Case Study #13 SchizophreniaGroup 3: Park UniversityPS401: Abnormal Psychology Professor Ms. Waxse September 18, 2020
- CASE: Jim is the son of immigrant parents who migrated to the United States. His mother suffered from mental health issues after a still birth when Jim was 13 months old. She was hospitalized for two years and Jim was cared for by lots of nannies. Jim was at the top of his class until the end of high school when his father suffered a heart attack. During this time Jim spent his time praying and when his father finally recovered he knew it was due to his prayers. Jim’s college career took a hit due to his low grades, and eventually he stopped going to college to spend all his time in front of the TV. Jim grew convinced that he was able to make TV characters do things and eventually this grew to humans in the real world. Jim “concluded that he, like God, must have a “life force” in his breath. In effect, he influenced people and objects through his breathing” (Gorenstein & Comer, 2015, pp.205). He went on to feed this delusion by hearing angel’s whisper that he was chosen to be the new Messiah. Over time, he grew paranoid that people knew this power and where talking about him and he became increasingly paranoid that they were going to do evil things to him. He was finally admitted to the hospital when his parents became alarmed and he was finally diagnosed at schizophrenia. Jim went on to repeat hospitalizations, stop taking medications, experiencing negative symptoms for the next ten years.
- DIAGNOSIS: Jim was diagnosed as schizophrenic based on the DSM-5 criteria:
“1. For 1 month, individual displays 2 or more of the following symptoms much of the time:(a) Delusions(b) Hallucinations(c) Disorganized speech(d) Very abnormal motor activity, including catatonia(e) Negative symptoms.At least 1 of the individual’s symptoms must be delusion, hallucinations, or disorganized speech.Individual functions much more poorly in various life spheres that was the case prior to symptoms.Beyond this 1 month of intense symptomology, individual continues to display some degree of impaired functioning for at least 5 additional months.” (Gorenstein & Comer, 2015, pp.203).Jim displayed all of the symptoms listed in criteria 1 over the 10 years that he was living with the disorder. Whenever Jim was not taking the medications he fell back into the symptoms for months to years at a time.
- MEDICAL CONDITIONS: Jim presented with no medical conditions prior to being diagnosed with schizophrenia.
- PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS.
Problems with primary support group including family circumstances – Jim’s disorder followed the health crisis that his father experienced during which time Jim thought he might lose his father who was a supporting figure in his life due to him still living at home in high school.Problems related to the social environment – During the medicated periods of Jim’s life he still dealt with delusions which caused him to “remain isolated from normal events and activities” (Gorenstein & Comer, 2015, pp.206).Problems related to life management difficulty – Jim spent most of his time watching t.v, sleeping, eating meals sporadically, and smoking marijuana.Problems related to education and literacy – Due to Jim’s father’s health crisis, Jim’s grades suffered in high school. Jim “registered at a community college in the fall. But after a few weeks became lax about attending classes. Eventually, he stopped going to classes altogether” (Gorenstein & Comer, 2015, pp.204).Problems related to employment and unemployment – According to the case study Jim hadn’t done any work for at least several years and spent most of his time in his room.Problems related to negative events in childhood – Jim’s father suffered a heart attack when Jim was around 17 years old.
- MODEL: According to the case study book, Dr. Sorkin felt that the diathesis-stress model would be the best to describe schizophrenia. Meaning that the patient is predisposed to the disorder and that certain stressors can cause the disorder to blossom. However there are different stages of diathesis, severe (chances to develop are high even without stressors), mild (might develop based on stressors), and none (no chance to develop disorder even with stressors). The clinician felt that the model called for the use of biobehavioral therapy.
- CULTURAL ASPECTS: The fact that his family did not take his diagnosis as seriously as the brushed it off could be a cultural aspect if they believe medical conditions are even real.
- MEDICATION: After his initial diagnosis of schizophrenia he was treated with Thorazine an antipsychotic. After having side effects from the first drug during his treatment process Dr. Sorkin prescribed him risperidone a newer antipsychotic, risperidone and other so-called atypical antipsychotic drugs do not operate on the dopamine activity of people with schizophrenia in the same way as the conventional antipsychotic drugs, and so do not produce as many Parkinsonian symptoms. (Gorenstein & Comer, 2015, pp.208).
- TREATMENT: Jim was hospitalized several times. Then he found a doctor who went through phases to get Jim too. A functioning level. Phase one was getting Jim to collaborate with Dr. Sorkin’s treatment for schizophrenia Is. In phase 2 was getting Jim to take the medication to help with schizophrenia. In phase 3 was he setting long-term goals. According to research, interventions that also address the social and personal difficulties of people with schizophrenia significantly improve their recovery rates and reduce their relapse rates (McGuire, 2000; Penn & Mueser, 1996). Such approaches offer practical advice; teach problem-solving, decision making, and social skills; make sure patients are taking their medications properly; and help them find work, financial assistance, and proper housing. . (Gorenstein & Comer, 2015, pp.209).
Some challenges are his mother at first was not very supportive because she did not want to feel like a failure. Another challenge was Jim believed he had a superpower and was not seeing his disorder as a serious condition as it was. He was also functioning as a child he did not have a normal social life he could not get a job and he was reluctant to try medication again after unpleasant side effects.
- PROGNOSIS: After Jim’s treatment he continued doing group meetings and taking his medication. After allowing his medication to run its course he started living productive and he was no longer having thoughts of his powers. Though he is doing better he has tried to make the move out his parents’ house but found it to be stressful. He is still on a journey to recovery and is leading a more normal life. . (Gorenstein & Comer, 2015, pp.218).
- CLINICAL OBSERVATIONS: I think all was covered even from involving the family to his recovering process was helpful.
- APPLY THE 4 D’S:
Deviance: Jim is considered to be deviant because he suffers from schizophrenia which “affect approximately 1 of every 100 people in the world” (Lindenmayer & Khan, 2012).Distress: Jim’s disorder did cause him distress. Since Jim did become afraid that evil people would try to use his power, Jim felt “the best solution, as he saw it, was to stay home as much as possible” (Gorenstein & Comer, 2015, pp.205).Dysfunction: Even before Jim was diagnosed with schizophrenia he was living a dysfunctional life. He was staying in his room and barely even coming out to eat. “It so upsets, distracts, or confuses people that they cannot care for themselves properly, participate in ordinary social interactions, or work productively” (Comer & Comer, 2018, pp.4). Jim fits this because “most of the time, he still watched television or slept, emerging periodically for meals. He had no interest in returning to school or doing anything else constructive” (Gorenstein & Comer, 2015, pp. 206).Danger: This case study does not present Jim as dangerous. He spent most of his time in his room sleeping, watching tv, or smoking weed with his one friend.
- FOUR-FRONT APPROACH TO FUNCTIONING
Deficiencies and undermining characteristics of the personJim has a mental health disorder that affects his everyday life. Due to the hallucinations and his delusions, Jim has anxiety to the point that he no longer wants to leave his house due to paranoia about the people around him wanting to harm him. Jim was also undermined by his parents who “criticized him constantly for his failures, both large and small” (Gorenstein & Comer, 2015, pp.214).Strengths and assets of the personJim is very capable of living a normal life and excelling in areas that he applies himself to as shown by his high school career. Throughout his treatment, Jim showed his willingness to get better and often reached out first for goals that he had. Lacks and destructive factors in the environmentJim lacks the ability to retain work, education, and any type of social life. Jim’s only friend spent his time smoking marijuana with Jim prompting him to stay in his room without interacting with anyone else.Resources and opportunities in the environmentJim’s parents supported him by allowing him to live in their house and spending “so much money over the years, to put him in and out of hospitals, and to pay for medications” (Gorenstein & Comer, 2015, pp. 207) Jim’s parents were presented with an opportunity to seek therapy for Jim when his mother attended a parent support group and was approached by other member who had gone through the same thing as her. Negative symptoms of schizophrenia are “those that seem to be “pathological deficits,” characteristics that are lacking in a person. Jim’s negative symptoms is the “inability to initiate or persist in normal, goal directed activities, such as work, education, or a social life” (Comer & Comer, 2018, pp.424). He also displayed lower than average social and occupational aspects.Positive symptoms are “”pathological excesses,” or bizarre additions, to a person’s behavior” (Comer & Comer, 2018, pp. 425). Jim’s positive symptoms are his delusions of controlling people with his breath, his incoherent speech, and his auditory hallucinations of hearing angel’s speaking to him.