Case Study Analysis: Maria Lopez

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 to rule 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.

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., Seritan, 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

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

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

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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Case Study Analysis: Part One

Purpose

This assignment allows students to evaluate the case assigned to them. The student will evaluate the case study to explore the neuroanatomy, physiological examination, mental status examination, diagnostic criteria, differential diagnosis, and treatment of the assigned topic. This paper is broken down into sections over two weeks.

Case Study Analysis: Maria Lopez

Part One – Module One 

• The entire paper is completed on the case study assigned.
• Part one of the paper should be three pages long (not including title/reference pages), using the current APA formatting requirements with appropriate grammar and spelling. The paper requires at least three peer-reviewed resources, one of which may be the DSM-V-TR. All peer-reviewed resources used in the paper should be less than five years old.
• Part One of the paper must include:
  • Title page in APA format
  • Brief opening description of the diagnosed disorder
  • Neuroanatomy of the diagnosed disorder
  • Physiological and mental status examination assessment findings for the diagnosed disorder
  • Diagnostic testing recommended for the diagnosed disorder, including screening tools
  • Formulation of the primary diagnosis for the client with two differential diagnoses. The student must outline the information that supports the primary diagnosis based on the criteria in the DSM-V-TR and a rationale for each of the two differential diagnoses, contrasting the features of these disorders with those of the primary diagnosis.
  • Reference page with all references in APA format