KNOWLEDGE CHECK PSYCHOLOGICAL DISORDERS NURS 6501

KNOWLEDGE CHECK PSYCHOLOGICAL DISORDERS NURS 6501

KNOWLEDGE CHECK PSYCHOLOGICAL DISORDERS NURS 6501

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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?  

Your Answer:

Genetics plays a significant role in the development of bipolar disorder type 2 (BP-II). Bipolar disorders, including BP-II, have a strong genetic component, and individuals with a family history of bipolar disorder are at a higher risk of developing the condition themselves.

Here are some key points regarding the genetic influence on the development of BP-II:

1. Family History: Individuals who have a first-degree relative (parent, sibling, or child) with bipolar disorder are at an increased risk of developing the disorder compared to the general population. This suggests that there is a hereditary component to bipolar disorder.

2. Heritability Estimates: Studies that have examined the heritability of bipolar disorder indicate that genetic factors account for a substantial portion of the risk. Heritability estimates for bipolar disorder, including BP-II, range from about 60% to 80%, indicating that genetics play a major role in its development.

3. Candidate Genes: Researchers have identified specific genes that may be associated with an increased susceptibility to bipolar disorder. These candidate genes are involved in various neurobiological processes, including neurotransmitter signaling, circadian rhythm regulation, and neural plasticity. Changes (mutations) in these genes may contribute to the risk of developing BP-II.

4. Complex Genetic Interplay: It’s essential to note that the genetics of bipolar disorder are complex and likely involve multiple genes interacting with each other and environmental factors. Bipolar disorder is considered a polygenic disorder, meaning that multiple genetic variations collectively contribute to its development.

5. Epigenetic Factors: In addition to genetic variations themselves, epigenetic factors also play a role in regulating gene expression and may influence the development of bipolar disorder. Epigenetic modifications can be influenced by environmental factors, and they can potentially impact an individual’s vulnerability to the disorder.

Question 1

4 out of 4 points

	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.
Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function. 1-  Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia. 2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination. 3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad. 4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. 5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure. Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood. In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution. Correct Answer:   Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution. Response Feedback: [None Given]

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. 

The characteristics of schizophrenia include positive, negative, mood, and cognitive symptoms. Positive symptoms include delusions, hallucinations, disorganized speech, and disorganized/catatonic behavior. Negative symptoms include avolition, apathy, abhuria, alogia, and anhedonia (Mosolov & Yaltonskaya, 2022). The patient presents with symptoms consistent with schizophrenia, like auditory and visual hallucinations, paranoid delusions, disjointed conversation, and mood symptoms such as unexpected rage and crying.

Reference

Mosolov, S. N., & Yaltonskaya, P. A. (2022). Primary and Secondary Negative Symptoms in Schizophrenia. Frontiers in psychiatry, 12, 766692. https://doi.org/10.3389/fpsyt.2021.766692