NURS 6501 - Advanced Pathophysiology

Review Test Submission: Week 6 Knowledge Check

A 21-year-old male college student was brought to Student Health Services by his

girlfriend who was concerned about changes in her boyfriend’s behaviors. The girlfriend

says that recently he began hearing voices and believes everyone is out to get him. The

student says he is unable to finish school because the voices told him he was not smart

enough. The girlfriend relates episodes of unexpected rage and crying. Past medical

history noncontributory but family history positive for a first cousin who “had mental

problems”. Denies current drug abuse but states he smoked marijuana every day during

his junior and senior years of high school. He admits to drinking heavily on weekends at

various fraternity houses. Physical exam reveals thin, anxious disheveled male who,

during conversations, stops talking, cocks his head and appears to be listening to

something. There is poor eye contact and conversation is rambling.

Based on the observed behaviors and information from girlfriend, the APRN believes

the student has schizophrenia.

Question 1 of 4:

Describe the positive symptoms of schizophrenia and relate those symptoms to the

case study patient.

Schizophrenia is characterized by plethora of positive and negative symptoms.

The positive symptoms in the given case are Hallucinations, delusions, Positive

formal thought disorder, and bizarre behavior.

Hallucinations: The client began "hearing voices" and is of opinion from that

voices that he is "not smart enough". These are described as auditory

hallucinations with voices commenting or conversing in the affected individual

Delusions: The client is experiencing a strange feeling that "everyone is out to

get him" which is a positive symptom of Delusion in Schizophrenia

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Positive formal thought disorder: Lack of logic, poor eye contact and rambling

conversation are signs of positive formal thought disorder which is also a

characteristic positive symptom in Schizophrenia

Bizarre behavior: Unexpected rage, crying, appearance are all positive symptoms

which can be described as Bizarre behavior

Question 2 of 4:

 Explain the genetics of schizophrenia.

 Based on this case, The Genetics of Schizophrenia has a hereditary

predisposition as many of the affected individuals share a family history of

schizophrenia. High susceptibility to schizophrenia in monozygotic twins and a

relatively moderate (but not lower) susceptibility in dizygotic twins support the

genetic predisposition of schizophrenia. Copy number variations involving

deletion of DNA sequences (especially at 22q11.2) is found to be a genetic

predisposition in the development of schizophrenia. Defective genes in the

affected individual leads to reduced Reelin (a protein responsible for neuronal

migration) function during the brain development in the childhood. Thus, reelin

function is compromised in prefrontal cortex and hippocampus resulting in

reduced Gamma Amino Butyric Acid (GABA-an inhibitory neurotransmitter)

function which could also be a genetic basis of Schizophrenia

Question 3 of 4:

The APRN reviews recent literature and reads that neurotransmitters are involved in the

development of schizophrenia. What roles do neurotransmitters play in the development

of schizophrenia?

Role of neurotransmitters in the development of schizophrenia:

• High concentration of Dopamine: Increased concentration of the

neurotransmitter dopamine and its effects on Dopamine receptors

(especially D2 receptor) in the mesolimbic dopaminergic pathway is

strongly correlated with symptoms associated with Schizophrenia.

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