Nrnpprac 6665 6675 Comprehensive Focused Soap Psychia 025651

Nrnpprac 6665 6675 Comprehensive Focused Soap Psychiatric Evaluatio

Identify the core assignment prompt: Write an academic, comprehensive, approximately 1000-word paper exploring a psychiatric case study based on a detailed SOAP note. Incorporate analysis of signs and symptoms of psychosis, primary differential diagnoses (depressive disorder with psychotic features, PTSD, schizophrenia), and formulate an appropriate treatment plan with pharmacological and non-pharmacological interventions. Use at least five credible peer-reviewed sources, with in-text citations and a references section, adhering to APA style.

Paper For Above instruction

Psychiatric evaluation and diagnosis are complex processes that require a thorough understanding of symptomatology, differential diagnoses, and tailored treatment approaches. The case of T.H., a 64-year-old woman with a history of psychosis, depression, and extensive trauma, exemplifies the intricacies involved in psychiatric assessment. This paper critically analyzes her case, explores differential diagnoses, and designs an individualized treatment plan supported by current psychiatric literature.

Initial comprehension of T.H.'s presentation reveals a woman experiencing persistent hallucinations and depressive symptoms, with a history suggestive of trauma and medication non-compliance. Her subjective report indicates auditory, visual, and tactile hallucinations predominantly occurring during depressive episodes, along with ongoing paranoia. The fact that she has a prior diagnosis of schizophrenia complicates her clinical picture, especially considering her cognitive alertness and relatively preserved insight, which are atypical of classic schizophrenia presentations. The comprehensive assessment elucidates that her primary features include depressive mood with psychotic features, ongoing trauma-related symptoms, and a history of significant childhood and adult trauma involving sexual abuse.

From a diagnostic perspective, the DSM-5 criteria guide the differential diagnosis among depressive disorder with psychotic features, PTSD with secondary psychotic features, and schizophrenia. The primary diagnosis favored in this case is depressive disorder with psychotic features, as her depressive symptoms are prominent, persistent, and episodic, with hallucinations predominantly linked to mood episodes. This diagnosis is supported by her reports of depression for most days over more than two weeks, feelings of hopelessness, fatigue, sleep disturbance, and prior hospitalization for depression, aligning with DSM-5 guidelines (American Psychiatric Association, 2022).

PTSD is a consideration due to her trauma history, including childhood sexual abuse, adult abuse, and recent stressors involving her mother. While her trauma history supports the possibility of PTSD, her presentation of hallucinations across multiple modalities and the absence of core trauma re-experiencing symptoms (e.g., flashbacks, hyperarousal) suggest that trauma-related psychosis is less likely to be the primary cause. Instead, PTSD with secondary psychotic features is a differential that may influence her overall functioning but does not primarily account for her ongoing hallucinations (Compean & Hamner, 2019).

Schizophrenia was historically considered given her previous diagnosis and family history; however, current clinical features do not fully meet the DSM-5 criteria for schizophrenia. The absence of disorganized speech, flat affect, catatonia, or cognitive decline diminishes the likelihood of schizophrenia. Her preserved insight, orientation, ability to participate, and absence of negative symptoms are inconsistent with a primary schizophrenia diagnosis (Hany et al., 2023). Consequently, the focus remains on depressive psychosis as the most fitting primary diagnosis.

This nuanced differential underscores the importance of trauma-informed care and avoids premature diagnostic labeling. The case highlights that trauma and depression can manifest with psychotic features, and proper diagnosis influences treatment choices significantly. The literature indicates that trauma-related experiences have a profound impact on the development and course of psychosis, demonstrating the necessity for an integrated approach to treatment (Monique Tello, 2018).

Formulating an effective treatment plan involves pharmacological and non-pharmacological strategies. Pharmacologically, continuation of her current medications, alongside the addition of atypical antipsychotics such as Zyprexa (olanzapine), is appropriate. Olanzapine is effective for mood stabilization and psychosis with a favorable profile for elderly patients if monitored closely (Barry & Hughes, 2021). Close collaboration with her primary care provider (PCP) is essential to adjust medications, especially considering her age, comorbidities, and history of adverse medication effects.

Non-pharmacological interventions, particularly trauma-focused psychotherapy such as cognitive-behavioral therapy for trauma (CBT-T), are crucial components. Such therapy can address residual trauma symptoms and reduce emotional distress linked to her hallucinations. Support groups and community resources are also beneficial, especially given her rural residence and social isolation. Behavioral health interventions should include psychoeducation about her illness, medication adherence, and coping strategies to manage hallucinations and depressive symptoms. Family involvement, if feasible, could bolster her support system and provide guidance on her treatment adherence.

Special considerations pertinent to her demographic include age-related pharmacokinetic changes, increased sensitivity to medication side effects, and risk for metabolic syndrome with atypical antipsychotics. Regular metabolic monitoring and assessment of medication tolerability are necessary (Barry & Hughes, 2021). Additionally, monitoring for tardive dyskinesia and weight gain is vital, given olanzapine's side profile. These precautions optimize treatment effectiveness while minimizing adverse effects.

In conclusion, the comprehensive assessment of T.H.'s case indicates that her primary diagnosis aligns with depressive disorder with psychotic features, with trauma-related factors influencing her symptomatology. An integrated treatment approach combining pharmacological therapy with trauma-informed psychotherapy offers the best prospects for symptom control and quality of life improvement. Continued collaboration with multidisciplinary teams, ongoing assessment, and patient-centered care are vital to her recovery journey.

References

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
  • Barry, H. E., & Hughes, C. M. (2021). An update on medication use in older adults: A narrative review. Current Epidemiology Reports, 8(3). https://doi.org/10.1007/s
  • Compean, E., & Hamner, M. (2019). Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Progress in Neuropsychopharmacology & Biological Psychiatry, 88. https://doi.org/10.1016/j.pnpbp.2018.08.001
  • Hany, M., Rehman, B., Azhar, Y., et al. (2023). Schizophrenia. StatPearls. Treasure Island (FL): StatPearls Publishing.
  • Monique Tello, MD, MPH. (2018). Trauma-informed care: What it is, and why it’s important. Harvard Health. https://www.health.harvard.edu
  • Hafner, H., & Lemos, T. (2018). Trauma and Psychosis: An Updated Review. Psychiatric Annals, 48(11), 508–514.
  • Luhrmann, T. M., et al. (2019). Hearing voices: A psychiatric and psychological exploration. Psychological Medicine, 49(8), 1246–1256.
  • Lewis, S. W., & Lieberman, J. (2020). Schizophrenia. The Lancet, 395(10232), 695–708.
  • Cameron, J. G., & Stallard, P. (2017). An overview of trauma and multimodal approaches to psychosis. Psychiatry Research, 259, 186–191.
  • McGorry, P. D., et al. (2020). Early intervention in psychosis: principles and practice. The Australian & New Zealand Journal of Psychiatry, 54(8), 745–753.

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