Scenario 1

Sam is a 25-year-old African American man who is incarcerated for robbing a jewelry store. He reported that he was “framed” for this offense. Sam reported that he was engaged in a “spiritual battle” against demonic spirits who told him to shoot himself. During the interview, he stated that he had “telepathic skills,” meaning that he heard voices inside his head with whom he had conversations. He felt disappointed he was unable to complete his suicide and asked the staff to call the FBI but declined to explain the reason for his request. The voices gave him “hypnotic commands” and also had the power to “increase his own serotonin.” He did not believe that the voices were part of any illness but just telepathic communications with demonic beings. He reported how voices controlled him: “They enjoy controlling me. They keep me from having complete thoughts. I find myself not realizing what I am trying to do; they make me feel ‘gyroscopic,’ give me heartburn, and they have the ability to nullify my medications.” The patient indicated that he had difficulties maintaining his train of thought: “Voices keep me from having complete thoughts very often, and they block my thoughts, keep me from doing things, and get me scared.” The voices were in total control of his future, and suicide was his only option: “I am not able to control my future enough to make things not happen.” Sam first consulted a psychiatrist when he was 17 and reported paranoid thinking. He started to hear voices when he was 21.

Primary diagnosis: 

• Unspecified Schizophrenia Spectrum and Other Psychotic Disorder. DSM-5 298.9 (F29) Note: In DSM-4, this category was called Psychotic Disorder (Not Otherwise Specified NOS). It is used where there is inadequate information (family history, medical history, etc.) to make a specific diagnosis. 

Write a 700 word analysis of the symptoms presented by the individual in the scenario to determine a possible etiology. If necessary details are missing from the case study, fill in the gaps with information from your research. In your analysis, you should:

• Describe the symptoms presented by the client.
• Analyze symptom development within the client. Consider these guiding questions:
• When did the symptoms begin?
• How often do the symptoms occur? 
• How long do the symptoms last? Have they changed over time?
• Analyze possible risk factors presented by the client that could have led to the diagnosis. Consider these guiding questions:
• Are men or women more commonly diagnosed with this disorder?
• Are there situational factors that commonly contribute to this diagnosis? 
• Analyze the etiology of disorder development from a biological, psychological, and social perspective.