Abstract
The Diagnostic and Statistical Manual of Mental Disorders provides a practical diagnostic approach for numerous mental disorders. Schizophrenia is among the disorders that the DSM-5 offers an outlook for. This study evaluates the diagnosis of schizophrenia in a high school teenager, focusing on their background history, including medical conditions to assert the prevalence of a different disorder, including a differential diagnosis. The study also evaluates an effective treatment plan and concludes with a prognosis, focusing on current knowledge and information about schizophrenia. The findings reveal the diagnosis of schizophrenia based on the client’s history and development of risk symptoms. With an effective management plan, the client can illustrate sound disorder management approaches and be able to lead a healthy and independent life.
Background Information
Personal History
The movie Words on Bathroom Walls introduces viewers to Adam Petrazelli, a teenager who is later diagnosed with a mental disorder following a psychotic attack in school. Adam often considers himself ‘possessed,’ which is evident by an internal voice speaking to him. In many instances throughout the movie, it is clear that Adam is not in control of his body, with the voice prompting his every action (Fraudenthal, 2020). This is a sign of an underlying mental health problem such as psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, or severe depression.
Client Behavior
Several events triggered Adam’s mental condition, including his father’s death and his mother’s remarrying. His school performance was negatively affected by the onset of these signs. He had a negative attitude toward his stepfather and even lost trust in his mother. The same behavior was replicated in school through the nuns. His friends, especially Maya, offered him a reprieve, reducing his psychotic behavior. On the day of diagnosis, Adam discovered the news of a new sibling who saw him having catatonic behavior resulting in his psychotic attack. Before this, he had delusions, hallucinations, and negative symptoms, including decreased motivation and reduced expressiveness. A clear case was his reduced motivation and expressiveness to declare his feelings for Maya until his friends prompted him.
Adam demonstrated all signs of a mental disorder when subjected to pressure situations but felt calm when surrounded by his security circle (friends). He also suffered from avolition and social withdrawal following his father’s death. His social and occupational skills diminished drastically below the standards of a high school teenager. These signs persisted over time and were replicated in pressure situations at home, society, and school, affecting his relationship with his parents and teachers. However, he did not indicate any abnormal motor activity or disorganized speech.
DSM 5 Diagnosis
Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) can pinpoint Adam’s symptoms as the correct disorder. There is a higher likelihood of a psychotic disorder, including schizophrenia. DSM-5 presents an overview of the prevalent symptoms of a mental disorder (American Psychiatric Association [APA], 2019). From the manual, Adam’s condition suggests the existence of a mental disorder suggested by:
- Adam had four acute symptoms of schizophrenia, including delusions, hallucinations, confused or impassive behavior, reduced expressiveness, and lessened motivation. These symptoms were present over a long period, within a month, following his father’s death.
- Adam’s level of functioning was also affected due to reduced expressiveness and lessened motivation. He had reduced functioning levels in his poor academic and extra-curricular performance in school. He also exhibited poor social skills in his lack of interest in asking Maya for prom.
- It had been a year since Adam’s father died when he started behaving differently. His initial signs of disturbance started showing a month following this event and persisted for over three months, demonstrating severe psychotic symptoms. He also started hearing voices prompting him to behave or treat those around him with indifference.
- Adam did not have any major depressive, manic, or moody episodes during the symptomatic stage when he started showing signs of a mental disorder to indicate schizoaffective or bipolar disorders.
- Adam also had no history of substance abuse or taking any prescription drugs to suggest that mood disturbance may have been attributed to a pre-existing behavior.
- Finally, Adam was not diagnosed with any autism spectrum of communication disorder in childhood, eliminating the role of pre-existing conditions to explain the disturbance.
Differential Diagnosis
The signs illustrated by Adam can also be used to diagnose another related mental disorder. The most prevalent symptoms spanning various mental disorders include manic episodes, mood-disturbance episodes, and psychosis. Therefore, Adam could also be diagnosed with schizoaffective disorder or major depressive disorder based on the prevalence of specific symptoms. However, these are only differential diagnoses, suggesting that some symptoms’ prevalence differs from the principal diagnosis. For instance, if Adam had been diagnosed with a schizoaffective disorder, the manic episodes must have occurred concurrently in the active symptomatic phase.
Additionally, mood-disturbance symptoms must be detected significantly during the active phase (APA, 2019). On the other hand, major depressive disorder would have been diagnosed if Adam’s mood disturbance, the gravity of manic symptoms, and psychosis depended on a temporal link between the three symptoms (APA, 2019). His hallucinations would have been experienced only during a manic episode and not often, as illustrated in various situations.
Rationale For Diagnosis
Elements contributing to the rationale for the early detection and prevention of schizophrenia include the condition’s risk factors. According to research, treatment resistance, severity, and chronicity of schizophrenia are critical risk factors supporting early diagnosis (Cella et al., 2018; Kochunov et al., 2019; Meier et al., 2020). This implies that the diagnosis’s most crucial predictive factor is the condition’s premorbid and onset phases, as shown when Adam started to illustrate psychotic signs. His neurobiological processes started to diminish, leading to the emergence of expressive symptoms forming schizophrenia.
Treatment Plan
An effective treatment plan for schizophrenia involves understanding the defining qualities of a patient and how early the disorder is diagnosed. Luckily, Adam was diagnosed early, meaning that his condition can be treated with a plan focusing on three mental health areas: biological, psychological, and social (Nishiyama et al., 2022). Adam’s physician will prescribe medication to boost Adam’s physical health, addressing the vulnerabilities associated with the condition to reduce the symptoms. This will entail medications such as dopamine and serotonin, although atypical antipsychotic drugs may also be administered to reduce Adam’s delusional and hallucination episodes (Tripathi et al., 2018). Medication is an appropriate starting point, especially since Adam has demonstrated a positive trend in taking his drugs.
Since Adam talked about his condition in front of the school, he proved that he had accepted his condition and was ready for help. The school can recommend that a therapist discuss the symptoms with Adam to boost his psychological well-being (Freeman et al., 2019). This will involve talking about how accurate the symptoms are, how Adam interprets his feelings, including the internal voice, and how he copes with the feelings.
Adam also realized that he was not alone in his struggle as Maya and his stepfather were there for him, showing him that he could also count on their support. With a large social circle, Adam will be able to receive immense support, who will regularly remind him of his medication and continuous therapy to manage his condition and boost his recovery (Jameel et al., 2020). Adam changed his attitude towards his stepfather following this realization, helping him reduce additional pressure events to retain a calm peace of mind. Maintaining a positive relationship with his close circle will help him boost his social well-being, boosting his recovery.
Prognosis and Summary
Schizophrenia is often considered to be part of mental disorders affecting cognitive functioning. Although there is no cure for schizophrenia, research is being done to understand its molecular and neural causes and establish new antipsychotic drugs (Haddad & Correll, 2018; Mishra & Kumar, 2021; Pruett & Meador-Woodruff, 2020). The continued improvement suggests that the outlook for Adam and other schizophrenic patients will improve. The availability of medications allows people to lead independent and satisfying lives. Females have a higher recovery rate than males among patients who recover fully to resume their everyday lives (Wang et al., 2020). Continued emotional, physical, social, and psychological support from connections helps people get by. Despite positive developments, mortality rates among schizophrenic patients are high and characterized by suicide (Vermeulen et al., 2019). Current recovery measures involve support and counseling to help patients integrate into society. Practical management approaches can contribute to a rapid improvement for a patient to gain independence after learning how to manage their symptoms well.
References
American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013. Journal of Physiotherapy Research, Salvador, 9(2), 155-158.
Cella, M., Okruszek, Ł., Lawrence, M., Zarlenga, V., He, Z., & Wykes, T. (2018). Using wearable technology to detect the autonomic signature of illness severity in schizophrenia. Schizophrenia Research, 195, 537-542.
Fraudenthal, T. (2020). Words on Bathroom Walls. [Film]. LD Entertainment, Roadside Attractions
Freeman, D., Taylor, K. M., Molodynski, A., & Waite, F. (2019). Treatable clinical intervention targets patients with schizophrenia. Schizophrenia Research, 211, 44-50.
Haddad, P. M., & Correll, C. U. (2018). The acute efficacy of antipsychotics in schizophrenia: A review of recent meta-analyses. Therapeutic Advances in Psychopharmacology, 8(11), 303-318.
Jameel, H. T., Panatik, S. A., Nabeel, T., Sarwar, F., Yaseen, M., Jokerst, T., & Faiz, Z. (2020). Observed social support and willingness for the treatment of patients with schizophrenia. Psychology Research and Behavior Management, 13, 193.
Kochunov, P., Huang, J., Chen, S., Li, Y., Tan, S., Fan, F., Feng, W., Wang, Y., Rowland, L. M., Savransky, A., Du, X., Chiappelli, J., Chen, S., Jahanshad, N., Thompson, P. M., Ryan, M. C., Adhikari, B., Sampath, H., Cui, Y., … Hong, L. E. (2019). White matter in schizophrenia treatment resistance. American Journal of Psychiatry, 176(10), 829-838.
Meier, S. M., Kähler, A. K., Bergen, S. E., Sullivan, P. F., Hultman, C. M., & Mattheisen, M. (2020). Chronicity and sex affect genetic risk prediction in schizophrenia. Frontiers in Psychiatry, 11, 313.
Mishra, P., & Kumar, S. (2021). Association of lncRNA with molecular regulatory factors in brain and their role in the pathophysiology of schizophrenia. Metabolic Brain Disease, 36(5), 849-858.
Nishiyama, S., Kurachi, M., Higuchi, Y., Takahashi, T., Sasabayashi, D., Mizukami, Y., & Suzuki, M. (2022). Development and validation of a scale of self-alienation-related attributes for the early diagnosis of schizophrenia. Journal of Psychiatric Research, 147, 212-220.
Pruett, B. S., & Meador-Woodruff, J. H. (2020). Evidence for altered energy metabolism increased lactate, and decreased pH in schizophrenia brain: A focused review and meta-analysis of human postmortem and magnetic resonance spectroscopy studies. Schizophrenia Research, 223, 29-42.
Tripathi, A., Kar, S. K., & Shukla, R. (2018). Cognitive deficits in schizophrenia: Understanding the biological correlates and remediation strategies. Clinical Psychopharmacology and Neuroscience, 16(1), 7.
Vermeulen, J. M., van Rooijen, G., van de Kerkhof, M. P., Sutterland, A. L., Correll, C. U., & de Haan, L. (2019). Clozapine and long-term mortality risk in patients with schizophrenia: A systematic review and meta-analysis of studies lasting 1.1–12.5 years. Schizophrenia Bulletin, 45(2), 315-329.
Wang, W. L., Zhou, Y. Q., Chai, N. N., Li, G. H., & Liu, D. W. (2020). Mediation and moderation analyses: Exploring the complex pathways between hope and quality of life among patients with schizophrenia. BMC Psychiatry, 20(1), 1-9.