NRNP PRAC 6635: Substance addictive disorder

Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

To Prepare:
Review this week’s Learning Resources and consider the insights they provide.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 8
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment?

Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

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Assessing and Diagnosing Patient with Substance Related Disorder

Student Name

College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning

Assessing and Diagnosing Patient with Substance Related Disorder

Patient Information: Initials: KB Gender: F Age: 41

Patient: Training Title 151


CC: elbow pain

HPI: BK is a 41 year old Caucasian female who is being assessed by a psychiatrist for the possibility of substance abuse. In order to relieve the pain she is experiencing from chronic elbow pain, she has been experimenting with various medications to help her cope. She did mention that she was also suffering from headaches, which drove her to use pain relievers. According to the information provided by the patient, it is clear that she has been suffering from pain, which has prompted her to experiment with several types of medicines that have failed to bring relief, prompting her to look into other drug forms. She reports that the other drugs she was taking caused her to undergo problems like constipation and dizziness, and, more importantly, they did not relieve her pain in the way she had hoped they would have. She bases her views on such perspectives when discussing the effects of drugs like Morphine and Dilaudid, which she claims seldom helped in terms of suppressing the pain she was experiencing.

Past Psychiatric History:

Denies any past mental history

  • General Statement: The patient is here to be assessed for probable substance abuse, and this is her first visit to a psychiatrist.
  • Caregivers (if applicable): none
  • Hospitalizations: denies any prior hospitalizations
  • Medication trials: denies past psychiatric Adderall abuse in the past.
  • Psychotherapy or Previous Psychiatric Diagnosis: Denies any past psycho Reports biofeedback in the past.

Substance Current Use and History: Patient has used a variety of substances, including alcohol, cannabis for headache relief, and Tylenol with codeine, which resulted in a flushed response. Ecstasy and LSD were used once or twice, with no adverse outcomes. Cocaine was used 1-2 months ago, Adderall 20mg was not prescribed.

Family Psychiatric/Substance Use History: No family history or substance abuse.

This information is critical in determining the patient’s medical history and in providing her with the most effective treatment possible.

Psychosocial History:

Katarina has two brothers and two sisters. She has a part-time job as a cashier at Aldi Grocery Store. She left high school when I was in the eleventh grade. She is a single woman with a boyfriend. In addition to having a son with whom she has been denied custody, she also has parents who are addicted to drugs. She consumes alcoholic beverages 1-2 times a week, when she is with family or on specific events. When she is with her lover, she drinks to the point of being inebriated, culminating in a DUI. She claims that she takes marijuana four times a week to alleviate her headaches.

Medical History:

  • Current Medications: Fish oil and vitamins

•      Allergies: Codeine

  • Reproductive Hx: She does not affirm or deny having sexual contact with her lover. Regular menstrual cycle.
  • Past Medical History: Chronic Pain



GENERAL: Denies weight loss, fever, and chills.

HEENT: Denies visual problems, hearing problems and ear pain. Denies sinus problems. Denies neck pain or injury.

SKIN: Denies rash, itching or lesions.

Cardiovascular/Peripheral Vascular: Denies chest pain, heart palpitations, murmurs, or edema.

RESPIRATORY: Denies breathing problems.

GASTROINTESTINAL: Normal bowel movements. Denies anorexia, nausea or vomiting.

GENITOURINARY: No pain or urinary changes.

NEUROLOGICAL: Positive for irregular sleeping patterns. Denies sleeplessness, reduced energy, and suicidal ideation.

MUSCULOSKELETAL: Denies back pain, muscle pain, joint pain or swelling. HEMATOLOGY: Denies anemia, bleeding, or bruising.

LYMPHATICS: Denies enlarged nodes, or history of splenectomy

ENDOCRINE: Denies heat or cold intolerance, or sweating.

Allergic/Immunologic: Denies asthma, hives or immunologic condition.


Physical exam:

Vitals: T- 97.4 P- 74 R 120 100/70 Ht 5’8 Wt 117lbs

Diagnostic results: CBC, CMP, UDS.

Among the numerous innovative procedures developed by Skinner (1982) was the objective of detecting drug abuse. The screening tool, referred to as the Drug Abuse Screening Test (DAST-10) is used to determine whether or not someone is abusing drugs (Shirinbayan et al., 2020). When it comes to clinical contexts, the DAST is a quick and simple test. Additionally, it can be utilized to assess the effectiveness of the treatment.


Mental Status Examination:

Client seems uneasy, fidgety, and easily disturbed, but he is alert and oriented x4. She is gentle and cooperative with the interviewer. She is properly attired and well groomed for the occasion. Gait is steady.   Her speech is coherent and clear; her tone is normal and she is able to communicate her ideas and emotions via her words. She has a fair insight of sickness. During the interview, the client exhibits a flat demeanor sometimes and seems suspicious at other times. There are no outward indicators of delusion, hallucination, or paranoia. The thought process is logical, and the contents of her thoughts is appropriate. Has a fair judgment. She has exceptional short- and long-term memory, and she is able to focus. The mood is euthemic.  Denies SI, HI, VH, AH. Differential Diagnoses:

Substance Use Disorder with severe opioid use disorder [F11.20]:

The DSM-5 acknowledges the existence of substance-related disorders caused by the consumption of a total of ten distinct kinds of drugs: alcohol, cocaine, methamphetamine, and opiates, among others (APA, 2013).  The client takes an opioid and claims that it is more effective in alleviating her elbow pain. She has also experimented with other substances such as cannabis, alcohol, caffeine, cocaine, and other drugs.

Alcohol Use Disorder with severe use: [F10.20].

AUD is a psychiatric illness that is defined by a poor capacity to quit or regulate alcohol use notwithstanding the negative implications of alcohol consumption on one’s social, vocational, and health lives. In certain circles, it is referred to as “alcohol abuse,” “alcohol dependency,” or “alcohol addiction,” while others use the word “alcoholism” (Takahashi, 2017)

Stimulant Use Disorder Moderate: [F15.20]:

Neuroadaptation and the impact of drug use on one’s ability to function socially and in relationships are taken into account while establishing the criteria for stimulant use disorder. In this case, the client has tried cocaine and Adderall, leading to the probability of the above-mentioned diagnosis being made.


When I first started looking into Bykov’s case, I was especially worried about the severe health impacts of illicit drugs. In this scenario, the first thing I considered was that legal drug usage is equally as harmful as illegal drug use since these medications are addictive. Bykov’s case clearly demonstrates that the majority of people who suffer from substance addiction do not realize they have the condition until it is severe. Considering the ease with which people suffering from chronic pain may get and utilize such drugs, it is necessary that such substances be subjected to stringent regulations in terms of their usage.


American Psychiatric Association. (2013). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Shirinbayan, P., Salavati, M., Soleimani, F., Saeedi, A., Asghari-Jafarabadi, M., Hemmati- Garakani, S., & Vameghi, R. (2020). The Psychometric Properties of the Drug Abuse Screening Test. Addiction & health, 12(1), 25–33.

Skinner H. A. (1982). The drug abuse screening test. Addictive behaviors, 7(4), 363–371.

Takahashi, T., Lapham, G., Chavez, L. J., Lee, A. K., Williams, E. C., Richards, J. E., Greenberg, D., Rubinsky, A., Berger, D., Hawkins, E. J., Merrill, J. O., & Bradley, K. A. (2017). Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial. Addiction science & clinical practice, 12(1), 17.