Question

A 25-year-old young woman is brought to the emergency department by the police after being found walking in traffic at a busy city intersection. The police place her on an involuntary commitment after she states that she was instructed to kill herself by accusatory, commanding voices. On examination, the patient appears disheveled, with an indifferent and flat affect, and disorganized thought processes. She answers most questions monosyllabically. When questioned about experiencing auditory hallucinations, she answers in the affirmative, but she is unable to articulate coherently the details of her experience. Throughout the examination, she appears intermittently distracted by internal stimuli; when asked what her experience is in the moment, she states: "They are talking to me." The patient's family reports that she became increasingly withdrawn after she moved away from home to attend graduate studies at a local university. The family reports that her academic performance in college was above average, but since starting university, she has struggled to complete her schoolwork. Since moving, she has also become more isolative: she made no new friends, stopped talking to her college friends, and maintained only sporadic contact with her family. The family was unaware of the patient experiencing any hallucinatory experiences. She had no past history of drug misuse, and her urine toxicology screen was negative, effectively ruling out a drug-induced psychosis. QUESTIONS: 1. What could have possibly triggered this young woman's episode? 2. a. What are two differential or possible diagnoses for her? b. Briefly explain each of these possible diagnoses. 3. What are the evidences which have informed each of the two possible diagnoses you listed in #2? 4. What is this young woman's actual diagnosis, and explain possible treatment options

A 25-year-old young woman is brought to the emergency department by the police after being found walking in traffic at a busy city intersection. The police place her on an involuntary commitment after she states that she was instructed to kill herself by accusatory, commanding voices. On examination, the patient appears disheveled, with an indifferent and flat affect, and disorganized thought processes. She answers most questions monosyllabically. When questioned about experiencing auditory hallucinations, she answers in the affirmative, but she is unable to articulate coherently the details of her experience. Throughout the examination, she appears intermittently distracted by internal stimuli; when asked what her experience is in the moment, she states: "They are talking to me." The patient's family reports that she became increasingly withdrawn after she moved away from home to attend graduate studies at a local university. The family reports that her academic performance in college was above average, but since starting university, she has struggled to complete her schoolwork. Since moving, she has also become more isolative: she made no new friends, stopped talking to her college friends, and maintained only sporadic contact with her family. The family was unaware of the patient experiencing any hallucinatory experiences. She had no past history of drug misuse, and her urine toxicology screen was negative, effectively ruling out a drug-induced psychosis.

QUESTIONS:
1. What could have possibly triggered this young woman's episode?
2. a. What are two differential or possible diagnoses for her? b. Briefly explain each of these possible diagnoses.
3. What are the evidences which have informed each of the two possible diagnoses you listed in #2?
4. What is this young woman's actual diagnosis, and explain possible treatment options

Added by John H.

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