Reference no: EM133909378

Question

A 20-year-old male patient was accompanied by his mother for an initial visit to your office. The patient was disheveled, had poor grooming, and body odor. His mother expressed great concern about her son. He had been an honor student and athlete in high school. He was artistic and had received an art scholarship from the local university where he was currently enrolled. Over the past year, his condition had deteriorated, and he had returned home. He was on academic probation, having failed all courses.

His mother reported that the patient sat in his room most of the time watching television. He refused to shower, brush his teeth, or change his clothing. He no longer participated in family or social activities and his old friends no longer come around to see him.

The patient provided minimal information but did report that his brain had been replaced by aliens. The "aliens" put voices in his head that told him to hurt himself. When asked if the voices were telling him to harm himself now, he nodded a yes. He did not answer when asked if he had a plan or intention of self-harm. He denied having any thoughts about harming others. He had a flat expression and made minimal eye contact. He denied feeling depressed or anxious. A non-smoker in high school, the patient has increased his smoking from a few cigarettes to two packs of cigarettes a day. Over the past year, he has tried to stop several times but has not been successful. When he did attempt to stop, he became anxious and wanted to eat all the time. He states that without his cigarettes he feels depressed and angry.

The patient's parents are divorced. His mother explained that her ex-husband was "weird" and had been hospitalized in a psychiatric facility because "he heard voices."

His mother had taken the patient to a psychiatrist several months ago. The psychiatrist had prescribed Haldol. The patient developed stiffness, stopped the medication, and did not return.

Questions:

What are the differential diagnoses? Rationales.

What are the patient's diagnoses? List DSM-5 diagnostic criteria and the patient's symptoms that reflect the diagnostic criteria to support the diagnosis(es).

What level of care is appropriate for the patient? Provide rationale.

What screening tools are appropriate to use to assist with diagnosis?

What diagnostic labs would you order? Provide rationales.

What are the red flags in this patient's presentation?

What treatments would be appropriate to include psychopharmacology and psychotherapy for the patient? Provide rationales.