Case Conceptualization: Case 16 of Kay who has been Diagnosed with Schizophrenia?

Case Conceptualization

Kay is a 41-year-old female. Her exact nationality is unknown due to the fact that she was unable to cooperate and provide consistent background information about herself. When brought into the psychiatric hospital, Kay was confused as to why she was brought in by the police. When asked questions about her background, Kay was unable to provide definite, valid answers due to her confusion. The subject presented with various abnormal behaviors. Finally, Kay stated that she has been hospitalized for psychosis 4 different times at different locations prior to this one.

Determination of Abnormal Behavior

The 4 D's are a way mental health doctors are able to assess the deviance, distress, dysfunction and danger that an individual exhibits, and act as a starting point in determining any abnormalities (Comer, 2016). Kay has a hard time dealing with conflict and difficult situations”it is during these instances that she becomes frustrated and exhibits loose associations and is unable to effectively collect her thoughts or communicate (distress). She is also openly provocative with male personnel in the hospital (dysfunction/deviance) and she is highly paranoid that everyone wants to take advantage of her, which causes her to have a hard time communicating without becoming defensive or keeping her guard up (distress). Finally, Kay mentions the people who matter keep her up at night talking about the job they have that she must complete (deviance). All of this information contributes to the conclusion that Kay does, in fact, exhibit abnormal behavior and must be further assessed.

Symptom Identification & Diagnosis

After careful examination, it was concluded that Kay has Schizophrenia. The DSM-5 criteria for Schizophrenia comply with Kay's case. The DSM states that, For one month, the individual displays two or more of the following symptoms much of the time: delusions, hallucinations, disorganized speech, abnormal motor activities, and negative symptoms The DSM also states that after this one severe month, the individual continues to show milder forms of impaired functioning for at least 5 additional months. (American Psychiatric Association, 2013). Although a specific time frame was not given for Kay, the fact that the client had been hospitalized for psychosis on 4 different occasions allows us to confirm that this is not just a temporary or recent issue and therefore, it does not comply with the Schizophrenia Spectrum Disorders. The DSM mentions that the individuals' level of interpersonal relationships is clearly below the level achieved prior to onset (American Psychiatric Association, 2013). Kay clearly has a problem communicating and maintaining the relationships in her life”whether with strangers or family. Also, while her mood switches from giddiness to rage, Bipolar Disorder can be ruled out because there is no clear presence of manic or depressive episodes, but she is emotionally unstable. Much of Kay's symptoms are positive symptoms of Schizophrenia. Comer defines these as, Delusions, disorganized thinking and speech, heightened perceptions and hallucinations, and inappropriate affect are the ones most often found in schizophrenia (2016). The symptoms included in this case begin with Kay's disorganized thoughts and behavior. She was confused about her own personal background information such as, nationality, marital status, etc. Kay also mentioned that when presented with a complicated situation, she is unable to organize her thoughts and her speech gets derailed”she experiences loose associations. The clearest of Kay's symptoms are the auditory hallucinations. Kay hears voices that tell her she must complete a job within each hospital she goes to, which is why she complies with being brought in. In addition to this she is highly paranoid others will take advantage of her and this causes her to act defensively in an intimidating, and guarded, manner. Although Kay is oriented to person, place, and time and has adequate vocabulary during her initial observation, does not mean this has always been the case.

Assessments

The recommended tests to be given include the Mental Status Exam and a Rorschach test. The MSE would allow recording of the level of function or dysfunction the person is exhibiting in different areas (general presentation, cognition, etc.) due to their condition and by doing this, the mode of treatment can be determined. The Rorschach test allows psychologists to determine a potential underlying cause of the patient's condition. By the patient verbally identifying what they see in a paint splotch, a secret of the past or a clue may come to surface that will aid in making a definite diagnosis.

Environmental, Psychosocial & Cultural Stressors and Functioning

There are many stressors that have occurred in Kay's life that may have contributed to her condition. To begin, Kay is divorced (possibly more than once), and a loss like this can cause both mental and emotional damage on a person”especially if it happens more than once. Additionally, the fact that Kay seems to have no contact with her three children leaves her alone and without any support. Another loss in her life may be the idea behind her twins being 'stolen'”perhaps they were taken from her custody due to her condition. Kay reports that her mother struggled mentally, was always talking to nonexistent people, and that she lived on the street (presumably with Kay). The textbook states that Freud had set in motion the idea that neglecting parents may, in a way, set a path for Schizophrenia to develop (Comer, 2016). Kay's father was in prison for most of her life, leaving Kay with virtually no parental guidance. These familial stressors may have been a precursor to Kay's condition. She also blames her lack of privilege on her race and blames society for treating her differently because of it”also mentions she often gets labeled by society. This contributes to the dysfunction of her daily life”she is unable to form legitimate relationships with people or act in a modest, professional way. As for level of functioning, currently, Kay is at a moderate level. While it is difficult for her to control her emotions at certain times, she is still able to have a conversation and has sufficient vocabulary and awareness of what is around her.

Etiology

It has been found that children who have a parent with Schizophrenia have a higher risk of also being diagnosed. According to Comer, by having one parent with Schizophrenia, a child has a 13% risk of getting it, as well (2016). By Kay's mother having a mental disorder, she may have had a genetic predisposition to developing schizophrenia. Additionally, a study completed in 2016 testing the effect of mentally ill mothers on their children concluded that, daughters of mothers with schizophrenia had lower levels of family functioning, a higher level of negative emotions and a lower level of positive emotions; (Alkan, et al. 2016, p. 11). All of these aspects comply with what was observed of Kay, as well as what she has mentioned about her past. This source also states that many studies previously done have shown that children of parents with schizophrenia have higher risks for a variety of social and emotional problems, and may have issues with social adjustment (Alkan, et al. 2016). These are all existent in Kay's case and further support the genetic, and also a possible sociocultural cause. With a potential predisposition and the stressors of Kay's life, the diathesis-stress model comes into play to explain a possible cause for her condition. Another potential biological cause is the fact that the subject mentioned she is African American and this race is more susceptible to the condition, possibly because the poverty rate is higher among this race, and those in poverty pose a greater risk of developing Schizophrenia (Comer, 2016). Finally, the subject blames her behaviors on the labels she receives, society assigns the label schizophrenic to people who fail to conform to certain norms of behavior, and once these labels are assigned, it does not take much for schizophrenic symptoms to appear (Comer, 2016). This could be an example of a self-fulfilling prophecy, as well. Each of these biological and environmental factors of Kay's life, past or present, could have contributed to her developing the disorder.

Treatment

The best method of treatment would include the integration of medication and therapy. Comer states, in direct comparisons the drugs appear to be a more effective treatment for schizophrenia than any of the other approaches used alone (Comer, 2016). As for biomedical treatments, the patient should take antipsychotic medication (as they have been proven to decrease symptoms by 65% (Comer, 2016)) to allow her thought processes to slow, and allow for her to gather and organize her thoughts so that therapy can be incorporated later. This would allow the patient to clearly, coherently, and correctly explain her situation. Social therapy would be a good mechanism to teach Kay better communication skills and to expose her to society so that she may learn to resist and deal with the labels that she believes are placed on her. Finally, if possible, family therapy could be incorporated to bring back a support system for Kay that would motivate her to work hard toward a healthier life.

Conclusion

In conclusion, all of this information places Kay's prognosis at fair to good. With the proper medication and therapeutic approaches, it is hopeful that Kay will be able to formulate her thoughts so that she could give more information, which would allow further investigation into her case to eventually make it possible to provide her with the best form of treatment. There does not seem to be a motivational issue in Kay's case, however, her coping abilities can be fixed by incorporating therapy that would allow her to accept and understand certain situations better, and this could all be aided by bringing forth a support system, as well, considering it does not seem as though Kay ever had one. By doing all of these modes of therapy, in the future, Kay may be in a better mental state, and therefore be able to hold a steady job, and live a productive life.

References

Alkan, O., Kushnir, J., Bar, M., & Kushnir, T. (2016). Quality of life of adult daughters of women with schizophrenia: Associations with psychological resource losses and gains. Comprehensive Psychiatry,68, 11-17.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Comer, Ronald J. (2016). Fundamentals of abnormal psychology. New York, NY: Worth Publishers.

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