NUR 620

Reply from Agar D Joseph Week Six Discussion

 

St. Thomas University

NUR 620: Psychiatric Management I

Dr. Elvira Silva-De Vera

October 5, 2025

 

     Mr. T is a 21-year-old male who presented to the emergency department exhibiting a range of concerning symptoms, which include bizarre delusions, auditory hallucinations, social withdrawal, and disorganized thought processes. He expresses a belief that extraterrestrial beings are transmitting messages to him and implanting thoughts within his mind. Additionally, Mr. T experiences auditory commands instructing him to engage in self-harm; however, he currently denies any intention of suicide.

Subjective and Objective Findings:

     Subjectively, Mr. T demonstrates guarded behavior and expresses feelings of paranoia. Objective observations indicate instances of thought blocking and vigilant scanning of his environment for perceived threats. His mother reports a gradual decline in his mental state over the past year, characterized by increasing social isolation, a cessation of academic activities, and an intensifying focus on delusional content. Furthermore, there is a documented family history of psychiatric illness; Mr. T's father exhibited similar symptoms and required extended psychiatric hospitalization.

Primary Diagnosis:

- Diagnosis: Schizophrenia, First Episode, Currently in Acute Phase
 - **DSM-5-TR Code:** 295.90 
 - ICD-10 Code: F20.9

     The symptoms exhibited by Mr. T—including delusions (belief in aliens), hallucinations (auditory messages), and disorganized thought processes (thought blocking)—align with the diagnostic criteria for schizophrenia as outlined in the DSM-5- TR. This diagnosis necessitates the presence of at least two core symptoms persisting for a minimum duration of six months, with at least one symptom being a delusion, hallucination, or disorganized speech (American Psychiatric Association [APA], 2022).

The insidious onset of these symptoms, along with notable social and occupational decline, provides further support for this diagnosis.

Differential Diagnoses:

1. Schizoaffective Disorder
    - **DSM-5-TR Code:** 295.70 
    - **ICD-10 Code:** F25.0 
    - This disorder manifests mood episodes that occur concurrently with psychotic symptoms. While Mr. T does not present with significant depressive or manic symptoms, this diagnosis remains a consideration should mood symptoms develop.

2. Substance/Medication-Induced Psychotic Disorder
    - **DSM-5-TR Code:** 292.89 
    - **ICD-10 Code:** F19.959 
    - Psychotic symptoms may arise due to substances or medications. It is advisable to conduct a toxicology screen to rule out any stimulant-induced psychosis (e.g., resulting from amphetamines or hallucinogens), as these substances can mimic primary psychotic disorders (National Institute for Health and Care Excellence [NICE], 2023).

Pharmacological Treatment:

     The recommended first-line pharmacological intervention is risperidone, initiated at a dosage of 1–2 mg orally per day and titrated to therapeutic effect (maximum 6 mg/ day), in accordance with the treatment guidelines provided by the APA (2023) and NICE (2023) for individuals experiencing first-episode schizophrenia. Risperidone is effective in addressing positive symptoms such as delusions and hallucinations and presents a more favorable side effect profile compared to first-generation antipsychotics. It is essential to conduct baseline laboratory assessments—including a complete blood count (CBC), lipid profile, fasting glucose, and liver function tests—to monitor for potential metabolic side effects.

Non-Pharmacological Treatment:

     Non-pharmacological interventions are critical in the management of early psychosis. Cognitive-Behavioral Therapy for Psychosis (CBTp) can aid patients in challenging delusional beliefs and enhancing cognitive insight. Family psychoeducation may diminish relapse rates by fostering understanding and adherence to treatment protocols. Coordinated Specialty Care (CSC), an evidence-based multidisciplinary model, integrates psychotherapy, medication management, case management, and support for employment and educational endeavors. This approach has demonstrated improvements in functional outcomes for individuals experiencing first-episode psychosis (Heilbronner et al., 2022).

Health Promotion Intervention:

     Health promotion strategies should emphasize support for adherence to treatment and relapse prevention. Educational initiatives regarding medication management, the identification of early signs of relapse, and strategies for stress management should be implemented. Given Mr. T's family history and social withdrawal, a referral to a community-based early intervention program for psychosis would be advantageous for his long-term recovery and reintegration into educational and social contexts. Additionally, promoting regular physical activity and balanced nutrition may contribute to mitigating metabolic side effects associated with antipsychotic medications (APA, 2023).

Reply from Daniela Barbeito Schizophrenia Spectrum Case Study

Clinical Summary

Mr. T is a 21-year-old male who has delusion beliefs related to aliens, thoughts insertion and visual problems. On a subjective level, he narrates that the aliens are communicating with him through sticks that are being put outside his home and sending images to his head. According to the objective view, he is guarded, thought blocking, anxious, and suspicious of the surroundings. His last year of gradual social withdrawal, poor academic functioning and obsession with science fiction and protective equipment are the complaints of his mother. His psychiatric family history is favorable, and his father had similar psychotic symptoms and was admitted to a hospital, which suggests that there were genetic predispositions. Diagnosis

The specified diagnosis is Schizophrenia, first episode, currently acute (DSM-5: 295.90; ICD-10: F20.9): the patient has delusions, thought insertion, disorganized thoughts, and social/occupational decline more than six months. Schizophrenic disorder (DSM-5: 295.70; ICD-10: F25.9) would be the first initial diagnosis since the mood disturbances would be comorbid with psychosis, however, the description of the mood disturbances was not a central feature of the case (Gangadin et al., 2024). The second alternative diagnosis is Delusional Disorder, persecutory type (DSM-5: 297.1; ICD-10: F22) since the patient experiences ongoing delusions of aliens, but the diagnoses is not common since the delusions are disorganized and the patient himself is performing poorly (Haywood et al., 2024). The primary diagnosis of Schizophrenia is the best because of the chronicity, the negative symptoms and family history.

Pharmacological Treatment

The American Psychiatric Association (APA) guidelines would make the first-line drug of pharmacological treatment an unusual antipsychotic such as risperidone or aripiprazole. These have positive symptoms (delusions, hallucinations) and very few extrapyramidal side effects as compared to traditional antipsychotics. Risperidone is particularly useful and well tolerated with first episode psychosis. There would be the need to closely monitor side effects such as metabolic syndrome, sedation or prolactin increase. In case of resistance to treatment at that point clozapine must also be considered but only after two unsuccessful attempts that have been made with other antipsychotics.

Non-Pharmacological Treatment

The cognitive behavioral therapy of psychosis (CBTp) can be viewed as the non- pharmacological intervention since they might enable Mr. T to re-process the delusional beliefs and enhance the efficiency of coping strategies. Psychoeducation must be provided to both the mother and the patient to facilitate insight, adherence to medication and the early detection of symptoms of relapse (Ma, 2022). Social skills training and occupational therapy can help in recovery and restore to normal everyday activity functions. Family therapy may also contribute to the reduction of stress and expressed emotion consequently reducing the chance of relapse. The combination of the solutions with medication is founded on the suggestion of the guidelines on the complete treatment of schizophrenia.

Health Promotion Intervention

An adequate health promotion intervention would consist of the relapse prevention program establishment through the medication adherence and frequent psychiatric follow-up and lifestyle change. The reduction of the stress and the further improvement of the overall well- being may be obtained in terms of sleep hygiene, healthy diet, and exercise education. Screening and the recommendation of the avoidance of drugs is required because the use of drugs like cannabis can aggravate psychosis (Gangadin et al., 2024). Peer support groups can help to overcome the effects of isolation by promoting social interaction and therefore recovery. These drugs are administered to manage mental and physical diseases, which will be beneficial in the long term health and quality of life of Mr. T.