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Inpatient psychiatric

Case Study: 14
You are working on an inpatient psychiatric unit conducting the initial assessment on 22 year old man brought in last night by police after he was found sitting in the middle of the campus circular drive at Oakland University. By way of explanation, he shares that “I was told to do it or else bad things would happen to us on campus. You don’t understand, people aren’t who they say they are.”
Robert has never been treated psychiatrically before. He tells you that he has been attending the university and living at home with his parents. He has always been a good student and has been active socially. Last semester his grades began declining, and he became very withdrawn. He is enrolled in school but has been missing classes and is apathetic about his studies. He spends most of his time alone in his room. His grooming has deteriorated; he may go days without bathing. For several weeks before admission he insisted on keeping all of the blinds and curtains in the house closed. For the past 2 days he will only eat things that are pre-packaged because “They have contaminated the food.” He denies current drug or alcohol use, although he reports that he occasionally smoked marijuana in the past. He says that he has discontinued this practice over the past 6 months because he can no longer afford it, and claims that marijuana was helping him feel more comfortable and relaxed. Robert denies any medical problems and is taking no medications.
On a mental status examination, he does appear disheveled with marginal hygiene. He appears somewhat hyper-vigilant with his new surroundings, scanning the room with his eyes and maintains his back to a wall as he paces back and forth in the room. He states that his mood is “okay.” His affect is congruent, although flat. His speech is of normal rate, rhythm, and tone. His thought processes are tangential, and loose associations are occasionally noted. His thought content is positive for delusions and auditory hallucinations are suspected due to his latency of response and whispering under his breath during the evaluation.

  1. Per the DSM criteria, please list the positive and negative symptoms that would indicate that Robert might have a Schizophrenia Spectrum Disorder?
  2. What other disorders may have psychotic presentations? Please list and contrast.
  3. Provide a list of nursing diagnoses for this scenario.
  4. Psychotropic medications are the drugs of choice for psychotic or agitated conditions. Please explain the benefits and risk profiles of “typical vs atypical antipsychotics”.
  5. What are extrapyramidal symptoms and how are they treated?

Sample Solution

sting ergot is exceptionally perilous. It contains isoergine (lysergic corrosive amide.) [28] The medication Lysergic corrosive diethylamide, ordinarily alluded to as LSD, was initially produced using ergot.[29] Ergot existed before the seventeenth century; in any case, it was normal that individuals accepted it had a place with the rye plant.[30] Ergot growth fills in wet environments and lowlands.[31] Salem Village dwelled in what is by and by the town of Danvers, in Essex County.[32] This town is situated in the seaside marshes and the environment is wet and gentle, ideal for ergot to thrive.[33] The homesteaders sowed seeds in April and get-together occurred in August.[34] It was then put away until required in the colder time of year months.[35] This could clarify why Abigail and Betty didn't end up being debilitated until winter, in light of the fact that the contaminated rye was not eaten up to that point. Once more, the people who were informers, aside from the beguiled young ladies, the larger part were from the western piece of Salem Village, and most of the witches were from the eastern side of town.[36] The ergot harming may have been uniquely on the west part of town. The most persuading contention regarding ergot harming is the connection between's ergot side effects and Abigail and Betty's indications. Ergot harming influences for the most part ladies and kids, since they "ingest more food per unit of body weight; thusly, they ingest more toxin per unit of body weight."[37] This would clarify why the main informers were female.[38] Side impacts of ingesting ergot are shivering hands or fingers, wooziness, mental trips, spewing, muscle withdrawals, lunacy, psychosis, daze and depression. Some correspond with the young ladies' manifestations of squeezing, yapping like a canine, and fantasize. An alternate hypothesis encompassing Salem is mass clinical delirium. Clinical mania is characterized as "in which a patient encounters actual indications that have a mental, rather than a natural reason; and theatrical behavioral condition described by extreme feelings, dramatizations, and consideration looking for behavior."[39] Historian Chadwick Hansen trusts that "the pressure of living in disrupted region, alongside the severe Puritan religion, prompted hysteria."[40]

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