case study

Case introduction: A 19 year-old gentlemen, SS, presented to station 20N through the emergency department, following what was described by friends and family as “bizarre behavior.” SS had recently begun college at a local liberal arts school. He had done well during the first semester, but began to struggle academically during the second semester. Family attributed the decline in academic success to an increase in class size, which made SS uncomfortable. Several weeks prior to hospital admission, SS became increasingly isolated, spending the majority of his time in the dorm room and less time in class. Friends and roommates reported that SS was exhibiting bizarre behavior, often confiding in friends that he was being “spied on” by others and that people around him could “read his thoughts.” SS also endorsed a strange delusion in which those around him would blink simultaneously as a form of communication. All of the aforementioned events became overly distressing to SS and his family, so they sought medical help. SS had a limited psychiatric history for which he had seen a psychiatrist. The psychiatrist had put him on an anti-psychotic medication some months prior, but SS self-discontinued the medication after just a several week trial. As a result of the above, and a lack of explanation regarding the past psychiatric referral, the events were described as “first-episode psychosis.” Discussion regarding the diagnostic work-up followed.

NAMI describes first-episode psychosis as an acute or subacute presentation in which a patient “loses contact with reality,” typically through hallucinations (auditory, visual, and/or olfactory) and delusions (fixed false beliefs, such as paranoia or mistaken identity). FEP is extremely...

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...structural changes in subcortical and cortical regions, and may have some diagnostic utility in various psychiatric conditions causing FEP. Still, more research on the cost-effectiveness of neuroimaging in FEP focused on the US needs to be conducted, both cross-sectionally and longitudinally, in order to better assess the economic benefits of routine neuroimaging.

Case conclusion: Upon admission to station 20N, SS underwent the first-episode psychosis work-up, which included an MRI. The MRI showed no focal or anatomic abnormalities. The remainder of the FEP work-up was unremarkable. SS remained on the unit for several days and was reinitiated on an anti-psychotic medication. His auditory and visual hallucinations improved, as well as his perceived thought broadcasting. He was discharged to home with his family with a plan to begin out-patient day treatment.