Question

For each case history provide: a diagnosis; list the criteria required for the diagnosis; and provide examples from the case history for each of the criteria listed. For example, if one of the criteria for a diagnosis is "delusions", then you should list "delusions, e.g., believes he is receiving special/hidden messages from television programs that he only understands".

Emilio (DSM-IV Casebook, p. 189-190)

Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his twelfth hospitalisation, by his mother because she is afraid of him. He is dressed in a ragged overcoat, bedroom slippers, and a baseball cap, and wears several medals around his neck. His affect ranges from anger at his mother ("She feeds me sh*t . . . what comes out of other people's rectums") to a giggling, obsequious seductiveness toward the interviewer. His speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hip movements. His mother reports that he stopped taking his medication about a month ago, and has since begun to hear voices and to look and act more bizarrely. When asked what he has been doing, he says "Eating wires and lighting fires." His spontaneous speech is often incoherent and marked by frequent rhyming and clang associations (speech in which sounds, rather than meaningful relationships, govern word choice).

Emilio's first hospitalisation occurred after he dropped out of school at age 16, and since that time he has never been able to attend school or hold a job. He has been treated with medication during his hospitalizations, but doesn't continue to take medication when he leaves, so he quickly becomes disorganised again. He lives with his elderly mother, but sometimes disappears for several months at a time, and is eventually picked up by the police as he wanders in the streets. There is no known history of drug or alcohol abuse.

Answer 1

The diagnosis for Emilio is Schizophrenia. The diagnostic criteria for Schizophrenia includes the presence of:

a) Delusions. For example, Emilio is experiencing persecutory delusion in which he feels that his mother is feed him something wrong.

b) Hallucinations. For example, Emilio's mother mentioned that he has been hearing voices which shows that he has been experiencing auditory hallucinations.

c) Disorganised Speech. For example, Emilio's speech is also found to be incoherent and marked by frequent rhyming and clang associations.

d) Grossly disorganised or catatonic behaviour. For example, Emilio's speech and manner have a childlike quality, and he walks with a mincing step and exaggerated hip movements.

The diagnostic criteria also mentions that since the onset of the symptoms, the level of functioning in major areas like work, interpersonal relationships and self care is markedly below the level achieved. For example, Emilio has never been able to attend school or hold a job ever since his first hospitalization. He can also be seen to have problematic relationship with his mother as he believes that she feeds him something wrong.

According to the criteria, the symptoms should be present for at least 6 months. For example, his first hospitalization was at the age of 16 and currently he is 40 which shows symptoms are present for more than 6 months.

The diagnostic criteria also states that the disturbance is not due to the effects of any substance. For example, there is no known history of drug or alcohol abuse in Emilio's case.

Thus, Emilio's case fulfils the criteria for Schizophrenia.