For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such

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Introduction:
In this assignment, we will analyze a case study related to a psychotic disorder, schizophrenia, or a medication-induced movement disorder. We will be required to complete and submit a Comprehensive Psychiatric Evaluation, including our differential diagnosis and critical-thinking process to formulate the primary diagnosis.

Question:
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?

Answer:
To derive the differential diagnosis, the patient provided information regarding their chief complaints, which were associated with hallucinations, delusions, and disorganized speech. The patient reported experiencing these symptoms for the past six months, and the severity of these symptoms has been gradually increasing. The symptoms have impacted the patient’s ability to function in daily life. The patient has been struggling to maintain their job, social relationships, and has lost interest in activities they used to enjoy.

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

Answer:
During the psychiatric assessment, the patient showed signs of being anxious, restless, and agitated while maintaining minimum eye contact. The patient had disorganized speech, and the conversation was often sidetracked due to the tangential thinking process. Additionally, the patient’s mood was observed to be sad and low, with a lack of initiative.

Question:
Discuss the patient’s mental status examination results. What were your (3) differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-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.

Answer:
The patient presented with a wide range of symptoms related to schizophrenia. Based on the patient’s symptoms, my three differential diagnoses would be:

1. Schizophrenia Spectrum and Other Psychotic Disorders
The patient is experiencing symptoms such as hallucinations, delusions, disorganized speech, and a lack of emotional responses, indicating the patient has a Schizophrenia Spectrum and Other Psychotic Disorder. DSM-5-TR criteria for Schizophrenia Spectrum disorder requires the presence of two or more positive symptoms such as delusions, hallucinations, disorganized speech, or behavior, and negative symptoms. The criteria for psychosis rules out depressive, anxiety, and mood disorders.

2. Mood Disorders
The patient showed signs of low mood and lack of initiative, indicating that the patient could be experiencing a mood disorder, specifically major depressive disorder. However, the presence of positive symptoms such as hallucinations and delusions puts this differential diagnosis into lower priority.

3. Substance-Related and Addictive Disorders
The patient’s symptoms could also be associated with substance abuse, specifically with the use of hallucinogens. The patient’s drug screen was positive for marijuana use, and drug-induced psychosis could be a possible diagnosis. While substance abuse is a common co-occurring condition in schizophrenia, it is ruled out as the primary diagnosis in this case due to the persistence of the symptoms even after drug withdrawal.

The critical-thinking process that led to the primary diagnosis of Schizophrenia Spectrum and Other Psychotic Disorders was based on the presence of a wide range of symptoms associated with psychosis, including hallucinations and delusions. The patient’s symptoms weren’t solely associated with mood disorders and also persisted beyond drug withdrawal. Based on the DSM-5-TR criteria, the patient’s symptoms meet the criteria to diagnose Schizophrenia Spectrum and Other Psychotic Disorders.

Pertinent positives observed in this case include hallucinations, disorganized speech, delusions, and a lack of emotional responses, and negatives include the absence of self-harm or harm to others.

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

Answer:
If I could conduct the session over, I would consider using a translator if required to improve the patient’s understanding and feedback while considering all necessary ethical and legal considerations. To ensure the patient’s safety and health promotion, I would discuss the patient’s legal and ethical rights and inform the patient of the procedures that will take place in upcoming treatment sessions. Furthermore, I would consider factors such as age, ethnicity, and socioeconomic background when formulating a treatment plan to provide a satisfying and effective patient-centered approach. I would also evaluate PMH (past medical history), making provisions as required based on the patient’s risk profile, to create comprehensive treatment goals in terms of disease prevention and health promotion.