| Course | NR 607 Diagnosis & Management in Psychiatric-Mental Health III Practicum |
|---|---|
| Week | 2 |
| Paper type | Longitudinal case write-up |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | October 2026 |
Free sample paper for NR 607 Week 2
Longitudinal Case Write-Up: K.A., 27, Six Years of Schizophrenia Organized by Turning Points, With Every Antipsychotic Trial's Dose, Duration and Reason for Ending
Student Name
College of Nursing, Chamberlain University
NR 607: Diagnosis & Management in Psychiatric-Mental Health III Practicum
Instructor Name
Month Day, Year
Longitudinal Case Write-Up: K.A., 27, Six Years of Schizophrenia Organized by Turning Points, With Every Antipsychotic Trial's Dose, Duration and Reason for Ending
Current State, in Three Sentences
K.A., 27, has schizophrenia and is on paliperidone palmitate 156 mg by monthly injection, with persistent voices most days that K.A. describes as "background, but mean." K.A. lives in a rented room in a shared house, works ten hours a week at a grocery store and smokes cannabis most evenings. The main concerns now are partial response after four antipsychotics, housing that may end next month and a history of one suicide attempt.
The Diagnosis and Its History
2019, age 21: first episode during the final year of college; hearing voices, believing classmates were recording thoughts. Diagnosed brief psychotic disorder; symptoms resolved within a month on risperidone.
2020: second episode six months after stopping risperidone; diagnosis revised to schizophrenia, given recurrence, duration over six months and decline in functioning (left college).
Mood episodes: none meeting criteria for mania or major depression; low mood during relapses, resolving with them. Schizoaffective disorder considered in 2022 and not supported.
Turning Points, Not Appointments
2020: first admission; diagnosis revised. Risperidone restarted.
Late 2021: risperidone stopped; olanzapine started.
2022: second admission after an overdose; olanzapine stopped; aripiprazole started and stopped during the admission; paliperidone palmitate injection started at discharge.
2023 to 2024: eighteen months relatively stable on the injection; part-time job started.
2025: third admission after missed injections and command voices; injection resumed; current partial response.
Between these points, months without change are carried as intervals: eighteen stable months take one line.
Trials, Doses and Why They Ended
| Medicine | Dose reached | Duration at that dose | Response | Why it ended |
|---|---|---|---|---|
| Risperidone | 4 mg daily | 10 months (2020 to 2021) | Partial: voices reduced | Raised prolactin with sexual side effects; K.A. stopped taking it |
| Olanzapine | 15 mg daily | 14 months (2021 to 2022) | Partial; pharmacy fills about 60% | Weight gain of 18 kg and prediabetes, A1c 6.1% |
| Aripiprazole | 15 mg daily | 6 weeks (2022, inpatient) | Little change | Restlessness (akathisia) |
| Paliperidone palmitate | 156 mg monthly | 3 years, with gaps | Partial: voices persist | Ongoing |
Olanzapine was briefly restarted at urgent care in 2024 and stopped within six weeks for the same weight gain; that episode is recorded here so it is not repeated.
Why Each Trial Ended Matters for What Comes Next
Risperidone ended for a side effect K.A. did not report at first; a lower dose or a different strategy might have kept it. Olanzapine ended for weight gain and prediabetes; comparative trial data rank olanzapine near the top for weight gain (Huhn et al., 2019), so it should not be restarted. Aripiprazole ended for restlessness after six weeks, which may have hidden any benefit. The injection continues because it removes daily adherence from the equation. Each reason closes or leaves open a different option, which is why the table records them.
How Relapses Line Up With Events
Each admission followed a change in K.A.'s circumstances. In 2020, K.A. had stopped risperidone without telling anyone. In 2022, K.A. was taking about 60% of olanzapine doses. In 2025, K.A. had missed two injections after moving rooms and losing a phone. Relapse in K.A.'s record has followed missed medicine, and missed medicine has followed disruption. The write-up records this because the next relapse is most likely to follow the same route.
Functioning
Before the first episode: full-time student, living in a dormitory. Now: part-time job, ten hours a week, which K.A. values; manages own money with help from a sister; no current friendships outside work. Functioning has been best during the eighteen stable months, when K.A. started work.
Substances
Cannabis most evenings since age 17, more during stress. Alcohol occasional. No other drugs. Cannabis use is associated with worse outcomes and relapse in psychosis.
Risk, Carried With Dates
2022: overdose of olanzapine tablets during a relapse, admitted to intensive care, no lasting harm.
2025: command voices telling K.A. to "walk into traffic" before the third admission; no action taken.
Current: voices present, no command content in the last two months; no current suicidal intent; sister holds medicines in weekly packs since 2022.
Family and Supports
K.A.'s sister, two years older, lives 15 minutes away, has been the main support since 2020 and holds a written role in the safety plan. K.A.'s parents live in another state and are in contact by phone. A coworker at the grocery store knows about K.A.'s illness and is listed as a backup contact. K.A. has no partner. The sister's role is large, and the team should watch for strain on the sister.
Legal and Practical
No legal holds or guardianship. K.A. manages benefits with the sister's help. K.A. has a phone, which K.A. lost in 2025; losing it coincided with missed injections. A second number, the sister's, is on file for reminders.
Physical Health
Body mass index 31; A1c 5.9% on metformin 500 mg twice daily, started in 2022 for antipsychotic-related weight gain. Smokes tobacco, 10 cigarettes a day.
What Is Still Unsettled
Whether K.A.'s illness is treatment-resistant, which depends on whether the trials were adequate; whether cannabis is driving the residual voices; whether clozapine should be offered; and where K.A. will live next month. Under the TRRIP consensus, resistance can only be called after two properly delivered trials of different antipsychotics, judged on dose, length and adherence (Howes et al., 2017). That question is examined in a separate analysis.
What the Record Did Not Contain Before This Write-Up
The reason risperidone stopped was in one outpatient note only. The olanzapine adherence figure was in pharmacy data nobody had pulled. The missed injections were scattered across nursing notes. Bringing these into one place is the point of a longitudinal write-up: the next reader should not have to find them again, and should not have to repeat the search that produced this page.
Current Safety Arrangements
A written safety plan was made after the 2025 admission using a structured approach (Stanley & Brown, 2012). K.A.'s sister holds medicines in weekly packs. These arrangements are part of the current state and should travel with the record.
Sources
Outpatient notes 2019 to 2025, three discharge summaries, pharmacy records, interviews with K.A. and K.A.'s sister. Where the sources disagreed, such as the reason risperidone stopped, the outpatient record and K.A.'s own account were used.
References
Howes, O. D., McCutcheon, R., Agid, O., de Bartolomeis, A., van Beveren, N. J. M., Birnbaum, M. L., Bloomfield, M. A. P., Bressan, R. A., Buchanan, R. W., Carpenter, W. T., Castle, D. J., Citrome, L., Daskalakis, Z. J., Davidson, M., Drake, R. J., Dursun, S., Ebdrup, B. H., Elkis, H., Falkai, P., ... Correll, C. U. (2017). Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. American Journal of Psychiatry, 174(3), 216-229. https://doi.org/10.1176/appi.ajp.2016.16050503
Huhn, M., Nikolakopoulou, A., Schneider-Thoma, J., Krause, M., Samara, M., Peter, N., Arndt, T., Bäckers, L., Rothe, P., Cipriani, A., Davis, J., Salanti, G., & Leucht, S. (2019). Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis. The Lancet, 394(10202), 939-951. https://doi.org/10.1016/S0140-6736(19)31135-3
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001
What the NR 607 Week 2 assignment asks for
The Week 2 write-up is a summary, not a diary, and the difference is the axis it runs on. Build it on decisions: where a diagnosis was revised, where a medicine stopped and why, the admission that reset everything after it. Carry time between those points as intervals, so eight settled weeks take a few words. Give every medication trial its dose, duration, response and reason for ending. Record functioning, not only symptoms. Carry risk with dates. End with what is still unsettled. Most rubrics mark down a visit-by-visit account, a medication list without doses, durations or reasons, symptoms with no functioning and risk without dates.
How this NR 607 Week 2 example is built
The sample opens with three sentences on the current state: persisting voices on a monthly injection, a rented room, part-time work, cannabis use and a lease ending. The diagnosis is traced from 2019 to its revision in 2020. Five turning points replace the appointment history. A table gives four antipsychotic trials with dose, duration, response and reason for ending, and notes a brief restart. Sections explain why each ending matters, line relapses up with the events before them and cover functioning, substances, family and practical supports, risk with dates, physical health, current safety arrangements and what the record did not contain before. Unsettled questions and sources close it.
Where the points sit in the NR 607 Week 2 rubric
The heaviest loss is a visit-by-visit account that loses the reader by the third page; this summary runs on five turning points. A medication list without doses, durations or reasons invites a repeat trial, while every trial here carries all four. Symptoms with no account of functioning cost a row, and work, money and relationships are recorded. Risk without dates loses marks, and each risk event is dated. Lining up relapses with the events before them earns the synthesis criterion, and naming what is unsettled shows the summary knows its limits. Recording what the record did not contain before the write-up shows why the summary was needed. Family supports and practical arrangements are recorded because they shape relapse risk. Sources are listed, with how disagreements between them were settled.
Common NR 607 Week 2 mistakes, and how to avoid them
Weak NR 607 Week 2 write-ups list every appointment in order. Others name past medicines without doses or reasons for stopping. Many describe symptoms without saying how the person is functioning. Risk is often recorded without dates. Few explain how relapses relate to events in the person's life. Organize the summary around turning points, give every trial its dose, duration and reason for ending and date every risk event. Then say what is still unresolved. If your patient's history differs, list the turning points and trials, and a write-up on that axis can be drafted. Note where your sources disagree and which one you used.
Get a NR 607 Week 2 example written to your instructions
Send the Week 2 prompt from your classroom and any template or rubric your section publishes, and a custom example is written to that case and returned inside 24 to 48 hours. The first one is free. What you take from it into your own draft is your call.
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NR 607 Week 2 questions, answered
How much history is too much?
The test is whether a colleague could act after one reading. Anything that does not change what somebody would do next is a candidate for cutting, however interesting it was at the time. Write-ups that come back marked down are long far more often than short, and the length usually comes from routine contacts recorded in full instead of summed up in a phrase.
Do I need real dates?
Intervals do more work than calendar dates and carry less identifying information. Eight weeks on a dose, four months of stability, an admission two years ago: a reader can order those and act on them. Exact dates in a de-identified assignment add risk without adding meaning, and most classrooms are content with relative timing as long as the sequence is unambiguous.
Can this be built from a vignette?
Yes, and that is the usual arrangement. A supplied case, a role play or a scenario written to your prompt gives everything the assignment is marked on, since the skill under test is compression and handover rather than access to a particular person. Nothing from your clinical site is needed to show it, and nothing from your site should be described.
Where can I find a free NR 607 Week 2 sample paper?
The full longitudinal case write-up of six years of schizophrenia, organized by turning points, is published on this page.
What pattern links the relapses in the NR 607 Week 2 write-up?
Each admission followed missed medicine, and the missed medicine followed a disruption such as a lost phone, a bus route change or a move.