Diagnostic Impressions: Schizophrenia Spectrum and Other Psychotic Disorders

Case Study

Devyn is a 20-year-old female college student in her sophomore year of studies. Devyn has recently been admitted to the psychiatric hospital where you are currently employed. You are completing Devyn's admissions assessment, taking clinical, medical, and historical information to arrive at an initial diagnostic impression. She reports that over the past two weeks she has been hearing someone talking to her when at home. She seems somewhat afraid of telling you this information, reducing her voice to a quiet whisper when telling you about what she calls "his voice." Devyn states that "his voice" is often angry, calls her vile names, and gets louder and louder the more she tries to stop listening. She shares that today "his voice" told her to hurt herself, which is when Devyn told her mom that she was scared. When going through the medical and historical information, you find out that Devyn has a history of some moderate head injuries. She was a gymnast in high school and had two or three tumbling accidents that resulted in concussions. Also, Devyn tells you that she has been mostly drug free, but has started smoking marijuana over the past four months. She says that sometimes smoking marijuana calms her and sometimes it makes her very agitated and angry. During the assessment, Devyn seems to have a flat affect, with the exception of some appearance of anxiety/fear when talking about "his voice." She is on no medications at this time and has no other medical history.

Please respond to the following:

• Identify and discuss the key symptoms experienced by the client.
• Discuss at least two possible diagnoses that could be used for the client.
• Provide a diagnosis for the client, including theDSM-5-TR coding.
  • Include a rationale for the diagnosis that you arrived at for the client.
  • Provide a rationale for ruling out at least one additional/possible diagnosis.
  • What additional (neuroimaging, neurophysiological, or serological) testing or information would be helpful in conclusively arriving at your diagnosis?