Differential Diagnosis and Plan for Treatment Sample Paper

The differential diagnosis I selected is schizoaffective disorder. This decision is owing to the fact that schizoaffective disorder is a mental health disorder presenting with a combination of schizophrenia symptoms, such as delusions or hallucinations, and mood disorder symptoms, such as mania or depression (Wy & Saadabadi, 2019). A.A has symptoms of auditory hallucinations since he complains of hearing voices even while at work, which distract him from his occupation. He also complains that he feels hopeless in some situations, driving him to be anti-social. A feeling of hopelessness is evident in major depression.

The primary aim of this diagnosis is to improve the quality of life of the patient by first establishing the pathology. Moreover, it is imperative to rule out other conditions that manifest with the same symptoms in order to arrive at the appropriate management strategy (Parker, 2019). Majority of persons with schizophrenia or schizoaffective disorder are at first misdiagnosed with major depression or bipolar disorder. Thus, my intention is to rule out other closely resembling conditions in order to zero down to the primary disorder affecting patient A.A.

The initial diagnosis for patient A.A is schizophrenia. Also, he has been on treatment for the same condition, with the medication olanzapine, 15 mg per oral daily and sequel 200 mg at night. Nonetheless, she complains of auditory hallucinations distracting her from work and feeling of hopelessness driving her to be anti-social.  Since she is on medication, she is not expected to experience auditory hallucinations, particularly if she is compliant. On the other hand, since the symptoms persist, the clinician is prompted to query the cause. Misdiagnosis is a probable cause why she is experiencing the symptoms even while on medication (Parker, 2019). Moreover, since in addition to the schizophrenic symptoms she has a feeling of hopelessness and anti-social drive, she is more likely to have schizoaffective disorder.

Treatment Plan for Psychotherapy

The first part of the psychotherapy comprised of individual counseling. The need for individual counseling cannot be overemphasized since it enabled the patient to better comprehend his condition. In addition, through individual counseling I was more able to offer support and guidance to patient A.A, particularly regarding his concerns (Potik, Moghrabi & Schreiber, 2020). He was concerned that the symptoms were driving him to leading an anti-social life. The counseling sessions allowed me to assist A.A on how to solve the difficulties facing his relationships or work.

Psychotherapy would be incomplete without cognitive behavioral therapy. Cognitive behavioral therapy aimed to guide A.A to develop positive thought patterns that would culminate in improved mental health. CBT is based on the principle that thought patterns affect the emotions that in turn affect behaviors (Potik et al., 2020). CBT assisted A.A to nurture positive thoughts, leading to more positive feelings and eventually positive behaviors. CBT involved the patient identifying specific problems/issues in his life. Under my guidance, A.A became aware of unproductive thought patterns and how they impacted his life. I then probed him to identify negative thinking in order to ultimately reshape it in a way changing his emotions. Finally, A.A. learnt new behaviors and how to put them into practice.

No differences were noted between my expectations and the actual achievement in patient A.A’s mental health. Individual counseling enabled him to embrace the condition without prejudice and without fear of discrimination or stigmatization. Accepting the condition was key to his prognosis since it foreshadowed his readiness to comply with the appropriate therapy (Green et al., 2019). Worth noting, after the cognitive behavioral therapy, A.A was in a better mood and gradually became sociable, engaging actively in social interactions and activities. His encouraging prognosis was directly attributable to the individual counseling and the cognitive behavioral therapy.

Treatment Plan for Psychopharmacology

The medication I prescribed for A.A. was paliperidone. Paliperidone is the only antipsychotic drug that the Food and Drug Administration specifically approves to manage schizoaffective disorder (Arndtzen & Sandlund, 2020). Nonetheless, other antipsychotic drugs such as olanzapine may manage the psychotic symptoms. Patient A.A was on paliperidone, intramuscular injection for sustained release, 234 mg in deltoid on the treatment day, then 156 mg 1 week later, followed by a maintenance dose of 234 mg in the gluteal muscle once monthly. Mood stabilizing medications were avoided in A.A since his schizoaffective disorder was not the bipolar type. Nonetheless, since he had a feeling of hopelessness and loneliness that are consistent with depression, sertraline was also prescribed, at a dose of 25 mg per oral four times in a day, which was gradually increased by 25 mg every 3 days until the dose was 200 mg four times in a day.

Paliperidone enabled patient A.A to calm down and effectively stopped the auditory hallucinations. My intention for prescribing paliperidone was primarily to relieve the symptoms associated with schizoaffective disorder (Huhn et al., 2021).  Sertraline relieved the feeling of hopelessness and loneliness and gradually A.A became engaging actively in social interactions. The primary goal of prescribing sertraline was to relieve the depressive symptoms, which proved to be successful.

Worth noting, the results achieved in patient A.A and my expectations were not different. A. A responded remarkably to the pharmacotherapeutic intervention. The ethical considerations involved in the treatment plan are diverse, owing to the debilitating nature of the condition. Since schizoaffective disorder affects the mental status of the patient, it was challenging for A.A to practice autonomy, which is an ethical principle in medical practice (Saya et al., 2019). Where the patient is unable to directly make decisions pertaining to his/her healthcare, a family member, often the next of kin is called upon to make the decision. However, A.A has never been in a relationship and had no kin to make the decision regarding his mental condition. Thus, the clinician had to intervene to improve the patient’s quality of life (Saya et al., 2019). Moreover, the clients’ families ought to know of the conditions affecting their kin, especially in mental illness. The families should also be notified of the treatment, which is done in family therapy.

References

  • Arndtzén, M., & Sandlund, M. (2020). To live with a Schizoaffective disorder. Journal of Psychiatric and Mental Health Nursing, (). https://doi.org/10.1111/jpm.12708
  • Saya, A., Brugnoli, C., Piazzi, G., Liberato, D., Di Ciaccia, G., Niolu, C. & Siracusano, A. (2019). Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Frontiers in Psychiatry, 10(), 271–. doi:10.3389/fpsyt.2019.00271
  • Huhn, M., Leucht, C., Rothe, P., Dold, M., Heres, S., Bornschein, S., Schneider-Axmann, T., Hasan, A. & Leucht, S. (2020). Reducing antipsychotic drugs in stable patients with chronic schizophrenia or schizoaffective disorder: a randomized controlled pilot trial. European Archives of Psychiatry and Clinical Neuroscience, 271(2), 293-302. doi:10.1007/s00406-020-01109-y
  • Green, A., Stephenson, T., Whiskey, E., & Shergill, S. (2019). Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis. BJPsych Open, 5(3), E43. doi:10.1192/bjo.2019.31
  • Parker, G. (2019). How well does the DSM-5 capture schizoaffective disorder? The Canadian Journal of Psychiatry, 64(9), 607610. https://doi.org/10.1177%2F0706743719856845
  • Potik, D., Moghrabi, F., & Schreiber, S. (2020). Case Report: Pharmacotherapy and EMDR Psychotherapy as an Effective Treatment for OCD Imagery in a Patient with a Psychotic Disorder. Israel Journal of Psychiatry, 57(1).
  • Wy, T. J. P., & Saadabadi, A. (2019). Schizoaffective Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541012/