20 Feb Training Title 24: Ms. Jess Davies

Training Title 24
Name: Ms. Jess Davies
Gender: female
Age: 30 years old
T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs
Background: Jess is brought for evaluation by her 2 roommates who are concerned with
behaviors. She had some issues with depression after aunt died but worsened in the 12 days after
she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her
parents and her brother was her only sibling. She is only sleeping 2 hours/24hrs; she will only eat
canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple
times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg
twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape
Symptom Media. (Producer). (2016). Training title 24 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-24

NRNP 6635 Case History Report – Week 7: Schizophrenia and Other Psychotic Disorders; Medication‑Induced Movement Disorders
Training Title 24: Ms. Jess Davies
1. Introduction
Patient: Ms. Jess Davies, 30‑year‑old female.

Context: Case study from Symptom Media video (2016).

Clinical Focus: Psychotic disorders following trauma, substance use, and risk of medication‑induced movement disorders.

Importance: Demonstrates how acute trauma, substance use, and poor sleep can precipitate psychotic symptoms in vulnerable individuals.

2. Demographics and Background
Age: 30 years old.

Gender: Female.

Vitals: T 98.6, P 86, R 20, BP 120/70 (normal).

Height/Weight: 5’2”, 126 lbs (BMI ~23 → normal).

Family: Estranged from parents; brother (only sibling) recently killed.

Education/Occupation: Works in a bakery.

Medical History: Allergic to medical tape.

Psychiatric History: Depression after aunt’s death; worsened after witnessing brother’s murder.

Substance Use: Daily cannabis since age 17; occasional alcohol with roommates.

Medications: Alprazolam 1 mg twice daily PRN for 15 days (prescribed by PCP).

3. Psychosocial Stressors
Trauma: Witnessed brother killed via gunshot wound during burglary.

Family Estrangement: No parental support, brother was only sibling.

Grief: Loss of aunt and brother.

Sleep Disturbance: Only 2 hours per night.

Dietary Restriction: Eats only canned foods.

Substance Use: Cannabis daily, alcohol socially.

Occupational Stress: Bakery work, possible financial strain.

Social Support: Roommates concerned, but limited family support.

4. Clinical Presentation (Psychotic Features)
Reported Symptoms:

Severe insomnia.

Restricted diet (canned foods only).

Daily cannabis use.

Possible paranoia, guardedness.

Trauma‑related flashbacks or intrusive thoughts.

Behavioral Indicators:

Social withdrawal.

Odd eating habits.

Substance dependence.

Risk Factors:

Trauma exposure.

Substance use (cannabis).

Family estrangement.

Sleep deprivation.

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, normal weight.

Behavior: Guarded, anxious, possibly paranoid.

Speech: Normal rate/volume, may be pressured.

Mood: Depressed, anxious.

Affect: Constricted, flat.

Thought Process: Possible disorganized or tangential.

Thought Content: Trauma‑related preoccupation, possible paranoia.

Cognition: Alert, oriented ×3.

Insight/Judgment: Limited, substance use and poor coping.

6. Differential Diagnosis
Schizophrenia: Chronic psychotic disorder with delusions, hallucinations, disorganized thought, negative symptoms.

Schizoaffective Disorder: Psychosis with mood episodes.

Brief Psychotic Disorder: Psychosis lasting <1 month, often triggered by trauma.

Substance‑Induced Psychotic Disorder: Cannabis use may precipitate psychosis.

PTSD: Trauma exposure with intrusive symptoms, avoidance, hyperarousal.

Major Depressive Disorder with Psychotic Features: Depression plus psychosis.

7. Diagnostic Considerations (DSM‑5)
Schizophrenia Criteria: ≥2 symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms) lasting ≥6 months.

Brief Psychotic Disorder: Psychotic symptoms lasting <1 month, often trauma‑related.

Substance‑Induced Psychotic Disorder: Psychosis due to cannabis or alcohol.

PTSD Criteria: Trauma exposure, intrusive memories, avoidance, negative mood, hyperarousal.

Jess’s Case:

Trauma and cannabis use complicate diagnosis.

Likely Brief Psychotic Disorder or Substance‑Induced Psychotic Disorder.

PTSD features also possible.

8. Medication‑Induced Movement Disorders
Antipsychotic Medications:

Typical (first‑generation): haloperidol, chlorpromazine.

Atypical (second‑generation): risperidone, olanzapine, quetiapine.

Movement Disorders:

Extrapyramidal Symptoms (EPS): Dystonia, akathisia, parkinsonism.

Tardive Dyskinesia (TD): Involuntary movements, often irreversible.

Neuroleptic Malignant Syndrome (NMS): Rare, life‑threatening.

Risk Factors:

Long‑term antipsychotic use.

High doses of typical antipsychotics.

Female gender, older age increase TD risk.

9. Assessment Tools
PANSS (Positive and Negative Syndrome Scale): Measures schizophrenia symptoms.

AIMS (Abnormal Involuntary Movement Scale): Screens for tardive dyskinesia.

Barnes Akathisia Rating Scale: Measures akathisia.

CAPS‑5: Assesses PTSD symptoms.

PHQ‑9: Screens for depression.

10. Treatment Plan
Pharmacological:

Antipsychotics:

Atypical preferred (lower EPS risk).

Short‑term use for acute psychosis.

Adjunctive Medications:

Anticholinergics (benztropine) for EPS.

VMAT2 inhibitors (valbenazine) for tardive dyskinesia.

Benzodiazepines: Short‑term for acute anxiety/insomnia (caution with alprazolam).

Psychotherapy:

Trauma‑focused CBT.

Psychoeducation.

Substance use counseling.

Grief therapy.

Lifestyle Interventions:

Sleep hygiene.

Balanced diet.

Stress management.

Supportive Measures:

Roommate/family involvement.

Case management.

Community support services.

11. Monitoring and Follow‑Up
Regular psychiatric visits.

Medication monitoring (side effects, adherence).

Movement disorder screening (AIMS).

Suicide risk reassessment.

Collaboration with primary care.

12. Challenges
Trauma: Witnessing brother’s murder.

Substance Use: Daily cannabis, alcohol.

Sleep Deprivation: Only 2 hours per night.

Dietary Restriction: Eats only canned foods.

Medication Risks: Alprazolam dependence, antipsychotic side effects.

13. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma, respect autonomy.

14. Case Summary
Ms. Jess Davies: 30‑year‑old female with trauma, substance use, insomnia, restricted diet, and possible psychosis.

Likely Diagnosis: Brief Psychotic Disorder vs. Substance‑Induced Psychotic Disorder, with PTSD features.

Treatment: Antipsychotics, psychotherapy, lifestyle interventions, supportive care.

Outcome Goal: Symptom reduction, improved functioning, prevention of relapse, monitoring for movement disorders.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Jess’s age? a) 28 b) 30 c) 32 d) 34

What traumatic event did Jess witness? a) Car accident b) Brother killed via gunshot wound c) Aunt’s death d) House fire

How many hours does Jess sleep per night? a) 8 b) 6 c) 2 d) 4

What type of food does Jess restrict herself to? a) Fresh produce b) Canned foods c) Fast food d) Frozen meals

What substance does Jess use daily? a) Alcohol b) Cannabis c) Cocaine d) Tobacco

What medication was prescribed by her PCP? a) Sertraline