Case Study- Rosalina
Identifying Information and Initial Presentation
Rosalina is a 59 years old woman. She is a wealthy person and a habitual liar who experiences illusions of greatness. More so, Rosalina experiences entitlement feelings that she uses to justify her lying behavior, cheating and stealing. She also uses entitlement feelings to justify her egotistical personality disorder.
Rosalina comes to see a mental practitioner and presents to the physician a history of sexual and physical abuse during childhood. This defines a history of emotional abuse. She is concerned that her emotional abuse is the major cause of her health issues. The physician asks questions concerning how the physical and sexual abuse actually took place and how she reacted to the incidences. He is concerned with Rosalina’s narration of her predicament to confirm her behavior. The psychologists confirm that Rosalina behavior is because of fear and paranoia that is combined with some kind of psychosis (Paranoid Schizophrenia).
Mental Status Exam
Rosalina appears to be of normal weight that corresponds to her height of 5’5″. However, her code of dressing and her personal hygiene is questionable. Her hair is unkempt while her clothes are loose fitting. She is stirred up and suspicious when asked to sit next to the psychologist. The psychologist notices that Rosalina appears to engage unusual thoughts or perceptions, mirages, thoughts disorders, movement disorders and disorganized thoughts (Comer, 2009). Physically, Rosalina seems to be in perfect health while mentally she appears disturbed. When engaged into deeper questions, Rosalina seems agitated and at one point accuses the practitioner of wanting to harm her. Moreover, when answering questions asked by the physician concerning her physical and sexual abuse that she say she went through when she was a child, Rosalina answers them with fear because she thinks that she is being watched. She demonstrates some kind of fear and confusion and always seems frightened.
The manner in which Rosalina responds to some questions suggests that she considers herself a privileged person. She believes that she is an important figure in the society and trust that she holds unusual powers. However, she cannot differentiate unreal and real. She cannot think clearly and control her emotions. She yells when responding to voices and images that she sees in illusions (Miller & Mason, 2011). When asked about illusions, she says that she sees images and hears voices that are beyond her control. She says that illusions have totally disorganized her life and she cannot take it anymore. More so, confirms that at times she becomes hostile and suspicious to anyone who comes her way especially when people tell her she is a liar or when she has stolen other people’s item. She says that she acknowledges that lying or stealing is wrong but she reacts extremely to such criticism. Though she claims to be a wealthy person, Rosalina cannot tell of her wealth, she uses her words strangely and gives unrelated answers
Other aspects of Mental Status Exam are noteworthy.
Functioning
Rosalina reports that she has been attending to her daily tasks properly. She confirms that her wealth is earned through her hard work. Although she is single and childless, Rosalina says that she had been engaging in social associations with other women but for two years now, she has trouble interacting with people. Her general daily functioning has declined due to unpredictable emotional responses, behaviors that hold no purpose and lack of impulse control. While she experiences no pain, she says that her daily activities are influenced by agitations and feeling of greatness. Therefore, no one wants to associate with her, and she lacks motivation to do her daily activities. She is always distracted and focuses on specific factors of the surrounding. She can no longer plan her activities.
Rosalina has no friend and close relations always avoid her. More so, she feels uncomfortable, insecure and disconcerted when she is around people.
Recent Events and History
Rosalina discloses to the psychologist that she has been fearful since her childhood. She describes her childhood tribulations as frightening and beliefs that the past events have led her to leading a single and childless life. She says that she feels great and does not want to associates with the outside world. She ascertains that she sometimes acts out of fear and confusion. Rosalina confirms that she has never used any tranquilizing drug whatsoever. She also says that she has never been treated for any mental illness. However, when asked about her single and childless life, Rosalina admits that she usually get angry and often yells, fights or insults those seeking to know of her personal life. She believes her life is hers alone and has lived it well with some sense of greatness.
Other Information
Rosalina medical information sent from the out-patient-department discloses that she has visited the hospital approximately two months ago for three times. The record indicates that she was brought in the hospital by close relatives who thought that she needed medical attention. All the visits were seemingly related to some mental episodes, violence and hostility towards others. However, when she was initially referred to a psychologist, Rosalina declined saying that she was sane and of sound mind. She accused her relatives of harassing her. From this perspective, Rosalina was not under any medication and the tranquilizers prescribed to her during the three visits were never taken. However, she now feels that she needs help in order for her to live a gratifying and happy life.
Clinical Decisions
The psychologist affirms that Rosalina is suffering from Paranoid Schizophrenia. Paranoid schizophrenia is a mental disorder that affects a person’s perceptions and behaviors (Haycock & Shaya, 2009). He asserts that Rosalina’s heath condition is made worse by sexual and physical abuse that she experienced during her childhood. The psychologist trust that the feelings of entitlement, delusions of grandeur, disorganized behaviors, sleeping issues, thought disorders, hallucinations, fear, strange facial expressions, illogical speech, emotional indifference and paranoia are all related to signs and symptoms of Paranoid Schizophrenia. He further confirms that the psychotic disorder exhibited by Rosalina is not genetic or inherited but rather triggered by environmental factors, which in this case is physical and sexual abuse. The psychologist further suggests that her social withdrawal is because of fear and suspiciousness. In addition, the psychologist confirms that Rosalina’s condition has been instigated by augmented stress levels given that she is single, childless and does not associate with anyone to share her problems. Particularly, her exposure to physical and sexual abuse induced stress that consequently led to increased creation of hormone cortisol (Comer, 2009).
After the psychiatric assessment, the psychologist ascertained that paranoid schizophrenia is manageable. To manage the symptoms, the psychologist suggests the use of cognitive behavioral therapy, psychosocial treatment, antipsychotic medications and family counseling. The psychologist believe that integration of medication, behavioral therapy and counseling is superlative for treating and managing symptoms related to paranoid Schizophrenia (Comer, 2009). However, it is imperative to note that schizophrenia medication may have side effects, which include among others weight gain, body tremors, sluggish mobility and sleepiness.
2. Answers to the following questions based on the diagnosis and treatment, which you have outlined in the section called “Clinical Decisions”.
Diagnosis
The symptoms of the disease schizophrenia are frightening hence might shock the patient that is suffering from the disease. To be capable to understand the disease, the patient suffering schizophrenia should visit the physician to obtain more guidance to the disease. It is important for the patient suffering from the disease to understand the type of disease that he/she is ailing. This assists the patient obtaining hope and knowing the exact date that the patient will heal from the disease. The symptoms of schizophrenia are not common like any other disease hence it is almost impossible for the patient to discover the disease with ease. For this reason, the relatives to the patient should ensure that immediate attention is undertaken with the slightest evidence possible. When the schizophrenia is treated at the first stages, it is much easier rather than at than at the late stage (Healy, 2007).
Patients that suffer from the disease schizophrenia need the psychiatrists to assist in the diagnosis of the disease. Since the schizophrenia does not have a single symptom to identify it, the physician needs to take a keen study of the patient’s characterizes. This is important to ensure that the patient is treated earlier enough to avoid severe disorders. After the identification of the disease, the physician should affect immediately on treating the patient (Healy, 2007). This is important to ensure that the health of the patient does not deteriorate but remains healthy.
Schizophrenia is a mental disorder that is classified into diverse clinical disorders that have no single identification of the signs and symptoms. There is no single symptom that can be used to rule out that the patient is suffering from schizophrenia. However, it is important for the patient to visit the doctor to ensure that adequate medication is received. Individuals suffering from the schizophrenia disorder have similar characteristics with psychosis. For this reason, the patients of schizophrenia appear to be out of far away from reality and base their lives on imagination. Unlike other diseases, there is no use of blood testes and brain scans vital in identification of schizophrenia. For this reason, the doctor should only base on the patients information to gauge whether the individual is actually suffering from schizophrenia. Only trained personnel are capable of making accurate judgment concerning the disease. The patient should be interviewed to acquire accurate diagnosis of the disease (Miller & Mason, 2010).
In the diagnosis of the disease, schizophrenia, the doctor can use verbal screening to assist in determining whether the results received from the patient are accurate. A successful schizophrenia diagnosis is only achieved when the patient has at least one single active flare-up lasting for more than one to two months. The flare-up must consist of not less than two of the following symptoms, hallucination, emotional unresponsiveness, delusions, flat speaking tone and disorganized thinking.
I. In a table, list the evidence for and against the diagnosis made.
NO. For the Diagnosis Against the diagnosis
1. The diagnosis assist in discovering the actual disease the patient is suffering. Using the diagnosis, the psychiatrist is capable of discovering the actual disease that the patient is suffering. The diagnosis does not have specific tests that assist in discovering the actual disease.
2. It increases the chances of the disease being treated before the patients suffer worse symptoms. In early stages, almost all disease can be treated with ease. When the doctors identify the schizophrenia disease at an earlier stage, it is simple for the patients to get appropriate medication. This assist in reducing the pain that the patient would otherwise undergo through if the disease was not diagnosied at an earlier stage. It is time involving before the schizophrenia disease is discovered. In the actual process of diagnosing the schizophrenia disease, the patient has to be interviewed. This takes a long period before actually the disease is discovered.
3. It might also be cheap to treat the schizophrenia disease at an earlier stage. If the schizophrenia is diagnosed at an earlier stage, the doctors will treat it at a cheaper price. This is for the key reason that the patient will only require less medication to solve the problem (Healy, 2007). In some cases, the patient might only be required to abstain from some activities especially those that promote stress. It is expensive to treat the disease especially if the patient delays in visit the medical centers. Since there is no actual method of identifying the disease, the treatment procedure might be expensive especially if the disease is discovered at a later stage.
4. The schizophrenia diagnosis is a simple procedure that takes only a few minute especially if the patient gives the actual symptoms. The diagnosis procedure might also be complicated specially if the patient and the doctor cannot interrelate with ease.
5. Diagnosis of the schizophrenia disease is simple especially if the sick person does not indulge into the use of drugs and alcohol (Marley, 2003). The diagnosis of schizophrenia might be difficult especially if the patient uses drugs. This is for the reason that the effects of the drugs can be similar with those of the disease.
ii. What other diagnoses may be appropriate and why?
Other diagnosis that can be appropriate for the schizophrenia disease encompass of disorganized type schizophrenia and undifferentiated type schizophrenia. In the disorganized type schizophrenia, the patient might be functioning appropriately just like any other human being. The individual might be attending school, attending church and even working just like any other normal person. However, the manner in which the individual performs his/her duties is exceedingly different (Miller & Mason, 2010). The individual might be performing some but not activities in an opposite manner. The diagnosis done through the disorganized type schizophrenia indicates that the patient is disorganized in one major activity in his/her life. For instance, the patient might be disorganized either in speech whereby he/she talks to much words without delivering the expected information. The patient might also be disorganized in displaying his behavior hence undergoing comparatively fewer delusions.
The undifferentiated type schizophrenia is a diagnose that is conducted when the patient suffering from schizophrenia which exhibits diverse mixture of symptoms. The patient undergoes diverse symptoms, which makes it difficult for the physician to identify the disease. In this case, the patient might be undergoing delusions, hallucinations and negative symptoms without any of the symptoms being dominant (Marley, 2003). This makes it almost difficult for the psychiatrist to identify the type of schizophrenia that the patient is suffering.
Treatment
I. In a table, list the evidence for and against the treatment recommendation made?
1. The treatment cures the patient from the schizophrenia disorder. Most of the treatments used in treating schizophrenia are effective. Most of the treatment are expensive for the patients hence not all the patients suffering from the schizophrenia are capable of using the medication.
2. The methods of treatment are appropriate and can be relied upon by the patients. The methods of treatment are involving and time consuming. The patients are treated for a long duration.
3. The patient recovers at a faster rate since the physician monitors the health of the patient (Healy, 2007). The treatment procedure limits the patients suffering from schizophrenia from performing other activities.
4. The psychiatrist usually base the treatment on the patient’s results obtained from the interview. The interview might not reveal the actual problems that the sick patient is feeling. Some patients might have difficulty in expressing on oneself to the doctor (Miller & Mason, 2010).
ii. What other treatment options should be considered and why?
The treatment of the schizophrenia depends on diverse factors such as medication and the family members. Dealing with patients that have mental disorder is not a simple task since the people ought to be treated with ease. The earlier the schizophrenia disease is treated, the faster the patient is treated. Earlier treatment assists in limiting the patient from acquiring other disorders that might arise from the schizophrenia disease. One of the other methods that might be essential in treating the schizophrenia is the use of guidance to assist the patient from abstaining from other activities (Marley, 2003).
The patient can abstain from activities such as use of addictive drugs. Drugs is the major cause of hallucination especially in the older patients suffering from schizophrenia. To assist in treating the patients, the psychiatrists might require the patients to abstain from the use of the drugs. Another treatment encompasses abstinence from activities that generate stress in the human body.
References
Comer, R.(2009). Abnormal psychology. New York: Worth Publishers.
Haycock, D., & Shaya, E.(2009). The everything health guide to schizophrenia: The latest information on treatment, medication, and coping strategies. New York: Columbia University Press.
Miller, R., & Mason, S.(2011). Diagnosis: Schizophrenia: A comprehensive resource for consumers, families and helping professionals. Columbia: Columbia University Press.
Healy, C. (2007). Understanding your schizophrenia illness: A workbook. Chichester: John Wiley.
Miller, R., & Mason, S. E. (2010). Diagnosis – Schizophrenia: A Comprehensive Resource for Consumers, Families, and Helping Professionals. Columbia University Press.
Marley, J. (2003). Family Involvement in Treating Schizophrenia: Models, Essential Skills, and Process, London: Routledge
