PATHOPHYSIOLOGY NR507 WK7 TD3

PATHOPHYSIOLOGY NR507 WK7 TD3 Week 7: Behavioral, Neurologic, and Digestive Disorders Discussion Part Three Loading... Discussion This week's graded topics relate to the following Course Outcomes (COs). 1 2 3 4 5 6 7 ...

PATHOPHYSIOLOGY NR507 WK7 TD3 Week 7: Behavioral, Neurologic, and Digestive Disorders Discussion Part Three Loading... Discussion This week's graded topics relate to the following Course Outcomes (COs). 1 2 3 4 5 6 7 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1) Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1) Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7) Distinguish risk factors associated with selected disease states. (PO 1) Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1) Distinguish risk factors associated with selected disease states. (PO 1) Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)Discussion Part Three (graded) A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact he claimed to actually hear God’s voice. When he is in your office you notice that he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind” • What is your differential diagnosis, how does it fit how might it not fit? • Based on the top of your differential what is the epidemiology of that disorder? Responses Lorna Durfee Discussion Part Three 6/14/2016 7:13:47 PM A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact, he claimed to actually hear God’s voice. When he is in your office you notice that he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind” What is your differential diagnosis, how does it fit how might it not fit? Based on the top of your differential what is the epidemiology of that disorder? Doctor Brown: My chosen differential is Differential #1: Schizophrenia. McCance, Huether & Brashers (2014) explain that schizophrenia is a severe emotional disorder that manifests itself with delusions, hallucinations, and a break from reality. This disorder results in bizarre, withdrawn, and inappropriate behavior (McCance et. al., 2014, p. 179). The authors relate that recent studies have shown associations between schizophrenia and genes that have products that interact with glutamate receptors (McCance et. al, 2014, pp. 179-180). The receptors are dysbindin, neuregulin 1, and D-amino acid oxidase activator. Another susceptibility is gene DISC1. Each of these has been seen in multiple populations and replicated. The exact mechanisms which mutations in the genes contribute to schizophrenia are not known at this time (McCance et. al, 2014, p. 180). Also, Tohyama, Miyata, Hattori, Shimizu, and Matsuzaki (2015) report that several susceptibility genes have been found in schizophrenia and major depression. They are disrupted-in-schizophrenia 1 (DISC1), dysbindin and pituitary adenylate cyclase- activating polypeptide (PACAP). The findings in DISC1 is related to neural development directly via the adhesion molecules or the partners of DISC1. They are elongation protein 1 (FEZ1), DISC1-binding zinc-finger protein (DBZ) and kendrin. PACAP regulates neural development. Dysbindin is involved with the neural development and regulates the centrosomal microtubule network and formation.The molecules that have been reviewed are involved in neural development and several neuropsychiatric disorders. Both DISC and DBZ are found in oligodendrocytes and thus in regulating oligodendrocyte and differentiation. There is also evidence that suggest that disturbance in oligodendrocyte development and major depression (Tohyama et. al., 2015, p. 137). The National Institutes of Health (2016) relate that past genome analyses have found more than 100 genetic regions related to schizophrenia risk. The specific genes that put a patient at risk are still unknown. Dr. Steve McCarroll, from the Broad Institute and Harvard Medical School, and his team have examined the region with the strongest link. They have found that there are associations near the C4 gene which encodes for complement component 4. The C4 gene is part of the complement cascade where the immune system has a pathway that eliminates pathogens and cellular debris. The scientists found that the more strongly a variation correlation with expression of C4A, the stronger the correlation with schizophrenia. When examining brain tissue and neurons from human brains they found C4 production in the neurons, especially at synapses. It is possible that C4 may be working with other components of the complement cascade to promote synaptic pruning. With testing, they found that C4 tags the synapse for pruning with another protein called C3. The higher the level of C4 in mice the greater the pruning. Dr. Thomas Lehner of the NIH relates that pruning gets rid of the excess connections we do not need so that the brain performs at an optimum level. However, with too much pruning it can impair mental function. Dr. Lehner feels this could help explain the delayed age of onset and the shrinkage of the brain’s working tissue. Perhaps stopping this process could help be the transformation needed to identify the problem behind schizophrenia (The National Institutes of Health, 2016). How does it fit, or not fit? Using the DSM-5, we know that two of Criterion A symptoms are necessary for any diagnosis of schizophrenia. The second change is that additionally, in Criterion A, an individual must have one of three of the positive symptoms: including delusions, hallucinations, and disorganized speech. There must be one of the positive symptoms to sustain a reliable diagnosis of schizophrenia. This patient exhibits three of the criteria listed in the DSM-5 for the diagnosis of schizophrenia as positive indicators for the disorder. The determination of a diagnosis is based on provided information. In this particular case, we do not have all the required information such as past medical history, physical examination, tests and procedures that could help delineate more clearly and more precisely an accurate diagnosis. I would want to investigate the use of drugs. I would also like to determine if there is another medical condition. However, given the information provided, I am certain that this patient is exhibiting the criteria for schizophrenia. What is the epidemiology of that disorder? Although the question did not include the etiology, I found that it was important to include. Holder and Wayhs (2014), explain that genetics have an important role in the etiology of schizophrenia. However, most patients do not have any background or family history of psychosis. The variations in genetics for this disease have not been completely identified. What is possible is that environmental factors could have a role. Other contributing factors for the development of schizophrenia include growing up in an urban area, the use of marijuana, infections, complications in obstetrics, and central nervous system infection in childhood (Holder & Wayhs, 2014, p. 775).As for the epidemiology of schizophrenia, the Centers for Disease Control and Prevention (2013) state that the worldwide estimates for Schizophrenia range between 0.5% and 1%. Men have the first episode at about 21 years of age, women age 27. By the age of 30, 9 out of 10 men will manifest, and women will be 2 out of 10. Patients with schizophrenia are high risk for suicide. In Canada, a study established that the costs of both direct care and non-health care costs to be in 2.02 billion in Canadian dollars, with a total cost of approximately 6.85 billion in the United States and Canadian dollars. Mortality and morbidity loss is 4.83 billion in Canadian dollars. The economic burden is greatest during the first year. This finding is critical for health care providers as it suggests the need to have improved monitoring upon initial diagnosis (The Centers for Disease Control and Prevention, 2013). Differential #2: Bipolar Disorder. The Centers for Disease Control and Prevention (2013) state that Bipolar disorder (formally known as manic-depressive disorder) is a mood disorder where a person can experience episodes of depression and mania. Mania is the elevated, unrestrained and irritable mood which may present itself as a self-assessment of importance and grandiosity, racing thoughts and pressured speech. The person engages in activities that seem to be very pleasing. However, these activities can be those that have a high potential for consequences that can be detrimental. Just like depression, medications and psychotherapy are effective in the treatment of this disorder (The Centers for Disease Control and Prevention, 2013). Differential #3: Antisocial Personality Disorder. Black (2016) defines antisocial personality disorder (ASPD) as a pattern of behavior that is socially irresponsible and exploitative. There is guiltless behavior that begins in childhood and manifests fully by late 20s or early 30s. The behaviors include criminality and the failure to conform to the law. Also, there is an inability to sustain employment that is consistent. The person can also exhibit manipulation of others for personal gain, and there is no ability to develop stable relationships. The person exhibits no empathy for others, are not remorseful, and they never learn from the negative results of the experiences. The use of the word sociopathy is the term used along with antisocial personality disorder, but not as often. The DSM-5 criteria for this disorder focuses on observable behavior. Psychopathy falls in the severe antisocial behavioral spectrum (Black, 2016). This patient is exhibiting signs of schizophrenia. The National Institute of Mental Health (2016) has determined that schizophrenia is a disorder that affects how a person will think, feel and act. People with this disorder can hear voices and see things that are not there. They can think that people read their minds and controlling the thoughts they have. The can feel as though someone is planning on hurting them. People with schizophrenia can talk about weird and strange ideas, and they have great difficulty in carrying on a conversation. The positive symptoms include; hallucinations, delusions, and thought disorders. They can have difficulty with movement and repeat certain motions. They can also become catatonic and not respond to anyone. The patients with schizophrenia cannot understand information and have a hard time making decisions. They cannot focus and pay attention very well. Their working memory is not working very well, and they cannot use any information given to them immediately after they learn it. (National Institute of Mental Health, 2016).This American Psychiatric Association (2013) made two changes from the DSM-IV Criteria for schizophrenia. The first change is the removal of the attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (two or more voices that are conversing). In DSM-IV, only one symptom was needed to meet the requirement diagnostically for Criterion A, instead of two other listed symptoms. This requirement was used because of the nonspecificity of Schneiderian symptoms and the unreliability in distinguishing bizarre from non-bizarre delusion. Therefore, in the DSM-5, two of Criterion A symptoms are necessary for any diagnosis of schizophrenia. The second change is that additionally, in Criterion A, an individual must have one of three of the positive symptoms: including delusions, hallucinations, and disorganized speech. There must be one of the positive symptoms to sustain a reliable diagnosis of schizophrenia (American Psychiatric Association, 2013, pp. 2-3). References American Psychiatric Association. (2013). Highlights and Changes from DSM-IVTR to DSM-5. Retrieved from http://www.dsm5.org/documents/changes%20from%20dsm-iv- tr%20to%20dsm-5.pdf Black, D. W. (2016). Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis. In T.W. Post (Ed.), UpToDate. Retrieved from http://www.uptodate.com/contents/antisocial-personality- disorder-epidemiology-clinical-manifestations-course-and-diagnosis? source=see_link Holder, S. D., & Wayhs, A. (2013). Schizophrenia. American Family Physician, 90 (11), 775-782. Jorde, L. B. (2014). Genes, environment-lifestyle, and common disease. In McCance, K. L., Huether, S. E., Brashers, V. L. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp. 179-180). St. Louis, MO: Mosby.National Institute of Mental Health. (2016). Schizophrenia. Retrieved from www.nimh.nih.gov/health/publications/schizophrenia-booklet-12- 2015/index.shtml Sekar, A., Bialas, A. R., De Rivera, H., Davis, A., Hammond, T. R., Kamitaki, N., … McCarroll, S. A. (2016). Schizophrenia risk from complex variation of complement component 4. Nature, 530(7589), 177-183. doi:10.1038/nature16549 The Centers for Disease Control and Prevention. (2013). Bipolar Disorder. Retrieved from https://www.cdc.gov/mentalhealth/basics/mental- illness/bipolar.htm The Centers for Disease Control and Prevention. (2013). CDC - Burden of Mental Illness. Retrieved from https://www.cdc.gov/mentalhealth/basics/burden.htm The National Institutes of Health. (2016). A biological mechanism for schizophrenia. Retrieved from https://www.nih.gov/news-events/nih-research- matters/biological-mechanism-schizophrenia Tohyama, M., Miyata, S., Hattori, T., Shimizu, S., & Matsuzaki, S. (2015). Molecular basis of major psychiatric diseases such as schizophrenia and depression. Anat Sci Int, 90(3), 137-143. doi:10.1007/s12565-014-0269-3 Lanre Abawonse Discussion Part Three 6/16/2016 7:04:19 PM Schizophrenia Schizophrenia refers to a chronic, remitting and relapsing psychotic disorder that is associated with significant impairment in social and vocational functioning. This means that patients with schizophrenia have a split or separation among normally well synchronized brain functions. Negative symptoms have a profound effect onsocial functioning and quality of life (Esan, Ojagbemi, & Gureje, 2012). What causes these negative symptoms in schizophrenia patient is decreased neurotransmission and connectivity from a neurobiological standpoint. Bipolar disorder Bipolar disorder (BD) is a highly complex mood disorder characterized by recurring symptoms of depression and elation that can become severe enough to produce psychosis. The most recognizable course of illness with BD is the sudden onset. Onset usually occurs in early adulthood (Jann, 2014). In many cases of BD, mania ids the hallmark whereas the depressive phase puts a lot of burden on the patient. Borderline personality disorder Borderline personality disorder is one of the cluster B types of personality disorder (PD). It is seen as a pervasive pattern of instability of interpersonal relationship, self- image, and affects pattern of behavior. This is often marked by impulsivity, with diagnosis usually made in early adulthood (Bhome& Fridrich, 2015). Borderline personality disorder presents in a variety of contexts such as identity disturbance, marked by unstable self-image or sense of self. Also, transient, stress-related paranoid ideation or severe dissociative symptoms can be present. Substance induced psychosis Substance induced psychosis is usually brief and carries one criteria for symptomatic schizophrenia. The patient presents with hallucinations, delusions, disorganized speech or behavior for at least several hours to one day but usually less than a month. The disorder could be as a result of life changing event or stressful situation, which leads to unusual and seldom seen symptoms. Drugs can cause mental health problems and if a preexisting mental illness exits, drugs can exacerbate the symptoms of the disease (Weibell, Joa, Bramness, Johannessen, McGorry, Ten Velden Hegelstad, & Larsen, 2013). Based on the top of your differential what is the epidemiology of that disorder? The global incidence rate of schizophrenia has consistently been estimated to be about one percent of the world population and is fairly equally distributed across genders. Weinstein and Stovall (2015) stated that the age of onset is typically <30 years, earlier in males (early to mid-20s) than females (late 20s), with a smaller peak that occurs is seen in women >45 years. There is a lifetime (1%) higher prevalence in people of lower socioeconomic classes and urban centers. Unfortunately, schizophrenia appears to be associated with an average life span reduction of 15 to 25years. Skikic and Stovall (2016) also contend that the age of onset is usually under the age of 30, with males being diagnosed in their early twenties and females in their late twenties. Reference Weinstein, J. J.,& Stovall, J. G. (2015) Schizophrenia: Differential diagnosis. In F. J. Domino (Ed.), The 5-minute clinical consult 2016 (Electronic). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Bhome, R., & Fridrich, P. (2015). Borderline personality disorder. British Journal of Hospital Medicine (London, England: 2005), 76(1), C14-C16. doi:10.12968/hmed.2015.76.1.C14 Esan, O. B., Ojagbemi, A., & Gureje, O. (2012). Epidemiology of schizophrenia - An update with a focus on developing countries. International Review of Psychiatry, 24(5), 387-392. doi:10.3109/09540261.2012.725219 Jann, M. W. (2014). Diagnosis and treatment of bipolar disorders in adults: A review of the evidence on pharmacologic treatments. American Health & Drug Benefits, 7(9), 489-498 10p. Skikic, M. & Stovall, J. G. (2016). Schizophrenia. In F. J. Domino (Ed.), The 5-minute clinical consult 2016 (24th ed., pp. 1000-1001). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Weibell, M. A., Joa, I., Bramness, J., Johannessen, J. O., McGorry, P. D., Ten Velden Hegelstad, W., & Larsen, T. K. (2013). Treated incidence and baseline characteristics of substance induced psychosis in a Norwegian catchment area. BMC Psychiatry, 13319. doi:10.1186/1471-244X-13-319 Rechel DelAntar Differential Diagnosis Hello Professor and Class, Differential Diagnosis This is a case of a 19-year-old freshman brought in by campus security. He had been having auditory hallucinations and stating he was the prophet of God and that He was speaking to him. He observed to be restless and unable to sit still with a fast speech that doe not make sense. Based on this, the differential diagnosis for this may be: 1. Substance Induced Psychotic Disorder = Also known as Stimulant Induced psychosis is a condition that is caused by the use of or withdrawal from some substances, such as hallucinogens and crack cocaine, that may cause hallucinations, delusions, or confused speech. Some drugs, when taken frequently for long periods of time, can actually manifest as psychotic symptoms indicative of schizophrenia and bipolar disorder. Drugs like cocaine, cannabis, and hallucinogens can cause mental health problems and, when paired with a pre-existing mental illness, can exacerbate the symptoms of such illnesses. Symptoms of drug abuse do not linger for years regardless of the frequency and prolonged use. Asides from delusions and hallucinations, substance induced psychosis symptoms 6/16/2016 9:16:28 PMinclude: lethargy, lack of motivation, incoherence in thought and action, incoherent speech, violent and erratic behavior (Foundations Recovery Network, 2016). This diagnosis may fit the patient as he is a you college male who may have had illicit drug use and developed psychosis as a result. Drug use can also mask an already underlying mental illness. However, most symptoms, if the condition is unrelated to drugs, will continue after abstinence from the drug. The opposite is true for drug-induced psychosis; the schizophrenic-like effects will more or less subside after the drug wears off. Drug test has to be performed and we will have to see if the symptom wears off in time. 2. Schizophrenia = Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. Patients with schizophrenia may seem like they have lost touch with reality. Although schizophrenia affects men and women with equal frequency, the disorder often appears earlier in men, usually in the late teens or early twenties, than in women, who are generally affected in the twenties to early thirties. The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive. Positive symptoms include, hallucinations, delusions, thought disorders, Movement disorders (agitated movements); negative symptoms include, flat affect, reduced feeling of pleasure in everyday life, difficulty beginning and sustaining activity and reduced speech; while cognitive symptoms include Poor “executive functioning” (the ability to understand information and use it to make decisions), trouble focusing or paying attention Problems with “working memory” (the ability to use information immediately after learning it). Some patient’s symptoms are very subtle and times difficult to recognize. Symptoms have lasted more than 6 months with a noted decline in work, school and social functioning. It's not known what causes schizophrenia, but researchers believe that a combination of genetics and environment contributes to development of the disorder (National Institute of mental Health, 2015). The symptoms of schizophrenia fit the patient’s presentation of delusion, hallucinations with disorganized speech and thought process. 3. Psychosis due to Medical Condition = There are certain medical conditions that cause hallucinations and delusions such as brain tumors, cerebrovascular disease, Huntington's disease, multiple sclerosis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, and infections of the central nervous system (Freudenreich, O., 2012). Some of the medical conditions may cause delusions and hallucinations, it is usually preceded by other symptoms prior to full-blown psychosis. A full work up can be done if the symptoms persist to rule out this diagnosis. 4. Bipolar Disorder = Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes. In some hypomanic episodes, some patients experience symptoms of psychosis. The psychotic symptoms match the patient’s current mood at the time. In a manic state, patient may think she/he is famous or has super powers and during depressive states one may feel ruined, hopeless and penniless. Children and teens may have distinct major depressive, manic or hypomanic episodes, between which they return to their usual behavior. The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings (Mayo Clinic, 2016). Although some of the symptoms of the patient matches the patient in the case study during the manic, the patient is exhibiting disorganized speech which not common for bipolar disorder. Therefore, this diagnosis can be excluded.5. Delusional Disorder = Otherwise known as paranoid disorder or psychosis. in which a person cannot tell what is real from what is imagined. The main feature of this disorder is the presence of delusions, unshakable beliefs in something untrue or not based on reality. Patients with delusional disorder generally experience non-bizarre delusions. It involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance. It is not with no accompanied by prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect (American Psychiatric Association, 2013). Although one of the symptoms of this disease is delusion, it does not exhibits hallucinations, which the primary symptom the patient is exhibiting which excludes this as a diagnosis for the patient. The primary diagnosis is drug induced psychosis however, when a drug user has a mental illness prior to drug use, it may be hard to identify symptoms that are exclusively due to the drug use itself. Most symptoms, if the condition is unrelated to drugs, will continue after abstinence from the drug. The opposite is true for drug-induced psychosis; the schizophrenic-like effects will more or less subside after the drug wears off. In this case, an accurate social history of the patient is needed as well as a drug test can be performed to check for presence of elicit drugs and wait to see if the symptoms may wear off. If the drug screen is negative then schizophrenia as a primary diagnosis can be entertained. The recent escalating use of methamphetamine throughout the world and its association with psychotic symptoms in regular users has fuelled concerns. The use of cannabis and cocaine by young people has considerably increased over recent years, and age at first use has dramatically decreased. There is some evidence that cannabis is now on the market in a more potent form than in previous decades. Furthermore, a large number of studies have reported a link between adolescent cannabis use and the development of stable psychosis in early adulthood. The situation is further complicated by the high rates of concomitant substance use by subjects with a psychotic illness, which especially in young users with an early-phase psychotic disorder, can make diagnosis difficult. In this longitudinal study, cannabis users by age 15 and 18 years had more schizophrenic symptoms. This result took into account psychotic symptoms preceding the onset of drug use, indicating that it is not secondary to a pre-existing psychosis. In addition, earlier use at age 15 years conferred a greater risk of schizophrenia outcomes than later use. Recent studies indicate that psychosis due to substance abuse is commonly observed in clinical practice than reported (Fioretini, A. et.al., 2011). References: American Psychiatric Association. (2013). Diagnostic and Statistical Manual Of Mental Disorders (5 ed.). Washington, DC: American Psychiatric Association. th Fiorentini, A., Volonteri, L.S., Dragogna, F., Rovera, C., Maffini, M., Mauri,M.C, & Altamura,C.A. (2011). Substance Induced Psychosis: A critical review of the literature. Current Drug Abuse Review. 4(4), 228-240. Freudenreich, O. (2012). Differential Diagnosis of Psychotic Symptoms: Medical “Mimics”. Retrieved from http://www.psychiatrictimes.com/forensic-psychiatry/ differential-diagnosis-psychotic-symptoms- medical-%E2%80%9Cmimics%E2%80%9D. Foundations Recovery Network. (2016). What is Stimulant Induced Psychosis? Retrieved from http://www.dualdiagnosis.org/drug-addiction/psychosis/. Mayo Clinic. (2016). Bipolar Disorder. Retrieved from http://www.mayoclinic.org/ diseases-conditions/bipolar-disorder/basics/definition/con-20027544. National Institute of Mental Health. (2015). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml.Sarah Boulware reply to Rechel DelAntar RE: Differential Diagnosis 6/19/2016 2:02:37 PM Rechel, After reading your post I agree with your differential diagnosis of substance induced psychotic disorder. It is hard to determine if this is from a drug or the onset of positive symptoms of schizophrenia or just an acute episode. Acute psychotic disorder is a diagnostic label given to patients with unusual symptoms of sudden onset, usually with florid disturbance and lasting from a few days to a few weeks. While complete recovery is the norm, a minority of patients can have a relapse with similar presentations. Delusions, hallucinations and restlessness are common. Time will have to tell if this is an acute episode or a persistent state. The concept of acute psychosis includes transient psychotic states that last less than one month. Since schizophrenia is often a long-lasting disorder you will likely see a persistent psychotic illness present. A drug test can determine if this is a drug induced psychotic state and if the patient’s symptoms persist it is likely that it is schizophrenia (Goldberg, Ivbijaro, Kolkeiwicz, & Ohene, 2013). Thanks, great post! Sarah Boulware References Goldberg, D. Ivbijaro, G., Kolkeiwicz, L., & Ohene, S. (2013). Schizophrenia in primary care. Mental Health in Family Medicine, 10(4), 231-239. Jaimie Buckner reply to Rechel DelAntar RE: Differential Diagnosis Rachel, You make a very valid point that I personally overlooked when reading the case study. I was thinking of a medical diagnosis, not thinking about the patient and his state of life at that time. Illicit drug use can result in impairment in cognitive function in healthy individuals (Donoghue et. al., 2012). Individuals with a psychotic disorder also show a deficit in cognitive function. Drug use may simply contribute to the characteristics cognitive deficit found in psychosis. A deficit in cognitive function is a core feature of schizophrenia, with impairments reported in all domains compared with healthy control (Donoghue et. al., 2012). Illicit substance misuse has been reported to have a detrimental effect on learning, memory and executive function. During care of the patient a urine drug screen would be ordered on the patient to determine if there was drug use. Then further diagnosis could be determined. Very interesting! Great post! Reference Donoghue, K., Mazzoncini, R., Hart, J., Zanelli, J., Morgan, C., Dazzan, P., & ... Doody, G. A. (2012). The differential effect of illicit drug use on cognitive function in first-episode psychosis and healthy controls. Acta Psychiatrica Scandinavica, 125(5), 400-411. Michelle Demey reply to Rechel DelAntar RE: Differential Diagnosis 6/19/2016 7:42:18 PM 6/19/2016 5:26:47 PMI agree that drug abuse is a valid cause of psychosis in this scenario. Evidence is mounting that regular marijuana use increases the chance a teenager will develop psychosis, a pattern of unusual thoughts or perceptions, such as believing the television is transmitting secret messages. It also increases the risk of developing schizophrenia. In one recent study, conducted in Germany, that followed nearly 2000 teenagers as they became young adults, young people who smoked marijuana at least five times were twice as likely to develop psychoses over the next 10 years as those who didn’t smoke pot (Kuepper et al., 2011). References Kuepper, R., Van Os, J., Wittchen, H., Hofler, M., & Henquet, C. (2011, March). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort. BMJ. doi:10.1136/bmj,d738 Nosimot Adepegba reply to Rechel DelAntar RE: Differential Diagnosis Hello Rechel. I enjoyed reading your post and I do agree with some of your differential diagnosis. Substance induced psychotic disorder sound like a possible condition that this individual is experiencing. Considering the fact that he is freshman who might be enjoying his new found freedom and could have been experimenting with drugs like cocaine and alcohol. It was not stated in the scenario how long this patient has been in this state so it is hard to determine whether it a an acute or a sustained episode, thus it might be safer to establish safety of the patient, perform a drug test to rule out intoxication and drug induction. Continuous monitoring of patient's behavior for 1 to 6 months is required to establish a diagnosis of schizophrenia (McCance & Huether, 2014). McCance, Kathryn, Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, 7th Edition. [VitalSource BookshelfOnline]. Retrieved from https://online.vitalsource.com/#/books/9780323088541/ Michelle Demey Discussion Part Three 6/18/2016 2:09:09 PM A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact he claimed to actually hear God’s voice. When he is in the office he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind” 6/19/2016 11:30:43 PM