Human Behavior DSM

Mental health problems are one of the main causes of the burden of disease worldwide. Consequently, state authorities of any country that cares about its citizens’ health aim to develop and support mental health centers and emergency psychiatric services delivery. The World Health Organization states that psychiatric centers and mental health centers are more accessible and effective in mental disorders diagnostic and treatment nowadays (World Health Organization, 2017). They lessen social exclusion, conduct professional diagnostics, medical and social intervention, as well as providing psychiatric or therapeutic treatment aimed at facilitating a patients’ recovery and helping them live a productive life in the society once again (World Health Organization, 2017). In addition, mental health centers offer outreach social programs that stipulate individual therapy and social rehabilitation to improve a patient’s emotional and mental conditions. Therefore, this paper analyzes the case of a patient whose mother applied to Kingsboro Psychiatric Center in order to diagnose the son’s mental health and behavioral disorders and acquire appropriate treatment.

Brief Description of Agency Setting and the Reason for Referral

Kingsboro Psychiatric Center considers its main mission providing competent psychiatric care to patients who suffer from serious and complicated mental diseases and disorders, with the aim of reintegrating them into social life. The Center has subordinated outpatient clinics that provide health screening and referrals, assessment and treatment planning, verbal and medication interventions, symptoms management, education, psychiatric rehabilitation, case management, clinical support, and family support services. Kingsboro Psychiatric Center has qualified, professional staff of licensed psychiatrists, registered nurses, licensed clinical social workers, mental health counselors, qualified clinicians, as well as case managers. Therefore, the Center offers qualified care to address adults’ mental disorders and provide brief outpatient and acute inpatient services, as well as long-term treatment for serious mental diseases.

Mother of the patient Mark has turned to the Kingsboro Psychiatric Center because of the dramatic changes in her son’s personality. Mark and his parents were brought to the housing program interview by a caseworker. Mark’s mother stated that she could no longer live with her son because he became very aggressive towards her. She also reported that due to the loss of one income in the household she now had two jobs and spent more time out of the house. Mark’s father stated that his attitude towards his son changed when he became symptomatic and thus he refused to live with the family. Consequently, the parents turned to the psychiatric center in order to diagnose Mark’s mental health, as well as providing appropriate psychiatric treatment to improve his severe condition and abnormal behavior.

Brief Description of the Сlient’s Background

Mark is a 29-year-old unemployed man who lives with his mother. Mark’s parents are married. However, they have been separated for the past six years and live in separate households. His family describes a change in his personality that appeared approximately five years ago when he started working for MTA. The patient was born in Puerto Rico. However, at the age of ten he moved with his parents to Boston, Massachusetts. The patient migrated from Puerto Rico to the USA in June of 1985. Mark graduated from college and got a job at MTA. After working for about eight months, he began to hear voices that told him his coworkers were spying on him at work. He also started to believe that his boss had set small video cameras in the office to catch him making mistakes. Mark became increasingly paranoid and agitated at work and began to say strange things to his coworkers. He accused one coworker of installing a camera in his closet at work and punched him in the face. In addition, there were other incidents where he yelled at his coworkers that he could not take the constant abuse of being watched by all the TV screens in the office and even at his own home, so he cut the wires.

During the past five years, Mark was hospitalized four times. He became increasingly confused and agitated. His mother stated that he began to accuse even the neighbors of spying on him. Consequently, he has destroyed their camera system by cutting the wires in an attempt to make them stop. She also mentioned that Mark used to lock himself in his room and cover his bedroom with mattress and sheets to hide from people who were spying on him. Furthermore, his father did not want to live with Mark because of his abnormal behavior.

Diagnosis and Documentation of the Process

Mark was referred to the program for housing by Kingsboro Psychiatric Hospital in order to diagnose his physical and mental health, observe his behavior, make a diagnosis, and provide a relevant treatment. Mark’s parents stated that he suffered from hallucinations. In addition, during observation and interviewing at the hospital, Mark was jumping from one chair to another for no apparent reason. He was constantly whispering about spying, cameras, and fear. It was evident that Mark felt anxiety, tension, and despair because of the hallucinations. Consequently, Mark was hospitalized in order to conduct clinical observation, laboratory analysis, and examine his physical and general conditions.

The clinical observation of the patient has shown that he was suffering from constant hallucinations and delusions. Mark claimed that somebody was spying on him. Therefore, he hid under the bed or in the wardrobe, and always asked for assistance to damage nonexistent cameras and spying devices. In addition, Mark complained about strange voices he heard, which prevented him from sleeping, eating, and playing with his friends. The patient’s behavior was not aggressive. However, the signs of abnormal behavior were evident. Mark cried, jumped on the bed like a kid, and made attempts to run away. Consequently, observations of Mark’s behavior have confirmed the prevalent symptoms of hallucinations and delusions.

In addition, neuropsychological assessments have shown Mark had difficulties in changing response set and focusing attention. Furthermore, Mark had slowing reaction times. Functional imaging techniques have indicated that Mark had abnormal cerebral blood flow and decreased hippocampal size. Finally, the patient had abnormalities in urine specific gravity or electrolyte imbalances due to the excessive drinking of fluid. Meanwhile, the patient's general state was satisfactory. Therefore, laboratory examinations have shown structural abnormalities in the Mark’s brain, neuropsychological difficulties, and water intoxication.

Thus, the conducted examinations and observations confirmed that Mark was suffering from hallucinations and delusions, as well as having neuropsychological and structural abnormalities in the brain. His behavior was not aggressive but paranoiac, related to the constant perceived spying on him. Consequently, the patient was diagnosed with schizophrenia. According to the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), to be diagnosed with schizophrenia, a patient must experience at least two of the following symptoms: “hallucinations, delusions, disorganized speech and behavior, and negative symptoms” (American Psychiatric Association, 2013; Morrison, 2014). Since Mark had hallucinations, delusions, and his behavior was characterized by paranoia, he was diagnosed with schizophrenia. In addition, as he suffered from multiple delusions based on a consistent theme of spying, the diagnosis was specified as schizophrenia of the paranoid type.

Treatment Approaches

Currently, both non-pharmacological and pharmacological treatments are used in the treatment of schizophrenia to optimize long-term outcomes. According to Andreou and Moritz (2016), the major goals in treating schizophrenia are addressing prevalent symptoms, preventing complications, and increasing adaptive functions in order to integrate a patient back into the community. In addition, the current research shows that many patients are recovering with the help of social workers’ intervention that focuses on the biological and social aspects of patients’ mental diseases or disorders (Patel, Cherian, Gohil, & Atkinson, 2014). In the analyzed case, individual social therapy and psychosocial rehabilitation will help the patient to identify reasons of his fear that may concern his social position in the society. Thus, Mark’s mother stated that her son began displaying abnormal behavior after he started working for MTA. Consequently, reasons for the patients’ mental disease may be rooted in the working environmental factors that had dramatically influenced his emotional and mental state.

Social workers are trained to analyze and use a broad perspective of what beneficial factors may contribute and facilitate the treatment of schizophrenia in patients. Thus, individual therapy with social workers is an important opportunity for patients to talk about life concerns, fears and possibilities to cope with difficulties. Social workers may help to overcome fear and teach patients to apply appropriate coping mechanisms for dealing with numerous challenges. According to Chien, Leung, Yeung, & Wong (2013), psychoanalytic therapy that is frequently applied to treat schizophrenia is not efficient in most cases. Meanwhile, intervention of social workers, with whom patients can confidentially share their concerns and problems, can be quite beneficial on the way to recovery.

In addition, current studies prove that psychosocial rehabilitation facilitates psychopharmacological interventions to treat schizophrenia. Thus, antipsychotic medication can reduce the symptoms of schizophrenia. Meanwhile, social rehabilitation efforts can reduce or compensate social and occupational disabilities and difficulties that patients may face (Chien et al., 2013). Social rehabilitation may be managed by social workers using educational methods to correct the patients’ behavior and minimize stressful effects of environmental factors. Social skills training has been used in both hospital and community settings to facilitate patients’ acquiring and maintaining interpersonal behaviors (Chien et al., 2013). For instance, patients learn the therapeutic and side effects of neuroleptic medication, how to monitor drug benefits and side effects, how to negotiate medication issues with a physician, how to interact with other patients, and how to be helpful to their families, friends, or doctors who want to facilitate patients’ recovery. Consequently, social workers intervention is a beneficial option in schizophrenia treatment as it helps to restore patients’ social functions, find mechanisms to address life problems and difficulties, and be helpful on the way to recovery.

Conclusion

Schizophrenia is a serious mental disease characterized by the development of the following symptoms: hallucinations, delusions, disorganized speech and behavior, and other negative symptoms. According to DSM-5, schizophrenia may be diagnosed in patients who have at least two of the above-mentioned symptoms. In the analyzed case, the patient suffered from constant hallucinations and delusions, as well as having neuropsychological and structural abnormalities in the brain. Consequently, the patient was diagnosed with schizophrenia based on the results of the clinical and behavioral observations, laboratory findings, and examination of his physical and general conditions. Furthermore, as the patient experienced multiple delusions based on a consistent theme of spying, the diagnosis was specified as schizophrenia of the paranoid type. In addition, taking into consideration that mental disorder was developed after the patient started working for MTA, reasons of his mental disease development may be rooted in the social environmental factors related to his workplace that had influenced his emotional and mental state. Consequently, intervention of social workers, mainly conduction of individual therapy and psychosocial rehabilitation, may help to identify reasons of the patient’s fear and identify mechanisms of coping with problems, as well as restoring his social position by means of social rehabilitation.