Sherman Tremaine Case study

Sherman Tremaine Case study

Week 5: A 54yo Male with Schizophrenia Spectrum Disorder and

Persecutory Delusional Disorder

Subjective:

CC (chief complaint): “Some people outside my window are watching me and won’t leave me alone.”

HPI: The client, S.T., is a 54yo male. The client was referred to the psychiatric clinic by his sister due to visual and audio hallucinations. During the psychiatric evaluation, the client claims that some people outside his house are watching him and won’t leave him alone. He claims to see their shadows and hear their voices. S.T. claims these symptoms have persisted for weeks. He believes the government sent those people to watch him so his taxes could be increased. The client claims to see a bird and heard heavy metal music during the interview. The voices are loud. He reports difficulty sleeping since the voices keep him awake for days. S.T. further reports that people watch him on TV. He adds that those people come into the house and poison his food. Consequently, he locks everything in the fridge to trick them, and they do not get there. He requests permission to smoke during the psychiatric evaluation. The client denies going to the grocery store, claiming they play too loud heavy metal music and people watching him follow him there. He denies seizures, blackouts, or hearing or seeing things due to alcohol or drug use. Denies legal issues resulting from alcohol or drug use. He denies a family history of suicides. He also denies intentions to kill himself. His mother and sister raised him but he currently lives alone.

Substance Current Use: The client reports smoking all day. He smokes three packs daily. S.T. also took alcohol and drank last yesterday. He reports past use of marijuana. However, he has not used marijuana since his mother’s death three years ago mom died three years ago. He denies using cocaine.

Family History of Psychiatric Disorders: His dad was diagnosed with paranoid schizophrenia. His mother had anxiety disorders.

Past/Current Treatment for Psychiatric Disorders: Haldol, Thorazine, Risperidone, Seroquel.

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Medical History: Reports diabetes Mellitus and fatty liver

  • Current Medications: Takes metformin for diabetes.
  • Allergies: Denies drug or food-related allergies.
  • Reproductive Hx: The client reports being single and does not have children.

ROS:

  • GENERAL: Denies weight gain or fatigue
  • HEENT: Denies scars on the scalp. Denies blurred vision. Denies hearing loss. Denies nasal congestion. Denies difficulty swallowing.
  • SKIN: Denies bumps or masses on the skin
  • CARDIOVASCULAR: Denies chest pressure
  • RESPIRATORY: Denies shortness of breath
  • GASTROINTESTINAL: Denies constipation
  • GENITOURINARY: Denies burning with urination
  • NEUROLOGICAL: Denies seizures or blackouts
  • MUSCULOSKELETAL: Denies back pain
  • HEMATOLOGIC: Denies swollen lymph nodes
  • LYMPHATICS: Denies anemia
  • ENDOCRINOLOGIC: Denies excessive sweating

Objective:

Diagnostic results: Not needed at this point

Assessment:

Mental Status Examination: The client is 54yo male. He is well-developed and attentive during the clinical interview. He demonstrates auditory and visual hallucinations during psychiatric evaluation. He speaks at normal volume and tone. His self-reported mood is “SaD.” He is alert and oriented to places, persons, and dates. Denies suicidal thoughts or ideations. He demonstrates disorganized and delusional thought processes during clinical interviews. Sherman Tremaine Case study

Diagnostic Impression:

  1. Schizophrenia Spectrum Disorder – Primary diagnosis
  2. Persecutory Delusional Disorder
  3. Schizoaffective Disorder

Schizophrenia Spectrum Disorder: This condition is the client’s primary diagnosis. Schizophrenia Spectrum is characterized by delusions, hallucinations, disorganized thinking, abnormal or disorganized motor behavior, and negative symptoms (Wu et al., 2018). According to DSM-V diagnostic criteria, an individual is diagnosed with Schizophrenia Spectrum upon demonstrating at least two of the five main symptoms explained above for at least six weeks (Guloksuz & van, 2018). The client demonstrates delusions since he believes that his sister and the government are sending people to watch over him so that his tax can be increased. He also demonstrates visual and auditory hallucinations since he claims that some people watch him through the window and TV. He also claims to see a bird and hear loud heavy metal music. The client also denies going to the grocery store, claiming they play too loud heavy metal music and people watching him follow him there. Lastly, he demonstrates disorganized thinking during psychiatric evaluation. The client reports experiencing these symptoms for weeks, qualifying for Schizophrenia Spectrum as the primary diagnosis.

Persecutory Delusional Disorder: This condition is the client’s second potential diagnosis. This delusion is closely related to schizophrenia. Delusions make individuals diagnosed with this disorder believe that an individual, organization, or group intends to harass or harm them. The DSM-5-TR states that people with persecutory delusions demonstrate false and fixed beliefs that cannot be changed due to conflicting evidence (Serdenes et al., 2018). Additionally, these beliefs are accompanied by psychosis. The client reports that his sister is collaborating with the government to send people to watch over him so that his tax can be increased significantly. Thus, S. T qualifies to be diagnosed with Persecutory Delusional Disorder.

Schizoaffective Disorder: The client also qualifies to be diagnosed with Schizoaffective Disorder. According to the DSM-V diagnostic criteria, Schizoaffective Disorder is characterized by psychotic symptoms, including hallucinations or delusions (Citrome et al., 2022). Clinical manifestations of a mood disorder, such as an episode of major depression, mania, or both, usually accompany these symptoms. The client qualifies for this diagnosis since he demonstrates visual and auditory hallucinations and claims that some people watch him through the window and TV. He also claims to see a bird and hear loud heavy metal music. Additionally, the client depicts delusions since he claims that his sister is collaborating with the government to send people to watch over him to increase his tax. However, Schizoaffective Disorder is ruled out since episodes of mood disorders were not reported.

Reflections:

Upon conducting the session again, I would focus on collecting comprehensive psychiatric history for this client for proper diagnosis and treatment. Therefore, I would engage the client’s sister during the psychiatric assessment. The next intervention upon following this patient would involve prescribing him medications and non-pharmacological interventions to manage presented psychotic symptoms, including hallucinations and delusions. Legal guidelines would be considered by prescribing the client the FDA-approved treatment for psychotic disorders in adults diagnosed with these conditions to ensure the efficacy of recommended treatment regimen in improving the client’s symptoms. Lastly, the client’s health promotion and disease prevention initiative would be based on his medical history. The client has a history of diabetes Mellitus and fatty liver. Therefore, he should be advised to limit his intake of calories and fats and exercise regularly to prevent his current medical conditions from deteriorating.

Case Formulation and Treatment Plan:

Psychotherapy, specifically cognitive behavioral therapy (CBT), should be considered the client’s primary treatment intervention due to its efficacy in treating psychotic disorders. Enrolling the client in an individual or group CBT would challenge his maladaptive thoughts, resolving his hallucinations and delusions. Additionally, the client should be prescribed Seroquel 150mg daily due to its efficacy in treating schizophrenia in adults. This drug is preferred since it was well-tolerated by the client with no side effects. Furthermore, medication-assisted therapy (MAT) would be recommended for this client to treat substance use dependence. The client should be advised to return to the clinic after four weeks to allow the mental healthcare provider to assess his response to the current treatment regimen based on the severity of presented psychotic symptoms. A health promotion activity involves developing the client a meal to enhance the management of his current diagnosis, including diabetes Mellitus and fatty liver. Lastly, the patient education strategy involves educating him benefits of adhering to the prescribed medications to enhance their efficacy in managing reported psychotic symptoms, including hallucinations and delusions. Sherman Tremaine Case study

 

References

Citrome, L., Preskorn, S. H., Lauriello, J., Krystal, J. H., Kakar, R., Finman, J., … & Rajachandran, L. (2022). Sublingual dexmedetomidine for the treatment of acute agitation in adults with schizophrenia or schizoaffective disorder: a randomized placebo-controlled trial. The Journal of Clinical Psychiatry, 83(6), 43180.

Guloksuz, S., & van Os, J. (2018). The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychological medicine, 48(2), 229-244.

Serdenes, R., Arana, F., Karasin, J., Kontos, N., & Musselman, M. (2023). Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion. General Hospital Psychiatry, 83 (3): 75-80.

Wu, Z. Y., Fung, H. W., Chien, W. T., Ross, C. A., & Lam, S. K. K. (2022). Trauma and dissociation among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. European Journal of Psychotraumatology, 13(2), 2105576. Sherman Tremaine Case study