Understanding Psychotic Disorders- Altered Reality Abnormal Thinking and Symptomatology

Subjective:

CC (chief complaint): “I was forced to come in by my sister after my mom’s death because I have a persistent belief that government agents are surveilling me, disrupting my sleep, and attempting to poison my food.”

HPI: S.T., a 55-year-old Caucasian male, presents with a chief complaint of being compelled to seek psychiatric evaluation by his sister following their mother’s death. He describes persistent, distressing beliefs that government agents are surveilling him, disrupting his sleep, and attempting to poison his food. S.T. reports experiencing these symptoms for weeks, accompanied by auditory hallucinations and visual observations of shadowy figures outside his window. He links these phenomena to a government conspiracy aimed at inflating his taxes. Despite attempts to safeguard his well-being by locking up food, he perceives constant external threats. Sleep disturbance is evident, and S.T. expresses reluctance towards medications, citing adverse reactions to Haldol, Thorazine, and Risperidone in the past.

Substance Current Use: S.T. acknowledges daily caffeine consumption; however, the specific amount is not disclosed. He reports smoking heavily, amounting to three packs of cigarettes per day. While he admits to previous marijuana use, he claims abstinence from it since his mother’s passing three years ago. Alcohol intake consists of a daily 12-pack of beer supplied by his sister, with the last recorded consumption being yesterday. Despite this consistent use, S.T. denies any historical complications related to withdrawal, such as tremors, Delirium tremors, or seizures.

Medical History:

Current Medications: T. dislikes Haldol and Thorazine, citing a refusal to take them. Risperidone is rejected due to breast enlargement. However, Seroquel is acknowledged as tolerable. He, nevertheless, adamantly expresses skepticism about the medications, labeling them as “poison.” He denies the use of any over-the-counter or homeopathic products.

Allergies: No reported allergies to drugs, food, or environmental factors

Reproductive Hx: No reproductive history provided.

ROS:

GENERAL: Reports disrupted sleep patterns, feelings of constant surveillance, and paranoid delusions linked to external threats.

HEENT: Reports no headaches, head injuries, or discomfort. Denies visual disturbances, blurriness, or eye pain. No hearing loss, tinnitus, or ear pain was mentioned. No nasal congestion, sinus pain, or issues with smell were reported. Denies sore throat, difficulty swallowing, or voice changes.

SKIN: No skin abnormalities, rashes, or irritations were reported.

CARDIOVASCULAR: Denies chest pain, palpitations, or any cardiovascular symptoms.

RESPIRATORY: No respiratory difficulties, shortness of breath, or coughing reported.

GASTROINTESTINAL: No gastrointestinal issues or discomfort were mentioned.

GENITOURINARY: No specific genitourinary symptoms were disclosed.

NEUROLOGICAL: Reports auditory hallucinations, visual observations of shadowy figures, and delusional beliefs related to external surveillance.

MUSCULOSKELETAL: No musculoskeletal pain, joint complaints, or limitations in movement were reported.

HEMATOLOGIC: No excessive bleeding, easy bruising, or unusual fatigue.

LYMPHATICS: No swelling was reported.

ENDOCRINOLOGIC: Takes metformin for diabetes and mentions a fatty liver.

Objective:

Diagnostic results:

Metabolic Panel: To assess for metabolic imbalances or abnormalities contributing to psychiatric symptoms (Sadock et al., 2015).

Complete Blood Count (CBC): To evaluate for any hematologic conditions that could impact mental health (Sadock et al., 2015).

Liver Function Tests (LFTs): Given the reported use of metformin and the mention of a fatty liver, LFTs can help assess liver health (Sadock et al., 2015).

Thyroid Function Tests (TFTs): Thyroid dysfunction can manifest with psychiatric symptoms; TFTs aid in ruling out or identifying such conditions (Sadock et al., 2015).

Neuroimaging (MRI or C.T. Scan): To investigate potential structural brain abnormalities contributing to auditory hallucinations and delusions (Sadock et al., 2015).

Toxicology Screen: To identify any substance use that may be exacerbating or contributing to psychiatric symptoms (Sadock et al., 2015).

Psychiatric Ass