Comprehensive Psychiatric Evaluation of Ms. Fatima Branning

Posted: September 10th, 2024

Comprehensive Psychiatric Evaluation of Ms. Fatima Branning
Introduction
Diagnosing mood disorders requires careful consideration of symptoms and patient history. This paper evaluates Ms. Fatima Branning, a 28-year-old woman experiencing workplace difficulties, to explore potential psychiatric diagnoses. The evaluation will consider her subjective experiences, objective observations, and possible differential diagnoses.

Subjective Information
Ms. Branning reports feeling targeted at work, believing her supervisor, Eric, is in love with her, which she thinks is causing tension. She has not made a sale in three weeks, attributing this to stress and a slow period. She also expresses concern about neck and back pain, fearing it might be cancer, although she has not sought medical evaluation.

Objective Observations
During the assessment, Ms. Branning appeared well-groomed but guarded. Her speech was coherent, yet her thought process revealed paranoid ideation and somatic concerns. She believes her colleagues are conspiring against her, and her insight and judgment appear limited.

Assessment
Mental Status Examination
Appearance: Well-groomed
Behavior: Guarded
Mood: Anxious
Thought Process: Paranoid ideation
Thought Content: Somatic concerns
Insight and Judgment: Limited
Differential Diagnoses
Delusional Disorder, Persecutory Type: Ms. Branning’s fixed beliefs about being targeted at work suggest this diagnosis. According to the DSM-5, delusional disorder involves non-bizarre delusions lasting at least one month (American Psychiatric Association, 2022).

Somatic Symptom Disorder: Her preoccupation with having cancer, despite no medical evaluation, aligns with this disorder. The DSM-5 criteria include excessive thoughts and anxiety about health (American Psychiatric Association, 2022).

Adjustment Disorder with Anxiety: The stress from perceived workplace threats may contribute to this condition. Adjustment disorders involve emotional responses to identifiable stressors (O’Donnell et al., 2019).

Reflections
In a future session, exploring Ms. Branning’s personal life and stressors outside work could provide a more comprehensive understanding. Legal and ethical considerations include addressing her workplace concerns and ensuring informed consent. Health promotion should involve encouraging medical evaluation for her somatic symptoms and discussing stress management strategies.

Conclusion
Accurate diagnosis of mood disorders requires a thorough evaluation of symptoms and patient history. For Ms. Branning, delusional disorder, somatic symptom disorder, and adjustment disorder with anxiety are considered. Further exploration of her experiences and stressors is essential for effective treatment planning.

References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537.
Stein, D. J., Phillips, K. A., Bolton, D., Fulford, K. W. M., Sadler, J. Z., & Kendler, K. S. (2019). What is a mental/psychiatric disorder? From DSM-IV to DSM-5. Psychological Medicine, 40(11), 1759-1765.
Tyrer, P., & Baldwin, D. (2019). Generalised anxiety disorder. The Lancet, 388(10063), 3048-3059.

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