Comprehensive Mental Health

This document provides a comprehensive mental health assessment of Sheryl Davis, including her presenting complaint, history, medications, and diagnostic differentials. It also offers insights into her personal and social history, mental state exam, and diagnostic reasoning. The assessment suggests a diagnosis of paranoid delusional disorder based on the patient's contentious behavior, imaging studies, and evidence of stress and substance abuse as contributing factors.

Running head: COMPREHENSIVE MENTAL HEALTH
Comprehensive Mental Health
Name
Institution Affiliation
Date

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Presenting Complaint
Sheryl Davis is a 25-year old white female who was admitted to the facility on
12/01/2019. She came with a chief complain of being irritable with low moods. The patient
further stated that she had hallucinations. However, she could not discern whether what she was
seeing and hearing was existent or imaginary. The patient provided assessment information. The
interview was held in a secluded room along with a therapist and senior clinician. Documents
from her previous placements were also used to gather more information for this assessment. The
patient was referred to this facility from California Developmental Training Center due to her
development through treatment, amended behaviors, and being able to function at a developed
level than maximum patients at her previous placement. She was cleared from state hospice and
moved to this facility. The patient would probably stay here until the time comes for her
transitioning into a group home. The treatment personnel trusts that the program here could
possibly improve her current state. Additionally, the staff believes that she may get maximum
benefit from a more group-oriented, and less restricting setting.
History of Presenting Complaint
The information acquired in the evaluation, and former records made me conclude that
the patient has had a very intricate history. Documents obtained paint Sheryl as being notorious
for irrational suspicion of others. She has also been incapable of fostering relationships or run
regular errands. Through the interview, she was regularly intense and detailed when she started
to pronounce facts.
Similarly, as she told her story resending was often necessary to stay absorbed on the
question deliberated. She inclined to want to respond to questions with others and appeared to

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choose expounding on certain subjects, rather than headway and finish the interview. Sheryl was
approaching with information testifying that she repeatedly messed herself up by harming herself
when she opens up to someone. She then rolled up her sleeve and exposed a lot of clear cuts on
her left limb. She appears to be a good narrator but a pitiable historian. Through the evaluation
course, the treatment workforce was somewhat confused as to if sure of the historical particulars
presented were gotten from Sheryl herself, prior documents, or family members.
Current medications
She is prescribed orlistat (Xenical), liraglutide (Saxenda) and Angiotensin II receptor
blockers. Upon admittance, she was ordered CMP, CBC with diff, and given a TB skin test. All
outcomes were unexceptional. The patient is booked to have vision analysis.
Relevant psychiatric history including risk
Sheryl has historical diagnoses of major anxiety made at the age of twelve. She,
therefore, started taking psychotropic drugs at an early age. At thirteen she was seen in the
emergency room for a 30-pound weight loss maintained in three weeks. At this period Sheryl
informed physical abuse by her stepmother. The patient's mother had been formerly probed for
child abuse.
Consequently, the patient and her sisters were detached from the home and made wards
of the state. It was also established that the patient's father was older compared to her biological
mother. At a certain point, they were taken back to their home then Sheryl’s sisters made claims
that she was extremely irritable and acted weirdly. From then, her conduct has been problematic
to cope. She has a documented history of self-harm, anger, insomnia, and rebelliousness.

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Therefore, Sheryl has had numerous psychiatric hospitalizations in several places all over the
state of California.
Relevant medical history
She has no identified drug sensitivities, a surgical history of thyroidectomy, and attained
progressive markers on time. The patient has a medical history of thyroidectomy and presently
suffers from high blood pressure, and obesity.
Family history
The patient has three younger sisters, one being non-biological. Her biological mother is
said to have had a history of significant substance abuse. Her father is older as compared to her
mother. Sheryl's stepmother is currently on punishment for alleged child abuse. In 2015, Sheryl's
judge ordered that the family should cut interaction owing to continuously trying to interrupt
treatment, telling her not to conform, and making promises that not ever happened. In the course
of the interview, she evaded eye contact as she spoke gently on her family, and it appeared to be
uncomfortable for her.
Personal and social history
As stated earlier, the patient was physically abused by her stepmother and was removed
from her home at a very early age. Most of her public interface has been in an official
background. Former records designate that she has an account of poor affiliations with peers and
workforce at several placements. She is labeled as unable to stomach having other peers get
attention from the team. She confessed to having physically interrupted, made up tales, and
forged ailments so people would give her attention. While at the California Development and

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Training Center she finished the Wechsler Adult Intelligent Scale III. This produced a full-scale
IQ of 67; verbal 75; and performance, 61. She has no kids, has never been in a job and she
articulated a sexual inclination to both genders. She admitted to having been eating marijuana,
sniffing cocaine and drinking a lot of alcohol.
Mental state exam
The patient is overweight with blond hair held back in a ponytail. She had a cheerful
effect and was reasonably insensitive socially. She had no spasms or unusual movements and
made respectable eye contact. Sheryl repudiated any recent suicidal contemplations but endorsed
obsession. She detailed that she hears and has visions of a workforce from a former placement
throughout the day and night. She branded her mood as nervous and dejected owing to a
different placement. Patient cognitive working appeared to be damaged. She was orientated to
the year but thinks it is still 2018. She declined to count from ten rearwards and did not look to
discern the dissimilarity between an apple and a tomato. She did not seem to put considerable
effort in responding to cognitive questions. Her discernment seemed to be poor during the
evaluation.
Diagnostic Differentials
Out of all the psychological health illnesses, schizophrenia is that which is
furthermost intensely linked with lunacy or psychosis (Rosenstrom, Torvik, Ystrom, &
Reichborn, 2018). Certainly, delusions and hallucinations are guarantees of schizophrenia and
principal constituents of diagnosis. Nevertheless, delusions alone are not sufficient to brand a
diagnosis of schizophrenia. Relatively, those besieged with the disorder should similarly

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experience substantial damage in functioning, and particular symptoms should be invariably
existent for a minimum of six months.
Paranoid delusional disorder, on the contrary, cores exclusively on the delusions which
should be existent for a minimum of one month (Haghighatfard, Andalib, & Ghadimi,
2017). Delusions are defined as permanent philosophies that do not vary, even when an
individual is offered with different proof. In individuals with the paranoid delusional disorder,
hallucinations are likely to be non-bizarre; that is, they implicate circumstances that are
theoretically conceivable but very improbable. For instance, the conviction that a partner is
double-dealing would be a non-bizarre delusion. Peculiar delusions, on the contrary, designate
philosophies that are unlikely, such as that external power is governing one’s thoughts. While
individuals with paranoid delusional disorder may experience these signs, they are far less
probable to occur than non-bizarre delusions. Unlike in schizophrenia, hallucinations are not
experienced at all by record individuals with this disorder and, if they are, they are corresponding
with the delusional conviction. As Harvard Health Publishing explains, “Someone who has the
delusions that internal organs are rotting may hallucinate smells or sensations related to the
delusion.”
While deliberating paranoid delusional disorder versus schizophrenia, one of the
furthermost noteworthy variances is in functionality (Iacovino, Jackson, & Oltmanns, 2017).
While compromised function is a fragment of the diagnostic conditions for schizophrenia,
principally basic functionality is obligatory for a diagnosis of paranoid delusional disorder.
According to Dr. Alistair Munro, an expert on the disease, the exceptional mechanism around
paranoid delusional disorder is that one does not get the delusions dispersing out and interfering

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the contemplations about other stuff. She further adds that it is solely around the thing [the
dominant delusion, not like in schizophrenia] where the disorder is dispersed right all through the
individual’s character and conduct. When functional disturbances do transpire, they are
unswervingly tied to the delusions themselves; for instance, an individual who considers a
colleague is scheming to assassinate them can resign from their employment.
Conversely, individuals with the paranoid delusional disorder are regularly conscious that
their philosophies are matchless and commonly do not discourse about them (Kulkarni,
Arasappa, Prasad, Zutshi, & Chand, 2017). As such, the disease might not be freely evident to
others. Dr. Munro alludes that they might be considered as somewhat weird, problematic,
irritable, that sort of thing. Nonetheless, this is habitually not the case; numerous individuals
show no apparent indications of anything strange to the spontaneous observer, which makes
paranoid delusional disorder way very hard to identify than schizophrenia is. Furthermore,
individuals with the disorder regularly see no purpose of pursuing psychiatric aid; they are
persuaded of their conviction and do not look at it as a sign of mental disorder, mostly if their
functionality stays integral and they do not perceive any patently detrimental impacts of their
disease in their life. At the same time, alertness that the conviction sounds impractical to others
and dread of discernment might steer them to hide their beliefs even to a healthcare expert.
Diagnostic tests
Physical examination- This may be conducted to assist in ruling out other complications that may
be causing symptoms and to check for other allied disorders.

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Tests and screenings- These can comprise tests that assist rule out diseases with comparable
symptoms and testing for liquor and substances. Imaging analyses, for example, an MRI or CT
scan to establish other internal issues that may be present in the body or brain abnormality.
Diagnostic criteria for paranoid delusional disorder and schizophrenia- This criteria in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American
Psychiatric Association, may also be used to ascertain the type of disorder. It generally requires
the occurrence of long-term suspicion and mistrust of others, deducing their intentions as
malicious, from an early grown-up age, happening in a variety of circumstances. Four of seven
particular concerns have to be existent, which consists of diverse sorts of doubts or uncertainty
(for instance of being abused, or that comments have an indirect intimidating significance), in
certain circumstances concerning others generally or precisely associates or partners, and in
other cases referring to a reaction of keeping resentments or retorting furiously.
According to the American Psychiatric Association, Paranoid delusional disorder may
embroil, in reaction to stress, minimal psychotic occurrences. The patient might similarly be at
more than the regular danger of suffering a primary depressive syndrome, agoraphobia, social
anxiety disorder, obsessive-compulsive disorder or drug and alcohol-related disorders.
Conditions for other behavior disorder diagnoses are usually likewise met, such as severe
personality disorder, schizoid, borderline, schizotypal, avoidant and narcissistic.
Diagnostic reasoning and formulation of diagnostic decision
The patient is diagnosed to have a paranoid delusional disorder, a diagnosis Nesvåg,
Jönsson, & Andreassen (2017) denote that is reached upon after careful consideration of the
client’s general appearance, assessment, findings, history, and diagnostic tests. In the course of

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the interview, the patient appeared to be very contentious. Through the conversation, she was
regularly intense and detailed when she started to pronounce facts. Similarly, as she told her
story resending was often necessary to stay absorbed on the question deliberated. She inclined to
want to respond to questions with others and appeared to choose expounding on certain subjects,
rather than headway and finish the interview. Studies show that individuals suffering from
paranoid delusional disorders tend to be very contentious and tend to want conversations to go
their way. From the imaging studies (MRI and CT scan) conducted on the patient. It was
established that some parts of her brain are not healthy. Research has shown that abnormal brain
regions that control perception and thinking may be linked to the delusional symptoms. This may
be a biological reason to ascertain that the patient indeed suffers from paranoid delusional
disorder.
Evidence suggests that stress can trigger the delusional disorder (Levy, 2018). Alcohol
and drug abuse also might contribute to it. In the course of the interview, the patient admitted to
having been drinking a lot of alcohol although she did not pinpoint a particular kind or the exact
quantity. Additionally, she said that she used to eat marijuana and sniff cocaine. This ascertains
the psychological causes of the diagnosis.
The patient underwent medical tests for Alzheimer’s disease, epilepsy, obsessive-
compulsive disorder, delirium, and other schizophrenia spectrum disorders. All the tests were
negatively ascertaining that there was no other medical condition to blame for the symptoms she
had. Even though she had undergone thyroidectomy, the analysis showed that it did not harm
her. She also had no previous diagnosis of schizophrenia. Therefore, the only likely cause of the
symptoms she revealed is a paranoid delusional disorder.

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The patient found relationships difficult. Documented accounts from her former
placements showed that she had difficulties establishing and maintaining relationships with her
peers and staff. Research has shown that individuals with paranoid delusional disorders have
problems fostering relationships due to their paranoia. They always think that the other person
has malicious intentions and may want to harm. Such patients find it hard to trust anyone as they
do not see the good side of people. However, this may be a result of what they went through in
their childhood that cultivated mistrust in humans.
In its criteria for the diagnosis of delusional disorders, the American Psychiatric
Association proposes that individuals with delusional disorders generally have the long-term
suspicion and distrust of others, deducing their intentions as malicious. From an early grown-up
age, Noort, Beekman, Gool, Braam, & van Gool (2018) denotes that it happens in a variety of
circumstances. Four out of seven particular concerns have to be in existence, which comprise
dissimilar kinds of doubts or suspicion (for instance of being abused, or that comments have an
indirect intimidating meaning), in certain circumstances concerning others generally or precisely
support system or spouses, and in other situations denoting to a reaction of keeping resentments
or retorting angrily. The patient met most of the criteria's particulars.
From her history, the patient had been seeing and hearing things that she could not
discern as being real or imaginary, an aspect that can be termed as hallucination according to
Peralta & Cuesta (2016). She detailed that she hears and has visions of a workforce from a
former placement throughout the day and night. Illusion not related to the themes of one's
delusions further confirms the diagnosis. Numerous studies have linked hallucinations to
paranoid delusional disorders. A survey conducted on individuals with the disease proved that

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100% of the patients experience hallucinations daily (Psychosis, 2019). The patients, however,
did not link the hallucinations to their delusions.
The patient could perform well in other areas not related to the delusion. While at the
California Development and Training Center she finished the Wechsler Adult Intelligent Scale
III. This produced a full-scale IQ of 67; verbal 75; and performance, 61. This proves that she
would perform well in other aspects of life. Similarly, she was transferred to our facility from
California Developmental Training Center due to her development through treatment, amended
behaviors, and being able to function at a developed level than maximum patients at her previous
placement. Studies have confirmed the capability of individuals suffering from paranoid
delusional disorder to do outstandingly well in delusion-unrelated aspects of their livelihoods.
The patient has cognitive impairment. During the interview I ascertained that she is
mentally impaired as her cognitive ability appeared to be very low. She refused to count from ten
rearwards. On asking her which year we are in, she could not tell as she thinks it is still 2018.
Additionally, she could hardly differentiate between an apple and a tomato. All these aspects
imply that her brain is malfunctioning as supported by Rizeanu (2015). The patient also admitted
to having a feeble memory as she had a tendency of forgetting very fast and would hardly recall
something that happened hours before. Studies have linked poor cognitive ability or cognitive
impairment to paranoid delusional disorder.
The patient tends to be very aggressive and irritable. In her history, it is documented that
her sisters alleged that she was very cranky with weird behaviors. Additionally, personnel in the
unit have reported that she has tried to destroy furnishes in the unit on three different occasions.
She also hit her head on the table a day ago while at the department's cafeteria. The patient is

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easily irritated by minor issues that do not need sensitive reactions. Aggression and irritability
have been confirmed by specialists in the medical field, to be a central feature of people with the
paranoid delusional disorder. Thus, a definite diagnosis was made.
Plan
Effective planning is essential for successful treatment of every health complication
(Rowland, Birchwood, & Thompson, 2019). The patient should be administered with routine
PRN and psychotropic medicines as recommended by Dr. Clifford. The patient is presently
prescribed fluphenazine, thiothixene, olanzapine, and risperidone daily. Chlordiazepoxide and
alprazolam recommended for managing anxiety/nervousness. Information nurses on duty will
have to fill the Suicide Assessment Tool every other day until the patient is capable of doing
away with suicidal contemplations and ideas and information reported to the doctor on duty
within a half an hour if the patient is put in a physical healing footing. Educate the program
workforce on patients Transition Behavioral Support Plan. Inspire the personnel to use pre-
emptive, reassuring, and precautionary approaches while dealing with patients.
Steps to be adopted will be to;
 Emergency suppositories and physical curbs are used only if the patient turns out
to be a threat to self, and others.
 Encourage the patient to take part in all related setting groups while in treatment,
and to establish confident friendships with peers.
 Patients may advance their general self-regulating, managing, and social abilities
with constant positive support.

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 Carry on with present high blood pressure and obesity suppositories as
recommended by the therapeutic doctor. Refer the patient to a specialist for
concerns linked to diagnoses of high blood pressure and obesity.
 Refer the patient to a dietitian for weight, and dietetic supervision.
 Psychotherapy may similarly be helpful, together with suppositories, as a means
to assist patients better manage the pressures associated with their delusional
beliefs and its effect on their livelihoods. Psychoanalyses that could be helpful in
paranoid delusional disorder include individual therapy, and cognitive
behavioral therapy (CBT).

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References
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Iacovino, J. M., Jackson, J. J., & Oltmanns, T. F. (2014). The relative impact of socioeconomic
status and childhood trauma on Black-White differences in paranoid personality disorder
symptoms. Journal of Abnormal Psychology, 123(1), 225–230.
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K. (2017). Risperidone versus olanzapine in the acute treatment of Persistent Delusional
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delusions in older adults: Diagnoses, combinations, and delusional

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characteristics. International Journal of Geriatric Psychiatry, 33(12), 1680–1687.
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79. https://doi.org/10.1016/j.schres.2018.08.036

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