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Case Study

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  1. 1. The Case of Anna
  2. 2. Anna is a 21 year old, Caucasian female from Los Alamos, NM. Anna comes to careafter being found playing “tag” with cars on the highway. She appears pale,emaciated, withdrawn and psychotic. Spectators claim that Anna ran out from theside of the road and was laughing hysterically and running after cars andtouching them. She was attempting to punch windows and knock off mirrors ofpassing cars. She is extremely slender, almost anorexic but the deputyattending states it took 3 large grown men to hold her down and get her off theroad.Deputy reports that Anna lives alone in an apartment with minimal furnishingsand stated he found only coke, chips and candy in her refrigerator. Anna’smother lives on the other side of town and is a foster parent, with Anna beingher only child. Anna’s mother, Laverne, states that she lost control of Annawhen she was about 15 and when she turned 17, she let the young girl move outand live on social security she received from her father’s death. Laverneadmits that she rarely checks on Anna and states that ever since Anna was ayoung child she often ate only chips, plain baked potatoes, water or coke andnothing else because she feared that everything was poisoned. Anna reports thatshe hears voices. “They make me laugh, they’re funny”. Anna denies any visualhallucinations but is obviously unnerved, unable to stay still and asks tosleep. Anna walks a short distance, lays down and goes to sleep. Anna refusesto eat and states she only wants Cheetos and a baked potato. Anna states shehas never had a menstrual cycle and does not know what puberty is.Laverne does not know where or how her daughter has been surviving for the pasttwo years or so. She claims that Anna took medications when she was younger butcannot recall the names of the medications now or what they were for. Lavernestates she knows one medication is for asthma. Anna reports that she hates hermother then cries and says she loves her and misses her and wants to go home.She complains of headaches, feeling tired, thirsty and then she becomesextremely hyperactive and aggressive. During her bouts of aggressiveness sheappears to be swinging her arms and trying to hit someone or something that isnot visible to anyone else in the room.Anna is considered an adult and Laverne never took her for any type ofpsychological testing or assessment as a child; therefore Anna can sign herselfin and out of treatment as she pleases and can refuse treatment. She, however,poses a threat to herself and the community. There appears to be several issuesthat are preventing Anna from functioning normally and will require somecooperation on her part or at least direct observation.
  3. 3. Assessment Tools•  Structured Clinical Interview•  Medical Testing•  Psychological Testing•  Mental status exam•  SASSI  
  4. 4. Presenting Symptoms•  Psychosis•  Gustatory Hallucination•  Auditory Hallucinations•  Aggression•  Loss of Volition•  Amenorrhea  
  5. 5. Patient’s Chief Complaints•  Anna reports she has never had a menstrual cycle and that she doesn’t know what puberty is.•  Anna reports she hates her mother then cries and says she loves her and misses her and wants to go home.•  Anna complains of headaches, feeling tired, thirsty and then she becomes extremely hyperactive and aggressive.
  6. 6. Possible Diagnosis SCHIZOPHRENIA
  7. 7. Schizophrenia  •  At least two of the following symptoms, each present for a significant portion of the time during a one-month period: –  Delusions –  Hallucinations –  Disorganized speech –  Grossly disorganized or catatonic behavior•  Functioning markedly below the level achieved prior to onset.•  Continuous signs of their disturbance for at least six months, at least one month of which includes symptoms in full and active form (as opposed to attenuated form)
  8. 8. AXIS I–  Schizophrenia Type 1: Positive Symptoms •  Hallucinations – Auditory – Possible visual •  Bizarre behavior •  Confused thinking •  Inappropriate affect
  9. 9. AXIS II•  Deferred
  10. 10. AXIS III•  Amenorrhea•  Possible Anorexia
  11. 11. AXIS IV •  Primary Support: –  Neglect as a child –  Estrangement –  Removal from home –  Death of family member •  Social Environment: –  Lives alone –  Inadequate social support •  Housing Problems: –  Inadequate housing •  Economic Problems –  Inadequate finances
  12. 12. AXIS V (GAF) Anna falls between 11 and 20 on the scale due to the auditory hallucinations she is beenhaving and her psychotic episodes for which she was taken to the hospital.
  13. 13. Possible Diagnosis for AnnaAXIS I: Schizophrenia, AcuteAXIS II: DeferredAXIS III: Amenorrhea Possible AnorexiaAXIS IV: Primary, Social, Housing, EconomicAXIS V: GAF: 11 - 20
  14. 14. Theoretical Model•  Biological Model –  Biochemical •  Dopamine•  Cognitive Model
  15. 15. Treatments and Therapy•  Antipsychotic Drugs – Psychopharmacology•  Cognitive-Behavioral Therapy•  Family Therapy•  Family Psychoeducational Therapy
  16. 16. Hollow Face Illusion
  17. 17. Questions?