Adult Psychopathology

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Adult Psychopathology

James is a 21 year-old university student. Over the past few weeks his family and friends have noticed increasingly bizarre behaviors. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his mobile phone, claiming that if he does something bad will happen. He refuses to speak with friends and family, and has isolated himself from the outside world. He has stopped attended classes altogether. He is showing signs of anxious and nervousness.

James was always quite through his childhood and kept himself to himself. Now at University he has made friends with a small group and occasionally would meet with them to have a few beers with his friends, but he’s never been known to abuse alcohol or use drugs. He does, however, have an estranged aunt who has been in and out of psychiatric hospitals over the years due to erratic and bizarre behaviour.

Screening of Indications for Mental Health Condition

• Increasingly bizarre behaviours over the week
• Whispering alone in an agitated voice
• Isolation (refusal to answer or make calls; refuses to speak; not attending classes)
• Fear (fear of something bad may happen)
• Anxiety
• Nervousness
• Family history of an aunt, who had a record of needing psychiatric help for odd behaviour.

Potential Diagnosis

According to Diagnostic and Statistical Manual of Mental Disorders – V or DSM – V (American Psychiatric Association, 2013) that schizophrenia can be recognized if any of the two symptoms are observed for at least a month in an individual that may either include delusions or auditory hallucinations.

Indications of schizophrenia may include persistent delusion, hallucination, disorganization in speech, incoherent or disorganized behaviour, and negative symptoms that may include alogia and avolition. Alogia is a condition of using poor or disoriented speech or words. While, avolition refers to a severity in lacking motivation in life. However, DSM – V states that for a clinical diagnosis, an individual must present at least one of the positive symptoms among delusions, hallucinations and disorganization in speech. The presented case of James have indicated more than two of these symptoms; therefore, the potential diagnosis for the patient has been identified as schizophrenia.

Treatment Actions

Schizophrenia is mainly treated with antipsychotic drugs like chlorpromazine, haloperidol and clozapine. Chlorpromazine and haloperidol have been recognized as pre dominant drugs for treating the positive symptoms of schizophrenia. While clozapine is known to efficiently deal with both the negative and positive symptoms along with the atypical features of schizophrenia. It is often used as an immediate choice in the situation of a relapse. These medicines can be prescribed with higher doses as per the need of the patients and can be reduced and even completely withdrawn with improvement. All these three drugs are well regarded for their sedative properties and ability to directly relieve delusional state and hallucination (Nakajima et al., 2015; Eramo et al., 2014).

Additional Information

Despite of several attempts, the exact mechanism, triggers and pathogenesis of schizophrenia has not been documented. However, a possibility has been asserted that it might have been a preceding condition to any other disorder that may have altered the cognitive capacity of the affected individual. Schizophrenic individuals may have a different dimension of thinking and perception, where they may develop odd associations between words and situations. This may precede into delusions related to control over life, social reputation and treatment from others. They may misconceive a slight interaction, like a glance, as a crucial sign emerging with irrelevant suspicions. This situation can further precede into a more critical state of hallucination that may involve frequent auditory perceptions that may drive them to develop anxiety, and depression. These people often appear to be irresponsive towards emotions however, they may episodes of breakdown (Lieberman et al., 2001).

According Diagnostic and Statistical Manual of Mental Disorders – IV, schizophrenia may appear as one of the following condition or may also occur as a multiple disorder. Thus, it is necessary to determine its subtype. The classification for schizophrenia has been observed as the following (Mattila et al., 2014):

1. Disorganized Schizophrenic:

This type primarily indicates disorganization in speech, behaviour, and mood.

1. Paranoid Schizophrenia:

It is has been noted to be the most prevalent subtype that is characteristically identified with the paranoia and delusions. These may further include the hallucinations involving voices and whispers long with catatonic behaviour, disturbed mood and disorganized speech.

1. Catatonic Schizophrenia:

This type of schizophrenia is recognized by both psychological and motor disorientation. It has been seen that an affected person experience hallucination in a dreamlike state.

1. Residual Schizophrenia:

This is a non-normative form of schizophrenia that may not indicate the typical symptoms hallucination, delusion and disorganization in speech and behaviour. It may though display the negative symptoms associated with the condition.

However, DSM – V has asserted this classification lacks diagnostic stability, reliability and validity. Thus, it has eliminated these four sub-types as this classification has failed to determine a particular pattern for the prognosis or treatment effectivity (American Psychiatric Association, 2013).

Current Debate

Though, the evidence suggest that schizophrenia may have genetic link and an association with neurochemicals in the brain. It is known to have an influence of maternal stress during gestation of the baby (Devor et al., 2017). Recent theory has commended that schizophrenia can also develop as a coping mechanism towards the stressors of the life. It has been noted that initially the condition may emerge as a critical state of stress that may include social withdrawal, isolation, fatigue, and a tendency to indulge in drug abuse. These factors are commonly seen as lapsing into schizophrenia. Thus, it is believed that the exaggerated sense of being involved with another entity and irrelevant fear of social dilemmas may appear as a coping strategy to deal with the stresses.

Case Study 2

Sarah is a 30 year-old married female. She has a very demanding, high stress job as a second a Doctor in a large hospital. Sarah has always been a high achiever. She graduated within the top 5% at medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past.

For the past few weeks Sarah has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her co-workers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping.

At home, Sarah’s husband has noticed changes as well. She’s shown little interest in him or the family and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him…… Read More