NURS 6501 Week 9 Assignment – Psychological Disorders

• NURS 6501 Week 9 Assignment

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Walden University

NURS-6501

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Submission Date

Concept Map – Psychological Disorders

Primary Diagnosis: Schizophrenia

1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?

Pathophysiology of Primary Diagnosis
Schizophrenia affects one’s thinking, perception, and feelings and changes one’s behavior. Schizophrenia’s pathophysiology is both complicated and mostly unidentified. It is suspected to be caused by a mixture of genetic, environmental, and neurological factors. One of the major neurobiological hypotheses is the dopamine hypothesis. It states that schizophrenia is caused by a dysregulation of dopamine in the brain. The positive symptoms, such as hallucinations or delusions, of schizophrenia are the result of the activation of mesolimbic dopamine D2 receptors. The negative symptoms of schizophrenia, which include social withdrawal, lethargy, and cognitive impairment, are the result of the hypoactivity of the prefrontal brain D1 receptors of dopamine. Schizophrenia is also associated with the dysregulation of the neurotransmitter glutamate. The glutamate hypothesis states that the hypofunction of the NMDA receptor is the balancing of the excitatory and inhibitory neurotransmission and is the cause of the symptoms of schizophrenia (Nakazawa & Sapkota, 2019). Evidence for this hypothesis is the fact that NMDA receptor antagonists, such as PCP and ketamine, can cause the symptoms of schizophrenia in healthy people.Structural brain abnormalities accompany a diagnosis of schizophrenia. Neuroimaging shows decreased gray matter in the temporal lobe, prefrontal lobe, and hippocampus. It is common to find large brain ventricles, which, in simplified terms, is decreased brain tissue, leading to large brain ventricles. It is possible that some of the changes in the brain’s structure may be due to issues in neurodevelopment. It is known that schizophrenia is a markedly heritable disorder. It is hypothesized that genes with smaller effects may be responsible for the majority of the risk factors at the level of a single gene. The disorders of dopamine and glutamate that, in turn, affect the signaling, synaptic development, and neurodevelopment may be some of the heritable risk factors that influence the development of schizophrenia. The risk for developing schizophrenia is believed to be higher in the presence of infections during pregnancy, poor nutrition, and psychosocial stress.
Causes	Risk Factors (genetic/ethnic/physical)
The causes of schizophrenia are unknown, but research indicates a confluence of factors that include genetic, environmental, and neurological elements. In terms of schizophrenia’s genetic component, there is a high level of heritability. Individuals who have first-degree relatives with schizophrenia have a significantly increased likelihood of developing the disorder (LE et al., 2020). While having some genetic variations is associated with an increased risk, there is no isolated gene for schizophrenia. It is, however, believed that changes and variations in the genetic code across a population are associated with the disorder. Environmental impacts on the developing brain can increase the risk of developing schizophrenia. Prenatal infections with the influenza virus and rubella, and infections with Toxoplasma gondii, as well as maternal folate deficiency, pose risks to fetal brain development and can lead to the development of schizophrenia later in life. Schizophrenia has been found to be associated with several perinatal complications, including hypoxia. Psychosocial stressors and adverse life events can trigger, worsen, and eventually lead to the development of schizophrenia symptoms. Trauma, including chronic stress and abuse in childhood (physical and sexual), is one of the primary risk factors. In adolescents, the use of psychoactive drugs (especially cannabis) can increase the precursors to the development of schizophrenia in genetically vulnerable individuals. Schizophrenia has been associated with several neurobiological disorders that can lead to imbalances of brain neurotransmitters and result in structural alterations of the brain (Fišar, 2023). The altered pathophysiology of the disorder is characterized by imbalances of the dopaminergic (neurotransmitter), glutamatergic, GABAergic, and serotonergic systems. The neurodevelopment of schizophrenia can be evidenced by structural alterations of the brain, including the reduction of gray matter and the enlargement of brain ventricles.	Schizophrenia includes genetic, environmental, and psychosocial risk factors. Genetics and predisposition are the factors. If a first-degree relative, such as a parent or sibling, has schizophrenia, it is likely to affect the population. The genetic risk is noted in the high rate of schizophrenia in schizo-affective twins, as well as in the high rate of concordance of schizophrenia in monozygotic twins. Both prenatal and perinatal risk factors contribute significantly to schizophrenia. Infections of the fetus during pregnancy or some toxins have been shown to cause schizophrenia. Obstetric complications, especially hypoxia and premature labor, have been shown to increase the risk of developing schizophrenia. Both childhood and adolescent trauma and chronic stress are considered risk factors. Physiological stress, especially during childhood, and physical, emotional, and sexual abuse have been noted to significantly increase the risk. The use of cannabis during adolescence, especially in a family with a genetic predisposition, is considered a factor that causes schizophrenia. Social isolation, city life, and immigration are considered risk factors. Social stress and hardship are likely to cause the symptoms. In vulnerable individuals, the loss of a family member, change of family relations, and the stress of getting used to a different life are likely to predispose them to developing a schizophrenia-like illness.

2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems, and what are the possible complications?

Signs and Symptoms – Common presentation

How does the diagnosis impact each body system? Complications?

Schizophrenia is broken down into three symptoms: positive, negative, and cognitive. Positive symptoms of schizophrenia can be hallucinations, delusions, and disorganization. People suffering from schizophrenia most often deal with hallucinations. A common experience can be the individual hearing auditory command hallucinations. An example of delusion can be when an individual believes and is convinced there is strong evidence that an individual or a group of people is out to get them. This is referred to as a “delusion of persecution.” A “delusion of historical greatness” can occur when an individual suffering from this disorder believes that they possess or are a relevant historical figure with some extraordinary and remarkable achievement. Negative symptoms of schizophrenia can show during everyday activities of a person. This can include restriction of the display of emotions, lack of interest, and low engagement or participation in activities that a person believes to be enjoyable, decreased speech, and low to no motivation to act towards the accomplishment of a goal. This low participation often causes the individual to become socially withdrawn.There are many cognitive symptoms that show. An example of cognitive symptoms can be due to the disorder, the individual is unable to hold a longer and consistent focus in order to be able to make a relevant and feasible decision, and act towards that. These can be devastating and have a disruptive effect on everyday life, and can even be debilitating.

Schizophrenia is a complex mental disorder that affects several body systems both psychologically and physically. One of the major effects of schizophrenia is the abnormality of the brain through a reduction in gray matter and the enlargement of the brain’s ventricles. Changes in the brain can cause emotional dysregulation as well as cognitive dysregulation.Schizophrenia dysregulates the HPA axis and results in elevated levels of the hormone cortisol. Dysregulation of the HPA axis can exacerbate the symptoms of schizophrenia and elevate the level of stress that an individual experiences. Metabolic syndrome and type 2 diabetes can also occur as a result of the side effects of antipsychotic medication, such as dyslipidemia, weight gain, and insulin resistance, as they also promote metabolic syndrome. Psychosis will also inevitably affect the heart and clog it. Factors such as obesity, high blood pressure, and diabetes typically worsen schizophrenia. Cardiovascular effects such as metabolic syndrome and weight gain may also result as side effects of antipsychotic drugs. Schizophrenia also indirectly causes heart diseases and early mortality.Schizophrenia erodes the immune system and makes it inflamed and dysfunctional. Schizophrenia is characterized by a high concentration of Pro-inflammatory cytokines that may be elevated in the blood, and that may also aid in the development and progression of the disease. Such an imbalance also raises the risk of autoimmune and inflammatory diseases.Schizophrenia and its treatment may affect the gastrointestinal tract. Constipation during treatment due to antipsychotic medication is a known side effect. Combined with weight gain, this treatment also increases the likelihood of digestive problems. Schizophrenia contributes to an increased risk of gastrointestinal disease, caused by an unhealthy diet and inactivity.There may be a relationship between schizophrenia and a compromised muscular/skeletal system caused by diminished physical activity and certain antipsychotic medication side effects, such as weight gain and corticosteroid-induced osteoporosis. Chronic pain that people with schizophrenia experience can be exacerbated by back pain and joint pain, resulting in diminished quality of life and physical disability.

3. What are other potential diagnoses that present in a similar way to this diagnosis (differentials)?

Several illnesses can cloud the diagnosis of schizophrenia if caution is not exercised, in which case, treatment is likely to be affected. Schizophrenia is a mood disorder related to depression and bipolar disorder. Schizophrenia can be characterized by mood changes, combined with psychosis, with the experience of hallucinations and delusions.Another concern of diagnosis is known as psychotic bipolar disorder. Psychotic symptoms of bipolar disorder can also be precipitated by hemodynamic bipolar disorder (Chakrabarti and Singh, 2022). Bipolar disorder is subdivided to reflect the different mood episodes, which is primarily the differentiating factor of bipolar disorder and schizophrenia. Schizophrenia type symptoms can also be experienced by patients with psychotic major depressive disorder. Severe depression can also be characterized by psychotic symptoms with hallucinations and even delusions. These symptoms of psychosis will be consistent with the depressive mood and will occur only during depressive mood episodes. In contrast, psychotic symptoms of schizophrenia can be chronic. Another important diagnosis is known as substance-related psychosis. Use of amphetamines, cocaine, and hallucinogens can precipitate psychosis that resembles schizophrenia. Substance-related psychosis can be differentiated from primary psychotic disorders by obtaining a thorough substance use history during diagnosis. Schizophrenia can also be mimicked by temporal lobe epilepsy, convulsive delirium, and neurodegenerative disorders, including Alzheimer’s disease. These can also cause chronic cognitive impairment and psychosis characterized by hallucinations and delusions. Inadequate response to treatment of these disorders is what is referred to as a thorough medical and neurological assessment. This would then warrant a thorough workup while trying to arrive at the most accurate diagnosis.

4. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

Diagnosing schizophrenia requires folding together a patient’s psychiatric history, a mental state assessment, brain imaging, and the evaluation of the DSM-5 criteria. During a clinical interview, the patient describes the symptoms and the duration, severity, and the daily activities that the symptoms impede the patient’s ability to perform. Family and caregivers can describe and give examples of the patient’s symptoms and the impacts of those symptoms on the patient and the family. Brain imaging during the clinical evaluation can eliminate the symptoms of the patient, family, and caregivers, and give answers other than brain trauma and other brain and spinal issues. Symptoms of schizophrenia may be structural and functional in the brain. Researchers are beginning to understand the condition that can be aided with brain imaging. In the research, these kinds of imaging are the first preference of the resources used (Ray et al., 2024).Other health disorders may be diagnosed by means of laboratory testing. In such situations, it may be important to obtain a complete blood count (CBC), a comprehensive metabolic panel (CMP), and thyroid function tests to eliminate metabolic disorders by identifying thyroid and/or electrolyte imbalances. If a patient’s symptoms are due to substance use and not a primary psychotic disorder, a substance use screen should be ordered. Cognitive and executive functioning evaluations, along with attention and memory tests, may also assist in identifying the cognitive deficits that can be caused by psychosis. Schizophrenia and some other mental disorders may also be characterized by cognitive deficits and psychosis.

5. What treatment options would you consider? Include possible referrals and medications.

People diagnosed with schizophrenia require a multi-faceted approach in the form of medication, therapy, rehabilitation, support, and care. Antipsychotics are the foundation of schizophrenia treatment. First-generation and second-generation antipsychotics include the following: haloperidol, chlorpromazine, risperidone, olanzapine, and aripiprazole. Atypical antipsychotics tend to be preferred over typical antipsychotics due to a less frequent occurrence of extrapyramidal symptoms in addition to an enhanced side effect profile. Most antipsychotics target the positive symptoms of schizophrenia by antagonizing the D2 dopamine receptors. Further, the antipsychotic agents are hypothesized to interact with and alter a variety of neurotransmitter systems, leading to a spectrum of varying side effects and a variety of therapeutic effects. The choice of antipsychotic is guided by the presentation of symptoms in the individual, previous treatment response, previous side effects experienced, and coexisting medical conditions. Alternative treatment options should be considered to manage the movement disorders and metabolic disorders like schizophrenia, which lead to weight gain. Psychotherapy is a core part of managing schizophrenia. Behavioral Therapy is useful in improving negative symptoms of schizophrenia and improving social skills and coping mechanisms. Some symptoms of schizophrenia may be managed by Behavioral Therapy. Support and rehabilitation of the family of the diagnosed individual are essential in helping family members understand the condition and how to best manage it. This is termed family therapy and psychoeducation. The implementation of psychosocial interventions addresses the social and workplace functioning and quality of life of people with schizophrenia. The goal of psychosocial interventions is to help people with schizophrenia reintegrate into society and to help them reach their personal objectives. These interventions, in conjunction with the patient’s ACT team and case managers, offer therapeutic structure, aid the patient in obtaining the resources, and provide access to the services. The treatment of schizophrenia is primarily pharmacological. The effective treatment of a patient relies on the combined services of a psychiatrist, psychologist, social worker, and occupational therapist. For psychotherapy and support, the patient relies on the psychologist and the therapist. The psychiatrist decides on the medication and monitors the response to it. The social worker and case manager help the patient to mobilize the social and medical resources and support, and assist the patient in overcoming the barriers of everyday life. Patients with treatment-resistant schizophrenia may need specialized, additional support. Clozapine is one of the antipsychotic medications of choice, but it may pose a risk of agranulocytosis to the patient and requires frequent monitoring. For the more serious borderline case, whereby the patient may be a danger to himself/herself and/or others, ECT may be a therapeutic option. In the more persistent treatment-resistant cases, neuromodulation through DBS and TMS is also a therapeutic consideration.

References

Chakrabarti, S., & Singh, N. (2022). Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World Journal of Psychiatry, 12(9), 1204–1232. https://doi.org/10.5498/wjp.v12.i9.1204

Gomes, F. V., & Grace, A. A. (2021). Beyond dopamine receptor antagonism: new targets for schizophrenia treatment and prevention. International Journal of Molecular Sciences, 22(9), 4467. https://doi.org/10.3390/ijms22094467

Inyang, B., Gondal, F. J., Abah, G. A., Minnal Dhandapani, M., Manne, M., Khanna, M., Challa, S., Kabeil, A. S., & Mohammed, L. (2022). Cureus, 14(1). https://doi.org/10.7759/cureus.21466

McCutcheon, R. A., Keefe, R. S. E., & McGuire, P. K. (2023). Cognitive impairment in schizophrenia: Aetiology, pathophysiology, and treatment. Molecular Psychiatry, 28(5), 1–17. https://doi.org/10.1038/s41380-023-01949-9

Nakazawa, K., & Sapkota, K. (2019). The origin of NMDA receptor hypofunction in schizophrenia. Pharmacology & Therapeutics, 205(1), 107426. https://doi.org/10.1016/j.pharmthera.2019.107426

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