Clinical vignette of an adult psychiatric patient
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- Clinical vignette of an adult psychiatric patient
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Clinical vignette of an adult psychiatric patient
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[ID] => 558743
[post_author] => 12815
[post_date] => 2024-12-26 08:23:48
[post_date_gmt] => 2024-12-26 13:23:48
[post_content] => Practice Passage (Question 1-5)
*This passage is the property of Khan Academy and has been reformatted into an AAMC-style interface in their entirety by MedLife Mastery. MedLife Mastery does not endorse and is not an affiliate of Khan Academy.
Tim is a 24 year-old PhD candidate at a large university. Over the past six months, his behavior has changed and become increasingly bizarre. Though originally very enthusiastic about graduate school, he states that he is no longer interested in pursuing a degree and has no motivation to continue with school. He used to drink alcohol socially, but has withdrawn his friends and is not currently using any substances. He has no history of drug or alcohol abuse. He is unable to concentrate on work and tells friends and family that he believes someone has been following him when he leaves the house, and spying on him in his bedroom at night. Police bring him to a state psychiatric hospital after he throws his cell phone against a bus window and causes a public disturbance. Hospital staff members comment that they often hear him whispering frantically when he is alone, as though he is having a conversation with another person.
When asked about his behavior, Tim states the following:
“ I couldn’t. I couldn’t use my phone anymore – they’re listening... and I just couldn’t.”
“The agents are listening. They’re after me and I can’t get away.”
“I am wanted by the government. I’m sitting in an office building right now and I see tear gas coming up from the floor. Can you smell the poison they’re releasing into the air?”
“The president wants to kill me, the agents all tell me it’s useless to fight it... I can’t go on.”
“I was born to end the world and bring down the government in this dismal country.”
“I had to stop drinking because my cups were all poisoned by government agents.”
The psychiatrist diagnoses Tim with schizophrenia and prescribes an antipsychotic. After 5 weeks on the medication, Tim shows minor improvements but the changes are not drastic. He continues to claim that he is a target of the government and is meant to bring down the country’s infrastructure. He occasionally claims to see agents hiding under the floorboards and above his head in ceiling tiles. In addition, he refuses to drink any beverages because he believes they have been poisoned. He is required to stay at the psychiatric hospital and receive treatment as an inpatient, because his psychiatrist believes he is a danger to himself and others.
[post_title] => Clinical vignette of an adult psychiatric patient
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[question] => Which of Tim’s relatives has the highest risk of developing schizophrenia?
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[answer] => 1
[description] => Reason for the Correct Answer:
Approximately 1% of the general population is diagnosed with schizophrenia . People who have second-degree relatives (aunts, uncles, grandparents, or cousins) with the disease develop schizophrenia more often than the general population; Tim’s grandmother has about a 3% chance of developing schizophrenia.
Approximately 10% of individuals who have first degree relatives with schizophrenia (like a parent, brother, or sister) will be diagnosed with schizophrenia. Tim’s mother and future son fall into this category.
The person most at risk is the identical twin of a person with schizophrenia. Tim’s twin brother has a 40 to 65 percent chance of developing schizophrenia.
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[answers] => Array
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[each_answer] => A. Tim’s identical twin brother
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[each_answer] => B. Tim’s mother
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[2] => Array
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[each_answer] => C. Tim’s fraternal grandmother
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[each_answer] => D. Tim’s future son
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[1] => Array
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[quiz_unique_key] => 3873426850
[question] => Which of the following statements describes one of Tim’s delusions?
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[answer] => 2
[description] => Reason for the Correct Answer:
Hallucinations are things a person sees, hears, smells or feels. No one else can witness a hallucination.
Delusions are false beliefs.
The idea that Tim is a person of importance (wanted by the government) and that the president wants to kill him. Despite the fact that this isn’t logical, Tim believes he is persecuted by the president and hunted by government agents. This is a delusion.
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[0] => Array
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[each_answer] => A. Tim talks to agents in his head that order him to do things.
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[each_answer] => B. Tim believes he is wanted by the government and that the president wants to kill him.
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[each_answer] => C. Tim smells toxins and sees tear gas that is coming up through the floor.
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[3] => Array
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[each_answer] => D. Tim sees poison floating in the general water supply and in his beverages.
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[2] => Array
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[quiz_unique_key] => 83407773
[question] => Which of the following is a negative symptom of schizophrenia that Tim experienced in the passage?
[value] => Array
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[answer] => 2
[description] => Reason for the Correct Answer:
In this case, “negative symptoms” does not mean that the behavior is judged as “good” or “bad.”
The words “positive symptoms” refer to symptoms that are added onto a person’s behavior – like seeing things that are not there or hearing voices.
The words “negative symptoms” refer to symptoms that detract from a person’s behavior and may diminish their functioning in some capacity. In this instance, Tim’s inability to begin or sustain activities is a detraction from his normal ability to function and would be a negative symptom.
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[each_answer] => A. Tim believes that agents are persecuting him and want to kill him.
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[each_answer] => B. Tim cannot begin or sustain his planned coursework in graduate school.
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[each_answer] => C. Tim sees government agents hiding in the ceiling tiles above his head.
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[each_answer] => D. Tim smells smoke coming up from the floorboards and is terrified.
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[3] => Array
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[quiz_unique_key] => 2261298308
[question] => The passage states that Tim received a diagnosis of schizophrenia, but did not state a specific type of schizophrenia that Tim could have. Which type of schizophrenia best fits the description of Tim’s symptoms?
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[answer] => 4
[description] => Reason for the Correct Answer:
Tim did not have motivation or interest in graduate school, but he would not receive a residual schizophrenia label because he is still suffering from delusions and hallucinations. Residual schizophrenia is characterized by a lack of delusions and hallucinations.
Tim was socially withdrawn, but did not meet the criteria for catatonic schizophrenia, which requires dramatic withdrawal from the world and muteness (on the catatonic end) and complete hyperactivity and mimic of sound/movement (on the hyperactive end). In addition, catatonic schizophrenia is often characterized by a tendency to hold uncomfortable or bizarre body positions for an extended period of time, or be completely still for long periods of time. There is no evidence in the passage that he experienced any of these symptoms.
Tim had significant delusions of persecution, delusions of grandiosity, and hallucinations that caused him to become suspicious and withdrawn. He probably experienced paranoid schizophrenia.
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[each_answer] => A. Disorganized schizophrenia, because Tim was incoherent in speech and thought.
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[each_answer] => B. Catatonic schizophrenia, because Tim was withdrawn, mute, and negative.
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[each_answer] => C. Residual schizophrenia, because Tim had no motivation or interest in activities in his life.
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[each_answer] => D. Paranoid schizophrenia, because Tim felt both persecuted and grandiose.
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[4] => Array
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[quiz_unique_key] => 574431310
[question] => During the intake process, Tim has a Magnetic Resonance Imaging (MRI) scan. Which of the following could appear on the MRI scan to support a diagnosis of schizophrenia?
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[answer] => 2
[description] => Reason for the Correct Answer:
While dopamine type 2 receptor levels are elevated in individuals with schizophrenia, dopamine receptors are viewed postmortem or with a Positron Emission Tomography (PET) scan.
While decreased prefrontal brain function is seen in individuals with schizophrenia, those results are found via PET or Functional Magnetic Resonance Imaging (fMRI) scans.
Magnetic Resonance Imaging (MRI) scans have found that temporal lobe volume is changed in individuals with schizophrenia, mainly that there is significant loss of temporal lobe gray matter volume, but not white matter volume.
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[answers] => Array
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[each_answer] => A. Decreased prefrontal brain function
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[each_answer] => B. Decreased temporal lobe gray matter
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[each_answer] => C. Increased temporal lobe gray matter
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[each_answer] => D. Elevated levels of dopamine type 2 receptors
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