Concepts of Psychological Disorders

Concepts of Psychological Disorders

What are the known characteristics of schizophrenia and relate those to this patient?

Schizophrenia is a frightful debilitating psychiatric disorder delineated by chronic or recurrent psychosis. Schizophrenia is a clinical diagnosis based on the DSM-5 criteria. The patient in the case scenario showcases distinct features of schizophrenia. For instance, the age of onset. According to Orrico-Sánchez et al. (2020), the peak age of onset of schizophrenia is usually late teens to mid-thirties which corresponds to her age.

Similarly, schizophrenia manifests with hallucinations, disorganized thought, delusions, and disorganized behavior (Hany et al., 2022). In her case, she has both auditory and visual hallucinations, paranoia, thought blocking, episodes of unexpected rage, and crying. She is untidy and unkempt, a common phenomenon in schizophrenics.

Likewise, she utilized cannabis during her early teen and likely from an urban environment which is a known environmental risk factor for schizophrenia. Individuals with schizophrenia are at risk of concurrent alcohol use. Finally, individuals with schizophrenia have concomitant psychopathologies in their families (Hany et al., 2022). For instance, her first cousin had mental problems.

Genetics are sometimes attached to schizophrenia, explain this

Genetic factors have been implicated in the etiology of schizophrenia. For instance, polymorphisms of the neuregulin, dysbindin, and catecholamine O-methyl transferase genes, that normally participate in brain development and glutamate signaling, glutamate release, and regulation of dopamine function respectively (Hany et al., 2022).

Similarly, the risk of schizophrenia in an individual stands at 10 and 40% if one and both parents are schizophrenic respectively (Orrico-Sánchez et al., 2020). Finally, concordance rates in monozygotic and dizygotic twins are 30-40% and 10-15% respectively (Orrico-Sánchez et al., 2020).

What roles do neurotransmitters play in the development of schizophrenia?

Several studies propose the dysregulation and abnormalities in various neurotransmitters as part of the underlying pathophysiologic mechanisms for the development of schizophrenia. For instance, negative psychotic symptoms are attributed to diminished dopamine in the prefrontal cortical pathway whereas positive psychotic symptoms correlate to increased dopamine in the mesolimbic pathway (Hany et al., 2022).

Similarly, reduced dopamine in the nigrostriatal pathway manifests in schizophrenics as motor symptoms. Other neurotransmitter abnormalities include GABA hypoactivity, serotonergic hyperactivity, diminished glutamatergic neurotransmission, and alpha-adrenergic hyperactivity (Hany et al., 2022).

Explain what structural abnormalities are seen in people with schizophrenia.

Structural and functional alterations to the brain appear consistently in individuals with schizophrenia. For instance, atrophy of the prefrontal cortex, thalamus, and limbic system enlarged third and lateral ventricles, atrophy of the hippocampus and amygdala, and diminished grey matter in the temporal and parietal lobes (Hany et al., 2022). Consequently, the array of cognitive changes such as inattention, poor executive functioning, impaired coordination, and memory impairment seen in schizophrenics has been attributed to the aforementioned structural changes.

How does genetics play in the development of bipolar 2 disorders?  

Bipolar 2 disorder is characterized by at least an episode of mania and one major depressive disorder with no prior episodes of mania. Bipolar 2 disorder is considered a complex genetic disorder although the mode of transmission is yet to be established. Studies established a correlation between bipolar disorder and single nucleotide polymorphisms (O’Connell & Coombes, 2021).

Furthermore, individuals with first-degree relatives with bipolar disorder have up to a 10% risk of developing the condition as opposed to a 1 to 3% lifetime prevalence in the general population (O’Connell & Coombes, 2021). Finally, monozygotic twins have a concordance rate of approximately 40 to 70% (O’Connell & Coombes, 2021).

References

Hany, M., Rehman, B., Azhar, Y., & Chapman, J. (2022). Schizophrenia. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539864/

O’Connell, K. S., & Coombes, B. J. (2021). Genetic contributions to bipolar disorder: current status and future directions. Psychological Medicine51(13), 2156–2167. https://doi.org/10.1017/S0033291721001252

Orrico-Sánchez, A., López-Lacort, M., Muñoz-Quiles, C., Sanfélix-Gimeno, G., & Díez-Domingo, J. (2020). Epidemiology of schizophrenia and its management over 8-years period using real-world data in Spain. BMC Psychiatry20(1), 149. https://doi.org/10.1186/s12888-020-02538-8

Concepts of Psychological Disorders Instructions

NURS 6501 Take Test: Quiz - Module 6 Knowledge Check Module 7
Week 9: Concepts of Psychological Disorders
 QUESTION 1

1.	Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.
PMH:  noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed. 
DIAGOSIS: schizophrenia.  

Questions
  1.   What are known characteristics of schizophrenia and relate those to this patient.  

QUESTION 2

1.	Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.
PMH:  noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed. 
DIAGOSIS: schizophrenia. 
 
Question:
1.     Genetics are sometimes attached to schizophrenia explain this.

QUESTION 3

1.	Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.
PMH:  noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed. 
DIAGOSIS: schizophrenia.  

Question:
What roles do neurotransmitters play in the development of schizophrenia?

QUESTION 4

1.	Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.
PMH:  noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed. 
DIAGOSIS: schizophrenia. 
 
Questions:
Explain what structural abnormalities are seen in people with schizophrenia.

QUESTION 5

1.	Scenario 2: Bipolar Disorder
A 44-year-old female  came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. 
DIAGNOSIS: bipolar type 2 disorder. 

Question
1.     How does genetics play in the development of bipolar 2 disorders?