Case 3a: Background Carrie Is A 13-Year-Old Hispanic Female

Case 3abackgroundcarrie Is A 13 Year Old Hispanic Female Who Is Brou

Carry is a 13-year-old Hispanic female presenting with behavioral changes, including hallucinations, delusions, social withdrawal, and cognitive difficulties. Her parents are concerned about her behavior, noting that she talks to imaginary friends, claims to communicate with spirits, and believes that television shows are specifically for her. They report that she has always had some behavioral and developmental issues, with early concerns about developmental delays and social isolation. Her academic performance has declined as she advanced to high school, and her teachers find her social skills and cognitive functioning atypical for her age. The parent reports family history of mental illness, including schizophrenia in her grandfather. During the clinical interview, Carrie displays minimal eye contact, reports hearing and seeing hallucinations, and holds delusional beliefs that the TV shows and commercial messages are meant for her. She denies suicidal or homicidal ideation. Her mental status exam reveals a well-developed, appropriately dressed adolescent who is alert and oriented but somewhat preoccupied.

Paper For Above instruction

This case study presents a 13-year-old Hispanic female, Carrie, who exhibits symptoms consistent with a diagnosis of early-onset schizophrenia. Her presentation includes hallucinations, delusional thinking, social withdrawal, and cognitive deterioration, all of which are hallmark features of psychotic disorders as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This essay discusses her symptomatology, supports the diagnosis from DSM-5 criteria, lists appropriate additional diagnostic tests, and considers treatment options including pharmacological intervention with lurasidone.

Introduction

Psychotic disorders in adolescents are relatively uncommon but pose significant clinical challenges due to their complex presentation and the developmental considerations unique to this age group (Cornelius et al., 2015). Early diagnosis and intervention are crucial for improving prognosis (McGorry et al., 2014). Carrie’s symptoms, including hallucinations, delusions, social withdrawal, and cognitive decline, raise suspicion of early-onset schizophrenia, a rare but severe manifestation of schizophrenia that occurs before age 18 (Fusar-Poli et al., 2017). This paper evaluates her clinical presentation against DSM-5 criteria, discusses the importance of additional diagnostics, and explores evidence-based treatment strategies.

Symptom Analysis and DSM-5 Criteria

According to DSM-5, schizophrenia is characterized by a constellation of symptoms lasting for at least six months, with at least one month of active-phase symptoms (American Psychiatric Association, 2013). Carrier’s symptoms include hallucinations—she reports hearing and seeing "strange things" that she communicates with, which she perceives as spirits from another world. Her delusional beliefs include the conviction that television programs are “just for her” and that she can control other people's thoughts, which relate to delusions of reference and control. She also believes that her teachers are "miserable" because they do not understand her thinking, indicating thought content disturbances.

Her social withdrawal and poor academic performance further support the diagnosis. DSM-5 requires at least two of the following symptoms for at least one month: delusions, hallucinations, disorganized speech, abnormal motor behavior, negative symptoms. In Carrie’s case, hallucinations and delusions are evident, and her minimal eye contact and affect constriction suggest negative symptoms (American Psychiatric Association, 2013). Her social and academic impairments reflect functional decline associated with the disorder (Fusar-Poli et al., 2017).

It is important to rule out other potential diagnoses, such as mood disorders with psychotic features or neurological conditions. However, her symptom profile aligns most strongly with early-onset schizophrenia, especially considering her family history and the persistence of symptoms over time.

Additional Diagnostic Tests

To confirm the diagnosis and exclude differential diagnoses, comprehensive diagnostic evaluations are essential. An initial step would involve neuroimaging, such as magnetic resonance imaging (MRI), to rule out structural brain abnormalities, tumors, or lesions that could cause psychosis-like symptoms (Schultz et al., 2018). Electroencephalography (EEG) should be considered to exclude seizure disorders or temporal lobe abnormalities contributing to her hallucinations (Benbadis & Boro, 2019).

Psychological testing, such as the Minnesota Multiphasic Personality Inventory (MMPI-2) and specific tools like the Whitaker Index of Schizophrenic Thinking (WIST), can assess the severity of psychotic thinking and distinguish between primary psychotic disorders and mood-related psychoses (Kaufman et al., 2016). Intelligence testing, including the Kaufman Adolescent and Adult Intelligence Test, will help identify any underlying cognitive deficits that may influence her functional decline (Kaufman & Kaufman, 2004).

Augmenting these assessments with neuropsychological testing can provide insights into her cognitive functioning and help tailor individualized treatment plans. A thorough medical evaluation should include laboratory tests, such as a complete blood count, electrolytes, metabolic panel, and infectious disease screening, to identify any biological contributors to her psychosis (Sass & Parnas, 2019). Given her family history, genetic testing for congenital or inherited neuropsychiatric conditions may also be warranted.

Treatment Strategy and Pharmacotherapy

Addressing early-onset schizophrenia requires a combination of pharmacological and psychosocial interventions. Pharmacotherapy aims to reduce hallucinations, delusions, and cognitive symptoms while minimizing side effects. Second-generation antipsychotics (SGAs) are preferred in adolescents due to their favorable side effect profiles compared to first-generation antipsychotics (FGA) (Correll et al., 2017).

Lurasidone, an atypical antipsychotic, has shown effectiveness in treating schizophrenia with minimal metabolic adverse effects, making it suitable for adolescents (DeLeon et al., 2020). In this case, off-label use of Lurasidone at a starting dose of 40 mg daily is justified after discussing risks, benefits, and informed consent with her guardians. Close monitoring of metabolic parameters, weight, blood glucose, and lipid profile is essential during treatment (Goff et al., 2018).

Psychosocial interventions including family psychoeducation, cognitive-behavioral therapy, and social skills training are vital adjuncts. Family involvement improves medication adherence and reduces relapse rates (Pharoah et al., 2014). Educational support in school settings can facilitate her academic reintegration and social development (McGorry et al., 2014).

Conclusion

In conclusion, Carrie’s clinical presentation fulfills DSM-5 criteria for early-onset schizophrenia, supported by her persistent hallucinations, delusions, social withdrawal, and cognitive decline. Accurate diagnosis necessitates comprehensive medical, neuropsychological, and neuroimaging assessments to exclude other causes. A combination of pharmacological treatment with second-generation antipsychotics like Lurasidone and targeted psychosocial interventions can help optimize her prognosis. Early detection and holistic management are essential to improve her functioning and quality of life throughout adolescence and beyond.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Benbadis, S. R., & Boro, A. (2019). EEG and neuroimaging in psychiatric diagnosis. Journal of Clinical Neurophysiology, 36(4), 305-312.
• Correll, C. U., et al. (2017). Managing side effects of antipsychotic medication in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(3), 157-164.
• DeLeon, J., et al. (2020). Efficacy and safety of Lurasidone in adolescent schizophrenia. Schizophrenia Research, 218, 62-68.
• Fusar-Poli, P., et al. (2017). Early-onset schizophrenia: clinical course and prognosis. World Psychiatry, 16(3), 245-246.
• Goff, D. C., et al. (2018). Metabolic monitoring of youth on antipsychotic medication. Journal of Psychiatry & Neuroscience, 43(4), 263-271.
• Kaufman, A. S., & Kaufman, N. L. (2004). Kaufman Adolescent and Adult Intelligence Test. (KAIT). Pearson.
• McGorry, P. D., et al. (2014). Early intervention in psychosis: evidence and future directions. World Psychiatry, 13(3), 279-286.
• Pharoah, F., et al. (2014). Family interventions for schizophrenia. Cochrane Database of Systematic Reviews, (12).
• Sass, L. A., & Parnas, J. (2019). Schizophrenia and related disorders: neurobiological and clinical perspectives. Routledge.