Running head: GERIATRIC CASE STUDY
Geriatric Case Study
Author's Name
Institutional Affiliation
GERIATRIC CASE STUDY
E.J. Transcript
E.J. is a 62-year-old Caucasian male who initially presented with new-onset
symptoms of psychosis and mood liability thought to be connected with high-dose
Prednisone treatment for poison ivy exposure. He was brought to an emergency
room by his grandson approximately 11 months ago with extreme agitation.
Evaluation of E.J. at that time revealed auditory hallucinations. E.J. noted that the
whispering voices had a persecutory tone. He also expressed feelings of paranoia,
saying that the voices were plotting against him and that he would not let them win.
The patient is currently residing in the secure wing of an assisted living facility.
History
E.J. has a past medical history that includes hypertension, hyperlipidemia, coronary
artery disease, chronic obstructive pulmonary disease, peptic ulcer disease, and
peripheral artery disease (with stents), but no prior psychiatric history. His mother
was diagnosed with schizophrenia.
GERIATRIC CASE STUDY
Assignment Instructions
For your assignment, complete the following information based on the patient
information you have been given. Include at least one Internet source and two
evidence-based articles in addition to the assigned texts to support your
recommendation(s).
1. Diagnoses, Differentials, and ICD Code(s):
Provide your recommendations for each.
2. Medications:
Provide your recommended drug therapy, including common side effects and
potential or actual adverse drug responses (ADR), common drug and/or food
interactions, and key monitoring points.
3. Psychosocial Issues:
Discuss the psychosocial issues and circumstance(s) surrounding this case.
GERIATRIC CASE STUDY
4. Variables Related to Aging and Mental Health:
Describe unique patient variables that are involved in the patient’s response to
aging and mental health.
5. Recommendations:
Include non-pharmacological interventions. List any changes in care
approaches you would suggest.
GERIATRIC CASE STUDY
Introduction: Case Study
E.J. is a 62-year-old Caucasian male who is brought to the facility with symptoms of psychosis
and mood liability. Medical history reveals that the patient's symptoms are thought to be linked
to high-dose Prednisone used to treat him for position ivy exposure. Approximately eleven
months ago, the patient was accompanied by his grandson to the facility, and he exhibits extreme
agitation. Evaluation results at that time reveal that the patient had auditory hallucinations. For
instance, he complained about voices in his head that were plotting evil against him, and he
would not let them win. The patient has a medical history that includes hypertension,
hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, peptic ulcer
disease, and peripheral artery disease (with stents), but no prior psychiatric history. Also, E.J's
mother was diagnosed with schizophrenia. It is against this background that this paper analyzes
this case study, diagnosis, medications, variable related to aging and mental health, and finally,
recommendations.
Diagnoses, Differentials, and ICD Code(s)
Psychosis is a type of mental disorder characterized by an impaired relationship with reality.
According to WebMD (2019), psychosis affects the way an individual's brain processes
information hence causing him or her to lose touch with reality. The major symptoms of
psychosis include hallucinations, delusions, thought disorder, disorientation, nervousness racing
thoughts, etc. Moreover, psychosis has several behavioral symptoms, including agitation,
hyperactivity, restlessness, self-harm, hypervigilance, and disorganized behavior. WebMD also
GERIATRIC CASE STUDY
reveals that the major symptoms of the psychotic episode include auditory hallucinations, tactile
hallucinations, visual hallucinations, and delusions.
Differential Diagnosis
According to the American Academy of Family Physicians (2019), "Acute psychosis is primary
if it is symptomatic of a psychiatric disorder, or secondary if caused by a specific medical
condition. A key diagnostic distinction must be made between psychotic symptoms caused by
delirium, a psychiatric disorder, or a defined medical condition." Essentially, psychosis is
diagnosed using a psychiatric evaluation whereby a doctor watches the individual's behavior and
ask questions regarding what he or she is experiencing. Moreover, the doctor may carry out
medical tests and x-rays to establish potential underlying illnesses that may be causing the
symptoms. However, it is important to note that psychosis symptoms in adults are not necessarily
the same symptoms among young people. The ICD Code for psychosis is the 2020 ICD-10-CM
Diagnosis Code F29.
While doctors don't know the exact causes of psychosis, there are several known risk factors.
These include genetics, drug (prescription medications and abuse of alcohol or drugs), trauma
(such as the death of loved ones, sexual assault, and war), injuries, and illnesses (stroke,
Alzheimer's disease, brain tumors, and dementia).
Medications
There are several medications that have been developed to treat psychosis symptoms. These
include:
GERIATRIC CASE STUDY
Chlorpromazine (Thorazine)
Belonging to a class of drugs known as phenothiazine, this medication is used in the treatment of
certain mental and mood disorders such as psychotic disorders as well as schizophrenia.
According to Medscape (2019), Chlorpromazine works by blocking various receptors in the
brain, especially dopamine receptions, and this helps to prevents overactivity of dopamine in the
brain. In so doing, the patient is able to thin clearly, reduce aggression, decrease hallucinations,
and overcome feelings of nervousness.
However, Chlorpromazine has several side effects, such as dizziness, anxiety, weight gain,
drowsiness, and sleeping problems. Also, the Medscape recommends that Chlorpromazine
should not be mixed with nutritional supplements because this may lessen its beneficial effect.
Aripiprazole (Abilify)
This is one of the new "second generation" or atypical antipsychotics. The drug works by
rebalancing dopamine as well as serotonin to improve one's thinking, moods, and overall
behavior. The drug works at a larger number of sites, particularly transporters, as well as
receptors. Some of the common side effects of Aripiprazole include akathisia, insomnia,
anxiety, nausea, fatigue, limb/joint pain, tremors, and nervousness.
Clozapine ODT
It is used in the treatment of certain mood and mental disorders. Essentially, the drug works by
restoring the balance of various neurotransmitters in the human brain. According to WebMD
(2019), "Clozapine decreases hallucinations and helps prevent suicide in people who are likely to
try to harm themselves." Hence, the drug helps the patient to think more clearly and positively
GERIATRIC CASE STUDY
about themselves and overcome feelings of nervousness. Its main side effects include weight
gain, drowsiness, tremors, headache, and blurred vision. Noteworthy, the drug should be taken
by mouth with or without food as directed by the doctor. It is also to ensure close monitoring of
the drug because its use can cause a decrease in white blood cells. Thus, blood tests should be
done regularly.
Other drugs for treating psychosis include Brexpiprazole (Rexulti), Quetiapine (Seroquel),
Perphenazine (Trilafon), Trifluoperazine (Stelazine) and Asenapine (Saphris) among others.
Psychosocial Issues
As revealed in the case study, E.J's mother was diagnosed with schizophrenia. This means
genetics might be a major risk factor contributing to his mental health problems. According to
Mayo Clinic (2019), people coming from families with some close members with have psychotic
disorders are more likely to suffer from the disorder. Also, his life circumstances could be a
significant cause of his psychotic symptoms. For instance, residing in an assisted living facility
could result in feelings of rejection or isolation. These, in turn, result in stress, anxiety, and other
psychological problems. Additionally, issues surrounding his retirements, such as financial
uncertainties or loss of loved ones, could also increase the risk of developing mental health
problems. For these reasons it is very important for the care providers to look into some of these
circumstances because they have significant impacts of mental health particularly among older
adults such as E.J. The treatment plan should, therefore, take into account the psychological and
circumstances of the patient in order to ensure proper diagnosis and medical interventions.
Variables Related to Aging and Mental Health
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According to the Centers for Disease Control and Prevention (2019), approximately 20% of
individuals aged 55 years or older experience at least one type of mental health concern such as
anxiety, severe cognitive impairment, or mood disorders. These statistics indicate that many
older adults are at risk of developing mental health problems, substance use issues, and
neurological disorders. Also, the CDC states that as individual’s age, they are more likely to
suffer several conditions at the same time. As they get older, changes in their lives, such as
illnesses, grief, and retirement, can make them more vulnerable to mental health problems.
Being a 62-year old adult, E.J is at a high risk of developing mental health problems such as
psychosis, mood disorders, and substance abuse problems. In other words, his advanced age
could be one of the factors contributing to his psychosis problems. Also, his age also puts him at
the risk of suffering several conditions at the same time.
Non-pharmacological interventions
There are several other non-pharmacological interventions that may be used to treat E.J's
psychosis symptoms and improve his well-being. The first key intervention is Hallucinations
focused integrative therapy (HIT). According to Jenner & Van De Willige (2011), HIT is an
effective early intervention for individuals with psychosis, especially because it helps to prevent
relapse. For the patient in this case study, HIT should be used as an early intervention for
reducing his psychotic symptoms and, more importantly, to improve the quality of life.
The second non-pharmacological intervention is Cognitive Behavioral Therapy (CBT). It is an
evidence-based intervention that focuses on how an individual's thinking patterns, behaviors, and
emotions are connected. In this particular case study, CBT will help the patient become more
aware of his thoughts and behaviors. More importantly, CBT can be used to normalize the
patient's thought patterns and train him on ways to cope and manage his psychotic symptoms.
GERIATRIC CASE STUDY
Social skills training, on the other hand, should be used to improve E.J's communication as well
as social interactions. This will significantly improve his relationships with others and the overall
quality of life. Family therapy and vocational rehabilitation are the other vital non-
pharmacological interventions that can effectively improve E.J symptoms and return him to
normalcy. A study conducted by Cuijpers et al. (2014) established that "combined treatment
with psychotherapy and antidepressant medication is more effective than treatment with
antidepressant medication alone." For this, combining medications with the above-mentioned
non-pharmacological interventions will significantly improve E.J recovery from psychotic
symptoms.
GERIATRIC CASE STUDY
References
Centers for Disease Control and Prevention (2019). The State of Mental Health and Aging in
America. Retrieved from https://www.cdc.gov/aging/pdf/mental_health.pdf
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F.
(2014). Adding psychotherapy to antidepressant medication in depression and anxiety
disorders: a meta-analysis. Focus, 12(3), 347-358.
Griswold, K. S., Del Regno, P. A., & Berger, R. C. (2015). Recognition and differential
diagnosis of psychosis in primary care. American family physician, 91(12), 856-863.
Jenner, J. A., & Van De Willige, G. (2011). HIT, hallucination focused integrative treatment as
early intervention in psychotic adolescents with auditory hallucinations: a pilot study.
Acta Psychiatrica Scandinavica, 103(2), 148-152.
Medscape (2019). Chlorpromazine (Rx). Retrieved from
https://reference.medscape.com/drug/chlorpromazine-342970
WebMD (2019). Psychosis and Psychotic Episodes. Retrieved from
https://www.webmd.com/schizophrenia/guide/what-is-psychosis#2
