Assessing and Diagnosing Patients With Schizophrenia

Patient Information

Name: Harold Fieldman Age: 20 Years Sex: Male

Subjective

Chief Complaint (CC): The patient’s parents called the doctor for an appointment, complaining that their son had “difficulties in school.”

History of Present Illness (HPI)

H.F. is a 20-year-old European-American male who presents for psychiatric evaluation for schizophrenia after his parents expressed concerns over his mental health. The patient has had paranoia for at least six months, for which he was prescribed risperidone but stopped due to its side effects. During the appointment, Fieldman answered the questions appropriately until the doctor asked about his choice of major and his roommate. When the doctor expressed interest in the patient’s choice to double major in philosophy and physics, the patient claimed that the courses were mysteries: once he thought he understood them, they were suddenly gone. This statement was incoherent and qualifies for disorganized speech. The patient is reluctant to talk about his roommate because he believes he is spying on him. He does appreciate his roommate’s decision to bring a microwave into their room. He also claims that the outside forces are spying on them, but he has the power to evade their espionage. Indeed, the patient cannot hold a conversation without wandering off topic. The patient also presents with loss of appetite evidenced by drastic weight loss: 18lbs since autumn. He has not kept in touch with his friends since coming home for spring break, has been sleeping for about 14 hours every day and lacks interest in self-care activities such as showering and grooming.  Assessing and Diagnosing Patients With Schizophrenia

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Past Psychiatric History

General Statement: The patient started treatment for his symptoms, notably mild paranoia, approximately six months ago.

Caregivers: The patient is currently seeing a therapist. His parents are also caregivers because they observe changes in his behaviour and communication and collaborate with health professionals to achieve better health outcomes.

Hospitalizations: The patient has no history of hospitalization, detox, residential treatment, suicidal, self-harm or homicidal tendencies.

Medication Trials: The patient took risperidone for six months in high school to manage the paranoia. However, he stopped the medication due to the inability to tolerate the associated adverse reactions.

Psychotherapy: Before this session, the patient has not undergone psychotherapy. He appears disengaged from the session as he distances himself from his parents’ efforts to set up the appointment. Further, he states that he does not know the reason for the appointment. Assessing and Diagnosing Patients With Schizophrenia

Substance Abuse History: The patient admits to using cannabis about once every week. However, he denies addiction or any withdrawal symptoms.

Family History: All immediate family members have mental illnesses. The patient has two younger sisters with separation anxiety and attention deficit and hyperactivity disorder (ADHD), respectively. The patient’s mother had depression, and the father had schizophrenia.

Social History:

The patient is the firstborn of three: he has two younger sisters, all raised by both parents. The patient lives with his roommate at State College and stays with his parents during breaks and holidays. He is single and does not have children yet. His highest level of education is a high school diploma, but he has enrolled in college. The patient has no legal issues and denies experiencing childhood or violence trauma.

Medical History: denies seizures, surgeries or head injuries.

Allergies: shellfish

Review of Symptoms

Constitutional: Denies weight loss, chills and fever

HEENT:  Negative for oral, hearing or vision impairment

Cardiovascular: Negative for chest pains or dizziness

Respiratory: Negative for wheezing or breathing difficulties

Neuro: Negative for seizures

Genitourinary: Negative for urine hesitancy or painful urination

Gastrointestinal: Negative for vomiting, heartburn, or nausea Assessing and Diagnosing Patients With Schizophrenia

Objective

Vital Signs: Temperature: 98.4 Pulse: 76 Respirations: 18 116/74 Height: 5’6 Weight: 120lbs

Physical Exam:

The patient generally appears healthy with no indication of distress. While the skin examination reveals no signs of cyanosis, palmer creases were fairly pale and indicative of anaemia (Abid et al., 2017). These findings were consistent with the history of weight loss and self-neglect. The patient does not seem to be taking enough iron to meet his dietary requirements. Examination of the hands and arms for needle tracks turned negative, corroborating the client’s denial of drug use. The patient could move all extremities with a full range of motion and had an appropriate gait. Further, no tremors were observed.

Diagnostic Tests

The recommended diagnostic tests are laboratory assays to rule out drug abuse. Patients who abuse drugs are likely to present with paranoia and disorganized speech.

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Assessment

Mental Health Test Results

The patient, a 20-year-old European American male, appears youthful and presentable, well groomed and dressed appropriately for his age. Although he is generally friendly and cooperative with the health professional, he appears disengaged and disinterested. His movements appear normal, but his speech is unclear, incoherent and abnormal in tone and volume: he speaks in low tones and asks the examiner to do the same. His thought process may be illogical, especially when he starts expressing paranoid thoughts. The patient has a scattered mood and a mood-appropriate affect. Although the patient denies delusions and hallucinations, the health professional observes disorganized speech and paranoia.  He denies any current suicidal or homicidal ideation. The patient is aware of time, place and person but presents with impaired memory, concentration and insight Assessing and Diagnosing Patients With Schizophrenia.

Differential Diagnosis

1. Schizophrenia

The patient’s symptoms meet the criteria for a schizophrenia diagnosis according to the diagnostic and statistical manual of mental disorders (DSM-V). The patient presents with atleast two active phase symptoms: paranoia and disorganized speech, as recorded in the transcript. The patient feels concerned that unnamed agencies and his roommate are spying on him. He is unhappy that his roommate brought a microwave into the room and claims that he knows its purpose but will not let anyone in on the secret. The patient also presents with disorganized speech as the health profession can barely follow the conversation regarding the patient’s college courses. A positive schizophrenia diagnosis also requires the presentation of atleast one negative symptom (Loch, 2019). In this case, the patient withdraws from social life and lacks interest in self-care.

2. Schizoaffective Disorder

The condition may be misdiagnosed as schizoaffective disorder considering the patient’s symptoms. Indeed, schizoaffective disorder patients may present with schizophrenia symptoms, including hallucination, disorganized speech, delusion, catatonic behaviour and negative symptoms. Moreover, 50% of all schizoaffective disorder patients have comorbid depression. In this regard, it is easy to misdiagnose the condition because the negative symptoms, such as loss of interest in previously interesting activities, may be confused for depression or the negative schizoaffective disorder symptoms (Wy & Saadabadi, 2022). However, schizophrenia differs from this disease due to the duration of the illness. With schizophrenia, the active phase lasts at least a month, while schizoaffective disorder symptoms appear periodically. Further, schizoaffective disorder patients experience bouts of depression or mania, unlike schizophrenia patients Assessing and Diagnosing Patients With Schizophrenia.

3. Schizoid Personality Disorder (SPD)

Some symptoms presented during the clinical visit may lead the health professional to misdiagnose the condition as a schizoid personality disorder (SPD). Patients with this condition tend to be disengaged, lack empathy, shy away from forming and maintaining social relationships and value privacy (Fariba & Gupta, 2022). For example, the patient seemed disinterested in the reason for the visit, avoided socializing with his friends since he came back for spring break and tried to keep the roommate and microwave story to himself. However, the patient’s complete symptom profile does not fit this diagnosis. For example, the most dominant symptom, in this case, is paranoia, which is not required for SPD diagnosis. Moreover, the patient is not entirely emotionally cold and still seeks to find pleasurable activities such as using cannabis.

Reflection

An important lesson from this patient’s comprehensive psychological evaluation is the importance of family support in achieving optimal healthcare outcomes. The patient’s parents are present and observant of behavioural changes. As soon as the patient developed the condition, they sought help. Further, they collaborate with the health professional by providing support and information. They also encourage the patient to attend sessions even though he does not feel compelled to seek help voluntarily Assessing and Diagnosing Patients With Schizophrenia.

The most significant social determinant of health (SDOH) at play, in this case, is easy healthcare access. The doctor is available to the patient’s parents and is only a phone call away. The patient’s family affords healthcare and will be able to put him through therapy and medication until he regains functionality. Finally, since the disease develops from the impairment of neuronal systems, the most important health promotion activity is complete compliance with the treatment plan (Hany et al., 2021). The patient’s family can play a supportive role by reminding him to take the medication every day.

References

Abid, M. B., Mughal, P., & Abid, M. A. (2017). Anaemia with Laugier-Hunziker Syndrome: a diagnostic dilemma. Singapore medical journal, 58(5), 281. https://doi.org/10.11622/smedj.2017040

Fariba KA, & Gupta V. Schizoid Personality Disorder. [Updated 2022 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559234/

Hany M, Rehman B, Azhar Y, et al. Schizophrenia. [Updated 2021 Nov 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539864/

Loch, A. A. (2019). Schizophrenia, not a psychotic disorder: Bleuler revisited. Frontiers in psychiatry, 10, 328. https://doi.org/10.3389/fpsyt.2019.00328

Wy TJP & Saadabadi A. Schizoaffective Disorder. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541012/Assessing and Diagnosing Patients With Schizophrenia

Assignment: Assessing and Diagnosing
Patients With Schizophrenia, Other
Psychotic Disorders, and MedicationInduced Movement Disorders
Photo Credit: [Hero Images]/[Hero Images]/Getty Images
Psychotic disorders and schizophrenia are some of the most complicated and
challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear
quite vivid in some patients; with others, symptoms may be barely observable.
Additionally, symptoms may overlap among disorders. For example, specific
symptoms, such as neurocognitive impairments, social problems, and illusions may
exist in patients with schizophrenia but are also contributing symptoms for other
psychotic disorders.
For this Assignment, you will analyze a case study related to schizophrenia, another
psychotic disorder, or a medication-induced movement disorder.
To Prepare:
• Review this week’s Learning Resources and consider the insights they provide about
assessing and diagnosing psychotic disorders. Consider whether experiences of
psychosis-related symptoms are always indicative of a diagnosis of schizophrenia.
Think about alternative diagnoses for psychosis-related symptoms.
• Download the Comprehensive Psychiatric Evaluation Template, which you will use Assessing and Diagnosing Patients With Schizophrenia
to complete this Assignment. Also review the Comprehensive Psychiatric
Evaluation Exemplar to see an example of a completed evaluation document.
• By Day 1 of this week, select a specific video case study to use for this Assignment
from the Video Case Selections choices in the Learning Resources. View your
assigned video case and review the additional data for the case in the “Case History
Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 7 Assessing and Diagnosing Patients With Schizophrenia
Complete and submit your Comprehensive Psychiatric Evaluation, including your
differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
• Subjective: What details did the patient provide regarding their chief complaint and
symptomology to derive your differential diagnosis? What is the duration and
severity of their symptoms? How are their symptoms impacting their functioning in
life?
• Objective: What observations did you make during the psychiatric assessment? 
• Assessment: Discuss the patient’s mental status examination results. What were
your differential diagnoses? Provide a minimum of three possible diagnoses with
supporting evidence, listed in order from highest priority to lowest priority.
Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and
explain what DSM-5-TR criteria rules out the differential diagnosis to find an
accurate diagnosis. Explain the critical-thinking process that led you to the primary
diagnosis you selected. Include pertinent positives and pertinent negatives for the

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specific patient case.
• Reflection notes: What would you do differently with this client if you could
conduct the session over? Also include in your reflection a discussion related to
legal/ethical considerations (demonstrate critical thinking beyond confidentiality
and consent for treatment!), health promotion and disease prevention taking into
consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk
factors (e.g., socioeconomic, cultural background, etc.) Assessing and Diagnosing Patients With Schizophrenia