This clinical case study examines BA, a 36-year-old African American woman admitted to a psychiatric emergency setting presenting with chest pain, shortness of breath, suicidal ideation, and bizarre behavior. Drawing on DSM-5 criteria, the paper establishes diagnoses of schizoaffective disorder, suicidal ideation, and potential delusional disorder, and discusses their etiology and epidemiology. The paper outlines a comprehensive, multidisciplinary treatment plan incorporating aripiprazole (Abilify), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT). It further describes session-level implementation strategies, evaluates progress indicators from an Advanced Practice Nurse perspective, and reflects on alternative approaches such as earlier family therapy and neurological consultation given the patient's history of traumatic brain injury.
The paper effectively uses case-based reasoning — anchoring every clinical recommendation to observed patient behavior, established diagnostic criteria, and cited literature. This technique, common in graduate nursing and medical education, shows how abstract diagnostic categories apply to a real patient presentation, and it models the kind of documented clinical judgment expected in advanced practice settings.
The paper opens with patient presentation and demographics, then moves through diagnosis (with separate subsections for schizoaffective disorder, suicidal ideation, and delusional disorder), treatment planning, session-level implementation, APN evaluation, reflective commentary, and a psychopharmacology rationale before concluding. This mirrors a formal psychiatric case formulation report, making it a useful model for graduate-level clinical writing assignments.
This assessment examines the case of BA, an individual presenting with symptoms spanning mood disturbances, psychotic experiences, and potential delusional beliefs. This evaluation discusses BA's diagnoses, the underlying etiology, and the most effective treatment modalities. It also considers the significance of her personal history and clinical presentation.
BA is a 36-year-old African American woman who was admitted to the medical emergency room (MER) with chief complaints of chest pain and shortness of breath (SOB). Additionally, she exhibited signs of mental distress, verbalizing suicidal ideations and displaying bizarre behavior while in the MER. Her psychiatric history includes a diagnosis of schizoaffective disorder. During her stay in the Comprehensive Psychiatric Emergency Program (CPEP), she demonstrated a flat affect and an excessive preoccupation with hygiene, evidenced by showering four times. She also made illogical and delusional statements — claiming to be pregnant without any supporting evidence, stating she is married and owns three houses, and providing a contact number for her husband that staff were unable to verify.
BA's past medical history is significant for hypertension (HTN), traumatic brain injury (TBI) following a motor vehicle incident with subsequent brain surgery, asthma, and a mechanical thrombectomy for which she is taking the anticoagulant Eliquis. She was previously administered Abilify Maintena at an outside facility and was started on Abilify 30mg orally daily while in the CPEP. BA denies any alcohol or substance use.
The combination of her medical and psychiatric history, along with her current presentation, necessitates a comprehensive evaluation and a multidisciplinary approach to her care (Patel & Jafferany, 2020).
The diagnostic work-up for BA's schizoaffective disorder began with a clinical interview assessing the presence of mood episodes occurring concurrently with psychotic symptoms. Observations made during BA's time in the CPEP — including her bizarre behavior, illogical thinking, and delusional statements — provided further information. A review of her past psychiatric history solidified the diagnosis. According to the DSM-5 criteria, a diagnosis of schizoaffective disorder requires that an individual experience a period in which a major mood episode — either depressive or manic — coincides with Criterion A of schizophrenia (Perrotta, 2020). An essential criterion is that delusions or hallucinations must be present for a minimum of two weeks in the absence of a major mood episode.
The etiology of schizoaffective disorder remains somewhat ambiguous; however, prevailing theories suggest that a combination of genetic, chemical, and environmental factors may be involved (Mallard et al., 2023). The brain's chemistry and structure are also considered influential. Epidemiologically, schizoaffective disorder is not widespread, affecting approximately 0.3% of the population (Gynther et al., 2019). It is slightly more prevalent in women and typically emerges in late adolescence or early adulthood (Gynther et al., 2019).
BA's suicidal ideation came to the fore when she verbalized these thoughts during her stay in the MER. A subsequent clinical interview focused on the severity, frequency, and intent behind these ideations. The DSM-5 does not classify suicidal ideation as a distinct diagnosis; however, it is acknowledged as a symptom commonly linked with psychiatric disorders. The etiology of suicidal ideation is typically rooted in a combination of biological, environmental, and psychological factors. From an epidemiological standpoint, suicidal ideation is a pressing public health concern. Current research suggests that approximately 12.3 million adults in the United States have grappled with suicidal thoughts in the past year (CDC, 2023).
The diagnostic work-up for BA's potential delusional disorder involved a clinical interview aimed at discerning the presence and duration of her delusions. BA's claims — including her belief in being pregnant, owning three houses, and being married — were noted during observations. According to DSM-5 criteria, a diagnosis of delusional disorder requires that an individual maintain one or more delusions for at least one month, without meeting the full criteria for schizophrenia (Perrotta, 2020). Beyond the direct influence of the delusion or its implications, overall functionality is predominantly intact in such individuals. The etiology of delusional disorder remains speculative, with genetic, biochemical, and environmental factors considered contributory. Epidemiologically, delusional disorder is rare, with a prevalence rate of approximately 0.02% in the general population (Gynther et al., 2019).
BA's case began with her presentation of schizoaffective symptoms, suicidal ideations, and potential delusional beliefs. Through the integration of insights from her history, clinical observations, and established diagnostic criteria, a tailored treatment plan was developed. The plan incorporated pharmacological and therapeutic interventions to address BA's complex needs. Reflecting on her case underscores the degree to which personalized, multidisciplinary care can be most effective in managing presentations of this complexity.
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