NEUR1202: Schizophrenia Case Study*

Learning Objectives

1. Distinguish between positive, negative and cognitive symptoms of schizophrenia, and

be able to name and describe several of these symptoms
2. List the DSM-5 symptoms for a diagnosis of schizophrenia
3. Understand the developmental progression of this disorder, and what determines a
better vs. worse prognosis
4. Describe changes in the brain observed among individuals with schizophrenia at both
a micro- and macro-anatomical level
5. List typical agents that effectively treat schizophrenia, and describe their mechanism
of action in the brain.

* disclaimer: this activity is for learning purposes only.

Assignment

Imagine you are a psychiatrist working in a clinic. Your first patient of the day is Adam. Adam is a
21-year-old male who presents with disorganized speech and anhedonia. His mother told him to
come in, as she noticed when he came back to visit from college, he was having difficulty having
conversations; he was getting off topic often. She also noticed he had lost interest in activities he
normally really enjoyed.

Question 1: Is there a clear diagnosis to be made in this situation? Why or why not? (2 marks)
Answer: A clear diagnosis can not be made due to the vague description of how often Adam has
been showing these symptoms oven a 1-month period. Furthermore, It is true that he possesses
disorganized speech, however, he does not display any other definitive symptoms. Lastly, if his
schizophrenia had developed in his teen years alongside his disorganized speech, he would have
displayed his odd behaviour then. Therefore, it could be possible that Adam has simply changed
since leaving his mother’s household.

Adam and his mother leave the clinic, having been told to monitor his symptoms. A few months
later, Adam’s mother accompanies him back into the clinic. She seems worried, and Adam appears
quite paranoid. His mother claims that he’s become very paranoid and has confided in her that he
believes there are CIA agents that are following and trying to capture him.
Question 2: How would you diagnose Adam using DSM-5 criteria? Provide an explicit diagnosis
and explain your answer with justification. (2 marks)
Answer: He could be diagnosed as schizophrenic because of his symptoms of disorganized speech
and delusions. However this would only stand if he has displayed these symptoms for a significant
portions of the time in a 1 month period.

Adam has been given a diagnosis. He’s not sure what this means in terms of how his life will be
affected from now on and is visibly concerned.

Question 3: Describe the prognosis for Adam’s diagnosis, and explain some of the factors that
contribute to recovery and remission. (2 marks)
It is not very likely that he will undergo complete remission since around 78% of patients usually
go through a cycle of relapse and recovery. However, his symptoms might decrease or even out as
he gets older. This includes a reduction or elimination of mood-related symptoms. Recovery and
remission are more likely if he had good social adjustments prior to the development of
schizophrenia, few negative symptoms, and with a good social support system.

He now awaits a treatment plan. Upon hearing mention of antipsychotics, he declines, insisting he
does not want to be sedated.

Question 4: Explain how and why antipsychotic medications work. Explain some of the side effects.
What would you tell Adam to reassure him about his treatment plan? (4 marks)
I would tell him that antipsychotic drugs will reduce his psychotic symptoms and that they do not
have high sedation properties. This includes the prescription of the antipsychotic chlorpromazine
or “Thorazine”. These antipsychotic drugs work by blocking the d2 dopamine receptors to prevent
the dopamine neurotransmitters to bind to them. Therefore, excessive stimulation of the d2
receptors in the striatum seem to be correlated with the symptoms of schizophrenia. Conclusively,
blocking these receptors with the antipsychotic drug relieve the symptoms of schizophrenia.
Now, Adam and his mother both feel comfortable with his diagnosis and treatment plan. Many
years later, Adam gets an MRI of his brain.

Question 5: Upon viewing this MRI, what would you expect to see? If you could look into Adam’s
brain at a microscopic level, what would you expect to see? (2 marks)
We could see enlarged lateral ventricles, and the empty space would contain cerebrospinal fluid.