NURS 6501 Knowledge Check Psychological Disorders

Sample Answer for NURS 6501 Knowledge Check Psychological Disorders Included After Question

In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.  

Possible topics covered in this Knowledge Check include:

  • Generalized anxiety disorder
  • Depression
  • Bipolar disorders
  • Schizophrenia
  • Delirium and dementia
  • Obsessive compulsive disease

A Sample Answer For the Assignment: NURS 6501 Knowledge Check Psychological Disorders

Title: NURS 6501 Knowledge Check Psychological Disorders

Primary Diagnosis:  ­­­­­­­­­­Depression

1.   Describe the pathophysiology of the primary diagnosis in your own words.  What are the patient’s risk factors for this diagnosis?

Pathophysiology of Primary Diagnosis
Depression has been primarily being associated with low brain 5‐hydroxytryptophan (5-HT) levels and altered 5‐HT receptors, such as upregulated 5‐HT2 and downregulated 5‐HT1A receptors causing mood alterations (Tian et al., 2022). Alterations in dopamine, glutamate, noradrenaline and GABA neurotransmitters and their receptors have been associated with synaptic plasticity and altered neurogenesis resulting in symptoms of major depression.In addition, stress has been associated with high cortisol levels that inhibit 5‐HT1 neurotransmission increasing risk of depression.High cortisol levels have also been associated with inflammatory cytokines such as interleukins that alter synaptic connections resulting in depression-like-behavior.
CausesRisk Factors (genetic/ethnic/physical)
Neurodegenerative diseases such as dementia.Genetic alterations in serotonin 5-HT receptors (Remes et al., 2021).Poor nutrition resulting in anemiaThyroid diseasesCushing diseasePregnancy and post-partum state.Family history of depression especially in a first degree relative.Medical conditions such as cancer and diabetes (Remes et al., 2021).Female gender.Psychological stressGrief and lossAlcohol and substance use.

2.  What are the patient’s signs and symptoms for this diagnosis?  How does the diagnosis impact other body systems and what are the possible complications?

Signs and Symptoms – Common presentationHow does the diagnosis impact each body system?  Complications?
Depressed moodInsomnia or hypersomniaAnhedoniaLoss of concentrationIncreased or reduced appetite (Christensen et al., 2020)Weight gain or lossFatigue and lack of energy.Feeling guilty or worthlessSuicidal ideationsThe diagnosis has been associated with an increased risk of comorbid alcohol and substance use.Depression has higher risks of relapse thus increasing morbidity rates (Fernandes et al., 2023).The diagnosis has been associated with an increased rate of suicide hence increasing their morbidity and mortality.Depression has an impact in a patient’s social life leading to failed friendships and marriage further worsening the prognosis.Obesity can co-occur increasing the patient’s risk for cardiovascular diseases.

3.  What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?

Central nervous system diseases such as Parkinson’s and dementia.Endocrine diseases such as hyperthyroidism, hypothyroidism, and Cushing’s disease (Menezes et al., 2022).Schizophrenia and schizoaffective disorders.Medical conditions such as syphilis and HIV.Alcohol and substance use intoxication.Anxiety disorders

4.  What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?

Thyroid function tests.Complete blood count.Rapid plasma reagin (RPR).HIV test.Dexamethasone suppression tests (Menezes et al., 2022).Blood alcohol level and toxicology screen.Urea, electrolytes, and creatinine (UECs).Brain magnetic resonant imaging (MRI).

5.  What treatment options would you consider?  Include possible referrals and medications.

Pharmacotherapy using antidepressants such as:Selective serotonin receptor inhibitors such as fluoxetine.Serotonin-Noradrenaline receptor inhibitors such as venlafaxine (Karrouri et al., 2021).Tricyclic antidepressants such as amitriptyline.Monoamine oxidase inhibitors such as phenelzine.Psychotherapy methods such as:Cognitive-behavioral therapy (Karrouri et al., 2021)Interpersonal therapyProblem-solving therapyBehavioral activationElectroconvulsive therapy in patients who:Have failed drug response.Have high risk of suicide (Karrouri et al., 2021).Need high antidepressant response.

References

Christensen, M. C., Wong, C. M. J., &Baune, B. T. (2020). Symptoms of major depressive disorder and their impact on psychosocial functioning in the different phases of the disease: Do the perspectives of patients and healthcare providers differ? Frontiers In Psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280

NURS 6501 Knowledge Check Psychological Disorders
NURS 6501 Knowledge Check Psychological Disorders

Fernandes, M. D. S. V., Mendonça, C. R., da Silva, T. M. V., Noll, P. R. E. S., de Abreu, L. C., & Noll, M. (2023). Relationship between depression and quality of life among students: a systematic review and meta-analysis. Scientific Reports13(1), 6715. https://doi.org/10.1038/s41598-023-33584-3

Karrouri, R., Hammani, Z., Benjelloun, R., &Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World Journal of Clinical Cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350

Menezes, I. C., von Werne Baes, C., Fígaro-Drumond, F. V., Dias Macedo, B. B., Bueno, A. C., Lacchini, R., Feijó de Mello, M., de Castro, M., &Juruena, M. F. (2022). Differential diagnosis of major depressive disorder and bipolar disorder: Genetic and hormonal assessment and the influence of early-life stress. Brain Sciences, 12(11), 1476. https://doi.org/10.3390/brainsci12111476

Remes, O., Mendes, J. F., & Templeton, P. (2021). Biological, psychological, and social determinants of depression: a review of recent literature. Brain Sciences, 11(12), 1633. https://doi.org/10.3390/brainsci11121633

Tian, H., Hu, Z., Xu, J., & Wang, C. (2022). The molecular pathophysiology of depression and the new therapeutics. MedComm, 3(3), e156. https://doi.org/10.1002/mco2.156

Question 1

4 out of 4 points

CorrectScenario 1: Schizophrenia A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying. PMH:  noncontributory FH: positive for a first cousin who “had mental problems”. SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses. PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.  DIAGOSIS: schizophrenia.   Questions 1.     What are known characteristics of schizophrenia and relate those to this patient.  
Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function. 1-  Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur.

Delusions occur in most people with schizophrenia. 2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination. 3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad. 4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks.

Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. 5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure. Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.

In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution. Correct Answer: Correct  Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution. Response Feedback: [None Given]
NURS 6501 Knowledge Check Psychological Disorders
NURS 6501 Knowledge Check Psychological Disorders

Question 2

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CorrectScenario 1: Schizophrenia A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying. PMH:  noncontributory FH: positive for a first cousin who “had mental problems”. SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses. PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.  DIAGOSIS: schizophrenia.   Question: 1.     Genetics are sometimes attached to schizophrenia explain this.
Selected Answer: The causes of schizophrenia are not known. There are probably at least two sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biological relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes. However, the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way. Correct Answer: Correct  The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way. Response Feedback: [None Given]

Question 3

4 out of 4 points

CorrectScenario 1: Schizophrenia A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying. PMH:  noncontributory FH: positive for a first cousin who “had mental problems”. SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses. PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.  DIAGOSIS: schizophrenia.   Question: What roles do neurotransmitters play in the development of schizophrenia?
Selected Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine, and reserpine, were structurally different, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine. D2 neurons are antipsychotic, and drugs that stimulate these neurons (e.g., amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved. Correct Answer: Correct  Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block both dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.   Response Feedback: [None Given]

Question 4

4 out of 4 points

CorrectScenario 1: Schizophrenia A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying. PMH:  noncontributory FH: positive for a first cousin who “had mental problems”. SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses. PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.  DIAGOSIS: schizophrenia.   Questions: Explain what structural abnormalities are seen in people with schizophrenia.
Selected Answer: Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, and there is decreased brain volume in medial temporal areas and changes in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that two networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and left and right prefrontal and temporal lobe volumes in many people at high genetic risk for schizophrenia. The changes in the prefrontal lobes are associated with the increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included whole-brain volume loss in both gray and white matter and increases in lateral ventricular volume. Correct Answer: Correct  Advances in neuroimaging studies show differences between the brains of those with schizophrenia and those without this disorder. In people with schizophrenia, the ventricles are somewhat larger, there is decreased brain volume in medial temporal areas, and changes are seen in the hippocampus. Magnetic resonance imaging (MRI) studies show anatomic abnormalities in a network of neocortical and limbic regions and interconnecting white-matter tracts. Some studies using diffusion tensor imaging (DTI) to examine white matter found that 2 networks of white-matter tracts are reduced in schizophrenia. Brain imaging showed reductions in whole-brain volume and in left and right prefrontal and temporal lobe volumes in many people who are at high genetic risk for schizophrenia. The changes in prefrontal lobes are associated with increasing severity of psychotic symptoms. MRI studies of schizophrenic patients show that structural brain abnormalities may progress over time. The abnormalities identified included loss of whole-brain volume in both gray and white matter and increases in lateral ventricular volume. Response Feedback: [None Given]

Question 5

4 out of 4 points

CorrectScenario 2: Bipolar Disorder A 44-year-old female  came to the clinic today brought in by her husband. He notes that she has been with various states of depression and irritability over the past 3 months with extreme fatigue, has lost 20 pounds and has insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to “flit from one thing to another.”. She hasn’t slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity.  DIAGNOSIS: bipolar type 2 disorder.  Question 1.     How does genetics play in the development of bipolar 2 disorders?  
Selected Answer: The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies indicate that bipolar disorder has a significant genetic component. First-degree relatives of a person with bipolar disorder are approximately seven times more likely to develop bipolar disorder than the rest. The heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on chromosome 22, which confers susceptibility to schizophrenia. Given that, large variations in clinical symptoms still suggest that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders. Correct Answer: Correct  The pathophysiology of bipolar disorder, or manic-depressive illness (MDI), has not been fully identified, and there are no objective biologic markers that correspond definitively with the disease state. Twin, family, and adoption studies all indicate that bipolar disorder has a significant genetic component. Firstdegree relatives of a person with bipolar disorder are approximately 7 times more likely to develop bipolar disorder than the rest of the population, and the heritability of bipolar I disorder (BPI) has recently been estimated at 0.73. Bipolar individuals, who may exhibit psychotic behavior, have deficits in reelin expression linked to genetic loci located on the chromosome 22, which confers susceptibility to schizophrenia. Given that, there still are large variations in clinical symptoms suggests that developmental and environmental factors are as important as genetic factors in contributing to the etiology of mood disorders. Response Feedback: [None Given]