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Case of a Patient with no Recollection of His Misbehavior
Differential Diagnosis
Acute Confusional State (ACS) and Schizophrenia
The acute confusional state is often evident among older individuals and has symptoms associated with lapses in memory and loss of mental consciousness. People suffering from ACS often forget their past activities quickly and may lose contact with their surroundings. In several cases, caregivers and those around the subject notice the condition, especially when conversing with the individuals or by observing their undertakings. Frailty, old age, and severe illnesses are some of the factors that can initiate the condition among individuals. Although the research concerning the cause of the condition has not been productive, some researchers state that brain and cortical disruption lead to the condition (Sendelbach & Guthrie, 2009). On the other hand, some scholars explain that stress, cholinergic deficiency, and inflammatory response, which lead to neurotransmitter dysfunction, initiate the condition. The relationship between the acute confusional state and the patient undergoing diagnosis takes effect because of the past activities that the individual undertook at the mall.
Consequently, schizophrenia is another condition that has symptoms similar to those demonstrated by the patient under examination. Absent-mindedness, hallucinations, and poor concentration are some of the symptoms associated with the problem. On several occasions, individuals suffering from schizophrenia can hear voices or sounds that others around them cannot hear and may act in a manner prompted by these unheard voices. The act of the patient who urinated at the mall without caring much about the consequences shows a close relationship to the behavior of individuals suffering from schizophrenia. Therefore, the problem of schizophrenia cannot be ruled out when undertaking a differential diagnosis on the patient. In the words of Fisch (2010), mental disorganization, weird behavior, and poor concentration are some of the symptoms displayed by people suffering from schizophrenia. The statement ascertains the essence of the condition in the differential diagnosis of the individual.
Temporal Lope Epilepsy (TLE), Alzheimer’s Disease (AD), and Alcohol Abuse
Temporal lope epilepsy (TLE) is another condition that will be assessed in the process of diagnosis. In the differential diagnosis process, TLE will need consideration given the symptoms that are evident among people suffering from the condition. TLE leads to loss of mental control, absent-mindedness, repeated activities performed unconsciously, hearing strange sounds, and a range of unexplained emotions. It is imperative to explain that the symptoms take place when individuals suffer from seizures triggered by the condition. According to Sendelbach and Guthrie (2009), the symptoms are usually evident when people suffer from seizures and enter into a dreamlike state. As such, they perform weird activities in the oblivion of the events taking place around them and cannot recollect the undertakings when they regain consciousness. A case of a person walking to a tree and urinating five times is an indication that the individual may be a victim of TLE, hence the inclusion of the condition in the diagnosis.
Another condition that falls under differential diagnosis is Alzheimer’s disease (AD), which has symptoms related to a memory lapse. The problem affects older individuals and is progressive. At old age, victims suffering from AD start demonstrating problems remembering people they recently met as well as events that took place. The memory of the individuals deteriorates and they eventually display challenges in reading and writing. Some of the signs associated with the later stages of the condition include failure to identify caregivers such as family or close friends. At the later stages, individuals need total care because they fail to remember their places of residence and may wander away from home. In the perspective of Fisch (2010), the main areas of the brain that the disease affects include the part of memory and consciousness. Although the disease has no cure, some medications minimize the effects that it occasions. Failure to recollect the events that took place moments before visiting the examination center and the homelessness appearance is an indication that the patient in the case may be suffering from AD.
Although several people downplay the issue of alcohol abuse, the problem has serious consequences in the absence of timely solutions. Absent-mindedness, memory lapse, slurred speech, and misguided behaviors are evident among people who abuse alcohol. Book Goroll and Mulley (2014) elucidate that alcohol abuse is practical among people who consume alcoholic drinks excessively and in an uncontrolled manner. It is fundamental to assert that the performance of misguided activities occurs because alcohol affects the nervous system and leads to behaviors that individuals cannot remember afterward. The eventual consequence of the condition is the contraction of diseases such as liver cirrhosis and death if the victim fails to receive the requisite solution on time. The behavior of the patient in question may have a relationship with long-term abuse of alcohol, which has affected the nervous system prompting the performance of weird activities.
Ordered tests
Before commencing the process of examination, the tests that need to be considered and ordered include MRI and EEG. Imperatively, EEG is very important in assessing the mental state of the patient concerning the level of abnormal prompts in the brain. The results from EEG inform the practitioner and help in the provision of augmented and high-end assessment services to the patient. Moreover, the results help the practitioner ascertain the presence of prompts that initiated the activities undertaken at the mall, which the patient cannot recollect. On the other hand, an MRI test is very important in ascertaining the physical state of the patient especially the brain. The behavior of the patient demonstrates issues linked to memory lapse and misguided activities. Memory lapses and misguided activities are occurrences associated with the brain. As such, by undertaking MRI tests, the practitioner will be informed on the nature and the cause of the condition that the patient in question is experiencing.
Bias on my differential diagnosis
The presence of a lesion in the temporal lobe of the patient in the case serves to bias the process of diagnosis. The bias takes place because the lesion leads to a likely conclusion that the patient may be suffering from TLE triggered by the presence of a lesion in the lobe. As such, the process may lean towards TLE and its ascertainment. In the explanation provided by Fisch (2010), MRI and EEG findings are among the cornerstones used by practitioners in the development of an informed diagnosis. Consequently, the fact that EEG provides results that there is unusual excitatory activity in the brain serves to confirm the likelihood that the patient may be suffering from TLE. Since TLE causes seizures and a range of unexplained emotions, unusual excitatory activity in the brain confirms the possibility that the individual may a victim of TLE.
Presence of a lesion
The presence of a lesion has a significant effect on the diagnosis because it creates a lead, which links the diagnosis with the temporal lope epilepsy (TLE). A lesion concerns a problem or damage that is evident in one of the brain lopes. As such, its presence is a factor that changes the course of diagnosis. It is important to note that a lesion has great relevance to the case in question.
Case of a College Student Proclaiming He Was the Prophet of God
Differential Diagnosis
Drug-induced psychosis
Drug-induced psychosis is a condition that takes place after excessive intake of drugs such as marijuana or cocaine. The aftermath of the consumption is characterized by hallucinations, delusions, and temporal loss of reality. In essence, the individual who is a victim of drug-induced psychosis demonstrates behaviors, which may not be remembered after sobering up. Consequently, once under the influence of psychosis-inducing drugs, the person undertakes weird activities without thinking about their consequences. According to McCance, Huether, Brashers, and Rote (2013), hallucinations are the major symptoms that are imminent among individuals suffering from the condition.
The disorder fits into the case in question because of the character demonstrated by the young man. Notably, the case in question that presents a young man who appears to be hallucinating qualifies drug-induced psychosis as a subject of differential diagnosis. However, to ascertain whether the condition meets the case of the young man tests need to be done by medical practitioners to check the history of drug abuse.
Bipolar disorder
The behavior demonstrated by the young man also leads to a diagnosis of the bipolar condition. Imperatively, the condition has moments of extreme happiness and those of sadness. According to Harrison et al. (2016), the condition leads to hallucinations, isolation, and engagement in suicidal activities without much regard for the consequences. In the study undertaken by Moore, Little, McSharry, Goodwin, and Geddes (2014) the risk of suicide among individuals, suffering from the bipolar condition is high unlike among normal individuals.
The diagnosis fits into the case of the young man because he demonstrates signs of hallucination and hears voices, which others around him cannot. Hallucinations evident in the character of the young man lead to the inclusion of the condition in the diagnosis of the probable disease that led to a performance of the activities. When the young man explains that ‘he heard the voice of God and that he saw the lecturer eat raw calculus,’ he demonstrates a condition that is evident in victims suffering from bipolar disorder. People who have the disorder, when hallucinating, can hear voices and see things that others cannot hear or see.
To ascertain whether the young man suffers from the disease, there is a need to assess his behavior patterns. By checking his behavior patterns, the practitioners will know whether the young man has been showing moments of extreme joy or sadness and whether he has been experiencing hallucinations before the current incident.
Epidemiology of the disorder
In assessing the epidemiology of the disorders, it is established that the rate of suicide among victims of bipolar disorder is higher concerning those that occur among normal individuals. Although the disorder claims several lives in the world, deaths linked to drug-induced psychosis are on the rise. Besides the deaths claimed by disorders like schizophrenia and bipolar disorder, the rise in the scale of deaths caused by drug-induced psychosis is something that scholars in the medical sector cannot downplay.
References
Book Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: office evaluation and management of the adult patient (7th ed.). Beijing, China: Wolters Kluwer.
Fisch, B. J. (2010). Epilepsy and intensive care monitoring: Principles and practice. New York, NY: Demos Medical.
Harrison, P. J., Cipriani, A., Harmer, C. J., Nobre, A. C., Saunders, K., Goodwin, G. M., & Geddes, J. R. (2016). Innovative approaches to bipolar disorder and its treatment. Annals of the New York Academy of Sciences, 1366(1), 76-89.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Study guide for pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
Moore, P. J., Little, M. A., McSharry, P. E., Goodwin, G. M., & Geddes, J. R. (2014). Mood dynamics in bipolar disorder. International journal of bipolar disorders, 2(1), 1-9.
Sendelbach, S., & Guthrie, P. F. (2009). Acute confusion/delirium: Identification, assessment, treatment, and prevention. Journal of gerontological nursing, 35(11), 11-18.
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