case study

Description

(40 points) you will choose, and review ONE case study provided. You will be responsible for reviewing the case and assigning multi-axial diagnoses. You will also be responsible for providing a rationale for the diagnoses, as well as a discussion of rule outs, differential diagnoses, and prognosis. This assignment should be 2-3 pages in length (typed, double-spaced, one-inch margins in APA format) Mr. Ben Simpson is a single, unemployed, 44-year-old Caucasian man brought to the emergency room by the police for striking an elderly woman in his apartment building. His chief complaint is, “That damn bitch. She and the rest of them deserved more than that for what they put me through.” The patient has been continuously ill since age 22. During his first year of law school, he gradually became more and more convinced that his classmates were making fun of him. He noticed that they would snort and sneeze whenever he entered the classroom. When a girl he was dating broke off the relationship with him, he believed that she had been “replaced” by a look-alike. He called the police and asked for their help to solve the “kidnapping.” His academic performance in school declined dramatically, and he was asked to leave and seek psychiatric care. Mr. Simpson got a job as an investment counselor at a bank, which he held for 7 months. However, he was receiving an increasing number of distracting “signals” from co-workers, and he became more and more suspicious and withdrawn. It was at this time that he first reported hearing voices. He was eventually fired and soon thereafter was hospitalized for the first time, at age 24. He has not worked since Mr. Simpson has been hospitalized 12 times, the longest stay being 8 months. However, in the last 5 years he has been hospitalized only once, for 3 weeks. During the hospitalizations he has received various antipsychotic drugs. Although outpatient medication has been prescribed, he usually stops taking it shortly after leaving the hospital. Aside from twice-yearly lunch meetings with his uncle and his contacts with mental health workers, he is totally isolated socially. He lives on his own and manages his own financial affairs, including a modest inheritance. He reads the Wall Street Journal daily. He cooks and cleans for himself. Mr. Simpson maintains that his apartment is the center of a large communication system that involves all the major television networks, his neighbors, and apparently hundreds of “actors” in his neighborhood. There are secret cameras in his apartment that carefully monitor all his activities. When he is watching television, many of his minor actions (e.g., going to the bathroom) are soon directly commented on by the announcer. Whenever he goes outside, the “actors” have all been warned to keep him under surveillance. Everyone on the street watches him. His neighbors operate two different “machines”; one is responsible for all his voices, except the “joker.” He is not certain who controls this voice, which “visits” him only occasionally and is very funny. The other voices, which he hears many times each day, are generated by this machine, which he sometimes thinks is directly run by the neighbor whom he attacked. For example, when he is going over his investments, these “harassing” voices constantly tell him which stocks to buy. The other machine he calls “the dream machine.” This machine puts erotic dreams into his head, usually of “black women.” Mr. Simpson described other unusual experiences. For example, he recently went to a shoe store 30 miles from his house in the hope of buying some shoes that wouldn’t be “altered.” However, he soon found out that, like the rest of the shoes he buys, special nails had been put into the bottom of the shoes to annoy him. He was amazed that his decision concerning which shoe store to go to must have been known to his “harassers” before he himself knew it, so that they had time to get the altered shoes made up especially for him. He realizes that great effort and “millions of dollars” are involved in keeping him under surveillance. He sometimes thinks this is all part of a large experiment to discover the secret of his “superior intelligence.” At the interview, Mr. Simpson is well groomed, and his speech is coherent, and goal directed. His affect is, at most, only mildly blunted. He was initially very angry at being brought in by the police. After several weeks of treatment with an antipsychotic drug that failed to control his psychotic symptoms, he was transferred to a long-term care facility with a plan to arrange a structured living situation for him.