Case Study on Psychological Disorder - Schizophrenia
LM is a 52-year old male. He holds a master’s degree in accounting and has had an illustrious career. He lives in a rented apartment after recently separating from his wife. They have had disagreements with his wife over the years and it got to a point the wife opted to move out. She went out with their two children, who are now teenagers. LM lives alone, but his siblings (two sisters and one brother occasionally visit him. His parents died several years ago. LM has not talked to his wife for more than three months. However, his two children call severally to talk to him. He has friends, who he occasionally goes out with for leisure on weekend.
Early last week, LM’s workmates found him mumbling as if talking to some people, yet he was alone at his desk. He was moving his lips and even demonstrating with his hands, indicating that he was conversing. He has also been found in two other instances mumbling to himself. He has also been wearing the same clothes for four days. His clothes now appear dirty and he confessed that he has not had a bath for days now. However, he is not bothered and does not see it as a major issue.
LM accused his supervisor of deducting and misusing part of his income. He said that he is frustrated with the workplace because the organization is no longer committed to supporting his growth. He argued that the supervisor is planning his downfall and even wants him fired from the company. LM said the supervisor has been assigning him unrelated duties to ensure that he fails and eventually gets fired. LM walked up to the supervisor and made the accusations to the amusement of other workers who have known the cordial working relationship between the two. LM went ahead to accuse his supervisor of wanting to beat him. At one point, LM thought the supervisor was signing his dismissal letter and he walked up to him and grabbed the papers he was holding. LM does not have a history of misusing drugs and has been a composed man over the years. However, he occasionally drinks alcohol when there are celebrations. He never drinks more than two bottles and it could take up to six months before he drinks. During his interactions in the recent past, his friends have noted that he is using irrelevant words. Sometimes he includes unnecessary words in a sentence to the amusement of his colleagues. One of his workmates said that it has become increasingly difficult to comprehend LM’s communication. He is disoriented and cannot settle on a task for long. He also confessed that he has missed dinner severally as he falls asleep on the couch and only awakens in the morning. The psychological disorder (schizophrenia) will affect LM’s daily functioning. He will not concentrate on his work and will not meet his work goals. He may also not complete activities of daily living and will struggle with his personal hygiene.
LM’s case could be explained using psychopathology models. Feldman (2019) indicated that psychopathology models entail psychodynamic and behavioral models, among others. Psychodynamic focused on bringing unacceptable impulses and unresolved past conflicts from the unconscious to the conscious, where a person can deal with them more effectively. A psychodynamic model would trace LM’s problem to repression; the act of pushing unpleasant and threatening thoughts back to the unconscious (Fulmer, 2018). A psychodynamic model would indicate that LM’s abnormal behavior is because of anxiety associated with the failure to avoid unacceptable impulses and thoughts. For instance, LM believes the supervisor is planning his downfall to the point that he thinks any papers the supervisor is holding are dismissal letters. That way, LM is anxious because he cannot imagine someone ruining his illustrious career.
Behavioral model posits that appropriate behavior is maintained through reinforcement while inappropriate behavior is avoided through punishment (Feldman, 2019). In LM’s case, the behavioral model would indicate that he is acting abnormally because he has failed to learn skills needed to cope with problems or he has acquired inappropriate skills that have been maintained through reinforcement (Eccleston, 2018). For instance, his wife separating from him and going away with the children, and living him alone has resulted in him not learning appropriate coping skills. That way, his failure in coping and a lonely life has aggravated his abnormal behaviors.
Eccleston, T. (2018). Behavioral psychology: Understanding human behavior. New York, NY: Clanrye International.
Feldman, R. (2019). Understanding psychology (14th Ed.). New York, NY: McGraw Hill Education.
Fulmer, R. (2018). The evolution of the psychodynamic approach and system. International Journal of Psychological Studies, 10(3), 1 – 6.
Health History and Physical Assessment
Patient and Health History
BK is a 43-year old man, who works as an accountant. He is employed by a multinational with several branches across the United States. He occasionally travels to the other branches for work. I met him at the emergency department and he indicated that he has been experiencing chest pains, shortness of breath, and a persistent cough for the past three days. He told me that he had just returned from a work trip in New York when he started experiencing the abnormalities. He does not have a history of respiratory disease. His family came to the United States at the age of six years. He grew up in the country and now has a bachelor’s and a master’s degree. His parents have since returned to their home country. His father died four years ago at the age of 79 due to asthma. Her mother is 72 years and has diabetes mellitus type 2. However, he is unaware of his grandparents’ health history. BK is single and does not have a plan of starting a family. His brother and sister are married and have good health, other than the fact that her brother had a motor vehicle accident early this year. BK is a heavy smoker and drinker.
Health History Assessment
BK is male and aged 43 years. He is a middle-income earner and has health insurance. He has purchased a house, where he lives alone. He is educated (has a master’s degree) and plans to acquire a Ph.D. by the time he is 50 years and go into lecturing. He perceives that he is healthy because he argues that he has not experienced significant health problems over his life. He feels that he is physically fit, considering he goes to the gym with his friends on weekends. However, he fears that his smoking could affect his health, yet he indicates he is unable to quit. He has a recurrent common cold that disappears on its own. He purchases ibuprofen over-the-counter to treat the cold. He remembers that he had a high fever when he was 29 years and that prompted him to seek medical attention. He noted that anytime he has a cold, he coughs and sneezes uncontrollably and produces sputum. However, he denied any hemoptysis. He also noted that he does not have any allergies. His father died of asthma and his mother has been diagnosed with diabetes. His siblings (brother and sister) are healthy, but the sister has experienced high fever severally. BK does not know about his grandparents’ and great-grandparents’ health. A review of the head, eyes, ears, nose, and throat (HEENT) revealed no changes in vision, no headache, but the presence of nasal discharge. In the cardiovascular system, there was no edema and palpitations, but there were mild chest pains. In the respiratory system, BK had a sore throat and irritation of bronchial tubes causing chest discomfort. No numbness, confusion, or weakness on the neurological system. In the digestive system, there was no vomiting, nausea, constipation, or diarrhea. No rashes on the skin and no weaknesses, myalgias, or arthralgias on the musculoskeletal system.
Health changes across the lifespan. Developmental considerations in BK’s life entail issues that occur in adulthood. BK is 43 years, thus, in the 20-64 age group. At this stage, non-communicable diseases are the major causes of health problems. Stress and lifestyle contribute to health problems. Occupational hazards also cause health problems at this age. BK is a heavy smoker and alcohol drinker and this could negatively affect his health. The smoking could be contributing to his respiratory problem. His occasional travel for work could be exposing him to the common cold. Culture influences perceptions on health, prevention measures, and approaches to seeking care. BK is an African-American and largely identifies himself as an American because he does not practice any cultural activities from his home country. However, his feelings that he is healthy despite the persistent common cold and failure to seek specialized care or initiate lifestyle change could be informed by his African-American background. Based on Erikson’s stages of psychosocial development, BK is in the generativity versus stagnation stage. The stage is characterized by the desire to contribute to family, work, and community. BK intends to further his education and go into lecturing, where he will contribute to nurturing the next generation of professionals. However, BK could feel stagnated, frustrated, or feel disconnected because of not starting a family. In collaborative resources, BK enjoys the company of his friends JM and DK, who occasionally check on him and they do most of their things together. His sister is also concerned and she checks on him almost daily.
I interacted with BK at a restaurant in a mall. It was in the afternoon and he had accompanied my friend, who I was meeting at the time. I greeted him and introduced myself in an attempt to establish rapport. I maintained eye contact with him, gave him time to express himself, and listened actively. My interaction with BK followed the aspects I learned in this class as I maximized therapeutic approaches and avoided non-therapeutic ones. Notable barriers were noise in the surrounding and constant interruption as BK responded to his phone. I overcame the barriers by moving to a quiet room, but could not control his tendencies to answer his phone. Next time, I will inform the patient early about the need to minimize interruptions and concentrate on the assessment. BK opening up and sharing pertinent details that were essential in health history assessment was a success in the assignment. I did not experience other unanticipated challenges other than interruptions. I wished BK understood his family medical history, particularly that of his grandparents. Next time, I will apply empathy and maximize reassurance throughout my interaction with the patient. That way, I will prompt them to open up more and share crucial details for the assessment.