Training Title 134

Name: Mrs. Bunny Warren

Gender: female

Age: 33 years old

CC There is nowhere that is safe

Background: Bunny was brought in by her best friend, Patty, after the police responded to her

home the fifth time today. The police was threatening to arrest her for misuse of the 911

system, Bunny called you and you informed the police she needed to go the emergency room.

She has been calling 911 saying people are looking in her windows, standing across the street

watching her, stated they are watching for her husband to return home so they can hurt him.

Today, she has a stomachache. She believes there is a snake inside of her stomach which she

would like to have removed. She stopped eating 2 days ago because of this.

During the assessment, the patient seemed on edge, anxious, and paranoid. The patient has

history of scoliosis. This is her third presentation to this hospital, she had one psychiatric

admission 2 years ago. No self-harm behaviors but has been physically aggressive toward

others in the past. She is guarded and refuses to answer questions whether there are memory

or concentration problems. She denies any recent head injuries. She states that she has been

sleeping nightly, one or two hours at a time and waking up throughout the night. Refuses labs,

refuses to have her vital signs obtained.

She obtains SSDI. She lives in Atlanta, GA. Bunny denies ever using any drugs and drinks

occasionally, once a month. She has a sister who is ten years older, both parents deceased in

the last two years. She has no children, her husband is out of town, truck driver. Family history

includes that her father had two previous inpatient psychiatric hospitalizations after bad drug

experiences in the 1970s, for one week each time. Mother had diagnosis and ongoing

treatment for depression. Her paternal grandmother was state hospitalized for several years.

She denies any past history of traumatic experiences, but her friend does say that losing her

parents was hard for her emotionally. No history of military service. No legal issues currently.

Has HS diploma. Allergies: haloperidol

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

00:00:15UNKNOWN Hi, Mrs. Warren, nice to see you again. How are you doing?

00:00:20WARREN You're with them.

00:00:20UNKNOWN Pardon me.

00:00:25WARREN I know you are. But you won't tell me, people like you never do.

00:00:30UNKNOWN I'm not sure that I follow.

00:00:30WARREN Sure. They dumb just like everybody else. We're on to you.

00:00:40UNKNOWN Who do you mean by we?

00:00:45WARREN Mm-hmm.

00:00:45UNKNOWN You are not going to tell me?

00:00:50WARREN I don't need to tell you. You have eyes and ears planted everywhere.

00:00:55UNKNOWN Everywhere meaning other places away from the hospital…

00:01:00WARREN Everywhere, enough set.

00:01:00UNKNOWN Let me make sure I understand. Are you saying you feel that I or someone else has been spying on you?

00:01:05WARREN I don't feel that. I know it. You and your people had… I don't need to explain it, you already know.

00:01:15UNKNOWN You feel safe here in the emergency department?

00:01:20WARREN There's nowhere that is safe. Don't pretend like there is.

Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.

For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.

To Prepare:

Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic disorders. Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.

Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment

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.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment? 

Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).