Mr. V is a 23-year-old male attending college in the nearby town. The mother is worried about the son has not seen him for the past 6 months. There are also concerns from friends about the changed behavior of Mr. V who in the past 6 weeks is acting odd and secretive. The mother receives at least two calls each day and the caller hangs up once she says hello and suspects that it is the son. A former girlfriend called the mother informing her that Mr. V. came to her house in the middle of the night last week and looked gaunt and unkempt. The former girlfriend said that Mr. V. told her that she is the only person she can trust as she is the keeper of the light. Mr. V also believes that someone was listening to all the time and at every place. He also confided to her that he lives in his car because when he is on the move, their detection system does not work. He could not spend time at her place and his cell phone recorded a message that the service for that phone was discontinued. Two other friends called Mrs. V. informing her that they had similar encounters. He was in a hurry when he visited them and said that none could speak louder than 25 decibels otherwise he will be detected. His speech was rapid and he darted around the living room in search of something. Mr. V was also in a hurry and according to the friends, if he disappeared, they should know that they have found him. Seven years ago Mr. V had symptoms depressions but the condition did not meet the criteria for a depressive disorder. He was hospitalized and treated with cognitive behavioral intervention.
Areas of Information Needed from Mrs. V
It is critical to determine whether Mr. V. is facing instances if delusion and hallucination and whether they feel real to the world around him. It will also be useful to determine whether Mr. V had any problems distinguishing the altered and actual reality. It is also necessary to establish the change in the mood, personal habits, personality and social withdrawal. Determine the genetic factors, environmental stressors or biochemical imbalances likely to have contributed to the problem. It is especially critical to determine sudden changes in the behavior and thoughts of Mr. V and when they were noticed. It is also useful to rule out substance use or other medical condition by inquiring more information from the two.
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It is also important to determine the history of mental disorders in the family and whether there were significant events that triggered a certain behavior. Similarly, the mother and the former girlfriend can have useful information that can be used to determine the condition of Mr. V. and come up with an appropriate diagnosis. Once it is evident that Mr. V. has not had another medical condition or abused any substance, the next step is to determine the prevalent symptoms associated with mental disorders. The predominant signs for the patient include prolonged depression, social withdrawal, strange thoughts, seeing or hearing things that are not there and confused thinking.
Diagnostic Impression
The information about Mr. V can be used to design a diagnostic impression. There are however factors to consider in order to arrive at the desired impression. The initial step is to list diagnostic criteria where all the factors that define the disorder are listed to differentiate it from similar disorders. The next step is to specify predominant features that exist or do not exist in order to make an accurate diagnostic impression. There is a need to determine the diagnostic features and symptoms, the level of impairment, the duration of the symptoms, as well as conditions that share the symptoms. The age of Mr. V also gives an insight of the condition and the possible mental disorder.
The diagnostic impression will be base on the information provided by the mother and the former girlfriend. Similarly, the behavior as reported by the friends will be used to determine the disorder. The impression will also include any other information that will be helpful. Some of the potential conditions include anxiety disorder, bipolar disorder, depression, generalized anxiety disorder, panic disorder, and schizophrenia.
Preliminary Diagnosis
Mr. V will be diagnosed with schizophrenia due to the symptoms described by the mother and the former girlfriend. Some of the common early symptoms of the disorder include depression, social withdrawal, hostility and suspicion, altered perception of the reality and believing that someone is trying to harm them or they are being constantly watched. The patient might also withdraw from the outside world and act in a fearful or confusing manner. The decision to diagnose Mr. V with schizophrenia is because of the following signs that are common with people who have the condition. It is evident from the description of the mother and former girlfriend that Mr. V has signs of hallucinations, delusion, disorganize behavior disorganized speech and negative symptoms.
According to the DSM- Diagnosis Criteria, there are five major criteria that an individual must meet to be diagnosed with schizophrenia. The patient must have two or more symptoms of delusion, hallucination, disorganized speech, catatonic behavior and negative symptoms. The symptoms must have persisted for more than 6 months. The level of functioning has also declined. Conditions like schizoaffective disorder, bipolar disorder, and major depression must have been ruled out. Similarly, substance abuse has been ruled out as a potential cause.
The patient must have experienced a combination of these symptoms and one or two are inadequate. The patient can have any of the symptoms but the following is a must; at least two symptoms where one must be hallucination, delusion or disorganized speech. The symptoms must be present for at least a month. According to the case, the symptoms have impaired the life of Mr. V and affected his ability to participate in school, establish a positive relationship. The duration for the symptoms must also be determined where they should have been experienced for at least one month and must be present earlier for six consecutive months.
Other Considerations
The following can help determine schizophrenia but are not necessarily diagnostic criteria according to the DSM-5 although their presence is a strong pointer of the condition; dysphoria, prodromal symptoms, inappropriate emotions, anxiety, phobias, sleep problems, shortened attention span, manic behavior among others.
The next step after examining present symptoms and features and those that are absent is to establish other conditions that have similarities with schizophrenia. Some of them include mood disorders, schizophreniform, brief psychotic disorder, body dysmorphic disorder, autism spectrum disorder, PTSD, communication disorder and substance use.
Treatment of the condition can include antipsychotic medication and psychotherapy or even social support treatment. The recovery of the patient can be enhanced through the support from friends and family. Similarly, establishing a daily routine can be useful for the patient. It is helpful for the family and friends to have the right knowledge on how to deal with the condition as they can help in the recovery of the patient. Mr. V needs all the support and empathy for a quick recovery and this should go on throughout their lives since he is likely to be under medication.
