Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Subjective:

Initials: H. F                 Sex: M            Age: 20yo      Ethnicity: European-American male

CC
: “My parents booked a psychiatrist appointment since I am having difficulties at the school.”

HPI
: The patient is a 20-year-old male. His parents booked him an appointment since he is experiencing some difficulties in school. H. F. claims that the interview room spies on them. He meets all childhood developmental milestones. His appetite is inconsistent. Besides, the patient has lost 18 lbs without efforts to lose weight. He has kept off from his friends since he came home for the spring. He reports sleeping for 14 hours daily. The patient denies showering.

Past Psychiatric History
:

G
eneral Statement: The patient entered mild paranoia treatment six months ago. Nonetheless, H. F. discontinued risperidone therapy since it was exposing him to over-sedation.

C
aregivers: N/A

H
ospitalizations: H. F. denies hospitalization history.

M
edication trials: F. reports participating in a short trial of risperidone six months ago as a treatment for mild paranoia.

P
revious Psychiatric Diagnosis: F. reports mild paranoia diagnosed when he was in high school.

Substance Current Use and History:
H. F. uses cannabis weekly.

Family Psychiatric History:
His younger sisters have a history of ADHD and separation anxiety. His father has a paranoid schizophrenia diagnosis. H. F’s mother has a depression diagnosis.

Psychosocial History:
The patient attends the State College. He has two sisters. He is in freshman year and has come home for spring break.

Medical History:
H. F. denies past medical problems.

Current Medications
: F. denies being under medications.

Allergies
: Shellfish causes skin irritation. Risperidone causes over-sedation.

Reproductive Hx
: H. F. denies being sexually active.

ROS
:

GENERAL: F. reports losing 18lbs since returning to school for the fall. He denies fatigue or fever.

HEENT: H. F. denies dents or scars on the head. Denies yellow sclerae or double vision. Denies hearing difficulties or ear pain. Denies recent nasal congestion. Denies bleeding gum or sore throat.

SKIN: H. F. Denies flaky or cracked skin.

CARDIOVASCULAR: H. F. denies recent palpitations or chest pressure.

RESPIRATORY: H. F. denies shortness of breath or a recent incident of sputum production.

GASTROINTESTINAL: H. F. denies diarrhea or recent abdominal pain.

GENITOURINARY: H. F. denies foul-smelling urine or hesitancy.

NEUROLOGICAL: H. F. denies experiencing dizziness or ataxia.

MUSCULOSKELETAL: H. F. denies experiencing muscle pain or stiffness.

HEMATOLOGIC: H. F. denies an incident of bruising.

LYMPHATICS: H. F. denies splenectomy history.

ENDOCRINOLOGIC: F. denies cold intolerance or polydipsia.

Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder

Objective:

Physical exam:

Vitals:
T- 98.4; R 18; BP 116/74; P- 76; Wt 120lbs and Ht 5’6.

Diagnostic results
:

Brief Psychiatric Rating Scale (BPRS): The patient scored 7, indicating severe Schizophrenia symptoms in adults (Allen & Becker, 2019).

Assessment:

Mental Status Examination
: H. F. appears well-nourished. H. F. seems well-developed and appropriate for his age. The patient is appropriately dressed, neatly groomed, and presentable. There was no evidence of abnormal motor activity during the assessment. H. F’s speech is raced with increased volume. His thought process could be more logical with a flight of ideas present. His today’s mood is sad, with affect aligning with his mood. H. F. denies current homicidal or suicidal ideations or behaviors. Cognitively, H. F is oriented and alert. The patient depicts delusional thinking and abnormal speech during the physiatrist’s assessment.

Differential Diagnoses:

Schizophrenia
Disorder:
This disorder is the diagnosis most pertinent diagnosis in this case. Schizophrenia primary symptoms are psychotic features, including hallucinations, thought disorders, and delusions (Fish et al., 2024). Other additional clinical features associated with schizophrenia are decreased expression of emotions, challenges in social relationships, decreased motivation to accomplish one’s goals, cognitive impairment, and motor impairment (Fish et al., 2024). H. F’s pertinent positives are psychotic features, including impaired thought patterns and delusions demonstrated during today’s assessment. Moreover, the patient reported challenges in social relationships. He has been avoiding his friends since he returned home for spring break. Besides, he reported being demotivated to shower.

ORDER HERE

The DSM-V provides diagnostic criteria for Schizophrenia in adults. An individual qualifies for schizophrenia diagnosis after experiencing two or more of the most significant symptoms of this psychotic disorder, including hallucinations, delusional thinking, or disorganized speech (Fish et al., 2024). Therefore, H. F. meets this diagnostic criterion since delusional thinking and disorganized speech were evident toward the end of the physiatrist’s assessment. Moreover, the patient’s score for the BPRS was 7, portraying severe Schizophrenia symptoms (Allen & Becker, 2019) Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder.

Delusional Disorder
: The most significant symptom of this psychotic disorder main symptom is the presence of delusions. Thus, persons with delusions believe in things that are untrue (Peralta & Cuesta, 2019). These beliefs do not represent an individual’s subculture or cultural values. Other people know that the belief is false. H. F. demonstrated delusions during the psychiatric interview. He talks about blood cells’ bleeding degeneration. H. F. also believes in bleeding humanity from people’s rightful destiny. These beliefs are untrue, qualifying for delusional disorder diagnosis. Delusional disorder is diagnosed in persons experiencing single or multiple delusions for at least a month (Peralta & Cuesta, 2019). Tus, delusional disorder diagnosis is dismissed since H.F. does not meet DSM-V criteria for this psychotic illness.

Schizoaffective Disorder
: Persons with disorder present schizophrenia symptoms combined with symptoms of mood disorders. Hence, persons with this disorder present delusional thinking, hallucinations, and disorganized speech accompanied by depressive symptoms, mania, and hypomania (Parker, 2019). The patient demonstrated delusions since he believes in untrue things. Besides, abnormal speech was evident during the assessment. In addition to these psychotic symptoms, H. F. reported symptoms of mood disorders, including an increased need for sleep, isolation from friends, losing interest in showering, and decreased appetite. In the DSMV criteria, schizoaffective disorder is diagnosed in persons experiencing an uninterrupted duration of illness characterized by concurrent schizophrenia criterion A and a major depressive or manic episode (Parker, 2019). A depressed mood must be present in the major depressive episode (Parker, 2019). Based on this criterion, schizoaffective disorder is dismissed since no depressed mood was reported.

Reflection

The preceptor’s perception toward the patient is supported in this paper. The preceptor anticipated diagnoses of psychotic disorders. Similarly, the patient portrayed psychotic features, including delusions and abnormal speech, qualifying to be diagnosed with various psychotic disorders, in particular schizophrenia disorder. I learned that persons with various psychotic illnesses present overlapping clinical features. For instance, delusional thinking is common in cases of delusional disorder or schizophrenia
disorder.
Something that I would handle differently is involving H.F.’s parents during the interview. They would provide a detailed report of his psychotic symptoms, especially delusions, resulting in the most appropriate diagnosis.

Adherence to legal considerations in this case is very crucial. This patient was diagnosed based on guidelines for diagnosing psychotic disorders provided in the DSM-V criteria. Consequently, adverse effects of potential misdiagnosis were eliminated. Moreover, the mental health provider based this case on social determinants of health factors. The patient was not scheduled for regular clinics since he was not scheduled regular clinics since e was less likely to access psychiatric clinics while at school. In disease prevention, the mental health provider considers the patient’s age and current situation. Being in his early 20s and spending most of his time with his peers at school, the patient is more likely to abuse drugs or alcohol. Studies show that substance abuse disorders are common in persons diagnosed with psychotic disorders (Catthoor & Dom, 2022). For this reason, the patient was informed about the risk of substance abuse, optimizing his mental health outcomes.

References

Allen, D. N., & Becker, M. L. (2019). Diagnostic and symptom interviews for adults.
In Handbook of psychological assessment
(pp. 355-393). Academic Press.
https://doi.org/10.1016/B978-0-12-802203-0.00012-2

Catthoor, K., & Dom, G. (2022). Psychotic disorders and substance abuse comorbidity: Characteristics and treatment.
In Psychosis and Personality Disorders: Unmet Needs in Early Diagnosis and Treatment
(pp. 57-73). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-031-09058-5_3

Fish, F. J., Casey, P., & Kelly, B. (2024). 
Fish’s clinical psychopathology: signs and symptoms in psychiatry
. Cambridge University Press.

Parker, G. (2019). How well does the DSM-5 capture schizoaffective disorder?
The Canadian Journal of Psychiatry
, 
64
(9), 607-610.
https://doi.org/10.1177/0706743719856845

Peralta, V., & Cuesta, M. J. (2019). An empirical study of five sets of diagnostic criteria for delusional disorder. 
Schizophrenia Research
, 
209
, 164-170.
https://doi.org/10.1016/j.schres.2019.04.027
  Mr. Harold Feldman 20 yo Male with Schizophrenia Disorder