Case Study Analysis: Maria Lopez

Part One

Maria Lopez is a 30-year-old Hispanic woman who has auditory hallucinations, experiences delusions of persecution, stays away from others, and has seen her functioning decrease for 18 months. Her main concern was, “I can’t trust anyone. The TV is talking directly to me.” Having a conversation with the TV is a typical symptom of schizophrenia, which is a long-lasting and serious psychotic illness: Case Study Analysis: Maria Lopez.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) describes schizophrenia as a condition where one experiences two or more central symptoms—such as delusions, hallucinations, disordered speech, and abnormal behaviors—for at least six months and this has a significant effect on their ability to socially function or be productive in their job (Crone et al., 2023). Since Maria still experiences psychosis and her social and work functions are impaired, the diagnosis recommended is schizophrenia, and further evaluation is warranted.

Neuroanatomy of Schizophrenia

The condition of schizophrenia is linked to changes in both the brain structure and its functions. Reductions in the volume of the prefrontal cortex, hippocampus, amygdala, and thalamus have all been regularly observed and are related to thinking, emotions, and memories (Luvsannyam et al., 2022). These anatomical abnormalities are linked to Maria showing impaired judgment, reduced emotional responses, and abnormal cognitive functions.

In addition, an increase in dopamine in the mesolimbic pathway plays a role in causing hallucinations and delusions. If the mesocortical system does not function properly, a person may show signs of a lack of motivation and avoid social interactions.

Emerging research further supports the neurodevelopmental model of schizophrenia. Disrupted synaptic pruning during adolescence may lead to abnormal connectivity in fronto-limbic and default mode networks (Chafee & Averbeck, 2022). Abnormalities in the corpus callosum and white matter tracts interfere with interhemispheric communication, exacerbating thought disorganization.

Moreover, oxidative stress and neuroinflammation may play contributing roles. These structural and biochemical disruptions offer a scientific rationale for Maria’s suspiciousness, auditory hallucinations, and lack of motivation.

Physiological and Mental Status Examination Findings

Maria’s physiological exam results are unremarkable. Her vital signs are within normal limits: blood pressure 118/75 mmHg, pulse 72 bpm, respiratory rate 14, temperature 97.8°F, height 65 inches, weight 140 lbs, and BMI 23.3. However, her mental status examination reveals several abnormalities that align with schizophrenia. She appears disheveled, with poor grooming and inappropriate clothing for the weather.

Eye contact is sporadic, and her behavior is guarded and suspicious. Her speech is slow and monotone. She displays a blunted effect, with circumstantial thought processes, loose associations, and delusions of reference. She reports auditory hallucinations that are critical in nature.

Insight and judgment are notably impaired, although orientation to person, place, and time is intact. These findings suggest profound disturbances in cognition, perception, and emotional processing, all of which are consistent with schizophrenia’s diagnostic criteria (American Psychiatric Association, 2022). Maria’s inability to maintain employment or engage in social activities further confirms the disorder’s impact on her functioning.

Recommended Diagnostic Testing and Screening Tools

Maria has undergone preliminary lab tests—CBC, CMP, TSH, and urine drug screen—all of which returned normal, ruling out medical and substance-induced causes of psychosis. To further substantiate the diagnosis, a brain MRI or CT scan is recommended to exclude organic causes such as brain tumors, lesions, or atrophy, particularly since this is the first episode of psychosis (Nguata et al., 2024). Additionally, EEG may be useful in ruling out seizure disorders if clinically indicated.

Psychometric tools and structured interviews play a critical role in diagnosis and monitoring. The Structured Clinical Interview for DSM-5 (SCID-5) is essential for establishing a formal diagnosis. The Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) are reliable for quantifying symptom severity.

Assessment instruments like WHODAS 2.0 and the Global Assessment of Functioning allow the doctor to measure her disability and help design her treatment. A rapid Mini International Neuropsychiatric Interview (MINI) is often employed to quickly find out if a patient has schizophrenia or symptoms related to mood or substance use.

Primary Diagnosis and Differential Diagnoses

Primary Diagnosis: Schizophrenia (F20.9)

Maria’s condition meets the DSM-5-TR’s requirements for schizophrenia by lasting for one month or more with two or more core symptoms and signs that continue for at least six months. She reports hearing voices that are not real and believes in delusions, while her thought processes are disorganized, and she has difficulties connecting with people (American Psychiatric Association, 2024). These symptoms have resulted in major functional problems that are not fully explained by mood or drug-related conditions.

Differential Diagnosis 1: Schizoaffective Disorder (F25.0)

Schizoaffective disorder has features of both schizophrenia and serious mood episodes. Maria has not been diagnosed with episodes of depression or mania, and her symptoms are not limited to mood swings. Her psychosis lasts even when her mood is stable, which determines that schizoaffective disorder is not the right fit (Wy & Saadabadi, 2023). The lack of a constant mood change lessens the chance that someone has schizoaffective disorder.

Differential Diagnosis 2: Delusional Disorder (F22)

Delusional disorder is characterized by one or more non-bizarre delusions lasting at least one month without significant functional impairment or other psychotic symptoms. Maria’s delusions are accompanied by hallucinations, disorganized speech, and clear social dysfunction, none of which are typical of delusional disorder (Joseph & Siddiqui, 2023). Additionally, delusional disorder generally preserves insight and daily function, which Maria lacks. Her broader psychotic symptoms clearly place her diagnosis beyond this scope.

Conclusion

Maria Lopez’s symptoms—hallucinations, delusions, and disorganized thinking—support a schizophrenia diagnosis. Stable vitals, abnormal mental status, and neurobiological evidence justify this. Diagnostic tools like MRI and PANSS are recommended. Schizoaffective and delusional disorders are ruled out. Treatment can support symptom management and improve daily functioning.

Part Two

Maria Lopez, a 30-year-old Hispanic woman, presents with symptoms of schizophrenia, including auditory hallucinations and delusions of persecution. Over the recent 18 months, her condition has continued to deteriorate and has affected her social as well as occupational functioning in a severe manner. DSM-5-TR criteria state that a diagnosis of schizophrenia should be given in case of the presence of at least two core symptoms (delusions, hallucinations, disorganized speech) lasting over six months (Crone et al., 2023).

This part focuses on evidence-based pharmacological and non-pharmacological treatment recommendations for Maris. In addition, it compares its treatments with the treatments of her differential diagnoses: schizoaffective disorder and delusional disorder.

Evidence-Based Non-Pharmacological Treatment Recommendations

Non-pharmacological treatments are critical in managing schizophrenia and can significantly improve patient outcomes. Cognitive behavioral therapy (CBT) is an established psychotic symptom reduction strategy. CBT assists patients such as Maria to come up with coping mechanisms to deal with delusions and hallucinations. CBT is capable of distress reduction in relation to psychotic experiences as well as the enhancement of social functioning (Kart et al., 2021). CBT may improve Maria’s insights and emotional control by questioning her distorted ideas about the TV and her neighbors.

Social skills training (SST) is another beneficial intervention, especially for individuals who experience social withdrawal and impaired interactions, which are common in schizophrenia. SST strives toward better social performance and decreased isolation. In addition, SST helps advance communicative acts and fosters social engagement (Soares et al., 2021). In the case of Maria, SST may play a vital role in dealing with her anti-social interaction behavior and reintegrate her into the community.

Additionally, family therapy plays a pivotal role in supporting both the patient and their caregivers. The presence of family improves medication compliance, lowers the stress level, and enables caregivers to offer more effective assistance. Besides, family interventions reduce the chances of relapse and enhance long-term results (Iuso et al., 2023). In the case of Maria, family therapy would enable her mother to effectively help her manage her condition well, enabling Maria to get the help she deserves.

Evidence-Based Pharmacological Treatment Recommendations

Pharmacological treatment is essential in managing schizophrenia, with second-generation antipsychotics (SGAs) being the first-line therapy. SGAs (Risperidone, Olanzapine, and Quetiapine) are effective in treating positive and negative symptoms and have a better profile of side effects when compared to first-generation antipsychotics. Risperidone may be a perfect option for Maria. The usual initial dose is 1-2 mg daily, increased to a maximum of 8 mg daily, depending upon response and tolerability. Risperidone would specifically help in the treatment of auditory hallucinations and delusions in Maria, and compared to older drugs, the probability of extrapyramidal side effects is relatively lower.

Additionally, Olanzapine is also useful for positive and negative symptoms of schizophrenia but with greater weight gain and metabolic side effect risk. Olanzapine would require close monitoring of Maria’s weight, glucose, and lipid profile in case it is prescribed. Olanzapine’s usual starting dose is 5 mg per day, and the maximum dose is 20 mg per day; depending on the patient’s response, the dose is adjusted accordingly.

Frequently checking side effects, mainly metabolic ones, is essential in the case of using antipsychotic drugs. The selection of drugs must be influenced by the response and tolerance of drugs by the patient.

Comparison of Treatment Recommendations

When comparing the treatment of schizophrenia with the differential diagnoses of schizoaffective disorder and delusional disorder, several differences emerge, particularly in the pharmacological and non-pharmacological approaches.

Schizoaffective Disorder (F25.0)

The condition combines the features of schizophrenia and mood disorders, such as depression or mania. Thus, the pharmacotherapy of schizoaffective disorder commonly requires the combination of antipsychotics to employ psychosis and mood stabilizers or antidepressants to treat the mood symptoms. Antipsychotics like Risperidone or Olanzapine can be combined with medications like Lithium or Valproate to treat the psychotic and mood aspects of the condition. Among non-pharmacological options, CBT and psychoeducation may be helpful in treating mood symptoms and in enhancing overall functioning.

Delusional Disorder (F22)

Unlike schizophrenia, delusional disorder is typified by the existence of one or more non-bizarre delusions that do not substantially affect social or occupational functioning. Antipsychotic drugs, like Aripiprazole or Olanzapine, are typical prescriptions targeting delusions, though the medication is not administered as intensively as with schizophrenia since mood symptoms and general psychosis do not have to be treated. The non-pharmacological treatment generally incorporates CBT into the treatment process so as to enable the patient to live with the delusions without giving them strength.

To summarize, although the treatment of schizoaffective disorder and delusional disorder have certain similarities with schizophrenia, the main difference is that the former two disorders have mood symptoms and limited psychotic symptoms, respectively. Schizophrenia necessitates a more enveloping treatment strategy, incorporating pharmacological and non-pharmacological measures, which are designed to control a wide range of symptoms.

Conclusion

The case of Maria Lopez, with the diagnosis of schizophrenia, needs a complex treatment. Pharmacological interventions, including Risperidone and Olanzapine, are evidence-based and necessary in the management of her symptoms, whereas non-pharmacological interventions, including CBT, SST, and family therapy, offer shared hope in the enhancement of her overall functioning and quality of life. The schizophrenia treatment plan is greatly different than the management of schizoaffective disorder and delusional disorder because the former requires mood stabilizers, and the latter is not as intense as the treatment of schizoaffective disorder and delusional disorder. The combination of pharmacological and non-pharmacological methods will contribute to the optimization of Maria’s treatment results and enhance her further functioning.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5^TM, 5th ed. Psycnet.apa.org. https://psycnet.apa.org/record/2013-14907-000

American Psychiatric Association. (2024). About DSM-5 and development. Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm

Chafee, M. V., & Averbeck, B. B. (2022). Unmasking schizophrenia: Synaptic pruning in adolescence reveals a latent physiological vulnerability in prefrontal recurrent networks. Biological Psychiatry, 92(6), 436–439. https://doi.org/10.1016/j.biopsych.2022.06.023

Crone, C., Fochtmann, L. J., Attia, E., Boland, R., Escobar, J., Fornari, V., Golden, N., Guarda, A., Jackson-Triche, M., Manzo, L., Mascolo, M., Pierce, K., Riddle, M., Sheridan, A., Uniacke, B., Zucker, N., Yager, J., Craig, T. J., Hong, S.-H., & Medicus, J. (2023). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. The American Journal of Psychiatry, 180(2), 167–171. https://doi.org/10.1176/appi.ajp.23180001

Iuso, S., Severo, M., Trotta, N., Ventriglio, A., Fiore, P., Bellomo, A., & Petito, A. (2023). Improvements in treatment adherence after family psychoeducation in patients affected by psychosis: Preliminary findings. Journal of Personalized Medicine, 13(10), 1437–1437. https://doi.org/10.3390/jpm13101437

Joseph, S. M., & Siddiqui, W. (2023). Delusional disorder. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539855/

Kart, A., Özdel, K., & Türkçapar, H. (2021). Cognitive behavioral therapy for schizophrenia. Archives of Neuropsychiatry, 58(1). https://doi.org/10.29399/npa.27418

Luvsannyam, E., Jain, M. S., Pormento, M. K. L., Siddiqui, H., Balagtas, A. R. A., Emuze, B. O., & Poprawski, T. (2022). Neurobiology of schizophrenia: A comprehensive review. Cureus, 14(4). https://doi.org/10.7759/cureus.23959

Nguata, M., Orwa, J., Kigen, G., Kamaru, E., Emonyi, W., Kariuki, S., Newton, C., Ongeri, L., Mwende, R., Gichuru, S., & Atwoli, L. (2024). Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1301976

Soares, E. E., Bausback, K., Beard, C. L., Higinbotham, M., Bunge, E. L., & Gengoux, G. W. (2021). Social skills training for autism spectrum disorder: A meta-analysis of in-person and technological interventions. Journal of Technology in Behavioral Science, 6(1), 1–15. https://doi.org/10.1007/s41347-020-00177-0

Wy, T. J. P., & Saadabadi, A. (2023, March 27). Schizoaffective disorder. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541012/

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Part Two – Module Two
The student will work individually on the assignment.
The entire paper is completed on the case study assigned to the student at the beginning of the course.