CASE NUMBER: (1)

PATIENT NAME: Martin GENDER: Male

DIAGNOSIS/Impression: Comorbidity: Schizophrenia with Obsessive-Compulsive Disorder

1: It was said that Martin had been out of work for several years following a prolonged
“psychotic episode” which began when he was studying at university.

Psychotic episode symptoms are:

Symptoms of psychosis include: difficulty concentrating. depressed mood
anxiety, suspiciousness, withdrawal, delusions.and hallucinations.

People with psychoses lose touch with reality.

2: But in the next paragraphs, Martin does not showed any symptoms of having delusions and
hallucinations.

3: According to DSM-V, people with OCD have:

OBSESSION
 Recurrent and persistent thoughts, urges, or images that are experienced, at some time
during the disturbance, as intrusive and unwanted, and that in most individuals cause
marked anxiety or distress.
 The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action.

COMPULSION
 Repetitive behaviors or mental acts that the individual feels driven to perform in
response to an obsession or according to rules that must be applied rigidly.
 The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or
preventing some dreaded event or situation ; however, these behaviors or mental acts
are not connected in a realistic way with what they are designed to neutralize or prevent,
or are clearly excessive.

The obsessions or compulsions are time-consuming (take more than 1 hour per day) or cause
clinically significant distress or impairment in social , occupational, or other important areas of
functioning.

4: Signs and Symptoms

 Martin explained that he had a breakdown caused by too much stress while he was at
college.
 He asked to speak to the person he had written to but if the person on the switchboard
asked the reason for his call he simply said that he was calling to follow up a letter he
had written.
 After approaching about 20 employers in this way he finally found one who said there
could be an opening for work experience in a couple of months’ time. So over the next
three months Martin kept in touch with the company by ‘phone once a month just to let
them know that he was still keen on coming to work for them.
 Although he was very shy at first he soon learned the importance of making small talk
with his colleagues and building good working relationships.
  He is very aware and conscious in everything he does.
 He is perfectionist and intolerance of uncertainty; and over-importance of his thoughts
(believing that having a forbidden thought is as bad as acting on it and he always asks
about the “benefit” that he will get.

5: So, can Martin and other people with schizophrenia still work?
 YES. People with SCHIZOPHRENIA CAN WORK even if they have symptoms. Several
studies have shown that people with major mental illnesses fare better if they work. The
ability to hold a job is not necessarily related to the severity of the person's illness.

6: Treatments and Recommendations

 The two main treatments for OCD and Schizophrenia are psychotherapy and
medications. Often, treatment is most effective with a combination of these.

 Cognitive behavior therapy (CBT) - This can help teach the patient to change his
thinking and behavior. His therapist will show him ways to deal with "voices"
and hallucinations. With a combination of CBT sessions and medication, he can
eventually tell what triggers his psychotic episodes (times when hallucinations
or delusions flare up) and how to reduce or stop them.

 Cognitive enhancement therapy (CET) -. It teaches people how to better recognize

social cues, or triggers, and improve their attention, memory, and ability to organize their
thoughts. It combines computer-based brain training and group sessions.

 Psychosocial Therapy - If your friend or family member sees improvement during his
psychotherapy sessions, it’s likely he needs more help with learning how to become part
of a community. That’s where psychosocial therapy comes in.

 Social skills training - This type of instruction focuses on improving the patient’s
communication and social interactions.

 Rehabilitation. Schizophrenia usually develops during the years we are building our
careers. So his rehabilitation may include job counseling, problem-solving support, and
education in money management.

 Medications: Antidepressants
Antidepressants must be taken only under expert guidance as some of them have
several side effects. Any change in the patient’s behavior due to the effect of medication
must be monitored consistently.
CASE NUMBER: (2)
PATIENT NAME: Jim GENDER: Male

DIAGNOSIS/Impression: Social Anxiety Disorder (SAD) [Social Phobia]

1: DSM-V: In social anxiety disorder (social phobia), the individual is fearful or anxious about
or avoidant of social interactions and situations that involve the possibility of being scrutinized.
These include social interactions such as meeting unfamiliar people, situations in which the
individual may be observed eating or drinking, and situations in which the individual performs in
front of others. The cognitive ideation is of being negatively evaluated by others, by being
embarrassed, humiliated, or rejected, or offending others.

Examples include: social interactions (having a conversation, meeting unfamiliar people) , being
observed (eating or drinking) , and performing in front of others (giving a speech) .

2: SIGNS AND SYMPTOMS that Joe showed:

 Jim was able to avoid almost all social responsibility -- except at his job.
 Joe said that when he has to call people up to tell them that their order is in.
 He also said, "I know my voice is going to be weak and break, and I will be unable to get
my words out. I’ll stumble around and choke up....then I’ll blurt out the rest of my
message so fast I’m afraid they won’t understand me. Sometimes I have to repeat
myself and that is excruciatingly embarrassing........"
 Jim felt great humiliation and embarrassment about this afterwards: he couldn’t even
make a telephone call to a stranger without getting extremely anxious and giving himself
away. Then he would beat himself up.
 When he knew he had to perform, do something in public, or even make phone calls
from work. The more time he had to worry and stew about these situations, the more
anxious, fearful and uncomfortable he felt.

3: According to DSM-V, people with Social Anxiety Disorder have:

 The individual fears that he or she will act in a way or show anxiety symptoms that will
be negatively evaluated (will be humiliating or embarrassing; will lead to rejection or
offend others).
 The social situations almost always provoke fear or anxiety.
 The social situations are avoided or endured with intense fear or anxiety.
 The fear or anxiety is out of proportion to the actual threat posed by the social situation
and to the sociocultural context.
 The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
 The fear, anxiety, or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
 The fear, anxiety, or avoidance is not attributable to the physiological effects of a
substance (a drug of abuse, a medication) or another medical condition.
 The fear, anxiety, or avoidance is not better explained by the symptoms of another
mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum
disorder.
 If another medical condition (Parkinson's disease, obesity, disfigurement from bums or
injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
Specify if:
 Performance only: If the fear is restricted to speaking or performing in public.
4: Treatments and Recommendations
Treatment depends on how much social anxiety disorder affects your ability to function in daily
life. The two most common types of treatment for social anxiety disorder are psychotherapy -
also called psychological counseling or talk therapy- or medications or both.

 Psychotherapy improves symptoms in most people with social anxiety disorder. In

therapy, you learn how to recognize and change negative thoughts about yourself and
develop skills to help you gain confidence in social situations.
 Cognitive behavioral therapy is the most effective type of psychotherapy for anxiety, and
it can be equally effective when conducted individually or in groups.
 In exposure-based cognitive behavioral therapy, you gradually work up to facing the
situations you fear most. This can improve your coping skills and help you develop the
confidence to deal with anxiety-inducing situations. You may also participate in skills
training or role-playing to practice your social skills and gain comfort and confidence
relating to others. Practicing exposures to social situations is particularly helpful to
challenge your worries.

Medications
 Though several types of medications are available, selective serotonin reuptake
inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social
anxiety.
 The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR)
also may be an option for social anxiety disorder.
 To reduce the risk of side effects, your doctor may start you at a low dose of medication
and gradually increase your prescription to a full dose. It may take several weeks to
several months of treatment for your symptoms to noticeably improve.
 Other antidepressants. You may have to try several different antidepressants to find one
that's the most effective for you with the fewest side effects.
 Anti-anxiety medications. Benzodiazepines may reduce your level of anxiety. Although
they often work quickly, they can be habit-forming and sedating, so they're typically
prescribed for only short-term use.
 Beta blockers. These medications work by blocking the stimulating effect of adrenaline.
They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice
and limbs. Because of that, they may work best when used infrequently to control
symptoms for a particular situation, such as giving a speech.

5: Being shy is a common personality trait and is not by itself pathological. In some societies,
shyness is even evaluated positively. However, when there is a significant adverse impact on
social, occupational, and other important areas of functioning, a diagnosis of social anxiety
disorder should be considered, and when full diagnostic criteria for social anxiety disorder are
met, the disorder should be diagnosed.
CASE NUMBER: (3)
PATIENT NAME: Suzie GENDER: Female

DIAGNOSIS/Impression: Bipolar 1

1: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and
abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week
and present most of the day, nearly every day (or any duration if hospitalization is necessary).

2: SIGNS AND SYMPTOMS TO SUZIE’S CASE:

1. She has spent her time in heightened state of activity which she herself describes as
“out of control.”
2. Having strange and grandiose ideas that often take on a mystical or sexual tone.
3. She proclaimed that she did not menstruate because she was a “third sex, a gender
above human sexes.”
4. She explained that she is a “superwoman” who can avoid human sexuality and still give
birth. That she is a woman who does not require sex to fulfill her place on earth.
5. Susie’s bizarre thinking centers on the political, such as believing that she had somehow
switched souls with the senior senator from her state. From what she believed were his
thoughts and memories, she developed six theories of government that would allow her
to single-handedly save the world from nuclear destruction.
6. She feels that her recent experiences with switching souls with the senator would make
her particularly well suited for a high position in government; perhaps even the
presidency.
7. Susie has experienced two previous episodes of wild and bizarre behavior similar to
what she is experiencing now; both alternated with periods of intense depression.
8. She could not bring herself to attend classes or any campus activities.
9. Insomnia
10. Poor appetite
11. Difficulty concentrating
12. At the lowest points of the depressive side of her disorder, Susie contemplated suicide
and having suicidal thoughts.

3: DSM-V: During the period of mood disturbance and increased energy or activity, three (or
more) of the following symptoms (four if the mood is only irritable) are present to a significant
degree and represent a noticeable change from usual behavior:
 Inflated self-esteem or grandiosity.
 A delusion is a false belief held by a person. It contradicts reality or what is
commonly considered true. The strength of a delusion is based on how much the
person believes it.
 Specifically, a delusion of grandeur is a person’s belief that they are someone
other than who they are, such as a supernatural figure or a celebrity. A delusion
of grandeur may also be a belief that they have special abilities, possessions, or
powers.
 Decreased need for sleep (feels rested after only 3 hours of sleep) .
 More talkative than usual or pressure to keep talking.
 Flight of ideas or subjective experience that thoughts are racing.
 Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
  Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation
 Excessive involvement in activities that have a high potential for painful consequences
(engaging in unrestrained buying sprees, sexual indiscretions, or foolish business
investments).

4: Treatment and Recommendations

 Hospitalization: In extreme cases patients are hospitalized. This is usually due to suicidal
thoughts or actions.

 Psychotherapy: One on one therapy where the client is helped to understand how their
thoughts effect their emotions.

 Electroconvulsive/ECT: When a patient doesn't respond to most medication ECT is

used. This therapy involves sending electrical currents through the brain to reduce
symptoms of the disorder.

 Anticonvulsants: helps to treat bipolar disorders that are similar to mixed episodes.

 Antidepressants: might trigger manic episodes but stabilize depression.

 Antipsychotics: for people who don’t gain benefits from anticonvulsants.

 Benzodiazepines: anti-anxiety and improves sleep.

 Lithium: stabilizes mood for extreme highs and lows for bipolar disorders.

 Symbyax: antidepressant plus antipsychotic for depression treatment and mood

stabilizers.

 Rehabilitation: one of several psychosocial treatments for schizophrenia. It involves

social and job-skills training to improve an individual's ability to function in society.
CASE NUMBER: (4)
PATIENT NAME: Joe GENDER: Male

DIAGNOSIS/Impression: PARANOID PERSONALITY DISORDER [PPD]

1: Paranoid Personality Disorder is a disorder that causes a person to have extreme distrust in
other people. In other words, a person who is diagnosed with PPD thinks that everyone is trying
to trick, cheat or hurt them. The main cause of PPD is from an imbalance of chemicals in the
brain that alters the thought process of how one person thinks, feels and acts.

2: According to DSM-V, people with PPD have:

 Failure to conform to social norms with respect to lawful behaviors as indicated by

repeatedly performing acts that are grounds for arrest.
 Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure.
 Impulsivity or failure to plan ahead.
 Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
 Reckless disregard for safety of self or others.
 Consistent irresponsibility, as indicated by repeated failure to sustain consistent work
behavior or honor financial obligations.
 Lack of remorse, as indicated by being indifferent to or rationalizing.

3: SIGNS AND SYMPTOMS SHOWED:

 Joe had troubles with relationships in his life because he felt like they were taking his
ideas and couldn’t form a trust with anyone. Therefore, he avoided crowds of people.
 Joe would work at a university, but got fired because he accused the school of trying to
kill him with radiation in the laboratory.
 Joe thought his wife was out of steal his idea that’s why they divorced.
 Later on Joe started getting panic attacks and directed him to a psychiatrist.
 The treatment did not work because Joe didn’t believe that he had a mental disorder.

4: Treatments and Recommendations

Treatment for people with Paranoid Personality Disorder [PPD] can be very successful if the
individual is willing to accept treatment options. Most patients who are not willing to though
because their feelings of paranoia do not allow them to trust people who are dealing with their
treatment. Medication and therapy options are available but treating the disorder is most
successful when these options are combined.

1. Anti-Anxiety Medications: Anxiety cause people who are diagnosed with PPD to suspect
others and make paranoid person believe that another person is out to get them and
distrustful. Anxiety also makes people with PPD display symptoms of being on guard
and alert and expecting another person to take advantage of them. Anti-Anxiety
Medications are also called Benziodiazephines that are used for relieving short term
severe anxiety.
 2. Anti-Psychotic Medications: It prevent symptoms of psychosis that are caused by PPD.
People who are diagnosed with PPD have thoughts and delusions of extreme suspicion.
These delusions are what cause the cycle of suspicion to continue. It lessens the
psychotic behavior that is caused by paranoia.

3. Psychotherapy: It is only helpful for a person with paranoid personality disorder if he or

she is willing to present themselves for treatment. This method helps the individual to
learn how to cope up with PPD, learn how to communicate with other people in social
situations and help to reduce the feelings of paranoia.

As the therapy with an individual with PPD progresses he or she will feel more and more
comfortable and begin to trust their client more. The therapist needs to be careful though to not
raise something that could be considered suspicious to the person with PPD.
CASE NUMBER: (5)
PATIENT NAME: Kathy GENDER: Female

DIAGNOSIS/Impression: Dissociative Identity Disorder (Multiple Personality Disorder)

1: Dissociative Identity Disorder (Multiple Personality Disorder) is the disruption of identity

characterized by two or more distinct personality states, which may be described in some
cultures as an experience of possession. The disruption in identity involves marked discontinuity
in sense of self and sense of agency, accompanied by related alterations in affect, behavior,
consciousness, memory, perception, cognition , and/or sensory-motor functioning. These signs
and symptoms may be observed by others or reported by the individual.
 Recurrent gaps in the recall of everyday events, important personal information, and/ or
traumatic events that are inconsistent with ordinary forgetting.
 The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning.

2: Signs and Symptoms that Kathy has:

 She became very depressed and mute and was admitted to a hospital.
 She showed dissociation and trance-like symptoms, with irritability and extensive
manipulation which caused confusion and frustration among the hospital staff.
 Sexual addiction
 She began to attribute what had happened to an alternate personality, Pat. Kathy would
insist on being called Pat during the abuse the father committed for the next five years.
 At the age of nine, after Kathy’s mom discovered her and her father in bed, Kathy could
not accept that her mother insisted Kathy to sleep with her mom every night and that’s
why she created another identity, “Vera”, who continued the relationship for another five
years.
 At age 14, Kathy was raped by her father's best friend and began calling herself Debbie.
 She became very depressed and mute and was admitted to a hospital.
 At age 18, Kathy became very attached to her boyfriend but her parents forbid her to see
him. Kathy then ran away from home to a new town. She began to call herself Nancy
when she could not find a job and her need of money drove her to prostitution.

3: Recommendation
 Stabilize the most functional or competent personality or integrate the disparate
personalities into 1.
 1st step: Facilitate recognition by the patient of the existence of alter personalities. One
example: Use videotapes to record the existence of alter behavior in an effort to help the
patient recognize radical changes that are otherwise unknown. It may also be important
to help patients understand the general nature of the problem as it has appeared in
others’ lives so that they can gain perspective on their own dilemma.
 2nd step: Fusion may be eventually be accomplished if the main personality comes to
share the memories and emotions of the alters.
 3rd step: Finally, the most important step involves learning to react to conflict and stress
in an adaptive fashion rather than engaging in the avoidance behaviors associated with
dissociative states.
 While working toward the process of integration, it is also important that the therapist
avoid further fragmentation of the patient’s behavior or personality.
4: Treatment

 Eye movement desensitization and reprocessing (EMDR), a treatment method that

integrates traumatic memories with the patient's own resources, is being increasingly
used in the treatment of people with dissociative identity disorder.
 Hypnosis (hypnotherapy) to learn more about their personality states in the hope of their
gaining better control of those states.
 Psychotherapy is the use of psychological methods, particularly when based on regular
personal interaction, to help a person change and overcome problems in desired ways.

Here are the top medications used for the treatment of dissociative identity:
 Antidepressant drugs: These drugs help reduce depression in some dissociative
identity disorder patients.
 Depressants: Depressants are used to calm down certain dissociative identity disorder
patients displaying violent and manic behavior. These drugs temporarily diminish
hyperactivity of the brain. They are used to prevent seizures or respiratory disorders that
can be associated with a dissociative identity disorder.
 Antipsychotic medication: These dissociative identity disorder drugs are used when
the patient exhibits psychotic behavior. They work as mood stabilizers as well. Even if
the dissociative identity patient is not diagnosed with psychosis, these drugs can be
used to tranquilize and stabilize the mood.
 Anxiety medication: These drugs are used for the treatment of dissociative identity
patients who display excessive anxiety, or when anxiety is a trigger for dissociative
identity disorder behavior. Anxiety can sometimes be an associated condition caused by
dissociative identity problems.
 Stimulants: These are used as dissociative identity disorder drugs when the patient
displays severe depression, or in cases where depression is a cause of dissociative
identity problems. Stimulants improve the central nervous system's response and make
the person alert, wakeful, and active. This medication should only be taken in
recommended doses and on a physician’s prescription. In addition, these medications
are not suitable for some dissociative identity disorder patients.
CASE NUMBER: (6)
PATIENT NAME: Given not mentioned GENDER: Male

DIAGNOSIS/Impression: Obsessive-Compulsive Disorder and Paraphilia

1: DIAGNOSIS TO THE PATIENT:

Paraphilia is recurring sexual fantasies, sexual urges or behaviors that involve nonhuman
objects, children or non-consenting adults, suffering or humiliation (to self or to others), lasting
for at least 6 months with resultant clinically significant distress or impairment in social,
occupational, or other important areas of functioning.

 Voyeurism is sexual gratification achieved from watching people undressing or nude, or

observing them during sexual acts without their knowledge or consent.
 Frotteurism refers to the sexual gratification achieved by touching or rubbing a non-
consenting person. This behavior often occurs in busy, crowded places, such as on busy
streets or on crowded buses or subways
 Scatologia deviant sexual practice in which sexual pleasure is obtained through the
compulsive use of obscene language. The affected person commonly satisfies his
desires through obscene telephone calls, usually to strangers.

Obsessive Compulsive Disorder

Obsessions are recurrent, intrusive, and distressing thoughts, images, or impulses that are
usually unpleasant and increase a person's anxiety. The patient recognizes them as his own, as
irrational & ego dystonic, unable to successfully resist them.

Compulsions are repetitive, seemingly purposeful, behaviors that a person feels driven to
perform to reduce anxiety, recognized by the individual as ineffectual, pointless makes repeated
attempts to resist them. Resistance to carrying out a compulsion results in increased anxiety.

2: SIGNS AND SYMPTOMS THAT THE PATIENT SHOWED:

 Difficulty in completing his job, increasing irritability & marital disharmony of one and half
years duration
 Difficulties since several years in his sexual behavior and ability to complete a task on
time
 At 10 years of age he had started rubbing his genitalia on bed to get pleasurable effects
but had no sexual thoughts attached. At 13 years of age started having repeated sexual
thoughts after reading pornographic material, also fantasized of having sex & continued
self-stimulation by rubbing his penis on the bed or pole and ejaculate at a frequency of
once every 2 or 3 days to about 2-3 times daily.
 By age of 14 years he also had repeated intrusive thoughts that while bathing soap has
not been properly washed from the body and keep on taking bath and drying his body,
spending 30-35 min in the bathroom, that his hands are dirty and had to be washed
repeatedly.
 He was having repeated thoughts to arrange things in particular pattern and spent lot of
time doing so and used to get irritated when his pattern was disturbed. This resulted in
deterioration of academic performance. He would often fondle his unsuspecting, young
 female relatives non-consensually & thereafter would masturbate. He would feel guilty
for the same even before doing the act and considered it as wrong but was not able to
stop himself.
 Unable to concentrate on studies his academic performance deteriorated gradually.
 By age of 18 years the frequency of his sexual thoughts increased and he started
touching unsuspecting females and rubbing his penis against females in crowded
places. For doing this he would purposefully board crowded buses.
 By age of 20 years he would peep in the houses of people to see women changing
clothes. Peep into other's houses to catch glimpse of people engaged in intercourse, or
women changing clothes or in compromised dresses. Thereafter would masturbate
either at that place or after returning to his home.
 he started calling unknown females on phone to talk on sexually explicit matters.
 While working in the unit had repeated doubts whether he has typed the letters correctly
and placed the letter in the right envelope and would check the same 3-4 times. Took
longer to complete a given task, irritability increased, had disturbed sleep, had bi-
temporal headache throughout the day.
 He had irregular drug compliance and developed restlessness, tremors, stiffness of the
body and difficulty in concentrating in work.

3: Treatments and Recommendations

 Treatment options may include psychotherapy, individual psychotherapy, group therapy,

marital therapy, and family therapy, as well as pharmacotherapy or even surgical
interventions, as indicated.
 Inpatient treatment is indicated for patients who are suicidal, homicidal, or disabled to
the point where they cannot take care of themselves. Suicide risk is high if they feel
exposed or confronted. If patients are charged with a crime or have been arrested, they
may be incarcerated.
 Physicians must be aware that not every therapist treats people with paraphilia. There
may be a need for consultations with other professionals, such as a neurologist (if
neurologic signs are present)

Approved interventions are:

SSRI: - block the reabsorption (reuptake) of serotonin in the brain, making more serotonin
available. SSRIs are called selective because they seem to primarily affect serotonin, not other
neurotransmitters.

Anti-androgens: are the name given to a diverse group of medicines that counteract the effects
of the male sex hormones, testosterone and dihydrotestosterone. Male sex hormones are also
known as androgens; anti-androgens may also be called androgen receptor blockers.