Psychodiagnostics in Schizophrenia Case

Biopsychosocial History, Presenting Problems, and Symptoms

In this case, Denise, a 26-year-old single woman, is a patient. During the last seven days, she was treated in the psychiatric unit, and now, her case manager delivers her to this examination. One of the evident complaints of the patient is that she is not as crazy as many people around like to think. She admits that she communicates with the “spiritual world”. Her strange behavior, loud singing, incoherent speech, energy, and lack of sleep are explained as a result of her communion with the universe. Similar episodes happened to her before and lasted about two weeks. Her irrational behavior, anger, irritability, and hostility are the symptoms reported by healthcare workers. The patient’s family does not participate in Denise’s treatment because they have not communicated for five years. The father has alcohol dependence, the mother is involved in her own affairs and development, and no information about her younger brother was given. However, the patient has a cousin with bipolar disorder who supports her ideas. Denise is a mother of three children who are under the state’s protection because the woman cannot take care of them.

Differential Diagnoses and Final Diagnosis

In the case under analysis, the client has the symptoms of psychotic disorders within the schizophrenia spectrum. First, schizophrenia may be diagnosed because Denise meets a number of its criteria, including delusions, disorganized speech, and irrational behavior. However, according to the American Psychiatric Association (2013), these symptoms should last for a significant period of time (at least one month). Denise identifies two weeks as the maximum length of her “episodes”. Psychotic disorder due to another medical condition is also characterized by hallucinations and delusions, but, these symptoms have to be caused by another disease, and additional information is required to clarify the situation (Hartman, Heinrichs, & Mashhadi, 2019). Finally, the patient should be assessed for brief psychotic disorder because delusions and mood changes are the evident signs. However, in this diagnosis, a stressful event has to be reported.

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At this moment, regarding the information about the patient and her behavior, Denise may be diagnosed with schizoaffective disorder. The symptoms of this disease, like disorganized thinking and delusions, begin in the early 20s. Schizoaffective patients show high mania signs, including increased energy, decreased need for sleep, and euphoria. The client develops an exaggerated sense of self-confidence by saying that she is not crazy but connected with the universe. With time, her high mood turns into a low mood, and Denise explains it as a kind of reboot from the universe. Social dysfunction is observed in her loud behaviors in the middle of the night, mismatched dressing code, and hostility without any reason in regard to people who try to help.

Contributing Factors to the Client’s Condition

Social and cultural factors may contribute to the current condition of Denise. First, the woman did not finish her college education, and no family support was offered to change the situation. She does not participate in community activities and does not share any traditional religious beliefs. Due to the lack of education and awareness of options, Denise is under the impact of her cousin with bipolar disorder. The patient believes that the universe offers enough for a good life, and she relies on the spirit world more than on traditional treatment and social help. Finally, she denies any mental health problems and does not want to agree with professionals about the need for medications. Even after her assessment, the client does not follow a plan and continues selling her goods and demonstrates aggressive reactions to any support.

Clinical Treatment

To help the patient, her schizoaffective disorder diagnosis has to be treated pharmacologically and non-pharmacologically. The use of antipsychotics (except clozapine) is the first-line treatment to control hallucinations and delusions and prevent relapse (Fellner, 2017). Denise has a bipolar type of schizoaffective disorder, and this classification may be explained by a close relative (a cousin) having bipolar disorder. Therefore, mood stabilizers are necessary to reduce her extreme energy, unreasonable depression, as well as the development of other behavioral changes. Cognitive behavioral therapy can help patients to manage their symptoms. In this case, Denise does not have family support, and individual or family therapies can hardly be effective. Attention should also be paid to social skills with the help of which the client learns how to improve the quality of life and reduce the number of strange behavioral episodes.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

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Fellner, C. (2017). New schizophrenia treatments address unmet clinical needs. Pharmacy & Therapeutics, 42(2), 130-134.

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