2. Auditory hallucinations
3. Delusions and hallucinations organized around a
central theme
The aetiology of schizophrenia remains unknown. 29 , 30 There is a strong genetic predisposition. 29 , 30 Patients who experience the onset of schizophrenia before age 22 are 10 times more likely to have a history of a complicated caesarean birth than patients with a later onset of schizophrenia, which suggests a possible neurodevelopmental factor in early-onset schizophrenia. 31 Mild childhood head injuries may play a role in the expression of schizophrenia in families with a strong genetic predisposition to this disorder. 32 Psychological stress has also been implicated in the onset of schizophrenia, since it often precipitates the first psychotic episode or increases the likelihood of a relapse. 33 , 34 In this case, the patient described a family “break-up” which may have precipitated the onset of psychosis. Details about his childhood head injuries and the circumstances of his birth were not obtained. After being diagnosed with schizophrenia, the patient revealed to the referring physician that his father had experienced something similar when he was younger, which may point to a genetic predisposition.
There are no conclusive diagnostic tests for schizophrenia. 22 However, imaging studies have suggested neurophysiologic changes as an associated finding. Volumetric magnetic resonance imaging (MRI) studies of patients with schizophrenia have demonstrated an overall reduction in grey matter; an increase in white matter; decreased size of the amygdala, hippocampus, and parahippocampus; an overall reduction in brain volume; and larger lateral ventricles relative to a control group. 35 – 37
As primary-care practitioners, physical therapists may encounter patients with possible psychiatric disorders such as schizophrenia. However, the physical therapy literature on psychiatric disorders as they relate to musculoskeletal disorders focuses mainly on low back pain (LBP). 7 , 8 In an examination of a large number of physical and psychological factors, one prospective case-control study points to the importance of psychological variables as a risk factor for chronic LBP and widespread musculoskeletal pain. 8 Previous research has also concurred with this study in implicating psychological variables as risk factors for LBP and neck pain. 9 , 10 These articles provide a link between psychological disorders and patients seeking physical therapy for musculoskeletal dysfunctions.
In this case report, the physical examination was suggestive of a mild supraspinatus tendinosis, but this did not explain the severity of pain reported by the patient or the referral of pain to the elbow, wrist, and knee. One of the limitations of the physical examination was that there was not sufficient time to perform physical examination of the elbow, wrist, and knee. The patient's undiagnosed and uncontrolled psychiatric symptoms took priority over the musculoskeletal dysfunction and required immediate medical referral without physical therapy intervention. Because of the inconsistencies between interview and physical examination, as well as the patient's perception that an electrical implant was causing his musculoskeletal pain, there is a possibility that at least some of his musculoskeletal symptoms may have been manifestations of his psychiatric disorder.
The medical literature indicates that 50% of all mental illness is recognized during the interview process as part of medical assessment by the primary-care physician. 38 As physical therapists embrace their role as providers of primary care, 4 , 5 they must rely on their skills in patient interviewing and physical examination to rule out medical pathology. Improved assessment skills by the physical therapist may help to identify primary or secondary medical pathologies that have not previously been diagnosed. Within the peer-reviewed literature, a number of case studies demonstrate identification of non-musculoskeletal or visceral pathology that can manifest as musculoskeletal disorders; 39 – 41 these case studies are examples of how physical therapists can perform an initial assessment, identify a medical pathology that precludes treatment, and make an appropriate referral. During a patient interview, physical therapists must be well aware of the psychological and psychosocial aspects of the examination to identify relevant aspects of the patient's demeanour (e.g., appropriate self-care) and emotional state (e.g., inappropriate affect). The patient interview should consist of non-leading, open-ended questions about how pain in multiple areas is related and how it is caused. Furthermore, physical therapists should avoid rationalizing the patient's symptoms during the interview process. At a minimum, patients should be permitted to speak about and describe their symptoms in a way that is meaningful to them.
Schizophrenia is most often initially recognized by the primary-care physician. 42 Psychiatrists, psychologists, and even the lay community have also been noted in the literature as making the initial identification. 43 – 45 Although conspicuously absent from the literature on the initial identification of schizophrenia, physical therapists are in a position to be important first-contact care providers who can make the initial identification of schizophrenia, and other psychiatric disorders, through effective patient interviews. Although labelling patients as having a psychiatric disorder is outside physical therapists' scope of practice, the diagnostic process is not exclusive to any one profession. In this case, the process of diagnosis, which involves assessing the patient, grouping findings, interpreting the data, and identifying the patient's problems, led me to conclude that the primary dysfunction was psychiatric in nature. 46 This process, which Few et al. call “diagnostic reasoning,” is well within physical therapists' scope of practice and is something we constantly engage in during our daily clinical practice. 11 Diagnostic reasoning involves taking into account all of the possible pathological structures and determining the most likely cause of the patient's symptoms. In practice, expert clinicians do not follow standardized protocols; 46 rather, they pay attention to cues provided by the patient, recognize patterns, and test hypotheses to arrive at a probable cause for the patient's symptoms. 11
The medical literature has identified gaps in the knowledge of primary-care physicians, specifically a lack of awareness of the symptoms and epidemiology of schizophrenia. 28 To facilitate early recognition, referral, and diagnosis of schizophrenia, the medical literature has suggested increased collaboration among family physicians and mental-health professionals, as well as ongoing mental-health training for family physicians. 47 , 48 Physical therapists should also heed these suggestions. A study in the physical therapy literature recommends mental-health training for recognizing the symptoms of depression in a population with LBP; 7 the same study, conducted in Australia, concluded that physical therapists' ability to recognize depressive symptoms in an outpatient setting was poor. 7
An initial step to address these gaps could be a position paper that draws on the medical literature to inform physical therapists about the presence, prevalence, signs, and symptoms of common psychiatric disorders. As well, future research needs to focus on the incidence of musculoskeletal signs and symptoms in patients with common psychiatric disorders.
What is already known on this topic.
To the authors' knowledge, there are no known studies in the literature describing a case of a patient referred to physical therapy for musculoskeletal dysfunction who was later diagnosed with schizophrenia.
This case report contributes to the existing literature on physical therapists functioning as competent providers of primary care who have the knowledge and skills needed to rule out non-musculoskeletal pathology. It also educates physical therapists about the signs and symptoms of schizophrenia.
Shah N, Nakamura Y. Case report: schizophrenia discovered during the patient interview in a man with shoulder pain referred for physical therapy. Physiother Can. 2010;62:308–315
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Schizophrenia is a significantly impairing and disabling psychiatric disorder affecting approximately 1% of the population worldwide. Schizoaffective Disorder occurs less This case involved a 42 frequently (estimates of 0.32-0.8%) and features both symptoms of schizophrenia and bipolar disorder, making diagnosis and treatment difficult.
Examination of a 37-year-old woman with adult-onset psychosis revealed weight loss, a thyroid nodule, anemia, and micronutrient deficiencies. Diagnostic tests were performed.
Introduction. Schizophrenia is a chronic severe mental illness with heterogeneous clinical profile and debilitating course. Research shows that clinical features, severity of illness, prognosis, and treatment of schizophrenia vary depending on the age of onset of illness.[1,2] Hence, age-specific research in schizophrenia has been emphasized.Although consistency has been noted in ...
The practice guidelines for the treatment of patients with schizophrenia and NICE guidelines for prevention and management of psychosis and schizophrenia in adults also recommend that other causes of psychosis should be ruled out initially with electrocardiogram and by screening the patient for substance abuse while on admission [2, 9, 10].
A total of 128,294 participants from the UK Biobank met inclusion criteria, as shown in Fig. 1.The mean age at recruitment into this study was 59.6 years (standard deviation (s.d.) of 5.69 years ...
Psychotic-like experiences are highly prevalent in the general population, with figures of 20% or above being reported in some studies. 1 Major self-mutilation (or NSSI) is a rare but potentially catastrophic complication of severe mental illness. Most people who inflict NSSI have a psychotic disorder, usually a schizophrenia spectrum psychosis.
Behavioral warning signs for psychosis include: Sudden drop in grades or job performance. New trouble thinking clearly or concentrating. Suspiciousness, paranoid ideas, or uneasiness with others. Withdrawing socially, spending a lot more time alone than usual. Unusual, overly intense new ideas, strange feelings, or no feelings at all.
Of the patients presenting with psychosis, the median age was 29; 79.3% were male and 32.8% were female. The drugs most frequently reported used were cannabis in 25.9% of cases, amphetamines in 25% and cocaine in 16.1%. More than one drug was taken in 54.3% of the cases.
Case Study: Bryant. Thirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors, depression, and distrust. At the time of admission, prominent ritualistic behaviors and depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder (OCD). Shortly after, psychotic symptoms such as disorganized ...
This single case study describes a structural therapy perspective applied to a family and examines interaction patterns within the clinical setting and the home; the therapeutic view examines contextual variables that affect an individual diagnosed with schizophrenia, his family, and his recovery.
Furthermore, the book illustrates how the case studies from developing countries lend support to some of the novel approaches being used to manage schizophrenia in the United States (3, 4). For this reason, I believe this book is suitable not only for the general public but also for scientists, clinicians, and policy makers, especially those in ...
Schizophrenia is the story of the way that poverty, violence, and being on the wrong side of power drive us mad. The madness only emerges from a body vulnerable to experience it, from genes and pathways we do not yet entirely understand. Of course, people whose bodies are more vulnerable are more likely to fall ill, and those with highly ...
Case study 1: A man who suddenly stops smoking. A man aged 35 years* has been admitted to a ward following a serious injury. He has been taking olanzapine 20mg at night for the past three years to treat his schizophrenia, without any problems, and does not take any other medicines. He smokes 25-30 cigarettes per day, but, because of his ...
Semantic Scholar extracted view of "Caffeine-Induced Psychosis: A Case Report and Review of Literature" by Dylan Mannix et al. ... [PDF] Save. Psychosis following Caffeine Consumption in a Young Adolescent: Review of Case and Literature ... an increasing number of clinical studies are showing that some … Expand. 121. PDF. Save. The ...
Aim. There is concern that the provision of the clinical high risk for psychosis (CHR) label is stigmatizing. Prior research suggests people have nuanced reactions to feedback involving the CHR label, including a positive experience receiving feedback and improvement in negative emotions (e.g., shame), while also exhibiting concerns about self-perception and perceptions from others related to ...
PDF | On Jan 1, 2015, Ms. Vipasha Kashyap published Case Study of a Young Patient with Paranoid Schizophrenia | Find, read and cite all the research you need on ResearchGate
Case Study #5a — Psychosis Background Information Jessica is an 18 year-old female with recent abnormal behaviour and perceptual disturbances. She describes a history of recurrent depressive feelings since the age of twelve. Last year her feelings of depression intensified, resulting in food-intake restriction and a loss of twenty pounds.
This study investigated relations between a measure of early-stage visual function and self-reported visual anomalies in individuals at clinical high risk for psychosis (CHR-P). Eleven individuals at CHR identified via the Structured Interview for Psychosis-Risk Syndromes (SIPS) were recruited from a CHR-P research program in NYC. The sample was ~36% female, ranging from 16 to 33 years old (M ...
A case study in adolescent's schizophrenia Matt, a 15 years, 6 month old boy, was referred simultaneously by his General Practitioner and the crisis intervention team. He had been found in a park wandering and had been reported to the police by onlookers. When the police arrived on the scene and questioned him, he had
needed for quick recovery from schizophrenia. The applicability of CBT for schizophrenia has many applications to social work practice. The aim of the present study was to . Aim: manage auditory hallucination using cognitive behavioural case work study approach. Methodology: It uses a single subject design and compares pre and post intervention -
Schizophrenia is a chronic disorder, characterized mainly by the gross distortion of reality, withdrawal from social interaction, and disorganization and fragmentation of perception, thought and emotion. Approximately, 1% world population suffering with the problem of Schizophrenia. Both male and female are almost equally affected with slight ...
Case Study: A Work up Case of Paranoid Schizophrenia . Garima Kapoor. 1 *, Ravindra Kumar. 2. ABSTRACT . Cognitive Behaviour Therapy and Group therapy interventions with schizophrenia patients are well researched areas. The current research focuses on application of these interventions and challenges while using them with paranoid schizophrenia ...
The physical health disparities experienced by people living with severe mental illness such as schizophrenia and related psychoses are well known. 1 Physical health diseases are the major drivers for the 13-15 year reduced life expectancy in people with severe mental illness compared to those without mental illness, 2,3 with cardiometabolic risks frequently developing early in the course of a ...
BACKGROUND AND AIM[|]Shared genetic risk between schizophrenia (SCZ) and bipolar disorder (BD) is well-established, yet the extent to which they share environmental risk factors remains unclear. We compare associations between environmental exposures from birth to diagnosis with the risk of SCZ and BD, adjusting for genetic risk.[¤]METHOD[|]We conducted a Swedish register-based nested case ...
Schizophrenia is a psychiatric disorder affecting between 0.5% and 1.5% of adults worldwide, with a slightly greater prevalence in men. 22 The age of onset may be from 5 to 60 years; however, more than 50% of first episodes occur between the ages of 15 and 24. 22,25,26 An earlier onset is more common among men, while later onset is more common ...
autism spectrum disorder (APA, 2013). Here, the facts regarding Emilio indicate gross disorganization, disorganized speech, odd. patterns of behavior and delusions. These symptoms appear to be chronic and extending beyond. 6 months given his current age of 40, and the fact that he dropped out of high school at 16.
Case study: Schizophrenia Dr.Amra Ahsan* Abstract Ms. S.K. was an unmarried 21 years old, female, single, from middle socio-economic status, came ... Schizophrenia is a psychotic disorder marked with severe impaired thinking, emotions and behaviour. The prevalence rate is estimated to be about 1% of the total population of the world.
Request full-text PDF. ... and psychosis. This systematic review of case reports and case series aimed ... Results A total of 28 studies, including 21 case reports and 7 case series involved 37 ...
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