NR 507 PATHOPHYSIOLOGY WEEK 7 TD3 Behavioral, Neurologic, and Digestive Disorders Discussion Part Three (NR507)

Exam (elaborations) NR 507 PATHOPHYSIOLOGY WEEK 7 TD3 Behavioral, Neurologic, and Digestive Disorders Discussion Part Three (NR507) Discussion Part Three Disorders - Loading... This week's graded topics relate to the following Course Outcomes (COs). 1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1) 2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1) 3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7) 4 Distinguish risk factors associated with selected disease states. (PO 1) 5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1) 6 Distinguish risk factors associated with selected disease states. (PO 1) 7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4) Discussion A 19-year-old freshman in college has been brought to your office by campus security. The patient had been standing on top of the school chapel proclaiming that he was the prophet of God and that God was speaking to him. In fact he claimed to actually hear God’s voice. When he is in your office you notice that he is speaking very fast, can’t seem to sit still and his sentences at times don’t seem to make sense. He states, “I saw the professor sit on the ham sandwich and eat the raw calculus in his mind” • What is your differential diagnosis, how does it fit how might it not fit? • Based on the top of your differential what is the epidemiology of that disorder? Discussion Part Three (graded) Responses Lorna Durfee 6/14/2016 7:13:47 PM Discussion Part Three TAh 1e9 p-yaetiaern-to hlda dfr ebsehemn asnta innd cinogll eogne t ohpa so bf etheen sbcrhoouoglh ct htoa pyeolu prr oofcfliaciem biyn gc athmaptu hse s wecausr tihtye. hpreoapr hGeot do’fs G voodic aen. dW thheant hGeo ids wina ys osupre aokffiincge tyoo hui nmo. t iIcne ftahcatt, hhee icsl asipmeaedki ntog avcetruya flalys t, c“aI ns’atw se tehme ptoro sfiet ssstoilrl saint do nh itsh ese hnatemn cseasn dawt tiicmhe asn ddo ena’tt stheeem ra two mcaalkceu lsuesn isne .h Hise m sitnadte”s, What is your differential diagnosis, how does it fit how might it not fit? Based on the top of your differential what is the epidemiology of that disorder? Doctor Brown: My chosen differential is Differential #1: Schizophrenia. dMiscoCradnecr eth, aHt umetahneirf e&st sB irtassehlfe rws i(th2 0d1e4lu) seixopnlsa,i hna tlhluatc isncahtiizoonpsh, raenndi aa ibs rae aske vferorem e rmeaoltiitoyn. a l aTlh.,i s2 0d1is4o,r pd.e 1r 7re9s)u. l tTsh ien abuizthaorrres, rweliathted rthawatn r,e acnendt i sntaupdpieros phraiavtee sbheohwavni oasr s(oMcicaCtiaonncse et. rbeectewpeteonrs s (cMhiczCopahnrceen eiat. aanl,d 2 g0e1n4e,s p tph.a 1t 7h9a-v1e8 p0r)o. d Tuhctes rtehcaetp itnotresr aacrte wdyitshb ginludtianm, ate nDeIuSrCeg1u. l iEna 1ch, aonfd t hDe-saem hianso b aeceind soexeind aisne m acutlitvipalteo rp. o Apunloatthioenr ss uanscde rpetpibliicliattye dis. g Tehnee ekxnaocwt nm aetc thhains itsimmse w(MhiccCh amncueta etito. nals, i2n0 t1h4e, gpe. n1e8s0 c).ontribute to schizophrenia are not sAulsscoe, pTtiobhiyliatym gae, nMesiy haatav,e H baetetno rfio, uSnhdim iniz suc,h aiznodp Mhraetnsiuaz aankdi (m20a1jo5r) d reepproersts itohnat. s Tevheerya la re adcistirvuapttiendg- ipno-slycpheizpotipdher e(PniAa C1A (DP)I.S CT1h)e, fdiynsdbiningdsi nin a DndIS pCit1u iitsa rryel aatdeedn ytola ntee ucryacl lase- edleovnegloatpimone nptr odtierienc t1ly ( FvEiaZ t1h)e, aDdIhSeCsi1o-nb imndoilnegcu zliensc o-fri nthgee rp parrtonteerins o(Df DBIZS)C a1n.d Tkehnedyr ainre. dPeAvCelAopPm reegnut laanteds rneeguurlaalt edse tvheel ocpemnteronst.o mDayls mbiincdriont uibs uinlev onlevtwedo wrki tahn tdh feo nrmeuartailo n. The molecules that have been reviewed are involved in neural several neuropsychiatric disorders. Both DISC and DBZ are fdoeuvnedl oinp ment and aollsigoo edveinddernoccey ttheast a snudg gtheusst tihna rte dgiusltautribnagn oceli gino doelingdordoecnydter oacnydt ed idfefevreelnotpimatieonnt .a nTdh emrea jiosr depression (Tohyama et. al., 2015, p. 137). 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Tthhaet stwecoo nodf Cchriatnergieo nis A th sayt madpdtoitmiosn aalrley n, einc eCsrsiatreyri foonr Aan, ya n ihnadlliuvcidinuaatli omnuss, ta hnadv dei soonreg aonf itzherde es poef etchhe. p Toshietirvee m suysmt pbteo monse: ionfc tlhued ipnogs idtievlue ssiyomnsp, toms tcori steursitaa ilnis tae dre ilnia tbhlee DdiSagMn-o5s ifso or ft hsec hdiizaogpnhorseins ioa.f Tschhisiz poapthiernent ieax ahsi bpiotss itthivreee i onfd itchaet ors Ifno rt hthise pdaisrtoircduelra.r Tchasee d, ewteer mdoi nnaotito hna voef aa ldl itahgen roesqius iirse db aisnefdo romna ptiroonv isduecdh iansf opramsta tion. mmeodreic calle harislyto aryn,d p mhyosreic palr eecxiasemlyin aanti oancc, utersattse adniadg pnroosciesd. uI rweso uthlda tw caonutl dto h ienlvpe dsetilginaetea tteh e uHseo wofe vderur,g gs.i vIe wn othueld i naflsoorm liakteio tno pdreotevrimdeidn,e Ii fa mth ecreer tiasi ann tohtahte trh mis epdaitciaeln tc oisn dexithioibni.t ing the criteria for schizophrenia. What is the epidemiology of that disorder? iAnlctlhuodueg. h H thoeld qeur easntido nW daiydh nso (t2 i0n1c4lu),d eex tphlea ient itohlaotg gye, nI eftoicusn dh atvhea ta int wimaps oimrtapnotr rtaonlet tion the featimoliolyg yh iosfto srcyh oizfo ppshyrcehnoias.i s .H Towhee vvearr,i amtioosnts p iant igeenntse tdicos n footr hthavise d ainseya bsea chkagvreo unnodt boere n rcoolme.p lOettehleyr icdoennttriifbieudti.n gW fhaactt oirss p foosrs tihbele d iesv tehlaotp emnvenirto onfm secnhtiazlo fpahcrteonrisa c ionuclldu dhea vgero aw ing cuepn itnra al nn eurrvboauns a sreyas,t etmhe iunsfee cotifo mn ainri jcuhainldah, oinofde c(tHioonlds,e cr o&m Wpliacyahtiso, n2s0 i1n4 o, bps. t7e7tr5ic).s , and As for the epidemiology of schizophrenia, the Centers for Disease Prevention (2013) state that the worldwide estimates for Schizoph rCenoinat rroanl gane db etween 0B.y5 %th ea nadg e1 o%f .3 0M, e9n o huatv oef t1h0e mfiresnt ewpiilsl omdea naitf easbto, uatn d2 1w yoemaresn o wf ialgl eb,e w 2o omuet no fa g1e0 .2 7. tPhaatti etnhtes cwoistths socfh biozothp hdrierenciat caarree h aingdh nriosnk- fhoera sltuhi cciadree. c oInst sC taon bade ai,n a 2 s.0tu2d byi lelsiotanb liins hed aCnadn aCdainanad diaonll adrosl,l warist.h Ma toorttaall ictoys at nodf mapoprrboixdiimtya ltoeslys i6s. 845.8 b3i lbliiollnio inn itnh eC Uannaidteidan S dtaotlelsa rs. h eTahleth e ccaorneo pmroicv ibduerrdse ans iist gsruegagteesstt sd tuhrein nge ethde t ofi rhsat vyee aimr. p Trohvise dfi mndoinnigt oisri ncrgi tuicpaoln f oinr itial diagnosis (The Centers for Disease Control and Prevention, 2013). Differential #2: Bipolar Disorder. (Tfhoerm Caelnlyte krsn ofowrn D aiss emasaen iCc-odnetprorel sasnidv eP dreisvoerndteior)n i (s2 a0 1m3o)o sdta dteis tohradte Br wiphoelarer dai psoerrdsoenr can ierxrpitearbileen mceo eopdi swohdiecsh o mf daeyp prreessseionnt iatsnedl fm aasn ai as.e lMf-aasnsieas issm thene te olef vimatepdo,r tuannrcees tarnaidn ed and tghraatn sdeioemsit yto, rbaec ivnegr yth polueagshitnsg a. nHdo pwreesvseurr,e tdh esspee eacchti.v iTtihees cpaenrs boen tehnogsaeg tehsa ti nh aavctei vai thieigsh apnodte pnstiyacl hfootrh ceoranpseyq aureen ecfefse cthtiavte c iann t hbee tdreetartimmeenntt aolf. tJhuiss td liiskoer ddeerp r(eTshseio Cne, nmteerdsi cfaotri ons Disease Control and Prevention, 2013). Differential #3: Antisocial Personality Disorder. tBhlaatc iks (s2o0c1ia6l)l yd eirfriensepso annstiibsloec aianld p eexrspoloniatlaittiyv de.i s oTrhdeerre ( iAs SgPuDilt)l easss ab pehatatveironr otfh abte bheagviinosr icnri cmhiinldahliotyo da nadn dth me afaniilfuerset st ofu clolyn fboyr mla tteo 2th0es olarw e.a r Alyl s3o0,s t.h eTrhee i sb eahna ivniaobrisl iitnyc tlou dseu stain epmerpsolonyaml geanitn t,h aant dis t hceornes iisst ennot .a b Tilhitey p teor sdoenv eclaonp asltsaob leex rheilbaitti omnasnhiippus.l a tTiohne opfe rostohne rs for enxeghiabtiivtse nroes eumltsp aotfh tyh efo erx optehreiresn, caerse. n Toht ere umseo rosfe fthuel, wanodr dt hseoyc inoepvaethr yle iasr nth fer otemrm th ues ed tahloisn dgi wsoirtdhe arn ftoiscoucsieasl opne rosbosnearlvitayb dlei sboerhdaevr,i obru. t Pnosyt cahso opfatethny. fTahlles DinS tMhe- 5se cvreitreer ia for antisocial behavioral spectrum (Black, 2016). THheiasl tpha (t2ie0n1t6 i)s heaxsh idbeitteinrmg isnigends t hoaf ts scchhizizoopphhrreenniaia. iTs hae d Nisaotridoenra tlh Iants atiftfuetcet so fh oMwe nat al tpheirnsgosn twhailtl a trhei nnko,t fteheelr ea.n dT ahcety. cPaeno tphlien wk itthha tth pies odpisleo rrdeeard ctahne ihr emarin vdosi caensd a cnodn streoel ling tPheeo tphloe uwgihthts stchheiyz ohpahvree. n Tiah cea cna tna lfke ealb aosu tth woueigrhd saonmd esotrnaen gise pidlaenansi,n agn do nth heuyr thinavge t hgermea.t dhiaflfliuccuilntayt iionn csa, r rdyeilnugs ioonn sa, caonndv tehrosuatgihotn .d iTsohred epross. iTtivhee ys ycmanp htoamves dinifcfliucduelt;y with rmesopvoenmde tnot aannydo rneep.e aTt hcee rptaaitnie mntos twioinths .s cThhizeoyp charne nailas oc abnencootm uen cdaetrasttoannidc iannfodr nmoat tion awnedll h. a Tvhe eai rh warodr ktiimnge mmeamkionrgy dies cniosito wnso.r kTinhge yv ecrayn nwoet lfl,o acnuds athnedy p caayn antotet nutsieo na nvye ry iMnfeonrtmala Htioenal tghi,v 2en0 1to6 ) immediately after they learn it. (National Institute of This American Psychiatric Association (2013) made two changes Criteria for schizophrenia. The first change is the removal of the aftrtorimbu tthioe nD oSfM bi-zIVar re adreel ucsoionnvse rasnindg S).c hInne DidSeMria-nIV fi,r ostn-lrya nokn ea usdyimtoprtyo hma lwluacsi nnaeteidoends (totw mo eoert mthoer ree vqouiicreems tehnatt dwiaasg nuosestdi cbaelclya ufoser Cofr ittheer inoonn Asp, eincisftiecaidty o off t wScoh ontehiedre rliiastne dsy smymptpotmoms as.n dT thhies requirement uDnSrMeli-a5b, itlwityo ionf dCisrittienrgiuoins hAin sgy mbipzatorrme sf raorme n neocne-sbsaizrayr froe rd aenluys dioiang. n Tohsiesr eoffo re, in the smcuhsizt ohpahvree noinae. o Tf hthe rseeec oofn dth ceh paonsgieti vise tshyamt apdtodmitiso:n ianlclylu, dinin Cg rditeelruisoino nAs,, ahna lilnudciinvaidtiuoanls , raenldia dbilseo drgiaagnnizoesdis sopfe secchhi.z oTphherreen miau (sAt mbee roincea no fP sthyec hpioastritiicv Ae sssyomcipattoiomns, t2o0 s1u3s,t paipn. a2 -3). References American Psychiatric Association. (2013). Highlights and Changes from DSM-IVTR to DSM-5. Retrieved from 20to% Black, D. W. (2016). Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis. In T.W. Post (Ed.), UpToDate. Retrieved from epidemiology-clinical-manifestations-course-and-diagnosis? source=see_link Holder, S. D., & Wayhs, A. (2013). Schizophrenia. American Family Physician, 90 (11), 775-782. Jorde, L. B. (2014). Genes, environment-lifestyle, and common disease. In McCance, K. L., Huether, S. E., Brashers, V. L. (Eds.), Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp. 179-180). St. Louis, MO: Mosby. National Institute of Mental Health. (2016). Schizophrenia. Retrieved from 2015/ Sekar, A., Bialas, A. R., De Rivera, H., Davis, A., Hammond, T. R., Kamitaki, N., … McCarroll, S. A. (2016). Schizophrenia risk from complex variation of complement component 4. Nature, 530(7589), 177-183. doi:10.1038/nature16549 The Centers for Disease Control and Prevention. (2013). Bipolar Disorder. Retrieved from The Centers for Disease Control and Prevention. (2013). CDC - Burden of Mental Illness. Retrieved from The National Institutes of Health. (2016). A biological mechanism for schizophrenia. Retrieved from biological-mechanism-schizophrenia Tohyama, M., Miyata, S., Hattori, T., Shimizu, S., & Matsuzaki, S. (2015). Molecular basis of major psychiatric diseases such as schizophrenia and depression. Anat Sci Int, 90(3), 137-143. doi:10.1007/s12565-014-0269-3 Lanre Abawonse 6/16/2016 7:04:19 PM Discussion Part Three Schizophrenia Schizophrenia refers to a chronic, remitting and relapsing psychotic disorder that is associated with significant impairment in social and vocational functioning. This means that patients with schizophrenia have a split or separation among normally well synchronized brain functions. Negative symptoms have a profound effect on social functioning and quality of life (Esan, Ojagbemi, & Gureje, 2012). What causes these negative symptoms in schizophrenia patient is decreased neurotransmission and connectivity from a neurobiological standpoint. Bipolar disorder Bipolar disorder (BD) is a highly complex mood disorder characterized by recurring symptoms of depression and elation that can become severe enough to produce psychosis. The most recognizable course of illness with BD is the sudden onset. Onset usually occurs in early adulthood (Jann, 2014). In many cases of BD, mania ids the hallmark whereas the depressive phase puts a lot of burden on the patient. Borderline personality disorder Borderline personality disorder is one of the cluster B types of personality disorder (PD). It is seen as a pervasive pattern of instability of interpersonal relationship, self- image, and affects pattern of behavior. This is often marked by impulsivity, with diagnosis usually made in early adulthood (Bhome& Fridrich, 2015). Borderline personality disorder presents in a variety of contexts such as identity disturbance, marked by unstable self-image or sense of self. Also, transient, stress-related paranoid ideation or severe dissociative symptoms can be present. Substance induced psychosis Substance induced psychosis is usually brief and carries one criteria for symptomatic schizophrenia. The patient presents with hallucinations, delusions, disorganized speech or behavior for at least several hours to one day but usually less than a month. The disorder could be as a result of life changing event or stressful situation, which leads to unusual and seldom seen symptoms. Drugs can cause mental health problems and if a preexisting mental illness exits, drugs can exacerbate the symptoms of the disease (Weibell, Joa, Bramness, Johannessen, McGorry, Ten Velden Hegelstad, & Larsen, 2013). Based on the top of your differential what is the epidemiology of that disorder? The global incidence rate of schizophrenia has consistently been estimated to be about one percent of the world population and is fairly equally distributed across genders. Weinstein and Stovall (2015) stated that the age of onset is typically <30 years, earlier in males (early to mid-20s) than females (late 20s), with a smaller peak that occurs is seen in women >45 years. There is a lifetime (1%) higher prevalence in people of lower socioeconomic classes and urban centers. Unfortunately, schizophrenia appears to be associated with an average life span reduction of 15 to 25 years. Skikic and Stovall (2016) also contend that the age of onset is usually under the age of 30, with males being diagnosed