Hello I am trying to complete my case study on hallucinations. I am hoping you m

Question

Hello I am trying to complete my case study on hallucinations. I am hoping you may assist me in refining this information. I need this to be DSM5 criteria and ICD 10. If you have any recent research avilable I would appreciate it. I have attached my document for your revi

Sam Coleman was a 25-year old U.S. Army veteran turned community college student who presented to the emergency room (ER) with his girlfriend and sister. On examination, he was a tall, slim, and well-groomed young man with glasses. He spoke softly, with an increased latency of speech. His affect was blunted except when he became anxious while discussing his symptoms.

Mr. Coleman stated that he had come to the ER at his sister’s suggestion. He said he could use a “general checkup” because of several days of “migraines” and “hallucinations of a spiritual nature” that had persisted for 3 months. His headache involved “sharp, shooting” sensations in various bilateral locations in his head and a “ringing” sensation along the midline of his brain that seemed to worsen when he thought about his vices.

                Mr. Coleman described his vices as being “alcohol, cigarettes, disrespecting my parents, girls.” He denied guilt, anxiety, or preoccupation about any of his military duties during his tour in Iraq, but he had joined an evangelical church 4 month earlier in the context of being “riddled with guilt” about “all the things I’ve done.” Three months earlier, he began “hearing voices trying to make me feel guilty” most days. The last auditory hallucination had been the day before. During this past few months, he had noticed that strangers were commenting on his past sins.

Mr. Coleman believed that his migraines and guilt might be due to alcohol withdrawal. He had been drinking three of four cans of beer most days of the week for several years until he “quit” 4 months earlier after joining the church. He still drank “a beer or two” every other week but felt guilty afterward. He denied alcohol withdrawal symptoms such as tremor and sweats. He had smoked cannabis up to twice monthly for years but completely quit when he joined the church. He denied using other explicit drugs except for one uneventful use of cocaine 3 years earlier. He slept well except occasional nights when he would sleep only a few hours to finish an academic assignment.

Otherwise, Mr. Coleman denied depressive, manic, or psychotic symptoms and violent ideation. He denied post-traumatic stress disorder (PTSD_ symptoms. Regarding stressors, he felt overwhelmed by his current responsibilities, which included attending school and near-daily church activities. He had been a straight-A student as the start of the school year but was now receiving Bs and Cs.

The patient’s girlfriend and sister were interviewed separately. They agreed that Mr. Coleman had become socially isolative and quiet, after having previously been fun and outgoing. He had also never been especially religious prior to this episode. His sister believed that Mr. Coleman had been “brainwashed” by the church. His girlfriend, however, had attended services with Mr. Coleman. She reported that several members of the congregation had told her they had occasionally talked to new members who felt guilt over their prior behaviors, but none who had ever hallucinated, and they were worried about him.

A physical examination of the patient, including a neurological screen, was unremarkable, as were routine laboratory testing, a blood alcohol level, and urine toxicology. A noncontrast head computed tomography (CT) scan was normal.

Primary diagnostic possibilities; what fits right now?

PTSD, Schizophreniform (due to the symptoms being present less than 6 months; could turn into schizophrenia).

What are Schneiderian symptoms? Which ones does he have?

A. Schneiderian Criteria

First Ranked Criteria

1. Audible Thoughts
The patient experiences hallucinatory voices that echo or speak his thoughts aloud.
2. Voices Debating or Disagreeing
The patient experiences hallucinatory voices engaged in debate or argument, frequent about himself.
3. Voices Commentating
The patient experiences hallucinatory voices that comment on his action.
4. Somatic Passivity
The patient believes that sensation is being imposed upon his body by an outside force.
5. Thought Withdrawal
The patient experiences his thoughts being withdrawn or taken out of his mind by an outside force.
6. Thought Broadcasting
The patient experiences his thoughts being disseminated to the world around him.
7. Thought Insertion
The patient experience thoughts being placed in his mind by an outside force.
8. "Made" Feeling
The patient has the experience that his feelings are not his own, they have been imposed upon him.
9. Made" Impulses
The patient experiences and generally acts upon a compelling impulse which he believes is not his own.
10. "Made" Acts
The patient experiences his action and his will to be under the control of an outside force.
11. Delusional Persecution
The patient takes a precept and ascribes an idiosyncratic value to it. The perceptions evolve into delusions.

B. Schneiderian Criteria

Second-rank Symptoms
1. Other disorders of perception
2. Sudden delusional ideas
3. Perplexity
4. Depressive and Euphoric Moods
5. Feeling of emotional impoverishment

Does the substance use have anything to do with his symptoms? Why/not? What other questions might you ask here? More than likely, substance abuse does not have anything to do with his symptoms. It would be unusual for withdraw from any of the substances he previously used to last for months. Also, his physical exam and labs came back normal. I would maybe ask when the last time he had used each of these substances was and if any of these symptoms he has now would have happened before. The substances being used probably contributes more to the guilt rather than withdraw.

How might "other specified dissociative disorders" fit?

Shared cultural syndrome might fit due to his family mentioning that he might be “brainwashed” since he started attending the church. His family states that the symptoms began around the time he started attending the church. He might also have PTSD from his time in the army, but more information is needed. A sign of PTSD is avoiding talking about the events or problems, so this may fit.

What impact might his migraines have?

His migraines might be making the problem worse by perpetuating the voices as well as interfere with his daily life functioning. This was the stressor that impacted his life so much that he decided to seek treatment. This is a physical manifestation of his symptoms.

How might PTSD fit here?

Being in an active war zone is a traumatic experience that might cause PTSD. Men are also more likely to have migraines with their PTSD. While he did not specifically talk about his army experience, avoidance can be a sign. It would be beneficial to explore this topic more in-depth.

How would a "shared cultural syndrome" fit?

Since he started attending church, he has had feelings of guilt over his substance use and his family describes him as “brainwashed”. This could be due to him adopting the churches culture and sharing their attitudes and beliefs on things rather than his own. This collective belief is shown through the church members saying they feel guilt too and their concern when he has hallucinations that don’t happen to them.

What would you recommend as far as treatment? When do you want the next visit to be?

What purpose did collateral contacts serve?

They were able to identify other sources of problems and state how the problem developed from an outside source. They are knowledgeable about the patients normal functioning as well as personality, so they were able to mention differences in his behavior. They helped paint a clearer picture of the problem and even identify other potential causes.

Thank you, T

Explanation / Answer

Answer:
In symptom criteria (primary) for schizophrenia, there were 2 basic changes were made.
According to APA, two changes were made to the primary symptom criteria for schizophrenia in DSM-5.

Removal of auditory hallucination(Schneiderian 1st rank)

Second is the necessary criteria for the positive symptom of schizophrenia are(at least one of them).

• Hallucinations
• Delusions
• Disorganized communication or Speech.
According to APA, These criteria may help in diagnosis the schizophrenia. Use of dimensional approach to diagnosing the symptoms (core) of schizophrenia.

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