Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM

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

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To Prepare:

• Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.

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

THE QUESTION

Subjective: 

Ø What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?

Ø What is the duration and severity of their symptoms?

Ø How are their symptoms impacting their functioning in life? Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM

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Objective: 

Ø What observations did you make during the psychiatric assessment?

Assessment:

Ø Discuss the patient’s mental status examination results.

Ø What were your differential diagnoses?

Ø Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority.

Ø Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rule out the differential diagnosis to find an accurate diagnosis.

Ø Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflection notes:

Ø What would you do differently with this client if you could conduct the session over?

Ø Include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!).

Ø Also include 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.).

Transcript

00:00:00TRANSCRIPT OF VIDEO FILE:

00:00:00______________________________________________________________________________

00:00:00BEGIN TRANSCRIPT:

00:00:00[sil.]

00:00:15OFF CAMERA Mr. Feldman? I understand you called us last week for an appointment.

00:00:20MR. FELDMAN My parents.

00:00:25OFF CAMERA Excuse me?

00:00:25MR. FELDMAN My parents called for the appointment.

00:00:25OFF CAMERA Oh. Do you know why your parents called for an appointment?

00:00:30MR. FELDMAN No.

00:00:35OFF CAMERA When your parents called me they said you were having some difficulty in school. Where are you in school?

00:00:50MR. FELDMAN State College.

00:00:50OFF CAMERA How long have you been at State College?

00:00:55MR. FELDMAN My freshman year.

00:01:00OFF CAMERA And how is it going?

00:01:05MR. FELDMAN Fine. Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM

00:01:10OFF CAMERA What courses are you taking at State?

00:01:15MR. FELDMAN In high school I took advanced placement courses. Theoretical physics, advanced calculus is what I’m taking now. Although I’m thinking about double majoring in philosophy and physics.

00:01:35OFF CAMERA That’s an interesting combination.

00:01:35MR. FELDMAN Yes, the mysteries of life. The courses are mysteries, and just when you think you’ve understood it, it’s gone.

00:01:45OFF CAMERA Gone?

00:01:50MR. FELDMAN The totality of life precludes us from repeating it. I mean what’s the point?

00:02:00OFF CAMERA Do you have a roommate at state?

00:02:05MR. FELDMAN You could call him that.

00:02:10OFF CAMERA Can you tell me about him?

00:02:15MR. FELDMAN Oh no.

00:02:15OFF CAMERA Why not?

00:02:20[sil.]

00:02:25MR. FELDMAN He put a microwave in there, but I know what that means. But I won’t tell. Not a word..

00:02:35OFF CAMERA A microwave oven?

00:02:40MR. FELDMAN They had them in here too, in this building. But they’ll spare me, and they’ll spare you too, because you are with me, and what that’s about a bleeding degeneration of blood cells, bleeding the humanity from our rightful destiny… but this room spies on us.

00:03:05OFF CAMERA I don’t understand what you mean.

00:03:10MR. FELDMAN It’s in the eyes. You can hold of forever if you know how.

00:03:20OFF CAMERA Mr. Feldman, did you come here with anyone else today?

00:03:25[sil.]

00:03:30MR. FELDMAN Sssshhhh.

00:03:35OFF CAMERA Mr. Feldman, I think I may need to contact your parents.

00:03:45SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com

00:03:45 END TRANSCRIPT. Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM