Tag: Clinical-Nursing

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025

Question 1                 
1 pts

Choose the following statement that is 
most
 true:  The lower the psychotherapy patient is determined to be on the model of Maslow’s hierarchy of needs

Group of answer choices

The less involved the therapist must be in active treatment

The more involved the therapist must be in active treatment

The patient needs no therapist for treatment

The more enmeshed the therapist must be.

Question 4               
1 pts

Dialectical Behavior Therapy is known to be the 
most
 effective treatment for all the following disorders:

Group of answer choices

Cluster A personality disordered patients

Cluster B personality disordered patients

Cluster C personality disordered patients

None of the above

Question 6                       
1 pts

Which of the following is consistent regarding termination of treatment in 
brief 
psychodynamic psychotherapy?

Group of answer choices

The termination date is not set and is ongoing as long as the patient wants to come for visits

The termination date is set within 30 sessions

The termination date is set within 60 sessions

None of these are true

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025 – Question 7   
1 pts

All of the following are potential ethical and legal violations for therapists when conducting therapy 
EXCEPT:

Group of answer choices

allowing a person to run up a high unpaid bill

sexual fantasies about a patient

processing therapist emotions about a patient in clinical supervision with a colleague in private

talking about a patient session in the elevator with a colleague

Question 8   
1 pts

The study of theories and principles for mental health, mental illness, and general psychodynamics is a strategy that supports which therapeutic group factor?

Group of answer choices

Imparting of information

Interpersonal learning

Imitative behavior

Development of socializing techniques

GET EXAM HELP

Question 9       
1 pts

What group therapeutic approach focuses on examining interactions among and between the group leader and group members, and assisting group members in increasing awareness of unconscious motivations and needs?

Group of answer choices

Cognitive Behavioral

Person-Centered

Psychodynamic

None of the above

Question 10     
1 pts

During the initial phase of family therapy one person is identified as “the problem”. The family therapist challenges linearity by which of the following?

Group of answer choices

Asking the children to not be involved

Asking the person identified as the problem to meet privately without regard to others in the family

Asking the person identified as the problem how they think the problem could be fixed.

Asking how others in the family about the involvement involved in or how affected by “the problem”.

Question 11   
1 pts

The therapist using a cognitive behavioral therapy approach says to the patient: “You say you become depressed. Explain to me what depression feels like to you.” This is an example of what question type in Socratic Dialogue?

Group of answer choices

Memory question

Translation question

Application question

History question

Question 13   
1 pts

Psychodynamic psychotherapy interventions focus on which of the following?

Group of answer choices

The person’s thoughts beliefs and behaviors

The person’s relationships and family dynamics

The person’s emotions and thoughts, deepening understanding of triggers form the past played out in the present.

The person’s body, beliefs, images, and emotions to process trauma

Question 16   
1 pts

What
psychotherapy
framework is the 
best
 choice for the therapy to use when assisting older adults with reflection and resolution in transitioning from one life stage to another focusing on bereavement, role transitions, and role conflict?

Group of answer choices

Interpersonal Psychotherapy

Cognitive Behavioral Therapy with use of computer keyboard for typing

Mindfulness-Based Interventions

Motivational Interviewing

 

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025

Factors that distinguish psychodynamic therapy from cognitive behavioral therapy include which of the following factors.

Group of answer choices

Emphasis on the past; Focus on expression of emotion; Emphasis on transference

Focus on here and now, focus on current relationships, exploration of intra psychic issues.

Emphasis on here and now; exploring and working with resistance to treatment, the working alliance.

Identification of patterns in actions, thoughts, feelings, experiences; Focus on current relationships.

Question 18
1 pts

Which of the following neurotransmitter stimulates the hypothalamic-pituitary-adrenal axis and acts on the reward system?

Group of answer choices

Gamma-aminobutyric acid

Dopamine

Cortisol

Norepinephrine

Which therapy is based on the theory of how a patient structures their experiences largely determine how they feel and behave (maladaptive thoughts are rooted in irrational or illogical assumptions)?

Group of answer choices

Psychodynamic Therapy

Supportive Psychotherapy

Cognitive Behavioral Therapy

Interpersonal Psychotherapy

Question 20
1 pts

Conducting psychotherapy is a skill and an art that must be learned by nurses transitioning from registered nurse to advanced practice registered nurses as they are accustomed to “taking care of people, being action-oriented, wanting to rescue patients by making them feel better” and helping the patient feel better is not the main goal of psychotherapy when in fact in psychotherapy attempts of “improving symptoms” may even be counterproductive to the therapeutic process.

Group of answer choices

True

False

True

Question 21
1 pts

In group therapy, which Yalom principle is displayed when one group member shares vulnerable information about their own experiences in order to help another member of the group?

Group of answer choices

Altruism

Imitative Behavior

Universality

Existential Factors

Question 22
1 pts

Key Concepts for Emotionally Focused Family Therapy include all the following 
EXCEPT
:

Group of answer choices

Attachment Styles

Coalitions

Emotions

Attachment Injuries

Question 23
1 pts

The therapist is assessing a patient for suicide risk.  All of the following are considered protective factors to lower suicide risk for patients 
EXCEPT
:

Group of answer choices

a patient having religious beliefs

a patient having a history of self harm but never hospitalized

a patient expressing responsibility for family, friends, work, and/or pets

a patient demonstrating resiliency and ability to cope with stress

Question 24
1 pts

The technique used by the CBT therapist to help the individual uncover underlying assumptions in logic and sequence through careful questioning by the therapist asking,” If this is true then what happens?”

Group of answer choices

Idiosyncratic Meaning

Labeling of distortions,

Downward Arrow

Questioning the Evidence

Question 29
1 pts

According to Yalom, which of the following is consistent with the therapeutic benefit of imitative behavior?

Group of answer choices

Imitative behavior generally plays a more important role in early stages of a group.

Imitative behavior may allow an individual to experiment with a new behavior.

Finding out what we are not is progress toward finding out what we are.

All of the above

Question 30
1 pts

According to Yalom, members of a cohesive psychotherapy group will demonstrate all the following variables 
EXCEPT
:

Group of answer choices

try harder to influence other group members

be more open to influence by other members

reluctantly participate in group meetings

be willing to listen and more accepting of others

Question 31
1 pts

All of the following are left-brain functions 
EXCEPT
:

Group of answer choices

Empathy

Problem-solving

Explicit reasoning

Controls the right side of the body

Question 32
1 pts

All of the following are features of Interpersonal Psychotherapy 
EXCEPT
:

Group of answer choices

Long term therapy sessions

Based on the present, not the past

Focused sessions, not open-ended

awareness of personality but not main focus

Question 33
1 pts

The idea that nothing happens by chance, that every thought and all behavior has a cause refers to which of the following concepts?

Group of answer choices

Id vs ego conflict

Super ego actions to censor and restrain

Psychic determinism

Ego synchrony

Question 34
1 pts

The therapist using a CBT approach in which the therapist encourages the patient to investigate whether their thoughts are based on facts or assumptions is known as which of the following?

Group of answer choices

Labeling of Distortions

Questioning the Evidence

Advantages and Disadvantages

Examining Options and Alternatives

 

 

The therapist is informed by the managed care company that authorization for additional treatment with a patient has been denied. The therapist is concerned stopping treatment will
 jeopardize 
the patient’s 
safety 
and realizes which of the following are the 
best 
ethical actions?

Group of answer choices

the therapist continues to work with the patient to ensure ongoing treatment while working with the managed care company on payment solutions.

Stop treatment immediately.

Attempt to work out a payment plan with the patient for ongoing treatment

Both A and C are correct

Question 37             
1 pts

According to Freud’s Psychosexual stages development of sexual identity occurs during what age range?

Group of answer choices

18 months to 3 years

3 years to 6 years

6 years to 12 years

13 years to 20 years

Question 39             
1 pts

Hildegard Peplau developed the psychodynamic interpersonal model for psychiatric nursing based on which theorist’s framework?

Group of answer choices

Eric Erickson

Sigmund Freud

Margaret Mahler

Harry Stack Sullivan

Question 40   
1 pts

Common patterns of behavior and experience derived from the settings in which people live is known as which of the following?

Group of answer choices

Race

Culture

Ethnicity

Family structure

Question 41     
1 pts

In patients with chronic hyperarousal their Resilience Zone may be too narrow. Strategies to widen the Resilience Zone would include which of the following?

Group of answer choices

Exercise, decreasing caffeine intake, and imagery

Relaxation exercises, increasing caffeine intake and imagery

Both A and B

None of the above because actually their Resilience Zone is too wide.

 
Question 49             
1 pts

Which of the following are consistent with findings related to levels of cohesiveness in groups?

Group of answer choices

The higher the overall levels of cohesiveness are associated with significantly better total outcome than groups with low cohesiveness.

Group member with little sense of belonging or attraction to a group is unlikely to have a negative outcome.

The attraction to the group is a powerful determinant of outcome.

A and C

Question 50     
1 pts

Choose the two 
most theorized
 psychiatric disorders that are thought to have heritability and epigenetic roots.

Group of answer choices

Schizophrenia

Persistent Depressive Disorder

Bipolar Disorders

Borderline Personality Disorder

 
Question 51     
1 pts

The therapist is meeting with a patient who is in the process of an unwanted divorce. The patient endorses persistent suicidal ideations, with strong intent. The therapist recognizes the patient is at high suicide risk and recommends which of the following?

Group of answer choices

Develop a crisis plan and give emergency numbers.

Hospital psychiatric admission and suicide precautions.

Refer to intensive outpatient therapy and give emergency numbers.

Develop a no-suicide contract and provide emergency numbers.

 
Question 53 
1 pts

Schizoid personality is a pathological outcome associated with which of Erickson’s psychosocial stages?

Group of answer choices

Autonomy vs. self-doubt

Industry vs. inferiority

Identity vs. role confusion

Intimacy vs. isolation

Question 54
1 pts

A descriptive/biological approach of specialized knowledge that treats individuals as members of a diagnostic group is based on

Group of answer choices

A biomedical model

A holistic model

A recovery model

A resilience model

Question 55                   
1 pts

A patient involved in expressive psychotherapy is having intense emotional reactions to painful experiences that have been expressed. This is known as which of the following?

Group of answer choices

Immediacy

Abreaction

Differentiation

Rapprochement

Question 56           
1 pts

Which of the following is 
NOT
 consistent with the underlying assumptions of psychodynamic psychotherapy?

Group of answer choices

What has happened in the past determines what we do today.

Psychodynamic psychotherapy is rooted in developmental theory

By changing one’s thoughts, emotions and behaviors can be changed.

Through understanding the past, the individual is impowered to make more conscious decisions.

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025    – Question 57     
1 pts

The Health Insurance Portability and Accountability Act defined psychotherapy notes as separate notes maintained by therapists documenting/analyzing the contents of sessions outside of the patient’s medical record. Progress notes are documented in the patient’s medical record. 
Psychotherapy notes
are treated differently in privacy laws than progress notes as they contain sensitive, personal notes from the therapist that are typically not required or useful for treatment, payment, or healthcare operations; they are only beneficial for the mental health provider who created the notes.   All the following are elements  documented in the progress note in the medical record that 
WOULD NOT
 be documented in protected psychotherapy notes 
EXCEPT
:

Group of answer choices

counseling session start and stop times

treatment plan modalities and frequencies

results of clinical screenings and testing

therapist thoughts about how difficult was to hear patient talk about sexual abuse due to potential countertransference

Question 72                 
1 pts

The nurse psychotherapist realizes that “true presence” in a therapeutic relationship involves which of the following?

Group of answer choices

Acceptance, nonjudgmental attitude and empathy.

Listening to what the meaning of a situation is in the moment.

“Being with” the patient rather than “doing to” the patient.

All of the above are true

Question 73                     
1 pts

All of the following are general principles of 
brief 
psychodynamic psychotherapy 
EXCEPT
:

Group of answer choices

define a precipitating event

no therapy termination date is set

identify developmental issues and defenses to understand how to proceed

be sensitive to how the past is influencing the present

Question 74               
1 pts

All of the following are 
appropriate
 reasons for using screening tools for assessment 
EXCEPT
:

Group of answer choices

measuring patient outcomes

evaluating efficacy of treatment

supplementing the psychiatric interview

obtaining information from a non-cooperative patient

Question 76                 
1 pts

Socratic Dialogue is the gold standard for therapists asking patients questions to elicit answers in Cognitive Behavioral Therapy (CBT).  The CBT therapist asks the patient “On a scale of 1 to 10 how would you rate your level of depression today?” “And how does that compare to 2 months ago?” This is an example of what type of question type in Socratic Dialogue?

Group of answer choices

Application questions

Memory questions

Evaluation questions

Translation questions

Question 77               
1 pts

Which of the following statements is true for Cognitive-Behavioral Therapy (CBT)?

Group of answer choices

CBT is a system of psychotherapy based on a theoretical framework which maintains how an individual structures one’s experiences largely determines how one feels and behaves.

Maladaptive thoughts relating to the “cognitive triad” are rooted in irrational or illogical assumptions.

By changing one’s thoughts, emotions and behaviors can be changed.

All of the above are true

NRNP 6645 Psychotherapy with Multiple Modalities midterm exam 2025 – Question 88             
1 pts

All of the following are types of Exposure Therapy aimed to reduce distress a person experiences with stimuli associated with danger 
EXCEPT:

Group of answer choices

Eye Movement Desensitization and Reprocessing

Dialectical Behavior Therapy

Prolonged Exposure

Exposure and Response Prevention

Question 91                     
1 pts

If a health care professional terminates treatment because of managed care failure to authorize the session who is liable for harm based upon abandonment of the treatment.

Group of answer choices

The health care provider

The managed care company.

The individual at the managed care company who failed to authorize necessary treatment.

all of these

Question 100                     
1 pts

Staff in an independent living facility notice that Mr. Smith, a 75-year-old male resident is alone most of the time and seems to have alienated most of the other residents and staff. The therapist understands that from Erikson’s psychosocial stages perspective, he is dealing with which psychosocial stage of development?

Group of answer choices

Intimacy vs. isolation

Ego integrity vs. despair

Generativity vs. stagnation

Autonomy vs. alienation

NRNP
6645
Psychotherapy with Multiple Modalities midterm exam 2025

After reading Chapters 19 and 20, please read the following scenario and respond to the questions with rationale from the textbook and/or other readings or references. This Discussion Board assignment is required for all students. It does have to be in APA format with at least 2 references (within 5 years)in APA format. Your response needs to be 200-300 words in length.

The 7 PM to 7 AM RN who usually works on the Adult Medical/Surgical unit is told to report to the Labor and Delivery (L&D) unit as it is his/her turn to float to another unit. The RN has not taken care of a patient in labor since nursing school 5 years ago. The unit supervisor on the L&D unit has assigned this RN to 2 patients in active labor. The floating RN states he or she is uncomfortable in this situation since it has been 5 years in caring for this type of patient. The unit supervisor says, “Don’t worry – you just need good basic nursing assessment and nursing skills.”

Respond to the question: Should the RN take the assignment?

If your answer is “yes”: State the rationale using support from the textbook or other references. If you have additional questions for the RN or the supervisor, please include those in your response.

If the answer is “no”: State the rationale using support from the textbook or other references. Give an alternative action in your response.

 

Discussion: Effective Delegation

Student’s First Name, Middle Initial(s), Last Name

Institutional Affiliation

Course Number and Name

Instructor’s Name and Title

Assignment Due Date

 

Discussion

The American Nurses Association highlights that professionally; nurses should know their rights and responsibilities when considering an assignment. If a nurse feels that they lack expertise in managing patients of a specific population or unit, the nurse is obligated to decline the assignment (American Nurses Association, n.d.). To know what decisions to make in which scenarios, nurses should familiarize with their state Nursing Practice Act or workplace hospital policy, which often highlight these circumstances.

In this case scenario, the author would decline the assignment. In practice, an assignment to an area that a practicing nurse is unfamiliar with and ordered to perform a task that the nurse may be unfamiliar with is likely to occur. In most cases, it can be because of a low staff: patient ratio or as a result of the rotational shifts of nurses from one department to another. For instance, in this case scenario, the nurse has never cared for patients in active labor and the in charge nurse assigns her to care for two patients who are in the active phase of labor. Although declining the assignment can amount to patient abandonment charges if anything wrong occurs, accepting the assignment is equally a threat to the patient’s and nurse’s wellbeing.

The nurse admits that she has never handled a patient in the active phase of labor since 5 years ago. This therefore implies that, she is convinced she lacks adequate practice and knowledge caring for this patient population, which can otherwise compromise the safety and overall well-being of the patients with both legal, financial, and professional implications to her and the hospital. When declining the assignment, Barrow & Sharma (2018) suggest that, a nurse should try to negotiate with the supervisor and demonstrate that, despite her willingness   to care for the assigned patients, she has never worked with mothers in the active phase of labor. Therefore, she cannot be in charge.

 

References

American Nurses Association (n.d.). Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses. https://www.nursingworld.org/practice-policy/nurse-staffing/questions-to-ask-in-making-the-decision-to-accept-a-staffing-assignment-for-nurses/

Barrow, J. M., & Sharma, S. (2018). Five rights of nursing delegation.

Sherman Tremaine SOAP note

Case Study

HPI: The session begins with Dr. Moore meeting Sherman Tremaine, a male avatar patient, who was born on November 3rd, 1968. Sherman appears well-dressed but avoids eye contact and fidgets during the session. He indicates that the current date is March 18th, either a Wednesday or Thursday, in Dr. Moore’s office. Sherman mentions his reason for the session, stating his sister compelled him to seek help after their mother’s death, claiming people outside were bothering him. Leaning with a subtle tilt, he gestures toward phantom silhouettes casting glances through the window, asserting they’ve been deployed by governmental bodies to observe him and unjustly inflate his tax liabilities. Sherman reports experiencing auditory and visual hallucinations of these people for weeks, alongside delusions of persecution. He mentions hearing loud voices that disrupt his sleep and believes they tamper with his food. Despite locking his food away, he feels paranoid about contamination. Sherman discloses his substance use, including heavy smoking and occasional alcohol consumption, influenced by his sister’s purchases. He denies cocaine use but admits to past marijuana use, emphasizing he dislikes medication due to adverse effects, citing risperidone’s side effect of gynecomastia. He brings up his father’s past with paranoid schizophrenia and his mother’s struggles with anxiety. Sherman denies suicidal ideation or self-harm history, although he acknowledges prior hospitalizations in his twenties. He takes metformin for diabetes but questions the diagnosis’s validity. Sherman discloses familial dynamics, expressing distrust towards his sister and alleging government conspiracy. Despite these concerns, he maintains a casual demeanor and denies a criminal history, except for frequent calls to 911 about perceived threats.

 

Introduction – Sherman Tremaine Soap note

Schizophrenia spectrum, as well as other psychotic disorders, are characterized by hallucinations, delusions, disorganized behaviors, and negative symptoms. Schizophrenia emerges in late adulthood and is marked with psychotic episodes. These conditions alter an individual daily life and affect their relationship, self-care, and work. In the provided case study, Sherman presents with psychotic symptoms, visual and auditory hallucinations, paranoid ideation as well as persecutory delusions. He has a family history of paranoid schizophrenia and has a history of hospitalization, heavy cigarette smoking, occasional alcohol use, and marijuana use that calls for the differentiation of psychotic disorders from substance induced conditions. Therefore, this case study ensures accurate assessment and collaborative treatment to manage symptoms and promote good quality of life.

Patient information:

Name: S.T

Date of Birth: 1968

Subjective:

CC
(chief complaint):

People outside are bothering me, and my sister has compelled me to seek help.

HPI
:

The onset
: A few weeks ago is when the symptoms started.

The course:
Persistent symptoms since onset.

Duration:
Symptoms lasted for some weeks.

Characteristics:
               Hallucinations: He has visual and auditory hallucinations. He mentions hearing loud voices that disrupt his sleep and people observing him through the window.               Delusions: He believes that people have been deployed by the government bodies to observe him and inflate tax liabilities. He also believes his food is being tampered with.Aggravating factor: Not mentioned.Relieving factor: Not mentioned.Associated symptoms: sleep disruptions due to voices.Substance use: heavy smoking, alcohol consumption, as well as past marijuana use.He dislikes medication because of side effects, like risperidone, because it causes gynecomastia.              
Substance Current Use:
He accepts heavy smoking, occasional alcohol consumption, and past marijuana use, but he denies cocaine use.

Medical History:
He had prior hospitalization in his twenties and was diagnosed with diabetes, which he questions the validity of the diagnosis.

Current Medications
: Metformin.

Allergies
: No allergy reported.

Reproductive Hx
: It is not provided.

BUY A CUSTOM SOAP NOTE HERE

ROS
:

GENERAL: He denies fever, weakness, fatigue or weight loss.

HEENT: Eyes: He denies visual loss, double vision, or blurred vision. Ear, Nose and Throat: There is no hearing loss, congestion, sneezing or sore throat.

SKIN: Denies any itching or rash.

CARDIOVASCULAR: Denies no chest pain, edema or palpitations.

RESPIRATORY: Denies no shortness of breath, sputum or cough.

GASTROINTESTINAL: He denies anorexia, nausea, vomiting, and diarrhea.

GENITOURINARY: He denies urgency, burning on urination and hesitancy.

NEUROLOGICAL: He denies headache, numbness, dizziness and seizures.

MUSCULOSKELETAL: he denies muscle pain, back pain, joint stiffness and pain.

HEMATOLOGIC: no bleeding, bruising or bleeding.

LYMPHATICS: No enlarged lymph nodes.

ENDOCRINOLOGIC: Denies heat and cold intolerance and sweating.

Objective:

Diagnostic results
:

Complete Blood count (CBC): CBC is done to assess for infection, anemia and hematologic diseases that manifest psychiatric symptoms (Juchnowicz et al., 2023). These tests include the hematocrit, platelet, white blood cell, red blood, and hemoglobin count that help rule out the condition.

Toxicology: This is done to identify the substances that could worsen or trigger psychotic symptoms, like cocaine, marijuana, and alcohol, as well as other drugs. For individuals with acute psychotic symptoms, it is advisable to do toxicology screening to rule out if it’s induced by substance use (Fiorentini et al., 2021). This is done by blood tests and urine to detect substances like marijuana, alcohol, cocaine and prescription drugs Sherman Tremaine Soap note.

Imaging studies, the MRI or CT scan: Through imaging studies, brain abnormalities like lesions, tumors and brain atrophy occur because psychotic symptoms are ruled out (Dabiri et al., 2022). Imaging studies are recommended for patients with a new onset of psychosis if neurological signs are present.

Positive and Negative Syndrome Scale (PANSS)

Its components are the positive scale, negative scale, and general psychopathology scale. Positive scale measures for delusions, hallucinations as well as conceptual disorganization. Negative scale measures for emotional withdrawal, blunted effort, and poor rapport. Psychopathology scale measures guilt, feelings as well as concentration difficulties. It is used to assess for severe symptoms of schizophrenia. Positive symptoms include hallucinations rated at 6, persecutory delusions rated 6, and conceptual disorganization rated 4. The negative symptoms include emotional withdrawal, rated 4; blunted affect rated five and poor rapport, rated 3. They are consistent with paranoid schizophrenia

Assessment:

Mental Status Examination:

Appearance
: he was well dressed, fidgeted and avoided eye contact.

Behavior:
he was fidgeting, had subtle leaning tilt and had gestures towards imaginary things.

Mood:
He was paranoid but distrustful.

Affect:
He maintains a casual demeanor.

Thought process:
He had persecutory delusions and delusional thinking.

Perception:
He had visual as well as auditory hallucinations.

Insight:
He has poor insight because of delusions and irrationality.

Judgment:
He has impaired judgment, evidenced by frequent calls to 911.

Diagnostic Impression:

Paranoid schizophrenia (F20.0)
:
He has visual and auditory hallucinations, persecutory delusions, and some symptoms that characterize paranoid schizophrenia. He believes that there are people deployed by the government to observe him as well as his tax liabilities inflation. He also has an auditory hallucination where there are sounds that disrupt his sleep. He sees phantom silhouettes outside. His father has schizophrenia, and it supports the diagnosis. Using the DSM-5-TR criteria, he meets the criteria because of symptoms like hallucinations and delusions as well as altered functioning like disrupted sleep and paranoia (Palit, 2023). He also has distrust issues and denies the history of psychiatric history.

Substance-Induced Psychotic
Disorder (F19. 959)
:
This disorder involves delusions and hallucinations that are directly related to substance. He has a history of heavy smoking, past marijuana use, and occasional alcohol consumption. DSM-5-TR criteria for diagnosis require that the symptoms are present during the withdrawal and intoxication periods (Gicas et al., 2022). They must be present during as well as soon after withdrawal or intoxication of the substances used. Despite his history of substance use, his symptoms are present even without the heavy usage of the substances, thus ruling out the diagnosis.

Delusional Disorder (F22):
This is the persecutory type that is characterized by delusions taking longer than one month without symptoms like impaired functions outside delusions impacts, disorganized and delusions. He believes that people are observing him fit this disorder. DSM-5-TR criteria hold that the hallucinations, if present, are related to the delusion the person is experiencing (González-Rodríguez & Seeman, 2022). In his case, the hallucinations, both auditory and visual, are not related to his delusions.

The primary diagnosis is paranoid schizophrenia.

The rationale for this is that his hallucinations, both auditory and visual, as well as delusions, are characteristics of schizophrenia. Additionally, there is a family history of schizophrenia. They are the pertinent positives for his case, indicating schizophrenia. The absence of current substance use usage, withdrawal or intoxications helps rule out the substance-induced psychotic disorder, while the hallucination’s presence rules out the delusional disorder diagnosis. They are the pertinent negatives. Sherman Tremaine Soap note

Reflections:

After this case review, I come to an agreement with the assessments as well as the diagnostic imprint of Sherman’s paranoid schizophrenia. The diagnosis is supported by his symptoms, which include visual and auditory hallucinations as well as delusions. The case emphasized the need for comprehensive psychiatric assessment, history, symptoms, and diagnostic tests to help in getting the potential diagnosis and differentiating the diagnosis. I have learned that it is important to consider medical factors as well as psychiatric factors during diagnosis formation. I also learned the importance of understanding various causes of psychotic symptoms and helping in giving the correct diagnosis.

What I would do differently is I would explore in-depth the substance use and its relationship with psychotic symptoms exhibited by him. I would try to create rapport with him to improve his trust in people and, in return, be able to obtain information accurate information because he would be truthful when trust is won.

I would ensure informed consent and confidentiality when dealing with him. Also, I would ensure his safety as well as other people’s safety with his history of calls to 911 that could be a result of perceived threats. I would also ensure he understands his condition and the importance of medication to manage symptoms despite the previous side effects of drugs he had used.

The health promotion would involve educating him on the benefits of medication adherence, psychotherapy and lifestyle medication, like quitting smoking and alcohol. Given his diabetes history, regular exercise and a balanced diet are essential for his health. I would educate on the antipsychotic drugs’ side effects because they can affect metabolic factors. The treatment should address the specific needs of the patient. I would involve him in care and be culturally sensitive.

Case Formulation and Treatment Plan:

Psychotherapy

Cognitive Behavioral Therapy(CBT).
This helps reduce paranoia and underscores reality testing. This helps him differentiate realistic from altered perception, and this would reduce his delusions of being watched (Kingdon & Turkington, 2022). This helps decrease the intensity and frequency of delusions.

Supportive therapy:
This is to help him build trust with those around him and enhance his coping skills. It helps improve stress management, offers emotional support, and ensures he gets a sense of security. This is achieved through showing empathy, active listening, and being experienced in rapport creation and trust.

Pharmacologic treatment

Initiation of aripiprazole, an antipsychotic drug. The starting dose is 10 mg OD. It has low metabolic side effects compared to risperidone that he had been prescribed (Preda & Shapiro, 2020). Also, he has a low risk of gynecomastia development that he experienced earlier. Its usage would be monitored for efficacy and side effects like nausea, akathisia, as well as dizziness. For diabetes management, metformin would be continued because he is already on medication. Monitoring of blood sugars would be essential when on medication to ensure it is well controlled. Additionally, to help with sleep disturbances, trazodone 50 mg should be prescribed. It has efficacy in treating insomnia for patients with psychiatric conditions and has no dependence risk associated with its usage (Jaffer et al., 2017).

Non-pharmacologic treatment

He should be enrolled in a smoking cessation program to address his heavy smoking that would affect his health. This program involves support groups, behavioral counseling and medications like bupropion. Also, alcohol consumption should be reduced because it has negative results on mental health. Alcoholics Anonymous support groups could be used to help him quit alcohol use Sherman Tremaine Soap note.

 

References

Dabiri, M., Dehghani Firouzabadi, F., Yang, K., Barker, P. B., Lee, R. R., & Yousem, D. M. (2022). Neuroimaging in schizophrenia: A review article. 
Frontiers in neuroscience
, 
16
, 1042814. https://doi.org/10.3389/fnins.2022.1042814

Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-induced psychoses: an updated literature review. 
Frontiers in psychiatry
, 
12
, 694863.
https://doi.org/10.3389/fpsyt.2021.694863

Gicas, K. M., Parmar, P. K., Fabiano, G. F., & Mashhadi, F. (2022). Substance-induced psychosis and cognitive functioning: A systematic review. 
Psychiatry Research
, 
308
, 114361.
https://doi.org/10.1016/j.psychres.2021.114361

González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini narrative review. 
World journal of psychiatry
, 
12
(5), 683.
https://doi.org/10.5498%2Fwjp.v12.i5.683

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. 
Innovations in clinical neuroscience
, 
14
(7-8), 24. Sherman Tremaine Soap note

Juchnowicz, D., Dzikowski, M., Rog, J., Waszkiewicz, N., Karakuła, K. H., Zalewska, A., … & Karakula-Juchnowicz, H. (2023). The usefulness of a complete blood count in the prediction of the first episode of schizophrenia diagnosis and its relationship with oxidative stress. Plos one, 18(10), e0292756. https://doi.org/10.1371/journal.pone.0292756

Kingdon, D. G., & Turkington, D. (2022). 
Cognitive-behavioral therapy of schizophrenia
. Psychology Press.

Palit, S. (2023). The science of paranoid schizophrenia, the science of biomedical research and the visionary future. 
SAR Journal of Psychiatry and Neuroscience
, 
4
(6), 25-26. DOI: 10.36346/sarjpn.2023.v04i06.001

Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. 
Expert opinion on drug safety
, 
19
(12), 1529-1538.
https://doi.org/10.1080/14740338.2020.1832990 
 Sherman Tremaine Soap note

FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Focused SOAP Note for Schizophrenia Spectrum Disorders

Subjective:

Chief Complaint (CC):

“I was living, and not bothering anyone, and those people, those people, they just won’t leave me alone.”

History of Present Illness (HPI):

Sherman Tremaine (ST) is a 53-year-old male with a history of schizophrenia who presents for a mental health assessment at the request of a friend. ST reports feeling lonely since his mother’s death three years ago. He claims to have lived a solitary life without causing trouble but believes people constantly watch him from outside his window. ST reports hearing and seeing shadows of these individuals. He expresses paranoid thoughts about the government sending people to monitor him due to what he perceives as excessively high taxes.

ST says he had audio hallucinations from trying to change his senses of sight and sound. His hallucinations include loud metallic noises that keep him awake for days. He watches TV to survive but thinks others outside observe him through the screen. Since these people break into his residence and mess with his food, ST keeps it in the fridge to avoid contamination.

BUY A CUSTOM PAPER  HERE

ST initially claims to drink beer and smoke three cigarettes daily but later admits this is false. He discloses that he stopped using marijuana and began misusing cocaine after his mother’s death. ST denies any history of seizures or blackouts related to substance use. He dislikes psychiatric drugs, including Thorazine, Haldol, Seroquel, and Risperidone, as hazardous. ST denies considering self-harm or harming others.

Past Psychiatric History:

ST reports a history of mental illness, with three psychiatric hospitalizations at age 20. He is currently prescribed medications for his mental illness but is non-compliant due to his beliefs about their harmful nature.

Family Psychiatric History:

ST’s father was in an old state facility for mental illness. Mother allegedly had anxiousness.

Substance Use History:

ST admits to currently smoking three packs of cigarettes per day. He drinks alcohol weekly, with his most recent consumption being the previous day. His sister provides him with a 12-pack of beer weekly during grocery shopping. ST stopped using marijuana three years ago after his mother’s death but began misusing cocaine at that time. He denies any history of seizures or blackouts related to substance use.

Medical History:

ST has a diagnosis of diabetes, for which he takes Metformin regularly.

Current Medications:

Metformin (dosage not specified) for diabetes management

Prescribed but not taking: Thorazine, Haldol, Seroquel, and Risperidone for mental health management

Allergies:

No known allergies

Reproductive History:

ST is unmarried and has no children.

Psychosocial History:

ST is younger than his older sister. Their mother and sister were his primary caregivers. His mother died three years ago. ST lived with his father before moving in alone after his mother’s death.  He believes his sister is attempting to change their living arrangement. ST’s education is limited to the 10th grade, restricting his personal development opportunities. He has no history of legal troubles but has had encounters with law enforcement due to frequent calls about his hallucinations.

Review of Systems (ROS):

General: Denies fever, chills, weight changes, or sweating.

HEENT: Denies eyesight loss, impairment, swallowing issues, sore throat, or nasal blockage.

Skin: Denies markings, rashes, or itching.

Cardiovascular: No cardiac symptoms or palpitations confirmed.

Respiratory: Coughing, breathing difficulty, or sneezing denied.

Gastrointestinal: Refuses nausea, diarrhea, constipation, or vomiting.

Genitourinary: Denies urgency, urination pain, nocturia, or frequency changes.

Neurological: Denies headache, syncope, and localized neurological deficits.

Musculoskeletal: Denies joint and muscle pain and stiffness

Hematologic: Does not report bruises or anemia

Lymphatics: No leg swelling or discomfort, no lymphadenopathy noted.

Endocrinologic: Denies cold/heat intolerance, excess thirst/hunger, or thyroid disorders.

Objective:

Diagnostic Results: All baseline testing, including hormonal functioning tests, came back within normal limits.

Assessment:

Mental Status Examination
: Sherman Tremaine, 53, appears his age. He is calm, alert, and helpful with the examiner. ST is appropriately clothed and groomed. Though oriented to people and places, he is disoriented by his current circumstances. He speaks coherently and at a regular volume. ST smiles appropriately but is anxious. His thought process is coherent and logical, without evidence of thought disorders such as dissociation or derealization. ST strongly denies any sensory disturbances in others despite reporting both auditory and visual hallucinations himself. There are no overt signs of delusions present during the examination. He denies any suicidal or homicidal ideation. ST’s memory and attention appear intact. His judgment and insight are assessed as fair.

Diagnostic Impression:

Primary Diagnosis: Schizophrenia Spectrum Disorder (F20.9)

Differential Diagnoses:

Substance-Induced Psychotic Disorder (F19.959)

Delusional Disorder (F22)

Rationale for Diagnoses

Schizophrenia Spectrum Disorder (F20.9): ST’s presentation strongly aligns with the DSM-5-TR criteria for schizophrenia. He exhibits positive symptoms (auditory and visual hallucinations, paranoid thoughts) and negative symptoms (social withdrawal). The symptoms have persisted for an extended period, causing significant functional impairment. ST’s history of multiple psychiatric hospitalizations in his 20s and ongoing symptomatology support a chronic course of illness characteristic of schizophrenia. FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Key supporting evidence includes

Persistent auditory and visual hallucinations

Paranoid thoughts about being watched and monitored

Disorganized thinking (e.g., beliefs about high taxes reaching the sky)

Social withdrawal and functional impairment

Chronic course of illness with onset in early adulthood

Substance-Induced Psychotic Disorder (F19.959): While ST’s cocaine use could potentially induce psychotic symptoms, this diagnosis is considered less likely than Schizophrenia Spectrum Disorder. The chronicity and nature of ST’s symptoms, along with his psychiatric history predating recent substance use, suggest that his psychotic symptoms are not solely attributable to substance use. However, substance use may be exacerbating his underlying psychotic Disorder.

Delusional Disorder (F22): Although ST displays paranoid thoughts, the presence of prominent hallucinations and the broader range of symptoms he experiences make Delusional Disorder a less fitting diagnosis. Delusional Disorder typically involves non-bizarre delusions without the significant functional impairment and hallucinations seen in ST’s case.

Critical Thinking Process

The primary diagnosis of Schizophrenia Spectrum Disorder is supported by the long-standing nature of ST’s symptoms, their impact on his functioning, and his history of psychiatric hospitalizations. The presence of both positive and negative symptoms, along with disorganized thinking, aligns closely with the DSM-5-TR criteria for schizophrenia. While substance use is a complicating factor, the onset and persistence of symptoms beyond periods of intoxication or withdrawal suggest an underlying psychotic disorder rather than a purely substance-induced condition.

Pertinent positives include auditory and visual hallucinations, paranoid thoughts, social withdrawal, and a history of multiple psychiatric hospitalizations. Pertinent negatives include the absence of manic episodes, which helps rule out bipolar Disorder with psychotic features, and the presence of hallucinations, which is less common in Delusional Disorder.

Plan

The comprehensive treatment plan for ST encompasses pharmacotherapy, psychotherapy, substance use treatment, psychoeducation, family involvement, social support, health monitoring, safety planning, and regular follow-ups. The pharmacological approach involves restarting antipsychotic medication, specifically Risperidone, starting at 2 mg orally at bedtime and titrating up to 4 mg daily as tolerated. This choice is based on the efficacy of second-generation antipsychotics in treating both positive and negative symptoms of schizophrenia, with a relatively favorable side effect profile (Huhn et al., 2019). Concurrently, ST’s diabetes management will continue with Metformin, with the dosage to be confirmed with his primary care provider.

Psychotherapy, particularly Cognitive Behavioral Therapy for psychosis (CBTp), will be initiated with weekly sessions for 16 weeks. This approach can help ST manage his symptoms, challenge distorted thoughts, and develop coping strategies. Medication adherence and substance use will be addressed using motivational interviewing. ST’s concurrent substance use disorder requires a referral to a dual-diagnosis treatment facility that may use Motivational Enhancement Therapy (MET) to treat cocaine and alcohol.

Psychoeducation regarding schizophrenia, its symptoms, and treatment alternatives will be crucial to ST therapy. This instruction will stress medication adherence and substance use dangers. Antipsychotic side effects and management will be discussed, considering their metabolic and cardiovascular concerns (Correll et al., 2017; Stroup & Gray, 2018).

With ST’s approval, family engagement in treatment planning and family psychoeducation will be encouraged, especially his sister. Support and treatment outcomes can improve with this strategy. Social support and rehabilitation will include referrals to local schizophrenia support groups and vocational rehabilitation to address ST’s inadequate schooling and improve functional outcomes.

ST’s care plan must promote and monitor health. This includes setting baseline metabolic parameters, monitoring antipsychotic medication metabolic side effects, encouraging smoking cessation, and working with ST’s primary care provider to provide comprehensive diabetes and other physical health care. Given the higher mortality risk of psychiatric diseases like schizophrenia, this integrated strategy is crucial (Nemani et al., 2021).

With ST, a safety plan will include emergency contact numbers and symptom exacerbation management. Self-harm and other harm risk assessments will be done regularly. A first evaluation in 2 weeks will measure drug response and side effects, followed by monthly consultations for the first 3 months and further changes based on symptom stability. FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Reflection

This case example raises many challenges and lessons. Knowing his paranoia and pharmaceutical suspicions, rapport/trust would be managed more strongly if we had to encounter again. Inherent in a strong therapeutic alliance is the key to improvement in effect of treatment. I still would investigate ST’s drug use, especially when he switched from marijuana to cocaine after his mother’s death. Knowing how his feelings of sadness and loss affect his substance use and symptom exacerbation might help tailor treatment. ST’s case raises some of the most critical legal and ethical issues engaged in autonomy vs. beneficence. On the one hand, he can refuse medication, but on the other hand, the pathophysiology of his disease impairs his judgment. Respect for his autonomy and duty to provide adequate care require careful consideration and continuous monitoring. Capacity for informed care decisions will have to be treated cautiously and monitored over time. Health promotion and disease prevention will have to take into consideration ST’s physical health. This patient has an increased risk for developing cardiovascular disease and metabolic syndrome because of schizophrenia, hence his treatment plan should include lifestyle interventions and regular monitoring of the status of physical health. Low education and social isolation of ST will mandate specific interventions in health literacy and access to resources. Psycho-educational interventions attuned to his level of knowledge, with a rated community support services will aid in the effectiveness of treatment and enhance quality of life.

Again, holistic, person-centered care is driven home in this case. ST will not improve or recover long term until his social determinants of health are addressed, such as stability at home, social relationships, and meaningful daily activities, not just his psychotic symptoms. ST’s story underscores the mental illness problem entwined with substance use and psychosocial problems. It puts into light the complex multidisciplinary care involving psychiatric symptoms and problems in life. The case is a classic scenario where, as a professional, continuous learning, sensitivity, and adaptability are called for in mental healthcare.

References

Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., Pigato, G., Favaro, A., Monaco, F., Kohler, C., Vancampfort, D., Ward, P. B., Gaughran, F., Carvalho, A. F., & Stubbs, B. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large‐scale meta‐analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry, 16(2), 163-180.
https://doi.org/10.1002/wps.20420

Huhn, M., Nikolakopoulou, A., Schneider-Thoma, J., Krause, M., Samara, M., Peter, N., Arndt, T., Bäckers, L., Rothe, P., Cipriani, A., Davis, J., Salanti, G., & Leucht, S. (2019). Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. The Lancet, 394(10202), 939-951.
https://doi.org/10.1016/s0140-6736(19)31135-3

Nemani, K., Li, C., Olfson, M., Blessing, E. M., Razavian, N., Chen, J., Petkova, E., & Goff, D. C. (2021). Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry, 78(4), 380-386.
https://doi.org/10.1001/jamapsychiatry.2020.4442

Psychiatry Simplified – Dr Sanil Rege. (2017, April 24). Movement Disorders with Antipsychotic Medication – Conversations with Dr Stephen Stahl [Video]. YouTube.

Scissus Animus. (2020, March 19). Realistic schizophrenia simulation [Video]. YouTube.

Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17(3), 341–356.
https://doi.org/10.1002/wps.20567
 FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Sherman Tremaine Case study

Week 5: A 54yo Male with Schizophrenia Spectrum Disorder and

Persecutory Delusional Disorder

Subjective:

CC
(chief complaint): “Some people outside my window are watching me and won’t leave me alone.”

HPI
: The client, S.T., is a 54yo male. The client was referred to the psychiatric clinic by his sister due to visual and audio hallucinations. During the psychiatric evaluation, the client claims that some people outside his house are watching him and won’t leave him alone. He claims to see their shadows and hear their voices. S.T. claims these symptoms have persisted for weeks. He believes the government sent those people to watch him so his taxes could be increased. The client claims to see a bird and heard heavy metal music during the interview. The voices are loud. He reports difficulty sleeping since the voices keep him awake for days. S.T. further reports that people watch him on TV. He adds that those people come into the house and poison his food. Consequently, he locks everything in the fridge to trick them, and they do not get there. He requests permission to smoke during the psychiatric evaluation. The client denies going to the grocery store, claiming they play too loud heavy metal music and people watching him follow him there. He denies seizures, blackouts, or hearing or seeing things due to alcohol or drug use. Denies legal issues resulting from alcohol or drug use. He denies a family history of suicides. He also denies intentions to kill himself. His mother and sister raised him but he currently lives alone.

Substance Current Use:
The client reports smoking all day. He smokes three packs daily. S.T. also took alcohol and drank last yesterday. He reports past use of marijuana. However, he has not used marijuana since his mother’s death three years ago mom died three years ago. He denies using cocaine.

Family History of Psychiatric Disorders
: His dad was diagnosed with paranoid schizophrenia. His mother had anxiety disorders.

Past/Current Treatment for Psychiatric Disorders
: Haldol, Thorazine, Risperidone, Seroquel.

BUY PAPER HERE

Medical History:
Reports diabetes Mellitus and fatty liver

Current Medications
: Takes metformin for diabetes.

Allergies
: Denies drug or food-related allergies.

Reproductive Hx
: The client reports being single and does not have children.

ROS
:

GENERAL: Denies weight gain or fatigue

HEENT: Denies scars on the scalp. Denies blurred vision. Denies hearing loss. Denies nasal congestion. Denies difficulty swallowing.

SKIN: Denies bumps or masses on the skin

CARDIOVASCULAR: Denies chest pressure

RESPIRATORY: Denies shortness of breath

GASTROINTESTINAL: Denies constipation

GENITOURINARY: Denies burning with urination

NEUROLOGICAL: Denies seizures or blackouts

MUSCULOSKELETAL: Denies back pain

HEMATOLOGIC: Denies swollen lymph nodes

LYMPHATICS: Denies anemia

ENDOCRINOLOGIC: Denies excessive sweating

Objective:

Diagnostic results
: Not needed at this point

Assessment:

Mental Status Examination: The client is 54yo male. He is well-developed and attentive during the clinical interview. He demonstrates auditory and visual hallucinations during psychiatric evaluation. He speaks at normal volume and tone. His self-reported mood is “SaD.” He is alert and oriented to places, persons, and dates. Denies suicidal thoughts or ideations. He demonstrates disorganized and delusional thought processes during clinical interviews. Sherman Tremaine Case study

Diagnostic Impression
:

Schizophrenia Spectrum Disorder – Primary diagnosis

Persecutory Delusional Disorder

Schizoaffective Disorder

Schizophrenia Spectrum Disorder
: This condition is the client’s primary diagnosis. Schizophrenia Spectrum is characterized by delusions, hallucinations, disorganized thinking, abnormal or disorganized motor behavior, and negative symptoms (Wu et al., 2018). According to DSM-V diagnostic criteria, an individual is diagnosed with Schizophrenia Spectrum upon demonstrating at least two of the five main symptoms explained above for at least six weeks (Guloksuz & van, 2018). The client demonstrates delusions since he believes that his sister and the government are sending people to watch over him so that his tax can be increased. He also demonstrates visual and auditory hallucinations since he claims that some people watch him through the window and TV. He also claims to see a bird and hear loud heavy metal music. The client also denies going to the grocery store, claiming they play too loud heavy metal music and people watching him follow him there. Lastly, he demonstrates disorganized thinking during psychiatric evaluation. The client reports experiencing these symptoms for weeks, qualifying for Schizophrenia Spectrum as the primary diagnosis.

Persecutory Delusional Disorder
: This condition is the client’s second potential diagnosis. This delusion is closely related to schizophrenia. Delusions make individuals diagnosed with this disorder believe that an individual, organization, or group intends to harass or harm them. The DSM-5-TR states that people with persecutory delusions demonstrate false and fixed beliefs that cannot be changed due to conflicting evidence (Serdenes et al., 2018). Additionally, these beliefs are accompanied by psychosis. The client reports that his sister is collaborating with the government to send people to watch over him so that his tax can be increased significantly. Thus, S. T qualifies to be diagnosed with Persecutory Delusional Disorder.

Schizoaffective Disorder
: The client also qualifies to be diagnosed with Schizoaffective Disorder. According to the DSM-V diagnostic criteria, Schizoaffective Disorder is characterized by psychotic symptoms, including hallucinations or delusions (Citrome et al., 2022). Clinical manifestations of a mood disorder, such as an episode of major depression, mania, or both, usually accompany these symptoms. The client qualifies for this diagnosis since he demonstrates visual and auditory hallucinations and claims that some people watch him through the window and TV. He also claims to see a bird and hear loud heavy metal music. Additionally, the client depicts delusions since he claims that his sister is collaborating with the government to send people to watch over him to increase his tax. However, Schizoaffective Disorder is ruled out since episodes of mood disorders were not reported.

Reflections:

Upon conducting the session again, I would focus on collecting comprehensive psychiatric history for this client for proper diagnosis and treatment. Therefore, I would engage the client’s sister during the psychiatric assessment. The next intervention upon following this patient would involve prescribing him medications and non-pharmacological interventions to manage presented psychotic symptoms, including hallucinations and delusions. Legal guidelines would be considered by prescribing the client the FDA-approved treatment for psychotic disorders in adults diagnosed with these conditions to ensure the efficacy of recommended treatment regimen in improving the client’s symptoms. Lastly, the client’s health promotion and disease prevention initiative would be based on his medical history. The client has a history of diabetes Mellitus and fatty liver. Therefore, he should be advised to limit his intake of calories and fats and exercise regularly to prevent his current medical conditions from deteriorating.

Case Formulation and Treatment Plan:

Psychotherapy, specifically cognitive behavioral therapy (CBT), should be considered the client’s primary treatment intervention due to its efficacy in treating psychotic disorders. Enrolling the client in an individual or group CBT would challenge his maladaptive thoughts, resolving his hallucinations and delusions. Additionally, the client should be prescribed Seroquel 150mg daily due to its efficacy in treating schizophrenia in adults. This drug is preferred since it was well-tolerated by the client with no side effects. Furthermore, medication-assisted therapy (MAT) would be recommended for this client to treat substance use dependence. The client should be advised to return to the clinic after four weeks to allow the mental healthcare provider to assess his response to the current treatment regimen based on the severity of presented psychotic symptoms. A health promotion activity involves developing the client a meal to enhance the management of his current diagnosis, including diabetes Mellitus and fatty liver. Lastly, the patient education strategy involves educating him benefits of adhering to the prescribed medications to enhance their efficacy in managing reported psychotic symptoms, including hallucinations and delusions. Sherman Tremaine Case study

 

References

Citrome, L., Preskorn, S. H., Lauriello, J., Krystal, J. H., Kakar, R., Finman, J., … & Rajachandran, L. (2022). Sublingual dexmedetomidine for the treatment of acute agitation in adults with schizophrenia or schizoaffective disorder: a randomized placebo-controlled trial. 
The Journal of Clinical Psychiatry
, 
83
(6), 43180.

Guloksuz, S., & van Os, J. (2018). The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. 
Psychological medicine
, 
48
(2), 229-244.

Serdenes, R., Arana, F., Karasin, J., Kontos, N., & Musselman, M. (2023). Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion. 
General Hospital Psychiatry
, 83 (3): 75-80.

Wu, Z. Y., Fung, H. W., Chien, W. T., Ross, C. A., & Lam, S. K. K. (2022). Trauma and dissociation among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. 
European Journal of Psychotraumatology
, 
13
(2), 2105576. Sherman Tremaine Case study

SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

Patient particular’s

Name: Sherman Tremaine

Age: 54 years

Gender: male

Ethnicity: American

Subjective Data

Chief complaint
: hallucinations

History of presenting illness:
Sherman Tremaine is a 54years old male who is not self-aware of having a mental illness. The patient has hallucinations both visual and auditory because he says some people cannot leave him to enjoy his time. He explains that he cannot sleep at night because of the loud metal music in his house. The patient has episodes of delirium and paranoia because he states that people watching him on the television are contemplating poisoning him. He has withdrawn social behavior because he wants to stay alone and has disorganized speech. He denies suicidal ideation, self-harm, and hopelessness.

Substance use history
: he smokes cigarettes and drinks pop. He admits to having ever taken marijuana but stopped three years ago. He denies the use of cocaine and other illegal drugs

Current medication
: metformin

PLACE ORDER HERE

Psychiatric medication trial:
the patient was on haldol and Thorazine but stopped because of the side effects. He was put on risperidone but stopped after putting on weight. He states that Seroquel is better though he is not compliant with medication.

Allergies
: he denies food, drug, latex, and environmental allergies.

Past medical history:
the patient has diabetes mellitus, fatty liver disease, and schizophrenia.

Family history:
the patient is the last born in a family of three. His mother passed three years ago and had an anxiety disorder. His father passed on a while ago and has paranoid schizophrenia. He denies a family history of suicidal events. SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

Social history:
the patient is single and has no children. He has been living with his mother and sister until his mother’s demise. He has studied up to 10
th
grade. He does not work. He enjoys smoking and drinking pops. He recalls his childhood traumas because his father was rough.

Review of systems

General:
the patient denies fever, fatigue, sweating, chills, rigors, and weight loss.

Heent:
the patient denies headache, dizziness, eye pain, blurring of vision,

Skin:
the patient denies skin rash and itchiness.

Cardiovascular:
he denies chest pain, palpitations, syncope, claudication, edema, orthopnea, dyspnea, and tachycardia.

Respiratory
: he denies cough, sputum, wheezing, shortness of breath, and difficulties in breathing.

Gastrointestinal
: he denies nausea, vomiting, abdominal pain, diarrhea, reflux, and reduced appetite.

Genitourinary:
he denies dysuria, hematuria, polyuria, oliguria, urethral discharge, and lower abdominal pain.

Neurological:
the patient denies dizziness, numbness of extremities, paralysis, facial droop, and tremors.

Musculoskeletal:
he denies muscle pain, joint pain, and muscle stiffness.

Hematologic
: he denies bleeding tendencies and easy bruising.

Lymphatics
: he denies lower limb swelling, fever, and recurrent infections.

Endocrinologic
: he denies heat and or cold intolerance, unintentional weight loss or weight gain, polyuria, polyphagia, and polydipsia.

Objective Data

General:
the patient is in fair general condition and calm. He has no pallor, jaundice, cyanosis, edema, dehydration, or lymphadenopathy.

Vitals:
his blood pressure is 115/88mmhg, the temperature at 36.6 degrees Celsius, weight is 66kgs, height is 161cm, oxygen circulation is at 95% room air, and respiratory rate at 16breaths per cycle.

Heent
: the head is round with no mass, swelling, or scar. The eyes are clear and moist. The nose is intact without scars and erythema and the mucus membrane is moist. The ears have no scars, swelling, wax impaction, and discharge, the mouth is pink and moist with no swollen tonsil gland.

Respiratory system:
the chest expands symmetrically when breathing. There is no mass or scar on the chest wall. There is a resonant percussion note and vesicular breath sounds on auscultation. There are no rhonchi, stridor, or crackles.

Cardiovascular system:
the heart is at 5
th
ics mcl. The peripheral pulses are present with normal volume, regular rhythm, and rate without bruits. The heart sounds s1 s2 are present without murmurs, parasternal heaves, and thrills. SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

Abdominal examination:
the abdomen is round with a normal contour. The bowel sounds are present in the four quadrants and there is a tympanic percussion note. There is no shifting dullness or organ enlargement.

Diagnostic investigations:
there are no specific tests for making a diagnosis of schizophrenia. However, one should rule out other diseases that may cause schizophrenia. A thyroid function test rules out hypothyroidism and hyperthyroidism. A complete blood count rules out sepsis, thrombocytopenia, and anemia. Renal function tests rule out kidney injury and electrolyte disturbance. Liver function test rules out chronic liver diseases like encephalopathy.

Assessment

Mental State Examination

Sherman Tremaine is neat and well-groomed for the time and occasion. He is oriented in person and place but disoriented to time. He seems agitated, does not maintain eye contact, and fidgets during the interview. He has coherent speech and language but goes off-topic occasionally. He seems to introduce new vocabulary during the interview. The patient has thought of insertions of people harming him and loosening of association when he states that the police officers want to arrest him for calling 911. The patient has evident delirium and hallucinations in the interview. He has no emotional expression, has poor judgment and insight regarding his illness, and his cognitive abilities are intact.

Differential diagnoses

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. It is characterized by a combination of symptoms, including hallucinations, delusions, disorganized thinking and speech, lack of motivation, and difficulties in social interaction (Keepers et al., 2020). Positive symptoms of schizophrenia perceiving things that are not there and/or hearing voices, having false beliefs, disorganized thinking and speech, and abnormal motor behavior. The negative symptoms are reduced emotional expression, social withdrawal, diminished motivation, and difficulties with speech and communication. Schizophrenia usually develops in late adolescence or early adulthood, although it can occur at any age. The exact cause of schizophrenia is unknown, but it is believed to result from a combination of genetic, environmental, and neurochemical factors (Keepers et al., 2020). The patient has schizophrenia because of the presenting signs and symptoms. The onset of these symptoms was in his early adulthood. Additionally, he had a traumatic environment when growing up and has a positive family history of schizophrenia.

Delusional disorder is a mental disorder characterized by the presence of persistent delusions without the presence of other prominent psychotic symptoms, such as hallucinations or significant disorganized thinking (González-Rodríguez et al., 2022). Delusions are fixed, false beliefs that are not based on reality and are not typically accepted by others within the person’s culture or background. Delusional disorder can manifest in different types such as persecutory delusions where one is being harassed, harmed, or targeted in some way. Grandiose delusions are beliefs of having exceptional abilities, wealth, or fame that are not grounded in reality. Erotomanic delusions are beliefs that someone, usually of higher status, is in love with the individual, despite lack of evidence. Patients with delusional disorder often have a strong conviction in the truth of their delusions and may have limited insight into their condition. The delusional disorder does not typically cause significant impairment in cognitive functioning or daily functioning outside of the specific area affected by the delusion (González-Rodríguez et al., 2022). However, the impact on relationships, social interactions, and overall well-being can vary depending on the content and severity of the delusion.

Substance-induced psychotic disorder is a mental disorder characterized by the presence of psychotic symptoms, including hallucinations, delusions, or disorganized thinking, that are directly caused by the use of or withdrawal from substances such as drugs or medications. These substances can include alcohol, hallucinogens, amphetamines, cocaine, cannabis, sedatives, and others (Tandon & Shariff, 2019). The psychotic symptoms of substance-induced psychotic disorder are directly linked to substance use. The symptoms emerge during intoxication or withdrawal from the substance and are not better explained by another primary mental disorder. The duration of substance-induced psychotic symptoms can be brief and resolved within a few hours or days after substance use has ceased, or they can last for an extended period if substance use continues. This is not the patient’s diagnosis because these symptoms are not associated with substance use SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note.

Plan

Pharmacologic Treatment

Seroquel-initiate at 50mg once daily and gradually increase the dosage by 50mg weekly while monitoring for tolerance, therapeutic efficiency, and side effects (Maan et al., 2017).

Non-Pharmacological Treatment:

Psychoeducation: educating individuals with schizophrenia and their families about the illness, its symptoms, treatment options, and coping strategies is crucial (Škodlar & Henriksen, 2019). It helps improve understanding, adherence to medication, and relapse prevention.

Individual therapy: cognitive-behavioral therapy helps individuals identify and change negative thought patterns and develop coping skills.

Family therapy: involving family members in therapy can provide support, improve communication, and enhance understanding of the illness (Škodlar & Henriksen, 2019). It can also help in addressing family dynamics and promoting a supportive environment.

Reflection Note

The assessment aimed to gather information about the patient’s current mental state, symptomatology, functioning, and treatment history. During the assessment, I observed several key findings indicative of schizophrenia presented with positive symptoms, including auditory hallucinations and persecutory delusions. The content of the delusions revolved around an external entity thus leading to significant distress and impaired functioning. The patient also exhibited disorganized thinking and speech, with tangentiality and difficulty maintaining a coherent conversation. The primary focus will be on addressing symptom management, improving insight, and enhancing overall functioning and quality of life. I will collaborate with the multidisciplinary team to ensure a comprehensive approach to care. Patients with schizophrenia provided valuable insights into their symptom profiles and functioning. By tailoring a comprehensive treatment plan that combines pharmacological and non-pharmacological interventions, we aim to alleviate symptoms, enhance insight, and improve the overall quality of life.

 

References

González-Rodríguez, A., Seeman, M. V., Izquierdo, E., Natividad, M., Guàrdia, A., Román, E., & Monreal, J. A. (2022). Delusional disorder in old age: A hypothesis-driven review of recent work focusing on epidemiology, clinical aspects, and outcomes. 
International Journal of Environmental Research and Public Health
, 
19
(13), 7911.
https://doi.org/10.3390/ijerph19137911

Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., … & (Systematic Review). (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. 
American Journal of Psychiatry
, 
177
(9), 868-872.
https://doi.org/10.1176/appi.ajp.2020.177901

Maan, J. S., Ershadi, M., Khan, I., & Saadabadi, A. (2017). Quetiapine.
https://www.ncbi.nlm.nih.gov/books/NBK459145/

Škodlar, B., & Henriksen, M. G. (2019). Toward a phenomenological psychotherapy for schizophrenia. 
Psychopathology
, 
52
(2), 117-125.
https://doi.org/10.1159/000500163

Tandon, R., & Shariff, S. M. (2019). Substance-induced psychotic disorders and schizophrenia: pathophysiological insights and clinical implications. 
American Journal of Psychiatry
, 
176
(9), 683-684.
https://doi.org/10.1176/appi.ajp.2019.19070734
  SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

 

 

TO PREPARE – SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.

• Review the video, Case Study: Sherman Tremaine. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.

• Consider what history would be necessary to collect from this patient.

• Consider what interview questions you would need to ask this patient.

 

THE ASSIGNMENT – SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a 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, and list them 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.

• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.

• Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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.).

• 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).

 

Transcript from case study – SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

[MUSIC PLAYING] DR. MOORE: Good afternoon. I’m Dr. Moore. Want to thank you for coming

in for your appointment today. I’m going to be asking you some

questions about your history and some symptoms. And to get started,

I just want to ensure I have the right

patient and chart. So can you tell me your

name and your date of birth? SHERMAN TREMAINE:

I’m Sherman Tremaine, and Tremaine is my game game. My birthday is November 3, 1968. DR. MOORE: Great. And can you tell

me today’s date? Like the day of the week,

and where we are today? SHERMAN TREMAINE: Use any recent

date, and any location is OK. DR. MOORE: OK, Sherman. What about do you know

what month this is? SHERMAN TREMAINE: It’s March 18. DR. MOORE: And the

day of the week? SHERMAN TREMAINE: Oh, it’s a

Wednesday or maybe a Thursday. DR. MOORE: OK. And where are we today? SHERMAN TREMAINE:

I believe we’re in your office, Dr. Moore. DR. MOORE: OK, great. So tell me a little bit about

what brings you in today. What brings you here? SHERMAN TREMAINE: Well,

my sister made me come in. I was living with my

mom, and she died. I was living, and not bothering

anyone, and those people– those people, they just

won’t leave me alone. DR. MOORE: What people? SHERMAN TREMAINE: The ones

outside my window watching. They watch me. I can hear them, and

I see their shadows. They think I don’t

see them, but I do. The government sent

them to watch me, so my taxes are high,

so high in the sky. Do you see that bird? DR. MOORE: Sherman,

how long have you saw or heard these people? SHERMAN TREMAINE: Oh, for weeks,

weeks and weeks and weeks. Hear that– hear that

heavy metal music? They want you to think

it’s weak, but it’s heavy. DR. MOORE: No, Sherman. I don’t see any birds

or hear any music. Do you sleep well, Sherman? SHERMAN TREMAINE: I try to

but the voices are loud. They keep me up

for days and days. I try to watch TV, but they

watch me through the screen, and they come in

and poison my food. I tricked them though. I tricked them. I locked everything

up in the fridge. They aren’t getting in there. Can I smoke? DR. MOORE: No, Sherman. There is no smoking here. How much do you usually smoke? SHERMAN TREMAINE: Well,

I smoke all day, all day. Three packs a day. DR. MOORE: Three packs a day. OK. What about alcohol? When was your last drink? SHERMAN TREMAINE: Oh, yesterday. My sister buys me a 12-pack,

and tells me to make it last until next week’s grocery run. I don’t go to the grocery store. They play too loud of

the heavy metal music. They also follow me there. DR. MOORE: What about marijuana? SHERMAN TREMAINE: Yes,

but not since my mom died three years ago. DR. MOORE: Use any cocaine? SHERMAN TREMAINE: No,

no, no, no, no, no, no. No drugs ever, clever, ever. DR. MOORE: What about

any blackouts or seizures or see or hear things

from drugs or alcohol? SHERMAN TREMAINE: No, no, never

a clever [INAUDIBLE] ever. DR. MOORE: What about

any DUIs or legal issues from drugs or alcohol? SHERMAN TREMAINE:

Never clever’s ever. DR. MOORE: OK. What about any medication

for your mental health? Have you tried those before, and

what was your reaction to them? SHERMAN TREMAINE: I hate

Haldol and Thorazine. SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note No, no, I’m not

going to take it. Risperidone gave me boobs. No, I’m not going to take it. Seroquel, that is OK. But they’re all poison,

nope, not going to take it. DR. MOORE: OK. So tell me, any

blood relatives have any mental health or

substance abuse issues? SHERMAN TREMAINE:

They say that my dad was crazy with

paranoid schizophrenia. He did in the old

state hospital. They gave him his beer there. Can you believe that? Not like them today. My mom had anxiety. DR. MOORE: Did any blood

relatives commit suicide? SHERMAN TREMAINE:

Oh, no demons there. No, no. DR. MOORE: What about you? Have you ever done anything

like cut yourself, or had any thoughts about killing

yourself or anyone else? SHERMAN TREMAINE:

I already told you. No demons there. Have been in the hospital three

times though when I was 20. DR. MOORE: OK. What about any medical issues? Do you have any

medical problems? SHERMAN TREMAINE: Ooh, I

take metformin for diabetes. Had or I have a fatty

liver, they say, but they never saw it. So I don’t know unless

the aliens told them. DR. MOORE: OK. So who raised you? SHERMAN TREMAINE: My

mom and my sister. DR. MOORE: And who

do you live with now? SHERMAN TREMAINE:

Myself, but my sister’s plotting with the

government to change that. They tapped my phone. DR. MOORE: OK. Have you ever been married? Are you single,

widowed, or divorced? SHERMAN TREMAINE: I’ve

never been married. DR. MOORE: Do you

have any children? SHERMAN TREMAINE: No. DR. MOORE: OK. What is your highest

level of education? SHERMAN TREMAINE: I

went to the 10th grade. DR. MOORE: And what do

you like to do for fun? SHERMAN TREMAINE: I don’t work,

so smoking and drinking pop. DR. MOORE: OK. Have you ever been arrested or

convicted for anything legally? SHERMAN TREMAINE: No, but

they have told me they would. They have told me they would

if I didn’t stop calling 911 about the people outside. DR. MOORE: OK. What about any kind of trauma

as a child or an adult? Like physical, sexual,

emotional abuse. SHERMAN TREMAINE: My dad was

rough on us until he died. DR. MOORE: OK. [MUSIC PLAYING] So thank you for answering

those questions for me. Now, let’s talk about

how I can best help you. [MUSIC PLAYING] SHERMAN TREMAIN Schizophrenia Spectrum Case study SOAP note

NRNP 6645 week 1 quiz answers

Question 1

0.1 
/ 0.1
 pts

How long does my instructor have to grade my assignments after the due date?

3 days

 

5 days

 

7 days

 

10 days

 

GET QUIZ HELP HERE

Question 2

0.1 
/ 0.1
 pts

Where do I find my instructor’s feedback on assignments?

In the grading comments

 

In the rubric

 

Grading comments and the rubric

 

NRNP 6645 week 1 quiz answers Question 3

0.1 
/ 0.1
 pts

How often should I check the announcements, email and doc sharing?

Every day

 

Once a week

 

Twice a week

 

Three times a week

 

Question 4

0.1 
/ 0.1
 pts

Who do I contact about a grade I don’t agree with?

Didactic faculty

 

Specialty Coordinator

 

Program Director

 

President

 

Question 5

0.1 
/ 0.1
 pts

Are assignment re-dos or extra credit allowed in the NP program?

Yes

 

No

 

Incorrect
Question 6

0 
/ 0.1
 pts

I cannot use my textbook as a resource or other patient centered websites such as WebMD.

True

 

False

 

Question 7

0.1 
/ 0.1
 pts

I cannot use textbooks, notes, videos, websites, or any other resource when taking the midterm and final exams.

True

 

False

 

Question 8

0.1 
/ 0.1
 pts

Are Grand Rounds mandatory to attend?

Yes

 

No

 

Question 9

0.1 
/ 0.1
 pts

Can I watch a recording of Grand Rounds later?

Yes

 

No

 

NRNP 6645 week 1 quiz answers Question 10

0.1 
/ 0.1
 pts

I have read the NP program Practicum Manual and will abide by the requirements to successfully complete this program.

True

 

False

 

Question 11

0.1 
/ 0.1
 pts

I am responsible for everything I post on social media.

True

 

False

 

Question 12

0.1 
/ 0.1
 pts

I understand the appropriate chain of command in the College of Nursing.

True

 

False

 

Question 13

1 
/ 1
 pts

I acknowledge reading the syllabus and understand the course requirements to successfully pass the class.

True

 

False

 

Question 14

Not yet graded 
/ 0.1
 pts

By signing below, I acknowledge that I have viewed the course information meeting in its entirety  and / or course materials and will adhere to the policies that have been set forth.

Type your name and the date below.

Therapy for Clients With Personality Disorders

Succinctly, in 1–2 pages, address the following:

Briefly describe the personality disorder you selected, including the 
DSM-5-TR
 diagnostic criteria.

Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session

Borderline Personality Disorder AND Narcissistic Personality Disorder

Therapy for Clients With Personality Disorders – Borderline Personality Disorder

Personality Disorder DSM-5-TR Overview

Borderline Personality Disorder (BPD) is a type of personality disorder that involves an unstable and disturbed pattern of mood and interpersonal relationships, as well as irresponsible behavior. The DSM-5-TR diagnostic criteria for BPD include sudden panic, the absence of a stable and secure attachment figure in their childhood, a constantly shifting sense of self, suicidal tendencies when overwhelmed by negative emotions, bipolar disorder-like tendencies, pervasive and persistent existential depression, rage reactions, brief psychotic episodes that manifest as paranoia, and split-off ego states (Leichsenring et al., 2024). According to DSM 5, the patient requires at least five of these characteristics are necessary for diagnosing the disorder. Interpersonal conflicts and perceived abandonment significantly increase emotional sensitivity, impulsivity, and self-harm in BPD. The sooner the diagnosis is made and treatment commenced, the better the prognosis.

Therapeutic Approach for Managing Borderline Personality Disorder

Dialectical Behavioral Therapy (DBT) is an efficient treatment method for managing BPD. DBT utilizes cognitive-behavioral approaches, but it is based on the principles of mindfulness. This modality aims to equip BPD clients with skills to control their emotions, cope with stress, and enhance their relational capabilities, making it suitable for treating the aspect of BPD that involves poor emotion regulation (Kujovic et al., 2024). This structure of DBT may be useful for clients with BPD, as it encourages the replacement of self-harming behaviors with better coping skills over time (Leichsenring et al., 2023).  Behavioral skills training further incorporates group and individual therapies to establish an organizational format to elicit healthier emotional reactions and improve Interpersonal communication skills.

Therapeutic Relationship in Psychiatry

In psychiatry, a therapeutic relationship can be described as a working partnership between the therapist and the client that involves trust, helpful communication, and participation in the therapeutic process. It is underpinned by empathy, respect, and positive regard for the client; they are encouraged to discuss their problems in this therapeutic alliance. Developing this trust is vital as it facilitates communication and compliance with the stipulated therapy regimes (Kujovic et al., 2024). Thus, therapists should be aware of possible power relations that impact the process and be open about this to foster a constructive relationship during the therapeutic process.

Sharing Diagnosis with the Client

The nurse practitioner should provide details on the patient, ensuring an understanding of the condition and the treatment plan that should be implemented. Therefore, when explaining BPD to a patient, concerns should be presented non-judgmentally, emphasizing positive qualities. I would describe the symptoms in basic language, noting how these characteristics may affect feelings and interpersonal connections and stressing the potential for recovery through medication. I emphasize that the diagnosis is driven by explaining the symptoms, prognostication, and treatment strategies (Wheeler, 2020). Applying this strategy could help the client gain more control over the process. It would not compromise the therapeutic alliance that personality disorder diagnoses often produce feelings of stigma or alienation.

 

 

Individual vs. Family vs. Group Session Disclosure

In the individual context, it would be critical for the nurse practitioner to explain the diagnosis, emphasizing the individual impacts of the disease and approaches for enhancing recovery. On the other hand, in the family setting, the approach should focus more on enhancing the family’s understanding of the diagnosis and the existing needs associated with the condition. The family setting interventions focus on empowering the patient and the family to understand their roles in managing the condition and address any myths and misconceptions that may affect the management of the condition. However, a group setting offers optimal opportunities for sharing experiences where patients can learn from one another and develop resilience in managing their conditions and needs (Wheeler, 2020). These settings require managing individual needs and preferences and maintaining privacy to help build trust, maintain therapeutic relationships, and foster mutual support.

 

 

References

Kujovic, M., Benz, D., Riesbeck, M., Mollamehmetoglu, D., Becker-Sadzio, J., Margittai, Z., Bahr, C., & Meisenzahl, E. (2024). Comparison of 8-vs-12 weeks adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment: A naturalistic study.
Scientific Reports
,
14
(1), 11264.
https://doi.org/10.1038/s41598-024-61795-9

Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies.
World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
,
23
(1), 4–25.
https://doi.org/10.1002/wps.21156

Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline personality disorder: A review.
JAMA
,
329
(8), 670–679.
https://doi.org/10.1001/jama.2023.0589

Wheeler, K. (2020).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(3rd ed.). Springer Publishing Company.

 

 

Therapy for Clients with Personality Disorders – 
Narcissistic
Personality Disorder

Briefly describe the personality disorder

Narcissistic personality disorder (NPD) is a psychiatric disorder marked by lack of empathy, need for admiration, and persistent pattern of grandiosity. NP is associated with a heightened risk of comorbid conditions, including anxiety and mood disorders; suicide substance and alcohol use disorders; and marital, relational, and vocational problems.  Narcissistic individuals are highly distressed, make others go through much pain, and have reduced quality of life (Weinberg & Ronningstam, 2022).  According to the DSM-5 diagnostic criteria, symptoms of NPD include limited ability to be empathetic, grandiose and entitled perception of self, arrogance, a disparate need for admiration and attention, being envious or believing others are envious of self, a propensity to destroy relationships, and desire for high status and exceptional achievements(Szalay et al., 2024).

A therapeutic approach and a modality to use to treat a client presenting with the disorder

Psychotherapeutic treatment for NPD is challenging since individuals with NPD feel ashamed of being reliant on others, a thing that makes it difficult to rely on healthcare providers. Also, they can envy the therapist along with their supposed status, which usually ignites a feeling of competitiveness (Szalay et al., 2024). Mentalization-based therapy (MBT) is a therapeutic approach I would use with a patient presenting with NPD. According to (Choi-Kain et al., 2022) metallization refers to the way humans understand their social interactions by considering the mental states (for example, intentions, desires, beliefs, and emotions) that reinforce observed behavior. Mentalizing enables an individual to create and sustain gratifying relationships and for other people to understand them in a manner that ignites a positive identity. MBT is the most appropriate therapy for NPD because it addresses personality dysfunction connected with coping in relational and self-management. MBT achieves this by augmenting contemplative abilities about self and other, stabilizing attachment, and promoting epistemic trust.  An individual with NPD have a high likelihood of being avoidant or dismissive in terms of vulnerabilities, emotional, and attachment, and the contributions and perspectives of other people (Choi-Kain et al., 2022).

An explanation of what a therapeutic relationship is in psychiatry

A therapeutic relationship refers to a collaborative partnership between the patient and healthcare provider in mental health care. According to Weinberg and Ronningstam (2022), the ability of a therapist to build a collaborative alliance with a patient is scheme to increase treatment effectiveness and  achieve treatment goal. Being attentive to the patient’s behaviors and inner experience and taking a nonjudgmental stance assist in treatment. Being attentive to the therapeutic relationship enables both the patient and therapist to negotiate contradictory perceptions, remain connected through affective tempests, and promote open-mindedness. Wheeler (2021) indicates that psychotherapy enhances healing happens through the connection that the patient has with the therapist.  Psychiatric nurses cultivate a relationship intended to alter patient’s interpersonal situation and the intrapsychic situation, thus altering the brain functioning.  The patient-nurse is the active component in therapeutic change.

I would share the NPD diagnosis with a patient by not using the diagnostic to avoid damaging the therapeutic relationship.  According to Hersh et al. (2019), sharing a diagnosis is essential in NPD to assist discussion of clinical features, etiology, treatment options, and course of illness.  Diagnostic sharing is the basis of informed consent to treatment (Hersh et al., 2019). Weinberg and Ronningstam (2022) emphasize that at the onset of treatment, it is essential explain diagnostic impressions to the patient.  Although some patients positively receive NPD disclosure on NPD diagnosis, others feel that NPD is a reprehensible label. As such, clinicians need to be flexible, and consider taking about the diagnosis without essentially utilizing the diagnostic label by referring to the patient as narcissist.  This will assist in describing treatment goals and behaviors that interfere with treatment,  and assists develop a longer commitment to treatment.

I would share the diagnosis with the individual in an individual session by providing the patient with useful information about NPD diagnosis and available treatments.  In a group and family session, I would discuss the diagnosis with the group members about NPD and provide education to group and family members about the disorder, behaviors that might interfere with treatment

Why sources are considered scholarly

The article by Choi-Kain et al. is peer-reviewed and authored by experts in psychiatry

The article by Hersh et al. is peer-reviewed and authored by experts in behavioral sciences

The article by Weinberg and Ronningstam is is peer-reviewed and authored by experts in psychiatry

The article by Szalay et al. is peer-reviewed and authored by experts in psychiatry

 

 

References

Choi-Kain, L. W., Simonsen, S., & Euler, S. (2022). A Mentalizing Approach for Narcissistic Personality Disorder: Moving From “Me-Mode” to “We-Mode.
American Journal of Psychotherapy, 75
(1), 38-43.
https://doi.org/10.1176/appi.psychotherapy.20210017

Hersh, R. G., McCommon, B., & Golkin, E. G. (2019). Sharing a Diagnosis of Narcissistic

Personality: a Challenging Decision with Associated Risks and Benefits. 
Current Behavioral Neuroscience Reports, 6
(16), 1-8.
https://doi.org/10.1007/s40473-019-00193-2

Szalay, Z., Hardaker, M., & Tsanikos, E. (2024). Narcissistic personality disorder: an opinionated review of the efficacy of psychotherapy.
Academia Mental Health & Well-Being, 1
, 1-8. https://doi.org/10.20935/MHealthWellB6239

Weinberg, I., & Ronningstam, E. (2022). Narcissistic Personality Disorder: Progress in Understanding and Treatment.
Focus, 20
(4), 368-377. doi:
10.1176/appi.focus.20220052

Wheeler, K. (2021). Psychotherapy for the Advanced Practice Psychiatric Nurse:  
A How-To Guide for Evidence-Based Practice
. Springer Publishing. Therapy for Clients With Personality Disorders

Week 1: Discussion

Biological Basis and Ethical/Legal Considerations of Psychotherapy

Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology?

Psychotherapy is used with individuals as well as in groups or families. The idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric-mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential.

For this Discussion, you will consider whether psychotherapy also has a biological basis and analyze the ways in which legal and ethical considerations differ in the individual, family, and group therapy settings.

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, reflecting on foundational concepts of psychotherapy, biological and social impacts on psychotherapy, and legal and ethical issues across the modalities (individual, family, and group).

Search the Walden Library databases for scholarly, peer-reviewed articles that inform and support your academic perspective on these topics.

By Day 3

Post
 an explanation of
whether psychotherapy has a biological basis
. Explain how culture, religion, and socioeconomics might influence one’s perspective on the value of psychotherapy treatments. Describe how legal and ethical considerations for group and family therapy differ from those for individual therapy, and explain how these differences might impact your therapeutic approaches for clients in group, individual, and family therapy. Support your rationale with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to 
at least two
 of your colleagues on 
2 different days
 by providing an additional scholarly resource that supports or challenges their position, along with a brief explanation of the resource.

 

Week 2: Assignment –
Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.

 

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 reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.

Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.

View the 
Mother and Daughter: A Cultural Tale
 video
in the Learning Resources and consider how you might assess the family in the case study.

The Assignment

Document the following for the family in the video, using the Comprehensive Evaluation Note Template:

Chief complaint

History of present illness

Past psychiatric history

Substance use history

Family psychiatric/substance use history

Psychosocial history/Developmental history

Medical history

Review of systems (ROS)

Physical assessment (if applicable)

Mental status exam

Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with 
DSM-5-TR
 diagnostic criteria

Case formulation and treatment plan

Include a psychotherapy genogram for the family

Note:
 For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.

 

Week 3: Assignment
– Analyzing Group Techniques

Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

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:

Select one of the
group therapy video demonstrations
from this week’s required media Learning Resources.

The Assignment

In a 3- to 4-page
paper
, identify the video you selected and address the following:

What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?

What evidence from the literature supports the techniques demonstrated?

What did you notice that the therapist did well?

Explain something that you would have handled differently.

What is an insight that you gained from watching the therapist handle the group therapy?

Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?

Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

By Day 7

Submit
 your Assignment.

Reminde
r
Links to an external site.
 The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

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 
WK3Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

 

Week 5: Discussion
– Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for
CBT in group settings and CBT in family settings
. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

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 the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.

 

By Day 3

Post
 an explanation of how the use of
CBT in groups compares to its use in family or individual settings
. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read
 a selection of your colleagues’ responses.

 

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.

 

Week 7: Assignment
– Comparing Humanistic-Existential Psychotherapy with Other Approaches

Comparing Humanistic-Existential Psychotherapy with Other Approaches

Understanding the strengths of each type of therapy and which type of therapy is most appropriate for each patient is an essential skill of the psychiatric-mental health nurse practitioner. In this Assignment, you will compare humanistic-existential therapy to another psychotherapeutic approach. You will identify the strengths and challenges of each approach and describe expected potential outcomes.

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 the humanistic-existential psychotherapy videos in this week’s Learning Resources.

Reflect on humanistic-existential psychotherapeutic approaches.

Then, select another psychotherapeutic approach to compare with humanistic-existential psychotherapy. The approach you choose may be one you previously explored in the course or one you are familiar with and especially interested in.

The Assignment

In a 2- to 3-page paper, address the following:

Briefly describe
humanistic-existential psychotherapy
and the second approach you selected.

Explain at least three differences between these therapies. Include how these differences might impact your practice as a PMHNP.

Focusing on one video you viewed, explain why humanistic-existential psychotherapy was utilized with the patient in the video and why it was the treatment of choice. Describe the expected potential outcome if the second approach had been used with the patient.

Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Week 8: Assignment
-Psychotherapy for Clients With Addictive Disorders

Psychotherapy for Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families.

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 diagnosing and treating addictive disorders. As you watch the 
187 Models of Treatment for Addiction
 video, consider what treatment model you may use the most with clients presenting with addiction.

Search the Walden Library databases and choose a research article that discusses a therapeutic approach for treating clients, families, or groups with addictive disorders.

The Assignment

In a
5- to 10-slide PowerPoint presentation
, address the following. Your title and references slides do not count toward the 5- to 10-slide limit.

Provide an overview of the article you selected.

What population (individual, group, or family) is under consideration?

What was the specific intervention that was used? Is this a new intervention or one that was already studied?

What were the author’s claims?

Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Use the Notes function of PowerPoint to craft presenter notes to expand upon the content of your slides.

Support your response with at least three other peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Provide references to your sources on your last slide. Be sure to include the article you used as the basis for this Assignment.

 

Week 9: Assignment
–

Posttraumatic Stress Disorder

It is estimated that more almost 7% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Institute of Mental Health, 2017). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to behavioral issues, adolescent substance abuse issues, and even physical ailments. For this Assignment, you examine a PTSD video case study and consider how you might assess and treat clients presenting with PTSD.

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 reflect on the insights they provide about diagnosing and treating PTSD.

View the media 
Presentation Example: Posttraumatic Stress Disorder (PTSD)
 and assess the client in the case study.

For guidance on assessing the client, refer to Chapter 3 of the Wheeler text.

Note:
 To complete this Assignment, you must assess the client, but you are not required to submit a formal comprehensive client assessment.

 

The Assignment

Succinctly, in 1–2 pages, address the following:

Briefly explain the neurobiological basis for PTSD illness.

Discuss the 
DSM-5-TR
 diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?

Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.

Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

By Day 7

Submit your Assignment. Also attach and submit PDFs of the sources you used.

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 
WK9Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

 

Week 10: Assignment
– Therapy for Clients With Personality Disorders

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.

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 reflect on the insights they provide about treating clients with personality disorders.

Select one of the
personality disorders
from the 
DSM-5-TR
 (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.

The Assignment:

Succinctly, in 1–2 pages, address the following:

Briefly describe the personality disorder you selected, including the 
DSM-5-TR
 diagnostic criteria.

Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.

Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

By Day 7

Submit
 your Assignment. Also attach and submit PDFs of the sources you used.

NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash – I-HUMAN PATIENTS CASE STUDY: EVALUATING AND MANAGING INTEGUMENTARY CONDITIONS

History and physical exam

How can I help you today?

Do you have any other symptoms or concerns we should discuss?

Tell me how that makes you feel?

How does this affect your lifestyle?

What symptom is the most distressing for you?

Have you been having fevers?

Have you ever been exposed to poison ivy/oak/sumac?

Have you been exposed to mosquitoes or ticks? Any bites?

Have you…

 

All Physical Exams

Temperature

Vitals: Pulse

Vitals: Blood pressure

Vitals respiration

Vitals…

GET i-HUMAN HELP HERE

Key Findings and Problem Statement

Key. Einding

Blateral, circular thigh rash for two weeks

Constant Itching, severity 6/10

Frequent workouts in hot, humid environments

No exposure to irritants or new products

No fever, recent camping, travel, or insect bites

PMH of type 2 diabetes

No discharge, palpable nodules, or fluctuance in affected areas Additional past medical/family history

Medications/Allergies

Additional social history (habits)

ROS: Inquiry into constitutional symptoms

ROS:…

Case: Problem Statement

This patient is a 36-year-old overweight female with a PMH of type 2 diabetes who reports two weeks of progressively worsening 6/10 ichy, circular rashes on both thighs. She has used an over-the-counter topical steroid for three days and reports intensified redness and a burning sensation. Reports beginning workouts at an indoor pool. She denies fever, recent travel exposure to known irritants or new skin products, recent skin injuries, insect or animal bites, or any infections. Physical exam reveals multiple circular lesions on the bilateral thighs with raised borders, central clearing, and associated erythema and scaling. No discharge palpable nodules, fluctuance, vesicles, or pustules are present.

 

Management Plan

…

 

I-HUMAN PATIENTS CASE STUDY: EVALUATING AND MANAGING INTEGUMENTARY CONDITIONS

This course will require you to complete a series of case studies using the i-Human Patients software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.

The integumentary system is susceptible to a variety of diseases, conditions, and injuries, ranging from the bothersome but relatively innocuous bacterial or fungal infections and categorized as disorders, to skin cancer and severe burns, which can be life threatening.

For this NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash Assignment, you will examine an i-Human Patients case study. You will then work with an i-Human patient with an integumentary condition.

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:

By Day 1 of this week, your Instructor will assign an i-Human Patients case study for this Assignment. 
Note:
 Please see the 
Course Announcements
 section of the classroom for your i-Human Patients Assignment.

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with integumentary conditions.

Access and review the assigned i-Human Patients case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.

Reflect on how the results would be used to make a diagnosis.

NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash

Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with integumentary conditions.

Assignment

As you interact with this week’s i-Human Patients patient, complete the assigned case study. For guidance on using i-Human Patients, refer to the 
i-Human Graduate Programs Help
 link within the i-Human Patients platform.

By Day 7 of Week 4

Upload
 your PDF from i-Human Patients to submit this Assignment.

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 
WK4Assgn_LastName_FirstInitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

By submitting this NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash Assignment, you confirm that you have complied with Walden University’s Code of Conduct including the expectations for academic integrity while completing the i-Human Patients Assessment. 

 

Rubric – NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash

NURS_6512_Week 4_Assignment_Rubric

NURS_6512_Week 4_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
History: Complete an appropriate health history. (Scores are automatically calculated in the i-Human platform.)

20
 pts

Excellent

Achieves a score of 85–100%

15
 pts

Good

Achieves a score of 84–75%

10
 pts

Fair

Achieves a score of 74–65%

5
 pts

Poor

Achieves a score of 64–55%

0
 pts

Unsatisfactory

Achieves a score of 54% or below

20
 pts

This criterion is linked to a Learning Outcome
Physical Exam: Complete an appropriate physical exam. (Scores are automatically calculated in the i-Human platform.)

20
 pts

Excellent

Achieves a score of 85–100%

15
 pts

Good

Achieves a score of 84–75%

10
 pts

Fair

Achieves a score of 74–65%

5
 pts

Poor

Achieves a score of 64–55%

0
 pts

Unsatisfactory

Achieves a score of 54% or below

20
 pts

This criterion is linked to a Learning Outcome
EMR Documentation History of Present Illness: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Subjective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
EMR Documentation Subjective Data Document Current Medications, Review of System: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Subjective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
EMR Documentation Objective Data Document Physical Exam Findings: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Objective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
Key Findings: Organize the key findings with the most important first and least important last.

5
 pts

Excellent

The key findings are complete and appropriately organized.

4
 pts

Good

The key findings are complete but the organization is not correct.

3
 pts

Fair

There are 1–2 key findings missing or organized inappropriately.

2
 pts

Poor

There are 3 key findings missing and organization is incorrect.

0
 pts

Unsatisfactory

There are more than 3 key findings missing and organization is incorrect.

5
 pts

This criterion is linked to a Learning Outcome
Problem Statement: Document a brief and accurate problem statement using professional language that includes the following: 1.) Name or initials, age; 2.) Chief complaint; 3.) Positive and negative subjective findings; 4.) Positive and negative objective findings.

5
 pts

Excellent

All requirements are met.

4
 pts

Good

3 requirements are met.

3
 pts

Fair

2 requirements are met.

2
 pts

Poor

1 requirement is met.

0
 pts

Unsatisfactory

No requirements are met.

5
 pts

This criterion is linked to a Learning Outcome
Management Plan: Use the expert diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan. Address the following criteria in the plan: 1.) Diagnostic tests; 2.) Medications (write out a complete order, even for OTC meds); 3.) Suggested consults/referrals; 4.) Patient education; 5.) Follow up, including time interval and specific symptoms to prompt a return visit sooner; 6.) Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable.

15
 pts

Excellent

All requirements are met.

13
 pts

Good

5 requirements are met.

10
 pts

Fair

4 requirements are met.

7
 pts

Poor

1-3 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

15
 pts

This criterion is linked to a Learning Outcome
References and Format: Current APA citations for references in management plan. Use of clinical practice guidelines when applicable.

5
 pts

Excellent

0–1 errors Clinical practice guidelines used when applicable.

4
 pts

Good

2–3 errors Clinical practice guidelines used when applicable.

3
 pts

Fair

4–5 errors Clinical practice guidelines not used when applicable.

2
 pts

Poor

6–7 errors Clinical practice guidelines not used when applicable.

0
 pts

Unsatisfactory

More than 7 errors; clinical practice guidelines not used when applicable.

5
 pts

Total Points: 
100 NURS 6512 week 4 ihuman – 36 y/o 5′ 0″ (152 cm) 144.0 lb (65.5 kg) with Itchy rash