ABNORMAL PSYCHOLOGY – MENTAL DISORDERS CASE …



ABNORMAL PSYCHOLOGY – MENTAL DISORDERS CASE STUDIES

CASE #1

A 35-year-old mathematician gave a history of episodic palpitations and faintness over the previous 15 years.

There had been periods of remission of up to 5 years, but in the past year the symptoms had increased and in the last few days the patient had stopped working because of the distress. His chief complaints were that at any time and without warning, he might suddenly feel he was about to faint and fall down, or tremble and experience palpitations, and if standing would cringe and clutch at the nearest wall or chair. If he were driving a car at the time he would pull up at the curbside and wait for the feelings to pass off before he resumed his journey. He was becoming afraid of walking alone in the street or of driving his car for fear that the episodes would be triggered by it and was loath to travel by public transport. Although he felt safer when accompanied, this did not abolish his symptoms. The attacks could come on at any time of day or night.

CASE #2

"I sometimes don't go to class because I think the professor might call on me. My fear doesn't have anything to do with being unprepared if he asks me a question because I'm almost always well prepared. My grades on exams are always near the top of the class. What I keep thinking about is that the professor and all the students will see how red my face gets whenever I have to say something in a group"

CASE #3

"I know it's crazy, but I really freak out when I see a German shepherd dog. Even a picture will make me kind of nervous. But if I see one for real, I start shaking, I can't think straight, all I want to do is get away. If I'm talking to someone at the time I have trouble staying in the conversation - I'm just feeling like I really want to get away. I know the dog won't really attack me, but I can't help being afraid anyways".

CASE #4

A newly married young computer programmer...spent many long hours ruminating over whether she had or had not murdered a solitary old lady whom she had visited regularly. This troublesome thought intruded repeatedly, seriously impaired her concentration, and provoked considerable discomfort and guilt. Repeated enquiries, including several visits to the local police station, failed to satisfy her that the woman had in fact died of natural causes some days after the (woman) had last seen her. (This) single tormenting persistent rumination...had plagued her for years.

CASE #5

A 38-year-old mother of one child was consumed by a fear of contamination for over 20 years. Her concern with the possibility of being infected by germs resulted in washing and cleaning rituals that invaded all aspects of her life. Her child was restrained in one room, which was kept entirely germ free. She opened and closed all doors with her feet in order to avoid contaminating her hands.

CASE #6

When experiencing symptoms, a 38 year old woman, periodically hospitalized because of her extreme moods, would become "overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for re-establishing different forms of lucrative business. She purchased many clothes, bought furniture, pawned rings, and wrote checks without funds. (She) played her radio until late in the night, smoked excessively, took out insurance on a car that she had not yet bought. Contrary to her usual habits, she swore frequently and loudly, (and) created a disturbance in a club to which she did not belong. On the day prior to her second admission to the hospital, she purchased 57 hats".

CASE #7

"I was seized with an unspeakable physical weariness. There was a tired feeling in the muscles unlike anything I had ever experienced...My nights were sleepless. I lay with dry, staring eyes gazing into space...The most trivial duty became a formidable task. Finally mental and physical exercises were impossible; the tired muscles refused to respond, my "thinking apparatus" refused to work, ambition was gone. My general feeling might be summed up in the familiar saying "What's the use." I had tried so hard to make something of myself, but the struggle seemed useless. Life seemed utterly futile".

CASE #8

"A 19-year-old youth was admitted to the psychiatric service. When he was admitted to us the boy's parents told us that over the past few months their son's behaviour had changed drastically the patient has spent most of his time staring vacantly out of the window. He has also become careless about his personal appearance and habits. There is little doubt that he has shown serious changes in recent behaviour, but further conversations with his parents have indicated that his childhood and adolescent adjustment had not been healthy. He had been an average student at college, but was forced to leave recently as he was failing all his subjects. While at college he had done well at non-team sports and won several medals, but now he does no exercise at all. The personnel of the psychiatric service found it difficult to talk to the patient. He volunteered no information except to answer direct questions in a flat, toneless way, with no emotion. Often his answers were not logically connected to the questions. The observers who took part found it difficult to record their conversations with the patient. Often after the conversations the observers themselves were left wondering what the conversations had been about. While speaking about a serious illness which had left his mother bedridden for a considerable period, the youth constantly giggled. At times he became agitated and spoke with a curious intensity. The patient said he felt that he was somehow being influenced by a force outside himself to commit an act of violence -as yet undefined -towards his parents."

CASE #9

When Mandy gave birth to her second child, the birth was unexpectedly complicated and what started as a natural birth ended up as a C-section and a baby in intensive care. However, the hospital staff were excellent and Mandy's little daughter came home after three weeks to meet her older sister and the rest of the extended family. Relieved, Mandy and her husband settled down to the task of bringing up daughter number two. Mandy was a little tired and run down, but she naturally put it down to the traumatic time she experienced during the birth followed by the worry about her newborn daughter together with the constant trips to the hospital and back. One day, after her husband came home from work, Mandy raced down to the local supermarket alone, so she could quickly pick up a few items for dinner. At the end of the first aisle she started to feel a little unwell, but pushed on with her shopping. By the time she got to the checkout, she was feeling uncomfortably stressed. She felt a tremendous sense of impending dread. Putting it down to tiredness, she continued unpacking her items from the trolley. That was when the first attack hit her. She couldn't breathe; her heart raced and felt like it would explode into the checkout operator's face. Her legs almost crumpled from under her and she badly wanted to run out of the shop, scream, or grab somebody to help her. She didn't know what was happening to her. All she knew was that she felt like she was going to die. She grabbed the items she needed, threw them into a bag, somehow managed to toss some cash at the operator and fled from the shop. Back in the car she settled down a little, but she still felt terrible. She slowly drove home but by the time she pulled into her driveway she felt almost her old self again. She promptly forgot about the ordeal after a day or so.

CASE #10

Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began "talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveillance photos of him that were being reviewed by the CIA". After about a year Jack quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the store and even in his own home. Jack lived with his parents at that time. He became increasingly confused and agitated. His parent took him to the hospital where he was admitted.

CASE #11

Lisa is 30 yrs old, married women and mother of 4 children.  She has various worries for years but has never before sought professional help. During the past three months she has become increasingly unhappy to the degree that her family physician finally suggested she seek psychological help. For a number of months Lisa has been experiencing intrusive, repetitive thoughts which centred around her children's safety.  She frequently imagined that various, serious accidents has occurred and could not put these thoughts out of her mind.  For example, on one occasion she imagined that her son had a broken leg playing football at school and called school to see if he was all right. Even after learning that he was fine, she admitted being somewhat surprised when he arrived home unharmed. Specific numbers have come to have special meanings for Lisa and her preoccupation with them was beginning to interfere with her daily routine.  While shopping she worried if she selected the first box of cereal off the shelf, something terrible would happen to her eldest child but if she selected the second box, the next eldest child would be harmed, and so on.  If she drank one cup of coffee she found she had to drink four and similarly, she had to smoke four cigarettes in a row to protect her children.  Her fears appeared to be valid as it seemed that, if she failed to protect the children in this way, some sort of problem or accident almost always happened to one of the children within a few days. In addition, Lisa reported dissatisfaction with both her marriage and problems in managing her children. Although her husband Tony was only 32 yrs old, he suffered a severe heart attack that made even normal physical exertion potentially dangerous for him.  He had to leave his job and stay home.  He relied upon Lisa and his kids for almost everything including bringing him a drink from the refrigerator.  Children are out of control. They didn't respond well to parental discipline which was generally inconsistent. Lisa was the eldest of 4 children and was raised in NYC.  A religious catholic but soon stopped going to church after services were done in English instead of Latin and when eating meat on Fridays was allowed.  She witnessed a friend's baby getting run over by a bike and had thoughts of committing suicide but prayed to God to take those bad thoughts away.

CASE #12

Mary is a 23-year-old married white female with two children, ages 5 and 8. She was sent to the psychiatrist office by her family physician because about two times a week she would wake up around four or five in the morning and feel as if she had a bad case of insomnia but could not bring herself to get out of bed. About 1 or 2 hours later she would feel as if she had taken some type of drug. She reported feelings of extreme depersonalization and visual hallucination. (E.g., neon Indians walking down the hallway.) She also complained that she was very depressed most of the time and that she had a hard time going to work. She said when she was there she would experience high levels of anxiety. She also pointed out that she felt funny but that she could not explain these feelings. In conducting a thorough history, the psychiatrist discovered that Mary suffered from panic attacks but she said these feelings were different. He also discovered she had been hospitalized for schizophrenia many times. It was also discovered that he had undergone electro convulsive therapy and sleep treatments (scopes). He ordered an MRI which came back negative and he also had Mary get an EEG. The EEG was normal but it was noted that the beta waves were abnormal.

CASE #13

Mike is a 33-year-old divorced white male with two children he rarely ever sees,  ages 8 and 10. He has never been seen by a psychiatrist.  His family physician has tried to get him to see a local psychiatrist but Mike refuses to go. Mike says he knows someone has removed his brain and replaced it with someone else's.  He believes that this brain is controlling him and that he is not responsible for his actions.  He works everyday and has been on his current job for 15 years.  He says he has lots of friends but sometimes he thinks its one of them who did this to him.  He has a college education and has a degree in computer science.  His family physician ordered an MRI which came back negative and he also had an EEG. The EEG came back normal.

CASE #14

Gary is 55, divorced the only woman he was ever with 20 years ago, dated scarcely and without physical relationship, raised 3 children alone after traumatic abandonment by wife/mother after 16 years of marriage.  Very little has changed in 20 years, as though his life is frozen in time.  Whenever change is threatened, he becomes very anxious, always holding out suicide as his way out if cornered or overwhelmed.

Gary has lived all his life on property in his family since 1800s, worked at the same job 35 years, driven same car more than 20 years, and lives in the same manufactured home he lived in with his wife.  Inside his home, cobwebs cover back of living room and dining room.  Showers/bathrooms, and kitchen have not been cleaned since one of the children did it years ago.  Gary uses the same towels and washcloths for twenty years, now rags. Gary never goes to a doctor, dentist, or psychiatrist, and refused any help.  While providing extravagantly in a material way for his children, Gary lives off frozen meal entrees, one or two per day, and wears the same clothes for all these years.  He won't accept gifts or help.

As a child, Gary was the youngest of six.  He was unwanted, and often speaks of wishing they would have "made him an abortion, like they considered to do."  He had one brother and all the others sisters.  He talks about being "in the way" all the time.  He spent his time roaming fields, with few if any friends.  Still he has no close relationships, and confides only in one of his sisters, who obviously attempts to translate her own opinions into him.  He has contradicting thoughts, some of the way he would like to live, and some, dominant ones, about how he "should" live, by what principles and standards.

Gary does not, has not, will not expose himself to pornography, violence, abusive speech, or drugs.  He is pristine.  He keeps himself physically clean and presentable, but spends nearly all his non-work hours at home in a chair watching TV or reading to "escape," he says.  He attends church on occasion when heavily prompted by, and accompanied by, a few members of his family.  He is afraid of "connections;" relationships.  He fears the elders in his church so much, that he parks his car near the entrance and leaves as soon as possible.

One more thing.  Gary seems unable to be assertive or aggression, being polite and passive all the time.

CASE #15

At age 20, Amy is the youngest of four children. Her sister Anne is 22, and her other sister Linda is 24. Bart is 26. Although Bart has been friendly with Amy, they have not been close as Bart spent most of his time as a child with other neighbourhood boys and male cousins. Linda and Anne did not get along with each other. Often they would fight for their mother’s affection by telling lies about each other or show how they could help their mother. Sometimes, they would try to enlist Amy to be on their side by being nice to her and flattering her. However, when she would borrow their clothes without asking, Anne would yell at and occasionally hit her. Linda would tolerate this behaviour. Amy would then cry to her mother about Anne; then her mother would discipline Anne. Her mother stayed at home with the children until Amy was 13. Then she returned to work as a secretary at a local business. When at home, her mother tried hard to spend time with each of her children. When Anne and Linda would take Amy to their sporting events. She notices that Amy tried to do as well at sports as her sisters and often she struggled with math at school. Also, Amy lost interest in sports around the time she entered ninth grade. Sometimes Amy’s mother would worry about Amy’s moping and sullenness.

Amy’s father owned a hardware store. Because it was busiest on Saturday, Amy rarely saw him then. During the week when the store closed at 9:00p.m., her father didn't get home until 9:30. Often her father would joke with her and treat her differently than the others. He was pleased that she didn't seem to be in trouble. When she was a child, he would tell her stories and play games with her and her stuffed animals. When she entered high school, he would talk to her about schoolwork and tell her amusing incidents that happened at work. Although Amy enjoyed his attention and interest, it never seemed enough. She worried about whether her schoolwork would please him. Sometimes she would work at the hardware store because she knew he appreciated that even though she didn’t particularly enjoy it. She kept busy both in and out of school, in part to earn money, but also to prove that she could be successful.

Amy is depressed and does not feel that her life is going well. She sees other women as being more attractive, more interesting, and brighter. She does not have a boyfriend and is upset that her friends spend too much time with their boyfriends. She feels that her professors do not make her courses interesting enough and that they make the courses too difficult.

ABNORMAL PSYCHOLOGY

MENTAL DISORDERS CASE STUDIES

In this activity you will be taking the role of a psychologist/psychiatrist. Your task is to carefully review the information contained in each case and to then determine appropriate diagnoses.

In all real-world cases, the client expresses a wide range of symptoms, and as a result, it can be difficult to determine a diagnosis. Keep in mind that there is not necessarily a "correct" answer. The important thing is that you carefully review all of the clinical information and provide a compelling argument about why a particular diagnosis is appropriate.

After providing your diagnosis, outline a treatment/therapy plan that you believe would be most effective in treating the patient.

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In preparing your response, be sure to answer the following questions:

1. Provide one or more diagnoses for this case. Please include both the name and the DSM-IV category for your diagnosis(es).

2. Describe the observations that support each diagnosis. Be sure to cite specific evidence from the case study.

3. Describe any clinical evidence that seems to be inconsistent with your diagnosis.

4. Outline a treatment/therapy plan for the patient. Be sure your plan is thorough and detailed.

Tips for Making A More Accurate Diagnosis

• These real-world cases represent complex human beings. No effort has been made to simplify the cases or to focus on only a single set of symptoms. As a result, you need to review the entire case file before you begin formulating your diagnosis(es).

• Be sure to use all of the information that is available. Your goal should be to form a diagnosis and be able to cite facts that support this diagnosis.

• Pay attention to all of the facts and symptoms. It is important to acknowledge symptoms that are both consistent and inconsistent with your diagnosis.

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