Week 9 Assignment 2: Diagnosed with Obsessive Compulsive Personality Disorder/NRNP 6635

Week 9 Assignment 2: Diagnosed with Obsessive Compulsive Personality Disorder/NRNP 6635

Week 9 Assignment 2: Diagnosed with Obsessive Compulsive Personality Disorder/NRNP 6635

For this Assignment, you will document information about a patient that you
examined during the last 3 weeks, using the Comprehensive Psychiatric Evaluation
Template provided. You will then use this note to develop and record a case
presentation for this patient. Be sure to incorporate any feedback you received on
your Week 3 and Week 6 case presentations into this final presentation for the
course.

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To Prepare
• Review this week’s Learning Resources and consider the insights they provide. Also
review the Kaltura Media Uploader resource in the left-hand navigation of the
classroom for help creating your self-recorded Kaltura video.
• Select a patient that you examined during the last 3 weeks who presented with a
disorder for which you have not already conducted an evaluation in Weeks 3 or 6.
(For instance, if you selected a patient with OCD in Week 6, you must choose a
patient with another type of disorder for this week.) Conduct a Comprehensive
Psychiatric Evaluation on this patient using the template provided in the Learning
Resources. There is also a completed exemplar document in the Learning Resources
so that you can see an example of the types of information a completed evaluation
document should contain. All psychiatric evaluations must be signed, and each page
must be initialed by your Preceptor. When you submit your document, you should
include the complete Comprehensive Psychiatric Evaluation as a Word document, as
well as a PDF/images of each page that is initialed and signed by your Preceptor.
You must submit your document using SafeAssign. Please Note: Electronic
signatures are not accepted. If both files are not received by the due date, Faculty
will deduct points per the Walden Late Policies.
• Then, based on your evaluation of this patient, develop a video case presentation
that includes chief complaint; history of present illness; any pertinent past
psychiatric, substance use, medical, social, family history; most recent mental status
exam; and current psychiatric diagnosis including differentials that were ruled out.
• Include at least five (5) scholarly resources to support your assessment and
diagnostic reasoning.
• Ensure that you have the appropriate lighting and equipment to record the
presentation
Assignment
Record yourself presenting the complex case for your clinical patient.
Do not sit and read your written evaluation! The video portion of the assignment is a
simulation to demonstrate your ability to succinctly and effectively present a complex case
to a colleague for a case consultation. The written portion of this assignment is a simulation
for you to demonstrate to the faculty your ability to document the complex case as you
would in an electronic medical record. The written portion of the assignment will be used
as a guide for faculty to review your video to determine if you are omitting pertinent
information or including non-essential information during your case staffing consultation
video.
In your presentation:
• Dress professionally and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA
(i.e., don’t use the patient’s name or any other identifying information).
• Present the full case. Include chief complaint; history of present illness; any
pertinent past psychiatric, substance use, medical, social, family history; most recent
mental status exam; and current psychiatric diagnosis including differentials that
were ruled out.
• Report normal diagnostic results as the name of the test and “normal” (rather than
specific value). Abnormal results should be reported as a specific value.
Be succinct in your presentation, and do not exceed 8 minutes. Address the following:
• Subjective: What details did the patient provide regarding their personal and
medical history? What are their symptoms of concern? How long have they been
experiencing them, and what is the severity? How are their symptoms impacting
their functioning?
• Objective: What observations did you make during the interview and review of
systems?
• Assessment: What were your differential diagnoses? Provide a minimum of three
(3) possible diagnoses. List them from highest to lowest priority. What was your
primary diagnosis, and why?
• Reflection notes: What would you do differently in a similar patient evaluation?
Reflect on one social determinant of health according to the HealthyPeople 2030
(you will need to research) as applied to this case in the realm of psychiatry and
mental health. As a future advanced provider, what are one health promotion
activity and one patient education consideration for this patient for
improving health disparities and inequities in the realm of psychiatry and mental
health? Demonstrate your critical thinking.

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Name: PRAC_6635_Week 9_Assignment 2_Rubric

	Excellent	Good	Fair	Poor
Photo ID display and professional attire	5 (5%) – 5 (5%) Photo ID is displayed. The	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Struggling to meet your deadline ? Get assistance on Week 9 Assignment 2: Diagnosed with Obsessive Compulsive Personality Disorder/NRNP 6635 done on time by medical experts. Don’t wait – ORDER NOW! Meet My Deadline Photo ID is not displayed. Student must remedy thi
	student is dressed			before grade is posted. The student is not dressed
	professionally.			professionally.
Time	5 (5%) – 5 (5%) The video does not exceed the 8-minute time limit.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) The video exceeds the 8-minute time limit. (Note: Information presented after the 8 minutes will not evaluated for grade inclusion.)
Description of chief complaint and history of present illness	5 (5%) – 5 (5%) The student provides an accurate, clear, and	4 (4%) – 4 (4%) The student provides an accurate description	2 (2%) – 3 (3%) The student provides a vague, inaccurate, or	0 (0%) – 1 (1%) The student provides a completely inaccurate, or incomplete description of the chief complaint and
	complete description of	of the chief complaint	incomplete description of	history of present illness, or the description is
	the chief complaint and	and history of present	the chief complaint and	missing.
	history of present illness.	illness.	history of present illness, or description is missing.

	Excellent	Good	Fair	Poor
Description of past psychiatric, substance use, medical, social, and family history	5 (5%) – 5 (5%) The student provides an accurate, clear, and complete description of	4 (4%) – 4 (4%) The student provides an accurate description of past psychiatric,	2 (2%) – 3 (3%) The student provides a vague, inaccurate, or incomplete description of	0 (0%) – 1 (1%) The student provides a completely inaccurate, or incomplete description of psychiatric, substance us medical, social, and family history, or description is
	past psychiatric,	substance use,	psychiatric, substance use,	missing.
	substance use, medical,	medical, social, and	medical, social, and family
	social, and family history.	family history.	history, or description is missing.
Discussion of most recent mental status exam and observations made during interview and review of systems	14 (14%) – 15 (15%) The student provides an accurate, clear, and complete discussion of results from most recent mental status exam and	12 (12%) – 13 (13%) The student provides an accurate discussion of results from most recent mental status exam and observations	11 (11%) – 11 (11%) The student provides a vague, inaccurate, or incomplete discussion of results from most recent mental status exam and	0 (0%) – 10 (10%) All or most of the discussion is inaccurate or missin
	observations made during	made during interview	observations made during
	interview and review of	and review of systems.	interview and review of
	systems.		systems.
Discussion of diagnostics with results	9 (9%) – 10 (10%) The student provides an accurate, clear, and	8 (8%) – 8 (8%) The student provides an accurate discussion	7 (7%) – 7 (7%) The student provides a vague, inaccurate, or	0 (0%) – 6 (6%) All or most of the discussion is inaccurate or missin
	complete discussion of	of diagnostics with	incomplete discussion of
	diagnostics with results.	results.	diagnostics with results.

	Excellent	Good	Fair	Poor
Diagnostic Impression with three (3) differential diagnoses   Reflection on this case	23 (23%) – 25 (25%) The student provides an accurate, clear, and complete diagnostic impression with three (3) differentials.	20 (20%) – 22 (22%) The student provides an accurate diagnostic impression with three (3) differentials.	18 (18%) – 19 (19%) The student provides a vague, inaccurate, less than 3, or incomplete diagnostic impression with differentials.	0 (0%) – 17 (17%) All or most of the discussion is inaccurate or missin No diagnostic impression and less than 2 differenti diagnoses.   Reflections are incomplete, inaccurate, or missing.
	Reflections are thorough, thoughtful, and demonstrate critical thinking.   Reflections contain all 3 elements from the assignment directions.	Reflections demonstrate critical thinking.   Reflections contain 2 of the elements from the assignment directions.	Reflections are somewhat general or do not demonstrate critical thinking.   Reflections contain 1 of the required elements from the assignment directions.	There are no Reflections elements from the assignment directions.
Comprehensive Psychiatric Evaluation documentation	23 (23%) – 25 (25%) The response clearly, accurately, and	20 (20%) – 22 (22%) The response accurately follows the	18 (18%) – 19 (19%) The response follows the Comprehensive Psychiatric	0 (0%) – 17 (17%) The response incompletely and inaccurately follows the Comprehensive Psychiatric Evaluation format to
	thoroughly follows the Comprehensive	Comprehensive Psychiatric Evaluation	Evaluation format to document the selected	document the selected patient case.
	Psychiatric Evaluation	format to document	patient case, with some
	format to document the selected patient case.	the selected patient case.	vagueness and inaccuracy.
Presentation style	5 (5%) – 5 (5%)	4 (4%) – 4 (4%)	3 (3%) – 3 (3%)	0 (0%) – 2 (2%)

Excellent Good Fair Poor Presentation style is exceptionally clear, professional, and focused. Presentation style is clear, professional, and focused. Presentation style is mostly clear, professional, and focused Presentation style is unclear, unprofessional, and/o unfocused. Total Points: 100

Name: PRAC_6635_Week9_Assignment2_Rubric

NRNP 6635: Psychopathology and Diagnostic Reasoning

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Week 9 Assignment 2: Diagnosed with Obsessive Compulsive Personality Disorder Sample

CC (chief complaint): Anxiety

HPI: PW is a 49 year- old Caucasian male who presents to the clinic for psychiatric evaluation. He claims that he is always focused on rules and schedules and aims for perfection, both of which interfere with his ability to complete tasks. He claims that he devotes an excessive amount of time to his job and is reluctant to assign tasks to others until he is certain that they will do the tasks in the manner that he prefers. He has a miserly attitude to spending money, which is based on the belief that it ought to be saved in case of some unforeseen contingency in the future. As such, he has been stuck driving the same car for the last two decades. He claims that he has always suffered from severe anxiety, and that he became aware of it for the first time around 10 years ago. After that, he began drinking heavily as a coping mechanism. Patient states that he went to see a therapist in order to go more deeply into the issues. Ten years ago, he and his wife separated, and he sought inpatient care to begin overcoming his issues when they went their separate ways. He went through a difficult time when he divorced his wife nine years ago. This period of his life was difficult for him. After things settled down and he relocated back to Greenville and he was better able to cope with the challenges he faced. Patient intentionally puts himself in situations with as few unexpected twists and turns as possible. Since  last year, he has been working in different jobs, which has put him in a stressful situation. The patient admits that he has always struggled to get a good night’s rest, and that this has made his problems much worse. He reports that he performs support work and is constantly attempting to solve problems, but at night he focuses on himself and his issues.

Past Psychiatric History:

• General Statement: Patient reports history of anxiety and panic attacks
• Caregivers (if applicable): unknown
• Hospitalizations: Reports past psychiatric hospitalization
• Medication trials: Doxepin
• Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History: Reports past alcohol use. Denies tobacco or illicit drugs use.

Family Psychiatric/Substance Use History: Mother has a history of depression and anxiety. Reports that several family members had  history of psychiatric diagnoses.

Psychosocial History: Patient was born in Jacksonville FL, raised by both parents and has 1 brother and 1 half brother. Currently lives alone and attends college. Reports that he works as a technical support in Telecomm Industry. Reports a strong support system. Denies history of legal issues. Never served in military. Identifies as heterosexual and is sexually active. Denies history of abuse. Divorced. No children. Averages 4-5 hours of broken sleep.

Medical History: Hypertension, Hashimoto

• Current Medications: Amlodipine 5mg PO QD, hydrocortisone 2.5 % cream topically PRN, Levothyroxine mcg tablet 88 mcg PO QD.
• Allergies: NKA

• Reproductive Hx: Identifies as heterosexual and is sexually active. No children.

ROS:

• GENERAL: Denies current fever, chills, or recent weight loss
• HEENT: Denies current vision changes hearing problems, and mouth or throat problems
• SKIN: Denies rash or itching
• CARDIOVASCULAR: Denies chest pain, palpitations or edema
• RESPIRATORY: Denies cough, wheeze or shortness of breath.
• GASTROINTESTINAL: Denies abdominal pain, nausea, vomiting, heartburn
• GENITOURINARY: Denies polyuria, dysuria, or difficulty voiding
• NEUROLOGICAL: Denies dizziness, seizures or stroke
• MUSCULOSKELETAL: Denies muscle pain, joint pain, or back pain
• HEMATOLOGIC: Denies bleeding or history of anemia
• LYMPHATICS: Denies swollen lymph nodes
• ENDOCRINOLOGIC: Denies increased thirst or excessive sweating

Physical exam:

Vital signs: W:161 lbTemp:36.7 °C BP:120/82 HR:69

Patient is well-developed and well-nourished, in no acute distress. Patient is not in respiratory distress and there is equal chest expansion bilaterally. Moves all four extremities spontaneously with full range of motion. Grossly normal muscle strength and tone based on observations of spontaneous movements. No tics or tremors evident. No atrophy or abnormal movements. Gait and station observed, which were noted to be not observed.

Diagnostic results:

PHQ9- severe depression

GAD7

GAD7

MOCA

Assessment

Mental Status Examination:

Patient appears his stated age. Dressed appropriately for the occasion. Clear and coherent speech with normal pitch and normal volume. Mood is noted as “better than average” and his affect is congruent with his mood.His thought process is logical, coherent, and goal directed. Patient demonstrates no thought disturbances. Alert and oriented to person, place, and time. Denies suicidal thoughts or intent. No specific plan to harm self.  Denies homicidal ideation, intent, or plan. Has appropriate insight into his health condition.  His judgement is intact with appropriate impulsivity. Short-term and long-term memory intact. Fund of knowledge is appropriate for his level of education.

Differential Diagnoses:

Obsessive Compulsive Personality Disorder (OCPD): This is a personality disorder that may be defined by the patient’s strong need for order, neatness, and perfectionism. Individuals who suffer from OCPD are also likely to have a strong want to impose their own standards on the world around them. Individuals who suffer from OCPD are characterized by: a problem communicating feelings; having trouble creating and keeping close relationships; being hardworking, but their drive for perfection may often go in the way of their effectiveness; having a sense of self-righteousness, indignation, and anger; dealing with social isolation; and suffering from the anxiety that accompanies depression (Wheaton & Ward, 2020). Despite the fact that they are drowning in work, people with OCPD often refuse to outsource tasks unless they are certain that others will adhere to the same procedures and practices. It is essential to keep in mind that this “workaholic” mentality is accepted as typical in certain societies; hence, it should not be labeled as obsessive-compulsive personality disorder in such situations (The American Psychiatric Association, 2013). Additionally, many who suffer from obsessive-compulsive personality disorder are notoriously frugal savers who are unable or unwilling to let go of possessions, even if they have no sentimental value (The American Psychiatric Association, 2013). This is the primary diagnosis for patient PW because his presenting symptoms are congruent with those of OCPD.

Generalized anxiety disorder (GAD): This mental illness is defined by continuous and excessive anxiety over a variety of different things. People who suffer from GAD may have an unrealistic fear of negative outcomes and may worry excessively about their finances, health, families, jobs, and other aspects of their lives. People who suffer from generalized anxiety disorder have trouble keeping their worries in check. They may worry more than is necessary about real occurrences or may assume the worst even when there is no obvious cause to be concerned (Iani et al., 2019).

Panic disorder: This is a mental illness that is characterized by panic attacks occurring often and unexpectedly. These episodes are marked by a sudden surge of panic or discomfort, or a sensation of losing control, even if there is no obvious threat or cause. The physical manifestations of a panic attack sometimes involve sensations that are similar to those of a heart attack, such as tingling, trembling, or a high heart rate (Kim, 2019). Panic attacks might take place at any moment. Many individuals who have panic disorder worry about the prospect of having another attack, and as a result, they may make considerable changes in their lives to eliminate the risk of future attacks. It is possible for panic attacks to occur as often as multiple times a day, or as seldom as once or twice per year.

Reflections: There is nothing I would do differently in a similar patient evaluation because I believe that the preceptor did a good job. It is estimated that around one in one hundred persons in the United States has OCPD (International OCD Foundation, n.d). Personality disorders such as obsessive-compulsive disorder do not have a single identifiable root cause. There are twice as many men as there are women who are diagnosed with OCPD. A person’s likelihood of getting OCPD may be increased by a number of risk factors, including having a preexisting mental health condition, especially anxiety disorder, childhood trauma, and a family history of personality disorders, anxiety, or depression (International OCD Foundation, n.d). It is essential for a PMHNP to encourage patients with OCPD to try not to be self-critical when they are experiencing obsessive thoughts and to develop strategies for self-soothing.

References

American Psychiatric Association. (2013). DSM 5 diagnostic and statistical manual of mental disorders. In DSM 5 Diagnostic and statistical manual of mental disorders (pp. 947-p).

Iani, L., Quinto, R. M., Lauriola, M., Crosta, M. L., & Pozzi, G. (2019). Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning. PLOS ONE, 14(11), e0225646. https://doi.org/10.1371/journal.pone.0225646

International OCD Foundation. (n.d). Obsessive Compulsive Personality Disorder (OCPD). https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf

Kim, Y. (2019). Panic disorder: Current research and management approaches. Psychiatry Investigation, 16(1), 1-3. https://doi.org/10.30773/pi.2019.01.08

Luo, Y., Chen, L., Li, H., Dong, Y., Zhou, X., Qiu, L., Zhang, L., Gao, Y., Zhu, C., Yu, F., & Wang, K. (2020). Do individuals with obsessive-compulsive disorder and obsessive-compulsive personality disorder share similar neural mechanisms of decision-making under ambiguous circumstances? Frontiers in Human Neuroscience, 14. https://doi.org/10.3389/fnhum.2020.585086

Wheaton, M. G., & Ward, H. E. (2020). Intolerance of uncertainty and obsessive-compulsive personality disorder. Personality Disorders: Theory, Research, and Treatment, 11(5), 357-364. https://doi.org/10.1037/per0000396