Question

Mr. C is a 22 year old, white, single, male who is in his third year at a local university in Albuquerque, New Mexico. He is majoring in Philosophy and American studies. When he is not in school he lives with his parents.

He has been taken to the mental health center for an evaluation today, brought by his parents who were concerned after he was demonstrating “strange” behaviors and then abruptly dropped out of school after he failed his summer class. This baffled the parents since he has always been an A and B student. Up until three months ago he seemed to be doing okay. He was living in the dorms and there were no reports he was doing poorly. When asked why he dropped out of school, he stated the administration of the school was watching and targeting him for being a suspected spy for another university.

He stated the professor of his philosophy class warned him of this in a coded message on one of his powerpoints. None of the other students noticed this, but the message was clear to him. He also verbalized he could hear the students laugh at him behind his back. Additionally, he began hearing two voices, which he did not recognize. These voices would comment on his behavior and criticize his actions. They were telling him to drop out of school because if he didn’t the administration was going to make a public spectacle of him.

He stated he smoked a little bit of pot when he was in high school, but didn’t like it because it made him feel weird. He also didn’t like the taste of alcohol. He grew up in an upper middle class environment. His mother is an attorney working in real estate law and his father is a professor in the English department of another university in New Mexico. They stated he has always been very intelligent and always a little shy, but not overly so. He spent a lot of time alone, but his parents didn’t consider him to be a “loner” since he occasionally had one or two friends. He didn’t like to go to parties or places where there were large gatherings. The parents did not see this as odd and were glad he was keeping away from trouble. He joined a couple of youth groups in his adolescence which were tied to his church, but dropped out after he felt they were pressuring him to change his beliefs.

When the social worker entered the room to begin the evaluation, Mr. C asked her if she worked for the administration and asked to see her credentials. He was disheveled in appearance, wearing a dirty wrinkled shirt--which was different from his past habits, according to the parents. He always prided himself on being clean and neat. He was slightly agitated and during the interview got up from his chair several times. His thinking, at times, was tangential with some loosening of associations. He denied any suicidal or homicidal ideation. His only previous psychiatric history was outpatient treatment he attended with his family in a family therapy session. This occurred when he was around 15 y.o. when his parents were thinking of getting a divorce. The parents did not divorce and have remained together. The father did state one of his brothers was hospitalized for psychiatric reasons in Colorado several years ago, and didn’t know the circumstances.

Based on the above vignette for Case #1, list the principal diagnosis/diagnoses (including any and all appropriate subtypes and specifiers)

Answer 1

Note: This response is in UK English, please paste the response to MS Word and you should be able to spot discrepancies easily. You may elaborate the answer based on personal views or your classwork if necessary.

(Answer) According to the boy’s behaviour, he is very likely to be a “Paranoid Schizophrenic.” His symptoms a quite obvious, especially because he thinks that the people at the university are out to sabotage him. He is wary of people and his surroundings along with having auditory hallucinations in the typical form of hearing voices.

Furthermore, it is mentioned below that the boy’s uncle also had a few psychological problems that they did not know the details of. Problems like Schizophrenia are likely to occur in families with a history of the problem.

At this point, psychiatrists might recommend psychotherapy, electroconvulsive therapy, hospitalisation, medication neuroleptics and other therapeutic measures. The condition might be lifelong but, treatment has shown to almost completely curb the symptoms.