Case Study: Jason

Introduction

This case study is of a 28-year-old male who has been transferred from the psychiatric unit to the acute hospital after three episodes of tonic-clonic seizure with subsequent altered conscious state. The purpose of the study is to provide details of the presenting problem, the health assessment, a critical evaluation of diagnostic investigations, clinical manifestations, aetiology and pathophysiology, interventions, and relevant evaluations.

Patient Demographics and History

Jason is a 28-year-old male with diagnosed schizophrenia. He lives with his parents and one older sister and has very good social support from his family. There is no primary family history of mental illness. Jason was a preterm baby (34 weeks) and has since been diagnosed with psychogenic polydipsia diagnosed after his most recent hospital admission.

Jason presented with seizures, and was transferred from the psychiatric unit to the acute hospital after three episodes of tonic-clonic seizure with subsequent altered conscious state. However, four days prior to the seizures, Jason had been feeling unwell with nausea, vomiting and lethargy. Jason had also appeared agitated, confused, disoriented, and unsteady on his feet, and held his head as if in pain and intermittently staring into space. Doctors focused on his pre-existing condition of schizophrenia, but are now concerned a co-morbidity of delirium may have been the cause of the recent health issue. This fear was based on the fact that 7 days ago Jason had presented with severe acute hyponatraemia [Serum Na+ 104mmol/L] which was corrected using hypertonic saline over a period of around 28 hours when his Serum Na+ reached 135mmol/L. Three days later, Jason developed acute psychotic symptoms, and was transferred to the psychiatric unit for ongoing management of his schizophrenia.Jason had been prescribed risperidone until recent admission for hyponatraemia; now he is on clozapine.

Health Assessment and Clinical Manifestations

Upon assessment, it is important to consider the presenting problem in its entirety. In the case of Jason, who is presenting with tonic-clonic seizure, severe acute hyponatraemia, and acute psychotic symptoms, a comprehensive physical examination is warranted. Assessment began by taking note of Jasons initial vital signs. It was found that Jasons temperature was 37.6 degrees Celsius, his blood pressure was 115/60, his heart rate was 91 beats per minute, and his respiratory rate was 22 breaths per minute. His oxygen saturation levels were good at 99% on room air, and his Glasgow Coma Scale score was 10. It was also noted that Jason had increased muscle tone throughout his limbs. Based on these findings, doctors could formulate a plan of action to further assess and treat there patient.

There are a number of approaches and techniques that could be used when undertaking a physical assessment for someone who is presenting with tonic-clonic seizure, severe acute hyponatraemia, and acute psychotic symptoms. One approach is to use the Glasgow Coma Scale (GCS) (Singh et al., 2019). This scale is a common tool used to assess someone's level of consciousness. For someone who is presenting with tonic-clonic seizure, the GCS may be used to determine the severity of the seizure and to identify any associated neurological deficits (Pruitt et al., 2019). In addition, the GCS can also be used to assess for acute psychotic symptoms, such as delusions or hallucinations (Khalid et al., 2021). Another approach that can be used is to perform a detailed physical examination. This examination can help to identify any physical abnormalities that may be causing or contributing to the person's presentation. This was done in Jasons case with regard to finding muscle tone heightened in limbs. Finally, laboratory tests can also be helpful in assessing someone with tonic-clonic seizure, severe acute hyponatraemia, and acute psychotic symptoms. These tests can help to rule out other potential causes of the persons presentation and to provide information about the severity of the person's condition (Bazmi et al., 2020).

There are several objective and subjective clinical manifestations that could be expected in someone presenting with tonic-clonic seizure, severe acute hyponatraemia, and acute psychotic symptoms. For example, seizure activity would likely be noted on EEG, and the patient may exhibit impaired cognition, catch their breath during the seizure or have a brief loss of consciousness. In addition, they may report subjective symptoms such as auras or fear (Braatz et al., 2021). A patient with severe acute hyponatraemia may have symptoms of delirium, seizures or coma, while those with acute psychotic symptoms may exhibit disorganized thinking, hallucinations or delusions (Adrogue et al., 2022). All of these manifestations would need to be taken into account in order to properly diagnose and treat the patient.

The diagnostic investigations were significant for the following findings: tonic-clonic seizure, severe acute hyponatraemia, acute psychotic symptoms, and a Glasgow Coma Scale score of 10. These findings are consistent with a diagnosis of psychogenic polydipsia. The patient's history of psychiatric problems and use of antipsychotic medications likely contributed to the development of this condition. However, it is unclear whether risperidone or clozapine are factors in the onset of Jasons symptoms, as either medication could be an agent destabilization (Kumar & Kukreti, 2020). Both are atypical antipsychotic medications commonly used to treat schizophrenia, but adverse effects can be seen in some patients (Kumar & Kukreti, 2020).

Further clinical assessments/diagnostic investigations that should be conducted ought to include: a brain MRI to assess level of normal brain activity; an EEG to assess whether there is any evidence of generalized slowing. A lumbar puncture would show whether there is elevated intracranial pressure. A CT scan of the head would show whether there is any evidence of mass lesions or hydrocephalus (Helms et al., 2020). The patient should in te meantime be treated with intravenous fluids, antiepileptic medication, and a course of steroids. The patients condition should be monitored for improvement pending further investigation.

Aetiology and Pathophysiology

The terms aetiology and pathophysiology are often used interchangeably, but they actually refer to two different concepts. Aetiology refers to the underlying cause of a disease or condition, while pathophysiology refers to the changes that occur in the body as a result of the disease or condition. In other words, aetiology is concerned with what causes a disease, while pathophysiology is concerned with how the disease manifests.

In other words, pathophysiology can be used to better understand the progression of a disease and to develop treatment strategies. A better understanding of aetiology can help to prevent diseases from developing in the first place. Therefore, both concepts are important in medical research and practice. By understanding...…et al., 2020).

For Jason, the patients medication should be adjusted as it is likely impacting his regulation of sodium levels, which could be the cause of the latest clinical symptoms of severe acute hyponatraemia and possible central pontine myelinolysis (Yang et al., 2018). Clozapine is a relevant pharmacological intervention that can be used to help treat psychogenic polydipsia (Ahmadi & Goldman, 2020). Thus, the pharmacological intervention should be recommended, but monitored..

Because Jason lives at home and has a strong support system with his family, it is not evident that any other intervention is needed at this time. This is not a new diagnosis (schizophrenia) and the complication that has arisen has a likely evident cause linking back to medication and lack of monitoring of sodium. Some health literacy could be provided on this matter to aid in the monitoring of Jasons health in the future. Health literacy is the ability to read, understand, and use health information in order to make informed decisions about one's health (Riebschleger et al., 2019). For parents of children with schizophrenia, monitoring sodium levels is an important part of maintaining their child's health.

When a young adult is diagnosed with severe acute hyponatraemia and possible central pontine myelinolysis, their parents may require psychosocial referral/support (Young et al., 2019). The diagnosis can be overwhelming and have a significant impact on the family, so it is important that they have access to resources and supports. Some referrals that may be beneficial for parents include counselling, support groups, and therapy (Young et al., 2019). These services can help parents to cope with the diagnosis, manage stress and anxiety, and provide practical guidance. In addition, psychosocial support can help to build a strong support system for the family. By accessing these services, parents can ensure that they are well-equipped to care for their young adult with schizophrenia (Young et al., 2019).

The clinical evaluation of a patient with severe acute hyponatraemia should include assessments of serum electrolyte levels, serum osmolality, urine output, and central nervous system function (Fernandez Martinez et al., 2019). Interventions for severe acute hyponatraemia should be directed at correcting the underlying cause and managing the symptoms. Close monitoring is essential in order to identify any developing complications, such as central pontine myelinolysis (Sindahl et al., 2020). Early diagnosis and treatment of central pontine myelinolysis is critical to preventing permanent neurological damage.

Conclusion

Jason is a 28-year-old male with diagnosed schizophrenia, who lives with his parents and one older sister and has very good social support from his family. Jason presented with seizures and altered conscious state. He also experienced severe acute hyponatraemia in the week prior, and medication was adjusted once sodium levels had balanced out. However, it is now believed that Jason is experiencing severe acute hyponatraemia with possible central pontine myelinolysis. Assessment began by taking note of Jasons initial vital signs. The diagnostic investigations indicated tonic-clonic seizure, severe acute hyponatraemia, acute psychotic symptoms, and with a Glasgow Coma Scale score of 10, these findings were consistent with a diagnosis of psychogenic polydipsia. Clozapine is a relevant pharmacological intervention that can be used to help treat psychogenic polydipsia (Ahmadi & Goldman, 2020). All other interventions in this case should be directed at correcting…