UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

QUESTION 1

A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who “had mental problems”.
Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.

Question 1 of 4:

Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient.

UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.

Question 2 of 4: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Explain the genetics of schizophrenia.

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.

Question 3 of 4:

The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia?

Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia.

Question 4 of 4: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia.

QUESTION 5

A 34-year-old woman was taken to the urgent care facility by her worried husband who has been noticing changes in his wife for the previous three months. He claims that his wife has been moody and irritated, has complained of being extremely exhausted, has dropped 10 pounds, and has experienced sleeplessness. After a long day at work, he returned home to find his wife glued to the television. Recently, she has suddenly developed extreme hyperactivity, been chatting nonstop, been easily distracted, and appears to “flit from one thing to another.” She has not slept for three days. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion
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. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment.

Question 1 of 6:

Discuss the role genetics plays in the development of bipolar 2 disorders.

Question 2 of 6:

Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease.

Question 3 of 6:

Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms

Question 4 of 6: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Discuss the role of the amygdala in bipolar disorder.

Question 6 of 6:

How does neurochemical dysregulation contribute to bipolar disorders?

Question 6 of 6:

What is the current status of the use of nutraceuticals in management of depression?

QUESTION 11

A female patient, 27, arrives at the emergency room complaining of palpitations, a racing heartbeat, sweating, trembling, and difficulty breathing. About 10 hours ago, the symptoms began, and they have since become worse. She claims that she experiences occasional chest discomfort that never goes away. Around her mouth and lips, she also experiences numbness and tingling. She claims to be aware of “something dreadful happening.” She disputes ever experiencing a comparable incident before. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion
Previous medical history is not relevant. Social background important for the current stressor of completing the Medical College Admission Test and applying to medical school (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26.
Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.

Question 1 of 2:

What are panicogens and how do they contribute to the development of panic attack symptoms?

Question 2 of 2:

How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders?

Question 1 of 2: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Describe the areas of the brain that are associated with social anxiety disorder.

Question 2 of 2:

How is oxytocin associated with SAD?

QUESTION 15

A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion
She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).

Question 1 of 2:

Discuss the role of neurotransmitters in the expression of GAD.

Question 2 of 2: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Explain the structural brain changes that occur in people with GAD.

QUESTION 17

A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq. He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares.
He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion
He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD). UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Question 1 of 2:

Describe the changes seen in the brain structure in patients with PTSD.

Question 2 of 2: UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Briefly discuss the role glucocorticoids may have on the development of PTSD.

QUESTION 19

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion
The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD). UMES NURS 6501 Mental Health the Positive Symptoms of Schizophrenia Discussion

Question 1 of 2:

What is primary pathophysiology of OCD?

Question 2 of 2:

Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.