My psychology class

I hope nobody minds, but I'm doing a psychology project at school and I wanted to get some input.

Everyone in the class was given a fictional patient to diagnose with mental disorders. We were allowed to ask two questions to the patient or anyone else mentioned in the patient's description, which my teacher would answer in character. I've used one of my questions, but by asking it I became completely confused as to what disorder my patient has.

I wasn't sure which forum to post this in, but since I think my patient might have schizotypal peronality disorder, I thought I'd get some input from anyone willing to help here.

This is my patient description:

"Steve is a 26 year old male. He lives with his adoptive parents and two younger sisters. His mother is a teacher. His adoptive father is a department store manager and a recovering alcoholic. The two younger sisters are high school students, a senior and a sophomore. Steve's biological mother was his adoptive father's late sister. Very little is known about Steve's biological father.

Steve attended a small community college for two years but did not obtain a degree. He presently works in the stockroom at a local department store.

During a pre-interview conversation, Steve's mother and younger sister expressed their concern over his recent behavior. According to these family members, in the days before they contacted this office, Steve engaged in the following behaviors:

--Screaming and jumping out of doorways in an apparent effort to frighten his sisters

--Smiling and staring fixedly at family members when spoken to, without making any other response.

--Extended periods of sleeping during the day.

--Entering his parents' room at night and sleeping on the floor beside their bed

--Prolonged periods of sitting and staring out of the bathroom window which overlooks lilac bushes and the neighbor's yard.

--Catching flies and eating them

These reports were not convermed since these behaviors were not observed during the initial interview with Steve. He responded to questions about his job and his dog, briefly, without elaboration. He became emotional during the interview, when questioned about the behaviors reported by his mother and sister and their concerns about him. He shouted that "they are always after me," "they wont let me be me." He yelled that his mother "is the big bitch" and that "Dad can save me, Dad can save me, where's Dad? Who's Dad? Where's Dad?" The subject then left the room and refused to continue the interview."



If you've taken the time to read all of that, thank you sooo much.

My thoughts about most of it are that he's acting like a small child because of his lack of biological parents, since his mother is dead and his father isn't known. However, I need a name for the disorder.

The last paragraph is what made me think he might have schizotypal personality disorder, but I'm not sure that's right either.

I originally thought he had Brief Psychotic disorder, but the first question I asked was how long his family had been noticing the symptoms and the symptoms had been going on for 6 weeks, perhaps longer, and are progressively getting worse.


I could really use any insight any of you might have.

Still realllyy really in need of help. I have almost no idea what I'm doing.

However, today, I asked my second question about my patient. The DSM said that another one of the symptoms for this disorder was that the person doesn't have close friends, so I asked the patient's adoptive father if my patient currently has/has ever had any close friends, or if he preffered being by himself. The response I got was that he had friends in high school but afterwards they drifted, then he went to college for a semester but things fell apart. Now he's gotten fired from his job, because his coworkers couldn't stand working with him and his boss was only keeping him because his adoptive father is the manager there.

I'm not sure if that confirms or squashes my theory about him having schizotypal personality disorder..

sounds a bit worse than schizotypal actually

i'd stick real close to the diagnostic criteria since it's very close to several other disorders

You really needed to know WHEN he was adopted hon...there are still too many possibilities now. i was leaning towards histrionic PD but....the "when" facter of the adoption is the key to the puzzle.

'core

I know, when he was adopted would've been really good to know, but it's too late for me to find out now.

Thank you so much for your input. He doesn't meet enough of the DSM-IV criteria for histrionic PD but I'll keep looking.

aries wrote:sounds a bit worse than schizotypal actually

i'd stick real close to the diagnostic criteria since it's very close to several other disorders

Thank you for the advice.
I'm really stressing myself out over this project, so it's great that I'm getting input.

Do you have any ideas as to what I should maybe look into?

If I can find a more fitting disorder to diagnose him with, I can use Schizotypal as an alternative diagnosis (we have to come up with a main diagnosis and an alternative)

I have a new theory that he might have Schizoaffective disorder, and I think this sounds more likely than Schizotypal.

I don't know a lot about this stuff, so I guess I'll just explain what I think and anyone who's willing to help can tell me if I'm totally off..

A. Two (or more) of the following symptoms are present for the majority of a one-month period:

* delusions

-- He thinks that his mother and sisters are always after him and wont let him be him and that "dad can save me dad can save me where's dad who's dad where's dad"

* hallucinations

--None of those that I can see.

* disorganized speech (e.g., frequent derailment or incoherence)

--I don't think there's any of that either, except for the whole "my mother is the big bitch and dad can save me dad can save me.." thing

* grossly disorganized or catatonic behavior

-- I don't think there's any of that unless eating flies, daydreaming, jumping out of doorways to scare his sisters, and smiling and staring at people without talking is grossly disorganized..

* negative symptoms (i.e., affective flattening, alogia, or avolition)

-- I looked up alogia and he definitely has that dead on. In the initial interview with him he answered questions very briefly without elaboration.

Note: Only one of these symptoms is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

---He doesn't have any of those.

AND at some time there is either a

* major depressive episode
* manic episode
* mixed episode

--I think his behaviors described by his adoptive mother and sister might be considered a mixed episode because he sleeps almost all day and daydreams and stuff but then he also screams and jumps out of doorways, and he freaked out when asked about his previous behaviors.. This is the one I'm most not sure about..

B. During the same period of illness, there have been delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms.

-- I'm really not sure about this one either


C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

--Again the thing about the mixed episode might apply here?

D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

--I'm pretty sure he's not a substance abuser and he has no medical conditions.


Any help you could give me on this one would be greatly appreciated.
I want to major in psychology in college, and this is the kind of psychology I'm interested in, but apparently I'm not very good at it..

Littlelizzy042 wrote:* grossly disorganized or catatonic behavior

-- I don't think there's any of that unless eating flies, daydreaming, jumping out of doorways to scare his sisters, and smiling and staring at people without talking is grossly disorganized..

The staring is stupor-like, and isn't disorganised but it IS catatonic behaviour.

Eating flies seems disorganised, I guess.

I want to major in psychology in college, and this is the kind of psychology I'm interested in, but apparently I'm not very good at it..

It's not that you're bad at it, it's that it's just so diverse. No case is the same.

Schizoaffective disorder sounds about right.

Paranoid Schizophrenia

http://en.wikipedia.org/wiki/Schizophrenia

It seems like everyday I come up with something new that seems to fit.

I think for a main diagnosis, I'm diagnosing him with Schizophreniform Disorder.
My initial thought when I started the project was that it was brief psychotic disorder, but the symptoms lasted too long for that, however, his symptoms fit for Schizophreniform disorder, and since his symptoms haven't been going on for 6 months yet, I'm making it a provisional diagnosis.

And I think for an alternative disorder, I'll use Schizophrenia, since if the symptoms do exceed six months, that's likely what he'll have.