Comprehensive Psychiatric Evaluation

Week (enter week #): Comprehensive Psychiatric Evaluation
Student Name
College of Nursing-PMHNP
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint): “I do not know why everyone thinks I should be here when I am being my normal self. I really need to rush home and watch the television to find out what they are planning next”. The patient is accompanied by his younger brother John (25 years old), who arrived at the hospital shortly after learning that the patient was being admitted for causing a disturbance at the grocery store.
HPI: Miller is a 29-year-old white male. He is recently divorced with two children and lives alone in a studio apartment. Miller was brought to the hospital by the police for his second admission after creating a disturbance at his workplace (the patient works at the local grocery store, which he co-owns with his younger brother, John). The patient started yelling at customers, accusing them of trying to take his business from him. One of the customers got upset by the accusations and punched the patient. A fight ensued, and the police were called, where they immediately brought him to the state hospital on order of protective custody. The patient believes that the customers were not buyers, but agents of the CIA sent to spy on his business. He claims to have made millions last year, and the government is out to take his business. The patient also states that he learned of the CIA’s trip to his shop last night after hearing voices from the television warning him against spies. Miller’s thoughts are disorganized, and his speech is regularly interrupted by wary glances at the door. The patient is agitated and wants to get back home and watch television to learn what scheme the government plans next.
Past Psychiatric History:
* General Statement: The patient’s younger brother reports that Miller’s first psychotic episode occurred six years ago at the height of a difficult divorce with his wife of five years. Miller would shout at customers and chase them out of his store while throwing produce in their direction. The divorce was not amicable, and the extreme life event made the patient increasingly irritable, disorganized, and delusional. He would claim to hear voices from the television set and start accusing everyone of scheming against him. After trying to set his neighbor’s house on fire, the patient was admitted for a psychiatric evaluation after voices from the television set commanded him to do so. Miller was given some antidepressants and appeared to recover from his psychotic break a few weeks after the incident. Although there were a few instances when the patient would demonstrate disorganized behavior, such as giving confusing orders to vendors, Miller appeared to be generally doing well. Everyone just thought he was a “strange bird” until the recent psychotic break when the police had to bring him to the hospital.
* Caregivers (if applicable): The patient lives alone, and the only caregiver appears to be his younger brother.
* Hospitalizations: The patient was admitted on March 23, 2017, and hospitalized for three days after being diagnosed with major depressive disorder.
* Medication trials: The patient is currently on maintenance treatment (for the major depressive disorder) of Prozac 20 mg PO dDay.
* Psychotherapy or Previous Psychiatric Diagnosis: Miller was diagnosed with the major depressive disorder during his first admission. The clinician attributed his angry outbursts, hopelessness, agitation, and trouble making decisions to depression, particularly given his ongoing divorce.
Substance Current Use and History: The patient has been experimenting with marijuana, although he claims that smoking three joints daily has hardly interfered with his daily functionality. Miller is an occasional drinker but admits to overindulging on weekends (8 glasses of beer).
Family Psychiatric/Substance Use History: The patient’s younger brother states that his parents suffered from mental health issues. Their father was diagnosed with schizophrenia and committed suicide over a decade ago. Their mother also shows depressive symptoms, but no clinical diagnosis has ever been conducted. She takes medications to “manage her nerves, but she is otherwise okay.” Family psychiatric history is otherwise negative, and apart from the patient, no other family relative has a history of psychiatric disorder or suicidal behavior.
Psychosocial History: The patient lives alone in a studio apartment. He sometimes visits his children but has little to no contact with his wife or relatives. The only close relationship he has is the younger brother: Miller describes his relationship with his mother as “strained” and that they have never spoken in five years. The patient has been experiencing financial difficulties and admits he sometimes feels “lonely.” He attributes his recreational drug use to his present difficulties, although he is grateful that the store manages to “pay the bills and keep a roof over my head.” The patient’s younger brother claims that Miller’s disagreeableness and irritability have alienated him from his friends and customers. He hopes that his brother can receive the treatment he needs so that “he can get back on the horse.”
Medical History:
* Current Medications: The patient is taking Prozac 20 mg PO dDay.
* Allergies: N/A
* Reproductive Hx: N/A
ROS:
* GENERAL: Conscious but distracted, agitated, no fevers, and not in cardiopulmonary distress
* HEENT: No epistaxis, bleeding gums, ear discharge, post-nasal discharge, red eye, o...