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Psychobiology Case Studies
Human Pathophysiology (NUR 252)
Creighton University
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Psychobiology, Development, and Cognition Case Studies
- Joe Smith is an 84-year-old male who lives with his wife. She has recently become concerned regarding his memory loss. He was described as “forgetful” a few months earlier but now his memory loss is becoming worse and he has started forgetting where he is going when walking in the house or grocery store.
A. What exemplar do you suspect Joe will be diagnosed with and why? Alzheimer’s based on his increasingly worse cognition symptoms and his age.
B. What are risk factors for developing this condition, in addition to what the patient presents with in the case study? Age, lack of brain/neuronal stimulation, genetics/family history
C. Discuss the pathophysiology behind the exemplar and how the symptom of forgetfulness occurs.
Although the causes of Alzheimer disease (AD) are still under investigation, a buildup of plaques consisting of beta amyloid, a protein in the brain, as well as tangles of another protein, tau, interfere with neuronal transport and eventually the cortex thins and the brain gradually shrinks. There is evidence of neuronal cell damage and death in the brain, which may result from interference from the plaques and tangles. Acetylcholine is also thought to play a role, as this enzyme is essential to many of the functions that deteriorate in individuals with AD. The hippocampus is thought to be impacted initially which is responsible for memory - leading to the symptoms of memory loss.
D. What other complications can result from this exemplar? Safety concerns, falls, aggressive behavior. There is no cure and the patient will progressively decline
E. What diagnostics tests would you anticipate being done to confirm the diagnosis? None that confirm; symptoms are used as diagnostic tool
- Mary Jones is a 53-year-old female who was walking with a friend. Mary lost her balance on the walk, had to sit down, and was unable to speak. Her friend called 911 and also noticed Mary’s right side of her face was drooping. Mary has a history of high cholesterol and has been a smoker for 30 years.
A. What exemplar do you suspect Mary will be diagnosed with and why? Ischemic stroke (possibly TIA) based on symptoms and risk factors.
B. What are risk factors for developing this condition, in addition to what the patient presents with in the case study? Age, smoking, hyperlipidemia, atrial fibrillation could lead to embolic stroke
C. Discuss the pathophysiology behind the exemplar and how the symptoms of speech difficulties, facial drooping, and hemiparesis/hemiplegia occur.
An ischemic stroke may involve partial or complete occlusion of cerebral blood flow to an area of the brain due to a thrombus or embolus (Figure 27). Several vascular disorders can lead to cerebral ischemia, the most common being atherosclerosis. Atherosclerosis develops from injury to vascular endothelial cells by mechanical, biochemical and/or inflammatory insults. Monocytes and lymphocytes that migrate to the vessel attach to the area of injury along the wall of the vessel and stimulate proliferation of smooth muscle cells and fibroblasts, leading to the formation of a fibrous
plaque. The damaged endothelial cells also cause aggregation and activation of platelets that secrete growth factors, leading to further proliferation of smooth muscle and fibroblasts. As an atherosclerotic plaque forms and enlarges on the vessel wall, it begins to reduce the amount of blood that can travel through the vessel. Over time, the plaque can fully occlude blood from reaching the brain tissue, leading to an ischemic stroke, or the plaque may rupture, releasing emboli. Motor deficits typically occur on the opposite side of the body as the stroke occurs due to the contralateral nature of neurons sending signals to the musculoskeletal system.
D. What other complications can result from this exemplar? Safety concerns, falls, personality changes. If this was a TIA, 33% of people will go on to develop a full ischemic stroke within one year. Death can occur due to a massive stroke.
E. What diagnostics tests would you anticipate being done to confirm the diagnosis? CT to rule out a hemorrhagic stroke before therapy is started; lipid levels to determine hyperlipidemia, ECG to see if atrial fibrillation is present
- Mrs. Walker brings her 21-year-old son, Jeff, to the clinic. She expresses to the provider that she has been concerned about Jeff’s behavior as he has recently begun hearing voices and speaking to people that are not there and has been withdrawing from family and friends.
A. What exemplar do you suspect Jeff will be diagnosed with and why? Schizophrenia due to the positive and negative symptoms that are present. His age is also when this disease is typically diagnosed.
B. What are risk factors for developing this condition, in addition to what the patient presents with in the case study? Genetic links, family history, link to other neurodevelopmental disorders such as autism, infections.
C. Discuss the areas of the brain and neurotransmitter abnormalities that are often associated with this condition.
Known pathologic mechanisms associated with schizophrenia include neurotransmitter abnormalities and impairments in immune function. The relationship between these mechanisms is complex, and it is not always clear which alterations are a cause of or a consequence of the disease. For example, alterations in the dopaminergic system have been implicated, in part because antipsychotic medications block dopaminergic receptors, particularly D2 receptors. These medications also influence several other neurotransmitters such as norepinephrine and serotonin. Gamma-aminobutyric acid and acetylcholine neurotransmitter systems are also believed to be involved.
Some sources state that neurotransmitter abnormalities may include norepinephrine (too much or too little), dopamine (too much), serotonin (too much), and GABA (too low).
- Enlarged ventricles
- Widened sulci and fissures
- Decreased cerebral cortical volume particularly in temporal and frontal lobes
medial frontal cortex) are considered key to depression because they receive projections from the limbic region, which is critical to experiencing and reading emotions
Another area of the brain that has been implicated in depression is the ACC. The ACC lies above and to the front of the knee (or genu) of the corpus callosum. It is situated between the frontal cortex with its dorsal portion connected to the prefrontal executive function areas and is thought to significantly influence cognitive controls and reward-based decision making. The more ventral portion (perigenual) projects downward to the limbic system and is involved with emotional control (processing emotional information, controlling the valence of emotions, affecting motivation, and ultimately regulating autonomic and endocrine functions). Research supports some volume loss as well as functional alterations in the ACC during major depression. Because the ACC is an important way station for controlling the balance of thinking and processing emotions, improvement in its functioning may be critical in the response to antidepressant treatment
D. What other complications can result from this exemplar? Anxiety is often a comorbidity, can occur with substance use/abuse, major concern is risk for suicide
- Mr. Green brings his 8-year-old son, John, to the clinic. John is starting to have behavioral problems at home and at school, including not paying attention and displaying impulsive behaviors.
A. What exemplar do you suspect John will be diagnosed with and why? ADD/ADHD based on his age and symptoms.
B. What are risk factors for developing this condition, in addition to what the patient presents with in the case study? Genetics, currently researching other possible causes/links including low birth weight, alcohol and tobacco use during pregnancy, premature birth, and exposures to environmental substances such as lead.
C. How should the nurse respond if Jason’s parents ask whether their parenting skills, the environment, or diet could have caused Jason’s ADHD?
Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, improper parenting, or social and environmental factors such as poverty or family chaos. Of course, these and other factors may affect symptom severity or illness trajectory, especially in certain individuals, but the evidence is not strong enough to conclude that they are the main causes of ADHD
D. On the basis of his manifestations, John is most likely afflicted with which of the three types of ADHD? Combined due to lack of attention and impulsivity
Psychobiology Case Studies
Course: Human Pathophysiology (NUR 252)
University: Creighton University
