Questions to Consider
What symptoms of psychosis does Donald display, and how long have these symptoms been evident?
In the case study, Donald displays delusions and hallucinations, as he perceives himself as being demon possessed. He also displays dramatic mood changes such as depressed moods, lack of self-awareness resulting to self-harm.
The diagnosis of Schizophrenia also requires impairment, is impairment evident in this case?
Yes. Donald experiences difficulties studying or working as he changes jobs within a short span. In addition, Donald has difficulties being social, is withdrawn and aggressive, which indicates impairment of his cognitive ability.
Are psychotic or mood disorders present among relatives?
Yes. Donald’s brother has bipolar disorder while his mother takes antidepressants. Additionally, his maternal relatives had many suicidal attempts.
Does Donald have a history of depression or mood swings that may indicate a schizoaffective, major depressive or higher bipolar disorder?
Yes. Donald exhibited depressed moods during his frequent illnesses that last several weeks. The depressed moods are indicative of a major depressive disorder.
Are there any medical conditions that may be contributing to Donald’s symptom development?
Yes. Donald displays anxiety disorders as he has sleeping difficulties and has difficulty completing tasks or attending to his treatment plan as per the schedule.
Suicide Risk Assessment
In the case study, Donald displays suicidal behaviors and thoughts. However, he has made no suicide attempts yet. Donald reported having his first suicidal thoughts at age 15 and at later at age 19 and 20. The suicidal thoughts are a cause for concern as he might attempt suicide later. Additionally, Donald’s maternal family has a history of many attempted suicides. Evidently, Donald’s social withdrawal symptoms point to a personality disorder i.e. borderline or antisocial behaviors. Personality disorders increase the rates of suicidal thoughts and attempts among individuals (Copolov, 1998, p. 76).
Moreover, a family or individual history of attempted suicide or suicidal thoughts, like in Donald’s case, is a strong predictor of later suicidal attempts or suicidal deaths. According to Jeffries (1996, p. 79), intentional self-infliction of injury is also a pointer to repeated suicide attempts or suicidal deaths. Donald displays symptoms of lack of self-care; he stays in the cold, sleeps in the backyard and does not feed properly, which are symptoms of self-harm (Robinson, 1997, p. 117). Other suicide risk factors in Donald’s case include the dramatic mood changes including depressed moods as reported by his mother, the psychiatrist and his social worker. His spirituality, particularly his belief that he is possessed by demons, is also a suicidal risk factor.
Mental Status Exam
In Donald’s case, the suicidal risk factors indicate the need for a mental status evaluation to assess the suicide risk. In mental health evaluation, the assessment of an individual’s attitude, social interaction, anxiety, mood, self-concept and intellectual functions is necessary (Robinson, 1997, p. 116). With regard to the mood, Donald displays a depressed and sometimes angry or irritable mood especially towards his parents. Donald appears withdrawn; he does not engage in any social interaction and neither does he engage in his usual hobbies such as listening to music or watching television. With regard to self-concept, Donald perceives himself as possessed by demons and consequently inflicts himself self-harm.
Additionally, Donald is delusional, has fantasies and believes that people are able to read his mind. His thought process reflects an exaggerated concern for children safety. His past intellectual functioning is above average; he scored a 3.6 and 3.1 GPA at high school and for the three semesters, he attended college respectively.
Intake Report
Client Personal Details
From the case study, the client’s name is Donald, aged 23. He lives with his parents and two siblings. Donald has been hospitalized on several occasions following aggressive behavior towards his family. Currently, he is undergoing mental treatment at a mental facility and has regular appointment by a psychiatrist and a social worker.
Present Concerns
The present concerns in Donald’s case include suicidal tendency, aggressive behaviors, anxiety, delusions and pre-occupation with children safety. Evident behavioral observations in Donald’s case include suicidal thoughts, aggression, anxiety characterized by sleep disorders and frequent delusions characterized by self-harm and feelings of demon possession.
Clinical History
Recently, Donald experiences prolonged periods of depression and has depressed moods. At age 13, Donald suffered from depression where the doctors put him under antidepressants medication until the age of 20. Presently, he does not respond well towards many of the medications, presenting various side effects such as tremors.
My Treatment Plan
My treatment plan for this client would entail four major goals. Firstly, by the end of my treatment plan, the client will be able to have a high degree of self-awareness with minimal delusions. Secondly, the client will be able to interact comfortably with his family and friends at the end of the treatment plan. Third, the client will be able to have a high degree of self-care particularly nutritionally by the end of the plan. Lastly, the client will be friendlier to his family and strangers alike at the end of the plan.
Evidence-based Practices and Professional Practice Guidelines
Mental health care professionals usually, based on information or data; have to evaluate the efficacy of a particular intervention. In Donald’s case, evidence indicates that the medications prescribed to him were not effective in the treatment of the psychotic disorder. Instead, they caused side effects on Donald’s health. A professional judgment in this case would be to discontinue the use of these drugs. In addition, considering the long-term and indirect consequences of the drugs, the doctors should change the treatment.
Reference List
Copolov, D. (1998). Psychoses: A Primary Care Perspective. MJA Practice Essentials, 9 (2), 76.
Jeffries, J. (1996). Is My Patient Schizophrenic? The Canadian Journal of Diagnosis, 6 (5), 79.
Robinson, D. (1997). Brain calipers: A guide to a successful mental status exam. London: Rapid Psychler Press.