Mental Health Consultation Psychopathology Gabrielle Sm

Mental Health Consultationpsy645 Psychopathologygabrielle Smithmarch 9

This study source was downloaded by from CourseHero.com on :01:00 GMT -06:00 2 Bob’s case was forwarded to me from a colleague who needs to make a provisional diagnosis. My colleague admitted the patient to the crisis house he works at and a diagnosis is needed within 24 hours in order for him to continue to stay there. However, my colleague is at a loss on how to diagnose him due to the lack of information and participation. Therefore, he forwarded me the information and asked me to assist with the diagnosis. I will do my best to assess and diagnose the patient with the limited information given.

Patient Background Information A 38-year-old male named Bob appeared at the crisis house late last night. He was not well groomed and very disordered. He stated repeatedly that “the police are after me” but he couldn’t explain why they might be looking for him. He was indirect with his speech and seemed to have an elevated body temperature while obviously being agitated. He mentioned that “for years” he had been in psychiatric treatment; however, he would not disclose any of his past diagnoses.

He also refused to complete a release of information form so his medical history couldn’t be accessed. It was explained to Bob that in order for him to receive help, it was essential to know his medical history. He then went on to scream “you work for the police, don’t you? I bet you’re a cop”. Due to him being at risk for decompensation, he was allowed to stay at the crisis house until further notice.

Paper For Above instruction

The case of Bob presents a complex and urgent scenario requiring careful clinical assessment despite limited information. His presentation—disheveled appearance, disordered speech, elevated temperature, and expressed paranoia—points toward an acute psychotic episode, possibly involving delusions, hallucinations, or both. The absence of medical history further complicates diagnosis, requiring clinicians to rely heavily on current symptoms and behavioral cues.

Firstly, examining his symptoms suggests the presence of psychosis, with delusions being a prominent aspect. Bob continually states “the police are after me” without providing rationale or evidence. Such a belief could be classified as a persecution delusion, known to be characteristic of various psychotic disorders including schizophrenia and delusional disorder (Morrison, 2014). The persistent conviction that law enforcement is targeting him, despite lack of evidence, indicates the possibility of paranoid or persecutory delusions, which are hallmark features of paranoid schizophrenia.

His physical symptoms—including agitation and elevated temperature—may indicate systemic stress responses or even a concurrent medical issue such as infection or intoxication. This necessitates immediate medical evaluation, including vital sign assessments and diagnostic tests, to rule out conditions like fever or infections that might contribute to or mimic psychiatric symptoms.

Given the limited history and refusal to share previous diagnoses, the clinician must formulate a provisional diagnosis based on observed symptoms. The presence of delusional thinking, agitation, and disorganized speech aligns with a brief psychotic disorder or possibly schizophrenia with an acute exacerbation. The fact that his symptoms appeared suddenly and with marked agitation favors a brief psychotic episode, which can be triggered by stress or trauma (American Psychiatric Association, 2013).

From a theoretical perspective, different orientations can inform treatment strategies. For instance, a biomedical approach would prioritize stabilization of symptoms through antipsychotic medications and management of any underlying medical condition. Psychotherapeutically, a cognitive-behavioral framework might focus on challenging delusional beliefs and managing agitation (Bennett, 2011). An integrative approach could be most effective, considering the complex nature of his presentation.

Other theoretical perspectives, such as psychoanalytic or behavioral models, also have relevance. A psychoanalytic view might interpret his paranoid delusions as manifestations of unconscious conflicts, possibly rooted in past trauma or childhood experiences (Bennett, 2011). Behavioral models might emphasize external cues and reinforcement histories that shape his current behavioral response, such as previous encounters with law enforcement influencing his current paranoid state.

Given the current circumstances, the diagnostic process must consider a differential diagnosis that includes schizophrenia spectrum disorders, brief psychotic episodes, substance-induced psychosis, or medical conditions affecting mental status. The lack of a tox screen or historical data limits certainty; nonetheless, immediate clinical management should focus on symptom stabilization, safety, and further assessment.

The DSM-5 provides a structured framework for diagnosis based on symptomatology, with criteria for schizophrenia, schizophreniform disorder, brief psychotic disorder, and substance/medication-induced psychotic disorder. Its use can assist clinicians in differentiating among these possibilities (American Psychiatric Association, 2013). Alternatively, the Psychodynamic Diagnostic Manual (PDM) offers a broader perspective that considers underlying psychological structures and processes, which might inform tailored interventions once the patient’s immediate safety is secured.

In conclusion, Bob’s presentation aligns with a psychotic disorder, most plausibly a brief psychotic episode or schizophrenia, with persecutory delusions being central. Rapid stabilization and comprehensive assessment are essential for accurate diagnosis and effective treatment planning. Collaboration among medical, psychiatric, and social services will be critical, especially given the constraints posed by incomplete history and the urgent need for diagnosis.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Bennett, P. (2011). Abnormal and clinical psychology: An introductory textbook (3rd ed.). Open University Press.
• Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. Guilford Press.
• Fusar-Poli, P., et al. (2014). The psychosis high-risk state: A comprehensive state of the art review. Schizophrenia Bulletin, 40(6), 1310-1319.
• Karotkin, E. H., & Gallo, A. M. (2014). Pharmacotherapy of schizophrenia. In S. M. Sultana (Ed.), Clinical aspects of psychiatric disorders. Springer.
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