Answer these two replies to my post again

I need one page for each reply to my post. From Engida.  I include my original post in the additional box below.

Hello Jean Robert

                    It was a pleasure reading and evaluating your discussion post about your patient, which I appreciate you taking the time to post. After ending a relationship with her partner, she began to experience major emotional difficulties like despair and anxiety, which are common among teenagers and students. The patient reports difficulties falling and staying asleep, sleeping for not more than 3 hours per night. The patient reports that she began developing these symptoms after breaking up with her boyfriend, whom she dated for two years. She states that her mother witnessed her internal preoccupied, talking to herself, and laughing inappropriately(Hypothyroidism Discussion Essay Example). The family has been woken up by this. The patient has been referred to a psychiatrist for evaluation. The patient admits to hearing voices telling her she is a prostitute and ugly. She has not attended classes for the past week. The patient denied feeling and helpless. She hears voices and sees recognizable faces. These events occur when she is alone and scared to leave the house. She reports being fatigued. I agree with the differential diagnosis, which is major depressive disorder, Bipolar I and “Is there another diagnosis that is more appropriate for this case?” F20.9 schizophrenia disorder with psychotic features. Currently patient admitted she is hearing voice. According to DSM-IV and DSM-V, the psychotic symptoms in major depressive disorder with psychotic elements are by definition episodic and only manifest themselves during a major depressive episode. In contrast, schizophrenia patients show psychotic symptoms that appear without a recognizable mood issue.(Hypothyroidism Discussion Essay Example)

 Thank you!


Zhang Q, Miao L, He L, Wang H. The Relationship between Self-Concept and Negative Emotion: A Moderated Mediation Model. Int J Environ Res Public Health. 2022 Aug 20;19(16):10377. doi: 10.3390/ijerph191610377. PMID: 36012021; PMCID: PMC9407814.

Rothschild AJ. Challenges in the treatment of major depressive disorder with psychotic features. Schizophr Bull. 2013 Jul;39(4):787-96. doi: 10.1093/schbul/sbt046. Epub 2013 Apr 18. PMID: 23599251; PMCID: PMC3686458.

 ReplyReply to Comment


From:  Susan

July 27, 2023

Hello Mr. Jean Robert,

What a great job you did on your discussion and paper!  I wanted to review my understanding of how hypothyroidism could play into this particular case, so I did some research.  A study in the Journal of Affective disorders found that even subclinical hypothyroidism in younger patients is associated with Major Depressive Disorder, first-episode. (Dai et al., 2023.). The study uncovered that study participants with higher levels of TSH tended to have more psychotic symptoms than the other patients.  Therefore, your note about checking thyroid levels in your written presentation is a very sound decision as it may be necessary to adjust the thyroid medication or consult with the endocrinologist. Kang et al. concur that checking for subclinical hypothyroidism is vital and their study found an association of high BMI and obesity to subacute hypothyroidism in young, first episode clients with MDD (2023.)(Hypothyroidism Discussion Essay Example)


Dai, W., Liu, J., Xie, H., Teng, Z., Luo, W., Yuan H., Chen, J., Liu, M., and Zhang, X. (2023). Associations between subclinical hypothyroidism and psychotic features in Chinese young adults with first-episode and untreated major depressive disorder. Journal of Affective Disorders, 333(2023), 209-215.

Kang, C., Liu, J., Zheng, Y., Wang, X., Yang, L., Qiu, S., Zhao, Y., Lackey, B. N., Wu, H. E., Zhao, N., & Zhang, X. (2023). Association of high BMI with subclinical hypothyroidism in young, first-episode and drug-naïve patients with major depressive disorder: a large-scale cross-sectional study. European Archives of Psychiatry and Clinical Neuroscience, 273(1), 183–190. to an external site.

Hypothyroidism Discussion Essay Example-Solution

Answer these two replies to my post again

Post #1


Thank you for taking the time to read and respond to my discussion and patient assessment. I like having different perspectives on a case, and often I approach my colleagues for their opinions and insights into a patient case. Having more than one viewpoint of a case can help make an informed decision. I assessed the patient and, per the symptoms, established that the likely diagnosis was major depressive disorder with psychotic features. Depressive symptoms and psychosis can co-occur and significantly affects a patient’s life and functioning, as seen in this case because the student cannot go to school and he is socially avoidant (Dold et al., 2019)(Hypothyroidism Discussion Essay Example). I agree that adolescents face a lot of challenges during adolescence, increasing the risk of developing mental health illnesses. Adolescents tend to be involved in romantic relationships as part of growing up. However, their emotional restraint and challenges in coping with emotionally difficult situations put them at risk of impairment when relationships end. The patient reported that symptoms began when she broke up with her boyfriend. She experiences self-esteem issues, does not want to engage with others, she has insomnia, talks to herself, she is internally preoccupied, and hears voices and sees recognizable faces. These symptoms indicate a severe case of depression and psychosis.(Hypothyroidism Discussion Essay Example)

I am glad we agree on the differential diagnosis part because having another person agree with my diagnosis boosts my confidence in comprehensive patient assessment and developing appropriate diagnoses. I like your rationale for selecting major depressive disorder with psychotic features rather than schizophrenia. Parental support is significant because parents are the closest to their children and can identify changes that need professional assessment (Pelham et al., 2022). Engaging parents more during assessment and treatment can help improve positive outcomes.(Hypothyroidism Discussion Essay Example)


Dold, M., Bartova, L., Kautzky, A., Porcelli, S., Montgomery, S., Zohar, J., Mendlewicz, J., Souery, D., Serretti, A., & Kasper, S. (2019). Psychotic Features in Patients With Major Depressive Disorder: A Report From the European Group for the Study of Resistant Depression. The Journal of clinical psychiatry80(1), 17m12090. Discussion Essay Example)

Pelham, W. E., 3rd, Tapert, S. F., Gonzalez, M. R., Guillaume, M., Dick, A. S., Sheth, C. S., Baker, F. C., Baskin-Sommers, A., Marshall, A. T., Lisdahl, K. M., Breslin, F. J., Van Rinsveld, A., & Brown, S. A. (2022). Parental Knowledge/Monitoring and Depressive Symptoms During Adolescence: Protective Factor or Spurious Association?. Research on child and adolescent psychopathology50(7), 919–931. Discussion Essay Example)

Post #2: Response to Susan

Hello, Susan.

I appreciate the time and effort taken to read, analyze, and respond to my comprehensive patient assessment and offer new perspectives to give additional information on the patient. The primary diagnosis for this patient was major depressive disorder with psychotic features(Hypothyroidism Discussion Essay Example). It occurs when patients experience co-occurring depressive symptoms and psychosis that cannot be categorized as bipolar I disorder or schizophrenia. I believe the provided symptoms and the physical and mental assessments of the patients adequately informed establishing major depressive disorder with psychotic features as the primary diagnosis.(Hypothyroidism Discussion Essay Example)

The patient has a medical history of hyperthyroidism, which she is taking medication for. I am glad you identified a physical health issue that, although it has no direct contribution to the patient’s mood, feelings, and emotions, can collectively contribute to poor health outcomes. You have provided evidence of a probable link between hypothyroidism and psychotic symptoms, which is exciting because it offers a new perspective that would help develop a comprehensive treatment plan. It is also supported by Lipkes et al. (2022)(Hypothyroidism Discussion Essay Example). I referred the patient to an endocrinologist for further assessment of hypothyroidism because it has been inadequately treated, and a specialist would help address the issue quicker. You have also provided evidence on the potential link between subacute hypothyroidism and high BMI and obesity, which is also supported by Mohammed Hussein and AbdElmageed (2021). I will read more into the sources you shared to learn more and adopt the information in this patient and in future assessments. I highly appreciate your response. It is why I like engaging other students to learn from them and also share my knowledge.(Hypothyroidism Discussion Essay Example)


Lipkes, C., Haider, S., Rashid, A., Angarita, G. A., & Riley, S. (2022). First episode psychosis and pituitary hyperplasia in a patient with untreated Hashimoto’s thyroiditis: A case report. Frontiers in Psychiatry13. Discussion Essay Example)

Mohammed Hussein, S. M., & AbdElmageed, R. M. (2021). The Relationship Between Type 2 Diabetes Mellitus and Related Thyroid Diseases. Cureus13(12), e20697. Discussion Essay Example)

Hypothyroidism Discussion Essay Example

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