Case Study Analysis: Part One

Delusional disorders are characterized by long-standing false beliefs that are unshakeable in the face of ample contradictory evidence. These beliefs can potentially result in serious interference in interpersonal relationships, occupational functioning, and daily functioning. For Ahmed Khan, a 40-year-old accountant, persecutory delusions have resulted in greater social withdrawal and affective detachment. This analysis considers the neuroanatomical substrates, test results, diagnostic issues, and differential diagnoses of Ahmed’s presentation according to evidence-based psychiatric practice: Case Study Analysis: Part One.

Overview of the Diagnosed Disorder

Ahmed Khan is experiencing repeated paranoid delusions that involve government spying and control of his ideas. The symptoms have lasted for over two years, resulting in significant impairment in occupational, social, and emotional functioning. Based on the information provided, Delusional Disorder, Persecutory Type, is the most appropriate diagnosis. This illness is characterized by the presence of one or more delusions that must exist for at least a month and with no substantial impairment of functioning except as a result of the delusion itself (American Psychiatric Association, 2022).

The delusions in Ahmed are systematized, not bizarre, and persecutory. His insight is poor, and his functioning has deteriorated in both the work and family settings. Despite the lack of evidence for hallucinations or mood symptoms, his fixed false delusions and guarded affect are most consistent with this disorder.

Neuroanatomy of Delusional Disorder

Delusional disorder has been associated with dysfunction in several crucial brain regions. Neuroimaging implicated the limbic system, particularly the amygdala and hippocampus, and was involved in emotion regulation and memory processing. Dysfunction in these areas can lead to misattribution of salience to neutral events, which can feed paranoid ideation, as stated by Joseph and Siddiqui (2023). Moreover, the prefrontal cortex, more specifically the dorsolateral prefrontal region, plays a role in the impaired reasoning and insight of delusional patients.

Such individuals are more likely to have less activity in the right hemisphere’s frontal and temporal regions, which are accountable for belief evaluation and reality testing. In Ahmed’s case, his intact memory and orientation but poor insight and judgment suggest frontal lobe disturbance rather than generalized cognitive impairment.

Physiological and Mental Status Examination Findings

Ahmed’s physical examination is unremarkable, with normal laboratory studies and stable vital signs, including thyroid function and urine drug screen. However, his mental status examination reveals a number of characteristic features of delusional disorder. He is dressed, oriented, and has clear speech, which would be consistent with spared cognition of this diagnosis.

His avoidant eye contact, guardedness, and refusal to talk are telling signs of paranoia. Although his thinking is rational, he remains preoccupied with the content of his delusions. His mood is described as “nervous,” and he has a flat affect, which is suggestive of underlying blunting of emotions. Insight is limited, and judgment is clouded, which is in keeping with a fixed, non-reality-based system of belief.

Recommended Diagnostic Testing and Screening Tools

Although delusional disorder is most often diagnosed by clinical examination, some diagnostic instruments may be used to aid assessment and eliminate other disorders. According to Zhu et al. (2024), neuroimaging, such as MRI or CT scans, can at least exclude structural abnormalities in middle-aged patients presenting with new-onset psychosis. Ahmed has no psychiatric background; therefore, neuroimaging would be the appropriate course of action. Routine laboratory examinations, like CBC, CMP, and thyroid panels, already completed, are required to rule out metabolic or endocrine causes.

Other psychological assessments, such as the Positive and Negative Syndrome Scale (PANSS), can be applied to quantify symptom severity and evaluate treatment response at follow-up. The Structured Clinical Interview for DSM-5-TR Disorders (SCID-5) is also helpful in establishing the diagnosis based on standard criteria.

Formulation of Primary Diagnosis

Ahmed meets DSM-5-TR Delusional Disorder, Persecutory Type (F22). His delusional notion of being watched and spied on by the government has persisted for over two years with unbroken duration. He lacks hallucinations, disorganized speech, or grossly disorganized behavior, distinguishing this condition from schizophrenia.

No co-occurring mood episode accompanies the duration of delusions, and his functioning, though impaired, is not disorganized or reduced to the extent seen with other psychotic illnesses. His intact memory, coherent speech, and absence of hallucinations support this diagnosis (American Psychiatric Association, 2022).

Differential Diagnoses

Schizophrenia (F20.9)

Schizophrenia is also a potential differential diagnosis in light of Ahmed’s delusions and social isolation. Schizophrenia, however, requires the presence of two or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms. Ahmed does not have hallucinations, disorganized thoughts or behavior, or other basic schizophrenia symptoms.

Secondly, his delusions are well-structured and relatively stable without impairments in speech or function, which are typical in schizophrenia (Hany et al., 2020). Thus, schizophrenia is unlikely because there is no manifestation of several psychotic features.

Paranoid Personality Disorder (F60.0)

Paranoid Personality Disorder (PPD) is also a differential diagnosis characterized by a pervasive distrust and suspiciousness of others. People with PPD are likely to mistake benign intentions for malicious ones. PPD is not an abrupt onset of delusions but a lifelong pattern.

Ahmed’s symptoms started two years ago and do not represent a lifelong suspicious temperament. Also, PPD is not characterized by fixed or very impaired false beliefs or judgment (Jain & Torrico, 2024). Based on Ahmed’s presentation and DSM-5-TR criteria, delusional disorder is still the best-fitting diagnosis.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5-TR). Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm

Hany, M., Rehman, B., Azhar, Y., & Chapman, J. (2020, January 1). Schizophrenia. PubMed. https://pubmed.ncbi.nlm.nih.gov/30969686/

Jain, L., & Torrico, T. J. (2024). Paranoid personality disorder. StatPearls. https://pubmed.ncbi.nlm.nih.gov/39163470/

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

Zhu, Y., Maikusa, N., Radua, J., Sämann, P. G., Fusar-Poli, P., Agartz, I., Andreassen, O. A., Bachman, P., Baeza, I., Chen, X., Choi, S., Corcoran, C. M., Ebdrup, B. H., Fortea, A., Garani, R. R., Glenthøj, B. Y., Glenthøj, L. B., Haas, S. S., Hamilton, H. K., & Hayes, R. A. (2024). Using brain structural neuroimaging measures to predict psychosis onset for individuals at clinical high-risk. Molecular Psychiatry, 1–13. https://doi.org/10.1038/s41380-024-02426-7

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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.

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