Posted: November 9th, 2022

A 22-year-old female student

Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions
1. What are known characteristics of schizophrenia and relate those to this patient.

Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying. Her boyfriend took her to the student health center at her college. She was 22 years old. He was worried about the way she had changed. Her boyfriend said that she has been hearing voices and seeing things that aren’t there. She also believes that people are out to hurt her. She told her family that she couldn’t finish college because the voices told her she was “dumb” and should quit. The boyfriend talks about times when the girl got angry and cried out of the blue.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
1. Genetics are sometimes attached to schizophrenia explain this.

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Question:
What roles do neurotransmitters play in the development of schizophrenia?

Scenario 1: Schizophrenia
A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”. The boyfriend relates episodes of unexpected rage and crying.
PMH: noncontributory
FH: positive for a first cousin who “had mental problems”.
SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.
PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.
DIAGOSIS: schizophrenia.
Questions:
Explain what structural abnormalities are seen in people with schizophrenia.

Scenario 2: Bipolar Disorder
A 44-year-old female came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.
DIAGNOSIS: bipolar type 2 disorder.
Question
1. How does genetics play in the development of bipolar 2 disorders?

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