21-Year-Old College Student: Voices, Rage, and Crying - Essay Sample

Introduction

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.

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Based on the observed behaviors and information from the 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.

The positive symptoms of Schizophrenia include exaggerated perceptions, ideas, and actions. People with Schizophrenia are likely to experience feelings, hear, smell, or see things that no one else could (hallucinations). In the case study, the student hears voices that his girlfriend couldn't hear. Furthermore, Schizophrenia is also characterized by delusions, which are strange beliefs that could not be proven either wrong or right. For instance, delusion is exhibited when the student feels that everyone is out to get him and that he cannot finish school because the voices have told him that he is not smart enough.

Question 2 of 4:

Explain the genetics of Schizophrenia.

The genetic liability of the Schizophrenia is exhibited as polygenic whereby the risk alleles from Schizophrenia converge onto particular synaptic gene-sets. As such, schizophrenia shares risk alleles with some additional neuropsychiatric disorders. It is known to have some strong genetic component.

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?

There are two primary neurotransmitters (serotine and dopamine) play essential roles in the development of Schizophrenia. For instance, the dopamine is responsible for the overstimulation as well as excess sensory information that results in difficulty with concentration as well as affecting the feeling and behavior and reality orientation. The effect of the serotine is that the brain becomes highly sensitive as if the nerve cells are somehow 'sandpapered.'

Question 4 of 4:

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

The structural abnormalities that have been observed in people with Schizophrenia include disrupted or reduced neural connectivity in which the impaired communication between the regions of the brain result in cognitive changes and associated symptoms. The disruption of the integrity of the white matter of the brain is has been highly associated with Schizophrenia. As such, schizophrenia patients have deficits in working as well as long-term memory tasks.

Scenario 2: Bipolar Disorder

A 34-year-old female was brought to the Urgent Care Center by her husband, who is very concerned about the changes he has seen in his wife for the past three months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds, and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to "flit from one thing to another.". She hasn't slept in 3 days. 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 by 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 to 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.

It is believed that bipolar disorder is not caused by a single gene but rather multiple genetic components, with each one contributing some small portions to the overall vulnerability. As such, bipolar disorder shares risk alleles with some additional neuropsychiatric disorders. It is known to have some strong genetic component.

Question 2 of 6:

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

The hypothalamic-pituitary-adrenal (HPA) system involves the interaction between the pituitary gland and the hypothalamus. The hypothalamic-pituitary-adrenal (HPA) axis controls the components of the flight-or-fight response through the release of cortisol hormones. As such, it controls the suicidal behavior and bipolar type 2 disease.

Question 3 of 6:

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

Cytokines influence the hypothalamic-pituitary axis through the release of corticotrophin-releasing hormones, which is associated with mood symptoms. As such, inflammatory cytokines are likely to inhibit the various hormones responsible for mood symptoms. This results in the development of symptoms such as fatigue and abnormal irritability.

Question 4 of 6:

Discuss the role of the amygdala in bipolar disorder.

Amygdala is responsible for fear conditioning. For instance, it acquires, stores and expresses the conditioned fears in human beings. The patients that have damaged the amygdala fail to show enhanced memory through emotional stimuli arousals. The amygdala is also associated with enhanced consolidation of sensory processing.

Question 5 of 6:

How does neurochemical dysregulation contribute to bipolar disorders?

Certain neurochemical dysfunction such as the faulty homeostatic balance between the transporter dopamine and the receptors may result in the depressive phases of the illnesses and, consequently, the bipolar disorder. Again, the abnormal concentration of neurochemicals such as serotonin could negatively influence the moods of an individual, thus resulting in bipolar disorder.

Question 6 of 6:

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

Some controlled clinical research has been conducted with regards to the adoption of the nutraceuticals in depression management. The more commonly adopted nutraceuticals are more tolerated than conventional and more standard antidepressants like SSRIs. However, the open-label utilization of the nutraceuticals has been noted as misleading, especially because of the associated placebo response.

Scenario 3: Panic Disorders and Attacks

A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hours ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something "terrible is going to happen." She denies having any similar episodes in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results before 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?

Panicogens are substances that cause anxiety within the human body. Such substances are believed to trigger the neurotransmitters such as dopamine, serotonin as well as gamma-aminobutyric acid, which are generally associated with alteration of the body functions and emotions. Such patients are thus hypersensitive to trauma-related experiences.

Question 2 of 2:

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

Panic and anxiety emanates from and perpetuates the dysregulations of the neurobiological systems. The GABA-benzodiazepine (BZ) receptor systems have been known to counterbalance the various actions of the excitatory neurotransmitter glutamate. It acts as an agonist, which induces conformational changes through increased chloride flux, which in turn hyperpolarizes the neuron. This causes a reduction in excitability, thus producing some inhibitory effects on the general activities of the neurons.

Scenario 4: Social Anxiety Disorder (SAD)

A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class, where the class is preparing for the semester's end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history is noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that have harmed both her scholarly and social endeavors. The APRN diagnoses the student with a social anxiety disorder (SAD).

Question 1 of 2:

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

The social anxiety disorder is associated with brain regions that are responsible for the interpretation of social behaviors such as the thalamus, superior temporal gyrus, and PFC. The amygdala, for instance, is responsible for the physiological changes that are linked with a 'fight-to-fight response that mobilizes the patient's body to respond to some real, imagined, or perceived social threats.

Question 2 of 2:

How is oxytocin associated with SAD?

The levels of oxytocin are significantly associated with symptoms of social anxiety disorders. Oxytocin reduces anxiety-like behaviors, which could make an individual react pro-socially to some social interactions. The OT receptor...