Assignent Solutionnurs

1. (Olivia) Schizophreniform disorder is a disorder with a very fast onset of symptoms lacking a long prodromal phase (Sadock, Sadock & Ruiz, 2017). Although patients with schizophreniform disorder may suffer a decline in occupational and personal relationships, these impairments are temporary. The presenting symptoms of schizophreniform disorder are comparable to schizophrenia and include two or more psychotic indicators such as hallucinations, delusions, disorganized speech and behavior, or negative symptoms (Sadock, Sadock & Ruiz, 2017). Positive and negative symptoms may present in schizophreniform disorder as well, and research states that those with positive symptoms, such as confusion and emotional turmoil have better outcomes than those presenting with negative symptoms. The DSM-5 diagnostic criteria states that in order to be diagnosed with schizophreniform disorder, symptoms must last at least one month and less than 6 months. Additionally, DSM-5 states that remission and recurring episodes may occur even after long periods of remission. Moreover, DSM-5 emphasizes that if symptoms last longer than 6 months, diagnosis of schizophrenia is likely (APA, 2014).
In order to diagnose schizophreniform disorder, clinicians must obtain key information by obtaining a detailed history, a physical assessment, medication reconciliation (including herbal supplements), laboratory studies and toxicology screen to rule out substance intoxication. As always, ruling out a medical condition as cause, in addition to substance intoxication, is essential.
DSM-5 states that diagnostic criterion for brief psychotic disorder is applicable when symptoms last at least 1 day but less than 1 month. In addition, symptoms of brief psychotic disorder must not be associated with intoxication of substances, medication adverse effects, or a medical condition. DSM-5 reports that there are three types of brief psychotic disorder: 1. the presence of a stressor, 2. the absence of a stressor, and 3. a postpartum onset (APA, 2014). DSM-5 states that although the etiology of brief psychotic episodes are poorly understood, many people experiencing this disorder have comorbid disorders such as histrionic, narcissistic, paranoid, schizotypal and borderline personality disorders (Sadock, Sadock & Ruiz, 2017). Presenting symptoms of brief psychotic disorder include indicators similar to psychosis such as: hallucinations, delusions, and disorganized thoughts. Additional symptoms also may include violent behavior, screaming or muteness, impaired memory or other peculiar behavior (Sadock, Sadock & Ruiz, 2017).
The symptoms of brief psychotic disorder usually have a very rapid onset (Sadock, Sadock & Ruiz, 2017). Moreover, while a patient is experiencing a brief psychotic episode, they are unlikely to provide an accurate history; therefore speaking to their family or friends may be essential. The DSM-5 emphasizes that more often than not, an extremely traumatic and stressful trigger leads to brief psychotic episodes in most people. Some triggers may be loss of a loved one, catastrophic accidents or illnesses, and a plethora of other traumatizing situations.
Differentiating these two disorders during an assessment may be difficult for clinicians. However, being well versed in the diagnostic criteria is essential because the duration of time is an enormous indicator for ruling out differentials. When other medical conditions, medication adverse effects or intoxications are ruled out, clinicians can differentiate these two disorders with certain information. If psychotic symptoms last longer than 1 month, the likely diagnosis is schizophreniform disorder. If symptoms last less than one month and at least one day, with association of an obvious trigger, the diagnosis is likely brief psychotic episode (Sadock, Sadock & Ruiz, 2017). Using family or friends may be necessary and asking the appropriate questions is very important. Inquiring about major life changes or catastrophic events may provide clinicians with the context needed to make a diagnosis. Having a timeline of presenting symptoms would also be incredibly helpful, as the duration of symptoms is associated with diagnostic criteria of these two disorders (APA, 2014).
References
American Psychiatric Association (APA) & American Psychiatric Association (APA). (2014). Dsm-5. Artmed Editora.
Sadock, B., Sadock MD, Virginia A., & Pedro, R. M. (2017). Kaplan & sadock’s concise textbook of clinical psychiatry (4th ed.). LWW.
2. (Jessica) Prepare a comprehensive posting on how one would assess and diagnose a catatonia. Be sure to consider the existing research literature on the topic to determine if any standardized assessment instruments can aid in this task.
Catatonia is not a disorder but a complex psychomotor syndrome. Catatonia involves a group of symptoms that involve impairment in movement and communication and is often accompanied by agitation, confusion, and restlessness. The impairment can be increased, decreased, or a change from the baseline (Edinoff, 2021).
Psychiatric and medical conditions as well as medications can cause catatonia. Psychiatric conditions such as schizophrenia, bipolar disorder, and autism are associated with catatonia. Neurological disorders such as head trauma and stroke are also associated with this disorder (Edinoff, 2021). Infections like encephalitis, metabolic disturbances such as hepatic encephalopathy and hyponatremia also cause this disorder. Finally, substances such as steroids, immunosuppressants, and antipsychotics can also cause this disorder (Sadock, 2017).
Two scores have shown specificity and sensitivity in aiding clinicians in diagnosis. They are the Bush Francis Catatonia Rating Scale (BFCRS) and the Pediatric Catatonia Rating Scale (PCRS). Catatonia is hard to diagnose because the presentation of this disorder is not fixed, and the symptoms vary from patient to patient and even vary with the same patient from interview to interview (Edinoff, 2021).
According to Edinoff (2021), three of the following twelve symptoms need to be present to diagnose catatonia:
stupor (no psychomotor activity; not actively relating to the environment)
catalepsy (passive induction of a posture held against gravity)
waxy flexibility (slight, even resistance to positioning by the examiner)
mutism (no, or very little, verbal response (excluded if known aphasia))
negativism (opposition or no response to instructions or external stimuli)
posturing (spontaneous and active maintenance of a posture against gravity)
mannerism (odd, circumstantial caricature of normal actions)
stereotypy (repetitive, abnormally frequent, non-goal-directed movements)
agitation
grimacing
echolalia (mimicking another’s speech)
echopraxia (mimicking another’s movements)
There are three types of catatonias:
Akinetic catatonia: This patient appears to be non-responsive, although they are alert and aware of their surroundings (Edinoff, 2021).
Excited catatonia: This patient move; however, their movements seem pointless and impulsive. They are often agitated and combative. Due to the increased motor activity, the patient may harm themselves or others (Edinoff, 2021).
Malignant catatonia: This type of catatonia is dangerous because it is associated with autonomic instability such as labile blood pressures. Neuroleptic malignant syndrome is associated with this type of catatonia and can be life threatening (Edinoff, 2021).
It’s important to diagnose catatonia early because early treatment is associated with better outcomes and limits morbidity and mortality. Understanding the three types of catatonia as well as the symptoms that indicate catatonia can lead to a thorough assessment, diagnosis, and ultimately treatment of this disorder (Edinoff, 2021).
References:
Edinoff, A. N., Kaufman, S. E., Hollier, J. W., Virgen, C. G., Karam, C. A., Malone, G. W., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Catatonia: Clinical overview of the diagnosis, treatment, and clinical challenges. Neurology international, 13, p. 570-586. https://doi.org/10.3390/ neurolint13040057
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s concise textbook of clinical psychiatry (4th ed.). Wolters Kluwer.