MSN 675 Week 7 Assignment: Management of Psych Mental Health Disorders: Special Populations: Pediatrics and Geriatrics video case

MSN 675 Week 7 Assignment: Management of Psych Mental Health Disorders: Special Populations: Pediatrics and Geriatrics video case

MSN 675 Week 7 Assignment: Management of Psych Mental Health Disorders: Special Populations: Pediatrics and Geriatrics video case

Assignment — — Special Populations: Pediatrics and Geriatrics video case assignment
Please watch and assess the following video case:

For this assignment, you will watch an assigned video clip that depicts a patient needing
psychiatric/mental health treatment. You then will complete a treatment plan for this patient, following
the attached formatting. You are required to follow APA 7, which includes, a title page, your typed
treatment plan, and a references page. Each video case that is assessed should result in a treatment plan
that is a minimum of 2 pages in length, in addition to the title page and references page. This is a
treatment plan, not a research paper. Follow the rubric guidelines for grading criteria.
Just like in practice, there are times when all the preferred information may not be available, yet you still
will need to formulate a treatment plan for the patient. Your treatment plan must include in-text citations
and proper APA 7 formatting.

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The following reference materials are required to be utilized and referenced:
– DSM-5
– Course Textbook
– Drug guide of your choice (text or online)
– 1 scholarly peer reviewed journal article, dated within the last 5 years, that supports your
treatment plan. UptoDate is a wonderful site, but it is not considered a scholarly peer
reviewed journal article.
The APA 7 style of writing is required. This includes (but is not limited to):
– Proper grammar and composition, capitalization and sentence structure
– APA 7 approved font (such as 12-point Times New Roman)
– Double spaced paper with 1” margins
– Paragraphs are to be left margin justified only
– Paragraph indentions
– Heading Levels (see APA p. 47-48)
– References that are formatted as per APA 7. See chapter 9 of the APA 7.
How to properly cite and reference the DSM-5.
For electronic versions:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https:doi.org/10.1176/appi.books.9780890425596
For printed version:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
American Psychiatric Association.
Basic in-text citation for the DSM-5: (American Psychiatric Association, 2013).
NKU MSN675 | 2022 Treatment Plans, DSM-5, Differentials
Treatment Plan: What to include and how to format the treatment plan
Your Treatment plan should include the following categories:
1. Title page
2. Content of treatment plan (The title of your treatment plan should be on line 1 of page 2).
a. Video # or Discussion Board Prompt #
b. Brief description of the patient
c. Brief explanation of the presenting symptoms
d. Any known medical history, allergies, etc.
e. Your psychiatric diagnosis (supported by the DSM-5).
f. List 3 of the differential diagnosis from the DSM-5, and briefly state why that was
chosen as a differential diagnosis, and not as the main diagnosis. (See course
materials on Differential Diagnosis) (supported by the DSM-5).
g. Suicide and/or homicidal risk assessment (this includes ideation, intent, plan,
means, etc.).
h. What psychiatric tools or scales you used (or that you would use) to help support
your diagnosis (include citations).
i. Medications being ordered
i. Include name of medication(s) and what the med is used for (include
citation)
ii. Include the route, dosage, frequency (include citation)
iii. Include black box warnings or what the pt needs to know/foods to avoid,
etc. (include citation)
j. Non-pharmacological treatments that are being ordered (include citation that
supports these).
k. Any labs or medical tests that need to be completed to rule out organic causes, for
medication monitoring, and so forth (include citation). (include a short line stating
why each lab/test is being ordered)
l. Questions that you would ask to further solidify your diagnosis (brief list)
m. Any further directives/resources for the patient (this would include, follow up with
primary doctor to monitor HTN or diabetes; directives to follow-up with other
members of the comprehensive treatment team; safety plan if you are sending the
pt home and they have suicidal or homicidal thoughts; return for medication
assessment in x number of weeks, etc. This also includes support group and hotline
phone numbers for things like SI and SUD).
3. References Page – include all citations used in the paper, formatted per APA 7, double
spaced and in alphabetical order. References are to include the DSM-5, the course textbook,
a drug book of your choice (text or online), and 1 scholarly journal article reference within
the last 5 years, for each of the videos or discussion board prompts being assessed.
Note:
Direct quotations should be kept to a minimum and properly cited as per the APA 7. It is imperative
that you synthesize the course information into your own words, using minimal direct quotations from scholarly
journal articles to support your treatment plan. Academic integrity is essential as proper citations give credence
and reliability to your treatment plan.
NKU MSN675 | 2022 Treatment Plans, DSM-5, Differentials
DSM-5 & Differential Diagnosis
In order to effectively treat patients, a reliable diagnosis and treatment recommendation is
essential. The DSM-5 provides a definition for each mental health disorder along with diagnostic
criteria that must be met for each diagnosis. These diagnoses are designed to “help clinicians to
determine prognosis, treatment plans, and potential treatment outcomes for their patients”
(American Psychiatric Association, 2013, p. 20). Diagnosis are then made after performing a
clinical interview with the patient, using DSM-5 descriptions, criteria, and using clinician
judgment (American Psychiatric Association, 2013).
1. All psychiatric disorders have a categorical place in the DSM -5. It includes the
symptoms that must be present with specifiers that allow for a more specific
diagnosis that help with the development of a treatment plan. (Example: Major
depressive disorder with psychotic features).
2. Most psychiatric disorders (and psychiatric emergencies) require a thorough suicide
risk assessment. If the patient in the DB or video requires a suicide risk assessment
you must mention that clearly, as well as giving the side effects of any meds that may
make suicidal thinking worse, as well as a safety plan.
3. Differential diagnoses: A reliable diagnosis is required to effectively treat the patient
and to have positive treatment outcomes. The differentials provide for clinicians and
alternate diagnosis that could be considered if it is proven that the patient does meet
the criteria for the primary diagnosis that was chosen.
A clinician does not randomly come up with a differential diagnosis on their own. The
DSM-5 provides for clinicians, differential diagnosis for each primary diagnosis. They
are listed in the DSM-5 at the end of each diagnosis chapter. The differentials are listed in
order of prevalence. For example, of all the patients diagnosed with Bipolar 1, if that
diagnosis was proven not to be correct, most often the correct diagnosis is found to be
first, major depressive disorder, then second most frequent is the 2nd differential listed,
then the 3rd most frequent is the 3rd differential that is listed. So the differentials should be
alternate diagnosis that you considered or wrestled with as you were determining the
primary diagnosis for the patient.
For example, if you have a patient who appears with a mood disorder, you may be
considering depressive disorder or bipolar 1 disorder. Upon examining the diagnostic
criteria in the DSM-5 for bipolar 1 (page 123-131) you determine that bipolar 1 is the
diagnosis that the patient meets the criteria for. You must then look to the differential
diagnosis that are listed in the DSM-5 (for bipolar 1 the differentials are on page 131-
132) and you choose 2 or 3 of them that your patient closely matches the criteria for. You
then briefly explain why you chose bipolar 1, as opposed to the differential diagnosis of
major depressive disorder (for example)

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Video Link: https://symptommedia.com/training-title-42/

Schizophrenia Treatment Plan

1. Video Prompt

https://symptommedia.com/training-title-42/

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1. Patient Description

The patient is a young school-going female and has been referred to psychiatric care by the guidance counselor after she presented hostile reactions to other students and teachers, including wanting to break the school rules to smoke within the school environment.

1. Brief explanation of the presenting symptoms

During the physical examination, the patients presented distinctive factors; cognitive, behavioral, mood, speech, and psychological symptoms. The cognitive factors include disorientation, false superiority belief, and a belief that different ordinary events had personal meaning. The behavioral factors include hostility, aggression, and agitation, with the mood factors being anger, inappropriate emotional response, and loss of interest in activities. Lastly, the psychological factors for the patient involve persecutory delusions while the speech was disorganized.

1. Any known medical history, allergies, etc.

No medical history and the allergic case presented.

1. Your psychiatric diagnosis

               From the presenting symptoms, the patient has schizophrenia. The diagnosis is based on the schizophrenia DSM-V which requires the patient to present at least two of the five main symptoms (Medscape, 2022). The symptoms include hallucinations, delusions, negative symptoms, disorganized speech, and unusual movements. The patient already has disorganized speech, delusions, and negative symptoms like social withdrawal and avolition.

1. The DSM-5, Differential Diagnosis

The main differential diagnosis is schizoaffective disorder, bipolar one disorder, and major depressive disorder. The reason for ruling out schizoaffective disorder is that the patient does not experience a detachment from reality. Bipolar 1 has been ruled out since the patient has more delusions than mood shifts (Dubovsky et al., 2021). And lastly, major depressive disorder is ruled out since psychotic features tend to be episodic, unlike schizophrenia.          

1. Suicide or homicidal risk

The patient poses a homicide risk, evidenced by how she describes how she needed to deal with Ludy by throwing him five feet.

1. What psychiatric tools or scales do you use

I would use the Clinical Global Impression scale (CGI), a 7-point scale that enables clinicians to rate a patient’s severity (Leucht et al., 2022).

1. Medications being ordered
2. Include the name of the medication(s) and what the med is used for

Olanzapine is an antipsychotic drug that helps patients relieve psychotic symptoms (Medscape, 2022).

1. Include the route, dosage, frequency

Due to the patient’s state, it will be administered through an intramuscular injection route, 5mg/day, but the dosage may increase later (Medscape, 2022).  

• Black box warnings

The patient needs to know that she can increase her weight to approximately 3kgs within six weeks (Medscape, 2022). Other side effects include dry mouth and restlessness.

1. Non-pharmacological treatments

The non-pharmacological treatments will involve cognitive-behavioral therapy and coping and social skills therapy (Vancampfort et al., 2019).

1. Any labs or medical tests

No lab test for schizophrenia. However, the clinician should regularly monitor the patient’s blood pressure and hepatic functions since the patient has been smoking.

1. Questions to solidify the diagnosis

• Have you ever had any suicidal thoughts? The question will help evaluate if the patient has ever had suicidal thoughts apart from the current homicidal thoughts.
• What makes you smoke, and at any chance would you stop it? What will homeschooling help you with apart from being out of restricted smoking areas? The questions will help me understand the patient’s stand on the current smoking condition.
• Who do you trust most and why? The question will be essential for follow-up activities and in inquiring more about the current patient’s condition.

1. Any further directives/resources

The other directives would require the patient to accompany a family member during the next visit to help fill the gaps, especially on patient history and former medication. Also, I will need to consult with other medics to ensure that I made the correct diagnosis since schizophrenia and schizoaffective disorders have close symptoms and require critical evaluation.

The school board should also be notified about the homicidal thoughts that the patient has to ensure that they keep an eye on her. Also, it will be effective to ensure that I collaborate with the school counsellor to ensure that the patient return after two weeks to assess the improvement of her condition.

References

Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic depression: Diagnosis, differential diagnosis, and treatment. Psychotherapy and Psychosomatics, 90(3), 160-177. https://doi.org/10.1159/000511348

Leucht, S., Barabássy, Á., Laszlovszky, I., Szatmári, B., Acsai, K., Szalai, E., … & Németh, G. (2019). Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: understanding negative symptom scores in schizophrenia. Neuropsychopharmacology, 44(9), 1589-1596. https://doi.org/10.1038/s41386-019-0363-2

Medscape (June 30, 2022). What are the DSM-5 criteria for schizophrenia? https://www.medscape.com/answers/288259-13968/what-are-the-dsm-5-criteria-for-schizophrenia

Vancampfort, D., Firth, J., Correll, C. U., Solmi, M., Siskind, D., De Hert, M., … & Stubbs, B. (2019). The impact of pharmacological and non‐pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry, 18(1), 53-66. https://doi.org/10.1002/wps.20614