Diagnosis
What are the diagnostic symptoms that the client is presenting with?
The major symptom in the diagnosis of the patient in the case (Randy) is summarized in their very initial response to the question on if they understand the reason for their reference to psychiatric evaluation: “ They – you – want to get inside my head. But I told her – I told her – I’ll tell you, they won’t find anything. My brain is missing, and I don’t know who took it. ” The subject in the case repeats these assertions throughout the session including trying to justify their actions. By any standards, Randy’s assertions can be categorized as delusions. The “Encyclopedia of Mental Disorders” defines delusions as irrational beliefs held with a high level of conviction, and are highly resistant to change even when the affected person is exposed to forms of proof that contradict the belief (American Psychiatric Association, 2013).
Analysis of the case in accordance with guidelines presented in the DSM-5 and Munro (1999) leads to the conclusion that Randy presents with the following signs and symptoms:
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Expression of an idea or belief with unusual persistence
The idea has an undue influence on the subject’s life, altering it to an inexplicable extent
Despite the profound conviction, the patient demonstrated secretiveness and suspicion when questioned
The patient shows lack of humor and are oversensitive about the belief
There is a quality of centrality as the patient accepts all the strange happenings unquestioningly (Munro, 1999).
An attempt to contradict the belief often resulted to inappropriately strong emotion reaction punctuated with irritability and hostility
The belief has no foundation on the subject’s social, cultural, or religious background
The patient has emotionally over-invested in the idea in a manner that overwhelms other elements of their psyche
When the subject acts out on the belief, they demonstrate behaviors that are abnormal or out of character, but which may be understandable from the perspective of the belief
The ideas and belief is logically constructed and internally consistent
The belief does not interfere with general logical reasoning and general disturbance of behavior is lacking (National Collaborating Centre for Mental Health & Britain, 2003).
The subject demonstrates a heightened sense of self-reference, give significance to events that are insignificant to others, and often operate in a charged atmosphere around the belief
What is the diagnosis?
The DSM-5 lists the following criteria for diagnosis of delusional disorder:
Presence of one or more delusions with a duration of one month or longer.
The criteria for schizophrenia has never been met (American Psychiatric Association, 2013).
Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
The disturbance is not better explained by another mental disorder such as obsessive-compulsive disorder, and is not attributable to the physiological effects of a substance or medication or another medical condition (National Collaborating Centre for Mental Health & Britain, 2003).
The diagnosis is “Delusional Disorder,” a form of psychosis. Psychosis refers to an abnormal mental state that causes detachment from reality and is symptomatic in individuals affected via personality changes and thought disorder. According to American Psychological Association (2013) DSM-5, Delusional Disorder is a mental illness in which the patient presents with delusions, but that not manifest with other signs and symptoms common in other psychotic disorders such as prominent hallucinations, mood disorder, thought disorder, or significant flattering of affect.
To be specific, the subject was diagnosed with persecutory delusional disorder which the DSM-5 defines as belief that a person is being malevolently treated in some way (Munro, 1999). Diagnosis is corroborated by evidence from the case showing the genetic or biological relationship between Randy and their father. Evidence shows that individuals who are closely related to a person with delusional disorder are at higher risk of developing delusional disorder or paranoid personality (National Collaborating Centre for Mental Health & Britain, 2003). The patient also portrayed outcomes of dysfunctional cognitive processing referring to the distorted way Randy uses to explain life to themselves, and develops conclusions about others. The case may also be an outcome of motivated or defensive delusions as Randy attempts to cope with life and maintain high self-esteem after the loss of their girlfriend and discontinuation from collage.
Treatment Plan
Treatment Modality
The modality of treatment as per the diagnosis will entail short term and long term approaches. Randy is in a critical stage requiring immediate intervention to alleviate the current persistent manic like symptoms; and long-term
Specific Techniques Used
The techniques to be used include medication, psychotherapy, and supportive therapy. Medication will include antipsychotics which are the first line of treatment for psychotic disorders with the ability to reduce the symptoms of the disorder in approximately 7-14 days (National Collaborating Centre for Mental Health, 2003). Cognitive therapy is the most applicable psychotherapy. Supportive therapy entails acceptance and commitment therapy.
Goal 1: Brandy will experience significant decline in the frequency in signs and symptoms of persecutory delusional disorder after 7-14 days.
Objective 1: The patient will show increased levels of awareness and acceptance of their condition
Objective 2: Brandy will express increased desire to participate in comprehensive therapy
Goal 2: Brandy will be able to move from detention to a psychiatric facility.
Objective 1: Brandy shows improved behavior to warrant being moved to a treatment facility
Objective 2: Brandy will demonstrate tolerance of the stimuli (TV)
Goal 3: Brandy will identify and implement coping mechanisms
Objective 1: The patient will present their perception of therapy approaches and identify their preferred coping mechanisms
Objective 2: Brandy will show marked improvement in coping ability
Frequency of Therapy
The frequency of medical therapy will be dependent on manifestation of delusional episodes that adversely affect Brandy’s behavior. Psychotherapy and behavior change will be after every two weeks, then monthly depending on progress.
Recommendations
The patient is the case was diagnosed with delusional psychotic disorder and should be treated as such
The patient is unfit to stand trial for charges proffered against them
Proper mechanisms must be initiated to place the patient under immediate therapy
The patient should be isolated from the trigger of charged emotions and other people until marked improvement in their condition is observed
Arrangements should be made to refer the patient to a psychiatric facility for long-term treatment
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders , (5th ed., text revision). Washington, DC: American Psychiatric Association.
Munro, A. (1999). Delusional disorder: paranoia and related illnesses . Cambridge, UK: Cambridge University Press.
National Collaborating Centre for Mental Health, & Britain, G. (Eds.). (2003). Schizophrenia: Full national clinical guideline on core interventions in primary and secondary care . Royal college of psychiatrists & British psychological society.
