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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarNRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarAssessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD EssayFear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.  NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarFor this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.ORDER A PLAGIARISM-FREE PAPER HERETo Prepare:Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.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. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarBy 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 primary diagnosis.Incorporate the following into your responses in the template:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarSubjective: 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 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.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarReflection 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.).PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:1). ZERO (0) PLAGIARISM2). AT LEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS)3). PLEASE SEE THE ATTACHED RUBRIC DETAILS, Exemplar & Template, week4 anxiety disorder, PTSD and OCD Comprehensive Psychiatric evaluation Template, and the video transcripts.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarRubric DetailSelect Grid View or List View to change the rubric’s layout.ContentName: NRNP_6635_Week4_Assignment_Rubric Grid ViewList View Excellent Good Fair PoorCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Past psychiatric history • Medication trials and current medications • Psychotherapy or previous psychiatric diagnosis • Pertinent substance use, family psychiatric/substance use, social, and medical history • Allergies • ROS Points: Points Range: 18 (18%) – 20 (20%) The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 16 (16%) – 17 (17%) The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 14 (14%) – 15 (15%) The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. Feedback:In the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 18 (18%) – 20 (20%) The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 16 (16%) – 17 (17%) The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. Feedback: Points: Points Range: 14 (14%) – 15 (15%) Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 13 (13%) The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. Feedback:In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 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.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 23 (23%) – 25 (25%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 20 (20%) – 22 (22%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. Feedback: Points: Points Range: 18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 17 (17%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. Feedback:Reflect on this case. Discuss what you learned and what you might do differently. 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.).NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 9 (9%) – 10 (10%) Reflections are thorough, thoughtful, and demonstrate critical thinking. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 8 (8%) – 8 (8%) Reflections demonstrate critical thinking. Feedback: Points: Points Range: 7 (7%) – 7 (7%) Reflections are somewhat general or do not demonstrate critical thinking. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 6 (6%) Reflections are incomplete, inaccurate, or missing. Feedback: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).NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 14 (14%) – 15 (15%) The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. Feedback: Points: Points Range: 12 (12%) – 13 (13%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 11 (11%) – 11 (11%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. Feedback: Points: Points Range: 0 (0%) – 10 (10%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarWritten Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Feedback: Points: Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided. Feedback:Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation Points: Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors Feedback: Points: Points Range: 3 (3%) – 3 (3%) Contains several (three or four) grammar, spelling, and punctuation errors Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar Points: Points Range: 0 (0%) – 2 (2%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Feedback:Show Descriptions Show FeedbackCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Past psychiatric history • Medication trials and current medications • Psychotherapy or previous psychiatric diagnosis • Pertinent substance use, family psychiatric/substance use, social, and medical history • Allergies • ROS–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 18 (18%) – 20 (20%) The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Good 16 (16%) – 17 (17%) The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Fair 14 (14%) – 15 (15%) The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. Poor 0 (0%) – 13 (13%) The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarIn the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 18 (18%) – 20 (20%) The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. Good 16 (16%) – 17 (17%) The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. Fair 14 (14%) – 15 (15%) Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. Poor 0 (0%) – 13 (13%) The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarIn the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 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.–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 23 (23%) – 25 (25%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. Good 20 (20%) – 22 (22%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. Fair 18 (18%) – 19 (19%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. Poor 0 (0%) – 17 (17%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarReflect on this case. Discuss what you learned and what you might do differently. 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.).–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 9 (9%) – 10 (10%) Reflections are thorough, thoughtful, and demonstrate critical thinking. Good 8 (8%) – 8 (8%) Reflections demonstrate critical thinking. Fair 7 (7%) – 7 (7%) Reflections are somewhat general or do not demonstrate critical thinking. Poor 0 (0%) – 6 (6%) Reflections are incomplete, inaccurate, or missing. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarProvide 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).–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 14 (14%) – 15 (15%) The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. Good 12 (12%) – 13 (13%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. Fair 11 (11%) – 11 (11%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. Poor 0 (0%) – 10 (10%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarWritten Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarLevels of Achievement: Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion were provided. Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation–Levels of Achievement: Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors Good 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors Fair 3 (3%) – 3 (3%) Contains several (three or four) grammar, spelling, and punctuation errors Poor 0 (0%) – 2 (2%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Feedback:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarTotal Points: 100Name: NRNP_6635_Week4_Assignment_Rubric______________________________________________________________________________00:00:00 BEGIN TRANSCRIPT:TRAINING TITLE 1500:00:15 OFF CAMERA So you, you said you were in the reserves? Inactive duty?00:00:20 PATIENT Well, I was inactive duty. But then I learned that they are using the stop-loss policy to extend our active duties. We have to all return to Iraq for another tour.00:00:30 OFF CAMERA Was that upsetting? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:00:30 PATIENT I can’t even begin to describe what I am feeling.00:00:35 OFF CAMERA Tell me about why you decided to make an appointment with a psychiatrist.00:00:40PATIENT Some questions I can answer. Sadness. Fear I guess. But other, other questions I can’t find the answers to.00:00:55[sil.]00:01:00 OFF CAMERA Go ahead.00:01:05 PATIENT You know how they repealed the “Don’t ask don’t tell” policy? Well, I’m struggling if I should… You don’t have to report what I tell you, do you?00:01:20 OFF CAMERA Well, it’s similar to civilian life, the military is under the same HIPPA laws. So if somebody, if one wants to look at your record, medical, only medical personnel can look in your record and only with a medical reason. And, no one else is allowed access. Any private, personal issues you have, which don’t break a law or a military rule, those are not reported. Someone could always illegally access your record, but that would be prosecuted.00:02:00 PATIENT Good. I guess you can figure out, well, I can’t figure out whether I should tell people when I go back.00:02:15 OFF CAMERA So have you been weighing the pros and cons of, the advantages and disadvantages about telling people about your sexuality?00:02:25 PATIENT Everyday. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:02:25 OFF CAMERA What do you feel are the pressures for you to tell people?00:02:30 PATIENT It’s miserable enough being over there just being a soldier, on top of that you have to listen to all these gay comments: “Oh Johnston, you look a fag when you wear your head gear like that.”00:02:45 OFF CAMERA Uh, huh. Who is Johnston?00:02:45 PATIENT He’s one of my best friends.00:02:50 OFF CAMERA Is he gay or someone who has homosexual-type thoughts?00:02:55 PATIENT Johnston. No. Never.00:02:55 OFF CAMERA Why do you say that?00:03:00 PATIENT I don’t know. I can just feel it, sense it, that he’s not gay.00:03:05 OFF CAMERA Okay. So, if I play, permit me to play the devil’s advocate, maybe there are others feel they know, can already feel whether you are gay or not.00:03:15 PATIENT No. I hide it. I’m very careful.00:03:20 OFF CAMERA Uh huh. I see. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:03:20 PATIENT If I told the other people in my unit, the men and the women, they’d be surprised. I promise.00:03:30 OFF CAMERA So you think that they all fell for the “lies” as you call it, about your sexuality?00:03:35 PATIENT Absolutely. Well, I think “absolutely.” I mean, I mean they wouldn’t feel free to make all the comments like they do if they thought that I were…00:04:00 OFF CAMERA Have you ever talked with anyone in your unit about your private, sexual thoughts,00:04:05 PATIENT No.00:04:05 OFF CAMERA Private sexual feelings?00:04:05 PATIENT No. Never.00:04:05 OFF CAMERA Do others talk with you about their sexual thoughts and feelings?00:04:10 PATIENT Like 59 minutes out of every hour, every day.00:04:15 OFF CAMERA Ah. Everyone?00:04:20 PATIENT Well, almost everyone. I mean some people are more private, stand offish.00:04:25 OFF CAMERA Yeah. So what do you fear could happen if you talk wit them?00:04:30 PATIENT They wouldn’t feel comfortable around me. In the showers. Patting me on the back. Guy hugs. Sleeping in close quarters.00:04:45 OFF CAMERA So some people, men and women, if they knew you were gay, they’d treat you differently. But hard it’s know in advance the exact gains and losses. All you know is that it would be different.00:05:05 PATIENT That it would feel lousy for somebody to get up and move away from me because they thought that I would… do something with them. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:05:15 OFF CAMERA Some may very well feel that way. Do you ever have sexual thoughts about any of the men in your unit?00:05:25 PATIENT Mild curiosity maybe about what you know someone looks like or something, undressed. But not actually having sex kinds of thoughts. I have thoughts of wanting to be close, but that’s, that’s not sexual. I mean with women, too. I enjoy close friendships.00:05:55 OFF CAMERA Sounds like… your own feelings are just a little bit confused separating out friendship and sexual feelings.00:06:05 PATIENT Well, I’ve never been in an on-going relationship. I mean a few times fooling around. A couple years back.00:06:20 OFF CAMERA Do you have doubts about whether you prefer women or if you prefer men?00:06:25 PATIENT No. No doubts. I’ve known since I was 8 what kind of… nude photos, later internet pics, videos, I like to look at. Just no real-life experiences.00:06:45 OFF CAMERA So it sounds like you feel pretty confident about your sexuality?00:06:50 PATIENT I’m gay. I know I’m gay.00:06:55 OFF CAMERA So who else, other than me just now, have you ever said those words to?00:07:00 PATIENT “I’m gay?”00:07:00 OFF CAMERA Yes.00:07:05 PATIENT Just you. Just now.00:07:05 OFF CAMERA So you don’t have experience in telling people. You haven’t practiced that skill.00:07:15 PATIENT I never thought about that as a skill. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:07:20OFF CAMERA Well you have the skill, it sounds like of thinking whether or not you are gay, which many people don’t even have that skill, But you are lacking in two skills. You have a little difficulty, little confusion about, thinking about separating friendships from sexual relations and then your lacking in that skill of telling people that you are gay. And not having those two skills, sometimes that scares people.00:07:50PATIENT Try terrifies.00:07:55OFF CAMERA Terrifies. Well, over the years, listening to people like I do with similar concerns, it’s, it’s clear to me that there are several skills in talking about one’s own sexuality. There are bad ways, bad timing for telling people about your sexuality. And there are good ways, better timing.00:08:20PATIENT Guess that makes sense.00:08:25OFF CAMERA And then another skill is recognizing that there are people who won’t want to learn directly from you about your sexuality, and there are people who do not want to learn it directly from you. Maybe because of their religious beliefs, or their cultural backgrounds, or even their lack of thinking about sexuality. So it’s a skill to look at people, talk to people and learn to sense their attitudes. So you don’t confront them and surprise them or alarm them.00:09:00PATIENT But these people, they’re supposed to be learning about sexuality in workshops and all, right?00:09:05OFF CAMERA How many times have you gone to class, learning, only to later discover it was more difficult to apply what you learned?00:09:15PATIENT Lots of times.00:09:20OFF CAMERA Yeah. So maybe one day, people will come into the military and talk open about sexuality and early in their meeting people, but not now. We’re not there now. I think we have to be realistic.00:09:35[sil.] NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:09:40OFF CAMERA You look confused. Maybe confusion’s okay. It’s a confusing topic at this point in our history.00:09:55PATIENT What other “skills” am I missing?00:10:00OFF CAMERA Well… What about dealing with rejection?00:10:05PATIENT Rejection? Damn.00:10:10OFF CAMERA Yep. That’s a skill. Think about it. Lots of celebrities and politicians, they have to be really superb at dealing with rejection. That’s a skill. If you tell people you are gay, there are people who will walk away from you. Those people may need time to go think about it. About what you shared with them. You’ve had lots of time to think about sexuality. Maybe they have not. You can expect that some of those people will come around and later be accepting. Other people who walk away from you, may feel deceived, and they may never, never come back to your side.00:10:55PATIENT That what scares me.00:10:55OFF CAMERA And you have to plan ahead for that. Rehearse it in your head, maybe rehearse with accepting friends, or counselors, people, about how you are going to deal with those moments. That’s, that’s a skill.00:11:15[sil.]00:11:20OFF CAMERA You look sad about that.00:11:25PATIENT I used to worry about rejection. And it just made me want to die.00:11:35OFF CAMERA Kill yourself?00:11:35[Shakes head “Yes”]00:11:40OFF CAMERA Any thoughts like that now? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:11:40PATIENT Not for years. I’ve seen too many people come out of the closet and do fine. I mean not so much people I know, but from TV, internet, hearing their stories.00:12:00OFF CAMERA In your unit, if you tell people, do you feel people may threaten your safety? Not watch your back when you’re in danger?00:12:15PATIENT Naw. The people in my unit are amazing. It’s more the small, the subtle looks, the… Feeling like I wasn’t with them I mean I don’t mean to sound like a pussy, but… These men, they’re all I have. Day after day. They’re right there, and I don’t… I don’t want to feel like I’m on the outside.00:13:00[sil.]00:13:05OFF CAMERA So back when you were with the unit, did you feel like they were with you, when you were not truthful with them?00:13:20PATIENT I guess not. They couldn’t be with me. I wasn’t being real. I used to dream that what I had was real. I want that to end. Not being real.00:13:50[sil.]00:13:55OFF CAMERA What are you thinking?00:14:05PATIENT That I still don’t have my answer. I have lots more weighing of pros and cons to do. Maybe that’s okay. Brush up on the skills, as you call them, while I prepare to… To tell them. How do I start? I wish I could use stop loss and take you with me.00:14:35OFF CAMERA [Laugh] Thank you for inviting me.00:14:40PATIENT You’re welcome.00:14:45OFF CAMERA I’ll tell you what, let me talk to a few people. See if… If I can identify someone with whom you can talk with overseas. But in the meantime, … Let’s, you and me… At least have a session or two before you leave. Okay?00:15:05 PATIENT Sure. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:15:10[sil.]00:15:10 END TRANSCRIPT  ______________________________________________________________________________Training Title 2100:00:00 BEGIN TRANSCRIPT:00:00:15OFF CAMERA Nice to meet you Sergeant. I’m Dr. Schwartz.00:00:20SERGEANT Nice to meet you, sir.00:00:25OFF CAMERA Can you tell me why you came here today.00:00:30SERGEANT My fiance suggested, well demanded that I make an appointment.00:00:40OFF CAMERA Why was she concerned?00:00:45[Sighs] NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:00:45SERGEANT Three nights ago, we went with her sister and husband to a county fair. Carnival rides, cotton candy, toss balls at bottles, and win big panda bears, all that silly, old-fashioned stuff, but we were having a good enough time.00:01:15OFF CAMERA So all was going well.00:01:20SERGEANT Then these fire works go off. No warning. Just big, full sky explosions.00:01:30OFF CAMERA Like county fairs do.00:01:35SERGEANT I didn’t know they did that.00:01:40OFF CAMERA Then what happened?00:01:45SERGEANT I took off running. Fast as I could. Tried to find cover.00:01:55OFF CAMERA Frightened?00:02:00SERGEANT [Sighs] Yeah, scared the… you know, out of me.00:02:10OFF CAMERA You didn’t expect the fire works.00:02:10SERGEANT These two cops saw me running, I guess they thought I pickpocketed someone, maybe tried to rob a poor country person and I was running away. They took me down, tried to cuff me.00:02:30OFF CAMERA Wow.00:02:35SERGEANT So I yelled “I’m a combat veteran sir.” Immediately they backed off. They were veterans, understood.00:02:50OFF CAMERA They understood that the fireworks sounded like combat fire?00:02:55SERGEANT Yeah, exactly sir. God. [Sighs, quivering]. They helped me to my feet, gave me some cold water. I was shaking pretty bad.00:03:10OFF CAMERA So they were helpful? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:03:15SERGEANT Yeah, absolutely.00:03:20OFF CAMERA The explosive sounds took you back in time.00:03:25SERGEANT I was… I was right back in the middle of enemy fire, sir.00:03:35OFF CAMERA What about other loud noises?00:03:40SERGEANT The same. Last week, a car backfired, I jumped behind a magazine rack. Even a sudden circular saw cutting into wood and I’m… right back there.00:04:05OFF CAMERA Are there any smells that set you off?00:04:10SERGEANT Yeah, it’s funny you should ask. Yes sir. Diesel fuel. I hate smelling diesel fuel. Chopper smells. And last week, Charlie, my neighbor, was grilling for Jenna’s birthday and he singed some hair on his arm. No injury but… the smell… I had to leave the party pretty fast.00:04:55OFF CAMERA What came to mind?00:05:00[He pauses, struggling to hold back tears].00:05:10SERGEANT Two of my buddies, they got burned when their Humvee was blown and I smelled their… I’d rather not talk about that, sir.00:05:40OFF CAMERA Memories are too strong?00:05:45SERGEANT Yeah, way too strong.00:05:50[sil.]00:05:55OFF CAMERA Do you ever dream about these events?00:06:00SERGEANT Every night, sir. Yeah, makes me not want to crawl in bed, not close my eyes.00:06:10OFF CAMERA So you have nightmares. You startle easily. Are there any other problems that you’ve noticed?00:06:20SERGEANT Like what, sir?00:06:25OFF CAMERA Other cues that cause flashbacks or make you anxious?00:06:35SERGEANT Traffic. I hate real busy, downtown traffic. Stopping at a traffic light, with people in front of you and behind you, on both sides of you. I can’t stand that. I start breaking out in a sweat, I start shaking, and I can’t catch my breath.00:07:05OFF CAMERA What about traffic is so bad?00:07:10SERGEANT Someone could roll an IED under your car. You’re trapped. You can’t get out.00:07:25OFF CAMERA That happened overseas?00:07:25SERGEANT Yeah. Yeah, to four of my buddies. Blew’em to hell. And I saw it happen to two other vehicles. I didn’t know the guys but… God several times we’d be stuck in traffic, and people were staring at us. And I knew we were going down. Men, women, children. I mean, any of ’em could’a rolled an IED under us.00:08:10[He breathes heavily] NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:08:15OFF CAMERA You look like you’re breathing heavily right now just talking about it.00:08:20[Holding back]00:08:20SERGEANT Yeah, sorry, sir. I can’t help it.00:08:30OFF CAMERA Any other difficulties?00:08:40SERGEANT Sometimes my fiancé argues with her mother. It used to not matter. Now I can’t handle it. It seems like any negative situation and I just want to crawl into a hole and hide. I’m a wimp, a freaking coward. I don’t, I don’t want to go anywhere. I don’t want to go out to restaurants, or shopping or even to baseball parks. I just stay in my room all day. Afraid to sleep. It’s bad.00:09:40OFF CAMERA Have you talked to anyone else about this?00:09:45SERGEANT Just you. Just now. I don’t want to remember.00:09:55OFF CAMERA You’re very brave for sharing your story with me. I know that must be horribly difficult for you.00:10:05SERGEANT Sometimes my stomach muscles get tight. I start getting nauseated.00:10:15OFF CAMERA Your body is reacting normally to bad events that you’ve experienced.00:10:20SERGEANT I don’t want to be a whiner.00:10:25OFF CAMERA You know, talking can actually help your brain to heal. Talking takes it out of the feeling mode and puts it into the thinking mode so that you don’t hear those same stories over and over again. So in a way you feel like you’re in control. We could work on this together.00:10:55SERGEANT I would like that, sir. Very much.00:11:00OFF CAMERA Good. Let’s get you scheduled for an appointment then.00:11:05SERGEANT Thank you, sir. Sometimes I feel like it’s never going to end. You know I thought I was going to crazy. Sometimes my mind just sinks back into itself, like I can’t see or hear or move. It’s like I’m numb all over. Lose track of time.00:11:40SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com00:11:40 END TRANSCRIPT NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarTraining Title 37BEGIN TRANSCRIPT: 00:00:15PATIENT I went to the emergency department last week, because I was feeling like I was dying from a heart attack, and they did one of those, what do you call it? Ah, an EKG. And it was normal. But I was sweating and I was having trouble like catching my own breath. And my heart was pounding really, really hard. And I, and I just felt like my, my heart was just going to explode out of my chest. It almost felt like, um, like when your… I don’t know, when you’re in the woods. Uh, alone and, and you… you, feel like someone is, is following or, or chasing you. Or something like that. I, I just, I just my heart felt like it was about to leap out of my chest. I… And uh… I don’t know, probably twelve, fifteen minutes went by and, and the feeling just went away. It just passed. But then… the next day, it was the very same thing and I, for no reason at all. Just all of a sudden, I was making coffee and then WAM, that, that, that tightness in my chest came back and I was sweating and my heart was pounding, same exact feeling. Twelve, fifteen minutes, and then it just went it away. It was like… almost it was almost like my mother, I remember she would get the same thing, probably three to four times a week. It’s just sheer panic for no particular reason at all. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:02:20SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com 00:02:20 END TRANSCRIPT   Training Title 40BEGIN TRANSCRIPT: 00:00:00[sil.] 00:00:15[She nervously plays with her scarf as she breathes anxiously] 00:00:25OFF CAMERA Hello Mrs. Weidre. Are you ok? Do you want some water or something? 00:00:30MRS. WEIDRE I’m ok. I’m fine. 00:00:35OFF CAMERA I understand you wanted to see me today. 00:00:40[She breathes anxiously] 00:00:40MRS. WEIDRE I just really needed to sit and talk. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:00:40OFF CAMERA Well, tell me what’s wrong, what are you feeling? 00:00:50MRS. WEIDRE I’m just so… so unsure. I’m tired of being stuck in my house. I don’t like it. 00:01:00OFF CAMERA Stuck in your house? Do you have difficultly leaving your house? 00:01:05MRS. WEIDRE Yes. All the time. 00:01:05OFF CAMERA When do you go out? 00:01:10MRS. WEIDRE …maybe, once or twice. 00:01:15OFF CAMERA A day? 00:01:15[She clutches her hands to her chest] 00:01:15MRS. WEIDRE A week. Tuesdays and Saturdays. 00:01:20OFF CAMERA Why Tuesday and Saturday? 00:01:30MRS. WEIDRE Because when my husband gets home, he can go with me. 00:01:35OFF CAMERA What do you do when you go out? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:01:40MRS. WEIDRE I take walks. 00:01:40OFF CAMERA Where do you walk? 00:01:40MRS. WEIDRE I only go to the end of the block, and then I cross the street, and turn around, and I go back around the cul-de-sac. I’ll do that three times. [Losing breathe] No more, then I have to go back inside… I also go in my backyard. That’s usually okay. 00:02:15OFF CAMERA On the walks, why do you have to go back after three times? What happens? 00:02:20MRS. WEIDRE [She nervously looks around] I just can’t go any further. 00:02:25OFF CAMERA Is this a physical problem, knees or something? 00:02:30[She plays with her scarf] 00:02:30MRS. WEIDRE No. No. Well… maybe. I just can’t breathe if I’m out any longer. 00:02:40OFF CAMERA Oh, breathing? 00:02:40MRS. WEIDRE Yeah. 00:02:40OFF CAMERA What do you feel? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:02:45MRS. WEIDRE [Her voice quivering] I’m just so frightened. Really, really scared. You don’t realize what it took for me to get here today. I really had to. I willed it. I closed my eyes and my husband turned the radio up all the way as he drove. And then he lead me into the building. 00:03:20OFF CAMERA Is there something that triggers this, anything in particular? 00:03:30MRS. WEIDRE I don’t like people. Maybe that’s it. I mean I can tolerate them. Ethan, the little boy next door, I’ll bake things for him and say hello. Sometimes, sometimes I watch him when his parents are gone. I mean I can be around people. Maybe that’s not that’s not what I meant. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:04:00OFF CAMERA Ok, can you walk me through what happens when you do leave the house? 00:04:05MRS. WEIDRE I get shortness of breathe, everything, the world just seems to close in on me, and everything gets feels really tight, the air in my body, my chest. I get dizzy. I don’t know what’s wrong… I could be sick. What is this? 00:04:30OFF CAMERA There can be many different causes for this. What is it that frightens you? 00:04:40MRS. WEIDRE [She’s short of breathe] Death. I’m afraid to die. 00:04:45OFF CAMERA You’re afraid you might die? 00:04:50MRS. WEIDRE Yes. Among other things but that’s what pops into my head. 00:04:55OFF CAMERA Is there other stuff? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:05:00[sil.] 00:05:05MRS. WEIDRE Cars go to fast. And there’s murders and rapes that I see on the news. And flashfloods. I just think its close, its safer to stay close to home. 00:05:15OFF CAMERA How long have you had this fear? 00:05:20MRS. WEIDRE I don’t really know. 00:05:20OFF CAMERA Do you know when it all started? 00:05:25MRS. WEIDRE I’m not sure. 00:05:30OFF CAMERA Do you know what started it? 00:05:30MRS. WEIDRE No. 00:05:35OFF CAMERA When was the last time you really ventured out for any length of time? 00:05:40MRS. WEIDRE Fifteen years. 00:05:45[She nervously shifts in her chair] 00:05:45OFF CAMERA That long. Is this the farthest you’ve been in fifteen years? What happened fifteen years ago? 00:06:00MRS. WEIDRE I don’t really know. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:06:05OFF CAMERA There is nothing that happened to you personally that could have made you afraid of dying? 00:06:10MRS. WEIDRE I always was. My mother died the year before that. But it happened little by little. First it was planes. And then I couldn’t drive on the freeway, then I couldn’t drive at all, then errands, then it was going out… and soon… here I am. 00:06:40OFF CAMERA It must have taken you extraordinary courage to come here today. What finally brought you to see me? 00:06:50MRS. WEIDRE My grandson was born. But I couldn’t go and see him. I still haven’t seen him. My daughter gave birth last week and she’s not going to bring him to see me for several months and I don’t want to wait that long. 00:07:10OFF CAMERA You miss out. 00:07:15MRS. WEIDRE Yes! Of course, I do! My grandson is a thousand miles away and I can’t leave the God damned house. 00:07:25[sil.] 00:07:25 END TRANSCRIPT  NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar  Training Title 55BEGIN TRANSCRIPT: 00:00:00[sil.] 00:00:15OFF CAMERA Hi, Mrs. Johnson. 00:00:20MRS. JOHNSON Hi. 00:00:20OFF CAMERA I’m Dr. Gray. 00:00:20MRS. JOHNSON Hi, Dr. Gray. 00:00:20OFF CAMERA Very nice to meet you. 00:00:25MRS. JOHNSON This is Matilda. Matilda, this is Dr. Gray. 00:00:25OFF CAMERA Hi, Matilda. Very nice to meet you. Matilda, can you tell me about why you came here today? 00:00:30MRS. JOHNSON Yes, we sure can. Matilda has been having headaches and stomachaches and so we thought there might be something wrong. So we went to her pediatrician, Dr. Ferguson, but Dr. Ferguson, he couldn’t find a thing. So he said we had to come here to see you. And in addition to having the headaches and the stomachaches, Matilda — she hasn’t wanted to go to school and, you know, she cries, and then when she gets there, she says she has a stomachache. And the teacher calls me and, of course, I come and get her right away. But we just can’t keep doing this. 00:00:55OFF CAMERA And how long has that been going on that she’s been missing school? 00:01:00MRS. JOHNSON Right after the holidays, so about three months. 00:01:05OFF CAMERA Three months? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:01:05MRS. JOHNSON Yeah, last week was really the last straw. I guess that’s why we kept this appointment. 00:01:10OFF CAMERA What happened? 00:01:10MRS. JOHNSON Well — well, I took Matilda to school. When we got there she refused to get out of the car. And so I had to lock the door and go inside and get the principal and the principal had to come back out and carry her into the school. I mean, it was awful and it was embarrassing for me, it was embarrassing for Matilda. It just — we just can’t go on like this. 00:01:30OFF CAMERA How many children do you have? 00:01:35MRS. JOHNSON Three; Matilda is my baby. 00:01:35OFF CAMERA Ah, the youngest. 00:01:35MRS. JOHNSON Yeah, I have a 12-year-old boy and a 14-year-old girl. 00:01:40OFF CAMERA And have they ever had any difficulty similar to this? 00:01:45MRS. JOHNSON No, I think that’s why this is so surprising. 00:01:50OFF CAMERA Matilda, what do you think about school? 00:01:55MATILDA I hate it. 00:01:55OFF CAMERA You hate it? You hate school? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:01:55MATILDA Mm-hmm. 00:01:55OFF CAMERA Why do you — what do you hate about it? 00:02:00MATILDA I don’t like the classwork they give me and stuff like that. 00:02:05MRS. JOHNSON Matilda makes very good grades. 00:02:05OFF CAMERA So she does okay? 00:02:05MRS. JOHNSON Yes, she’s a very good student. 00:02:10OFF CAMERA Do you have friends there at school? 00:02:10MATILDA Yeah. 00:02:10OFF CAMERA Yeah? And what about the teachers? Are they nice? What’s it like leaving home to go to school? 00:02:25MATILDA Scary. 00:02:25OFF CAMERA Scary? Matilda, there’s no reason to be frightened. 00:02:30OFF CAMERA What — what is it that scares you when you leave home to go to school? 00:02:35MATILDA That I might get kidnapped or something. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:02:40OFF CAMERA Kidnapped? 00:02:40MRS. JOHNSON Kidnapped? 00:02:40OFF CAMERA Have you ever known someone to get kidnapped? 00:02:45MATILDA No. 00:02:45OFF CAMERA Is anybody ever said that they were going to do that to you? 00:02:50MATILDA No. 00:02:50OFF CAMERA But that scares you when — that something is going to happen to you when you go to school? 00:02:55MATILDA Right. 00:02:55OFF CAMERA And how old are you? 00:02:55MATILDA Nine. 00:03:00OFF CAMERA Nine? Okay, and what grade are you in? 00:03:00MATILDA Third. 00:03:00OFF CAMERA Third. Is this a new kind of problem over the last few months? 00:03:10MRS. JOHNSON Yes, I had no idea that she was frightened. 00:03:15OFF CAMERA Do you know if any traumatic things have happened around the school? Or any special things at home? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:03:20MRS. JOHNSON No, no, nothing. Nothing’s has been happening at all. 00:03:20OFF CAMERA Well, Mrs. Johnson, I’d like to talk to Matilda alone for a few minutes — maybe about five minutes or so. If you could just wait in that room where you came from right next door there and then Matilda and I will talk, okay? 00:03:35MRS. JOHNSON I think that would be okay; Matilda, is that okay with you? 00:03:35MATILDA Yeah. 00:03:40MRS. JOHNSON Okay, you sure? Okay, because you know I’m always here for you, Matilda. You need me you just tap on the wall, okay, and I’ll come right in. 00:03:45MATILDA Okay. 00:03:45MRS. JOHNSON Okay. 00:03:45OFF CAMERA Okay. Thanks, Mrs. Johnson. 00:03:50MRS. JOHNSON Matilda, it’s okay, I’m just going to be right next door. Okay? You okay? 00:03:55MATILDA Yeah. 00:03:55MRS. JOHNSON Okay. 00:04:00OFF CAMERA Okay, Matilda, Matilda; can you just stay here — just have a seat for just a moment. We’re just going to talk for about five minutes. Your mom’s in the room right next door and then we’ll just — and then I’ll let you go get her and you can bring her back, okay? Thank you very much for sitting there. What is that like for you when your mom’s away in the next room, away from you? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:04:15MATILDA Scary. 00:04:20OFF CAMERA Scary? What’s scary? 00:04:20MATILDA That she might leave and not come back. 00:04:20OFF CAMERA Like to stay away for a long time? Or forever? 00:04:25MATILDA Forever. 00:04:25OFF CAMERA Forever. Did she ever threaten that she was going to do that? 00:04:30MATILDA No. 00:04:30OFF CAMERA Did she ever leave you before? 00:04:30MATILDA No. 00:04:30OFF CAMERA Anybody ever leave you? 00:04:35MATILDA Hmm-mm. 00:04:35OFF CAMERA But you fear that’s what’s going to happen? You have nightmares? 00:04:40MATILDA Mm-hmm. 00:04:40OFF CAMERA When you have nightmares, what is it you dream about? 00:04:45MATILDA That mommy or daddy will be in an accident. 00:04:45OFF CAMERA In an accident? What kind of accident? 00:04:50MATILDA A car accident. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:04:50OFF CAMERA Have they ever been in a car accident? 00:04:55MATILDA No. 00:04:55OFF CAMERA What about almost had an accident? 00:04:55MATILDA No. 00:04:55OFF CAMERA Have you ever known someone who was in a car accident? 00:05:00MATILDA No. Can she come out and — 00:05:00OFF CAMERA Just, just a minute. When it gets dark and night time, what’s that like for you? 00:05:10MATILDA Scary. 00:05:10OFF CAMERA The dark scares you? What is it about the dark? 00:05:15MATILDA That people are staring at me. Can she come now? 00:05:20OFF CAMERA Just a moment — just want to sit — do you feel that people are staring at you? Can you see these people? 00:05:25MATILDA No. 00:05:25OFF CAMERA Can you hear the people? 00:05:25MATILDA No. Can she come now? 00:05:30OFF CAMERA Just a minute, just a minute. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:05:30MATILDA No. 00:05:30OFF CAMERA Wait, wait, wait. I want you to stay here for just a minute. 00:05:35MATILDA No. No, no. 00:05:35OFF CAMERA Okay, okay. 00:05:40[sil.] 00:05:45OFF CAMERA Did you find her? 00:05:45MATILDA No. 00:05:45OFF CAMERA Okay. Yeah. 00:05:45MATILDA No. 00:05:45OFF CAMERA Well, I’m sure she’s just right — here she comes. Here she comes. 00:05:50MRS. JOHNSON You okay? Okay. 00:05:55MRS. JOHNSON How’d she do? 00:06:00OFF CAMERA Well, I think she gets pretty scared when you are out of the room, when you’re not around her. 00:06:05MRS. JOHNSON Scared, Matilda? There’s no reason to be frightened. I’m always here for you. It’s going to be okay. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:06:10OFF CAMERA Does she have any problems going to sleep? 00:06:10MRS. JOHNSON No, she goes to sleep from — I want to say around 8:30 and then I lay down with her and we read a book or sometimes we’ll talk and then she falls asleep and I get up and leave. And no, she never has any problems. 00:06:25OFF CAMERA Does she — does she ever go to sleep without your lying beside her? 00:06:30MRS. JOHNSON No, I’m almost always lie down with her. 00:06:30OFF CAMERA Did she ever spend the night over at friends’ houses? 00:06:35MRS. JOHNSON Was it two weeks ago Katie asked you to spend the night? Yeah, we were surprised because we really like Katie and we really wanted her to, but so far Matilda’s never spent the night at another friend’s house. 00:06:45OFF CAMERA Does she ever go away to camp or something like that? 00:06:50MRS. JOHNSON Well, last Sunday at church they had a sign-up for camp and Matilda — we were so proud she put her name down. And then when we got in the car we were all ready to go home, she announced that wasn’t going to camp and nobody could make her. And we asked her why, and she wouldn’t tell us. And so I think she’d have a really good time but now I don’t know whether she’s going to camp or not. 00:07:10OFF CAMERA So what — if you tried to push her to do something that she wasn’t — doesn’t want to do; what’s that like? 00:07:15MRS. JOHNSON She’ll have a temper tantrum. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:07:15OFF CAMERA Oh, she has a temper? 00:07:20MRS. JOHNSON Yeah, do you mind if I tell him about last Saturday? So the dog was sitting by the door, wanted to go for a walk and Matilda was watching her favorite TV, and of course, she didn’t want to. And she started screaming and yelling. And we sent her upstairs to her room for a time out. Are you sure you want me to tell him? 00:07:40MATILDA Yeah. 00:07:40MRS. JOHNSON Okay. It’s okay. She has this model house that she made and she threw it across the room and it broke. I mean, it’s totally broken. So yeah, she can have a temper. 00:07:55OFF CAMERA Matilda, what about walking the dog did you not like? 00:08:00MATILDA I was scared. 00:08:00OFF CAMERA What were you scared of? 00:08:00MATILDA That I might get kidnapped. 00:08:00MRS. JOHNSON Kidnapped? Matilda you were just going around the block. 00:08:05OFF CAMERA Mrs. Johnson, can you think of anything that has happened n the neighborhood? 00:08:10MRS. JOHNSON No, nothing at all. I can’t imagine her being afraid. 00:08:15OFF CAMERA Has anyone died or moved away? 00:08:15MRS. JOHNSON No, we’ve been very lucky no one in our family has died. 00:08:20OFF CAMERA Both sets of grandparents? 00:08:20MRS. JOHNSON Yes, we still have both sets. 00:08:25OFF CAMERA Oh, nice, nice. How about any pets? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:08:25MRS. JOHNSON No, Matilda just has the one dog. No, she never had a pet die. 00:08:30OFF CAMERA Mrs. Johnson, do you work? 00:08:35MRS. JOHNSON No, I mean — I work at home, of course, but I don’t work outside the home. I used to when my other children were little. I was a secretary. I always knew I would go back to work when Matilda turned three. But for some reason I never did. I really — I really enjoy having Matilda. 00:08:50OFF CAMERA And being there with her? 00:08:50MRS. JOHNSON Yeah. 00:08:50OFF CAMERA How’s she about doing chores? 00:08:55MRS. JOHNSON She is a real helper. She’ll help me unload the dishwasher, sometimes even load it. Last weekend she dusted. She’s a gem. I love her. 00:09:05OFF CAMERA Does she ever go out with her brother or with other relatives? 00:09:05MRS. JOHNSON She’ll play with her brother once in a while. And she use to spend the night over at my brother’s house, but she hasn’t done that in a long time. 00:09:15OFF CAMERA Okay. Matilda, has anyone ever hurt you? Or beat you up in any way? 00:09:20MATILDA No. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:09:20OFF CAMERA Have you ever had anybody — has she ever had any medical illnesses? 00:09:25MRS. JOHNSON No, she was a really healthy baby. 00:09:25MATILDA Okay. 00:09:30MRS. JOHNSON She had the chickenpox about three years ago. You don’t think that could have… 00:09:35OFF CAMERA Can you think of anything special that happened when she had the chickenpox? 00:09:35MRS. JOHNSON No, not really. No, she’s been real healthy. 00:09:40OFF CAMERA Matilda have you had — ever had anybody touch you in a way that didn’t feel right? That made you feel uncomfortable? 00:09:50MATILDA No. 00:09:50MRS. JOHNSON You haven’t, have you, Matilda? Have you? 00:09:50MATILDA No. 00:09:55MRS. JOHNSON You’re sure? You’d tell me, right? 00:09:55MATILDA Mm-hmm. 00:09:55MRS. JOHNSON Oh God, Matilda. I don’t think I could live with that. Oh my God. Matilda… 00:10:00 END TRANSCRIPT  Training Title 85BEGIN TRANSCRIPT: 00:00:15 CAROL Sorry, I, I can’t find it. 00:00:20 OFF CAMERA It’s okay. 00:00:20CAROL No, it’s not. Where is it? I never, I never leave without it. Oh Jesus. 00:00:30OFF CAMERA What is it you’re looking for? 00:00:30CAROL My cell. I never check the b. . . um, the trunk. I have to go. 00:00:45OFF CAMERA You seem very upset not to have your phone with you. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:00:50CAROL Of course, who wouldn’t be? We’ll have to talk some other time. 00:00:55OFF CAMERA Your husband must have his phone, he called that you were running late. 00:01:00CAROL Yeah, he has his phone, but . . . 00:01:00OFF CAMERA But what? 00:01:05CAROL The children do not call their father when they want something. 00:01:10OFF CAMERA They never call your husband? 00:01:10CAROL No, they only call me. 00:01:10OFF CAMERA Uh-huh, are you expecting your children to call? 00:01:15CAROL My children are at home with the babysitter, my neighbor. She’s a widow. I just, I don’t feel comfortable, in case they need me. And I always call, they’ll be worried if I don’t. 00:01:35OFF CAMERA How often do you call your children when you’re away from home? 00:01:40CAROL I don’t know, a few times. Just normal checking. 00:01:45OFF CAMERA Do you work? 00:01:45CAROL I’m a mother, so yes, I work. 00:01:50OFF CAMERA I’m sorry, I didn’t mean to suggest parenting isn’t work. It very much is work. Do you also have a job outside of the home? 00:02:00CAROL I used to work from home. I quit my job after my last child, Colin, he’s five now. But, this really isn’t the time for this right now. Nor ever, really. I’m just here as a courtesy, no offense. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:02:20OFF CAMERA I understand you do not want to be here. But it would be helpful if we could talk for a few minutes. Perhaps your husband can call your children. Do you want me to go get him for you? 00:02:35CAROL I’ll be fine. We can talk for five more minutes. 00:02:40OFF CAMERA Thank you. You seem to have strong feelings that you want to call your children. But you do not have strong feelings that you want to ask your husband to call them. 00:02:50CAROL He refuse. We don’t see eye-to-eye. But I’m not here for marriage counseling. 00:03:00OFF CAMERA What is your understanding about why you’re here? 00:03:00CAROL Ask my husband, Greg. 00:03:05OFF CAMERA What current concerns do you have when you leave your children? 00:03:10CAROL There’s a laundry list on that one. Start with serial rapists and end with Newtown, and you’ve only scratched the surface. 00:03:20OFF CAMERA How often do you worry about those types on incidents? 00:03:20CAROL I’m mother of three. I have to keep in mind the world as it is. Part of my job description. Every day, people die from gun deaths. 18,000 people are raped. Over 50,000 children go missing every year. 00:03:40OFF CAMERA Those are unsettling statistics. 00:03:45CAROL Dr. Phil did a profile on a serial rapist, that was horrifying. I called my friends to watch it. I TiVo’ed it for them. 00:03:50OFF CAMERA Do you follow a lot of news programs? 00:03:55CAROL Yeah. 00:03:55OFF CAMERA What do you tend to watch? 00:03:55CAROL Most of the shows. I have CNN on background for when I’m doing laundry or cooking, or prepping lessons. 00:04:05OFF CAMERA Lessons, what lessons do you prepare? 00:04:10CAROL For the children. 00:04:10OFF CAMERA Oh, do you school your children at home? NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:04:15CAROL Yes, I homeschool my children. I don’t appreciate your connotations. The stereotype that homeschooling is for religious nuts is outdated. The reality is our school systems are broken. Our public schools can’t even afford protection for our children. 00:04:35OFF CAMERA Was that one of the reasons you decided to homeschool your children was because of school violence? 00:04:45CAROL You mean… ? 00:04:45OFF CAMERA Pardon? 00:04:45CAROL Ridge View? 00:04:50OFF CAMERA Yes, Ridge View, uh-huh. 00:04:50CAROL 12 students murdered, three teachers gunned down trying to protect students. They couldn’t protect themselves. Campus police didn’t have time to stop it. That kid’s mother and father lay dead in their house for over a week before that school massacre. Today Show profiled the ex-girlfriend. She said there was plenty of warning signs. Did the administrators listen? No. No one was capable of seeing what was coming. Yet, their signs were obvious. That child murderer drew horrifying pictures in his art classes, and you know what the teachers said? 00:05:25OFF CAMERA No. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:05:25CAROL The teachers defended him. Said his evil artwork was a school assignment. Yes, to answer your question. Yes, I think school violence is a reason for homeschooling children. 00:05:45OFF CAMERA Do these violent events seem to stay with you, hang with you? 00:05:55CAROL I see those children’s faces. They could have been my children. Greg is heartless. Instead of helping me protect our children, he sent me to a shrink. 00:06:15OFF CAMERA Do you think that there are times where you over-worry? 00:06:25CAROL I won’t lose my children. 00:06:25OFF CAMERA Do you fear that similar violent events may happen here at these schools? 00:06:35CAROL Ridge View is only 100 miles from here, 100. That may as well be one mile. 00:06:45OFF CAMERA How long have you been homeschooling your children? 00:06:50CAROL Two months. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:06:50OFF CAMERA So you began homeschooling them, so that was about a month after the Ridge View incident shootings? 00:07:00CAROL Yeah. When I pulled the children from school, Greg and I had a big fight, but it’s for the best. The children are learning more now than they ever learned at school. They still socialize, they still have friends. Now, my girlfriends are considering doing the same with their children. They see how well mine are doing. My girlfriends are every bit as frightened as I was. This isn’t some sort of frantic phobia on my part. I’m an educated woman about these matters. Greg, doesn’t understand what it’s like to lose family. 00:07:50OFF CAMERA Do you have stronger feelings about losing people than your husband does? 00:07:55CAROL Yes, I do. 00:08:00OFF CAMERA Have you lost people who were close to you? 00:08:05CAROL My parents, car accident, drunk driver, I was 19. 00:08:10OFF CAMERA Oh, I’m sorry to hear that. 00:08:15CAROL It happens, like that. They’re gone. I won’t lose a child. I won’t lose more people I love. 00:08:25OFF CAMERA Have these fears been increasing more recently for you? Preoccupying you, more of your time? 00:08:35CAROL Yes. I think about what happened to me, to my parents, what could happen to my children. 00:08:50 OFF CAMERA What is it like to realize you cannot protect them all of the time? 00:09:00CAROL That’s what Greg says. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:09:05 OFF CAMERA Do you disagree with him? 00:09:10 CAROL, you protect them from what you can. You stop what you can. I couldn’t prevent that driver from sideswiping my parents, pinning them to the freeway median. I can prevent another Adam Lanza from pointing a gun at my babies. I won’t send them back to school. I won’t turn off the television, and I won’t stop informing myself. I will do what I can as a mother to protect my children. I’m sorry, I have to end this now, and call my children. I’ll call them now. 00:09:45 END TRANSCRIPT  NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarTraining Title 95 BEGIN TRANSCRIPT: 00:00:10[sil.] 00:00:15 UNKNOWN On your mental health checklist here, I see you checked shame and checked embarrassment. 00:00:20UNKNOWN Yes. 00:00:25UNKNOWN And checked feelings of loss of control. Is… is that all accurate? 00:00:30UNKNOWN Very. 00:00:30UNKNOWN Are those feelings weak feelings, strong feelings, somewhere in between? 00:00:35UNKNOWN Strong. 00:00:40UNKNOWN When… when did this feeling start? 00:00:40UNKNOWN About the time I started pulling out my hair. 00:00:45UNKNOWN Uh-huh. And how long ago was that? 00:00:50UNKNOWN I have, maybe six years ago. 00:00:50UNKNOWN Uh… 00:00:50UNKNOWN Could’ve been seven, I’m not sure. 00:00:55UNKNOWN Okay. Where… where on your body did you first pull out here? 00:00:55UNKNOWN Hmm, my eyebrows. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:00:55UNKNOWN Uh-huh. 00:01:00UNKNOWN Umm…Yeah, I just started playing with them while I was at work, proofreading reports I typed umm… with more just like rubbing them, you know, playing with them, not actually pulling the hairs out just like a nervous habit. 00:01:15UNKNOWN Uh-huh. 00:01:15UNKNOWN You know that that was all. 00:01:20UNKNOWN And… and did that change what you were doing? 00:01:25UNKNOWN Umm… Well, my coworkers noticed it before I didn’t… 00:01:30UNKNOWN Uh-huh. 00:01:30UNKNOWN You know, one day she said to me uh… goodness girl, that’s how we used to talk to each other. 00:01:35UNKNOWN Oh, okay. 00:01:35UNKNOWN She said, “Goodness girl, you’re plucking out your eyebrows.” And I… I said, “I was not.” Umm… “Maybe just some fell out while I was rubbing them. They can do that, you know, like fall out or never do… 00:01:50UNKNOWN Right. Uh-huh. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:01:50UNKNOWN Well, at least, I think they can. Then when I checked in the mirror, my… my right eyebrow had fewer hairs on my left eyebrow. 00:02:00UNKNOWN Was that the first time you ever had pulled out any hairs? 00:02:05UNKNOWN I mean, apart from maybe when getting ready for a party, you know, the first time was by accident so… 00:02:10UNKNOWN Uh… Uh-huh. And it was only your right eye… eyebrow? 00:02:15UNKNOWN Uh… Well, at first, yeah, then uh… I… I put wax on my right eye… eyebrows so that when I reached up there it felt different. 00:02:25UNKNOWN Oh, oh. 00:02:25UNKNOWN Uh… Then umm… I started playing with my left eyebrow and pulling those hairs out umm… until all the hair was gone from both eyebrows umm… I mean, some women do that for fashion and then they… they draw them in. 00:02:45UNKNOWN Right. 00:02:45UNKNOWN Mostly older women, so that’s what I did, but then they both grew back and so I never touched him again. 00:02:55UNKNOWN Uh-huh. They never pulled out eyebrow, hairs again? 00:02:55UNKNOWN Never. Mm-mm. Then uh… I just started pulling out hair from my scalp. 00:03:05UNKNOWN Mm-hmm. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:03:05UNKNOWN It just started the same, playing and twisting, and trolling like I was a little girl and then somewhere in that I started pulling the hairs out. 00:03:20UNKNOWN How did you feel when you realize that’s what you were doing? 00:03:25UNKNOWN Oh, shit. When I felt sorry… Pardon the language, but that’s what I felt like, here we go again. 00:03:35UNKNOWN Did anyone else notice? 00:03:40UNKNOWN Coworkers, I mean, you… you can’t get anything passed at bunch. I mean, I would deliberately play and twist and twirl with my hair in places that I knew I hadn’t pulled any hair out, you know, just in case I stopped subconsciously pulled more hair out uh… but they… they noticed the bald spots. I mean, they were little bald spots, but like I said, you… you can’t get anything passed at bunch. 00:04:05UNKNOWN So you quit pulling hairs out of your eyebrows and then you started pulling hairs out of your scalp, did you pull hairs from anywhere else? 00:04:15UNKNOWN Where else can I pull hairs from? 00:04:20UNKNOWN Arms, legs, private parts. 00:04:20UNKNOWN No. Hell, no. It was bad enough I was going to bald as it was. 00:04:25UNKNOWN I… I notice you have a scarf on today. 00:04:30UNKNOWN Yeah, I’ve got a scarf on over a wig. I mean, there’s not much hair going on underneath it. No one seeing me with a bald head. No. 00:04:40UNKNOWN That… that uh… embarrasses you and makes you feel ashamed? 00:04:45UNKNOWN Yes, sir, it does. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:04:45UNKNOWN Uh-huh. 00:04:45UNKNOWN Do you have any other habits or rituals that concern you? 00:04:50UNKNOWN What do you mean “rituals”? 00:04:55UNKNOWN Umm… Some people have habits or rituals is like, they have to touch a refrigerator a certain number of times before they open or they have to wash their hands at a certain number of times before they feel like their hands are clean, ritual something you do is a habit that maybe other people don’t usually do. 00:05:15UNKNOWN Yeah. I mean, when I have to unplug my… my mixer or… or hair dryer, I mean, not that I’m drying much hair nowadays, but I have to unplug it then plug it back in, unplug it, plug it back in… 00:05:30UNKNOWN Uh-huh. 00:05:30UNKNOWN Just same with the light switch. You know, I have to switch it on, switch off, switch it on, switch it off. 00:05:35UNKNOWN Uh-huh. How many times? 00:05:40UNKNOWN Eleven. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:05:40UNKNOWN Eleven times plugging and unplugging and also turning on and off switches. Uh-huh. 00:05:45UNKNOWN Yes. 00:05:45UNKNOWN They must cut in your time. 00:05:45UNKNOWN Sure, it does. 00:05:50UNKNOWN Mm-hmm. How long has that been going on? 00:05:55UNKNOWN Since I was a little girl. You know, my mom would always get mad at me for taking so long, you know. I mean, I don’t know what she thought I was doing in the bathroom and bedroom for so long all the time. I can pitch her yelling at me to come downstairs to dinner or get into the car. 00:06:15UNKNOWN Uh-huh. Any other rituals? 00:06:15UNKNOWN I think that’s enough for one person. 00:06:20UNKNOWN Yeah. What… what about thoughts that get stuck in your head, they play over and over you think about it and even though you want to quit thinking about it. 00:06:35UNKNOWN Like cats? 00:06:35UNKNOWN Uh-huh. What… what about cats? 00:06:40UNKNOWN Cats carry diseases, you know. 00:06:40UNKNOWN Uh-huh. 00:06:45UNKNOWN I mean, cats being around babies can make babies sick, same with mother is carrying baby sick. Cats… cats are like pigeons carrying diseases. I think about this all the time when I’m… when I’m on the bus, when I’m walking on the grass, when I’m… when I’m sitting on the couch in my friend’s house like, I’m always worried that I might touch something, there’s some dirty cat has like licked or… or spit on on something. You know, I can’t stop thinking about it. Like, I’m worried that I might then carry that disease to some poor woman somewhere that’s pregnant with a baby or… or that my new neighbor will bring a cat or my old neighbor will get a cat like, I hate cats. 00:07:30[sil.] NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar00:07:35 END TRANSCRIPT NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template    Week 4 (enter week #): (Enter assignment title)   Student NameCollege of Nursing-PMHNP, Walden UniversityNRNP 6635: Psychopathology and Diagnostic ReasoningFaculty NameAssignment Due Date            Subjective:CC (chief complaint):HPI:Past Psychiatric History:· General Statement:· Caregivers (if applicable):· Hospitalizations:· Medication trials:· Psychotherapy or Previous Psychiatric Diagnosis:Substance Current Use and History:Family Psychiatric/Substance Use History:Psychosocial History:Medical History:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar· Current Medications:· Allergies:· Reproductive Hx:ROS:· GENERAL:· HEENT:· SKIN:· CARDIOVASCULAR:· RESPIRATORY:· GASTROINTESTINAL:· GENITOURINARY:· NEUROLOGICAL:· MUSCULOSKELETAL:· HEMATOLOGIC:· LYMPHATICS:NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar· ENDOCRINOLOGIC:Objective:Physical exam: if applicableDiagnostic results:Assessment:Mental Status Examination:Differential Diagnoses:Reflections:ReferencesNRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLYIf you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarIn the Subjective section, provide:· Chief complaint· History of present illness (HPI)· Past psychiatric history· Medication trials and current medications· Psychotherapy or previous psychiatric diagnosis· Pertinent substance use, family psychiatric/substance use, social, and medical history· Allergies· ROS· Read rating descriptions to see the grading standards!In the Objective section, provide:· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.· Read rating descriptions to see the grading standards!In the Assessment section, provide:· Results of the mental status examination, presented in paragraph form.· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 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 .NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar· Read rating descriptions to see the grading standards!Reflect on this case. Include: Discuss what you learned and what you might do differently. 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.).(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) EXEMPLAR BEGINS HERECC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarHPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.OrP.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarThen, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.Caregivers are listed if applicable.Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarPsychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarSocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:Where patient was born, who raised the patientNumber of brothers/sisters (what order is the patient within siblings)Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?Educational LevelHobbies:Work History: currently working/profession, disabled, unemployed, retired?Legal history: past hx, any current issues?Trauma history: Any childhood or adult history of trauma?Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarCurrent Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concernsROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.Example of Complete ROS:GENERAL: No weight loss, fever, chills, weakness, or fatigue.HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.SKIN: No rash or itching.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarCARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.RESPIRATORY: No shortness of breath, cough, or sputum.GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd colorNEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.HEMATOLOGIC: No anemia, bleeding, or bruising.LYMPHATICS: No enlarged nodes. No history of splenectomy.ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarA ssessmentMental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarHe is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarDifferential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarAlso included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?Also include in your reflection a discussion related to legal/ethical considerations (demonstrating 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.).NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation ExemplarReferences (move to begin on next page)You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD EssayNRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

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