CASE STUDY: SCHIZOPHRENIA

By: Kelly Tran

CONSIDER THE FOLLOWING INDIVIDUAL

Jeremy, a 21-year-old male, works part-time delivering pizza. Upon arriving at a customer’s house, he has extreme difficulty deciding whether to ring the doorbell or knock on the door. After a couple minutes, he rings the doorbell. A woman opens the door, pulls out her wallet, and asks Jeremy the cost of the order. He doesn’t hear her because he is focused on a eerie silhouette in a brightly lit corner of her house. A voice repeatedly tells him to grab her wallet and run. The woman hands him a $50 bill and tells him to keep the change. Jeremy is able to focus on his job again and quickly departs. This is the fourth time Jeremy has experienced this since beginning his job three months ago.

YOUR TURN

What is your initial diagnosis for Jeremy?

Which tests would you perform to confirm your

diagnosis?

DIAGNOSIS

• A physical exam was performed and ruled out conditions harboring similar symptoms, such as seizure disorders, metabolic disorders, thyroid dysfunction, and brain tumors.

• Various tests and screenings were done to pinpoint causes that may have been induced by drug and alcohol use. Results were negative.

• Diagnosis of schizophrenia was made by a psychiatrist. Jeremy’s mental status was checked through questions about his thoughts, moods, delusions, hallucinations, and violent/suicidal urges.

QUICK OVERVIEW

MECHANISM

• Although an exact mechanism is not known, there are multiple hypotheses that attempt to explain the causes behind schizophrenia.

DOPAMINE HYPOTHESIS• Argues that a patient’s unorthodox behavior is

caused by an excess amount of dopamine receptors at the post-synaptic membrane of their neurons.

• Evidence comes from studies of numerous schizophrenic patients compared to healthy patients• Schizophrenics are more sensitive to dopamine

uptake, have different volumes of grey matter in their brains (which are linked to dopamine sensitivity), and experience less symptoms when dopamine receptors are blocked

PRUNING HYPOTHESIS

• Based on the observation that schizophrenia tends to run in families• A group at Harvard Medical School examined the C4 gene, which codes for

complement component 4, because it has the strongest ties to schizophrenia. (C4 is part of the immune system pathway that eliminates pathogens and cell debris.)• Found that C4 was expressed at much higher levels in schizophrenic patients,

especially at synapses• Concluded that C4 is likely involved with promotion of synaptic pruning• Recurrent synaptic pruning can largely impair mental function, which may explain

schizophrenic behavior

TREATMENT

• Schizophrenia requires a lifetime of treatment, even when symptoms lessen• Usually administered and guided by a psychiatrist, possibly along with a

psychologist, social worker, or case manager• Antipsychotic medications that regulate dopamine are usually prescribed

• Antidepressants and anti-anxiety medication may also be prescribed• Various therapy sessions may also be conducted to help focus on learning

how to cope with stress, identifying signs of relapse, and improving communication among friends and family

REFERENCES

• A biological mechanism for schizophrenia. (2016, February 2). Retrieved December 19, 2016, from https://www.nih.gov/news-events/nih-research-matters/biological-mechanism-schizophrenia

• Schizophrenia. (2016, October 11). Retrieved December 19, 2016, from http://www.mayoclinic.org/diseases-conditions/schizophrenia/home/ovc-20253194

• Schizophrenia explanations. (2016). Retrieved December 19, 2016, from http://flipped.gardenpsychology.co.uk/a2-psychology/a2-class-resources/clinical/clinical-content/schizophrenia-explanations/