic review and network meta-analysis. NIHR Journals Library. http://www.ncbi.nlm.nih.gov/books/NBK572522/
CDC. (2020, September 21). Symptoms and Diagnosis of ADHD | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., Freitag, C. M., & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 1–25. https://doi.org/10.1038/s41572-019-0095-y
Rolon-Arroyo, B., Arnold, D. H., Breaux, R. P., & Harvey, E. A. (2018). Reciprocal Relations Between Parenting Behaviors and Conduct Disorder Symptoms in Preschool Children. Child Psychiatry & Human Development, 49(5), 786–799. https://doi.org/10.1007/s10578-018-0794-8
Sample Answer 2 for PRAC 6645 Wk 7 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