Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Scenario: C.Z. is a 20-year-old Caucasian male who is in his second year of college. He is seeking treatment due to persistent fears that campus security and the local police are tracking and surveilling him. He cites occasional lags in his internet speed as evidence that surveillance devices are interfering with his electronics. His intense anxiety about this has begun getting in the way of his ability to complete schoolwork, and his friends are concerned – he says they have told him, “you’re not making sense.”
C.Z. occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-sentence, looking off in the distance as though he sees or hears something. He expresses concern about electronics in the room (phone, computer) potentially being monitored and asks repeatedly about patient confidentiality, stating that he wants to be sure the police won’t be informed about his treatment. His beliefs are fixed, and if they are challenged, his tone becomes hostile.
Questions: Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Discuss the etiology, course, and the structural/functional abnormalities of schizophrenia.
- Discuss the evidence-based pharmacological and nonpharmacological treatment for this patient using the US Clinical Guidelines.
Full Answer Section
function, structural brain abnormalities, and neurodevelopmental disturbances. Environmental stressors, such as early trauma or substance abuse, can also play a role.
The
course of schizophrenia is typically characterized by acute exacerbations and periods of remission. The onset is usually in late adolescence or early adulthood. Positive symptoms, such as delusions and hallucinations, tend to be more prominent in the early stages. Negative symptoms, like apathy and social withdrawal, often become more pronounced over time.
Structural and functional abnormalities associated with schizophrenia include:
- Enlarged ventricles: Fluid-filled spaces in the brain
- Reduced gray matter volume in various regions
- Abnormal functioning of the prefrontal cortex, involved in decision-making, planning, and impulse control
- Dysregulation of dopamine and glutamate neurotransmitter systems
C.Z.'s presentation, with delusions of surveillance, disorganized speech, and inappropriate affect, aligns with the positive symptoms of schizophrenia.
Question 2: Discuss the evidence-based pharmacological and nonpharmacological treatment for this patient using the US Clinical Guidelines.
Pharmacological Treatment:
- Antipsychotics: First-line treatment for the management of psychotic symptoms. Second-generation antipsychotics (SGAs) like risperidone, olanzapine, or quetiapine are often preferred due to a lower risk of extrapyramidal side effects.
- Adjunctive medications: May be considered for specific symptoms, such as mood stabilizers for mood instability or anxiolytics for anxiety.
Non-pharmacological Treatment:
- Psychotherapy: Cognitive-behavioral therapy (CBT) can help C.Z. challenge delusional beliefs and develop coping strategies.
- Social skills training: Can improve interpersonal skills and social functioning.
- Family therapy: Involves educating family members about schizophrenia and providing support.
- Case management: Provides coordination of care and support services.
- Supported employment: Assists with job placement and retention.
It's crucial to establish a therapeutic alliance with C.Z., given his mistrust and suspicion. A gradual approach, emphasizing empathy and understanding, can help build rapport. Involving his friends or family in treatment planning, with his consent, can also be beneficial.
Note: This is a brief overview. A comprehensive treatment plan should be tailored to the individual patient and consider factors such as symptom severity, comorbidities, and patient preferences. Regular monitoring and adjustment of treatment are essential.
Sample Answer
Understanding C.Z.'s Presentation
Disclaimer: This response is intended for educational purposes only and does not constitute medical advice. A comprehensive evaluation by a qualified mental health professional is necessary for accurate diagnosis and treatment planning.
Question 1: Discuss the etiology, course, and the structural/functional abnormalities of schizophrenia.
Etiology of schizophrenia is complex and multifactorial, involving a combination of genetic, neurobiological, and environmental factors. While a definitive cause remains elusive, research suggests a strong genetic predisposition, with multiple genes contributing to the risk. Neurobiological factors include abnormal dopamine