PSY645 Fictional Mental Health Consultation Scenario

You have received the following email from a colleague working at a local crisis house.

*encrypted message*

Here is the case we talked about briefly over the phone. Please let me know your thoughts. This one really has me stumped.

John Smith, PsyD Clinical Psychologist (PSY042)

Please note the following privacy information: This message and any files transmitted with it may contain privileged and confidential information intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient or the person responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination or copying of this message or any of its attachment(s) is strictly prohibited. If you have received this message in error, please immediately notify Dr. Smith by email and permanently delete the original message and attachment(s) from your computer system. Thank you for your time and consideration in this matter.

——-

Bob is a 38-year-old male. He presented to the crisis house late last night, appearing disheveled and poorly groomed. He repeatedly stated, “The police are after me,” but did not articulate any reason why the police would be looking for him. His speech was pressured and circumstantial; he had significant psychomotor agitation and elevated body temperature. Bob reported having been in psychiatric treatment “for years,” but refused to share previous diagnoses and would not complete a release of information to allow examination of his medical history. When I shared with Bob that his medical history is important information for me to know in order to help him, he screamed, “You work for the police, don’t you? I bet you’re a cop!” Bob was admitted to the crisis house due to risk of further decompensation without this level of care.

Normally, I would wait a few days to observe Bob and make a diagnosis, but I need to make a diagnosis within 24 hours of admittance according to our crisis house policy. Additionally, I do not currently have access to a tox screen or a toxicology report for Bob. Help me understand what’s happening with him so I can make a provisional diagnosis.

Mental Health Consultation

PSY645 Psychopathology

Gabrielle Smith

March 9, 2020

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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.

Evaluation

Since Bob will not sign a release of information form it can make it difficult to diagnose

him with no access to his medical records. He also will not inform anyone of what his previous

diagnoses are so it is challenging trying to understand what may be going on with him with such

little information.

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Symptoms and Presenting Problems

Based on the information provided about Bob, one of his symptoms include delusions

which can be a sign of a psychotic disorder. He mentioned that “the police are after me” but

couldn’t give a logical explanation as to what would make him believe they were indeed

following him. Of the many types of delusions, he may be experiencing a form of persecution

delusions in which he believes he is “being hounded, followed, or otherwise interfered with”

(Morrison, J., 2014). Other symptoms that he exhibited included increased body temperature,

psychomotor agitation, disordered speech, and he was not groomed. Unfortunately because he

will not complete a release of information form that would disclose his medical records to be

certain of this, there is no way to know for sure if or what psychotic disorder he may suffer from.

Theoretical Orientation. These symptoms displayed are related to one of the four major

schools of psychological therapy. Based on the symptoms and behavior being shown, Bob’s

problems seem to stem from a behavioral approach. According to the text, behavioral approach

theories can be determined by external events and past learning experiences can drive a person’s

present behavior (Bennett, P., 2011). Therefore, with the information presented, it is in my

opinion that Bob had a previous experience with the police which has him experiences delusions

about police being after him.

Other Perspectives and Theoretical Orientations

When looking at Bob’s scenario from an alternate viewpoint, I would say that a psychoanalytic or

cognitive behavioral approach could apply to his case. A psychoanalytic approach “views childhood

trauma and the unconscious as the causes of problems in adulthood” (Bennett, P., 2011). Bob could be

experiencing delusions about cops being after him due to a previous encounter with the police as a child

or young adult, which could be causing some unwanted memories bringing about delusions. Cognitive

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behavioral approaches “assumes that the critical element of psychopathology is inappropriate,

dysfunctional, cognitions” (Bennett, P., 2011). With cognitive approaches, there tend to be a phobia or

phobias in which individuals have troubles getting past them. It is possible for Bob to have a phobia of

police officers in which he has begun to think that everyone is working for the cops or that the cops are

following him around.

Conclusion

The DSM-5 is probably the most frequently used book to diagnose individuals of certain

conditions. Another book that is similar to the DSM-5 that could be used to assess the patient is the

Psychodynamic Diagnostic Manual (PDM). It is a manual that focuses on various treatments and mental

disorders. The PDM is a “collaborative project of Div. 39, the American Psychoanalytic Association, the

International Psychoanalytical Association, the American Academy of Psychoanalysis and the National

Membership Committee on Psychoanalysis in Clinical Social Work” (Packard, E., 2007). Both the DSM-

5 and the PDM could assist with assessing this patient to discuss and discover and diagnosis he may have.

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References

Bennett, P. (2011). Abnormal and clinical psychology : An introductory textbook (3rd ed.).

Berkshire, England: Open University Press. Retrieved from http://www.ebrary.com

Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The

Guilford Press. Retrieved from https://redshelf.com

Packard, E. (2007, January). A new tool for psychotherapists. Retrieved March 9, 2020, from

https://www.apa.org/monitor/jan07/tool

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