Comprehensive Psychiatric Evaluation: Ms. Fatima Branning

Posted: September 10th, 2024

Comprehensive Psychiatric Evaluation: Ms. Fatima Branning

Subjective:

Chief Complaint: Work-related issues referred by employer

History of Present Illness:
Ms. Fatima Branning, a 28-year-old female, presents with concerns regarding her workplace dynamics. The patient expresses belief that her supervisor, Eric, harbors romantic feelings for her, despite both parties being in separate relationships. Ms. Branning perceives her boss, Mr. Nehring, as intent on terminating her employment due to this alleged situation. Notably, she reports no actual inappropriate behavior from Eric, yet interprets routine supervisory actions as indicators of attraction.

Ms. Branning acknowledges a three-week period without sales, attributing this to market fluctuations rather than personal performance. Additionally, she reports neck and back pain, which she believes may be cancer resulting from work-related stress. These somatic complaints appear to be intertwined with her workplace concerns.

Past Psychiatric History:
The patient exhibited guardedness and declined to discuss any past psychiatric history. Information regarding previous hospitalizations, medication trials, or psychotherapy remains unknown due to patient’s reluctance to disclose.

Substance Use History:
No information provided regarding current substance use or history.

Family Psychiatric/Substance Use History:
Ms. Branning denied any family mental health issues and refused permission to contact parents for corroborative information.

Psychosocial History:
Ms. Branning is an only child raised by both parents. She currently resides alone in Coronado, CA. Employed as an administrative assistant in car sales, she holds a bachelor’s degree in hospitality.

Medical History:
Current medical conditions: Scoliosis (managed with chiropractic care)
Current Medications: None reported
Allergies: Latex
Reproductive History: Regular menstrual cycles, no contraceptive use reported

Review of Systems:
General: Reports neck and back pain
Neurological: Neck pain noted
Musculoskeletal: Back pain reported
Other systems: Not specifically addressed in provided information

Objective:

Physical Examination:
Not performed during this psychiatric evaluation.

Diagnostic Results:
None reported.

Assessment:

Mental Status Examination:
Appearance: 28-year-old female, 5’0″, 118 lbs
Behavior: Guarded
Speech: Normal rate and rhythm
Mood and Affect: Anxious, suspicious
Thought Process: Circumstantial, with paranoid ideation
Thought Content: Delusions of reference (interpreting coworkers’ normal behaviors as specifically directed at her), somatic delusions (believing work stress is causing cancer)
Perception: No hallucinations reported
Cognition: Alert and oriented, no obvious cognitive deficits noted
Insight: Poor
Judgment: Impaired

Differential Diagnoses:

Delusional Disorder, Erotomanic Type (primary diagnosis)
Somatic Symptom Disorder
Paranoid Personality Disorder
Rationale for Diagnoses:

Delusional Disorder, Erotomanic Type emerges as the primary diagnosis based on Ms. Branning’s fixed false belief that her supervisor is in love with her, despite a lack of evidence. This aligns with the DSM-5-TR criteria for delusional disorder, which specify the presence of one or more delusions lasting at least one month, with relatively intact functioning outside the delusional belief (American Psychiatric Association, 2022). Ms. Branning’s delusions appear to be non-bizarre and primarily revolve around the theme of another person being in love with her, characteristic of the erotomanic subtype.

Somatic Symptom Disorder warrants consideration due to Ms. Branning’s preoccupation with physical symptoms (neck and back pain) and her belief that these symptoms indicate a serious illness (cancer). This aligns with the DSM-5-TR criteria for somatic symptom disorder, which include excessive thoughts, feelings, or behaviors related to somatic symptoms (Henningsen, 2018). However, this diagnosis is considered secondary as the somatic concerns appear to be intertwined with her primary delusional beliefs.

Paranoid Personality Disorder is included in the differential due to Ms. Branning’s suspiciousness and tendency to interpret benign actions as threatening or malevolent. However, her symptoms appear to be more acute and centered around specific delusions rather than a pervasive pattern of distrust characteristic of personality disorders (Triebwasser et al., 2019).

The primary diagnosis of Delusional Disorder is favored over Schizophrenia or other psychotic disorders due to the absence of hallucinations, disorganized speech, or negative symptoms. Additionally, Ms. Branning’s functioning outside of her delusional beliefs appears relatively preserved, which is more consistent with Delusional Disorder (Munoz-Negro & Cervilla, 2021).

Treatment Considerations:

Treatment for Ms. Branning should focus on a combination of pharmacological and psychotherapeutic interventions. Antipsychotic medications, particularly second-generation agents, may be beneficial in reducing the intensity of her delusions. Cognitive Behavioral Therapy (CBT) tailored for delusional beliefs could help challenge and restructure her thought patterns (Gonzalez-Rodriguez et al., 2020).

Given Ms. Branning’s somatic complaints, a thorough medical evaluation is warranted to rule out any underlying physical conditions. Collaboration with her primary care physician would ensure comprehensive care.

Addressing the workplace issues is crucial. While maintaining patient confidentiality, providing general recommendations to her employer about accommodations for mental health concerns could be beneficial. Additionally, vocational rehabilitation services might help Ms. Branning maintain employment while managing her symptoms.

References:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). Arlington, VA: American Psychiatric Association.

Gonzalez-Rodriguez, A., Esteve, M., Alvarez, A., Guardia, A., Monreal, J. A., Palao, D., & Labad, J. (2020). What we know and still need to know about gender aspects of delusional disorder: A narrative review of recent work. Journal of Clinical Medicine, 9(8), 2555. https://doi.org/10.3390/jcm9082555

Henningsen, P. (2018). Management of somatic symptom disorder. Dialogues in Clinical Neuroscience, 20(1), 23-31. https://doi.org/10.31887/DCNS.2018.20.1/phenningsen

Munoz-Negro, J. E., & Cervilla, J. A. (2021). A systematic review on the pharmacological treatment of delusional disorder. Journal of Clinical Psychopharmacology, 41(1), 51-61. https://doi.org/10.1097/JCP.0000000000001321

Triebwasser, J., Chemerinski, E., Roussos, P., & Siever, L. J. (2019). Paranoid personality disorder. Journal of Personality Disorders, 33(5), 679-699. https://doi.org/10.1521/pedi_2019_33_453

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College of Nursing-PMHNP
NRNP 6635: Psychopathology and Diagnostic Reasoning
Assignment .

Assessing and Diagnosing Patients With Mood Disorders
Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.
• Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
• By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, 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, 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 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.
• 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.).

Schizophrenia and Other Psychotic Disorders; Medication Induced Movement Disorders
Training Title 9 Name: Ms. Fatima Branning Gender: female Age: 28 years old T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs
Background: Raised by parents, lives alone in Coronado, CA. Only child. Works as an administrative assistance in car sales, has a bachelor’s in hospitality. Has medical history of scoliosis, currently treated with chiropractic care. Guarded and declined to discuss past psychiatric history. Denied family mental health issues, declined to allow you to speak to parents for collaborative information. Allergies: latex; menses regular, no birth control

Transcript of the video
00:00:15OFF CAMERA Ms. Branning, Mr. Nehring asked suggested you see me. He said your having some issues at work.
00:00:20MS. BRANNING You could call them that.
00:00:20OFF CAMERA What kind of difficulty are you having at work?
00:00:25MS. BRANNING Well Mr. Nehring wants to fire me.
00:00:30OFF CAMERA Why do you think Mr. Nehring wants to fire you?
00:00:30MS. BRANNING Because Eric is in love with me. And it’s probably getting in the way. And he wants to fire me.
00:00:40OFF CAMERA Who is Eric?
00:00:40MS. BRANNING Eric is my supervisor.
00:00:45OFF CAMERA Are the two of you in a relationship?
00:00:45MS. BRANNING No! Eric has his own girlfriend, I have my own boyfriend. But Mr. Nehring got it in his head that this is my fault. And they’ve been ganging up against me.
00:01:00OFF CAMERA What happened to make you feel this way?
00:01:00MS. BRANNING Eric is lustful for me. Lust. Lustful.
00:01:10OFF CAMERA Well has Eric done anything inappropriate?
00:01:10MS. BRANNING No, he doesn’t have to.
00:01:15OFF CAMERA What do you mean?
00:01:15MS. BRANNING Well, he has this way of walking toward me and he gives me the easiest assignments to do and he asks me to voice my opinion a lot in our weekly meetings. And I’m beautiful. I mean, not to be boastful or anything but I’m a strong woman. And people are attracted to that. And others, like Mr. Nehring feel threatened by it. He probably feels I could replace him in a couple years. And I could.
00:01:45OFF CAMERA But there have been no instances of sexual harassment.
00:01:50MS. BRANNING No. And now they want to fire me, and it’s probably because they don’t want me to get in the way of their day. I’m probably a distraction or something.
00:02:00OFF CAMERA According to Mr. Nehring you haven’t made a sale in three weeks.
00:02:05MS. BRANNING Oh, it’s been a slow time period. I guess it wouldn’t be bad thing if they fired me. I mean after all of this, all the bad it’s done for my health. You know I should really sue for discrimination, you know the stress and the health problems.
00:02:25OFF CAMERA You’ve been having health problems?
00:02:25MS. BRANNING Yes. Yes. It keeps getting worse.
00:02:30OFF CAMERA Can you describe it for me?
00:02:30MS. BRANNING Well you know there’s this pain in my neck, it aches, it spreads to my back, I think there’s a lump, right here. I’m really worried.
00:02:55OFF CAMERA And what do you feel is the cause?
00:02:55MS. BRANNING I told you, pain, suffering, broken heart. I think it’s cancer.
00:03:05OFF CAMERA Have you been seen by a doctor?
00:03:10MS. BRANNING No. But it’s probably cancer. And it’s slowly killing me. And it’s all because of them. And Eric’s obsession with me.
00:03:20OFF CAMERA Ms Branning, I don’t think you have to worry, a broken heart can’t cause cancer.
00:03:25MS. BRANNING You never know until it happens.
00:03:30[sil.]
00:03:30END TRANSCRIPT

Important
Informal blogs, internet posts and websites that are not part of a scholarly review process. This includes popular hospital websites (such as MayoClinic.org), Patient facing websites with information designed for the patient, not the provider (such as WebMD, Healthline and MedicineNet, among many others), and UptoDate.com. Information should not be utilized from UptoDate.com since all information is a synthesis of the most up to date literature available. If you wish to use information from UpToDate, use the original sources, not the UpToDate website.
Another student’s work. Regardless of where it is obtained, the use of another student’s written work is never appropriate. This includes use of another student’s work as a “reference”, or exemplar assignment. Templates and examples are often provided in the classroom. If they are not and you would like one, please request this from your instructor.

College of Nursing-PMHNP
NRNP 6635: Psychopathology and Diagnostic Reasoning
Assignment