Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their paper presentations. You may also provide additional information, alternative points of view, research to sup

TJ describes feeling constantly on edge, unable to relax in his own home due to fear of impending harm. He reports difficulty sleeping and concentrating, as his thoughts are consumed by worries about his safety. Additionally, he expresses frustration over his family's skepticism regarding his perceptions, feeling misunderstood and isolated in his experiences. Substance Current Use: TJ denies any history of substance abuse or dependence. He reports never having used illicit drugs, including cocaine, heroin, methamphetamine, or hallucinogens.

Additionally, he states that he has never misused prescription medications or engaged in excessive alcohol consumption. Besides, TJ describes himself as a moderate drinker, consuming alcohol occasionally and in social settings. TJ also reports that he has never smoked cigarettes or used other forms of tobacco products. Medical History: • Current Medications : TJ mentions that he takes Lisinopril 10 mg daily for hypertension. © 20 21 Walden University Page 3 of 11 • Allergies : TJ denies any known drug allergies. He reports never experiencing adverse reactions or allergic responses to environmental factors, such as house dust and food. • Reproductive and Sexual Hx . He currently denies sexually transmittd diseases. He has one daughter aged 26 years. ROS : • GENERAL : TJ reports decreased appetite over the past month. He describes feeling fatigued and emotionally drained due to his persistent paranoid thoughts and worries about his safety. • HEENT: Head: Denies history of head trauma, headaches, or scalp tenderness. Eyes: Reports no changes in vision or blurring. He denies double vision or seeing spots. He notes that his eyesight has been stable. Ears: Reports no changes in hearing or ringing in the ears (tinnitus). He denies ear pain, drainage, or itching. Nose: Denies nasal congestion, runny nose, or sinus pressure. He reports no history of nosebleeds. Throat: Denies s ore throat, difficulty swallowing (dysphagia), or hoarseness. He reports no history of tonsillitis or strep throat. • SKIN: Denies any skin lesions, rashes, or itching. • CARDIOVASCULAR: Denies any chest pain, palpitations, or shortness of breath. He reports regular physical activity within his capabilities, such as walking and light gardening, without experiencing any cardiovascular symptoms. • RESPIRATORY: Denies any cough, wheezing, or shortness of breath. He reports no history of respiratory infections or chronic lung conditions. © 20 21 Walden University Page 4 of 11 • GASTROINTESTINAL: Denies any abdominal pain, nausea, vomiting, or changes in bowel habits. He reports regular bowel movements and does not have any gastrointestinal concerns. • GENITOURINARY: Denies any urinary frequency, urgency, dysuria, or hematuria. He reports no difficulty with urinary continence and denies any genital or urinary symptoms. • NEUROLOGICAL: Acknowledges occasional forgetfulness but denies any significant memory problems or cognitive impairment beyond what he considers age -appropriate. He denies experiencing seizures, tremors, or weakness in his extremities. • MUSCULOSKELETAL: Reports occasional joint stiffness and discomfort, particularly in his knees and hands. • HEMATOLOGIC: Denies any history of bleeding disorders or abnormal bruising. He reports no recent injuries or trauma that would suggest hematologic issues. • LYMPHATICS: Denies any swollen lymph nodes or recurrent infections. He reports no concerns related to his lymphatic system. • ENDOCRINOLOGIC : Denies a ny excessive thirst, urination, or changes in weight. Objective: Physical Exam • Vital Signs : BP: 130/80 mmHg, HR: 76 bpm, RR: 16 bpm, T: 98.6°F. • GENERAL : TJ presents as a well -groomed elderly gentlema n, appearing his stated age of 5 5 years. • HEENT: Head: Normocephalic and atraumatic, with symmetrical facial features and hair distribution. No signs of tenderness or palpable masses. Eyes: Bilateral pupils are equal, round, and reactive to light (PERRLA). Extraocular movements (EOM) are intact. © 20 21 Walden University Page 5 of 11 Ears: External ear structures are symmetrical, with no deformities or auricular swelling. Otoscopic examination shows intact tympanic membranes with visible landmarks. Nose: Nasal passages are patent bilaterally, with pink, moist mucosa and no signs of obstruction or discharge. Throat: Oropharynx is normal, with pink, moist mucosa and intact dentition. No signs of tonsillar enlargement or exudates. • SKIN: Warm and dry: Skin is intact and without lesions, rashes, or discoloration. No evidence of jaundice, pallor, or cyanosis. • CARDIOVASCULAR: No visible pulsations or visible heaves. Chest wall movements are symmetrical with respiration. Heart sounds S1 and S2 are normal and distinct. No murmurs, rubs, or gallops appreciated. Peripheral pulses are palpable and symmetrical. • RESPIRATORY: Breath sounds are clear and equal bilaterally, with no adventitious sounds such as wheezes, crackles, or rhonchi. • GASTROINTESTINAL: Abdomen is flat and non -distended, with no visible masses or pulsations. Skin is smooth and without striae or dilated veins. • NEUROLOGICAL: Cranial nerves II -XII are intact, with normal visual fields, intact gag reflex, and symmetric facial movements. • MUSCULOSKELETAL: Full range of motion observed in all extremities, with no limitations or signs of discomfort noted during passive or active movement. No gross deformities or asymmetry noted in the musculoskeletal system. The posture is erect, with no signs of joint swelling or erythema. Diagnostic R esults An ideal assessment tool for TJ is the Scale for Assessment of Positive Symptoms, SAPS. According to Kumari et al. (2017), SAPS is a clinician -rated assessment tool that comprises 34 © 20 21 Walden University Page 6 of 11 items that measure hallucinations, bizarre behaviors, and thought disorders. Each item has a score of 0 to 5, with a total score ranging from 0 -170 (Bio -Protocol.org, n.d.). Shahar (2019) attested that the tool comprises hot cognitions about oneself and identity as they unfold throughout the lifespan. Upon administering the tool to TJ, the scores indicated the need for further evaluation as there were positive symptoms of hallucinations and delusions. Assessment : Mental Status Examination TJ presents as a well -groomed elderly gentleman, neatly dressed in appropriate attire for the clinic visit. He maintains good eye contact throughout the examination and demonstrates cooperative behavior. His posture is upright, and he appears relaxed, with no signs of psychomotor agitation or restlessness. His speech is clear, fluent, and coherent, with a normal rate and rhythm. He articulates words effectively and expresses himself in a logical and organized manner. Language comprehension appears intact, a s he demonstrates an understanding of questions and responds appropriately. Besides, his mood is predominantly anxious and apprehensive, as evidenced by his concerns about his neighbors conspiring against him. He appears tense and guarded, with occasional expressions of worry and distress. His affect is congruent with his mood, displaying appropriate emotional responses to conversation topics.

Additionally, his thought process is coherent and goal -directed, with logical connections between ideas. He maintai ns a linear and sequential flow of thought during conversation, demonstrating the ability to stay on topic and provide relevant information. However, his thought content is primarily focused on his delusional beliefs about persecution by his neighbors, which he describes in a fixed and unwavering manner. Also, TJ displays partial insight into his condition, acknowledging that his beliefs about his neighbors may not be widely shared but remaining © 20 21 Walden University Page 7 of 11 highly convinced of their truth. He demonstrates limited capacity for self -reflection regarding the potential impact of his delusions on his daily functioning and relationships. Judgment appears intact in other areas of decision -making, such as his adherence to medication and willingness to seek medical attention. Lastly, TJ's cognitive functioning appears intact overall. He is alert and oriented to person, place, and time, accurately recalling relevant details about his personal history and current circumstances. Diagnostic Impression : Primary Diagnosis: Delusion disorder: F22. TJ presented with signs and symptoms that are associated with delusional disorder. He met the diagnostic criteria for the condition. The American Psychiatric Association (2022) noted that individuals with delusional disorder often present with one or more delusions that last for at least one month. As for TJ, he had fixed false beliefs that his neighbors intended to harm him, which caused significant distress and impairment in social functioning. Ddx1: Paranoid Schizophrenia, F20 : TJ presented with symptoms associated with schizophrenia as set out by the American Psychiatric Association (2022). Such include the presence of persecutory delusions. However, the condition requires additional symptoms, such as hallucinations, disorganized speech, and negative conduct, such as flattened affect or social withdrawal, which were not evident in TJ’s presentation. Ddx 2: Brief Psychotic Disorder, F.23: Factors necessitating consideration of the condition include the presence of delusions and hallucinations. However, the condition is ruled out on the basis that TJ’symptoms have persited for more than one month and indicate a chronic pattrn that is more consistent with delusional and not a brief psychotic episode. © 20 21 Walden University Page 8 of 11 Ddx 3: Schizoaffective disorder, F25: The American Psychiatric Association (2022) noted that individuals with schizoaffective disorder may feature some manic episodes. Such may be associated with depressive episodes, anxiety, and distress. The aspect that rules out the likelihood of the condition is the fact that TJ’s presentation is not accompanied by prominent mood symptoms that would be indicative of a mood episode. Reflections: If I could conduct the session with TJ again, I would focus more on building rapport and trust from the outset. I would spend additional time empathetically validating TJ's experiences and concerns, acknowledging the distress caused by his delusions while gently exploring the possibility of alternative explanations. Additionally, I would involve TJ's family members or caregivers in the treatment process, providing psychoeducation about delusional disorder and strategies for supporting him effectively. The proposed interventions, i.e., the cognitive -based therapy, were successful. TJ’s self -report on his symptoms during the next sessions indicated a positive improvement in his outcomes. Case Formulation and Treatment Plan : TJ’s self -reported symptoms, mental status examination, and SAPS score indicate he could be battling a delusional disorder. An ideal psychotherapy option for him involves the use of cognitive behavioral therapy. Agbor et al. (2022) recognized that cognitive behavioral therapy improves the self -esteem and psychological well -being wellbeing of individuals with delusional disorders. Similarly, Avasthi and Sahoo (2020) acknowledged that cognitive behavioral therapy improves delusional beliefs about current and past beliefs. An ideal health promotion activity that I vouched for TJ is regular physical activity, such as walking or light exercise, to promote overall wellbeing and reduce stress levels. Besides, I © 20 21 Walden University Page 9 of 11 provided psychoeducation to TJ and his family about delusional disorder, including information about the nature of delusions, treatment options, and strategies for managing symptoms. I emphasized the importance of medication adherence and regular follow -up appointments with healthcare providers. TJ was started with Haloperidol 2mg per day, which is a first -generation antipsychotic. The effect of the medication complemented the cognitive behavioral therapy. Besides, alternative therapy is family therapy and support groups to provide additional social support and facilitate communication within TJ's support network. The follow -up parameters include regular follow -up appointments every two weeks initially to monitor TJ's response to treatment, assess for any adverse effects of medication, and make necessary adjustments to the treatment plan. Once stabilized, follow -up appointments will occur less frequently, typically every two months. An identified social determinant of health relevant to TJ’s condition is social isolation. TJ's paranoid delusions about his neighbors may lead to increased social withdrawal and avoidance of social interactions, leading to feelings of loneliness and isolation. A referral to community -based support services or group therapy programs that provide opportunities for social engagement and peer support is ideal for TJ’s case. Questions 1. What are your thoughts on the patient's diagnosis of delusional disorder based on the presented symptoms? 2. Which differential diagnosis do you believe is most relevant to consider in this case, and why? 3. How do you perceive the effectiveness of the proposed treatment plan for managing the patient's delusional symptoms? © 20 21 Walden University Page 10 of 11 References Agbor, C., Kaur, G., Soomro, F. M., Eche, V. C., Urhi, A., Ayisire, O. E., Kilanko, A., Babalola, F., Eze -Njoku, C., Adaralegbe, N. J., Aladum, B., Oyeleye -Adegbite, O., & Anugwom, G. (2022). The role of cognitive behavioral therapy in the management of psychosis.

Curēus . https://doi.org/10.7759/cureus.28884 American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM -5-TR (5th ed.). American Psychiatric Publishing. Avasthi, A., & Sahoo, S. (2020). Clinical Practice Guidelines for Cognitive Behavioral Therapy for Psychotic Disorders. Indian Journal of Psychiatry/Indian Journal of Psychiatry , 62 (8), 251. https://doi.org/10.4103/psychiatry.indianjpsychiatry_774_19 Bio -Protocol.org. (n.d.). Scale for the Assessment of Positive Symptoms (SAPS) . https://bio - protocol.org/exchange/minidetail?type=30&id=10071967&utm_source=miniprotocol Kumari, S., Malik, M., Florival, C., Manalai, P., & Sonje, S. (2017). An Assessment of Five (PANSS, SAPS, SANS, NSA -16, CGI -SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS). Journal of Addiction Research & Therapy , 08 (03). https://doi.org/10.4172/2155 -6105.1000324 Shahar, G. (2019). The subjective –agentive personality sector (SAPS): Introduction to the special issue on self, identity, and psychopathology. Journal of Personality , 88 (1), 5 –13. https://doi.org/10.1111/jopy.12497 © 20 21 Walden University Page 11 of 11 PRECEPTOR VERIFICATION: I confirm the patient used for this assignment is a patient who was seen and managed by the student at their Meditrek -approved clinical site during this quarter's course of learning. Preceptor signature: ________________________________________________________ Date: ________________________