20 Feb Training Title 9: Ms. Fatima Branning

Training Title 9
Name: Ms. Fatima Branning
Gender: female
Age: 28 years old
T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs
Background: Raised by parents, lives alone in Coronado, CA. Only child. Works as an
administrative assistance in car sales, has a bachelor’s in hospitality. Has medical history of
scoliosis, currently treated with chiropractic care. Guarded and declined to discuss past
psychiatric history. Denied family mental health issues, declined to allow you to speak to parents
for collaborative information. Allergies: latex; menses regular, no birth control
Symptom Media. (Producer). (2016). Training title 9 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-9

NRNP 6635 Case History Report – Week 7: Schizophrenia and Other Psychotic Disorders; Medication‑Induced Movement Disorders
Training Title 9: Ms. Fatima Branning
1. Introduction
Patient: Ms. Fatima Branning, 28‑year‑old female.

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

Clinical Focus: Schizophrenia spectrum disorders, psychotic features, and risk of medication‑induced movement disorders.

Importance: Highlights challenges in assessment when patients are guarded, decline collateral information, and have limited disclosure of psychiatric history.

2. Demographics and Background
Age: 28 years old.

Gender: Female.

Vitals: T 98.4, P 82, R 18, BP 124/74 (normal).

Height/Weight: 5’0”, 118 lbs (BMI ~23 → normal).

Family: Raised by parents, only child. Lives alone in Coronado, CA.

Education/Occupation: Bachelor’s in hospitality; works as administrative assistant in car sales.

Medical History: Scoliosis, treated with chiropractic care.

Psychiatric History: Guarded, declined to discuss past psychiatric history.

Family Psychiatric History: Denied.

Allergies: Latex.

Reproductive Health: Menses regular, no birth control.

3. Psychosocial Stressors
Social Isolation: Lives alone, only child, limited support system.

Occupational Stress: Administrative role in car sales may involve high stress, interpersonal demands.

Guarded Behavior: Declines to share psychiatric history or allow collateral information.

Medical Issues: Chronic scoliosis may contribute to stress and somatic complaints.

Family Dynamics: Limited disclosure, possible strained relationships.

4. Clinical Presentation (Psychotic Features)
Possible Symptoms (from case context):

Guardedness, reluctance to disclose history.

Suspiciousness, possible paranoia.

Flat or blunted affect.

Social withdrawal.

Possible hallucinations or delusions (not disclosed but suspected).

Behavioral Indicators:

Avoidance of questions.

Declining collateral information.

Limited insight.

Risk Factors:

Young adult age (typical onset of schizophrenia).

Social isolation.

Guardedness may indicate paranoia or psychotic process.

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

Behavior: Guarded, suspicious, limited disclosure.

Speech: Normal rate/volume, may be terse.

Mood: Neutral or anxious.

Affect: Flat or blunted.

Thought Process: Possible disorganized or tangential.

Thought Content: Guarded, possible paranoia.

Cognition: Alert, oriented ×3.

Insight/Judgment: Limited, avoids discussion of psychiatric history.

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

Schizoaffective Disorder: Psychosis with mood episodes.

Delusional Disorder: Persistent delusions without other psychotic features.

Brief Psychotic Disorder: Psychosis lasting <1 month.

Mood Disorder with Psychotic Features: Depression or bipolar disorder with psychosis.

Medical Causes: Thyroid dysfunction, neurological illness.

7. Diagnostic Considerations (DSM‑5)
Schizophrenia Criteria:

≥2 symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms).

Duration ≥6 months.

Impaired functioning.

Schizoaffective Disorder: Psychosis plus mood episodes.

Delusional Disorder: Delusions ≥1 month, no other psychotic features.

Fatima’s Case:

Guardedness, social isolation, possible paranoia.

Limited disclosure complicates diagnosis.

Schizophrenia spectrum disorder most likely.

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.

Simpson‑Angus Scale: Assesses parkinsonism.

10. Treatment Plan
Pharmacological:

Antipsychotics:

Atypical preferred (lower EPS risk).

Clozapine for treatment‑resistant schizophrenia.

Adjunctive Medications:

Anticholinergics (benztropine) for EPS.

VMAT2 inhibitors (valbenazine) for tardive dyskinesia.

Psychotherapy:

CBT for psychosis.

Psychoeducation.

Social skills training.

Lifestyle Interventions:

Structured routine.

Stress management.

Nutrition and exercise.

Supportive Measures:

Family involvement (if possible).

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
Guardedness: Limited disclosure complicates diagnosis.

Collateral Information: Declined, reduces accuracy.

Medication Risks: EPS, TD, NMS.

Stigma: Mental health stigma in psychotic disorders.

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. Fatima Branning: 28‑year‑old female, guarded, possible psychotic disorder.

Likely Diagnosis: Schizophrenia spectrum disorder.

Treatment: Antipsychotics, psychotherapy, 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 Fatima’s age? a) 26 b) 28 c) 30 d) 32

Where does Fatima live? a) Los Angeles, CA b) Coronado, CA c) San Diego, CA d) Sacramento, CA

What medical condition does Fatima have? a) Diabetes b) Scoliosis c) Asthma d) Hypertension

What is her occupation? a) Teacher b) Administrative assistant in car sales c) Nurse d) Accountant

Which behavior complicates diagnosis? a) Guardedness and refusal of collateral information b) Excessive disclosure c) Substance use d) Legal issues

Which disorder involves delusions, hallucinations, disorganized thought, and negative symptoms? a) Schizophrenia b) OCD c) PTSD d) GAD

Which disorder combines psychosis with mood episodes? a) Schizoaffective Disorder b) Delusional Disorder c) Panic Disorder d) Adjustment Disorder

Which tool measures schizophrenia symptoms? a) PANSS b) AIMS c) HAM‑A d) PHQ‑9