Week 5: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and
Medication-Induced Movement Disorders
Patience Ocansey
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Course instructor: Dr. Ashley Lockhart
Assignment Due Date: 30th June, 2024
Subjective:
, Patient Information
Name: Sherman Tremaine (ST)
Gender: Male
Age: 53 years
CC (chief complaint): The patient's sister urged him to visit the medical facility to get mental
assessment since he was experiencing responses to stimulus from within.
HPI: ST is a 53-year-old African American male seeking a mental assessment. He claims to
observe individuals beyond his window observing him. He perceives the sound of their
conversation as well as observes their shadows, however he remains skeptical of their ability to
perceive his presence. He claimed to have experienced these delusions for an extended period of
time, specifically "several weeks". He perceives strong metal music that others can't hear as well
as observes a bird in flight. He expresses dissatisfaction with the excessive volume of the voices,
which is causing him difficulty in maintaining sleep, resulting in several consecutive days of
wakefulness. He has the belief that his meals has been contaminated by unidentified individuals
and as a precautionary measure, he safeguarded every item of food within his fridge. He stays
away from going to his store due to the presence of mysterious individuals who would trail him
to that location. He avoids from taking drugs of any kind due to his belief that they are toxic to
his body. He has the belief that his sister has affiliations with the federal authorities and she is
conspiring against him. He suspects that his cellphone has been subjected to surveillance. He has
subsequently contacted emergency services (911) to notify them of the presence of unidentified
individuals who are pursuing him.
Medication-Induced Movement Disorders
Patience Ocansey
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Course instructor: Dr. Ashley Lockhart
Assignment Due Date: 30th June, 2024
Subjective:
, Patient Information
Name: Sherman Tremaine (ST)
Gender: Male
Age: 53 years
CC (chief complaint): The patient's sister urged him to visit the medical facility to get mental
assessment since he was experiencing responses to stimulus from within.
HPI: ST is a 53-year-old African American male seeking a mental assessment. He claims to
observe individuals beyond his window observing him. He perceives the sound of their
conversation as well as observes their shadows, however he remains skeptical of their ability to
perceive his presence. He claimed to have experienced these delusions for an extended period of
time, specifically "several weeks". He perceives strong metal music that others can't hear as well
as observes a bird in flight. He expresses dissatisfaction with the excessive volume of the voices,
which is causing him difficulty in maintaining sleep, resulting in several consecutive days of
wakefulness. He has the belief that his meals has been contaminated by unidentified individuals
and as a precautionary measure, he safeguarded every item of food within his fridge. He stays
away from going to his store due to the presence of mysterious individuals who would trail him
to that location. He avoids from taking drugs of any kind due to his belief that they are toxic to
his body. He has the belief that his sister has affiliations with the federal authorities and she is
conspiring against him. He suspects that his cellphone has been subjected to surveillance. He has
subsequently contacted emergency services (911) to notify them of the presence of unidentified
individuals who are pursuing him.
