Mrs. Patricia Warren’s Case Study

QUESTION

ame: Mrs. Patricia Warren
Gender: female
Age: 42 years old
Background: Patricia was brought in under a emergency evaluation order after her best friend,
Felicia, after the police for Patricia locking herself in a closet and screaming loudly for over an
hour. EMS was able to calm her with a small dose of Ativan enroute to the emergency
department. This is Patricia’s third presentation to the emergency room in 2 weeks. She had one
psychiatric hospitalization around this same last year. No self-harm behaviors but has assaulted
other in the past. No hx of TBI. Sleeps 1-2-hour increments for total of 6 hrs. daily, refuses to
sleep at night. Refused vitals, wt., refuses labs, not cooperative. She obtains SSDI. She lives in
Cameron, Montana. She denies ever using any drugs and drinks one glass of wine weekly. She has
a sister who is five years older, both parents deceased in the last three years. She has no children,
her husband is out of town, a truck driver. Family history includes that her father had two previous
inpatient psychiatric hospitalizations for paranoia Mother had a history of bipolar depression.
Paternal grandmother had “shock therapy”. Denies a history of trauma experience, but her friend

reports parent’s death was extremely difficult for Patricia. no current legal charges. dropped out
of high school in 11th grade, was pregnant, and had an abortion. allergies: Clozaril

• 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? With Diagnostics Include both psychometric tools and labs/diagnostics to guide your differential diagnoses. (support with evidence and guidelines).
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-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. References can not be over five years old.
• Reflection notes: What would you do differently with this client if you could conduct the session over? Also, include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

School references

American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

• Chapter 5, “Schizophrenia Spectrum and Other Psychotic Disorders”
• Chapter 2 only section 2.14, “Early-Onset Schizophrenia”

ANSWER

Subjective

According to the patient, Mrs. Patricia Warren, her chief complaint is the recent episode of locking herself in a closet and screaming for over an hour. She denies any self-harm behaviors but has a history of assaulting others. Mrs. Warren has experienced three emergency room presentations in the past two weeks, with one psychiatric hospitalization the previous year. She reports sleep disturbances, sleeping only 1-2 hours at a time during the day and refusing to sleep at night. Her symptoms have a significant impact on her daily functioning. She mentions the recent deaths of both her parents and the difficulty she experienced in coping with those losses.

Objective

During the psychiatric assessment, Mrs. Warren’s observations include her refusal to cooperate with vital signs and lab tests. She reports taking only one glass of wine weekly and denies drug use. She lives alone in Cameron, Montana, and receives SSDI. Mrs. Warren dropped out of high school, had an abortion, and has no children. She has a sister, and her husband is a truck driver who is currently out of town. Family history reveals her father’s previous psychiatric hospitalizations for paranoia and her mother’s history of bipolar depression. Allergies include Clozaril.

Assessment

Based on the mental status examination, three differential diagnoses are considered, listed in order of priority:

Psychotic Disorder due to Another Medical Condition: This diagnosis is supported by Mrs. Warren’s psychiatric symptoms, including the recent episode of screaming and refusal to cooperate during the assessment. The DSM-5-TR criteria for this diagnosis require the presence of prominent delusions or hallucinations that are attributed to the physiological effects of another medical condition. Given her refusal for labs and diagnostics, ruling out medical causes may be challenging but important for accurate diagnosis.

Substance/Medication-Induced Psychotic Disorder: Considering Mrs. Warren’s history of alcohol consumption, this diagnosis becomes relevant. The DSM-5-TR criteria require the presence of prominent delusions or hallucinations that are attributable to substance intoxication or withdrawal. Clozaril allergy should also be considered in the assessment of medication-induced effects.

Brief Psychotic Disorder: Mrs. Warren’s recent presentation to the emergency room and the significant impact on her functioning support the consideration of this diagnosis. The DSM-5-TR criteria for brief psychotic disorder include the presence of at least one positive symptom, such as delusions, hallucinations, or disorganized speech, with a duration of one day to less than one month. The stressor of her parents’ recent deaths may have contributed to the development of this disorder.

The critical-thinking process led to the selection of the primary diagnosis of Psychotic Disorder due to Another Medical Condition. This diagnosis takes precedence as it aligns with the patient’s recent psychiatric symptoms, the refusal for medical evaluations, and the need to rule out underlying medical conditions that could be contributing to her psychotic symptoms.

Reflection

If given the opportunity to conduct the session over, it would be important to approach Mrs. Warren with empathy and establish a therapeutic alliance to encourage her cooperation and engagement in the diagnostic process. Exploring the impact of her parents’ deaths and providing appropriate support and resources for grief management could also be beneficial. Addressing legal and ethical considerations, it is crucial to ensure that Mrs. Warren’s autonomy and rights are respected throughout the assessment and treatment process. Privacy and confidentiality should be maintained, and informed consent for any interventions or diagnostic procedures should be obtained.

Considering Mrs. Warren’s socioeconomic background, age, and cultural factors, it is essential to provide a holistic approach to care. Collaborating with her sister, involving the appropriate community resources, and considering a multidisciplinary team approach may facilitate a comprehensive assessment and treatment plan. Health promotion and disease prevention can be addressed by providing education and support regarding the management of stressors, grief, and sleep disturbances. Involving Mrs. Warren in shared decision-making and fostering a supportive therapeutic environment will contribute to her overall well-being and treatment outcomes.

Legal and ethical considerations go beyond confidentiality and consent. In this case, respecting Mrs. Warren’s autonomy and right to make decisions about her care, ensuring her privacy and confidentiality, and providing culturally sensitive and individualized care are crucial. Additionally, adhering to professional boundaries and refraining from discussing patient information outside of the healthcare setting are important ethical obligations.

In conclusion, the assessment of Mrs. Patricia Warren reveals a complex presentation with potential underlying medical and psychiatric factors contributing to her symptoms. Through a careful evaluation and consideration of differential diagnoses, the primary diagnosis of Psychotic Disorder due to Another Medical Condition emerges as the most probable. Reflecting on the session, it is evident that a compassionate and collaborative approach, taking into account legal/ethical considerations, patient factors, and risk factors, is essential in providing optimal care and promoting Mrs. Warren’s well-being.