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MENTAL DISORDERS The DSM IV (Diagnostic and Statistical Manual of Mental Disorders) systems which was published in 1994, represents the official classification system used in the United States for diagnosing psychological disorders. It gives specific criteria that are used in diagnosis, along with other information regarding other features that are sometimes seen in people with specific disorders and issues that are considered differential diagnosis (distinguishing between a primary disorder and other conditions that may be similar in some ways). All three of the patients in the case studies exhibit symptoms that can be diagnosed through this system. James Chatterton One case deals with schizophrenia, another with obsessive-compulsive disorder, and the other with substance abuse disorder (specifically, substance-induced). However, induced mood disorder could represent an alternative diagnosis which should be considered. Although the previous diagnosis is themes appropriate.
All three patients exhibit characteristics that enable them to be diagnosed through the DSM IV classification system. When considering both the history and presenting symptoms of this patient, it would seem tat themes appropriate diagnoses would be schizophrenia paranoid type. An alternative diagnosis of mood disorder with psychotic features would have to be considered, although this diagnosis seems much less likely than a primary diagnosis of schizophrenia. The primary features of schizophrenia fall into a number of categories. Characteristic symptoms include delusions, hallucinations, disorganized speech, grossly disorganized behavior, as well as symptoms of affective flattening (e. g. , showing a lack of range of emotional response).
Patients only need to show two of these features for diagnosis. Other symptoms include evidence of major social or occupational dysfunction. This may be reflected in a failure to function at an expected level in terms of job or school performance, as well as major problems in relating to others in social situations. The disorder must have lasted for six months or more, and the patient must not show evidence of a number of other conditions such as mood disorder with depressive features, or substance induced psychotic disorder. James Chatterton displays a number of features that are highly suggestive of a diagnosis of schizophrenia. He shows very unusual and unconventional behaviors.
Indeed, he is said to have had no friends and displayed an uncharacteristic lack of interest in the opposite sex during his adolescent years. His problems in social functioning are not only indicated by his unusual behaviors and hid lack interpersonal relationships but it is also indicated by the fact that during his senior year his social functioning declined to the extent that he stopped attending school and displayed a generalized lack of interest in doing much of anything. Clearly, he shows evidence of social dysfunction. Perhaps the features most characteristic of schizophrenia are the presence of delusions and auditory hallucinations. Here it can be pointed out tat the patient had suggested to his cousin that she should not take her medication, as it was a plot by a religious group to make her sterile.
This, alongwith his lectures about extraterrestrial is indicative of delusional thinking. Such delusions are of theyre most commonly seen in schizophrenics with paranoid features. It can be noted that, even as a child, the patient thought other people were talking about him. Other classic schizophrenic characteristics displayed by this patient include auditory hallucinations, as when he noted that a woman s voice was telling him to do things. His tendency to laugh without apparent reason. as though he had heard something, is also supportive of the presence of auditory hallucinations.
The fact that the Mental State Exam found the patient to be disoriented in terms of not knowing the d! ate or where he was, also is suggestive of schizophrenia by his lack of appropriate expression of feelings. All in all, a multitude of features strongly supports a diagnosis of Schizophrenia. Specifically, schizophrenia Paranoid Type. It can be noted that the Paranoid type of Schizophrenia is diagnosed when the patient shows evidence of delusions and other features such as either disorganized behavior or inappropriate affect (expressions of feelings). His delusions have already been discussed.
Inappropriate affect is suggested by this tendency to laugh inappropriately for no apparent reason. His blank facial expression is also suggestive of flat affect. While all of the above strongly support diagnosis of schizophrenia, the fact that the patient shows evidence of sleep disturbance, weight loss, and has made what would be seen as a suicide attempt makes it important to consider that he may display among disorder with psychotic features as these features are all! suggestive of depression. The primary argument against this alternative diagnosis appears to be the presence of auditory hallucinations, which are infrequently found in mood disorders and the fact that what appear to the primary symptoms of schizophrenia in this patient do not necessarily coincide with evidence of depression as is the case with psychotic features (e. g. , delusions) which are associated witha mood disorder.
Thus, this alternative diagnosis appears much less likely than a diagnosis of schizophrenia. Psychosis associated with substance abuse seems relatively unlikely due to the fact tha the patient has not engaged in serious substance abuse, although there appears to have been some experimentation. It can be noted that, unlike the pseudo patient described by Rose nhan, this patient displays aside range of symptoms that clearly differentiates him from normal individuals. Treatment of a patient such as this would likely involve treatment with antipsychotic medications, perhaps combined with psychotherapy.
SARA WINKLER It would seem that the most appropriate diagnosis for this patient would be Obsessive-Compulsive Disorder. An alternative diagnosis would be Major Depressive Episode. According to DSM IV Criteria, the primary features characteristic of Obsessive-Compulsive Disorder are either obsessions or compulsions. Here the patient experiences recurrent, persistent thought, impulses or images that are intrusive and cause marked anxiety or distress, that go beyond normal worrying about real life problems, and which the person realizes are irrational and attempts to suppress or deal with through some thought or action. Alternatively, the person may experience repetitive behaviors which they feel compelled to perform.
These behaviors are directed toward reducing anxiety or preventing some feared event or situation. These obsessions or compulsions are seen by the patient as being excessive or irrational, cause marked distress, and interfere with the patients ability to function. It is obvious that Sara shows both obsessions and compulsions. Her obsessions take the form of intrusive thoughts and impulses related to her arming her child.
Her compulsive behaviors take the form behaviors which represent attempts to ward off or prevent such threatening things from happening. Other characteristics of this patient might be seen as suggestive of a Depressive Disorder which might be considered as an alternative diagnosis. In this regard it can be noted that the patient reports feelings of depression, shows a loss of interest in most activities, describes a lack of energy, and evidence of weight loss and sleep disturbance. All of these features are associated with Depressive Disorder. While these features are clearly present, it could be argued that the primary diagnosis forth patient should be Obsessive-Compulsive disorders it seems to be the case that depressive features have occurred secondary to the distress resulting from her obsessions and compulsions and the disruption in her personal and family life that has resulted. Treatment of this patient would likely involve dealing with several issues.
The treatment of obsessive-compulsive disorder has been approached through the use of pharmacological treatments as in these of antidepressant drugs such as Prozac. Psychological treatment where the patient is exposed to situations likely to result in increased compulsive behavior and where they are not allowed to engage incompulative behaviors have also been found to be useful. Either of these types of treatment might be useful with this patient. DEAN WANNAMAKERThis case seems to present the most difficulties in terms of making a differential diagnosis. It seems clear that this patient displays a substance abuse disorder of some type. Two specific diagnoses appear to most likely characterize his symptoms.
The first is Substance-induced Psychotic Disorder. My hypothesis is that this is the most appropriate primary diagnosis. The second is Substance-induced Mood Disorder with Depressive Features. The primary symptoms of Substance-induced Psychotic Disorder include prominent hallucinations or delusions. It is suggested that there should be evidence that these symptoms developed during or within month of substance intoxication or withdrawal, that symptoms are not better accounted for by anon-substance-induced psychotic disorder and that symptoms do not occur just during a delirium. For this diagnosis to be made it is also the case that the hallucinations or delusions should not be recognized bythe patient to be the result of substance abuse.
This patient appears to clearly meet these criteria. First of all, he shows evidence of auditory hallucinations that began when he was in his early 40 s. These hallucinations began after the onset of bouts of heavy drinking and are described by his girlfriend as only occurring after he has been drinking for a while. The patient shows no insight into the fact that the voices he hears are related to his substance abuse. Of special concern is the fact that the voices he hears now speak to him regarding the topic of death. This would raise concern over possible suicide attempts later.
The patient also seems to meet the criteria for the alternative diagnosis of Substance-induced Mood Disorder with Depressive Features. He shows significant depression by his crying, weight loss sleep disturbance, loss of interest in sex, and loss of energy. His recent thoughts about dying are also suggestive of significant depression. His girlfriend s statement that he has been depressed most of theme for the last month and a half not quite as long as he d been drinking suggests that the patient s depression likely developed subsequent to alcohol abuse. Treatment might well involve participation in a substance abuse treatment program and helping develop more adequate ways of coping with major stress so that he is less likely to abuse alcohol in attempting to cope with this stress. Psychotherapy would seem likely to be helpful in this regard.
Given that both the psychotic symptoms and depression are substance abuse could be dealt with these other symptoms (e. g. , hallucinations, depression) should be greatly diminished.
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Research essay sample on Obsessive Compulsive Disorder Auditory Hallucinations
