Dear Journal - 5-8-12 - Getting A's oh what a feeling!

Dear Journal:

Last week I handed in my first research paper that I had to write for my major (Psychology).  I was really nervous about this paper because although I love to write and I have written many papers for school in the last 3 years, I had not written one that was as important to me as this one.  Additionally, this paper was on a mental disorder that I have always been fascinated with.  It is not only a very serious and completely sad one, but it's also one that has no cure and that for many many years, people were treated like animals when they had this condition, because no one knew what it was, and at one point in history, people were put into asylums because of it.  


I am fascinated by the human mind and I hope to continue to learn more and more about it and hope that some day, I am able to help myself and others, when they are going through difficulties when dealing with life.  There is nothing wrong with seeking mental health, actually, mental health has a significant role in our health in general, therefore, I encourage all individuals who feel overwhelmed, sad, or just feel the need to seek mental health to do so.  Sometimes, just knowing someone is really listening, makes a very big difference.

Anyway, below is my A+ paper! YES I got an A+ why else would I put it on my blog DUH! I am extremely proud of it and also felt it was important to share it because it is truly informative.  I am sure that this will not be the last paper I post on my blog, as these things are what make Jazzy, Jazzy!

Hope you find this information as interesting as I did.

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Case Study: Brian’s Diagnosis

Jazzy

Brooklyn College - Abnormal Psychology

Abstract

This research paper is an attempt to diagnose the information provided about Brian.  It will discuss the founding that Brian is suffering from schizophrenia, undifferentiated type.  It will also discuss the history of this condition, followed by a diagnosis overview which will pertain to how the disorder affects individuals.  Additionally, it will explain how each of Brian’s symptoms is pertinent to the criteria needed to properly diagnose the disorder, according to the Diagnostic and Statistical Manuel (DSM) of mental disorders version IV.  And finally, it will give the 5 Axis diagnosis which is needed in order to set up a treatment plan. 

Historical Perspective

Schizophrenia like symptoms, have been observed in humanity dating back to pre-classical and classical cultures, where the cultural belief was that people who showed the symptoms of what we now know to be schizophrenia were considered to be manifestations of supernatural forces that were invading the individual (Buchanan, Lewish, & Shon., 2007). 

In the medieval times, the classical models were still widely accepted and the belief that any sort of illness with psychotic behaviors were due to superstitious and or moralistic reasons continued (Buchanan et. al., 2007). 

During the Renaissance times however, although classical thoughts were still widely accepted, many things began to change due to the first European psychiatric hospitals being established, this gave scientist new information about the workings of the body that led to a more rational and scientific approach to the study of the mind (Buchanan et. al., 2007). 

But it wasn’t until about 100 years ago however, when a German Psychiatrist by the name of Emil Kraeplin observed  hundreds of patients with the same features of those from previous cultures, that he finally introduced a more thorough diagnosis of the mental illness and gave it its first name of dementia praecox ((Biedel, Bulik, & Stanley, 2010).  Kreaplin described dementia praecox currently named schizophrenia as a type of mental deterioration that he believed resulted from autointoxication (Biedel et. al., 2010). 

Later, the Swiss psychiatrist Eugen Bleuler, who’s studies focused on the core of the disorder, which were the splitting of thoughts and the affect and behavior of such thoughts, that he changed the name of dementia praecox to schizophrenia, by combining two Greek words split (schizo) and mind (phrene) which better described the mental illness (Biedel et. al., 2010).

Diagnosis Overview

Schizophrenia is a mental disorder that is characterized by disorganized thoughts, perceptions and behaviors like poor emotional responses.  Individuals with this mental disorder are not able to think logically or perceive the world accurately, which in turn does not allow the individual to interact properly with society an impediment for everyday living (Biedel et al., 2010).  

People with Schizophrenia have symptoms such as delusions, confused thinking and hallucinations.  Schizophrenia often has a lifetime prevalence no matter how good the treatment (Biedel et al., 2010).  It affects about one percent of the population affecting both males and females equally, its onset is usually adolescence and young adulthood, and it is considered a medical illness that is not contagious (Miller, Mason, & E., 2010).

According to Miller et al., (2010) the exact cause of schizophrenia is still not known, however it seems to be a biological disease.  Miller et al., (2010) also state that schizophrenia frequently runs in families, a person is more likely to develop the mental illness if there is someone else in the family with it.  Other risk factors are viral and autoimmune mechanisms, some scientist have expressed concerns that marijuana use may be a contributing factor to developing schizophrenia, due to the chemicals in marijuana that may have a substantial effect on the way the brain develops, especially in young teenagers (Miller et al., 2010).

There are three symptoms that are categories in schizophrenia, positive symptoms, negative symptoms, and cognitive impairment (DSM-IV-TR: Schizophrenia).  Biedel et al., (2010) define the symptoms as follows: positive symptoms refer to unusual thoughts, feelings and behaviors.  Negative symptoms are thoughts, feelings and behaviors that are common in people without the mental illness but that are substantially diminished in people with Schizophrenia and cognitive impairment refers to impairments in visual, verbal learning and memory.

Clinical Impressions

Brian is a 25 year old male who was raised as an only child by his parents.  He seems to be a bit of a loner, this is evident because he states that although he likes women, at the age of 25 he has never dated.  Brian says that he gets very nervous around women.  Brian came from a low income family who was supported solely by his father who past away about 6 years ago.  He has worked as a driver in the same company for 7 years and said that although he has always loved his parents, they were kind of weird and compares himself to them.   Brian’s behavior has indeed been abnormal.  Abnormal behavior as defined by (Biedel et al., 2010) is behavior that is not consistent with an individual’s developmental, cultural and societal norms, this behavior creates emotional distress and interferes with daily functioning.

Brian demonstrates various criteria described in DSM-IV-TR manual the first most notable thing is that Brian suffers from delusions.  On one occasion, while delivering a package he handed the package to a pedestrian that was on the street and told the pedestrian “this is a gift from Jesus, please keep it with you always” this clearly illustrates that he believed he was a messenger for a higher being.  Moskowitz, Schafer, Dorahy, & A. (2009) state that a common delusion among schizophrenics, is the amusement by the ironies of divinity, often believing that they are messengers from a higher being.  Another delusion that Brian demonstrated was the strong belief that he was suffering from stomach cancer, he said that he could “feel the rotting inside of him” this is a somatic delusion, individuals having these sorts of delusions show an unreasonable fear of disease and a strong belief that they are infested (Munro, & Alistair, 1999).  When Brian was sent to a specialist by his primary care physician the specialist after sending him to get blood work an MRI and X-rays of his intestinal system, concluded that he did not have the disease.

Brian also shows signs of auditory hallucinations which is another criteria that Brian fulfills.  Brian admitted that he sometimes hears voices telling him that he’s making another mistake and that he’s “Big Dumb Brian.”  Auditory hallucinations are a common positive symptom for someone with Schizophrenia (Moskowitz et al., 2009)

Disorganized speech is a criteria that Brian does not exhibit.  Brian communicates effectively at work.  He expressed that his feelings were hurt by his co-workers, when the incident regarding the package that he gave the pedestrian, was spread around his job.

Grossly disorganized or catatonic behavior, Brian does not display grossly or disorganized symptoms.

Social/occupational dysfunction another criteria for schizophrenia has also been displayed by Brian.  At the age of 25 Brian has never dated even though he states that he likes women.  During the past two years, Brian’s social interactions are very odd.  Co-workers pointed out that his behavior is very odd, he smiles when he should be upset and seems distressed and agitated when everyone else is laughing.  This is an example of a deficit social cognition (Bellack, Morrison, Wixted, & Mueser, 1990).

Duration, Brian fulfills this criteria because his negative symptoms have been consistent.  He first started his paranoid behavior, by stating that it was "too dangerous" to walk the streets in his neighborhood, although he had been doing so for 5 years.  Then he began to double check all the deliveries he would make which shows he is compulsive.

Schizoaffective and mood disorder exclusion, Brian does not exhibit any major depressive, manic or mixed episodes

Substance/general medical condition exclusion, Brian is excluded from substance/general medical condition because Brian volunteered to take a drug test which came back negative for all illicit drugs.

Relationship to a pervasive developmental disorder - Although Brian said that his mother and father were kind of weird and his maternal aunt was put in a mental institution on several occasions, Brian does not have Autistic Disorder. 

 Diagnosis

Axis I	295.90	schizophrenia undifferentiated type
Axis II		No Diagnosis
Axis III	V61.9	Brian is currently displaying difficulties performing his job effectively.
Axis IV		None
Axis V	GAF = 30

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev.). Washington, DC: Author

A S Bellack, R L Morrison, J T Wixted and K T Mueser (1990).  An analysis of social competence in schizophrenia [Electronic version].  The British Journal of Psychiatry, 156: 809-818.  Retrieved April, 2012, from http://bjp.rcpsych.org/content/156/6/809.short

Buchanan, Robert W Lewish, Shôn W (2007).  Fast Facts : Schizophrenia (2nd Edition).

  Abingdon, Oxford, GBR: Health Press Limited

Biedel, D., Bulik, C., & Stanley, M. (2010). Abnormal psychology. New Jersey: Pearson

Education.

Miller, Rachel Mason, Susan E. (2010) Diagnosis: Schizophrenia : A Comprehensive Resource for Consumers, Families, and Helping Professionals (2nd ed.).  New York, NY:  Columbia University Press

Moskowitz, Andrew Schafer, Ingo Dorahy, Martin Justin (2009) Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology. Hoboken, NJ: Wiley

Munro, Alistair (1999). Delusional Disorder: Paranoia & Related Illnesses. Port Chester, NY: Cambridge University Press