Patient Evaluation
Andy is a 21-year-old male university student in his final year of school who lives with three housemates. The patient started exhibiting psychotic tendencies about two months ago when he believed his housemates were working for MI5 (Storey, 2016). The subject also believes the government agency put a microchip in his brain to track his movement. Andy believes MI5 uses the chip in his head to influence his thoughts as he has experienced various ideas that he denies he can be associated with; therefore, the government is behind this development (Storey, 2016). He discerns it is necessary to have weapons to protect himself from his housemates. In this instance, he keeps a baseball bat and knife in his room but does not leave with them to avoid breaking the law and getting into trouble (Storey, 2016).
Additionally, Andy’s eating patterns have shifted, and he eats very little food because of paranoia that the housemates have poisoned his food. He remains locked in his room most of the time and only leaves to eat when his housemates have left (Storey, 2016). The patient appears frustrated the government is targeting him despite being an obedient citizen. This frustration has led him to feel cornered as he has considered buying sleeping pills and taking an overdose to end his life (Storey, 2016). However, he did not purchase the pills as it entails leaving the house, indicating he might be avoiding any interaction with others. Nonetheless, the patient has tended to use marijuana regularly, taking a substantial amount daily while also using speed on the weekends (Storey, 2016). He claims they take speed with some friends, illustrating he is not fully detached from others. It is also important to note that Andy feels safer and does not hear his housemates talking about him when he is at his parents’ home (Storey, 2016). He also illustrates a positive bond with his parents as Andy does not move back home to avoid making them worried.
Evaluation Process Critiquing the Approach to Differential Diagnoses
Healthcare providers deem differential diagnoses as critical components in clinical decision-making. It elicits differentiation of competing structures to develop an accurate assessment of the underlying condition. A typical differential diagnosis identifies an illness’s etiology by evaluating the patient’s history, reviewing laboratory data, and conducting physical examinations. Nonetheless, it is important to note that differential diagnosis varies depending on the healthcare provider. In this case, Andy’s diagnosis involves communicating his history, taking a risk assessment, and defining the condition as the healthcare provider sees it. She seeks answers on the interaction between the patient, his housemates, and his family.
This diagnosis entails developing a clear image of the individual’s perception. He seems agitated and looks around the room when the interview begins. The healthcare provider also questions whether he hears the housemates talking when they are not within his vicinity and if they can hear his thoughts. Psychosis patients tend to hear other people critiquing them even when they are not around and may consider that other people can hear their thoughts. While Andy does not perceive that other people can hear him, he claims he can hear his housemates when they are not around (Storey, 2016). Nonetheless, he states the voices seem different from a one-on-one conversation, providing the medical provider with greater insight into the patient’s condition. She does not agitate the patient and dodges his question about whether she believes his version of events (Storey, 2016). While differential diagnosis can be used for preventative measures, Andy’s case has already progressed, and she deems it necessary to include his mother in the treatment procedure, asking if he is comfortable with calling her in for the session before they can determine the effective treatment process necessary for his recovery.
Therapeutic Communication Techniques
The practitioner does not aggravate Andy’s paranoia about being watched and remains neutral when communicating with the patient. She does not impose her opinion on the subject and touches on some issues lightly to gain a clear picture of his condition. The practitioner allows Andy to communicate fully and does not interrupt him during the conversation. She does not provide any hint of disbelief at his assertions despite his indication of psychotic tendencies (Storey, 2016). The patient also feels comfortable talking to her about his drug use, where she assures him of doctor-patient confidentiality when he is anxious about whether she will tell his parents if he is using any substance (Storey, 2016). While her questions are direct, they are not overbearing and are posited inquisitively. In this way, she gains helpful information that would help his prognosis.
It is also important to note the practitioner’s office does not showcase a buffer between her and the patient. They sit casually in a way that does not intimidate the patient about the surroundings. In this way, Andy is comfortable narrating his issues to the practitioner. It is also crucial to note the healthcare provider does not take out a notebook to record the conversation during the session (Storey, 2016). This setting helps the patient feel relaxed as one notices he stops fidgeting and looking around the room as the interview progresses. The practitioner mentions she does not believe Andy towards the end of the interview. I would wait until the mother is present to offer my prognosis as the patient may become defensive and refuse to cooperate if they feel ambushed as they have claimed they suspected their parents were also criticizing them at one point. This approach would enable them to divulge information freely and aid in the treatment process.
Reference
Storey, D. (2016). Psychiatric interviews for teaching: psychosis. MediaSpace. Web.