Introduction
Establishing a patient’s most likely diagnosis from a clinical case depends on objective and subjective data. The 18-year boy had started talking about aliens trying to steal his soul before his mother carried him to the emergency room (ER). The patient asserted that the aliens had left messages at home by arranging sticks and giving him ideas. The patient had discomforts accompanied by disorganization of his speech and conduct during the interview. The patient’s mother stated that he had severally attempted to isolate himself from the family. These symptoms had increased in recent weeks, making the patient begin talking to himself and abandon college studies. Even though the patient is disturbed by schizophrenia disorder, he has a passion for technology and reads science fiction literature to create inventions that defend him from attacks by extraterrestrials.
The patient’s mother is worried because her husband, who left the patient at an infancy stage to live in a psychiatric hospital, showcased similar signs long ago. This data shows that the patient suffers from paranoia and delusions related to extraterrestrials. In light of the patient’s family background data, the patient has schizophrenia. Hence, this patient needs a mental health professional to make an effective diagnosis and set up a treatment plan for schizophrenia disorder.
The diagnosis carried out in the emergency room satisfies the symptoms of schizophrenia. Patients with schizophrenia tend to experience hallucinations, delusional thinking, and disordered behaviors and thinking (Lysaker et al., 2018). They always believe they are at risk of prosecution by others, including aliens and the government. Thus, these patients isolate themselves from others and become paranoid. In this case study, the patient’s signs and symptoms are sufficient for those exhibited by schizophrenia. Further, the report from the patient’s mother that her son’s symptoms have been severe in recent weeks is consistent with the course of schizophrenia. The typical treatment plan for patients with schizophrenia comprises psychotherapy and medication. The two modes of treatment benefit the patient in the recovery process in case one treatment fails.
Schizophrenia ranks as the most debilitating mental illness diagnosed in patients in healthcare. Hallucinations and delusions cause patients with schizophrenia to isolate and withdraw themselves from society (Lysaker et al., 2018). The case of the 18-year patient in the emergency room is severe because the patient has increasingly become fixated on aliens and paranoid besides experiencing delusions and hallucinations. Medical professionals recommend that patients with such conditions should be given medication treatment to control paranoia and psychotherapy to reduce hallucinations and delusions (Lysaker et al., 2018). Psychotherapy and medication serve as the best treatment for schizophrenia in controlling severe symptoms to enable the patient to resume a relatively normal life.
Differential Diagnosis
Differential diagnosis is the differentiation between conditions with the same signs and symptoms. Differential diagnosis is essential in investigating all possible disorders contributing to observable signs and symptoms (Perrotta, 2019). Medical professionals take several tests on the patient to determine the accompanying stage of treatment. Hence, these pre-tests help nurse practitioners to rule out symptoms that prompt the need for more testing. Differential diagnosis helps medical professionals determine all potential disorders to effectively diagnose the patient’s ailment. Thus, findings obtained after diagnosing the patient’s condition facilitate accompanying treatment.
Findings are clinically reached according to a historical basis and investigation of the patient’s psychological state without biomarkers and analytic tests. More often, schizophrenia gives psychosis, differential judgments in DSM510, and emotional psychoses (Carruthers et al., 2022). Emotional psychoses include crazy highlights of bipolar confusion and burdensome turmoil. Another firmly related differential diagnosis is non-full of having psychoses which consist of schizophreniform scatter and schizoaffective confusion. Substance abuse such as liquor might have similar signs with schizophrenia, and insane might disarrange due to common disease (Perrotta, 2019). Differential diagnosis is essential since it considers the duration of sickness, examples related to the disorder, and the nature of the ailment to determine accurate symptoms and treatment.
The patient has exhibited symptoms of the paranoid form of schizophrenia. Paranoid schizophrenia symptoms include delusions such as the conviction that aliens are trying to steal the patient’s soul. The patient’s paranoia and hypervigilance in perceiving aliens to be following him constitute symptoms consistent with the established diagnosis. Paranoid schizophrenia is determined when two or more DSM5 criteria are achieved (Perrotta, 2019). This criterion reveals disorganized speech, delusions, catatonic conduct, and hallucinations. Generally, the paranoid type of schizophrenia is denoted as F20.0 (paranoia schizophrenia).
The patient could further have psychosis or delusional disorder attributed to medical conditions that are not yet specified. However, delusions have an insignificant correlation to disorganized speech, hallucinations, and incomprehensible conduct. Medical professionals code delusional disorder as F22.0 on the diagnostic scale. Psychosis realized in a patient on continuing medication contains symptoms that result from medical conditions (Perrotta, 2019). For this reason, the diagnosis of psychosis is confirmed through a differential diagnosis approach attributed to medical illness.
Labs conducted by the PMHNP
The antipsychotic medication would be the most appropriate pharmacological treatment for the patient. The antipsychotic pharmacological medication comes first in treating schizophrenia because they have proven efficient in eliminating and reducing hallucinations and delusions (Lysaker et al., 2018). However, there are expected side effects of antipsychotic medications, such as weight gain, drowsiness, and dry mouth. Therefore, the patient’s medical history, age, and any current medication will greatly impact the selection of the most appropriate antipsychotic medicine in the future. Most clinical guidelines highly recommend that these medications be established in treating schizophrenia. Thus, this recommendation enhances increased credence in using these medications to treat schizophrenia. The American Psychiatric Association (APA) has published guidelines recommending antipsychotic medications help as the first therapy option for patients diagnosed with schizophrenia. Besides, psychosocial therapy and antipsychotic pharmaceutical regimen are prerequisites by APA guidelines.
PMHNP monitors other labs such as renal function tests, complete blood cell count, pregnancy testing in women, and calcium levels of a patient. The nurse practitioner should also conduct a lab test of the patient’s body, such as computed tomography and magnetic resonance imaging. These tests help to rule out symptoms characterized by brain tumour problems. Generally, the mental health nurse practitioner can rule out symptoms of schizophrenia after concluding different tests on the patient. The patient is said to suffer from schizophrenia if he frequently showcases two or more symptoms, such as hallucinations, delusions, and flattening emotions in a month.
Appropriate Steps for the PMHNP to Take in the Acute Management of Patient
Cognitive-behavioural therapy (CBT) is an alternative to medication treatment that could benefit the acute management of the patient. CBT psychotherapy has become useful in treating schizophrenia because it lessens incidences of hallucinations and delusions in the patient (Carruthers et al., 2022). In this manner, CBT promotes change and challenges patients’ thinking processes. According to the American Psychiatric Association’s Practice Guidelines for Schizophrenia Treatment (APAPGST), antipsychotic medication and CBT is the best remedy that helps to stabilize the normal lives of patients with schizophrenia disorder (Murphy et al., 2020). Professional standards in healthcare recommend CBT as the most useful treatment for schizophrenia patients. APAPGST guidelines further suggest that CBT should be jointly used with antipsychotic medication while treating patients with schizophrenia (Murphy et al., 2020). These guidelines assert that patients who fail to respond to antipsychotic medication can positively benefit from CBT.
Psychoeducation is a vital strategy that effectively enhances mental health. Psychoeducation is an initiated treatment that enables patients and their families to access knowledge about certain mental health conditions they experience (Matsuda & Kohno, 2021). This type of treatment carries greater numbers as far as advantages go while administering treatment to patients with schizophrenia disorder. It helps to reduce stigmatization associated with mental illness (Soroka et al., 2022). Moreover, psychoeducation significantly increases treatment compliance for healthcare professionals and nurse practitioners. The recovery process can easily be concluded in a patient if alternative strategies such as CBT and psychoeducation are combined with medication and psychotherapy.
For this reason, APA practice guidelines that treat people with schizophrenia presupposes that families that have schizophrenia subjects should participate in psychoeducation. Patient and family participation promotes a higher understanding of the patient’s needs and compliance with the medical professional (Soroka et al., 2022). Psychoeducation can be disseminated to individuals and families via various approaches and means. For instance, group sessions, online materials, and written resources effectively serve the purpose of public awareness and education about schizophrenia mental illness. However, the form of psychoeducation administered to the patient depends on the patient’s level of illness and the accessibility to the available resources in their surroundings.
Conclusion
In conclusion, schizophrenia is a chronic mental illness that affects an individual’s behavior, mood, and thinking. Patients showing signs of schizophrenia must undergo differential diagnosis to rule out disorders with similar symptoms, such as bipolar disorder. It is presupposed that patients with schizophrenia should receive immediate treatment to control symptoms and live a quality and normal life. The first treatment step by a nursing practitioner should be the patient’s diagnosis. This diagnosis consists of a thorough evaluation conducted by a mental health professional. Mental health professional deploys standard assessment tool, structured clinical interview, and the clinical and statistical manual of mental disorders (DSM) to evaluate the patient. Diagnosis will allow the patient’s family to discuss the best treatment options.
Medication is the first treatment for schizophrenia, consisting of varied antipsychotic effective medications. The patient benefits from these medication treatments and significantly reduces severe symptoms. Psychotherapy has significant benefits to the patient as it comprises individual therapy. Individual therapy is essential for the patient to psychologically corp and manage schizophrenia symptoms. Family therapy is significant in making the family understand the patient and readily render their support to the patient.
The chronic nature of schizophrenia requires the patient to be consistent with treatment in the subsequent survival years. Treatment guarantees higher chances that the patient will still lead a quality, productive, and normal life. Individuals who experience mental illness symptoms such as paranoia, hallucinations, and delusions should be helped to seek help from healthcare professionals. The solution to mental illness is readily available, and no individual should get ashamed of seeking professional help.
References
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Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018). Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry, 17(1), 12-23. Web.
Matsuda, M., & Kohno, A. (2021). Development of a blended learning system for nurses to learn the basics of psychoeducation for patients with mental disorders. BMC nursing, 20(1), 1-10. Web.
Murphy, R., Calugi, S., Cooper, Z., & Dalle Grave, R. (2020). Challenges and opportunities for enhanced cognitive behavior therapy (CBT-E) in light of COVID-19. The Cognitive Behaviour Therapist, 13. Web.
Perrotta, G. (2019). Bipolar disorder: definition, differential diagnosis, clinical contexts and therapeutic approaches. Journal of Neuroscience and Neurological Surgery, 5. Web.
Soroka, E., Słotwiński, M., Pawęzka, J., & Urbańska, A. (2022). Between self-stigma and the will of recovery. Difficulties in accepting a psychiatric diagnosis–case study. Psychiatr. Pol, 56(1), 183-193. Web.