NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
WK5 ASSIGN NRNP 6675
Week 5: Schizophrenia Spectrum and Other Psychotic Disorders; Medication-Induced Movement Disorders
Two groups of symptoms found with schizophrenia spectrum and related psychotic disorders are “positive” and “negative” symptoms. Positive symptoms generally “add” and include things such as delusions, hallucinations, and repetitive movements. Negative symptoms generally “detract” and may include difficulty showing emotions, withdraw from social relationships, or apathy.
While many disorders result in the development of “positive” symptoms, not all of these conditions represent schizophrenia. When treating schizophrenia spectrum and other psychotic disorders, place emphasis not only on treating the positive symptoms but the negative and residual symptoms as well.
Medication-induced movement disorders, one example of which is tremors, can stem from both recreational and therapeutic drugs, with dopamine receptor blocking drugs, such as antipsychotic and antiemetics, being common causes. These types of disorders can range from subtle to lethal.
This week, you will explore a wide variety of disorders along the schizophrenia spectrum as well as medication-induced movement disorders.
Learning Objectives
Students will:
Assess patients with schizophrenia, other psychotic, and medication-induced movement disorders
Develop differential diagnoses for patients with schizophrenia, other psychotic, and medication-induced movement disorders
Develop appropriate treatment plans for patients with schizophrenia, other psychotic, and medication-induced movement disorders
Advocate health promotion and patient education strategies for patients with schizophrenia, other psychotic, and medication-induced movement disorders
Learning Resources
Required Readings (click to expand/reduce)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. (For review as needed)
Chapter 7, “Schizophrenia Spectrum and Other Psychotic Disorders”
Chapter 29.2, “Medication-Induced Movement Disorders”
Chapter 29.3, “α2-Adrenergic Receptor Agonists, α1-Adrenergic Receptor Antagonists: Clonidine, Guanfacine, Prazosin, and Yohimbine”
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Chapter 43, “Pharmacological, Medically-Led and Related Disorders”
Chapter 57, “Schizophrenia and Psychosis”
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 9, “Psychotic Disorders and Delusions”
Document: Focused SOAP Note Template
Document: Focused SOAP Note Exemplar
Required Media (click to expand/reduce)
PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication – Conversations with Dr. Stephen Stahl [Video]. YouTube. https://www.youtube.com/watch?v=ipW5AcbFzzE
Vallejo, E. (2020). Realistic schizophrenia simulation [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU
Walden University. (2021). Case study: Sherman Tremaine. Walden University Blackboard. https://class.waldenu.edu
Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.
For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder.
To Prepare
Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating schizophrenia spectrum, other psychotic, and medication-induced movement disorders.
Photo Credit: Getty Images/Wavebreak Media
Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
Review the video, Case Study: Sherman Tremaine. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
The Assignment
Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:
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?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, and list them 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.
Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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.).
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
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