An 18-Year-Old Is Brought To The ER By His Mother After He B

An 18 Year Old Is Brought To The Er By His Mother After He Began Talki

An 18-year-old male patient presents to the emergency room accompanied by his mother, who reports a recent escalation of bizarre behaviors and thought patterns. The patient is observed to be guarded, anxious, and repeatedly scanning the environment for perceived threats, specifically aliens. He reports experiences of extraterrestrial beings attempting to steal his soul, leaving messages via sticks outside his residence and transmitting thoughts into his mind. He admits that the aliens sometimes influence him to self-harm, such as throwing himself in front of a car, which he believes could alter systemic forces. These symptoms have worsened over the past few weeks, following months of social withdrawal, self-talk, cessation of schooling, and a preference for reading science fiction and devising devices to protect himself. His mother reveals that his father exhibited similar symptoms earlier in life, leading to multiple psychiatric hospitalizations.

This clinical presentation raises concerns about acute psychiatric illness, with particular suspicion of a primary psychotic disorder given the prominent hallucinations, delusional content, and social withdrawal. The differential diagnosis should also encompass organic causes such as neurological or metabolic disturbances, substance-induced psychosis, and other psychiatric conditions like mood disorders with psychotic features or severe anxiety disorders.

Paper For Above instruction

Introduction

The presentation of psychotic symptoms in adolescents and young adults demands careful assessment to distinguish primary psychiatric disorders from organic causes. In this case, the patient's hallucinations involving aliens and delusional beliefs about protecting himself reflect a possible psychotic process. A thorough diagnostic approach combining clinical evaluation with targeted laboratory investigations is essential for accurate diagnosis and effective management.

Most Likely Diagnosis

The patient's core symptoms—visual and auditory hallucinations, paranoid delusions involving extraterrestrials, social withdrawal, and disorganized behavior—are characteristic of a primary psychotic disorder, most likely schizophrenia. Schizophrenia typically manifests in late adolescence or early adulthood, with positive symptoms such as hallucinations and delusions being prominent (American Psychiatric Association, 2013). The history of a paternal family member with similar symptoms further supports a genetic predisposition. The evolving nature of his symptoms over months suggests the prodromal to active phase transition commonly seen in schizophrenia (Kahn & Keefe, 2013).

Differential Diagnosis

• Substance-Induced Psychosis: Use of substances such as cannabis, synthetic cannabinoids, or methamphetamine can induce psychotic symptoms (Leweke et al., 2012). An assessment of recent substance use is necessary.
• Organic Brain Disorders: Neurological conditions like brain tumors, head trauma, infections (e.g., encephalitis), or metabolic disturbances (e.g., hypoglycemia, hyponatremia) can cause psychosis (Patel et al., 2016).
• Mood Disorders with Psychotic Features: Major depressive disorder or bipolar disorder can include psychotic elements, especially if mood symptoms predominate (Malhi et al., 2019).
• Post-infectious or autoimmune encephalitis: Conditions such as anti-NMDA receptor encephalitis can present with psychosis (Dalmau et al., 2011).
• Severe Anxiety or Trauma-Related Disorders: While less likely, extreme anxiety or PTSD can sometimes produce psychosis-like symptoms, necessitating careful evaluation.

Laboratory and Imaging Studies

To rule out organic causes, the following assessments are recommended:

• Complete Blood Count (CBC): To evaluate for infection or hematologic abnormalities.
• Serum metabolic panel: Including electrolytes (sodium, potassium), blood glucose, renal and liver function tests to identify metabolic derangements.
• Thyroid Function Tests: To exclude thyroid abnormalities (McClain et al., 2019).
• Serum B12 and Folate Levels: Deficiencies can contribute to neuropsychiatric symptoms.
• Urinalysis and Toxicology Screen: To detect recent substance use.
• CSF Analysis and Neuroimaging: MRI brain scan to exclude structural brain abnormalities or lesions; lumbar puncture if infection or autoimmune etiologies are suspected.
• Infectious Disease Tests: Screening for HIV, syphilis, or other infections affecting the CNS.

Acute Management Steps

The initial management of this patient involves ensuring safety, stabilization, and initiating treatment. This includes:

1. Safety and Monitoring: Immediate assessment for self-harm or harm to others. Involuntary hospitalization may be considered if the patient poses a risk.
2. Psychiatric Evaluation and Observation: Collaborate with psychiatry for comprehensive assessment and determine the need for inpatient psychiatric care.
3. Medication: Initiation of antipsychotic medication—second-generation agents like risperidone or olanzapine—may alleviate psychotic symptoms (Leucht et al., 2013). Medication choice should consider side effect profiles and patient tolerability.
4. Supportive Interventions: Establish a therapeutic milieu emphasizing safety, medication adherence, and family involvement.
5. Addressing Comorbidities and Organic Causes: Treat any identified metabolic, infectious, or neurological conditions concurrently.
6. Family and Psychiatric Support: Engage family members to provide psychoeducation, monitor symptoms, and ensure support during stabilization.

Conclusion

The clinical picture suggests a primary psychotic disorder, most consistent with schizophrenia, given the age of onset, symptomatology, and family history. A comprehensive approach involving ruling out organic causes through laboratory and neuroimaging studies, coupled with prompt psychiatric intervention, is crucial for effective management. Early recognition and treatment improve outcomes, particularly in the context of emerging psychosis during adolescence and young adulthood.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Dalmau, J., Tüzün, E., Wu, H. Y., Masjuan, J., Rossi, J. E., Voloschin, A., ... & Lynch, D. R. (2011). Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Annals of neurology, 69(4), 572-580.
• Kahn, R. S., & Keefe, R. S. (2013). Schizophrenia is a neurodevelopmental disorder. Schizophrenia Bulletin, 39(6), 1279-1282.
• Leweke, F. M., Koethe, D., Kranaster, L., & Veling, W. (2012). Psychosis and substance use. European Neuropsychopharmacology, 22(12), 866-868.
• Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Orey, D., Richter, F., ... & Davis, J. M. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treament meta-analysis. The Lancet, 382(9896), 951-962.
• Malhi, G. S., Green, M. J., Fagiolini, A., Peselow, E. D., & Mizuno, Y. (2019). Bipolar disorder. The Lancet, 393(10189), 1451-1462.
• McClain, D. E., et al. (2019). Thyroid dysfunction and neuropsychiatric manifestations. Psychosomatics, 60(5), 448-455.
• Patel, V., et al. (2016). Organic causes of psychiatric symptoms in adolescents. Journal of Child and Adolescent Behavior, 4(2), 880.
• Dalmau, J., et al. (2011). Autoimmune encephalitis and psychosis. Nature Reviews Neurology, 9(4), 245-258.