NRNPPRAC 6635 Comprehensive Psychiatric Evaluation ExemplarIN

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation
Exemplar
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND
TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to
include, follow the
Comprehensive Psychiatric Evaluation Template
AND the Rubric
as your guide. It is also helpful to review the rubric in
detail in order not to lose points unnecessarily because you
missed something required. Below highlights by category are
taken directly from the grading rubric for the assignment in
Weeks 4–10. After reviewing the full details of the rubric, you
can use it as a guide.
In the
Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use,
social, and medical history
· Allergies
· ROS
·
Read rating descriptions to see the grading standards!
In the
Objective section, provide:

· Physical exam documentation of systems pertinent to the chief
complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other
assessments needed to develop the differential diagnoses.
·
In the
Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them
from top priority to least priority. Compare the
DSM-5-TR diagnostic criteria for each differential
diagnosis and explain what
DSM-5-TR 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.
·
Reflect on this case. Include: Discuss what you learned and
what you might do differently. Also include in your reflection a
discussion related to legal/ethical considerations (
demonstrate critical thinking beyond confidentiality and
consent for treatment!), social determinates of health, 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.).
(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing
this type of note in this course. You will be ruling out other
mental illnesses so often you will write up what symptoms are

present and what symptoms are not present from illnesses to
demonstrate you have indeed assessed for all illnesses which
could be impacting your patient. For example, anxiety
symptoms, depressive symptoms, bipolar symptoms, psychosis
symptoms, substance use, etc.)
EXEMPLAR BEGINS HERE
CC (chief complaint): A
brief statement identifying why the patient is here. This
statement is verbatim of the patient’s own words about why
presenting for assessment. For a patient with dementia or other
cognitive deficits, this statement can be obtained from a family
member.
HPI: Begin this section with patient’s initials, age, race, gender,
purpose of evaluation, current medication and referral reason.
For example:
N.M. is a 34-year-old Asian male presents for psychiatric
evaluation for anxiety. He is currently prescribed sertraline
which he finds ineffective. His PCP referred him for evaluation
and treatment.
Or
P.H., a 16-year-old Hispanic female, presents for psychiatric
evaluation for concentration difficulty. She is not currently
prescribed psychotropic medications. She is referred by her
therapist for medication evaluation and treatment.
Then, this section continues with the symptom analysis for your
note. Thorough documentation in this section is essential for
patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is
bringing the patient to your evaluation. Then, include a
PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms
onset, duration, frequency, severity, and impact. Your
description here will guide your differential diagnoses. You are

seeking symptoms that may align with many DSM-5-TR
diagnoses, narrowing to what aligns with diagnostic criteria for
mental health and substance use disorders.
Past Psychiatric History: This section documents the patient’s
past treatments. Use the mnemonic
Go
Cha
MP.
General Statement: Typically, this is a statement of the patients
first treatment experience. For example: The patient entered
treatment at the age of 10 with counseling for depression during
her parents’ divorce. OR The patient entered treatment for detox
at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where
was last hospitalization? How many detox? How many
residential treatments? When and where was last
detox/residential treatment? Any history of suicidal or
homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic
medications the patient has tried and what was their reaction?
Effective, Not Effective, Adverse Reaction? Some examples:
Haloperidol (dystonic reaction), risperidone
(hyperprolactinemia), olanzapine (effective, insurance wouldn’t
pay for it)
Psychotherapy or
Previous Psychiatric Diagnosis: This section can be
completed one of two ways depending on what you want to
capture to support the evaluation. First, does the patient know
what type? Did they find psychotherapy helpful or not? Why?
Second, what are the previous diagnosis for the client noted
from previous treatments and other providers. Thirdly, you

could document both.
Substance Use History: This section contains any history or
current use of caffeine, nicotine, illicit substance (including
marijuana), and alcohol. Include the daily amount of use and
last known use. Include type of use such as inhales, snorts, IV,
etc. Include any histories of withdrawal complications from
tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains
any family history of psychiatric illness, substance use
illnesses, and family suicides. You may choose to use a
genogram to depict this information. Be sure to include a
reader’s key to your genogram or write up in narrative form.
Social History: This section may be lengthy if completing an
evaluation for psychotherapy or shorter if completing an
evaluation for psychopharmacology. However, at a minimum,
please include:
Where patient was born, who raised the patient
Number of brothers/sisters (what order is the patient within
siblings)
Who the patient currently lives with in a home? Are they single,
married, divorced, widowed? How many children?
Educational Level
Hobbies:
Work History: currently working/profession, disabled,
unemployed, retired?
Legal history: past hx, any current issues?
Trauma history: Any childhood or adult history of trauma?
Violence Hx:
Concern or issues about safety (personal, home,
community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries,
include any hx of seizures, head injuries.
Current Medications: Include dosage, frequency, length of time
used, and reason for use. Also include OTC or homeopathic
products.
Allergies:
Include medication, food, and environmental allergies
separately. Provide a description of what the allergy is (e.g.,
angioedema, anaphylaxis). This will help determine a true
reaction vs. intolerance.
Reproductive Hx:
Menstrual history (date of LMP), Pregnant (yes or no),
Nursing/lactating (yes or no), contraceptive use (method used),
types of intercourse: oral, anal, vaginal, other, any sexual
concerns
ROS: Cover all body systems that may help you include or rule
out a differential diagnosis. Please note: THIS IS DIFFERENT
from a physical examination!
You should list each system as follows:
General:Head:
EENT: etc. You should list these in bullet format and
document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or
yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing,
congestion, runny nose, or sore throat.
SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest
discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or
diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy,
odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia, numbness, or tingling in the extremities. No change in
bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or
stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat
intolerance. No polyuria or polydipsia.
Physical exam (If applicable and if you have opportunity to
perform—document if exam is completed by PCP): From head
to toe, include what you see, hear, and feel when doing your
physical exam. You only need to examine the systems that are
pertinent to the CC, HPI, and History.
Do not use “WNL” or “normal.” You must describe
what you see. Always document in head-to-toe format i.e.,
General: Head: EENT: etc.
Diagnostic results: Include any labs, X-rays, or other
diagnostics that are needed to develop the differential diagnoses
(support with evidenced and guidelines).
Assessment
Mental Status Examination: For the purposes of your courses,
this section must be presented in paragraph form and not use of
a checklist! This section you will describe the patient’s
appearance, attitude, behavior, mood and affect, speech, thought
processes, thought content, perceptions (hallucinations,
pseudohallucinations, illusions, etc.)., cognition, insight,

judgment, and SI/HI. See an example below. You will modify to
include the specifics for your patient on the above elements —
DO NOT just copy the example. You may use a preceptor’s way
of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated
age. He is cooperative with examiner. He is neatly groomed and
clean, dressed appropriately. There is no evidence of any
abnormal motor activity. His speech is clear, coherent, normal
in volume and tone. His thought process is goal directed and
logical. There is no evidence of looseness of association or
flight of ideas. His mood is euthymic, and his affect appropriate
to his mood. He was smiling at times in an appropriate manner.
He denies any auditory or visual hallucinations. There is no
evidence of any delusional thinking. He denies any current
suicidal or homicidal ideation. Cognitively, he is alert and
oriented. His recent and remote memory is intact. His
concentration is good. His insight is good.
Differential Diagnoses:
You must have at least three differentials with
supporting evidence. Explain what rules each differential in or
out and justify your primary diagnostic impression selection.
You will use supporting evidence from the literature to support
your rationale. Include pertinent positives and pertinent
negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this
case and discuss whether or not you agree with your preceptor’s
assessment and diagnostic impression of the patient and why or
why not. What did you learn from this case? What would you do
differently?
Also include in your reflection a discussion related to
legal/ethical considerations (
demonstrating critical thinking beyond confidentiality

and consent for treatment!), social determinates of health,
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.).
References (move to begin on next page)
You are required to include at least three evidence-based, peer-
reviewed journal articles or evidenced-based guidelines which
relate to this case to support your diagnostics and differentials
diagnoses. Be sure to use correct APA 7th edition formatting.
© 2021 Walden University
Page 1 of 3
January/February 2016 11
FRANÇOIS BOURGUIGNON is Professor of
Economics at the Paris School of Economics,
former Chief Economist of the World Bank, and
the author of The Globalization of Inequality.
IN
EQ
U
A
LITY
reversal of the trend that prevailed for
most of the twentieth century, global
inequality has declined markedly since

2000 (following a slower decline during
the 1990s). This trend has been due in
large part to the rising fortunes of the
developing world, particularly China and
India. And as the economies of these
countries continue to converge with those
of the developed world, global inequality
will continue to fall for some time.
Even as global inequality has declined,
however, inequality within individual
countries has crept upward. There is
some disagreement about the size of this
increase among economists, largely owing
to the underrepresentation of wealthy
people in national income surveys. But
whatever its extent, increased inequality
within individual countries has partially
offset the decline in inequality among
countries. To counteract this trend, states
should pursue policies aimed at redistrib-
uting income, strengthen the regulation
of the labor and financial markets, and
develop international arrangements that
prevent firms from avoiding taxes by
shifting their assets or operations overseas.
THE GREAT SUBSTITUTION
Economists typically measure income
inequality using the Gini coefficient,
which ranges from zero in cases of perfect
equality (a theoretical country in which
everyone earns the same income) to one
in cases of perfect inequality (a state in
which a single individual earns all the
income and everyone else gets nothing).

In continental Europe, Gini coefficients
tend to fall between 0.25 and 0.30. In
the United States, the figure is around
0.40. And in the world’s most unequal
countries, such as South Africa, it exceeds
0.60. When considering the world’s
Inequality and
Globalization
How the Rich Get Richer as
the Poor Catch Up
François Bourguignon
When it comes to wealth and
income, people tend to com-
pare themselves to the people
they see around them rather than to those
who live on the other side of the world.
The average Frenchman, for example,
probably does not care how many Chi-
nese exceed his own standard of living,
but that Frenchman surely would pay
attention if he started lagging behind
his fellow citizens. Yet when thinking
about inequality, it also makes sense to
approach the world as a single commu-
nity: accounting, for example, not only
for the differences in living standards
within France but also for those between
rich French people and poor Chinese
(and poor French and rich Chinese).
When looking at the world through
this lens, some notable trends stand out.

The first is that global inequality greatly
exceeds inequality within any individual
country. This observation should come
as no surprise, since global inequality
reflects the enormous differences in
wealth between the world’s richest and
the world’s poorest countries, not just
the differences within them. Much more
striking is the fact that, in a dramatic
Jan_Feb_2015_2.indb 11 11/17/15 7:33 PM
12
population as a whole, the Gini coe� -
cient comes to 0.70—a � gure so high
that no country is known to have ever
reached it.
Determining the Gini coe� cient for
global inequality requires making a num-
ber of simpli� cations and assumptions.
Economists must accommodate gaps in
domestic data—in Mexico, an extreme
case, surveys of income and expenditures
miss about half of all households. They
need to come up with estimates for years
in which national surveys are not avail-
able. They need to convert local incomes
into a common currency, usually the
U.S. dollar, and correct for di� erences
in purchasing power. And they need to
adjust for discrepancies in data collec-
tion among countries, such as those that

arise when one state measures living
standards by income and another by
consumption per person or when a state
does not collect data at all.
Such inexactitudes and the di� erent
ways of compensating for them explain
why estimates of just how much global
inequality has declined over the past
two-plus decades tend to vary—from
around two percentage points to up to
� ve, depending on the study. No matter
how steep this decline, however, econo-
mists generally agree that the end result
has been a global Gini coe� cient of
around 0.70 in the years between 2008
and 2010.
The decline in global inequality is
largely the product of the convergence
of the economies of developing coun-
tries, particularly China and India, with
those of the developed world. In the
� rst decade of this century, booming
economies in Latin America and sub-
Saharan Africa also helped accelerate
this trend. Remarkably, this decline
Assistant Editor
Foreign A� airs is looking for
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editorial team.
The Assistant Editor position
is a full-time paid job o� ering

exceptional training in serious
journalism. Previous Assistant
Editors have included recent
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master’s programs. Candidates
should have a serious interest in
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The Assistant Editor works for one
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February 1, 2016.
05_Bourguignon_pp11_15b_Blues.indd 12 11/19/15 12:10
PM
Inequality and Globalization
rising fast enough to offset the rapid
decline in inequality among countries.
The good news is that the current
decline in global inequality will prob-

ably persist. Despite the current global
slowdown, China and India have such
huge domestic markets that they retain
an enormous amount of potential for
growth. And even if their growth rates
decline significantly in the next decade,
so long as they remain higher than those
of the advanced industrial economies, as
is likely, global inequality will continue
to fall. The prospects for growth are less
favorable for the smaller economies in
Latin America and sub-Saharan Africa
that depend primarily on commodity
exports, since world commodity prices
may remain low for some time. All told,
then, global inequality will likely keep
falling in the coming decades—but
probably at the slow pace seen during
followed a nearly uninterrupted rise in
inequality from the advent of the Indus-
trial Revolution in the early nineteenth
century until the 1970s. What is more,
the decline has been large enough to
erase a substantial part of the inequality
that built up over that century and a half.
Even as inequality among countries
has decreased, however, inequality
within individual countries has increased,
gaining, on average, more than two
percentage points in terms of the Gini
coefficient between 1990 and 2010. The
countries with the biggest economies
are especially responsible for this trend—
particularly the United States, where the

Gini coefficient rose by five percentage
points between 1990 and 2013, but also
China and India and, to a lesser extent,
most European countries, among them
Germany and the Scandinavian states.
Still, inequality within countries is not
S
T
R
/ A
F
P
/ G
E
T
T
Y
IM
A
G
E
S
Left behind: scavenging in a garbage dump in Hefei, China,
December 2012
05_Bourguignon_pp11_15b_Blues.indd 13 11/19/15 11:39
AM

François Bourguignon
14 f o r e i g n a f fa i r s
to converge with those of the developed
world. The resulting boom triggered
faster growth in Africa and Latin
America as demand for commodities
increased. In the developed world, mean-
while, as manufacturing firms outsourced
some of their production, corporate
profits rose but real wages for unskilled
labor fell.
Economic liberalization also played
an important role in this process. In
China, the market reforms initiated by
Deng Xiaoping in the 1980s contrib-
uted just as much to rapid growth as
did the country’s opening to foreign
investment and trade, and the same is
true of the reforms India undertook in
the early 1990s. As with globalization,
such reforms didn’t just enable devel-
oping countries to get closer to the
developed world; they also created a
new elite within those countries while
leaving many citizens behind, thus
increasing domestic inequality.
The same drive toward economic
liberalization has contributed to increas-
ing inequality in the developed world.

Reductions in income tax rates, cuts to
welfare, and financial deregulation have
also helped make the rich richer and, in
some instances, the poor poorer. The
increase in the international mobility of
firms, wealth, and workers over the past
two decades has compounded these
problems by making it harder for gov-
ernments to combat inequality: for
example, companies and wealthy people
have become increasingly able to shift
capital to countries with low tax rates
or to tax havens, allowing them to
avoid paying more redistributive taxes
in their home countries. And in both
developed and developing countries,
technological progress has exacerbated
the 1990s rather than the rapid one
enjoyed during the following decade.
The bad news, however, is that
economists might have underestimated
inequality within individual countries
and the extent to which it has increased
since the 1990s, because national sur-
veys tend to underrepresent the wealthy
and underreport income derived from
property, which disproportionately accrues
to the rich. Indeed, tax data from many
developed states suggest that national
surveys fail to account for a substantial
portion of the incomes of the very
highest earners.
According to the most drastic

corrections for such underreporting, as
calculated by the economists Sudhir
Anand and Paul Segal, global inequal-
ity could have remained more or less
constant between 1988 and 2005. Most
likely, however, this conclusion is too
extreme, and the increase in national
inequality has been too small to cancel
out the decline in inequality among
countries. Yet it still points to a dis-
heartening trend: increased inequality
within countries has offset the drop in
inequality among countries. In other
words, the gap between average Amer-
icans and average Chinese is being partly
replaced by larger gaps between rich
and poor Americans and between rich
and poor Chinese.
INTERCONNECTED AND UNEQUAL
The same factor that can be credited
for the decline in inequality among
countries can also be blamed for the
increase in inequality within them:
globalization. As firms from the devel-
oped world moved production over-
seas during the 1990s, emerging Asian
economies, particularly China, started
Jan_Feb_2015_2.indb 14 11/17/15 7:33 PM
Inequality and Globalization

progressive taxation and welfare poli-
cies. Because the mobility of capital
dulls the effectiveness of progressive
taxation policies, governments also
need to push for international
measures that improve the transpar-
ency of the financial system, such as
those the G-20 and the Organization
for Economic Cooperation and Devel-
opment have endorsed to share infor-
mation among states in order to clamp
down on tax avoidance. Practical steps
such as these should remind policymak-
ers that even though global inequality
and domestic inequality have moved
in opposite directions for the past few
decades, they need not do so forever.∂
these trends by favoring skilled workers
over unskilled ones and creating econo-
mies of scale that disproportionately
favor corporate managers.
MAINTAINING MOMENTUM
In the near future, the greatest potential
for further reductions in global inequal-
ity will lie in Africa—the region that
has arguably benefited the least from
the past few decades of globalization,
and the one where global poverty will
likely concentrate in the coming decades
as countries such as India leap ahead.
Perhaps most important, the popula-
tion of Africa is expected to double
over the next 35 years, reaching some

25 percent of the world’s population,
and so the extent of global inequality
will increasingly depend on the extent
of African growth. Assuming that the
economies of sub-Saharan Africa sustain
the modest growth rates they have seen
in recent years, then inequality among
countries should keep declining, although
not as fast as it did in the first decade
of this century.
To maintain the momentum behind
declining global inequality, all countries
will need to work harder to reduce in-
equality within their borders, or at least
prevent it from growing further. In the
world’s major economies, failing to do
so could cause disenchanted citizens to
misguidedly resist further attempts to
integrate the world’s economies—a
process that, if properly managed, can
in fact benefit everyone.
In practice, then, states should seek
to equalize living standards among
their populations by eliminating all
types of ethnic, gender, and social dis-
crimination; regulating the financial
and labor markets; and implementi ng
Jan_Feb_2015_2.indb 15 11/17/15 7:33 PM
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