Delusional disorder, somatic type, is where a composite archivist's MN667 evaluation note lands, but only after substances, thyroid, B12 and a dermatology workup have each been accounted for. Searches like "mn 667 unit 2 assignment example", "mn667 unit 2 sample" and "mn667 unit 2 example" land here.
Psychiatric Evaluation Note: A 57-Year-Old Archivist Certain That Mites Live Under Her Skin
[Student Name]
Purdue University Global
MN667: PMHNP Diagnosis and Management Across the Lifespan III
Unit 2 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses and dates are bracketed; nothing here is a prescribing instruction.
Identifying Data and Chief Complaint
Composite 57-year-old woman, museum archivist, married, referred by dermatology. Chief complaint, in her words: "I have mites under my skin, and nobody will believe me."
History of Present Illness
She dates onset to [March], after a stay in a hotel for a conference, when she felt crawling and biting on her arms and scalp. Since then she has seen four dermatologists. She has used [permethrin] twice, bathed in diluted bleach several times a week, thrown out a sofa and her bedding, and sealed her clothes in plastic bags. She brought three pill bottles of material she collected from her skin, which she believes contain the mites; under the clinic magnifier they hold lint, skin flakes and hair. She says the crawling is worst at night. She is sleeping five hours and has stopped having friends to her home. She continues to work full time and says her work is unaffected.
Psychiatric, Medical and Substance History
Psychiatric: no prior diagnoses or treatment. Medical: hypothyroidism, treated with [levothyroxine]. Substances: no stimulant, cocaine or cannabis use; one glass of wine on weekends; urine drug screen negative. Family: a maternal aunt was "never right" after her forties, with no known diagnosis. Social: married 30 years; her husband is supportive but has stopped discussing the mites with her.
Medical Review
TSH, vitamin B12, complete blood count, metabolic panel and liver function are within normal limits. The referring dermatology note describes excoriations and bleach irritation on both forearms, with no infestation on skin scraping.
Mental Status Examination
Well groomed, cooperative and articulate, with scratch marks visible on both forearms. Mood "frustrated"; affect anxious and congruent. Thought process organized and goal directed. Thought content: a fixed belief that mites live under her skin, held with full conviction despite repeated negative findings; the belief is not bizarre, since infestations do occur. No other delusions. Perception: a crawling sensation on the skin; no voices or visions. No suicidal or homicidal thoughts. Cognition: oriented, attention and memory intact on bedside testing. Insight: poor regarding the belief. Judgment: impaired by the bleach use.
Risk
Low risk of suicide; she denies thoughts of self-harm and has no history of it. Risk of harm to herself from treatments: moderate, because bleach baths have burned her forearms and she has asked about stronger chemicals. She was advised to stop bleach baths today and agreed to try.
Formulation
A primary psychiatric diagnosis is now defensible because the medical and substance causes that most often produce this picture have each been excluded with a result. Scabies and other infestations: negative skin scraping by dermatology. Thyroid disease and B12 deficiency: normal levels. Stimulant or cocaine use, which can cause the sensation of insects crawling: negative urine screen and denied. Kidney and liver disease: normal panels. Delusional infestation is well described in middle-aged and older women, and many sufferers bring samples, which has been called the "specimen sign" (Freudenmann & Lepping, 2009).
Delusional disorder, somatic type, fits better than schizophrenia because she has no other psychotic features, no disorganization and good function outside the belief, and the belief has lasted more than a month (American Psychiatric Association, 2022). The crawling sensation is consistent with the somatic theme. What keeps it going: repeated negative findings feel to her like dismissal, the scratching and bleach cause skin damage that seems to confirm the belief, and isolation has removed friends who might have offered another view.
Considered and Rejected
Skin picking disorder: she scratches because she believes something is there, not as a repetitive behavior she is trying to stop. Formication from stimulants: negative screen and no use. Obsessive-compulsive disorder: she has no insight that the belief may be false. Major depression with psychotic features: mood is frustrated, not depressed, and the belief came first.
Diagnosis
Delusional disorder, somatic type (DSM-5-TR). Hypothyroidism, treated.
Plan
Clinician: offer [an antipsychotic trial], described as treatment for the crawling sensation and the distress it causes, with the psychiatric reasoning stated openly. Antipsychotics have produced partial or full remission in most patients in case series and reviews, although there are no randomized trials (Lepping et al., 2007).
Clinician: return visit in [two weeks] to review her decision and any side effects.
Clinician: letter to dermatology so that both clinics give her one consistent message, including skin care for the bleach burns.
Patient: stop bleach baths; bring the specimen bottles only if she wishes.
Husband, with her consent: invited to the next visit.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Freudenmann, R. W., & Lepping, P. (2009). Delusional infestation. Clinical Microbiology Reviews, 22(4), 690-732. https://doi.org/10.1128/CMR.00018-09
Lepping, P., Russell, I., & Freudenmann, R. W. (2007). Antipsychotic treatment of primary delusional parasitosis: Systematic review. British Journal of Psychiatry, 191(3), 198-205. https://doi.org/10.1192/bjp.bp.106.029660
How this MN667 Unit 2 example is structured
Written for its next reader, the note places the facts that change management where a colleague skimming for five minutes would find them. Chief complaint is quoted, because her own word, mites, is what any clinician must work with. The formulation carries the reasoning: why a primary psychiatric diagnosis is now defensible, with the medical and substance mimics named and excluded, each beside its result; why somatic type and not schizophrenia, given no other psychotic features and function preserved outside the belief; and what keeps it going. Considered-and-rejected diagnoses get a line each, including skin picking disorder and formication from stimulants. The plan reads as orders with owners: [an antipsychotic trial], offered as treatment for the crawling and the distress with the psychiatric reasoning stated openly, a return visit at two weeks, and a letter so dermatology and psychiatry give one message.
Get an MN667 Unit 2 example written to your instructions
Evaluation notes vary most in their required headings, so paste the Unit 2 case from your MN667 section with any note template the course supplies, plus the rubric. Returned free as your first sample in 24-48h, the note records the visit in chart form, with the workup behind the diagnosis and an owner on every order. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN667 Unit 2 questions, answered
Should an evaluation note include a formulation, or only a diagnosis?
Both, in most course templates. The diagnosis tells the next reader what the author concluded; the formulation tells them why, and what keeps the problem going. A short paragraph is enough. Name the evidence behind the diagnosis, the alternatives excluded and the factors a plan should target, so a colleague can disagree intelligently rather than start over.
How should a note describe a belief the patient holds firmly?
Quote it, describe its content and fixity, and record what the patient has done because of it. Avoid language that mocks or argues, since patients increasingly read their notes. The mental status examination can state that the belief is fixed and not shared by others without calling the person irrational, which keeps the record accurate and the relationship intact.
Does the note need lab results the case does not give?
Name the tests the diagnosis depends on and say which results the case supplies. Where one is missing, write it as pending, with who ordered it and which result would alter the working diagnosis. Inventing a value is the error to avoid; a clearly labeled gap shows the reasoning a colleague picking up the case depends on.