The symptoms often come on suddenly, as in Ms. Johnny’s case, as evidence by the report of her witnessing the tragic death of her three year old son which occurred nine days ago. Further evidence that she may be experiencing this disorder Is related to her husband’s report of hallucinations, which are sensory perceptions of things that aren’t actually present, such as hearing voices. Ms. Charlie’s hallucinations include hearing her dead son calling her from outside, and hearing him coming in the door. Ms.
Charlene is also experiencing delusions, which are false beliefs that the person refuses to give up, even In the face of contradictory facts. In her case, her delusion has manifested Into a false belief that her dead son Is still alive, and that he Is Just lost and will return home. Ms. Charlie’s husband also stated that another delusion she experienced was at the funeral, when she shouted that the corpse was not her child, and attempted to remove the corpse from the coffin. This diagnosis also meets the criteria because according to her husband, Ms.
Charlene has no history of mental problems, and prior to this tragic accident, always seemed well adjusted and happy. II. List four differential diagnoses. Which ones can you rule out? Explain your reasoning. A wide selection of general medical conditions can present with psychotic symptoms of short duration. Psychotic Disorder Due to a General Medical Condition or a delirium is diagnosed when there is evidence from the history, physical examination, or laboratory tests that designates that the delusions or hallucinations are the direct physiological consequence of a specific general medical condition (e. . , Cunning’s syndrome, brain tumor). In Ms. Johnny’s case, there Is no history of other medical symptoms or conditions that could be helping to cause the hallucinations or elisions; therefore we can simply rule that out. Other differential diagnosis can be Substance-Induced Psychotic Disorder, Substance-Induced Delirium are distinguished from Brief Psychotic Disorder by the fact that a substance (e. G. A drug of abuse, a medication, or exposure to a toxin) is Judged to be etiological related to alcohol level, may be helpful in making this determination, as may a careful history of substance use with attention to sequential relationships between substance intake and onset of the symptoms and the nature of the substance being used. At this point, e can rule these out since there is no history of substance abuse, and a full drug screening including urine sample can be performed to further rule it out.
Another differential diagnosis could be Schizophrenia. At this point in time I would not personally diagnose her with Schizophrenia since the symptoms were directly generated by her son’s tragic death, which only occurred Just nine days ago. Since it has been less than one month time that the hallucinations and delusions have been present, I would rule Schizophrenia out for the time being, and if the symptoms do resist after one month, then I would carefully review the case.
By definition, a diagnosis of Brief Psychotic Disorder requires a full remission of all symptoms and a return to the performed level of functioning within 1 month of the onset of the disturbance. In some individuals, the duration of psychotic symptoms may be quite brief. If Ms. Johnson does not return to her previous level of functioning fully, then we can change the diagnosis. Further ongoing observation and therapy is needed to conclude if Ms. Johnson is really suffering from Schizophrenia at this time. Ill. What o you feel is the etiology of the disorder?
The exact cause of brief psychotic disorder is not known; however multiple theories exist. One theory suggests a genetic link, because the disorder is more common in people who have family members with mood disorders, such as depression or bipolar disorder. Another theory suggests that the disorder is caused by poor coping skills, as a defense against or escape from a particularly frightening or stressful situation. These factors may create a vulnerability to develop brief psychotic disorder. In most cases, the disorder is triggered by a major stress or traumatic vent.
The etiology in Ms. Johnny’s case is the fact that she witnessed the traumatic, and violent, death of her youngest son, and her symptoms have such a rapid onset. Since there is not a known reported family history of mental illness in her family, and her husband reports that Ms. Charlene was otherwise happy, the theory of poor coping skills and this being her defense mechanism to escape the stressful situation is most likely to be attributed to her present mental state. ‘V. Do you feel the individual needs hospitalizing? At this moment in time, since Ms.
Johnson does not seem oriented to place and time erectly, as evident by her incorrect replies, and her delusions and hallucinations are presently active, I would temporarily hospitalize her in an inpatient unit Just for further evaluation at the present hospital. Even though her husband reports that she does not appear suicidal, and stated that “she seems to out of it to think about anything like that”, I believe the temporary hospitalizing would be needed for further evaluation of suicidal/homicidal ideation, and if this state of psychosis is brief, or if it will become a diagnosis of Schizophrenia.
If we can address the current homonyms now effectively, and get her to her pre-functional state, and the symptoms do not continue for a month, we can help to relieve what might turn into Schizophrenia. I am concerned with her poor Judgment and disc-connection with the disheveled state, and reports of lack of eating and sleeping by her husband. If we were to keep her in the hospital for a couple nights, we could make sure she is not malnourished or sleep deprived, because either of these physical states could exacerbate further psychosis.
Ms. Johnson is preoccupied by the thoughts of her dead son, related to the constant humming of the lullaby and perceived idea that he s Just missing, and this is hindering her activities of daily living and her role as a wife and mother to her living son. Hospitalizing, because of the Milieu component of creating a safe, structured therapeutic environment, is important at this time to address all these issues, and to begin to seek the best therapy for her to get her back to her living son as soon as possible, safely and coherently.
We need to keep her safe, and temporarily hospitalizing her because we do not know how dangerous her hallucinations and delusions will become because of lack of food and sleep, will benefit her safety. V. What would be your course of treatment? Why did you choose this treatment plan? What treatment(s) would you not use? My immediate course of treatment would focus on containing Ms. Johnson and stabilizing her. I would emphasize a supportive and reassuring role, and accept that her hallucinations and delusions are real to her at this moment, even though they are not congruent with reality.
It is important at this time to not argue, play into, or arouse into her delusions and hallucinations because we do not want to exacerbate any more stress to her. It is also imperative at this time to build an alliance and port to help built a trusting relationship to help her work through her psychosis, as she may become not trusting of anyone. I would also work in coordination with a psychiatrist to see if an anti-psychotic would benefit her right now to reduce or eliminate her psychotic symptoms.
In addition, with recommendation from the psychiatrist, we may further asses her mental status to determine if other medications may be needed, like an anti-depressant, so we may begin to slowly address the psychosocial issues that have led to her current state of decomposition. Gently, then we can explore her feelings surrounding her traumatic event, and encourage her to focus on reality, as opposed to her disturbed thought process. A combination of psychosocial approaches such as family management, social-skills training, cognitive-behavioral therapy, and setting up an individual treatment plan for Ms.