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Tim is a 24 year-old PhD candidate at a large university. Over the…
Tim is a 24 year-old PhD candidate at a large university. Over the past six months, his behavior has changed and become increasingly bizarre. Though originally very enthusiastic about graduate school, he states that he is no longer interested in pursuing a degree and has no motivation to continue with school. He used to drink alcohol socially, but has withdrawn his friends and is not currently using any substances. He has no history of drug or alcohol abuse. He is unable to concentrate on work and tells friends and family that he believes someone has been following him when he leaves the house, and spying on him in his bedroom at night. Police bring him to a state psychiatric hospital after he throws his cell phone against a bus window and causes a public disturbance. Hospital staff members comment that they often hear him whispering frantically when he is alone, as though he is having a conversation with another person.
When asked about his behavior, Tim states the following:
” I couldn’t. I couldn’t use my phone anymore – they’re listening… and I just couldn’t.”
“The agents are listening. They’re after me and I can’t get away.”
“I am wanted by the government. I’m sitting in an office building right now and I see tear gas coming up from the floor. Can you smell the poison they’re releasing into the air?”
“The president wants to kill me, the agents all tell me it’s useless to fight it… I can’t go on.”
“I was born to end the world and bring down the government in this dismal country.”
“I had to stop drinking because my cups are all poisoned by government agents.” The psychiatrist diagnoses Tim with schizophrenia and prescribes an antipsychotic. After 5 weeks on the medication, Tim shows minor improvements but the changes are not drastic. He continues to claim that he is a target of the government and is meant to bring down the country’s infrastructure. He occasionally claims to see agents hiding under the floorboards and above his head in ceiling tiles. In addition, he refuses to drink any beverages because he believes they have been poisoned. He is required to stay at the psychiatric hospital and receive treatment as an inpatient, because his psychiatrist believes he is a danger to himself and others.
1. Which of Tim’s relatives has the highest risk of developing schizophrenia? Indicate risk factors/ prevalence based on kinship in %
Tim’s identical twin brother:
Tim’s mother:
Tim’s fraternal twin:
Tim’s future son:
Give possible explanations for heritability factors (adoption studies, chromosomal anomalies, differences between various psychotic disorders)
2. Which of the following statements describes one of Tim’s delusions?
Tim talks to agents in his head that order him to do things.
Tim smells toxins and sees tear gas that is coming up through the floor.
Tim sees poison floating in the general water supply and in his beverages.
Tim believes he is wanted by the government and that the president wants to kill him.
Differentiate delusions from hallucinations:
Hallucinations:
Delusions:
Describe the various delusions:
Erotomanic:
Grandiose:
Jealous:
Persecutory:
Somatic:
Folie à deux:
3. Which of the following is a negative symptom of schizophrenia that Tim experienced in the passage?
Tim believes that agents are persecuting him and want to kill him.
Tim smells smoke coming up from the floorboards and is terrified.
Tim cannot begin or sustain his planned coursework in graduate school.
List positive and negative symptoms from this case:
4. The passage states that Tim received a diagnosis of schizophrenia, but did not state a specific type of schizophrenia that Tim could have. Which type of schizophrenia best fits the description of Tim’s symptoms?
Paranoid schizophrenia, because Tim felt both persecuted and grandiose.
Residual schizophrenia, because Tim had no motivation or interest in activities in his life.
Catatonic schizophrenia, because Tim was withdrawn, mute, and negative.
Disorganized schizophrenia, because Tim was incoherent in speech and thought.
brief (imaginary) case description for one of the four different types of schizophrenia
5. Schizophrenia develops in stages. Describe the stages, possible behavior changes and time relationship:
Description Behavior changes Time relationship
Stage 1
Stage 2
Stage 3
Stage 4
Which stage is Tim in? Why?
6. During the intake process, Tim has a Magnetic Resonance Imaging (MRI) scan. Which of the following could appear on the MRI scan to support a diagnosis of schizophrenia?
Please choose from one of the following options.
Decreased prefrontal brain function.
Decreased temporal lobe gray matter
Elevated levels of dopamine type 2 receptors
Increased temporal lobe gray matter
Explain how the various symptoms of schizophrenia can be associated with the above mentioned changes in brain function or structure
7. Compare and contrast the different types of psychotic disorders
Schizophrenia
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
9.
Apply the dimensions of schizophrenia to the four schizophrenia patients in the video clip
https://www.youtube.com/watch?v=bWaFqw8XnpA.
Support your classification.
