The narrator is a 53 year old Caucasian man who was referred for psychological assessment to establish his mental and emotional state especially after confessing to a murder. He has an extensive history of recluse behaviour and seclusion. The contributing factors to this problem is possible history of mental illness and the patients warped sense of reality.
Sources of information
Information used for the psychological assessment was derived the neighbours, police, medical records and the patients parents. Furthermore, interviews were conducted for him; a developmental history was also looked into to determine any instances of child abuse.
Based on information obtained from his mother, he was born via spontaneous vaginal delivery and no complications were experienced by the mother during her pregnancy. His birth weight was normal although he always seemed agitated as an infant; this was manifested by chronic cases of colic.
As mentioned before, the client experienced bad bouts of colic as an infant which lasted up to a year based on his mothers account. His cognitive abilities as child were normal and he even exhibited excellence in his academic endeavours. However, as a child, he was a recluse and feared interacting with other children. When forced to interact with other children, he would develop fits of anxiety and sometimes would even throw a tantrum.
Family and Social History
Hi biological worked as a county clerk for over forty years while his father worked as a plumber therefore the family could be classified as middle-income. His mother, though very conservative and strict, was very involved in his life as opposed to his father who seemed a bit detached. This could be attributed to his fear of dealing with the episodes of colic that the client experienced as a child. His father was violent however and the client was often at the receiving end as a child. These incidents were exacerbated by his fathers alcoholism. He was often whipped with iron rods to the point of bleeding by his father late into his teenage hood. He eventually ran away from home when he was 17 years old after gruelling years of incessant abuse. Based on medical records and the mothers accounts, his paternal side of the family has a history of mental illness, with one case of schizophrenia.
Summary of previous evaluations
Up until the murder, the client has not undergone psychological or psychiatric evaluation. This is because the client is a recluse and therefore any attempts for assessment were met with resistance.
The client has had episodes of hallucinations in which he asserts that an evil eye is glaring at him all the time. This evil eye makes him uncomfortable and feels eerie. He also felt that the police were unassuming of his crime even though he could clearly hear the old mans heartbeat. He also has referential delusions, for instance his thinks some actions are specifically directed at him even if they are not. For example, he considered the old mans eye as sinister and evil.
The patient is likely presenting symptoms of schizophrenia due to his referential delusions and instances of hallucinations. Most of his hallucinations are auditory in nature, he hears people calling out his name as well as the heartbeat of the dead man.
The client is convinced that he is completely sane in spite of carrying out a meticulous and premeditated murder. He insists that insane people do not carry out murders so well.
The auditory hallucinations started when he was 40 years old and he would have conversations with these voices. Subsequently, he morphed into a recluse therefore shutting out other people out of his life. He experiences these hallucinations at least three times a day.
Impact on family
His mental condition has been particularly difficult on his mother since he stopped talking to her when he ran away from home. He claims that his dad died when he was nine years old.
Evolution of symptoms over time
His memory has deteriorated over the years. Additionally, his hallucinations have increased over the years.
Interviews were conducted on his neighbours and family to determine if there was a trail of mental illness and imminent signs of abnormal behaviour.
The client was observed for a period of a month to identify his behavioural tendencies. These observations were then jotted down in a diary that was analysed later on.
His medical records were carefully scanned for any information on mental illness or any incidents of violence or diseases that could precipitate his condition.
This criterion was used by the mental officer to determine if the client could be diagnosed with Schizophrenia.
Results from Testing
Results from the tests showed that the client has paranoid type schizophrenia due to presence of auditory hallucinations, thought disorganization and grandiose delusions.
The client has a family history of schizophrenia and was brought in for assessment after confessing to a murder in which he dismembered his victim.
It is imperative that the client is immediately put on antipsychotic medication to reduce the instances of hallucinations and perceived danger.
He should also be placed on psychosocial therapy which includes family therapy, assertive community treatment and cognitive remediation
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