{"id":866,"date":"2020-08-11T11:25:42","date_gmt":"2020-08-11T11:25:42","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=866"},"modified":"2022-07-26T20:06:31","modified_gmt":"2022-07-26T20:06:31","slug":"case-studies-schizophrenia-spectrum-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/case-studies-schizophrenia-spectrum-disorders\/","title":{"raw":"Case Studies: Schizophrenia Spectrum Disorders","rendered":"Case Studies: Schizophrenia Spectrum Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\">Identify schizophrenia and psychotic disorders in case studies<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Case Study: Bryant<\/h2>\r\nThirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors, depression, and distrust. At the time of admission, prominent ritualistic behaviors and depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder (OCD). Shortly after, psychotic symptoms such as disorganized thoughts and delusion of control were noticeable. He told the doctors he has not been receiving any treatment, was not on any substance or medication, and has been experiencing these symptoms for about two weeks.\u00a0Throughout the course of his treatment, the doctors noticed that he developed a catatonic stupor and a respiratory infection, which was identified by respiratory symptoms, blood tests, and a chest X-ray. To treat the psychotic symptoms, catatonic stupor, and respiratory infection, risperidone, MECT, and ceftriaxone (antibiotic) were administered, and these therapies proved to be dramatically effective.[footnote]Bai, Y., Yang, X., Zeng, Z., &amp; Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. <em>BMC psychiatry<\/em>, 18(1), 67. https:\/\/doi.org\/10.1186\/s12888-018-1655-5[\/footnote]\r\n<div class=\"textbox tryit\">\r\n<h3>TRY IT<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/a11263b2-2b39-40a0-b38c-e407daadd2ad\r\n\r\n<\/div>\r\n<h2>Case Study: Shanta<\/h2>\r\nShanta, a 28-year-old female with no prior psychiatric hospitalizations, was sent to the local emergency room after her parents called 911; they were concerned that their daughter had become uncharacteristically irritable and paranoid.\u00a0The family observed that she had stopped interacting with them\u00a0and had been spending long periods of time alone in her bedroom. For over a month, she had not attended school at the local community college.\u00a0Her parents finally made the decision to call the police when she started to threaten them with a knife, and the police took her to the local emergency room for a crisis evaluation.\r\n\r\nFollowing the administration of the medication, she tried to escape from the emergency room, contending that the hospital staff was planning to kill her. She eventually slept and when she awoke, she told the crisis worker that she had been diagnosed with attention-deficit\/hyperactive disorder (ADHD) a month ago.\u00a0At the time of this ADHD diagnosis, she was started on 30 mg of a stimulant to be taken every morning in order to help her focus and become less stressed over the possibility of poor school performance.\r\n\r\nAfter two weeks, the provider increased her dosage to 60 mg every morning and also started her on dextroamphetamine sulfate tablets (10 mg) that she took daily in the afternoon in order to improve her concentration and ability to study.\u00a0Shanta claimed that she might have taken up to three dextroamphetamine sulfate tablets over the past three days because she was worried about falling asleep and being unable to adequately prepare for an examination.\r\n\r\nPrior to the ADHD diagnosis, the patient had no known psychiatric or substance abuse history.\u00a0The urine toxicology screen taken upon admission to the emergency department\u00a0was positive only for amphetamines. There was no family history of psychotic or mood disorders, and she didn't exhibit any depressive, manic, or hypomanic symptoms.\r\n\r\nThe stimulant medications were discontinued by the hospital upon admission to the emergency department and the patient was treated with an atypical antipsychotic.\u00a0She tolerated the medications well, started psychotherapy sessions, and was released five days later.\u00a0On the day of discharge, there were no delusions or hallucinations reported.\u00a0She was referred to the local mental health center for aftercare follow-up with a psychiatrist.[footnote]Henning A, Kurtom M, Espiridion E D (February 23, 2019) A Case Study of Acute Stimulant-induced Psychosis. Cureus 11(2): e4126. doi:10.7759\/cureus.4126[\/footnote]\r\n<div class=\"textbox tryit\">\r\n<h3>TRY IT<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/abf10f9f-b178-495b-a7a5-6cdc0ef862a1\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nAnother powerful case study example is that of\u00a0Elyn R. Saks, the associate dean and Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California Gould Law School.\r\n\r\nSaks began experiencing symptoms of mental illness at eight years old, but she had her first full-blown episode when studying as a Marshall scholar at Oxford University. Another breakdown happened while Saks was a student at Yale Law School, after which she \"ended up forcibly restrained and forced to take anti-psychotic medication.\" Her scholarly efforts thus include taking a careful look at the destructive impact force and coercion can have on the lives of people with psychiatric illnesses, whether during treatment or perhaps in interactions with police; the Saks Institute, for example, co-hosted a conference examining the urgent problem of how to address excessive use of force in encounters between law enforcement and individuals with mental health challenges.\r\n\r\nSaks lives with schizophrenia and has written and spoken about her experiences. She says, \"There's a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life.\"\r\n\r\nIn recent years, researchers have begun talking about mental health care in the same way addiction specialists speak of recovery\u2014the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. Approaches include \"medication (usually), therapy (often), a measure of good luck (always)\u2014and, most of all, the inner strength to manage one's demons, if not banish them. That strength can come from any number of places...love, forgiveness, faith in God, a lifelong friendship.\" Saks says, \"We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.\"\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=f6CILJA110Y\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/ATaleOfMentalIllnessElynSaks_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"A tale of mental illness | Elyn Saks\" here (opens in new window)<\/a>.\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li style=\"font-weight: 400;\">Identify schizophrenia and psychotic disorders in case studies<\/li>\n<\/ul>\n<\/div>\n<h2>Case Study: Bryant<\/h2>\n<p>Thirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors, depression, and distrust. At the time of admission, prominent ritualistic behaviors and depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder (OCD). Shortly after, psychotic symptoms such as disorganized thoughts and delusion of control were noticeable. He told the doctors he has not been receiving any treatment, was not on any substance or medication, and has been experiencing these symptoms for about two weeks.\u00a0Throughout the course of his treatment, the doctors noticed that he developed a catatonic stupor and a respiratory infection, which was identified by respiratory symptoms, blood tests, and a chest X-ray. To treat the psychotic symptoms, catatonic stupor, and respiratory infection, risperidone, MECT, and ceftriaxone (antibiotic) were administered, and these therapies proved to be dramatically effective.<a class=\"footnote\" title=\"Bai, Y., Yang, X., Zeng, Z., &amp; Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. BMC psychiatry, 18(1), 67. https:\/\/doi.org\/10.1186\/s12888-018-1655-5\" id=\"return-footnote-866-1\" href=\"#footnote-866-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<div class=\"textbox tryit\">\n<h3>TRY IT<\/h3>\n<p>\t<iframe id=\"assessment_practice_a11263b2-2b39-40a0-b38c-e407daadd2ad\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/a11263b2-2b39-40a0-b38c-e407daadd2ad?iframe_resize_id=assessment_practice_id_a11263b2-2b39-40a0-b38c-e407daadd2ad\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<h2>Case Study: Shanta<\/h2>\n<p>Shanta, a 28-year-old female with no prior psychiatric hospitalizations, was sent to the local emergency room after her parents called 911; they were concerned that their daughter had become uncharacteristically irritable and paranoid.\u00a0The family observed that she had stopped interacting with them\u00a0and had been spending long periods of time alone in her bedroom. For over a month, she had not attended school at the local community college.\u00a0Her parents finally made the decision to call the police when she started to threaten them with a knife, and the police took her to the local emergency room for a crisis evaluation.<\/p>\n<p>Following the administration of the medication, she tried to escape from the emergency room, contending that the hospital staff was planning to kill her. She eventually slept and when she awoke, she told the crisis worker that she had been diagnosed with attention-deficit\/hyperactive disorder (ADHD) a month ago.\u00a0At the time of this ADHD diagnosis, she was started on 30 mg of a stimulant to be taken every morning in order to help her focus and become less stressed over the possibility of poor school performance.<\/p>\n<p>After two weeks, the provider increased her dosage to 60 mg every morning and also started her on dextroamphetamine sulfate tablets (10 mg) that she took daily in the afternoon in order to improve her concentration and ability to study.\u00a0Shanta claimed that she might have taken up to three dextroamphetamine sulfate tablets over the past three days because she was worried about falling asleep and being unable to adequately prepare for an examination.<\/p>\n<p>Prior to the ADHD diagnosis, the patient had no known psychiatric or substance abuse history.\u00a0The urine toxicology screen taken upon admission to the emergency department\u00a0was positive only for amphetamines. There was no family history of psychotic or mood disorders, and she didn&#8217;t exhibit any depressive, manic, or hypomanic symptoms.<\/p>\n<p>The stimulant medications were discontinued by the hospital upon admission to the emergency department and the patient was treated with an atypical antipsychotic.\u00a0She tolerated the medications well, started psychotherapy sessions, and was released five days later.\u00a0On the day of discharge, there were no delusions or hallucinations reported.\u00a0She was referred to the local mental health center for aftercare follow-up with a psychiatrist.<a class=\"footnote\" title=\"Henning A, Kurtom M, Espiridion E D (February 23, 2019) A Case Study of Acute Stimulant-induced Psychosis. Cureus 11(2): e4126. doi:10.7759\/cureus.4126\" id=\"return-footnote-866-2\" href=\"#footnote-866-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<div class=\"textbox tryit\">\n<h3>TRY IT<\/h3>\n<p>\t<iframe id=\"assessment_practice_abf10f9f-b178-495b-a7a5-6cdc0ef862a1\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/abf10f9f-b178-495b-a7a5-6cdc0ef862a1?iframe_resize_id=assessment_practice_id_abf10f9f-b178-495b-a7a5-6cdc0ef862a1\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>Another powerful case study example is that of\u00a0Elyn R. Saks, the associate dean and Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California Gould Law School.<\/p>\n<p>Saks began experiencing symptoms of mental illness at eight years old, but she had her first full-blown episode when studying as a Marshall scholar at Oxford University. Another breakdown happened while Saks was a student at Yale Law School, after which she &#8220;ended up forcibly restrained and forced to take anti-psychotic medication.&#8221; Her scholarly efforts thus include taking a careful look at the destructive impact force and coercion can have on the lives of people with psychiatric illnesses, whether during treatment or perhaps in interactions with police; the Saks Institute, for example, co-hosted a conference examining the urgent problem of how to address excessive use of force in encounters between law enforcement and individuals with mental health challenges.<\/p>\n<p>Saks lives with schizophrenia and has written and spoken about her experiences. She says, &#8220;There&#8217;s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life.&#8221;<\/p>\n<p>In recent years, researchers have begun talking about mental health care in the same way addiction specialists speak of recovery\u2014the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. Approaches include &#8220;medication (usually), therapy (often), a measure of good luck (always)\u2014and, most of all, the inner strength to manage one&#8217;s demons, if not banish them. That strength can come from any number of places&#8230;love, forgiveness, faith in God, a lifelong friendship.&#8221; Saks says, &#8220;We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.&#8221;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"A tale of mental illness | Elyn Saks\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/f6CILJA110Y?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/ATaleOfMentalIllnessElynSaks_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;A tale of mental illness | Elyn Saks&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-866\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Wallis Back for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>A tale of mental illness . <strong>Authored by<\/strong>: Elyn Saks. <strong>Provided by<\/strong>: TED. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=f6CILJA110Y\">https:\/\/www.youtube.com\/watch?v=f6CILJA110Y<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><li>A Case Study of Acute Stimulant-induced Psychosis. <strong>Authored by<\/strong>: Ashley Henning, Muhannad Kurtom, Eduardo D. Espiridion. <strong>Provided by<\/strong>: Cureus. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.cureus.com\/articles\/17024-a-case-study-of-acute-stimulant-induced-psychosis#article-disclosures-acknowledgements\">https:\/\/www.cureus.com\/articles\/17024-a-case-study-of-acute-stimulant-induced-psychosis#article-disclosures-acknowledgements<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Elyn Saks. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Elyn_Saks\">https:\/\/en.wikipedia.org\/wiki\/Elyn_Saks<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. <strong>Authored by<\/strong>: Yuanhan Bai, Xi Yang, Zhiqiang Zeng, and Haichen Yangcorresponding. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5851085\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5851085\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-866-1\">Bai, Y., Yang, X., Zeng, Z., &amp; Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. <em>BMC psychiatry<\/em>, 18(1), 67. https:\/\/doi.org\/10.1186\/s12888-018-1655-5 <a href=\"#return-footnote-866-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-866-2\">Henning A, Kurtom M, Espiridion E D (February 23, 2019) A Case Study of Acute Stimulant-induced Psychosis. Cureus 11(2): e4126. doi:10.7759\/cureus.4126 <a href=\"#return-footnote-866-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":13,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"A tale of mental illness \",\"author\":\"Elyn Saks\",\"organization\":\"TED\",\"url\":\"https:\/\/www.youtube.com\/watch?v=f6CILJA110Y\",\"project\":\"\",\"license\":\"other\",\"license_terms\":\"Standard YouTube License\"},{\"type\":\"cc\",\"description\":\"A Case Study of Acute Stimulant-induced Psychosis\",\"author\":\"Ashley Henning, Muhannad Kurtom, Eduardo D. Espiridion\",\"organization\":\"Cureus\",\"url\":\"https:\/\/www.cureus.com\/articles\/17024-a-case-study-of-acute-stimulant-induced-psychosis#article-disclosures-acknowledgements\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Elyn Saks\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Elyn_Saks\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy\",\"author\":\"Yuanhan Bai, Xi Yang, Zhiqiang Zeng, and Haichen Yangcorresponding\",\"organization\":\"\",\"url\":\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5851085\/\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Wallis Back for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"9446a410-e07b-410c-975d-b8c776ac13df, 79954ba9-f8f3-4900-8d09-974f8eca573f","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-866","chapter","type-chapter","status-publish","hentry"],"part":152,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/866","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":33,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/866\/revisions"}],"predecessor-version":[{"id":7538,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/866\/revisions\/7538"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/152"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/866\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=866"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=866"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=866"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}