Case study report #3

The client presents with a number of Schizophrenia type symptoms as well as Obsessive Compulsive symptoms. The client is a 28 year old male. He is currently unemployed and has a high school education. Employment history is sparse. He held a job as a bank teller and an elevator operator.

The client lived on his own after high school but moved back with his mother after losing his latest job. He is currently living with his sister and her family. The client grew up in a large family. There is no known history of mental illness on either the mother or father’s side of the family. The client tends to isolate. This behavior has been apparent since childhood. According to the history taken, this client has few friends. Due to his large family, as a child, he spent much of his time with cousins. There are a number of potential triggers for Schizophrenia.

In the case of this client, he had an over protective mother and a strained relationship with his father. His tendency to isolate may have manifested by his mother’s overprotection. Additionally, the client is preoccupied with the moral thinking of homosexuality. This preoccupation may have been a root cause of his paranoia. Additionally, the client witnesses numerous fights between his mother and father. This family strain and undue stress is typical for individuals suffering from Schizophrenia.

According to the DSM IV-TR, Schizophrenia, Paranoid type must meet the following: symptoms must be present at least six months, with at least two of the following five symptom types: Delusions (if these are bizarre then only one of the five symptoms are required), Hallucinations (if auditory hallucination is two or more voices talking to each other then only one of the five symptoms is required), speech irregularities (this includes incoherent speech, derailed speech, or disorganized speech), Disorganized or Catatonic behavior, and Negative symptoms (this includes flat affect, reduced speech, of lack of volition) .

These symptoms must also have a direct negative effect on the individual’s daily life including school or work. Additionally, criteria for paranoid type include: a preoccupation with delusions, and does not exhibit disorganized speech, disorganized or catatonic behavior, or inappropriate or flat affect.  This client displayed many of these symptoms.

According to self and family report, the client “daydreams” and talks to himself. Client admits to delusions and auditory hallucinations. His delusions are bazaar and extremely complex. The client believes the delusions to be true. He feels he has been secretly followed and recorded. These recordings resulted a film of his homosexual life. The client also admits to hearing voices. Often times these voices argue or discuss the client’s homosexuality.

The client stated that he does not recognize these voices and they often say things uncharacteristic of the client’s beliefs or feelings. To make up for these voices the client will act out behaviors or repeat certain sayings “scruples”. These actions interfere with his daily life as they take up time and the voices cause increased anxiety in the client. They have also been apparent at least since he graduated from high school. This is evidenced by coworker’s feelings about the client at his bank job, which he held right after high school.

The client also displayed repetitive behaviors of twitching. This repetitive behavior is characteristic of Obsessive Compulsive Disorder. The following details the criteria for Obsessive Compulsive Disorder. Obsessions are thoughts that are recurring, intrusive, and are more then typically worries. Additionally, the individual must know that the thoughts are their own and are irrational. Compulsions are repetitive behaviors that the individual must perform in order to reduce anxiety.

Compulsions also follow a set of rules, for example an individual with germ compulsions may have to wash their hands seven times to reduce anxiety. While these thoughts and behaviors meet some of the criteria for Obsessive Compulsive Disorder, the client is not aware that they are irrational or from his own mind. Finally, this behavior is dependent on his delusions and auditory hallucinations. The voices he hears often talk about his homosexuality which is related to the delusion of the film that was produced. Due to the incompliance of all criteria of Obsessive Compulsive Disorder this secondary diagnosis should be ruled out.

The Diathesis-stress perspective is a psychological theory pulling from both nature and nature to explain the root causes of an illness. In this case the diathesis-stress perspective is relevant. If there is a predisposition to this illness this client’s apparent strained relationships with his parents may have been a strong enough stressor to trigger the development of schizophrenia.

His family has a set value system and his father believed in a certain order to things. This thinking clashed with the client and hindered the growth of the father-son relationship. His relationship with his mother was also strained. As a child she was overprotective. This did not change when the client become an adult. According to client report, when he lived with his mother as an adult she made him anxious. Finally, his sexuality was contrary to what his family believed to be right. This again could have caused the necessary amount of stress of trigger the onset of this illness.

This stress is evidenced by his complex delusion of the film of his homosexuality. Using this theory was beneficial to this client because the therapist was able to weed out stressful triggers in the client’s life. As an adult, the client’s childhood stressor remained his mother. The therapist recognized that staying with his mother more then likely would have increased the client’s symptoms. The therapist therefore encouraged the client to continue to live with his sister. The client received support and independence at his sister’s house. The therapist also worked with the client’s sister and her husband on behavior modification techniques.

Treatment for this client began as cognitive-behavioral. This made the start of therapy difficult because therapy was not the client’s idea. However, as the client become more comfortable with the therapist, he was able to disclose more information regarding his childhood. Here the therapist learned of the dynamics of his family and was able to better understand some potential reasons for the client’s onset of schizophrenia.

With this information the therapist was able to implement different therapeutic techniques to increase the client’s social activities and participation in the family. As therapy continued behavior modification used positive reinforcements to increase positive behaviors. Cognitive-behavioral therapy was also used in an attempt of stop the client’s mumbling. Again this technique for therapy was as not effective as other techniques may have been.

In order for cognitive-behavioral therapy or behavior modification to be effective there must be rewards that the client enjoys. In this case, the client preferred to be alone and did not express interest in anything.  Medication was finally use and was effective in reducing his mumbling.

Axis I: 295.30 Schizophrenia, Paranoid Type

Axis II: No Diagnosis

Axis III: None

Axis IV: psychosocial stressors, unemployed, strained family relationships, no support network

Axis: 30

The client presented with all symptoms associated with Schizophrenia, Paranoid Type. He did not exhibit any personality disorder and there was no medical condition reported. The client’s current GAF score is 30 due to his level of functioning.  This low rating signifies severe impairment. In this case the client’s delusions preoccupied his life. He was unable and unwilling to work or have any type of social life. As this client continues through treatment this rating should increase.