Sally is a young girl suffering from schizophrenia. Schizophrenia is a psychotic disorder, or a group of disorders represented by a severe impairment of individual thought process, and behavior (TheFreeDictionary, 2012). According to Meyer, Chapman, and Weaver (2009) “it may be more accurate to refer to schizophrenia as a family of disorders rather than a singular disorder.” (p. 90). Untreated patients suffering from schizophrenia are normally unable to filter various sensory stimuli, and exhibit enhanced perception of color, sound, and other environmental factors. In most cases, a patient suffering from schizophrenia will gradually withdraw from personal interactions, and loose the ability to care for his or her individual basic needs (TheFreeDictionary, 2012). Schizophrenia is considered to be one of the top ten illnesses resulting in long-term disability, and accounts estimate that approximately 1% of the world population is affected by the illness (TheFreeDictionary, 2012).
The following analysis is designed to provide and analysis of the patient’s history, and events that resulted in her hospitalization. The analysis will provide the specifics of the patient’s biological, behavioral, cognitive, and emotional components that factor into her illness.
Schizophrenia includes three different subtype, and two over subtypes. The main subtypes include the classifications of paranoid, disorganized, and catatonic, and each of these subtypes displays unique characteristics or symptoms (Hansell, & Damour, 2008). Patients suffering from paranoid schizophrenia will usually display symptoms of hallucinations or delusions. Patients suffering from disorganized schizophrenia are subject to an inappropriate effect, and disorganized speech patterns. Patients suffering from catatonic schizophrenia display symptoms of strange or bizarre sensory motor function (Hansell, & Damour, 2008). Individuals who display symptoms of schizophrenia but lack any symptoms of the three primary classifications are likely to be diagnosed into one of two alternate classifications: residual or undifferentiated schizophrenia (Hansell, & Damour, 2008). Symptoms of schizophrenia are classified into two primary categories. These two categories relate to positive and negative symptoms. Patients displaying positive symptoms exhibit pathological excesses including hallucinations, irrational thinking, and irrational behaviors, whereas patients displaying negative symptoms will exhibit pathological deficits including withdrawal and isolation from social interactions, and poverty of speech capabilities ((Hansell, & Damour, 2008).
Schizophrenia is a complex illness that affects both men and women on an equal level. The illness usually starts around the age of ten, or in young adulthood. However, cases of childhood-onset schizophrenia indicates that the illness can start as young as five years of age. This is a more rare case of schizophrenia that can difficult to diagnose in relation to other childhood developmental problems (PubMedHealth, 2012). While researchers have yet to discover the cause of schizophrenia, many suspect genetics to be a major contributor (PubMedHealth, 20120).
The patient’s case study indicates that she has a history of eccentricity. Medical notations indicate that the patent's mother was an avid smoker, consuming approximately two packs of cigarets daily before and during pregnancy. Further notations include that the patient’s mother suffered from a very severe case of the flue during her fifth month of pregnancy. As a child, the patient showed signs of slower developmental skills, and was diagnosed as suffering from hyperactivity in early childhood. Records indicate that the patient experienced a turbulent home life because of ongoing conflicts between her parents that resulted in separation, and reconciliation. Because of her apparent developmental disabilities, her parents devoted time to the patient however, the patient did receive criticism from her father for her behavioral dysfunctions.
As the patient matured, she displayed signs of being socially awkward and isolated from her peers, and in early adulthood started to display worsening symptoms like talking to herself, and displaying unusual behavior like stating at the floor for long periods. Her first documented schizophrenia episode requiring hospitalization occurred shortly after the additional symptoms started to be displayed. During her examination, the patient displayed signs of unresponsiveness, and waxy flexibility that allowed her limbs to be easily positioned (Meyer, Chapman, & Weaver, 2009). After the initial hospitalization, the patient was returned home to facilitate a quicker recovery. that was short lived because the patient failed to follow the prescribed treatment regimen which, resulted in a secondary episode shortly after her return to college. Further home-based treatments proved unsuccessful as the patient slowly declined, resulting in unresponsiveness, and displaying hebephrenic symptoms like unprovoked giggling, and rocking movements (Meyer, Chapman, & Weaver, 2009).
The patient’s second hospitalization and treatments started to show positive results, and she was taken back to her home environment. She was able to obtain a part-time position at work, and maintain daily household chores. However, the patient failed to follow the prescribed treatment regimen. Following the death of her father, and additional stressors resulting from her mother’s added dependency, the patient suffered from a third regression of the illness. Her third hospitalization resulted from local law officials discovering her walking in a local pond while incoherently mumbling to herself.
Components of the Schizophrenic Episodes
The primary component of the patient’s episodes appear to be related to stress as the primary factor. However, biological factors resulting from her mother’s illness and smoking during pregnancy, and a genetic predisposition related to her grandfather's eccentricity are viable underlying factors resulting in the patient’s illness. In addition to the primary stressor, and the underlying genetic and biological factors, it is possible that the emotions of the patient also contributed to her condition. Further documentation indicates that interfamilial expressed emotion, and communication deviance are probably contributors that appear to be operative in the patient’s case (Meyer, Chapman, & Weaver, 2009). The first of these factors, expressed emotion would be explained by the turbulent relationship, combined with her mother’s over protective nature conflicting with her father’s over critical reactions to the patient’s behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors, communication deviance resulted from the patient’s inability to focus and maintain normal dialog with others (Meyer, Chapman, & Weaver, 2009).
Cognitive factors are a viable consideration for this patient’s case. Meyer, Chapman, and Weaver (2009) suggest that prodomal pruning theory may be one example of a cognitive factor. Prodomal pruning theory suggests that the human brain deletes unnecessary synapses to allow the brain to function properly during the change from adolescence to adulthood (Meyer, Chapman, & Weaver, 2009). Behavior is another factor relating to the patient’s repeated hospitalization. The patient displayed behavior deficiencies in regard to compliance to prescribed treatment regimens, and involvement in situations that could produce high level stressors in her life.
Because illnesses like schizophrenia relate to various and different factors, each person effected by the illness will show differences in ability to function in a normal environment. The various classifications of schizophrenia, ability to receive treatments, and the consideration of various influences and base-line factors help researchers determine what classification a patient falls into. In this particular case, the patient displays symptoms of catatonic schizophrenia. She is able to function in environments that do not produce high levels of demand or stress on the individual. However, the underlying assumptions would indicate that the combination of outlined biological, emotional, cognitive, and behavioral were in-place, and waiting for the appropriate stressor to trigger her symptoms.
b.Emotional Factors - Interfamilial Expressed, Emotion, Communication Deviance
d.Behavioral Factors - Lack of Treatment, High Stress Activities
1. Davenport TE, Watts HG, Kulig K, Resnik C. Current status and correlates of physicians' referral diagnosis for physical therapy. J Orthop Sport Phys Ther. 2005;35:572–9. doi: 10.2519/jospt.2005.2050. [PubMed]
2. Ehrmann-Feldman D, Rossignol M, Abenhaim L, Gobeille D. Physician referral to physical therapy in a cohort of workers compensated for low back pain. Phys Ther. 1996;76:150–7.[PubMed]
3. Wong WP, Galley P, Sheehan M. Changes in medical referrals to an outpatient physical therapy department. Aust J Physiother. 1994;40:9–14.[PubMed]
4. Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining the clinical practice of primary contact physical therapy. J Orthop Sport Phys Ther. 2004;34:284–304. doi: 10.2519/jospt.2004.1298. [PubMed]
5. Murphy BP, Greathouse D, Matsui I. Primary care physical therapy practice models. J Orthop Sport Phys Ther. 2005;35:699–707. doi: 10.2519/jospt.2005.2167. [PubMed]
6. World Health Organization. International Classification of Function, Disability and Health (ICF) [cited 2010 Jan 11]. Available from: http://www.who.int/classifications/icf/en/
7. Haggman S, Maher CG, Rafshauge KM. Screening for symptoms of depression by physical therapists managing low back pain. Phys Ther. 2004;84:1157–66.[PubMed]
8. Friedrich M, Hahne J, Wapner F. A controlled examination of medical and psychosocial factors associated with low back pain in combination with widespread musculoskeletal pain. Phys Ther. 2009;89:786–803.[PubMed]
9. Linton SJ. A review of psychological risk factors in back and neck pain. Spine. 2000;25:1148–56.[PubMed]
10. Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine. 1995;20:722–8. doi: 10.1097/00007632-199503150-00014. [PubMed]
11. Few CD, Davenport TE, Watts HG. A hypothesis-oriented algorithm for symptom-based diagnosis by physical therapists: description and case series. Orthop Pract. 2007;19:72–9.
12. Farrar JT, Young JP, La Moreaux L, Werth JL, Poole M. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58. doi: 10.1016/S0304-3959(01)00349-9. [PubMed]
13. Cole B, Finch E, Gowland C, Mayo N. Physical rehabilitation outcome measures. Baltimore: Williams & Wilkins; 1995.
14. Magee DJ. Orthopedic physical assessment. 3rd ed. Philadelphia: W.B. Saunders; 1997.
15. Fedorak C, Ashworth N, Marshall J, Paull H. Reliability of the visual assessment of cervical and lumbar lordosis: how good are we? Spine. 2003;28:1857–9. doi: 10.1097/01.BRS.0000083281.48923.BD. [PubMed]
16. Lewis J, Green A, Reichard Z, Wright C. Scapular position: the validity of skin surface palpation. Man Ther. 2002;7:26–30. doi: 10.1054/math.2001.0405. [PubMed]
17. Hislop HJ, Montgomery J. Muscle testing. 6th ed. Philadelphia: W.B. Saunders; 1995.
18. Cuthbert SC, Goodheart GJ. On the reliability and validity of manual muscle testing: a literature review. [cited 2010 Jul 8];Chiropr Osteopat. 2007 Mar;15(4):23. doi: 10.1186/1746-1340-15-4. [PMC free article][PubMed]
19. Hoppenfeld S. Physical examination of the spine and extremities. New York: Prentice-Hall; 1976.
20. Cools AM, Cambier D, Witvrouw EE. Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Brit J Sport Med. 2008;42:628–35. doi: 10.1136/bjsm.2008.048074. [PubMed]
21. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Brit J Sport Med. 2008;42:80–92. doi: 10.1136/bjsm.2007.038406. [PubMed]
22. First MB. Diagnostic and statistical manual of mental health text revisions. 4th ed. Washington: American Psychiatric Association; 2000. [DSM-IV-TR]
23. Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Brit J Psychiatr. 1998;172:35–7. doi: 10.1192/bjp.172.1.35. [PubMed]
24. Stephens JH, Richard P, McHugh PR. Suicide in patients hospitalized for schizophrenia: 1913–1940. J Nerv Ment Dis. 1999;187:10–4.[PubMed]
25. Varma VK, Wig NN, Phookun HR, Misra AK, Khare CB, Tripathi BM, et al. First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology. Acta Psychiatr Scand. 2007;96:431–8. doi: 10.1111/j.1600-0447.1997.tb09944.x. [PubMed]
26. Nasrallah HA, Tolbert HA. Neurobiology and neuroplasticity in schizophrenia: continuity across the life cycle. Arch Gen Psychiatr. 1997;54:913–4.[PubMed]
27. Fuchs J, Steinert T. Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psych Psych Epid. 2004;39:375–80. doi: 10.1007/s00127-004-0767-z. [PubMed]
28. Verdoux H, Cougnard A, Grolleau S, Besson R, Delcroix F. A survey of general practitioners' knowledge of symptoms and epidemiology of schizophrenia. Eur Psychiatr. 2005;21:238–44. doi: 10.1016/j.eurpsy.2005.05.013. [PubMed]
29. Twang MT, Kendler KK, Gruenberg AM. DSM-III schizophrenia: is there evidence for familial transmission? Acta Psychiatr Scand. 1985;71(Suppl 1):77–83. doi: 10.1111/j.1600-0447.1985.tb08524.x. [PubMed]
30. Husted JA, Greenwood CM, Bassett AM. Heritability of schizophrenia and major affective disorders as a function of age, in the presence of strong cohort effect. Eur Arch Psychiatr Neurol Sci. 2006;256:222–9. doi: 10.1007/s00406-005-0629-z. [PMC free article][PubMed]
31. Verdoux H, Geddes JR, Takei N, Lawrie SM, Bovet P, Eagles JM, et al. Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data. Am J Psychiatr. 1997;154:1220–7.[PubMed]
32. AbdelMalik P, Husted J, Chow EW, Bassett AS. Childhood head injury and expression of schizophrenia in multiply affected families. Arch Gen Psychiatr. 2003;60:231–6. doi: 10.1001/archpsyc.60.3.231. [PMC free article][PubMed]
33. Chabungbam G, Avasthi A, Sharan P. Sociodemographic and clinical factors associated with relapse in schizophrenia. Psychiatr Clin Neurosci. 2006;61:587–93.[PubMed]
34. Phillips LJ, Mcgorry PD, Garner B, Thompson KN, Pantelis C, Wood SJ, et al. Stress, the hippocampus and the hypothalamic-pituitary-adrenal axis: implications for the development of psychotic disorders. Aust NZ J Psychiatr. 2006;40:725–41. doi: 10.1111/j.1440-1614.2006.01877.x. [PubMed]
35. Lawrie SM, Abukmeil SS. Brain abnormalities in schizophrenia: a systematic and quantitative review of volumetric magnetic resonance imaging studies. Brit J Psychiatr. 1998;72:110–20. doi: 10.1192/bjp.172.2.110. [PubMed]
36. James AC, James S, Smith DM, Javaloyes A. Cerebellar, prefrontal cortex, and thalamic volumes over two time points in adolescent-onset schizophrenia. Am J Psychiatr. 2004;161:1023–9. doi: 10.1176/appi.ajp.161.6.1023. [PubMed]
37. Ferrari MC, Kimura L, Nita LM, Elkis H. Structural brain abnormalities in early-onset schizophrenia. Arq Neuropsiquiatr. 2006;64:741–6. doi: 10.1590/S0004-282X2006000500008. [PubMed]
38. Weyerer S. Detection of psychiatric diseases in general practice: results from Germany. Gesundheitswesen. 1996;58(Suppl 1):68–71.[PubMed]
39. Troyer MR. Differential diagnosis of endometriosis in a young adult woman with nonspecific low back pain. Phys Ther. 2007;87:801–10. doi: 10.2522/ptj.20060141. [PubMed]
40. Alnwick GM. Misdiagnosis of serotonin syndrome as fibromyalgia and the role of physical therapy. Phys Ther. 2008;88:757–65.[PubMed]
41. Ross MD, Cheeks JM. Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma. Phys Ther. 2008;88:98–104. doi: 10.2522/ptj.20070033. [PubMed]
42. Farrell JL, Goebert DA. Collaboration between psychiatrists and clergy in recognizing and treating serious mental illness. Psychiatr Serv. 2008;59:437–40. doi: 10.1176/appi.ps.59.4.437. [PubMed]
43. Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T. Pathways to psychiatric care in Eastern Europe. Brit J Psychiatr. 2005;186:529–35. doi: 10.1192/bjp.186.6.529. [PubMed]
44. Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H, et al. Pathways to care of first-admitted subjects with psychosis in south-western France. Psychol Med. 2004;34:267–76. doi: 10.1017/S003329170300120X. [PubMed]
45. Addington J, Van Mastrigt S, Hutchinson J, Addington D. Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand. 2002;106:358–64. doi: 10.1034/j.1600-0447.2002.02004.x. [PubMed]
46. Guccione AA. Physical therapy diagnosis and the relationship between impairments and function. Phys Ther. 1991;71:499–503.[PubMed]
47. Verdoux H, Cougnard A, Grolleau S, Besson R, Delcroix F. How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? Soc Psych Psych Epid. 2005;40:892–8. doi: 10.1007/s00127-005-0975-1. [PubMed]
48. Hodges B, Inch C, Silver I. Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950–2000: a review. Am J Psychiatr. 2001;158:1579–86. doi: 10.1176/appi.ajp.158.10.1579. [PubMed]