Assessment: Mental Status Examination: The patient looks at his stated age. He is well-groomed and kempt. He is oriented to place, time, and people. His speech is normal and his mood is consistent with affect. However, he does not maintain eye contact. He answers questions properly. He reports delusions and hallucinations. No suicidal or homicidal thoughts. Memory and concentration are intact. Judgment and insight are also intact. Diagnostic Impression: Schizophrenia DSM-5 295.90 (F20. 9) Schizoaffective Disorder DSM-5 295.70 (F25.0) Delusion Disorder DSM-5 297.1 (F22)
Assessment:
Mental Status Examination: The patient looks at his stated age. He is well-groomed and kempt. He is oriented to place, time, and people. His speech is normal and his mood is consistent with affect. However, he does not maintain eye contact. He answers questions properly. He reports delusions and hallucinations. No suicidal or homicidal thoughts. Memory and concentration are intact. Judgment and insight are also intact.
Diagnostic Impression:
- Schizophrenia DSM-5 295.90 (F20. 9)
- Schizoaffective Disorder DSM-5 295.70 (F25.0)
- Delusion Disorder DSM-5 297.1 (F22)
The primary diagnosis is schizophrenia. According to McCutcheon et al. (2020), schizophrenia is a mental health condition that causes delusions and hallucinations. The symptoms of schizophrenia include negative symptoms, delusions, hallucinations, catatonic behavior, and disorganized speech (American Psychiatric Association (APA), 2013).
DSM-5 highlights that at least two symptoms should be noted for one to be diagnosed with schizophrenia (APA, 2013). One of the symptoms should either be hallucinations or delusions. The patient has both hallucinations and delusions making the disorder a primary diagnosis. The second diagnosis is schizoaffective disorder.
A patient with schizoaffective disorder causes schizophrenia symptoms and depressed mood (Peterson et al., 2019). According to DSM-5, patients should be diagnosed with schizoaffective disorder if they have depressed mood and schizophrenia symptoms (APA, 2013). The disorder was included in the diagnosis because the patient has delusions and hallucinations.
However, the patient does not have a depressed mood, and thus the disorder has been ruled out. The last disorder is delusion disorder. Delusion disorder is associated with delusional ideas (Joseph & Siddiqui, 2021). The disorder has been ruled out because the delusions the patient experience are a result of schizophrenia.
Reflections:
I agree with the preceptor’s diagnosis. The patient has schizophrenia. If I was given a chance, I would have screened the patient for depression. The ethical consideration, in this case, is the safety of the medication. The patient has the right to safe medication. The patient also has a right to be treated justly without any discrimination. I would avoid being judgmental when treating the patient. I would educate the patient to avoid alcohol and cigarette since they can negatively affect his health.
Case Formulation and Treatment Plan:
The presented symptoms show that the patient has schizophrenia. However, he should be referred to a psychiatrist for extensive mental health assessment and treatment. The patient can be recommended quetiapine fumarate extended-release (XR) 300 mg/day PO (Li et al., 2018). The dosage should be maintained between 400-800 mg/day.
Quetiapine has been selected because it is effective in treating schizophrenia, is well-tolerated and has good completion rates (Li et al., 2018). Li et al. (2018) noted that quetiapine is safe and has high efficacy in treating schizophrenia. Quetiapine XR tablets have been recommended because they allow a physician to start treatment at a high dose quickly to reach a therapeutic level.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Publishing.
Joseph, S. M., & Siddiqui, W. (2021). Delusional disorder. In StatPearls [Internet]. StatPearls Publishing.
Li, H., Shen, Y., Wang, G., Shi, J., Ma, C., Xie, S., & Gu, N. (2018). A 6-week, multicenter, double-blind, double-dummy, chlorpromazine-controlled non-inferiorityrandomized phase iiitrial to evaluate the efficacy and safety of quetiapine fumarate (SEROQUEL) extended-release (XR) in the treatment of patients with schizophrenia and acute episodes. Psychiatry Research, 259, 117-124. https://doi.org/10.1016/j.psychres.2017.07.006