Psychiatric Assessment and Fundamentals Q 35
A 32-year-old male graduate student, who has become increasingly withdrawn and neglectful of his work and personal hygiene, is brought to the psychiatric hospital by his parents. After detailed assessment, a diagnosis of schizophrenia is made. It is unlikely that the client will demonstrate:
A. Low self-esteem
B. Concrete thinking
C. Effective self-boundaries
D. Weak ego
Correct Answer: C. Effective self-boundaries
A person with this disorder would not have adequate self-boundaries. Traditionally, symptoms have divided into two main categories: positive symptoms which include hallucinations, delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech, and lack of motivation.
Option A: Common presentations include a relative noticing social withdrawal, personality changes or uncharacteristic behavior; deliberate self-harm or suicide attempts; calling the police to report their delusional symptoms or referral via the criminal justice system. The use of screening tools such as COPS (Criteria of Prodromal Syndromes), SIPS (Structured Interview for Prodromal Syndromes) and PACE (Personal Assessment and Crisis Evaluation Clinic) has been shown to increase the detection rate of schizophrenia in premorbid states although there is controversy surrounding indicating treatment at this stage.
Option B: Evidence showing exacerbation of positive and negative symptoms in schizophrenia by NMDA receptor antagonists insinuate the potential role of glutamatergic hypoactivity while serotonergic hyperactivity has also been shown to play a role in schizophrenia development.
Option D: A thorough risk assessment must also be undertaken to determine the risk of harm to self and others. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore few will present directly to seek help for their psychotic symptoms.