NRNP 6635: Week 7 Comprehensive Psychiatric Evaluation

Assessment Context

NRNP 6635 Psychopathology and Diagnostic Reasoning at Walden University requires a Week 7 Comprehensive Psychiatric Evaluation for the Fall 2026 quarter. The assignment carries 100 points and asks students to analyze a video case study involving schizophrenia, another psychotic disorder, or a medication-induced movement disorder. Students complete the Walden Comprehensive Psychiatric Evaluation Template and submit a 5- to 7-page document that includes subjective history, objective findings, a mental status examination, at least three differential diagnoses ordered by priority, a primary diagnosis supported by DSM-5-TR criteria, reflection notes, and at least five current peer-reviewed references. The assessment follows Walden University College of Nursing PMHNP program conventions and aligns with the AACN Essentials for psychiatric-mental health nurse practitioner education. The target audience is the course faculty and, by extension, the clinical supervisors who evaluate diagnostic reasoning in practicum settings. The assignment is due by Day 7 of Week 7. Late submissions lose 10% per day for up to three days unless an approved extension sits on file. Walden University mandates APA 7th edition for all written work in this course.

Faculty designed this assessment around the competency of diagnostic reasoning under uncertainty. Students who list differential diagnoses without comparing DSM-5-TR criteria lose marks in the Assessment criterion. The rubric rewards explicit criterion matching, pertinent positives and negatives, and a visible critical-thinking chain from data to diagnosis. A student who names schizophrenia as the primary diagnosis without explaining why cannabis-induced psychosis and schizoaffective disorder were ruled out produces a weak evaluation. The video case is selected from the Video Case Selections in the Learning Resources by Day 1 of Week 7. Students may not substitute a case from outside the approved list. The template is mandatory; submissions that do not use the template receive a zero on the formatting criterion. The rubric below translates the Walden scoring guide into four achievement levels.

Task Description

Select one video case from the approved Video Case Selections. Complete the Comprehensive Psychiatric Evaluation Template with four sections: Subjective, Objective, Assessment, and Reflection. The Subjective section must include chief complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent substance use, family psychiatric and substance use history, social history, medical history, allergies, and a review of systems that informs the differential. The Objective section must document the physical examination of systems pertinent to the chief complaint and report any diagnostic results, including labs or imaging needed to develop the differential. The Assessment section must present the mental status examination in paragraph form, list at least three differential diagnoses ordered from highest to lowest priority, compare DSM-5-TR criteria for each differential, explain which criteria rule out each alternative, and state the primary diagnosis with pertinent positives and negatives. The Reflection section must discuss what the student would do differently if conducting the session again, address legal and ethical considerations beyond confidentiality and consent, and discuss health promotion and disease prevention with attention to patient factors such as age, ethnicity, and socioeconomic background. At least five peer-reviewed references no more than five years old must support the assessment and differential. APA 7th edition governs citations, references, and headings.

Assessment Requirements

• Length: 5–7 pages, excluding title page and references.
• Format: Walden Comprehensive Psychiatric Evaluation Template; APA 7th edition.
• Case selection: One video case from the approved Video Case Selections; selected by Day 1 of Week 7.
• Differentials: Minimum of three, ordered by priority, each compared against DSM-5-TR criteria.
• Primary diagnosis: Stated with supporting DSM-5-TR criteria, pertinent positives, and pertinent negatives.
• Reflection: Legal and ethical considerations beyond confidentiality and consent; health promotion and disease prevention with patient factors.
• References: Minimum five peer-reviewed sources, no more than five years old.
• Submission: Turnitin similarity below 20%, with no more than 5% from a single source.
• Due: Day 7 of Week 7; late penalty 10% per day for up to three days.

Grading Rubric

Criterion	Excellent (A)	Good (B)	Fair (C)	Poor (D/F)	Weight
Subjective Documentation	Thorough and accurate documentation of chief complaint, HPI, past psychiatric history, medications, psychotherapy history, substance use, family history, social history, medical history, allergies, and ROS relevant to the differential.	Accurate documentation; minor omissions that do not affect diagnostic reasoning.	Documentation present but vague or containing minor inaccuracies.	Incomplete or inaccurate subjective documentation; or section missing.	20%
Objective Documentation	Thorough and accurate physical exam of pertinent systems; diagnostic tests and results thoroughly documented.	Accurate physical exam and diagnostic documentation; minor gaps.	Documentation vague or containing minor inaccuracies.	Incomplete or inaccurate objective documentation; or section missing.	20%
Assessment and Differential Diagnosis	Mental status exam documented thoroughly; at least three distinctly different differentials ordered by priority; DSM-5-TR criteria compared for each; critical-thinking process explained; pertinent positives and negatives included.	Accurate documentation; three differentials justified; minor gaps in DSM-5-TR comparison.	Documentation present but vague; differentials listed with weak justification.	Incomplete or inaccurate assessment; fewer than three differentials; or section missing.	25%
Reflection	Thorough and thoughtful reflection demonstrating critical thinking; legal and ethical considerations beyond confidentiality and consent; health promotion and disease prevention with patient factors.	Reflection demonstrates critical thinking; minor gaps in one area.	Reflection somewhat general; does not demonstrate critical thinking.	Reflection incomplete, inaccurate, or missing.	10%
Evidence-Based Resources	At least three current, evidence-based peer-reviewed resources that strongly support the assessment and diagnosis; resources reflect latest clinical guidelines.	At least three current, evidence-based resources that appropriately support the assessment and diagnosis.	Three resources provided but with vague or weak justification.	Two or fewer resources; resources not current or not evidence-based.	15%
Written Expression and APA	Paragraphs flow logically; clear purpose statement and introduction; flawless APA 7th edition; no errors in grammar or spelling.	Writing follows standards for flow and clarity 80% of the time; minor APA errors.	Writing follows standards 60–79% of the time; multiple APA errors.	Writing follows standards less than 60% of the time; pervasive APA errors.	10%

Sample Answer Writing Help

Mr. H.F., a 20-year-old male college freshman, presented with a six-month history of paranoia, auditory hallucinations, and social withdrawal. His parents initiated the appointment after noticing weight loss, poor grooming, and declining academic performance. The mental status examination revealed blunted affect, thought blocking, and delusions of reference. The differential diagnosis included schizophrenia, cannabis-induced psychotic disorder, and schizoaffective disorder. Schizophrenia was prioritized because the patient met Criterion A with hallucinations and delusions, Criterion B with functional decline, and Criterion C with continuous disturbance for more than six months. Cannabis-induced psychosis was ruled out because the patient’s symptoms persisted beyond the expected window of intoxication and withdrawal, and his cannabis use did not meet DSM-5-TR criteria for a cannabis use disorder. Schizoaffective disorder was ruled out because psychotic symptoms occurred in the absence of a major mood episode for at least two weeks. This criterion-matching approach reflects the standard the Walden rubric rewards, and it mirrors the diagnostic logic described in reviews of substance-induced psychosis transition (Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder).

Students who lose points on this assignment usually lose them in the Assessment section. A list of differentials without DSM-5-TR criterion matching reads as opinion, not diagnosis. The strongest evaluations treat the differential as an argument: each alternative is named, its criteria are compared to the patient’s data, and the reason for ruling it out is stated explicitly. Pertinent negatives do as much work as pertinent positives. A patient who denies manic episodes, for example, provides evidence against schizoaffective disorder even when mood symptoms appear in the history. The reflection section is not a formality. It tests whether the student can identify what went wrong in the interview and what legal or ethical issue sits beneath the surface. A reflection that mentions confidentiality and consent and stops there has not demonstrated critical thinking beyond the obvious.

DSM-5-TR Criterion Matching and Diagnostic Precision

Diagnostic reasoning in psychotic disorders depends on precise criterion matching rather than pattern recognition. A recent review of first-episode psychosis assessment notes that the boundary between schizophrenia and schizoaffective disorder is one of the most common sources of diagnostic error in clinical practice, largely because mood symptoms are under-documented during the acute phase (Rognli et al., 2023). The evaluation should record the temporal relationship between psychotic and mood symptoms with enough specificity that an independent reviewer could verify the diagnosis. A statement that the patient “has mood symptoms” is insufficient. The record must state when the mood symptoms occurred relative to the psychotic symptoms, how long each lasted, and whether psychosis ever occurred in the absence of mood disturbance. Cannabis use adds another layer. The distinction between cannabis-induced psychosis and schizophrenia with comorbid cannabis use hinges on persistence beyond the physiological window and on the longitudinal pattern of symptoms (D’Souza, 2023).

• Document the duration of psychotic symptoms both with and without substance use.
• Record the temporal overlap between mood episodes and psychotic episodes.
• State which DSM-5-TR criterion each differential fails and why.

Medication-Induced Movement Disorders in the Differential

A common student question concerns when to include medication-induced movement disorders in the differential for a patient with psychotic symptoms. The answer depends on the medication history. A patient who has taken a first-generation antipsychotic for six months and presents with involuntary facial movements may have tardive dyskinesia, and the evaluation must document the Abnormal Involuntary Movement Scale (AIMS) score and the medication timeline. The DSM-5-TR classifies medication-induced movement disorders as separate diagnostic categories, and the evaluation should distinguish them from the primary psychotic disorder even when both are present. Research on antipsychotic-induced movement disorders emphasizes that tardive dyskinesia is under-recognized in routine practice and often emerges after months of treatment (Citrome, 2023). The evaluation should record the medication name, dose, duration, and the temporal relationship between the movement disorder and the antipsychotic exposure. If the patient has not taken antipsychotics, a medication-induced movement disorder is unlikely, and the differential should focus on primary psychotic disorders and substance-induced conditions.

• Record the AIMS score if a movement disorder is suspected.
• Document the antipsychotic name, dose, start date, and any dose changes.
• Distinguish medication-induced movement disorders from catatonia and extrapyramidal symptoms.
• Include the movement disorder as a separate diagnosis when it meets DSM-5-TR criteria.

Evidence Selection and Clinical Guideline Alignment

The evidence-based resources criterion rewards sources that directly support the diagnostic decision rather than sources that describe the disorder in general. A paper on the neurobiology of schizophrenia may be informative, but it does not help a reviewer verify why cannabis-induced psychosis was ruled out. The strongest submissions cite sources that address differential diagnosis, diagnostic stability, or the specific comorbidity in question. A 2024 network meta-analysis of tardive dyskinesia treatments, for example, supports both the diagnosis and the treatment plan when the patient has antipsychotic exposure (Citrome, 2024). A 2024 study on the functional network connectivity of psychotic disorders supports the argument that schizophrenia and schizoaffective disorder share overlapping features but remain distinguishable on clinical grounds (Zhang et al., 2024). Students should select evidence that maps to a specific claim in the evaluation, not evidence that fills a reference list.

Conclusion

This evaluation rewards the student who shows the diagnostic work. A list of differentials is not a diagnosis; an argument that matches patient data to DSM-5-TR criteria is. The Subjective and Objective sections exist to feed the Assessment, and the Assessment exists to justify the primary diagnosis. The Reflection section tests whether the student can step outside the diagnosis and see the person, the law, and the ethics of the encounter. Start the template early, select the video case by Day 1, and write the differential before writing the final diagnosis. A submission that could have been written without watching the video has not completed the assignment.

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References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Citrome, L. (2023). Differentiating tardive dyskinesia: A video-based review of antipsychotic-induced movement disorders in clinical practice. CNS Spectrums, 27(2), 208–217. https://doi.org/10.1017/S109285292000200X

Citrome, L. (2024). Efficacy and acceptability of pharmacological interventions for tardive dyskinesia in people with schizophrenia or mood disorders: A systematic review and network meta-analysis. Molecular Psychiatry. Advance online publication. https://doi.org/10.1038/s41380-024-02865-2

D’Souza, D. C. (2023). Cannabis, cannabinoids and psychosis: A balanced view. World Psychiatry, 22(2), 231–232. https://doi.org/10.1002/wps.21075

Rognli, E. B., et al. (2023). Transition from substance-induced psychosis to schizophrenia spectrum disorder or bipolar disorder. American Journal of Psychiatry, 180(6), 437–444. https://doi.org/10.1176/appi.ajp.22010076

Zhang, W., et al. (2024). The overlap across psychotic disorders: A functional network connectivity analysis. International Journal of Psychophysiology, 201, 112354. https://doi.org/10.1016/j.ijpsycho.2024.112354

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Comprehensive Psychiatric Evaluation: Schizophrenia in a Young Adult

Subjective

Mr. H.F. is a 20-year-old male college freshman who presents with a six-month history of paranoia, auditory hallucinations, social withdrawal, and declining academic performance. His parents initiated the appointment after observing weight loss, poor grooming, increased isolation, and unusual statements about classmates monitoring or discussing him. He reports hearing two male voices commenting on his behavior and telling him that other students plan to harm him. He also believes that professors use class discussions to send him hidden messages. The patient describes these experiences as distressing and states that he has begun avoiding campus because he fears being watched.

The history of present illness began approximately six months ago, after a period of increasing stress related to academic demands and a recent relationship breakup. Initially, Mr. H.F. became suspicious that roommates were talking about him. Over time, his beliefs became more fixed, and he developed auditory hallucinations that occur both during the day and at night. He reports sleeping approximately four hours per night, with frequent awakenings related to fear and intrusive thoughts. He has missed several classes, stopped attending social activities, and spends most of the day alone in his dormitory room.

His psychiatric history is otherwise limited. He denies previous psychiatric hospitalization, suicide attempts, self-harm, or prior treatment with psychotropic medication. He has never received psychotherapy and has no documented history of a mood disorder. He denies current suicidal ideation, homicidal ideation, or intent to harm others. However, he reports feeling increasingly unsafe and states that he may need to “protect himself” if others try to hurt him. Safety concerns therefore require direct clarification and a documented risk assessment.

Mr. H.F. reports using cannabis two to three times per week for approximately two years, primarily through smoking. He denies using methamphetamine, cocaine, hallucinogens, opioids, or other illicit substances. He consumes alcohol occasionally, approximately two drinks per month, and denies nicotine or caffeine excess. He reports that psychotic symptoms began before his cannabis use increased and have continued during periods when he has not used cannabis for several weeks. This temporal pattern is central to distinguishing a primary psychotic disorder from a substance-induced psychotic disorder.

Family history reveals that his maternal uncle received treatment for schizophrenia, although the patient cannot confirm the diagnosis or treatment details. His father has a history of alcohol misuse but no known psychotic disorder. His mother has depression treated with an antidepressant. No family history of bipolar disorder, suicide, or neurodegenerative illness is reported. The family history increases concern for genetic vulnerability to schizophrenia-spectrum illness, although it does not independently establish the diagnosis.

Social history indicates that Mr. H.F. lives in a university residence hall, is unmarried, and has no children. He grew up in a two-parent household and describes his childhood as generally stable. He reports financial stress related to tuition and part-time work, which may contribute to his current distress. He has few close friendships and states that he has become more isolated since beginning college. He denies homelessness, legal involvement, or recent trauma, although further trauma screening would be appropriate.

Medical history is noncontributory. He denies head injury, seizures, thyroid disease, autoimmune illness, or major medical hospitalization. He takes no prescription medications, over-the-counter medications, or herbal supplements. He reports no known drug allergies. A review of systems is negative for fever, headache, visual changes, focal weakness, recent infection, chest pain, shortness of breath, gastrointestinal symptoms, or urinary symptoms. These responses reduce, but do not eliminate, concern for an underlying medical cause of psychosis.

Objective

Mr. H.F. is a thin young adult male who appears his stated age. He is alert and oriented to person, place, time, and situation. Vital signs are within expected limits: blood pressure 118/76 mmHg, pulse 78 beats per minute, respiratory rate 16 breaths per minute, temperature 98.4°F, and oxygen saturation 98% on room air. Height is 5 feet 10 inches and weight is 138 pounds, representing a body mass index of approximately 19.8 kg/m². Weight loss is noted by history, although no prior weight measurement is available for comparison.

Physical examination of pertinent systems is largely unremarkable. The head is normocephalic and atraumatic. Pupils are equal, round, and reactive to light, with no papilledema. The thyroid is nonenlarged and nontender. Cardiac, pulmonary, and abdominal examinations reveal no abnormal findings. Neurological examination demonstrates intact cranial nerves II through XII, normal muscle strength, normal deep tendon reflexes, and no focal neurological deficits. No abnormal involuntary movements, tremor, rigidity, bradykinesia, or dystonic postures are observed.

A medication-induced movement disorder is unlikely because Mr. H.F. has no history of antipsychotic, antiemetic, or other dopamine receptor blocking agent exposure. Tardive dyskinesia, drug-induced parkinsonism, acute dystonia, and akathisia require a temporal relationship to medication exposure and should be assessed with the Abnormal Involuntary Movement Scale when suspected (Citrome, 2023). The absence of dopamine receptor blocking agent exposure, abnormal movements, rigidity, restlessness, or autonomic instability makes a medication-induced movement disorder a low-priority diagnosis in this case.

Diagnostic testing is necessary to exclude medical and substance-related contributors to psychosis. Recommended studies include a urine drug screen, complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, vitamin B12, and rapid plasma reagin testing. Brain magnetic resonance imaging should be considered if neurological examination is abnormal, onset is abrupt, or first-episode psychosis occurs with atypical features. Laboratory testing cannot diagnose schizophrenia, but it helps rule out reversible medical, metabolic, infectious, and substance-related causes before attributing symptoms to a primary psychotic disorder (Japanese Society of Neuropsychopharmacology, 2024).

Assessment

Mr. H.F. presents as a poorly groomed young man who is alert, cooperative, and oriented. His speech is slow in rate and low in volume, with occasional pauses and thought blocking. Thought content reveals persecutory delusions and ideas of reference, including the belief that classmates and professors are monitoring him. He reports auditory hallucinations consisting of critical and threatening voices. He denies visual hallucinations, command hallucinations, and delusions of control. Insight is limited because he attributes some experiences to external monitoring rather than recognizing them as symptoms of illness. Judgment appears impaired in relation to academic functioning and safety planning.

The primary diagnosis is schizophrenia. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, schizophrenia requires at least two Criterion A symptoms during a one-month period, with at least one symptom being delusions, hallucinations, or disorganized speech (American Psychiatric Association, 2022). Mr. H.F. meets this requirement through persecutory delusions, ideas of reference, and auditory hallucinations. Criterion B is met because social withdrawal, academic decline, impaired self-care, and reduced occupational functioning represent marked deterioration since onset. Criterion C is met because the disturbance has persisted for at least six months. Schizoaffective disorder and depressive or bipolar disorder are excluded because no sustained major mood episode is identified.

Cannabis-induced psychotic disorder is the first differential diagnosis and is ranked second in priority. The DSM-5-TR requires that psychotic symptoms develop during or shortly after substance intoxication or withdrawal and that the disturbance is better explained by the substance than by another disorder (American Psychiatric Association, 2022). Mr. H.F. uses cannabis, and cannabis exposure can contribute to both transient psychotic symptoms and longer-term risk of schizophrenia-spectrum illness (D’Souza, 2023). However, his symptoms began before an increase in cannabis use, persisted during abstinence, and continued beyond the expected period of intoxication or withdrawal. Therefore, cannabis-induced psychotic disorder is less likely than schizophrenia. Rognli et al. (2023) found that 27.6% of individuals with substance-induced psychosis transitioned to a schizophrenia-spectrum disorder within six years, supporting close longitudinal follow-up rather than premature diagnostic closure.

Schizoaffective disorder is the second differential diagnosis and is ranked third in priority. The DSM-5-TR requires an uninterrupted period of illness during which a major mood episode is present for the majority of the total duration, concurrent with Criterion A symptoms of schizophrenia (American Psychiatric Association, 2022). Mr. H.F. reports irritability, anxiety, and poor sleep, but he does not describe a distinct manic, hypomanic, or major depressive episode. Psychotic symptoms occur in the absence of a sustained mood syndrome, and no evidence indicates that mood symptoms account for the majority of the illness duration. Therefore, schizoaffective disorder is not supported. Schizoaffective disorder is often considered when mood and psychotic symptoms overlap, but diagnostic precision requires documentation of the timing, duration, and independence of each symptom cluster (Malhi et al., 2018).

Brief psychotic disorder is the third differential diagnosis and is ranked lowest in priority. The DSM-5-TR requires sudden onset of one or more psychotic symptoms lasting from one day to less than one month, followed by full return to premorbid functioning (American Psychiatric Association, 2022). Mr. H.F. does not meet the duration requirement because his symptoms have persisted for approximately six months. He also has not returned to his baseline academic, social, or self-care functioning. Brief psychotic disorder is therefore ruled out on both duration and functional criteria.

Reflection

If the interview were repeated, more time would be devoted to establishing the chronology of psychosis, cannabis use, mood symptoms, sleep disturbance, and functional decline. A timeline would clarify whether hallucinations and delusions occurred during periods of abstinence, which would strengthen the case for a primary psychotic disorder. The clinician would also ask collateral questions of the patient’s parents, residence hall staff, and academic advisers, with appropriate consent. Collateral history is particularly important in first-episode psychosis because patients may have limited insight and may minimize substance use, safety concerns, or functional deterioration.

Legal and ethical considerations extend beyond confidentiality and informed consent. The clinician must assess imminent risk to self or others, determine whether involuntary evaluation is necessary, and follow jurisdictional requirements for emergency detention or protective intervention. Capacity must be evaluated when the patient refuses treatment, particularly if psychosis impairs his ability to understand the risks of untreated illness. Cultural humility is also necessary. The clinician should avoid interpreting spiritual beliefs, family expectations, or culturally specific explanations of distress as psychosis without careful exploration. Documentation should distinguish observed behavior from the clinician’s interpretation and preserve the patient’s dignity throughout the encounter.

Health promotion should address the patient’s age, socioeconomic stress, and risk for continued substance use. Psychoeducation should explain the relationship between cannabis and psychosis without blaming the patient or assuming that cannabis alone caused his illness. The treatment plan should include abstinence counseling, relapse-prevention planning, sleep hygiene, nutrition, and gradual return to academic activities. Social determinants of health also require attention because poverty, housing instability, discrimination, and limited access to care can worsen outcomes for people with schizophrenia-spectrum disorders (Jester et al., 2023). Connecting Mr. H.F. with campus counseling, financial aid services, peer support, and community mental health services may reduce isolation and support recovery.

Evidence-Based Resources

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Citrome, L. (2023). Differentiating tardive dyskinesia: A video-based review of antipsychotic-induced movement disorders in clinical practice. CNS Spectrums, 27(2), 208–217. https://doi.org/10.1017/S109285292000200X

D’Souza, D. C. (2023). Cannabis, cannabinoids and psychosis: A balanced view. World Psychiatry, 22(2), 231–232. https://doi.org/10.1002/wps.21075

Japanese Society of Neuropsychopharmacology. (2024). Guideline for pharmacological treatment of schizophrenia 2022. Neuropsychopharmacology Reports, 45(1), e12497. https://doi.org/10.1002/npr2.12497

Jester, D. J., Thomas, M. L., Sturm, E. T., Harvey, P. D., Keshavan, M. S., & Davis, B. J. (2023). Review of major social determinants of health in schizophrenia-spectrum psychotic disorders: I. Clinical outcomes. Schizophrenia Bulletin, 49(4), 837–850. https://doi.org/10.1093/schbul/sbad023

Malhi, G. S., Green, M., Fagiolini, A., Vahia, I. V., & Manjunath, S. (2018). Schizoaffective disorder: A review. Annals of Clinical Psychiatry, 30(1), 48–57. https://pubmed.ncbi.nlm.nih.gov/30699217/

Rognli, E. B., Heiberg, I. H., Jacobsen, B. K., Høye, A., & Bramness, J. G. (2023). Transition from substance-induced psychosis to schizophrenia spectrum disorder or bipolar disorder. American Journal of Psychiatry, 180(6), 437–444. https://doi.org/10.1176/appi.ajp.22010076