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This case presents a 37-year-old African American woman with a 5-year history of a chronic psychotic illness, diagnosed as schizoaffective disorder- bipolar type who presented to the emergency room complaining of a severe headache, while appearing confused and experiencing auditory and visual hallucinations (AVH). There is no history available confirming the diagnosis according to the DSM V diagnostic criteria. She tells you that she has been on several antipsychotics all of which have been non-efficacious. She states, “I cannot remember all the meds, I know there have been more than 10.” Her sister is present and confirms these statements. The client states the headaches “just won’t go away” At this time you cannot confirm the time frame of AVHHow will you proceed? What else do you need to know? What are your differentials? Rule outs? Discuss the neurobiology of your differentials/rule outs. Are there any cultural considerations? Possible misdiagnosis? Why or why not? Be sure to label each query accordingly and cite evidenced based resources. .
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