Suffering from a Schizophrenia - Case Study Example

CASE ANALYSIS Name Instructor Class City Date Case scenario three involves a seventy two year old lady that is presenting with erratic behavior. She lives with her husband though she does not seem to recognize him. A physical examination shows that she is pale and still in her night clothes. Additionally, she tries to get up but is unable to move. Accordingly, after reviewing the patient’s symptoms, the first probable mental illness diagnosis is that the patient may be suffering from schizophrenia and changing thought patterns associated with psychosis. Consequently, this paper discusses the diagnostic procedures involved in the diagnosis of schizophrenia and psychosis. Further, the current paper will examine the relevant literature regarding the causes of these disorders as well as their documented treatment plans. Diagnosis According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV-TR, diagnosis of both schizophrenia and psychosis is based on the self-reported experiences of the individual, and abnormalities in behavior reported by family members and colleagues (Association, 2000). Further, diagnosis of these disorders is also based on clinical assessments by a psychiatrist, clinical psychologist, social worker or other mental health professional. Consequently, in the diagnosis of schizophrenia, the DSM-IV-TR outlines and recommends three criteria to be followed. Firstly, the patient must present with two or more the characteristic symptoms for a period of one month. These characteristic symptoms include delusions; hallucinations (may include somatic or auditory hallucinations); disorganized speech; grossly disorganized behavior or catatonic behavior; and negative symptoms (such as affective flattening, alogia, or avolition) (News-Medical. Net, 2012). The second criterion is social or occupational dysfunction which is characterized by a significant decline in the performance of occupational duties or interpersonal relations. The third criterion stipulates that the signs of the disorder should have persisted for at least six months, where during that period; the patient must have had at least one month of symptoms (News-Medical. Net, 2012). Similarly, the DSM-IV-TR outlines the same criteria for the diagnosis of brief psychotic disorders. Firstly, the patient should exhibit delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Secondly, the duration of disturbances or episodes should be at least a day but less than a month. Lastly, the DSM-IV-TR stipulates that the psychotic episode should be in a manner that it is not accounted for by other disorders such as schizoaffective, substance abuse or schizophrenia (BestPractice, 2012). Therefore, according to these criteria, the patient in case study there is suffering from schizophrenia since she has exhibited three of the characteristic symptoms including grossly disorganized and catatonic behavior, somatic hallucinations and disorganized speech. Diagnosis for schizophrenia is also supported by the patient’s inability to maintain interpersonal relationships characterized by the inability to identify her spouse. In addition to this diagnosis, the patient is also suffering from brief psychotic disorder as evidenced by symptoms such as hallucinations, disorganized speech, strange and potentially dangerous behavior and catatonic or grossly disorganized behavior. Particularly, brief psychotic behavior is identified in this case due to the somatic hallucinatory behavior where the patient feel cold and uses the oven to warm herself even though it is not cold. Medical Examination In order to treat and manage these disorders effectively, it is necessary to conduct a thorough medical examination of the patient, including a medical history examination, a physical examination and additional test battery. Medical history Firstly, medical history is vital to establish Prodome of the disorder that is, the history of cognitive impairment symptoms, such as the timing of earliest disruptive episodes and the rate of progression of those symptoms. Secondly, it is essential to establish existing and previous medical problems such as neurological disorders; head trauma; systemic diseases, alcohol or substance abuse; and infectious or metabolic illnesses. Thirdly, a historical examination will help establish the patients’ functional status specifically, performance of ADLs and IADLs (Green, 2005). Fourthly, the historical examination is also aimed at documenting the patient’s current medications, particularly prescription and nonprescription medications that contain anticholinergic properties. Fifthly, the historical exam will help chart the patient’s family history, particularly any early-onset dementia, neurological disorders, and vascular diseases. Lastly, historical examination describe the patient’s social history to identify key aspects such as family and social supports; educational background; literacy levels ; language preferences, alcohol, tobacco, and other substance use (BestPractice, 2012). In addition to historical examination, other assessments are necessary to establish the diagnosis. These include a physical examination, diagnostic testing; cognitive testing and neuropsychological testing. A physical examination intends to establish the general appearance or behavior of the patient; pulse and blood pressure, as well as, orthostatic changes, cardiac and pulmonary auscultation and the neurological battery (Freudenreich, Weiss, & Goff, 2010). Diagnostic testing involves CBC with differential, chemistry profiles, chest x-rays, ECGs, urinalysis, blood culture, CXR and consideration of ANA and ESR (BestPractice, 2012). Literature on the Biological Causes of Schizophrenia and Brief Psychotic Disorder Even though, the causes of schizophrenia are not known, most specialists conclude that schizophrenia occurs a result of three main factors. The first cause of schizophrenia is genetics. For a long time, experts have associated schizophrenia to genetic compositions that are inherited in families. Particularly, studies show that schizophrenia occurs in ten percent of people who have a first-degree relative with the condition, such as a parent, brother, or sister, as compared to a one percent occurrence rate in the general population (Mortensen, Pedersen, & Pedersen, 2010). Individuals with second-degree relative diagnosed with the disorder have a higher risk in developing the disorder, as compared to the general population. This risk is increased in an individual with an identical twin diagnosed with schizophrenia (Smith, Horwath, & Cournos, 2010). In this regard, research findings link numerous genes to an increased risk of schizophrenia, and provide evidence that no specific gene is responsible for the disease on its own. In particular, recent research has established that individuals with schizophrenia are likely to have higher amounts of rare genetic mutations (Bentall, Jackson, & Pilgrim, 2011). These genetic alterations encompass hundreds of various genes and possibly disorganize brain development. Other studies propose that schizophrenia may occur in part, due to a malfunction of a particular gene that is responsible for production of vital brain chemicals. Accordingly, this gene malfunction may affect the area of the brain associated with the development of higher functioning skills (Frankenburg & Dunayevich, 2012). The second factor attributed to the development of schizophrenia is the environment. Particularly, researchers agree in recent studies that schizophrenia develops due to an interaction of the biological predisposition to schizophrenia and the nature of environmental exposure of an individual (Tost & Meyer-Lindenberg, 2012). Environmental factors such as pre-natal viral exposure and/or malnutrition, problems during birth, postnatal viral infections and other psychosocial factors (including childhood physical and sexual abuse, and early parental separation or loss) combined with inherited genetic mutations increase the risk of developing schizophrenia (Stöber, et al., 2009). Essentially, this research suggests that brain development disruption is the product of genetic predisposition and environmental stressors early in development (especially during pregnancy or early childhood) that lead to subtle variations in the brain chemistry that make an individual prone to developing schizophrenia. Subsequently, environmental influences later in life (such as during early childhood and adolescence) may either cause more damage to the brain and thus intensify the risk of schizophrenia, or decrease the manifestation of genetic or neurodevelopmental defects and consequently decline the risk of schizophrenia (Koenig, 2010). In fact, researchers categorically state that schizophrenia is a direct result of the interactions of the biological, environmental psychological and environmental social factors, otherwise known as the bio-psycho-social model (NIMH , 2009). Thirdly, another factor associated with schizophrenia is variations in brain chemistry and structure. Researchers conclude that, imbalances in the intricate, interconnected chemical responses of the brain that involve the neurotransmitters glutamate and dopamine, as well as others, play a part in schizophrenia. Also, these studies have shown brains variations such as enlarged brain ventricles, in individuals with schizophrenia, as compared to those of healthy individuals (Gilmore, 2010). Further examination of the brains of individuals with the disorder show a tendency to have a lesser amount of gray matter, while some areas of the brain such as the frontal lobe, may have a reduced amount of or increased activity. Other studies have proposed that structural deformities in the temporal lobes, hippocampus, and amygdala are linked to schizophrenia’s positive symptoms (Nasrallah, Tandon, & Keshavan, 2011). Similar to schizophrenia, there is no specific cause associated with brief psychotic behavior. However, researches offer a number of suggested causes. Firstly, due to the parallels between brief psychotic disorder, schizophrenia and schizophreniform disorders, many researchers assess and term brief psychotic disorder as the precursor to another prolonged psychotic disorder. Secondly, professionals classify brief psychotic behavior as a response to severe stress that manifest in various aspects of life such as death of a spouse, natural disasters, occupational hazards. Thirdly, brief psychotic disorders may also be caused by defense mechanisms in personality disorders. In this sense, case study three patient may be presenting with brief psychotic behavior as a result of the long term schizophrenia condition. Treatment of Schizophrenia and Brief Psychotic Behavior In general schizophrenia treatment, involves pharmacologic cure through antipsychotic proxies alongside psychosocial interventions. Moreover, second-generation antipsychotics currently more frequently used more often than the first-generation proxies. The second-generation antipsychotics contain both the serotonin and dopamine receptor antagonism. Consequently, the pharmacologic outcome on serotonin receptors lessens the motor side effects allied to the first-generation proxies (Lieberman , 2007). These medicines do not entirely cure the illnesses, however, they are extremely effective in suppressing the most disquieting symptoms in psychotic disorders, for example, illusions, phantasms, and thinking problems. Antipsychotic medications may include Haldol, Thorazine, and Mellaril and Atypical medications or atypical antipsychotics such as Invega, Abilify, Clozaril, Geodon, Risperdal, Seroquel, Saphris and Zyprexa (Frankenburg & Dunayevich, 2012). These newer medications are deliberated to being valued treatments because they reflect less and more bearable side effects (Mathews & Muzina , 2007). For the case study three patient, a combination of both the first and the second generation drugs is recommended since, the initial treatment did not work. Additionally, the patient has also been diagnosed with Osteoporosis which must be factored in so that the choice antipsychotic medication will not aggravate its symptoms. In addition, antipsychotic pharmacotherapy and augmentation improves selected symptoms of schizophrenia and brief psychotic behavior in late life, though other symptoms can still persist. Thus, psychosocial therapies combined with pharmacotherapy are particularly essential further treatments required for this patient, in order to assuage enduring symptoms, as well as improve social functioning and overall quality of life (Karim & Byrne, 2005). In many cases, psychosocial care of older patients with schizophrenia is structured within the framework of rehabilitation. This encompasses a “care program approach” containing a team of physicians, occupational therapists, nurses, social workers and others. Research outlines seven key ideal features of this plan. These features include ideal treatment of the psychiatric illness; optimum treatment of the accompanying physical illnesses) with enhanced education and awareness of these illnesses; maintenance of abilities to perform daily living activities; preservation of social contacts; involvement in day activities; proper administration of finances; and, risk assessment (Felmet , Zisook , & Kasckow, 2011). Furthermore, psychoeducation is a crucial element in this approach and may constantly require modification for older patients due to probable cognitive deficits. Accordingly, researchers have outlined practical oriented social skills training program for elderly patients with schizophrenia. The program utilizes “role play” to develop patients’ behavioral performance and to boost their communication skills. Other significant psychosocial treatment strategies that can be used to treat patients with schizophrenia and psychosis include Family Intervention, Cognitive Behavioral Therapy, Cognitive Remediation, and Social Skills Training. These approaches have promising properties in elderly patients with schizophrenia and psychotic symptoms. Essentially, each approach effectively addresses selected domains of these disorders. For instance, Cognitive Behavioral Therapy (CBT) targets psychopathology and symptoms, whereby its main effect is the improvement of positive and negative symptoms (Temple & Ho BC, 2005). In fact, recent meta-analyses of CBT support the findings of individual studies (Zimmermann , Favrod , Trieu , & Pomini , 2005). On the other hand, the aims of Social Skills Training treatment approach include enhancement of social skills and fulfillment of occupational or family responsibilities. Family Therapy treatment approach focuses on the improvement of treatment adherence and deterrence of relapses and rehospitalization; while, Cognitive Remediation intends to improve neurocognitive functioning. Lastly, integrated psychotherapies also offer potential by dealing with a broader array of outcomes. Moreover, these integrated approaches are also cost-effective in cases where they are able to constantly augment adherence and reduce relapse (Stant , et al., 2003). Conclusion This paper has discussed the occurrence of schizophrenia and brief psychotic behavior in geriatric individuals. The paper details the diagnostic procedures for both schizophrenia and psychosis as outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV-TR. Further, the paper has explored existing research regarding the causes of these disorders such as genetics, environmental influences, abnormal brains structure, and other pre-existing medical conditions. In addition, the current paper has discussed the available treatments and management of schizophrenia and psychotic behavior. Accordingly, this pharmacological outlook, recommends that the treatment of psychotic symptoms in patients with schizophrenia requires antipsychotics and psychosocial interventions. References Association, A. P. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV-TR®. Arlington, VA: American Psychiatric Pub. Bentall, R., Jackson, H., & Pilgrim, D. (2011). Abandoning the concept of ‘schizophrenia‘: Some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology Vol.27 Issue 4, 303-324. BestPractice. (2012, May 14). Assessment of psychosis. 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