Case Study Jenny

PSYCHOTIC DISORDERS Psychotic disorders are a collection of disorders in which psychosis predominates the symptom complex. Psychosis is defined as a gross impairment in reality testing. Specific psychotic symptoms include delusions, hallucinations, ideas of reference, and disorders of thought Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)

Felicia Allen is a 32 year old woman, who was initially brought into therapy after an attempt to steal a bus. Due to her reported “emotionally disturbed” nature, this consult became a priority. The police report states that Ms. Allen pulled out a knife, and threatened the driver after the driver declined her dollar bills. She then took control of the bus, and crashed it across the street. Upon our meeting, Ms. Allen was fidgety, and swayed back and forth all the while mumbling to herself. If she were questioned, she would look up and say “Sorry, sorry.” As far as patient history goes, Ms. Allen started hearing voices when she was 5 years old. These auditory hallucinations were mostly composed of critical, disparaging voices that made comments on her actions and behaviors. Her severe symptoms led her to be hospitalized fairly consistently since she was 11. Ever since she was young, she has been driven to please, and has a strong desire to be independent. Felicia has been prescribed clozapine for 1 calendar year, which helped her auditory hallucinations a great deal. Given the above symptoms and information, I have diagnosed Felicia Allen with schizophrenia.

According the fourth edition diagnostic manual of mental disorders (American Psychiatric Association, 2000), the category psychotic disorders (Psychosis) include Schizophrenia, paranoid (Delusional), disorganized, catatonic, undifferentiated, residual type. Other clinical types include Schizoaffective Disorder, Bipolar Affective Disorder/Manic depression, mania, Psychotic depression, delusional (paranoid) disorders. These are mental disorders in which the thoughts, affective response or ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality; the classical and general characteristics of psychosis are impaired reality testing,

Rationale: Jennifer has been presenting with symptoms for unspecified amount of time. Jennifer meets six of the criteria for symptoms being present during the same 2-week period and represents a change from previous functioning. Jennifer is depressed most of the day, nearly every day, has diminished interest in all or almost all activities most of the days, nearly every day, has fatigue or loss of energy nearly every day, feelings of worthlessness, and diminished ability to think or concentrate, is having recurrent thoughts of death, recurrent suicidal ideation without a specific plan. The symptoms have cause clinically significant distress or impairment in social, occupational, and other functioning areas. There is no know substance or medical condition and occurrence is not better explained by Schizophrenia Spectrum or Psychotic Disorders. Jennifer has never had a manic episode or a hypomanic episode. Possible family history of depression - mother.

symptoms of delusions (Frank, 1998). According to Foster and Levinson (1998) this client has a

Additional, inferences about the disorder are provided by Whitcomb and Merrell (2013). The authors characterize the symptoms of schizophrenia as delusions that are “typically bizarre and implausible” and pronounced hallucinations such as hearing voices for long periods of time (p. 363). Additional, impairments noted by the authors include “severe disturbances in perception, thought and affect, a severe decline in personal and social functioning, poor personal hygiene, inability to function effectively at school or work, and a severe impairment in social relationships” (Whitcomb and Merrell, 2013 p.363).

A couple of culture-specific protective factors that may have helped Andrea cope with the racism that she faced church attendance, community involvement, and family. Church attendance would have helped Andrea by helping her recognize that racism exist and helping her forgive. If Andrea isn’t religious, her community might also have helped her cope with the racism she faced. She could've created a support group with other individuals that have also faced racism. Her family could of helped her with social support such as caring, love and affection.

Classic symptoms of delusional disorder are varying degrees of visual hallucinations (although not normally as prominent as shown in the story) and olfactory hallucinations related to the delusional theme(s) or object(s). Delusional disorder does not markedly impair psychosocial functioning or cause a person to display odd or bizarre behavior when other people are known to be present. Undetected and/or untreated delusional disorder often degenerates into schizophreniform disorder, or even full blown schizophrenia, and the delusions take control over the person's mind (DSM - IV Diagnostic and Statistical Manual of Mental Disorders 290, 296 - 301). The person's every action is in response to the perceived actions of the delusion, very similar to what occurred to Jane in the story. In Jane's case, the symptoms ended up flying way out of proportion simply because she had nothing else on which to focus.

Jenny appeared to look healthy. She dressed appropriately for the weather, and her hygiene was within normal limits. Jenny appeared to be a little over weight for her height. She maintained eye contact, and her tone of voice was within normal limits. She reported that overly congested areas are making her starting to panic. She stated that it is happening at work when it gets busy. She stated that she feels she must rush through her job to avoid angry customers. Jenny stated that none of her customers have been angry towards her.

Evidence of her auditory hallucinations is mentioned when her husband reported he has seen her repeatedly whispering to someone for the last 5 weeks without anyone in the room. It is important to note delusions are often seen in other disorders such as schizoaffective disorder and depressive, mania and delusional depression, or bipolar disorder. However, Janice’s case as she expressed although she had major depressive disorder in the past, she has not experienced any mood symptoms since she was 14. Since depressive or mood episodes did not occur along with her delusions, it would rule out the possible diagnoses I previously indicated. Her hallucinations also support her diagnosis as hallucinations is more so present in those with schizophrenia than other psychotic disorders.

The impact of depressive symptoms on the clinical presentation of Persistent Delusional Disorder. Asian Journal Of Psychiatry, 32123-125. Opjordsmoen, S. (2014). Delusional disorder as a partial psychosis. Schizophrenia Bulletin, 40(2), 244-247. doi:10.1093/schbul/sbt203

Psychotic episodes stream from the result of a mental or physical illness, substance use, trauma or

Schizophrenia is an incredible example of mental muddle which is exemplified by crumbling of thought processes and emotional receptiveness. It can be straightforwardly acknowledged by auditory hallucinations, paranoid or bizarre illusions, dislocated speech or thinking aptitude pursued by social or occupational dysfunction. The warning signs initiate untimely in the adulthood. The disease is recognized to affect about 1% of the human population with about 2 million patients from the United States unaided.

2011). Varcarolis et al. 2006 describe positive symptoms of schizophrenia as ‘florid psychotic symptoms’ ‘as they capture attention’. Cognitive deficits lay primarily within the domains of memory and language affecting mood and behaviour (Elder et al. 2009). Positive symptoms of schizophrenia include delusions, hallucinations and sever thought process disturbances and have an acute onset (Elder et al. 2009).Varcarolis, Carson and Shoemaker (2006) state that a patient experiencing a delusion is convinced that what they perceive is real and consequently the patients thinking often reflects feelings of great fear, isolation and trust issues. Additionally Elder et al. (2009) state that cognitive deficits are considered psychotic symptoms and that behaviours, perceptions and beliefs shown in a person having an exacerbation of schizophrenia are not consistent with normal human experience.

As I sat in on a therapist appointment I met Bill McClary. Bill is single, unemployed, and a twenty-five year old living with his sister’s family. He has spent his last eighteen months dealing with daydreaming, social isolation, living in private fear, and other behaviors. His unordinary behaviors and speech made his sister and Roger worry. After observing all of Bill’s symptoms for over six months I decided that if I was a Doctor I would of diagnosed him with Schizophrenia. It is a psychotic disorder that causes major disturbances in thought, emotion, behavior, and disordered thinking. The requirement for Schizophrenia in the DSM-5 is having at least one of delusions, hallucinations, or disorganized speech. Other symptoms are disordered behavior, different negative symptoms, and their functioning in work or relationships decline. They have to have two or more symptoms for at least one month and signs of the disorder for at least six months.