NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template
Week 4: Grand Rounds Discussion: Complex Case Study Presentation
College of Nursing-PMHNP, Walden University
PRAC 6675: PMHNP Care Across the Lifespan II
Graduate Studies
Date:
At the end of the presentation, the audience will understand the objectives below.
Objectives for this presentation:
1. The audience will be able to summarize the defining characteristics of paranoid personality disorder as identified in the DSM 5 manual.
2. The audience will understand how to diagnose paranoid personality disorder accurately.
3. The audience will gain insight into possible pharmacological management of paranoid personality disorder
4. The audience will be able to identify nonpharmacological management of paranoid personality disorder.
Subjective:
CC (chief complaint): “ I suspect my neighbors want to hurt me”.
HPI: R.H is a 46-year-old African American female who presents for follow-up with a concern of feeling suspicious of her neighbors. She reported feelings of suspicion, which began when she was about 22 years old. She explained that she suspects her neighbor is conspiring to hurt her, but she cannot justify her suspicion. She explained that her neighbor insulted her, which led her to bear grudges toward her neighbor. This incident resulted in her paying her friend to have the windscreen of her neighbor’s car shot. She reported that her friend took her money and did not shoot the neighbor’s car windscreen resulting in her developing homicidal thoughts towards her friend. She narrated going to a psychiatric hospital for homicidal ideation towards the said friend and got hospitalized for two days. She reported explaining to the hospital that she was under the influence of drugs when she thought of having her neighbor’s windscreen shot. The hospital then signed a duty to warn against her. She highlighted that after being discharged from the hospital, she was free of homicidal thoughts toward her friend and attempted to apologize to her neighbor for the intention to have her car windscreen shot. But her neighbor had a peace order issued against her.
She reported that she constantly grudges against people and is unforgiving of insults. She highlighted feeling afraid to confide in anyone to prevent such information from being maliciously used against her. She also reported another incident with a different friend who plans to ruin her reputation. She explained that this new friend deceived her into allowing her to walk with her dog, and afterward, the dog bit the friend. She said she doubts her friends and close associates as everyone seems to be plotting ways to indict her. She highlighted that her suspicions make her react very angrily in most situations causing recurrent fights and altercations. She reported feeling irritable and angry as she quickly reads meanings into people’s remarks that she feels are designed to hurt her. She also highlighted her need for assistance to relocate from her present house to a different home to avoid her neighbors and friends. She also reported hearing voices that are non-commanding. She further explained that she does not think anything is wrong with her and does not take her medications every day. She is prescribed paroxetine 30mg p.o daily, buspirone 10mg p.o tid, prazosin 1mg nightly, and depakote 750 mg p.o daily.