Hi! Below is the case study and I want to make sure I\'m on the right track. I b

Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-7). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you so much for your time and work!!

Questions:

1. Diagnosis; what is the evidence for it? Hint it's not a personality disorder!

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder?

3. Differential diagnosis (why is it this disorder and not this disorder). Specifically, why it is NOT some other diagnosis (such as a brief reactive psychosis or delusional disorder)?

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that? What co-morbid disorder he might have and what that means for his diagnosis

5. What would the primary causal theories be?

6. What type of hallucinations is he having? What are his positive and what are his negative symptoms?

7. What is the neurobiology and neurochemistry of his particular disorder?

CASE STUDY BELOW:

John is a 20 year old college student who is not doing well at all. John was a normal young man until recently with no medical issues or traumas. He has a lot of stress at college, but no more than most people and he uses some alcohol and marijuana, but not to excess. His parents are healthy and his college is paid for, so he does not have any significant outside stressors. He has always been very involved in church and volunteer work and is very devoted to his studies. Recently John’s family and friends have become quite concerned about him as he has recently become quite obsessed with his religious beliefs and he is constantly talking about the devil. He believes that the devil has been talking to him and telling him to do bad things. He has called his pastor and the police numerous times asking for their help in combating the devil’s hold on him. He believes that his left hand has been taken over by the devil and he cannot control what that hand does, so he has chosen to wrap it in an ace bandage to try to control it. He believes that he has been chosen by God to spread peace on earth and cure all of society’s ills, and he is also quite concerned about fighting some “great conspiracy” but he is unclear as to what that conspiracy is. He believes that the radio is talking to him telling him what God wants him to know. When he speaks it is difficult to understand him, as his speech patterns are often quite random. John also has very flat emotions and his voice can be quite monotone. He does not speak much anymore and he has removed himself from almost all of his activities. He has no motivation to attend his classes and just wanders around campus or lays on his couch most of the time.

Explanation / Answer

1. John is showing symptoms that are associated with Schizophrenia. Symptoms shown by John is basic to Schizophrenia and matches those described by DSM. His symptoms, as included in the case study, that are evident of Schizophrenia are:

These symptoms (false beliefs, hallucinations, delusions, lack of emotion, social isolation, demotivation, etc.) are basic pointers to that of Schizophrenia.

2. First line treatment in Schizophrenia usually involves the treatment of psychosis. So first symptoms that will be targeted by a physician for John will be his psychosis using anti-psychotics. Once John stabilizes he will be put in for therapy sessions. Therapies include Cognitive Behavioral Therapy (CBT), Rehabilitation and social skill training, Psychoeducation, family therapy, group therapies and support groups and sometimes art therapy. CBT involves managing the symptoms and modifying the behavior so as to not fall into relapse. Psychoeducation involves learning about the illness, recognizing the symptoms so as to avoid getting an episode. Family therapy involves getting advice, and counsel from a therapist so that the caretakers can help manage the symptoms, maintain healthy relationships with each other while efficiently taking care of the afflicted person. Group therapies and support groups provide help by gaining insight and knowledge from others who are battling the same disorder. Art therapy is used to facilitate talents, creativity, and skills so as to distract the patient away from the symptoms and help them relax by reducing negative symptoms and feelings associated with the disorder. Rehabilitation and social skill programs help patients to get back to their everyday life and also help develop social skills, communications and interactions with others of peer group.

Schizophrenia is a severe and debilitating disease that never goes away. John can get remission from episodes and he and his parents can manage to control it from having a relapse or worsening it. Certain symptoms (delusions and hallucinations) may go away but not the other symptoms. So, treatments and therapies are a lifelong process for schizophrenics.

Medications usually include anti-psychotics, anti-depressants and anti-anxiety drugs, anti-convulsant, and anti-tremor drugs. Anti-psychotics are administered to alleviate the psychotic symptoms like hallucinations and delusions. These usually include drugs like Amisulpride, olanzapine, risperidone, and clozapine. Anti-psychotics are mostly always paired with anti-anxiety or anti-depressants like Selective serotonin reuptake inhibitors (SSRIs) (citalopram, clomipramine, fluvoxamine, fluoxetine, sertraline, etc.). Anti-convulsant like Topiramate, valproate, etc. are given to stabilize moods and fits. Anti-tremor drugs are only given in the case of patient experiencing tremors, shakiness or unsteadiness.

3. Given below are differential diagnosis of this disorder and their difference from that of Schizophrenia:

DIFFERENTIAL DIAGNOSIS

DIFFERENCE FROM SCHIZOPHRENIA

Developmental Disorder (mental Retardation, Autism, etc.)

Bipolar Disorder and related Disorders (dysthymia, cyclothymia, etc.)

Personality Disorder

Substance induced psychosis and schizophrenia

Other forms of psychotic disorders (schizoaffective, schizophreniform, delusional, etc.)

Psychosis

Dementia and Amnesia

4. More than one diagnosis are possible, but that is only and only if the John is known to have co-morbid disorders. Co-morbid disorders for Schizophrenia includes depression, bipolar disorder, anxiety, panic attacks, Post-Traumatic Stress Disorder, Obsessive Compulsive Disorder, substance abuse, etc. Here dual diagnosis is possible since John has admitted to using substance. So John needs to be diagnosed for Substance abuse as well and its severity and usage. DSM-5 specifically states that for classification of Schizophrenia it should satisfy the following criteria:

5. Many causes have been attributed as being a risk factor to schizophrenia, but have not been any conclusive evidence as of now. Environment has been attributed as one of the cause. It includes stress, traumas, drug use, prenatal stressors, living environment, abuse, etc. Many researchers say that factors like birth weight, stress, malnutrition, substance use, hypoxia and infection in mothers can directly contribute to schizophrenia development. Genes are also considered major contributor to schizophrenia. Heritability of disease through genes and linkage to certain mutation of genes are linked to schizophrenia.

6. John is having Auditory Hallucination where he is hearing God and Devil talking to him, God talking through the radio, etc.

Positive symptoms (those being added to the personality) here include: Disorganized speech, hallucinations, delusion.

Negative Symptoms (lacking of important skills) here include: Social isolation, lack of motivation, lack of emotion in speech (affective flattening), lack of interest.

7. Neurobiology - Genetic studies are now identifying proteins that may be a candidate to genetic risk factors for schizophrenia. It includes neuregulin 1, dysbindin, DAOA, DISC1, and COMT. Researchers believe that DISC1 especially may be able to offer valuable insights. Mechanistic studies of the properties of these genes and their respective protein products should be able to clarify the molecular, cellular, and systems-level pathogenesis of schizophrenia.

Neurochemistry - Researchers believe that a primary disturbance in dopamine neurotransmission might be the cause and these and correlation of positive symptoms might be secondary to disturbances occurring in other neurotransmitter systems. Evidence from studies of the brain also points to dysfunction of both GABA- and glutamate-containing neurons. Understanding these might help in finding a cure for Schizophrenia.

DIFFERENTIAL DIAGNOSIS

DIFFERENCE FROM SCHIZOPHRENIA

Developmental Disorder (mental Retardation, Autism, etc.)

1. Low IQ or any form of intelligence retardation is not mentioned
2. Formed speech
3. Fully developed skills and motor ability

Bipolar Disorder and related Disorders (dysthymia, cyclothymia, etc.)

1. Mood swings duration (takes days or weeks from one pole to other)
2. symptoms are reflection of mood and they change (not constant)

Personality Disorder

1. Presence of different identities, or loss of flexibility of personality
2. For one's with personality disorders, their personalities are living in reality, schizophrenics lose touch with reality.
3. Mood shifts and shift of view about self is dependent on personality

Substance induced psychosis and schizophrenia

1. Duration of delusions and hallucinations
2. Symptoms are present only when substance is used, otherwise not present

Other forms of psychotic disorders (schizoaffective, schizophreniform, delusional, etc.)

1. Mood disturbances and presence of mood disorder
2. Duration of delusions and hallucinations

Psychosis

1. Major symptom is delusion and hallucination
2. Schizophrenia has other symptoms too

Dementia and Amnesia

1. Cognitive functions deteriorate as time goes on
2. Eventually individual forgets everything (even about self, and their basic livelihood skills)

Related Questions

Navigate

• Browse (All)
• Browse H
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.