NCD CASE STUDIES
Mark, a 45-year-old male, is brought in by his wife after sustaining a severe head injury in a car accident one year ago. Since the injury, Mark has had ongoing problems with short-term memory, often forgetting recent conversations or appointments. His wife also notes changes in his personality, with Mark becoming more irritable, impulsive, and easily frustrated over small things. He used to be very organized and methodical at work, but now he struggles to focus, often starting tasks and leaving them unfinished. Mark has also developed frequent headaches and complains of feeling dizzy at times. His wife reports that Mark's sleep has been disrupted, and he frequently wakes up during the night. Mark is aware of some of these changes, particularly his memory problems, and expresses frustration that he’s not “back to normal” despite completing months of rehabilitation.
Mild NCD due to TBI
Paul, a 45-year-old male, was brought in by his wife, who had grown increasingly concerned about his behavior over the past year. Paul had developed a strong belief that his neighbors were engaged in a long-term plot to ruin his reputation. He was convinced that they were spreading rumors about him and had installed cameras around his house to watch his every move. Paul would spend hours every day writing letters to local authorities, demanding they investigate the “illegal surveillance” being conducted against him. Despite reassurance from his family and friends, Paul remained fixated on these beliefs and his delusions had started to interfere with his ability to maintain his job as an accountant. His wife mentioned that Paul continued to function relatively well in other areas of his life and didn’t display any other odd behaviors. Upon examination, Paul was calm but remained firmly convinced of the conspiracy, showing no insight into the irrationality of his thoughts. He denied any hallucinations or other psychotic symptoms and had no prior history of mental illness.
Delusional Disorder
1st and 2nd most common NCDs
1. Alzhiemer's
2. Vascular
Delirium
A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment.
B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.
On being sane in Insane Places—D.L Rosenhan
The article questions the reliability of psychiatric diagnoses and whether we can truly distinguish between sane and insane people. Rosenhan conducted an experiment where eight "pseudopatients" (individuals without mental illness) were admitted to psychiatric hospitals to observe if they would be recognized as sane. The results revealed that psychiatric labels are powerful and sticky, leading to misdiagnosis and mistreatment.
Henry is an 81-year-old male, and his wife reports progressive memory loss over the past two years. Henry has started misplacing everyday items like his wallet or keys, and on several occasions, he has left the stove on, creating a safety concern. His wife mentions that Henry often repeats the same questions multiple times within a short conversation, and he has difficulty remembering names of close family members. Recently, Henry has begun to struggle with familiar tasks like dressing and preparing simple meals. He becomes easily frustrated and occasionally agitated when he can’t remember things. Although Henry recognizes that he’s been “a little forgetful,” he dismisses it as a normal part of aging. However, his wife is increasingly concerned as he has recently been unable to recall events from the previous day and can no longer remember how to write his signature on important documents.
Major NCD due to Alzheimer's, probably
Emily, a 27-year-old single female, was brought to the emergency department by her parents, who were concerned about her erratic behavior over the past year. According to her parents, Emily had been isolating herself in her bedroom, refusing to come out, and would often spend hours speaking to herself. She began expressing bizarre beliefs that the government had implanted devices in her home to monitor her every move. Emily’s hygiene had deteriorated, and she would wear the same clothes for days, despite her parents’ pleas to bathe. Recently, she accused her parents of conspiring with the government to control her thoughts, leading to an altercation in which she became physically aggressive. During her examination, Emily was uncooperative, muttering about “hidden messages” in the lights of the hospital room. Her speech was disorganized, and she seemed highly suspicious of the medical staff, refusing to engage in conversation. Emily has no history of substance abuse, but her family history includes a maternal uncle who was diagnosed with schizophrenia.
Schizophrenia
1st and 2nd most common delusions
1. Persecutory delusions
2. Referential delusions
Parkinson’s Disease
Criteria are met for major or mild neurocognitive disorder
Disturbance occurs in the setting of established Parkinson’s disease
There is insidious onset and gradual progression of impairment.
The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.
Probably : No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline) AND Parkinson's disease precedes onset of neurocognitive disorder
Possible: One or the other.
The myth of mental illness – Thomas S. Szasz
The article challenges the concept of mental illness as a legitimate medical disorder. Szasz argues that the term "mental illness" is a myth used to obscure deeper issues related to personal responsibility and moral conflicts in human life.
Sandra, a 60-year-old female, is brought in by her husband, who describes dramatic changes in her behavior and personality over the last 18 months. Once a polite and sociable person, Sandra has started acting impulsively and making inappropriate remarks to strangers. Her husband also reports that she’s become obsessive about certain activities, like repeatedly checking the door locks, and has lost interest in her hobbies, including gardening and reading, which she once loved. Sandra no longer seems to understand or respond to the emotions of others, appearing apathetic even when her family is upset. Although her memory appears intact, she struggles with decision-making and organizing daily activities. Her husband is worried because Sandra, once a meticulous housekeeper, now seems indifferent to hygiene and cleanliness, often neglecting basic self-care routines. Sandra is unaware of her behavioral changes and dismisses her husband's concerns.
Major NCD due to Frontal Temporal Disorder, Behavioral Varient, Possible
Rachel is a 32-year-old divorced female. Her sister reported that Rachel had been experiencing severe mood swings for the past few months, alternating between periods of deep depression and intense energy. During her depressive episodes, Rachel would isolate herself, speak of feeling hopeless, and often cried for hours. In her manic phases, she would become irritable and paranoid, staying up all night working on what she claimed were “important projects” to expose a conspiracy against her. She also reported hearing voices that told her she was “chosen” to uncover hidden truths about society. Rachel recently quit her job as a graphic designer, claiming that her co-workers were sabotaging her. Her sister became alarmed when Rachel started writing bizarre letters to government agencies, accusing them of spying on her. Rachel has been in a psychiatric hospital for 3 weeks now; although her erratic mood swings have subsided, she still experiences psychotic features, including auditory hallucinations and grandiose delusions. Rachel has a history of bipolar disorder, but this is the first time she has experienced psychotic symptoms.
Schizoaffective Disorder, Bipolar type
Hallucinations may be a normal part of...
religious experience in certain cultural contexts.
Schizophreniform Disorder
A. Two (or more) of the following, present for significant potion of time during 1-month period (or less of successfully treated). At least 1 must be 1,2,3.
1. Delusions
2. Hallucinations
3. Disorganized speech (frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (diminished emotional expression or abolition)
B. Lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
C. Rule out schizoaffective & depressive or bipolar disorder with psychotic features
1. no major depressive or manic episodes occurred concurrently w/ active-phase sx
2. if mood episodes occurred during active-phase sx, they were present for a minority of the total duration of the active & residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Racial and Ethnic Disparities Associated with Traumatic Brain Injury Across the Continuum of Care: a Narrative Review and Directions for Future Research
a Narrative Review and Directions for Future Research" reviews how racial and ethnic disparities manifest throughout the traumatic brain injury (TBI) continuum in civilian populations. The authors aimed to understand these disparities to raise awareness among healthcare providers and guide the development of tailored interventions for minority populations.
Marjorie, a 72-year-old female, is brought to the clinic by her daughter, who is concerned about her mother’s strange behavior and cognitive issues. Over the past year, Marjorie has been experiencing vivid visual hallucinations, often seeing animals and people in her home who aren't there. She’s also been very stiff in her movements, frequently shuffling and showing signs of tremors. Her daughter reports that Marjorie’s memory seems relatively good but has fluctuating periods of alertness, where one moment she looks perfectly fine, but hours later she’s disoriented and drowsy. Her daughter also expresses that her mother doesn't sleep more than a couple hours at night and hears her walking around the house throughout the night. When asked, Marjorie acknowledges seeing things but believes they are real and says, “I’ve always been healthy, this is just old age.”
Mild NCD due to Lewy Bodies, Probable
David, a 23-year-old male, was brought to the hospital by his girlfriend after he experienced a sudden and intense episode of paranoia and agitation. According to his girlfriend, David had been under significant stress due to his final exams and had recently lost his part-time job. A week prior, he began expressing odd beliefs, claiming that people were following him and tapping into his phone. On the day of admission, David suddenly became convinced that his neighbors were trying to poison him through the walls. He barricaded himself in his apartment and refused to eat or drink anything. His girlfriend found him pacing the room, muttering to himself about secret government plots. Upon arrival at the hospital, David was visibly distressed, disoriented, and unable to focus on questions. He denied any prior history of mental illness, and his symptoms had appeared suddenly, with no clear cause. His psychotic episode lasted for about two weeks, and after treatment, he returned to his normal baseline. There was no history of substance abuse or family history of mental illness.
Brief Psychotic Disorder with stressors
Name the cognitive domaines
Social Cognition
Complex Attention
Perceptual Motor Functioning
Executive Functioning
Language
Learning and Memory
Brief Psychotic Diorder
A. One (or more) of the following. At least 1 must be 1,2,3.
Delusions
Hallucinations
Disorganized speech (frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Note: Do not include a symptom if it is a culturally sanctioned response.
B. Duration of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
3. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Racial and Ethnic Diagnostic Patterns in Schizophrenia Spectrum Disorders
The chapter does not focus on a specific clinical population but rather synthesizes findings from a broad range of studies involving: Individuals diagnosed with schizophrenia spectrum disorders across various racial and ethnic backgrounds. This includes research on how diagnostic patterns and outcomes may vary among different cultural groups.
Major Ideas:
Impact of Racial and Ethnic Factors
Cultural Competence in Diagnosis
Diagnostic Patterns and Disparities
Robert, a 75-year-old male, is brought to the clinic by his daughter after he suffered a small stroke six months ago. Robert is also diabetic and suffers from high blood pressure. Since the stroke, Robert has had significant trouble with memory, attention, and planning. His daughter reports that Robert has become increasingly forgetful, losing track of conversations and misplacing items. He also seems easily confused, especially when trying to follow instructions or complete tasks with multiple steps. Robert frequently has trouble finding the right words and becomes frustrated when he cannot communicate clearly. His daughter is also concerned about his ability to manage his finances, as Robert recently made several late payments on bills, something that never happened before. His daughter also claims he has been struggling with his administering his Inulin and is incredibly worried. Robert is aware of his difficulties and feels embarrassed about his declining abilities, but he’s unsure how to improve them. His daughter is particularly worried because he seems to be getting worse, despite recovering physically from the stroke.
Major NCD due to Vascular Disease, Probable
Jordan, a 19-year-old college student, was brought to the psychiatric ward by his parents after he began displaying increasingly bizarre behavior. Over the last two months, Jordan had become withdrawn and stopped attending his classes. He started talking to people who weren’t there and told his parents that he was receiving special messages from the television about a secret mission he was assigned to complete. His parents initially thought he was stressed due to school, but his behavior became more concerning when he began believing that his professors were trying to harm him. Jordan started wearing strange outfits, claiming they would protect him from “dangerous frequencies.” He also stopped bathing and eating regularly. His parents reported no prior history of mental illness, and Jordan had been a high-achieving student before these symptoms appeared. Upon admission, Jordan was disorganized in his speech, displaying clear signs of paranoia and auditory hallucinations. His symptoms had been present for about two months, and he showed no history of substance use. His condition improved with treatment, though his prognosis was still uncertain due to the brief duration of symptoms.
Schizophreniform Disorder with no good prognostic features
Huntington's disease is a hereditary and progressive disorder. What does it do?
causes the progressive death of nerves in the brain (basal ganglia)
TBI
A. Criteria are met for major or mild neurocognitive disorder
B. Evidence of traumatic brain injury (impact to head or rapid movement/displacement of brain within the skull), with 1 or more:
1. Loss of consciousness
2. Disorientation and confusion
3. Neurological signs (neuroimaging, seizures, visual field cuts, anosmia, hemiparesis)
4. Posttraumatic amnesia
C. Disorder presents after TBI or after recovery of consciousness and persists past acute post injury period
D. The symptoms are not better explained by another brain disease or systemic disorder.
Differences between delusional disorder and schizophrenia: a mini narrative review
The findings showed that DD, while rarer than schizophrenia, is marked by more isolated delusions, and patients tend to maintain higher functionality. On the other hand, schizophrenia presents with a broader range of debilitating symptoms. Both conditions pose risks for suicide, especially when delusions involve persecution, with DD patients showing higher responsiveness to lower-dose antipsychotic treatments.
In conclusion, while there are shared traits between DD and schizophrenia, important differences in onset age, symptom severity, and treatment responses support their classification as separate disorders