Presenting Problems

Published: 2019-08-28 07:30:00
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James is a 28-year-old male. He has been working as a driver for the last five years. James now comes to the clinic with a psychological disorder. He claims that he is fine, but his relatives are all believing something is wrong. His parents think he has been fine, and all this began five months ago. The relatives have a lot to say concerning how James has been carrying on lately.

James of late has been showing some strange behaviors. He has been so much unmotivated in everything and lacked emotion. He isolates himself from the family members and friends. He has changed his physical appearance drastically. James goes to work late and sometimes he fails to appear for work. He even abandons his car and goes home any time while on a journey. He previously enjoyed fishing, but now he doesnt think of it anymore.

For the past five months, James has been living alone and had no friends lately. James was known to be a clean person, but now he is untidy, never changes his attire and has long unkempt hair. Many times you can find him just staring at something for a long time. He rarely shows any sign of joy or anger. By the look of things James feels so much depressed. James has been expressing a prolonged long laughter over nothing. He has been waking up so late and even sleeps so much during the day ("Schizophrenia: Symptoms, Types, Causes, and Early Warning Signs", 2016).

James has been claiming that his passengers are watching everything he does. He even claims to see many Lorries ahead of him all trying to block him. At such instances, James usually stops and get out of the car. For the last two months, he has reported for work once. James complains that the company sends a spy to watch him on the road. He reports being hearing the strange hooting of the cars on the road. At one instance he failed to stop the vehicle and ended up driving to a far and inappropriate destination. Many passengers have reported hearing him speak strange words. He has been giving very strange ideas on how to speed. He even reports being hearing voices that command him to stop the car in the middle of the road. He sometimes stops and says that a traffic police officer was stopping him ("Schizophrenia", 2016). James is so mute often that he cant even speak to anybody the whole day.

Relevant History

a). Demographic Information.

James is a 28-year-old male who leaves in his rural area with his family. James is married with three children. He has one boy and two girls. The residential home for James is Olai in Ohio County. He works as a driver and has been experiencing the disorder for the past five months. He came here to the hospital accompanied by his relatives when they noticed his changed behavior and personality. He has been at the hospital for the last two weeks. He didnt resist coming with the family members to the hospital.

b). Family and Social History

James is a third born son in a family of six four children. He has two sisters and one brother. The father is 67 years old well and alive. The mother is deceased. James mother died while giving birth to James. His elder sister Jane has been having a history of bipolar I disorder for the last three years. His other sister, Mary is well and alive. George, his younger brother is 21 years old, and he is well and alive. The grandmother was diagnosed with schizophrenia. His wife and children are all well and alive.

James before the illness as reported by the relatives is a social person. He had many friends from both genders. James do smoke both cigarette and Cannabis. He states taking 15 sticks of cigarette per day. He has been smoking for the last 25 years. He smokes two sticks of cannabis for the previous five years. Moreover, he also uses cocaine once per week depending on the availability of money. James also takes alcohol every weekend. He takes five bottles of spirits whenever he drinks.

c). Medical History

James has never been admitted before for any psychological disorder. This was his index admission.

d). Academic and Occupational History

James went to Ospas School for his lower level education in the year 1995. He completed his primary education in the year 2003. He passed well where he was able to join Pelto high school for his secondary level education in the year 2004. James was a discipline boy all through his studies. Though, sometimes he could be sent home for some few mistakes. James completed his secondary level education in 2009. He acquired a minimum grade to join a college. Due to lack of school fees, James was unable to continue with his college education. His father worked as a casual laborer and could not afford his school fees. One sponsor helped him study driving where he acquired a license in 2011.Since then James has been working as a driver. He began his job in 2011 at Metro Trans Company.

Diagnosis

My diagnosis should rule out possible medical illnesses and other psychotic disorders. By the look of things, the possible diagnosis of James condition is Schizophrenia. The diagnosis will involve three aspects: psychiatric evaluation, medical history and exam and laboratory tests such as urine tests. The diagnosis is based on the diagnostic criteria of schizophrenia in DSM-5. The first criteria in DSM-5. The requirement is that at least two of these symptoms be present for at least a month. These symptoms are hallucinations, delusions, disorganized behavior, disorganized speech and lastly negative symptoms such as lack of emotions and expression (Tandon et al., 2013).

The second criterion is social and occupational dysfunction. James has been unable to arrive at work. Moreover, he no longer be social or love fishing. He doesnt care anymore about his hygiene.

The third criterion from DSM-5 is the continuity of signs for at least six months with active symptoms for at least one month. For our case, James has been experiencing this condition for last five months now proceeding for the sixth month. He has been experiencing intense symptoms for the last two months (Tandon et al., 2013).

The fourth criterion is the exclusion of other schizoaffective and mood disorders like depressive or bipolar disorders. These disorders are ruled out in James in that he hasnt experienced any manic or major depressive episode. If at all mood episode has occurred it could have been for a very short duration (Tandon et al., 2013).

The fifth criterion is the exclusion of general mood condition and substance use. The last criterion on DSM-5 is the relationship to Global Developmental Delay or Autism Spectrum Disorder. It will involve assessing if there is any history of autism spectrum disorder for at least one month (Tandon et al., 2013).

Case Formulation

The causes of James condition could involve different factors.

1. Abnormal brain structure. James brain could be having abnormalities in his brain chemistry or abnormalities in his brain structure. These defects include reduced brain tissue which could manifest as enlarged brain ventricles. There could be low activity from his frontal lobe that would impair his planning, decision making, and his reasoning. There could be abnormalities in his temporal lobes, his hippocampus or the amygdala. ("Schizophrenia: Symptoms, Types, Causes, and Early Warning Signs", 2016)

2. The cause could be genetic. A family history of the illness could predispose him to the illness. This condition of schizophrenia tends to run in families.

3. Stress. As shown in the video, the HPA axis plays a role in the regulation of stress. The hypothalamus releases corticotrophin-releasing hormone. This hormone signals the pituitary gland to release adrenocorticotrophic hormone. This hormone travels down to act on the adrenal glands. The adrenal glands, therefore, produces glucocorticoids, epinephrine, and norepinephrine. These hormones help in stress response. Stressful life events could have happened to James. Such events include bereavement, losing something, end of a relationship or any form of abuse (2-Minute Neuroscience: HPA Axis, 2016).

4. Drug abuse. Though the use of drugs does not cause schizophrenia, then it plays a role in triggering the illness. The use of drugs like cannabis and cocaine could have contributed to the development of James disorder ("Schizophrenia", 2016).

5. Environmental cause. These environmental factors include early parental loss, low birth weight, and low oxygen at birth and prenatal exposure to viral infection. And physical or sexual abuse during childhood ("Schizophrenia: Symptoms, Types, Causes, and Early Warning Signs", 2016)

Treatment

James diagnosis is schizophrenia. The best part of the treatment is ensuring that he gets a medical assessment and is brought to a mental health officer as soon as possible. The early treatment and diagnosis will ensure better recovery and best outcome. The treatment aims at providing a better life for James. The treatment will make sure that he is productive to the development of the society. It ensures he returns to his regular work of and live a fulfilling life. A proper treatment plan is needed. The method involves medication and rehabilitation programs

The type of services that James need include:

1. Rehabilitation programs. This helps him to rediscover his usual work and hobbies as well. It ensures he engages in activities like driving, fishing, cleaning, managing stress, being social, shopping and many other normal activities.

2. Self-help groups. It provides support to James from the people who once had the same problems.

3. Housing programs. This program will offer support and supervision as he recovers from his illness.

4. Employment programs. The plan will help James return to his work as a driver.

5. Drop-in centers where James will have the opportunity to socialize and receive support services.

6. Counselling. This will involve conversations with James and also his family member. This will help in all the parties to understand the illness.

As James is under rehabilitation, he should be taking medication as well. This will contribute to reducing the biochemical imbalances that caused the episode and avoid relapse. The drugs should be given and supervised by a psychiatrist. It includes conventional antipsychotics to reduce hallucinations, delusions, and confusion. Atypical antipsychotics will be given to treat both the negative and positive symptoms of schizophrenia ("Schizophrenia", 2016).

References

Schizophrenia. (2016). Mental Health America. Retrieved 8 April 2016, from http://www.mentalhealthamerica.net/conditions/schizophrenia

Schizophrenia: Symptoms, Types, Causes, and Early Warning Signs. (2016). Helpguide.org. Retrieved 8 April 2016, from http://www.helpguide.org/articles/schizophrenia/schizophrenia-signs-types-and-causes.htmSilberberg, C. (2010). DSM-V: IMPLICATIONS FOR SCHIZOPHRENIA RESEARCH. Schizophrenia Research, 117(2-3), 418-419. http://dx.doi.org/10.1016/j.schres.2010.02.767Tandon, R., Gaebel, W., Barch, D., Bustillo, J., Gur, R., & Heckers, S. et al. (2013). Definition and description of schizophrenia in the DSM-5. Schizophrenia Research, 150(1), 3-10. http://dx.doi.org/10.1016/j.schres.2013.05.028

www.youtube.com/watch?v=DduN12D019M

sheldon

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