Case Study 4 SCHIZOPHRENIA

San Pedro College
Graduate School Studies

Department of Psychology
Case no. 04
A CASE REPORT ON
SCHIZOPHRENIA
(Level A)
A Course Requirement on
Advance Abnormal Psychology
Master of Science in Clinical Psychology
Submitted by:
MICHAEL JOHN P. CANOY, RPm
Submitted to:
DR. ORENCITA V. LOZADA, RP, RGC, CSCLP
Professor
A.Y. 2019-2020
Michael John P. Canoy, RPm MS in Psychology
CLINICAL PROFILE
I. PURPOSE OF EVALUATION
This undertaking was originally meant to screen and assess evidences of
underlying physical, mental, and psychological dysfunctions of the client. This will
provide plausible information that will serve as a basis for full clinical diagnosis, case
management and further therapeutic interventions. This document is endorsed for
educational purposes only and will be submitted as a course requirement for PSY504 -
Advanced Abnormal Psychology in the Graduate School Program of the Psychology
Department of San Pedro College, Davao City.
II. IDENTIFYING INFORMATION

a. Demographic Profile
Name: Bill McClary
Age: 25 Years Old
Gender: Male
Educational Attainment: High School Graduate
Marital Status: Single
Religion: Not Specified
Ethnicity: Irish American
Mother’s Name: Mrs. McClary (First name not specified)
Mother’s Occupation: Do have a job but not clearly specified

Father’s Name: Mr. McClary (First name not specified)
Father’s Occupation: Firefighter
b. Medical History
Medical
Although Bill appears to be healthy with his physical condition. There were no
notable medical history mentioned in Bill’s case.
Psychiatric
Bill was repeatedly encouraged by her sister, Colleen to seek professional help.
And even though Bill acknowledged that he ought to keep more regular hours and
assume more responsibility, but he insisted that he did not need psychological treatment.
Yet, he still did agreed to seek professional help to please his sister and mollify her
husband, who was worried about Bill’s influence on their three young children. The
interviews revealed his concerns and what appears to be delusional tendencies.
c. Family Background
Family Dynamics
Relationship Age/Status Occupation Medical History Psychiatric Remarks
History
Father Age was not Firefighter Not Specified Not Specified Has a mistress
mentioned in
the case For further
assessment to
gain more
information
Mother Age was not Do have a job Not Specified Not Specified Closer with Bill
mentioned in but not clearly than Bill
the case specified towards his
father
For further
assessment to
gain more
information
Older Sister Not Specified Not Specified Not Specified Not Specified Bill lives with
Colleen her for about 18
months now
Already married
with Roger with
3 children.
For further
assessment to
gain more
information
Two (2) Older Not Specified Not Specified Not Specified Not Specified For further
Sibling assessment to
gain more
information
d. Psycho-emotional-social History
Early Developmental Stage
Bill was the youngest of four children. He grew up in New York City where his father
worked as a firefighter. Both of his parents were first-generation Irish Americans. Many of their
relatives were still living in Ireland. Both parents came from large families. Bill’s childhood
memories were filled with stories about the family’s Irish heritage.
Bill was always much closer to his mother than to his father, whom he remembered as
being harsh and distant. When his parents fought, which they did frequently, Bill often found
himself caught in the middle. Neither parent seemed to make a serious effort to improve their
relationship. Bill later learned that his father had carried on an extended affair with another
woman. His mother depended on her own mother, who lived in the same neighborhood, for
advice and support and would frequently take Bill with her to stay at her parents’ apartment after
particularly heated arguments. Bill grew to hate his father, but his enmity was tempered by guilt.
He had learned that children were supposed to respect their parents and that, in particular, a son
should emulate and revere his father. Mr. McClary became gravely ill when Bill was 12 years
old, and Bill remembered wishing that his father would die. His wish came true. Years later, Bill
looked back on this sequence of events with considerable ambivalence and regret.
Bill could not remember having any close friends as a child. Most of his social contacts
were with cousins, nephews, and nieces. He did not enjoy their company or the games that other
children played. He remembered himself as a clumsy, effeminate child who preferred to be alone
or with his mother instead of with other boys.
High School Age

He was a good student and finished near the top of his class in high school. His mother
and the rest of the family seemed certain that he would go on to college, but Bill could not decide
on a course of study. The prospect of selecting a profession struck Bill as an ominous task. How
could he be sure that he wanted to do the same thing for the rest of his life? He decided that he
needed more time to ponder the matter and took a job as a bank clerk after graduating from high
school.
Bill moved to a small efficiency apartment and seemed to perform adequately at the
bank. His superiors noted that he was reliable, though somewhat eccentric. He was described as
quiet and polite; his reserved manner bordered on being socially withdrawn. He did not associate
with any of the other employees and rarely spoke to them beyond the usual exchange of social
pleasantries. Although he was not in danger of losing his job, Bill’s chances for advancement
were remote. This realization did not perturb Bill because he did not aspire to promotion in the
banking profession. It was only a way of forestalling a serious career decision. After 2 years at
the bank, Bill resigned. He had decided that the job did not afford him enough time to think
about his future.
He was soon able to find a position as an elevator operator. Here, he reasoned, was a job
that provided time for thought. Over the next several months, he gradually became more aloof
and disorganized. He was frequently late to work and seemed unconcerned about the reprimands
that he began receiving. Residents at the apartment house described him as peculiar. His
appearance was always neat and clean, but he seemed preoccupied most of the time. On occasion
he seemed to mumble to himself, and he often forgot floor numbers to which he had been
directed. These problems continued to mount until he was fired after working for 1 year at this
job.
During the first year after finishing high school, while working at the bank, Bill had his
first sexual experience. A man in his middle forties who often did business at the bank invited
Bill to his apartment for a drink, and they became intimate. The experience was moderately
enjoyable but primarily anxiety provoking. Bill decided not to see this man again. Over the next
2 years, Bill experienced sexual relationships with a small number of other men as well as with a
few women. In each case, it was Bill’s partner who took the initiative. Only one relationship
lasted more than a few days. He became friends with a woman named Patty who was about his
own age, divorced, and the mother of a 3-year old daughter. Bill enjoyed being with Patty and
her daughter and occasionally spent evenings at their apartment watching television and drinking
wine. Despite their occasional sexual encounters, this relationship never developed beyond the
casual stage at which it began.
After he was fired from the job as an elevator operator, Bill moved back into his mother’s
apartment. He later recalled that they made each other anxious. Rarely leaving the apartment,
Bill sat around the apartment daydreaming in front of the television. When his mother returned
from work, she would clean, cook, and coax him unsuccessfully to enroll in various kinds of job-
training programs. His social isolation was a constant cause of concern for her. She was not
aware of his bisexual interests and encouraged him to call women that she met at work and
through friends. The tension eventually became too great for both of them, and Bill decided to
move in with Colleen, her husband, and their three young children.
III. REASON FOR REFERRAL
His sister, Colleen, with whom he had been living for 18 months, had repeatedly
encouraged him to seek professional help. She was concerned about his peculiar behavior and
social isolation. He spent most of his time daydreaming, often talked to himself, and occasionally
said things that made little sense. Bill acknowledged that he ought to keep more regular hours
and assume more responsibility, but he insisted that he did not need psychological treatment. The
appointment was finally made in an effort to please his sister and mollify her husband, who was
worried about Bill’s influence on their three young children. Bill’s “daydreaming” and other
eccentric behavior were sources of considerable concern to him, and it interfered significantly
with his daily activities.
IV. PROBLEMS AND SYMPTOMS

Identifying Data and Presenting Conflict
 Difficulty in in clearing thoughts or return to concentration

 Daydreaming episodes that interfered significantly with his daily activities
 Intrusive repetitive thoughts
 Unusual blinking and head shaking associated with experience of intrusive
thoughts
 Extensive delusional belief system that become so pervasive and intricately woven
that it was no longer open to logical refutation.
 Anxiety and suspicions
 Guilt as a result to his delusions
 Hearing non-existing voices discussing his personal life
V. MENTAL EXAMINATION
The diagnostician in training conducted a Mental Status Examination to Sam and
found out the following based on the data collected:
Appearance
 The client doesn’t look physically unkept nor untidy
 Clothing is also not messy nor dirty
 There is no unusual physical characteristics
Behavior
 Posture is not seen as slumped
 There is also no rigidity in his body posture
 His posture doesn’t appear to be atypical nor inappropriate
 In his facial expressions, there is marked anxiety, fear, apprehension especially
during his delusional episodes
 There is no anger and hostility.
 There is no seen decreased in variability of expression
 There is no inappropriateness and bizarreness in his facial expression especially
when talking about things he likes doing
 There is marked dominance whenever he wants to persuade things regarding his

paranoia and delusions
 Submissiveness and overly compliant is not present to the client
 Provocative behaviors were not present especially when teasing and playing with
his sister.
 There is a marked suspicious behavior being shown by the client.
 Initially the client is hesitant in sharing information within the therapeutic
relationship however, eventually he was able to be cooperative in the succeeding
process.
Feeling (affect/mood)
 There is a marked inappropriateness to client’s thought content which causes
significant concerns.
 Euphoria and elation is present to the client especially when climbing out of his
second-story bedroom window and racing his bicycle down the hill of a heavily
trafficked local street.
 There is no anger and hostility present with the client
 There is marked anxiety, fear, apprehension especially during his delusional
episodes
 There were no signs of depression and sadness with the client although his
disturbances may signify such.
Perception
 Illusions were not present with the client
 There is a presence of Auditory hallucinations with the client
 There were no experienced visual hallucinations and other hallucination, beside
auditory hallucination, with the client
Comments: Delusions were also present
Thinking
 There is marked impairment in his level of consciousness

 There is marked impairment with his attention
 There is no impairment in calculation ability with the client
 There is also no impairment in his intelligence as has achieved developmental
milestones that his age requires except his inattention, hyperactivity and
impulsivity
 Bill doesn’t show disorientation to person
 He also doesn’t show any disorientation to place
 The client did not show any disorientation to time
 There is difficulty in acknowledging the presence of psychological disorder as
Bill acknowledged that he ought to keep more regular hours and assume more
responsibility, but he insisted that he did not need psychological treatment
Blaming others for his difficulties was not present. In some occasion he blames
his frustration to her sister.
 Blaming others for his circumstances was not present with Bill
 There is marked impairment in managing the client’s daily living activities such
as his inability to find many friends, accomplishing work-related tasks and other
major areas of functioning.
 There is a marked impairment in his ability to make reasonable decisions
especially during the disturbances.
 Impaired immediate recall was not present
 Impairment in recent memory is occasionally he often forgot floor numbers to
which he had been directed.
 Impaired remote memory was also not present
 Obsessions were not present with the client
 Compulsions were also not present
 There were no signs of phobias
 Depersonalization is not present with the client
 There were also no suicidal and homicidal idealization with the client
 Delusions are not present with the client
 There were also no ideas of reference nor ideas of influence

 The client also doesn’t show disturbance in association of thoughts
 Decreased and increased flow of thoughts were not seen
Although there were tendencies and other difficulties seen with the client especially in his
hallucinations and delusions, further evaluation and assessments are needed for a more
holistic and definitive diagnosis.
VI. CASE OVERVIEW

Bill, a 25-year old client, was referred by his sister regarding his difficulty in in clearing
thoughts or return to concentration; Daydreaming episodes that interfered significantly with his
daily activities; Intrusive repetitive thoughts; Unusual blinking and head shaking associated with
experience of intrusive thoughts; Extensive delusional belief system that become so pervasive
and intricately woven that it was no longer open to logical refutation.; Anxiety and suspicions;
Guilt as a result to his delusions and; Hearing non-existing voices discussing his personal life.
Her sister was concerned about his peculiar behavior and social isolation. He spent most of his
time daydreaming, often talked to himself, and occasionally said things that made little sense.
Bill acknowledged that he ought to keep more regular hours and assume more responsibility, but
he insisted that he did not need psychological treatment. Bill then agreed in order to please his
sister and mollify her husband, who was worried about Bill’s influence on their three young
children. Bill’s “daydreaming” and other eccentric behavior were sources of considerable
concern to him, and it interfered significantly with his daily activities.
VII. PRELIMINARY DIAGNOSIS

Based on the information provided and thorough evaluation of the data, the
symptoms and history of the client have fully met the criteria of
295.90 (F20.9) Schizophrenia, with Continuous symptoms, With severe
Hallucinations, with severe Delusions, and with mild Disorganized Speech.
Note: The color red indicates that the presented fact(s) is present in the case. The
color green means that it is evident in the case, however, it is not directly stated. The
color blue, on the other hand, means that it is not present in the case but is probable
which will be given a remark “for further observation”
295.90 (F20.9) Schizophrenia, with Continuous symptoms, With severe Hallucinations, with
severe Delusions, and with mild Disorganized Speech
DIAGNOSTIC CRITERIA PRESENTED FACTS
A. Two (or more) of the following, each Three (3) of the following, each present for a
present for a significant portion of time significant portion of time during a 1-month
during a 1 -month period (or less if period.
successfully treated). At least one of these
must be (1 ), (2), or (3):
1. Delusions. He believes that a group of conspirators had secretly

produced and distributed a documentary film about his
homosexual experiences. Several of his high school
friends and a few distant relatives had presumably used
hidden cameras and microphones to record each of his
sexual encounters with other men
Bill believed that the conspirators had agreed to kill
him if he ever found out about the movie. This
imagined threat had prevented Bill from confiding in
anyone prior to this time. It was clear that he now
feared for his life.
Bill was, of course, terrified by this experience and sat
motionless in his room as the debate continued. When
Roger tapped on his door to ask if he was all right, Bill
was certain that they were coming to take him away.
In Bill’s mind, his cousin was clearly part of a
continuous surveillance that had been carefully
arranged by the conspirators. The fact that Bill came
from a very large family and that such coincidences
were bound to happen did not impress him as a
counterargument
2. Hallucinations.
He thought he overheard a conversation in the next

room. It was a heated argument in which one voice
kept repeating “He’s a goddamned faggot, and we’ve
got to kill him
3. Disorganized speech (e.g., frequent
derailment or incoherence).
Over the next several months, he gradually
became more aloof and disorganized. On
occasion he seemed to mumble to himself.
4. Grossly disorganized or catatonic
behavior.
This symptom was not manifested by the
client however, it is a duty to know its
presence or absence for sure, thus,
recommended for further observation.
5. Negative symptoms (i.e., diminished

emotional expression or avolition).
This symptom was not manifested by the
client however, it is a duty to know its
presence or absence for sure, thus,
recommended for further observation.
B. For a significant portion of the time since He was frequently late to work and seemed
the onset of the disturbance, level of unconcerned about the reprimands that he
functioning in one or more major areas, began receiving. Residents at the apartment
such as work, interpersonal relations, or house described him as peculiar.
self-care, is markedly below the level He often forgot floor numbers to which he
achieved prior to the onset (or when the had been directed. These problems continued
onset is in childhood or adolescence, there to mount until he was fired after working for
is failure to achieve expected level of 1 year at this job.
interpersonal, academic, or occupational
functioning).
C. Continuous signs of the disturbance His hallucinations and delusions and other
persist for at least 6 months. This 6-month disturbances were persistent and present for
period must include at least 1 month of 18 months.
symptoms (or less if successfully treated)

that meet Criterion A (i.e., active-phase
symptoms) and may include periods of
prodromal or residual symptoms. During
these prodromal or residual periods, the
signs of the disturbance may be
manifested by only negative symptoms or
by two or more symptoms listed in
Criterion A present in an attenuated form
(e.g., odd beliefs, unusual perceptual
experiences).
D. Schizoaffective disorder and depressive or There were no reported and seen major
bipolar disorder with psychotic features depressive or manic episodes have occurred
have been ruled out because either 1 ) no concurrently with the active-phase symptoms
major depressive or manic episodes have presented in Criterion A.
occurred concurrently with the active-
phase symptoms, or 2) if mood episodes
have occurred during active-phase
symptoms, they have been present for a
minority of the total duration of the active
and residual periods of the illness.
E. The disturbance is not attributable to the There were no reported and seen misuse of
physiological effects of a substance (e.g., substances that can induce these disturbances.
a drug of abuse, a medication) or another Another medical condition is also non-
medical condition. contributory with his disturbances
F. If there is a history of autism spectrum There is no history of autism spectrum
disorder or a communication disorder of disorder or communication disorder with Bill.
childhood onset, the additional diagnosis
of schizophrenia is made only if
prominent delusions or hallucinations, in
addition to the other required symptoms of
schizophrenia, are also present for at least
1 month (or less if successfully treated).

Specify if: Bill’s condition will be specified under
The following course specifiers are only to Continuous since his symptoms fulfilling the
be used after a 1-year duration of the diagnostic symptom criteria of the disorder
disorder and if they are not in are remaining for the majority of the illness
contradiction to the diagnostic course course, with subthreshold symptom periods
criteria. being very brief relative to the overall course.
First episode, currently in acute
episode: First manifestation of the
disorder meeting the defining diagnostic
symptom and time criteria. An acute
episode is a time period in which the
symptom criteria are fulfilled.
First episode, currently in partial
remission: Partial remission is a period of
time during which an improvement after a
previous episode is maintained and in
which the defining criteria of the disorder
are only partially fulfilled.
First episode, currently in full
remission: Full remission is a period of
time after a previous episode during which
no disorder-specific symptoms are
present.
Multiple episodes, currently in acute
episode: Multiple episodes may be
determined after a minimum of two episodes
(i.e., after a first episode, a remission and a
minimum of one relapse).
Multiple episodes, currently in partial
remission
Multiple episodes, currently in full

remission
Continuous: Symptoms fulfilling the
diagnostic symptom criteria of the
disorder are remaining for the majority of
the illness course, with subthreshold
symptom periods being very brief relative
to the overall course.
Unspecified
Specify if: There were no catatonic features present in
With catatonia (refer to the criteria for Bill’s case.
catatonia associated with another mental
disorder, pp. 119-120, for definition).
Coding note: Use additional code 293.89

(F06.1) catatonia associated with
schizophrenia to indicate the presence of
the comorbid catatonia.
Specify current severity: With severe Hallucinations, with severe
Severity is rated by a quantitative Delusions, and with mild Disorganized
assessment of the primary symptoms of Speech.
psychosis, including delusions,
hallucinations, disorganized speech, See attachment about Clinical-Rated
abnormal psychomotor behavior, and Dimensions pf Psychosis Symptom Severity
negative symptoms. Each of these
symptoms may be rated for its current
severity (most severe in the last 7 days) on
a 5-point scale ranging from 0 (not
present) to 4 (present and severe). (See
Clinician-Rated Dimensions of Psychosis
Symptom Severity in the chapter
“Assessment Measures.”) Note: Diagnosis
of schizophrenia can be made without

using this severity specifier.
Justification Fully satisfied. The diagnostic criteria for

295.90 (F20.9) Schizophrenia, with
Continuous symptoms, With severe
Hallucinations, with severe Delusions, and
with mild Disorganized Speech is fully met.
VIII. DIAGNOSTIC FEATURES

The characteristic symptoms of schizophrenia involve a range of cognitive, behavioral, and
emotional dysfunctions, but no single symptom is pathognomonic of the disorder. The diagnosis
involves the recognition of a constellation of signs and symptoms associated with impaired
occupational or social functioning. Individuals with the disorder will vary substantially on most
features, as schizophrenia is a heterogeneous clinical syndrome. At least two Criterion A
symptoms must be present for a significant portion of time during a 1-month period or longer.
Three (3) of these symptoms were present in Bill’s clear presence of delusions (Criterion Al),
hallucinations (Criterion A2), or disorganized speech (Criterion A3). Grossly disorganized or
catatonic behavior (Criterion A4) and negative symptoms (Criterion A5) were not present in his
condition be present. In those situations in which the active- phase symptoms remit within a
month in response to treatment. Criterion A is still met if the clinician estimates that they would
have persisted in the absence of treatment. Schizophrenia involves impairment in one or more
major areas of functioning as He was frequently late to work and seemed unconcerned about the
reprimands that he began receiving. Residents at the apartment house described him as peculiar.
He often forgot floor numbers to which he had been directed. These problems continued to
mount until he was fired after working for 1 year at this job (Criterion B).
Some signs of the disturbance were persistent for a continuous period of at least 6 months
(Criterion C). Prodromal symptoms often precede the active phase, and residual symptoms may
follow it, characterized by mild or subthreshold forms of hallucinations or delusions. Individuals
may express a variety of unusual or odd beliefs that are not of delusional proportions (e.g., ideas
of reference or magical thinking); they may have unusual perceptual experiences (e.g., sensing
the presence of an unseen person); their speech may be generally understandable but vague; and
their behavior may be unusual but not grossly disorganized (e.g., mumbling in public). Negative
symptoms are common in the prodromal and residual phases and can be severe. Individuals who
had been socially active may become withdrawn from previous routines. Such behaviors are
often the first sign of a disorder. Mood symptoms and full mood episodes are common in
schizophrenia and may be concurrent with active-phase symptomatology. However, as distinct
from a psychotic mood disorder, a schizophrenia diagnosis requires the presence of delusions or
hallucinations in the absence of mood episodes. In addition, mood episodes, taken in total,
should be present for only a minority of the total duration of the active and residual periods of
the illness. In addition to the five symptom domain areas identified in the diagnostic criteria, the
assessment of cognition, depression, and mania symptom domains is vital for making critically
important distinctions between the various schizophrenia spectrum and other psychotic disorders.
There were no reported and seen major depressive or manic episodes have occurred
concurrently with the active-phase symptoms presented in Criterion A (Criterion D). There were
no reported and seen misuse of substances that can induce these disturbances. Another medical
condition is also non-contributory with his disturbances (Criterion E). There is no history of
autism spectrum disorder or communication disorder with Bill. (Criterion F).
IX. CONTRIBUTORY AND CAUSAL FACTORS
Although contributory factors and/or causal factors were not fully stipulated in the
case, the diagnostician in training is looking into possibility that these difficulties may
involve the following factors:
Culture-Related Diagnostic Issues Cultural and Socioeconomic factors must

be considered, particularly when the individual and the clinician do not share the same
cultural and socioeconomic background. Ideas that appear to be delusional in one culture
(e.g., witchcraft) may be commonly held in another. In some cultures, visual or auditory
hallucinations with a religious content (e.g., hearing God's voice) are a normal part of
religious experience. In addition, the assessment of disorganized speech may be made
difficult by linguistic variation in narrative styles across cultures. The assessment of

affect requires sensitivity to differences in styles of emotional expression, eye contact,
and body language, which vary across cultures. If the assessment is conducted in a
language that is different from the individual's primary language, care must be taken to
ensure that alogia is not related to linguistic barriers. In certain cultures, distress may take
the form of hallucinations or pseudo-hallucinations and overvalued ideas that may
present clinically similar to true psychosis but are normative to the patient's subgroup.
Gender-Related Diagnostic Issues. A number of features distinguish the clinical
expression of schizophrenia in females and males. The general incidence of
schizophrenia tends to be slightly lower in females, particularly among treated cases. The
age at onset is later in females, with a second mid-life peak as described earlier (see the
section "Development and Course" for this disorder). Symptoms tend to be more affect-
laden among females, and there are more psychotic symptoms, as well as a greater
propensity for psychotic symptoms to worsen in later life.
Other symptom differences include less frequent negative symptoms and
disorganization. Finally, social functioning tends to remain better preserved in females.
There are, however, frequent exceptions to these general caveats.
X. ASSOCIATED FEATURES
Individuals with schizophrenia may display inappropriate affect (e.g., laughing in
the absence of an appropriate stimulus); a dysphoric mood that can take the form of
depression, anxiety, or anger; a disturbed sleep pattern (e.g., daytime sleeping and
nighttime activity); and a lack of interest in eating or food refusal. Depersonalization,
derealization, and somatic concerns may occur and sometimes reach delusional
proportions. Anxiety and phobias are common. Cognitive deficits in schizophrenia are
conrmion and are strongly linked to vocational and functional impairments. These
deficits can include decrements in declarative memory, working memory, language
function, and other executive functions, as well as slower processing speed.
Abnormalities in sensory processing and inhibitory capacity, as well as reductions in
attention, are also found. Some individuals with schizophrenia show social cognition
deficits, including deficits in the ability to infer the intentions of other people (theory of
mind), and may attend to and then inteφret irrelevant events or stimuli as meaningful,
perhaps leading to the generation of explanatory delusions. These impairments frequently
persist during symptomatic remission.
Some individuals with psychosis may lack insight or awareness of their disorder
(i.e., anosognosia). This lack of "'insight" includes unawareness of symptoms of
schizophrenia and may be present throughout the entire course of the illness.
Unawareness of illness is typically a symptom of schizophrenia itself rather than a coping
strategy. It is comparable to the lack of awareness of neurological deficits following brain
damage, termed anosognosia. This symptom is the most common predictor of non-
adherence to treatment, and it predicts higher relapse rates, increased number of
involuntary treatments, poorer psychosocial functioning, aggression, and a poorer course
of illness.
Hostility and aggression can be associated with schizophrenia, although

spontaneous or random assault is uncommon. Aggression is more frequent for younger
males and for individuals with a past history of violence, non-adherence with treatment,
substance abuse, and impulsivity. It should be noted that the vast majority of persons with
schizophrenia are not aggressive and are more frequently victimized than are individuals
in the general population.
Currently, there are no radiological, laboratory, or psychometric tests for the

disorder. Differences are evident in multiple brain regions between groups of healthy
individuals and persons with schizophrenia, including evidence from neuroimaging,
neuropathological, and neurophysiological studies. Differences are also evident in
cellular architecture, white matter connectivity, and gray matter volume in a variety of
regions such as the pre- frontal and temporal cortices. Reduced overall brain volume has
been observed, as well as increased brain volume reduction with age. Brain volume
reductions with age are more pronounced in individuals with schizophrenia than in
healthy individuals. Finally, individuals with schizophrenia appear to differ from
individuals without the disorder in eye- tracking and electrophysiological indices.
Neurological soft signs common in individuals with schizophrenia include

impairments in motor coordination, sensory integration, and motor sequencing of
complex movements; left-right confusion; and disinhibition of associated movements. In

addition, minor physical anomalies of the face and limbs may occur.
Significant disturbances were present in Bill’s case especially with Hallucinations

and Delusion that resulted to impairment in his major areas of functioning including,
social relationships, and work.
XI. ETIOLOGY AND PREVALENCE
Environmental. Season of birth has been linked to the incidence of schizophrenia,

including late winter/early spring in some locations and summer for the deficit form of
the disease. The incidence of schizophrenia and related disorders is higher for children
growing up in an urban environment and for some minority ethnic groups.
Genetic and physiological. There is a strong contribution for genetic factors in

determining risk for schizophrenia, although most individuals who have been diagnosed
with schizophrenia have no family history of psychosis. Liability is conferred by a
spectrum of risk alleles, common and rare, with each allele contributing only a small
fraction to the total population variance. The risk alleles identified to date are also
associated with other mental disorders, including bipolar disorder, depression, and autism
spectrum disorder.
Pregnancy and birth complications with hypoxia and greater paternal age are associated
with a higher risk of schizophrenia for the developing fetus. In addition, other prenatal
and perinatal adversities, including stress, infection, malnutrition, maternal diabetes, and
other medical conditions, have been linked with schizophrenia. However, the vast
majority of offspring with these risk factors do not develop schizophrenia.
Prevalence
The lifetime prevalence of schizophrenia appears to be approximately 0.3%-0.7%,

although there is reported variation by race/ethnicity, across countries, and by geographic
origin for immigrants and children of immigrants. The sex ratio differs across samples
and populations: for example, an emphasis on negative symptoms and longer duration of
disorder (associated with poorer outcome) shows higher incidence rates for males,
whereas definitions allowing for the inclusion of more mood symptoms and brief
presentations (associated with better outcome) show equivalent risks for both sexes.
XII. DEVELOPMENT AND COURSE

The psychotic features of schizophrenia typically emerge between the late teens
and the mid-30s; onset prior to adolescence is rare. The peak age at onset for the first
psychotic episode is in the early- to mid-20s for males and in the late-20s for females.
The onset may be abrupt or insidious, but the majority of individuals manifest a slow and
gradual development of a variety of clinically significant signs and symptoms. Half of
these individuals complain of depressive symptoms. Earlier age at onset has traditionally
been seen as a predictor of worse prognosis. However, the effect of age at onset is likely
related to gender, with males having worse premorbid adjustment, lower educational
achievement, more prominent negative symptoms and cognitive impairment, and in
general a worse outcome. Impaired cognition is common, and alterations in cognition are
present during development and precede the emergence of psychosis, taking the form of
stable cognitive impairments during adulthood. Cognitive impairments may persist when
other symptoms are in remission and contribute to the disability of the disease.
The predictors of course and outcome are largely unexplained, and course and
outcome may not be reliably predicted. The course appears to be favorable in about 20%
of those with schizophrenia, and a small number of individuals are reported to recover
completely. However, most individuals with schizophrenia still require formal or
informal daily living supports, and many remain chronically ill, with exacerbations and
remissions of active symptoms, while others have a course of progressive deterioration.
Psychotic symptoms tend to diminish over the life course, perhaps in association
with normal age-related declines in dopamine activity. Negative symptoms are more
closely related to prognosis than are positive symptoms and tend to be the most
persistent. Furthermore, cognitive deficits associated with the illness may not improve
over the course of the illness.
The essential features of schizophrenia are the same in childhood, but it is more
difficult to make the diagnosis. In children, delusions and hallucinations may be less
elaborate than in adults, and visual hallucinations are more common and should be
distinguished from normal fantasy play. Disorganized speech occurs in many disorders
with childhood onset (e.g., autism spectrum disorder), as does disorganized behavior
(e.g., attention-deficit/hyperactivity disorder). These symptoms should not be attributed
to schizophrenia without due consideration of the more common disorders of childhood.
Childhood-onset cases tend to resemble poor-outcome adult cases, with gradual onset and
prominent negative symptoms. Children who later receive the diagnosis of schizophrenia
are more likely to have experienced nonspecific emotional-behavioral disturbances and
psychopathology, intellectual and language alterations, and subtle motor delays.
Late-onset cases (i.e., onset after age 40 years) are overrepresented by females,
who may have married. Often, the course is characterized by a predominance of
psychotic symptoms with preservation of affect and social functioning. Such late-onset
cases can still meet the diagnostic criteria for schizophrenia, but it is not yet clear whether
this is the same condition as schizophrenia diagnosed prior to mid-life (e.g., prior to age
55 years).
XIII. RISK AND PROGNOSTIC FACTORS

Environmental. Season of birth has been linked to the incidence of schizophrenia,
including late winter/early spring in some locations and summer for the deficit form of
the disease. The incidence of schizophrenia and related disorders is higher for children
growing up in an urban environment and for some minority ethnic groups.
Genetic and physiological. There is a strong contribution for genetic factors in

determining risk for schizophrenia, although most individuals who have been diagnosed
with schizophrenia have no family history of psychosis. Liability is conferred by a
spectrum of risk alleles, common and rare, with each allele contributing only a small
fraction to the total population variance. The risk alleles identified to date are also
associated with other mental disorders, including bipolar disorder, depression, and autism
spectrum disorder.
Pregnancy and birth complications with hypoxia and greater paternal age are associated
with a higher risk of schizophrenia for the developing fetus. In addition, other prenatal
and perinatal adversities, including stress, infection, malnutrition, maternal diabetes, and
other medical conditions, have been linked with schizophrenia. However, the vast
majority of offspring with these risk factors do not develop schizophrenia.
Approximately 5%-6% of individuals with schizophrenia die by suicide, about 20%

attempt suicide on one or more occasions, and many more have significant suicidal
ideation. Suicidal behavior is sometimes in response to command hallucinations to harm
oneself or others. Suicide risk remains high over the whole lifespan for males and
females, although it may be especially high for younger males with comorbid substance
use. Other risk factors include having depressive symptoms or feelings of hopelessness
and being unemployed, and the risk is higher, also, in the period after a psychotic episode
or hospital discharge.
XIV. DIFFERENTIAL DAGNOSIS

Major depressive or bipolar disorder with psychotic or catatonic features. Delusions
or hallucinations were not present during a major depressive or manic episode, the
diagnosis is depressive or bipolar disorder with psychotic features. Thus, this differential
diagnosis is ruled out.
Schizoaffective disorder. There were no major depressive or manic episode occur

concurrently with the active-phase symptoms and that the mood symptoms be present for
a majority of the total duration of the active periods. Thus, this differential diagnosis is
ruled out.
Schizophreniform disorder and brief psychotic disorder. Bill’s symptoms persisted

for 18 months. Thus, this differential diagnosis is ruled out.
Delusional disorder. Client fully met the criteria for schizophrenia and is better
explained by this disorder. Thus, this differential diagnosis is ruled out.
Schizotypal personality disorder. Subthreshold symptoms that weren’t associated with

persistent personality features. Thus, this differential diagnosis is ruled out.
Obsessive-compulsive disorder and body dysmorphic disorder. Prominent obsessions,

compulsions, preoccupations of bill weren’t present with regards to appearance or body
odor, hoarding, or body-focused repetitive behaviors. Thus, this differential diagnosis is
ruled out.
Posttraumatic stress disorder. In Bill’s case there were no traumatic events that is
directly related to his hypervigilance and hallucinatory quality. In to most of them are not
true. Thus, this differential diagnosis is ruled out.
Autism spectrum disorder or communication disorders. There were no presentation

of social interaction with repetitive and restricted behaviors and other cognitive and
communication deficits with Bill’s case. Thus, this differential diagnosis is ruled out.
Other mental disorders associated with a psychotic episode. There were no misuse of
other substances that can induce these episodes. Bill’s case indicates that it fully met the
criteria for Schizophrenia thus, this differential diagnosis is ruled out.
XV. COMORBIDITY
Rates of comorbidity with substance-related disorders are high in schizophrenia.
Over half of individuals with schizophrenia have tobacco use disorder and smoke
cigarettes regularly. Comorbidity with anxiety disorders is increasingly recognized in
schizophrenia. Rates of obsessive-compulsive disorder and panic disorder are elevated in
individuals with schizophrenia compared with the general population. Schizotypal or
paranoid personality disorder may sometimes precede the onset of schizophrenia.
Life expectancy is reduced in individuals with schizophrenia because of
associated medical conditions. Weight gain, diabetes, metabolic syndrome, and
cardiovascular and pulmonary disease are more common in schizophrenia than in the
general population. Poor engagement in health maintenance behaviors (e.g., cancer
screening, exercise) increases the risk of chronic disease, but other disorder factors,
including medications, lifestyle, cigarette smoking, and diet, may also play a role. A
shared vulnerability for psychosis and medical disorders may explain some of the
medical comorbidity of schizophrenia.
XVI. TREATMENT PLAN
LONG-TERM GOALS
Schizophrenia requires lifelong treatment, even when
symptoms have subsided. Treatment with medications
and psychosocial therapy can help manage the
condition to be able to let client live a life that is not
disrupted by his disturbances and return to be
productive with his major areas of functioning. In

some cases, hospitalization may be needed.
SHORT-TERM GOALS THERAPEUTIC INTERVENTION

Complete psychological testing to measure the nature  Arrange for psychological testing and/or
and extent of Schizophrenia and/or rule out other objectives measures to assess the features of
possible contributors. Schizophrenia; give feedback to the client and
his/her parents regarding the testing results.
Provide behavioral, emotional, and attitudinal  Assess the client’s level of insight (syntonic
information toward an assessment of specifiers versus dystonic) toward the “presenting
relevant to a DSM diagnosis, the efficacy of treatment, problems” (e.g., demonstrates good insight
and the nature of the therapy relationship into the problematic nature of the “described
behavior,” agrees with others’ concern, and is
motivated to work on change; demonstrates
ambivalence regarding the “problem
described” and is reluctant to address the issue
as a concern; or demonstrates resistance
regarding acknowledgment of the “problem
described,” is not concerned, and has no
motivation to change).
 Assess for any issues of age, gender, or
culture that could help explain the client’s
currently defined “problem behavior” and
factors that could offer a better understanding
of the client’s behavior.
 Assess for the severity of the level of
impairment to the client’s functioning to
determine appropriate level of care (e.g., the
behavior noted creates mild, moderate, severe,
or very severe impairment in social, relational,
vocational, or occupational endeavors);
continuously assess this severity of
impairment as well as the efficacy of

treatment (e.g., the client no longer
demonstrates severe impairment but the
presenting problem now is causing mild or
moderate impairment).
Take prescribed medication as directed by the  Arrange for the client to have an evaluation by
physician a physician to assess the appropriateness of
prescribing Schizophrenia medication.
 Monitor the client for psychotropic
medication prescription compliance, side
effects, and effectiveness; consult with the
prescribing physician at regular intervals
Parents, the client, and other significant individuals  Educate the client’s parents and siblings about
demonstrate increased knowledge about the symptoms of Schizophrenia.
Schizophrenia and its treatment.  Assign the parents readings to increase their
knowledge of Schizophrenia.
 Assign the client readings to increase his/her
knowledge about Schizophrenia and ways to
manage related behavior.
Parents work with therapist and school to implement a  Consult with the client’s teachers to
behavioral classroom management program implement strategies to improve school
performance, such as sitting in the front row
during class, using a prearranged signal to
redirect the client back to task, scheduling
breaks from tasks, providing frequent
feedback, calling on the client often, arranging
for a listening buddy, and implementing a
daily behavioral report card.
 Consult with parents and pertinent school
personnel to implement a Behavioral
Classroom Management Intervention.
Complete a peer-based treatment program focused on  Conduct or refer the client to a Behavioral
improving social interaction skills Peer Intervention (e.g., Summer Treatment

Program or after school/weekend version) that
involves brief social skills training, followed
by coached group play in recreational
activities guided by contingency management
systems (e.g., point system, timeout) and
utilizing objective observations, frequency
counts, and adult ratings of social behaviors as
outcome measures.
Learn and implement social skills to reduce anxiety  Use instruction, modeling, and role-playing to
and build confidence in social interactions build the client’s general and developmentally
appropriate social and/or communication
skills.
Increase the frequency of socially appropriate  Give homework assignments where the client
behaviors with siblings and peers. identifies 5 to 10 strengths or interests; review
the list in the following session and encourage
him/her to utilize strengths or interests to
establish friendships.
 Assign the client the task of showing
empathy, kindness, or sensitivity to the needs
of others (e.g., allowing sibling or peer to take
first turn in a video game, helping with a
school fundraiser).
Identify stressors or painful emotions that an trigger  Explore and identify stressful events or factors
increase in hallucinations and delusions. that contribute to an increase in hallucinations
and delusions.
 Explore possible stressors, roadblocks, or
hurdles that might cause hallucinations and
delusions to increase in the future.
Parents and the client regularly attend and actively  Encourage the client’s parents to participate in
participate in group therapy an Schizophrenia support group.
Psychosocial interventions  Individual therapy. Psychotherapy may help
to normalize thought patterns. Also, learning
to cope with stress and identify early warning

signs of relapse can help people with
schizophrenia manage their illness.
 Social skills training. This focuses on
improving communication and social
interactions and improving the ability to
participate in daily activities.
 Family therapy. This provides support and
education to families dealing with
schizophrenia.
Vocational rehabilitation and supported
employment. This focuses on helping people
with schizophrenia prepare for, find and keep
jobs.
XVII. REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author
Jongsma, A. E. Jr. (2014). The Child Psychotherapy Treatment Planner. 5th Edition, 425-434
Mayo Foundation for Medical Education and Research (MFMER) (n.d.). Schizophrenia.
Retrieved from https://www.mayoclinic.org/diseases-
conditions/schizophrenia/diagnosis-treatment/drc-20354449
XVIII. ATTACHMENTS
CASE STUDY
Reporter: Eman Claudette J. Eng
Topic: Schizophrenia Spectrum and other Psychotic Disorders
Bill McClary made his first appointment at the mental-health center reluctantly. He was 25 years
old, single, and unemployed. His sister, Colleen, with whom he had been living for 18 months,
had repeatedly encouraged him to seek professional help. She was concerned about his peculiar
behavior and social isolation. He spent most of his time daydreaming, often talked to himself,
and occasionally said things that made little sense. Bill acknowledged that he ought to keep more
regular hours and assume more responsibility, but he insisted that he did not need psychological
treatment. The appointment was finally made in an effort to please his sister and mollify her
husband, who was worried about Bill’s influence on their three young children.
During the first interview, Bill spoke quietly and frequently hesitated. The therapist noted
that Bill occasionally blinked and shook his head as though he was trying to clear his thoughts or
return his concentration to the topic at hand. When the therapist commented on this unusual
twitch, Bill apologized politely but denied that it held any significance. He was friendly yet shy
and clearly ill at ease. The discussion centered on Bill’s daily activities and his rather
unsuccessful efforts to fi t into the routine of Colleen’s family. Bill assured the therapist that his
problems would be solved if he could stop daydreaming. He also expressed a desire to become
better organized.
Bill continued to be guarded throughout the early therapy sessions. After several weeks,
he began to discuss his social contacts and mentioned a concern about sexual orientation. Despite
his lack of close friends, Bill had had some limited and fleeting sexual experiences. These had
been both heterosexual and homosexual in nature. He was worried about the possible meaning
and consequences of his encounters with other males. This topic occupied the next several weeks
of therapy.
Bill’s “daydreaming” was also pursued in greater detail. It was a source of considerable
concern to him, and it interfered significantly with his daily activities. This experience was
difficult to define. At frequent, though irregular, intervals throughout the day, Bill found himself
distracted by intrusive and repetitive thoughts. The thoughts were simple and most often alien to
his own value system. For example, he might suddenly think to himself, “Damn God.
“Recognizing the unacceptable nature of the thought, Bill then felt compelled to repeat a
sequence of self-statements that he had designed to correct the initial intrusive thought. He called
these thoughts and his corrective incantations “scruples. “These self-statements accounted for the
observation that Bill frequently mumbled to himself. He also admitted that his unusual blinking
and head shaking associated with the experience of intrusive thoughts.
Six months after Bill began attending the clinic regularly, the therapist received a call
from Bill’s brother-in-law, Roger. Roger said that he and Bill had recently talked extensively
about some of Bill’s unusual ideas, and Roger wanted to know how he should respond. The
therapist was, in fact, unaware of any such ideas. Instead of asking Roger to betray Bill’s
confidence any further, the therapist decided to ask Bill about these ideas at their next therapy
session. It was only at this point that the therapist finally became aware of Bill’s extensive
delusional belief system.
For reasons that will become obvious, Bill was initially reluctant to talk about the ideas to
which his brother-in-law had referred. Nevertheless, he provided the following account of his
beliefs and their development. Shortly after moving to his sister’s home, Bill realized that
something strange was happening. He noticed that people were taking special interest in him and
often felt that they were talking about him behind his back. These puzzling circumstances
persisted for several weeks during which Bill became increasingly anxious and suspicious. The
pieces of the puzzle finally fell in place late one night as Bill sat in front of the television. In a
flash of insight, Bill suddenly came to believe that a group of conspirators had secretly produced
and distributed a documentary film about his homosexual experiences. Several of his high school
friends and a few distant relatives had presumably used hidden cameras and microphones to
record each of his sexual encounters with other men. Bill believed that the film had grossed over
$50 million at the box office and that this money had been sent to the Irish Republican Army to
buy arms and ammunition. He therefore held himself responsible for the deaths of dozens of
people who had died as the result of several recent bombings in Ireland. This notion struck the
therapist and Bill’s brother-in-law as being quite preposterous, but Bill’s conviction was genuine.
He was visibly moved as he described his guilt concerning the bombings. He was also afraid that
serious consequences would follow his confession. Bill believed that the conspirators had agreed
to kill him if he ever found out about the movie. This imagined threat had prevented Bill from
confiding in anyone prior to this time. It was clear that he now feared for his life.
Bill’s fear was exacerbated by the voices that he had been hearing for the past several
weeks. He frequently heard male voices discussing his sexual behavior and arguing about what
action should be taken to punish him. They were not voices of people with whom Bill was
personally familiar, but they were always males and they were always talking about Bill. For
example, one night when Bill was sitting alone in his bedroom at Colleen’s home, he thought he
overheard a conversation in the next room. It was a heated argument in which one voice kept
repeating “He’s a goddamned faggot, and we’ve got to kill him!” Two other voices seemed to be
asking questions about what he had done and were arguing against the use of such violence. Bill
was, of course, terrified by this experience and sat motionless in his room as the debate
continued. When Roger tapped on his door to ask if he was all right, Bill was certain that they
were coming to take him away. Realizing that it was Roger and that he had not been part of the
conversation, Bill asked him who was in the next room. Roger pointed out that two of the
children were sleeping in the next room. When Bill went to check, he found the children asleep
in their beds. These voices appeared at frequent but unpredictable intervals almost every day. It
was not clear whether or not they had first appeared before the development of Bill’s delusional
beliefs.
The details of the delusional system were elaborate and represented a complex web of
imaginary events and reality. For example, the title of the secret film was supposedly Honor Thy
Father , and Bill said his name in the fi lm was Gay Talese. Honor Thy Father was, in fact, a
popular novel that was written by Gay Talese and published several years prior to the
development of Bill’s delusion. The actual novel was about organized crime, but Bill denied any
knowledge of this “other book with the same title.” According to Bill’s belief system, the film’s
title alluded to Bill’s disrespect for his own father, and his own name in the fi lm was a reference
to his reputation as a “gay tease.” He also maintained that his own picture had been on the cover
of Time magazine within the past year with the name Gay Talese printed at the bottom.
An interesting array of evidence was marshaled in support of this delusion. For example,
Bill pointed to the fact that he had happened to meet his cousin accidentally on a subway in
Brooklyn 2 years earlier. Why, Bill asked, would his cousin have been on the same train if he
were not making a secret film about Bill’s private life? In Bill’s mind, the cousin was clearly part
of a continuous surveillance that had been carefully arranged by the conspirators. The fact that
Bill came from a very large family and that such coincidences were bound to happen did not
impress him as a counterargument. Bill also pointed to an incident involving the elevator
operator at his mother’s apartment building as further evidence for the existence of the fi lm. He
remembered stepping onto the elevator one morning and having the operator give him a puzzled,
prolonged glance. The man asked him if they knew each other. Bill replied that they did not.
Bill’s explanation for this mundane occurrence was that the man recognized Bill because he had
obviously seen the film recently; he insisted that no other explanation made sense. Once again,
coincidence was absolutely impossible. His delusional system had become so pervasive and
intricately woven that it was no longer open to logical refutation. He was totally preoccupied
with the plot and simultaneously so frightened that he did not want to discuss it with anyone.
Thus, he had lived in private fear, brooding about the conspiracy and helpless to prevent the
conspirators from spreading knowledge of his shameful sexual behavior.
Bill was the youngest of four children. He grew up in New York City where his father
worked as a firefighter. Both of his parents were first-generation Irish Americans. Many of their
relatives were still living in Ireland. Both parents came from large families. Bill’s childhood
memories were filled with stories about the family’s Irish heritage.
Bill was always much closer to his mother than to his father, whom he remembered as
being harsh and distant. When his parents fought, which they did frequently, Bill often found
himself caught in the middle. Neither parent seemed to make a serious effort to improve their
relationship. Bill later learned that his father had carried on an extended affair with another
woman. His mother depended on her own mother, who lived in the same neighborhood, for
advice and support and would frequently take Bill with her to stay at her parents’ apartment after
particularly heated arguments. Bill grew to hate his father, but his enmity was tempered by guilt.
He had learned that children were supposed to respect their parents and that, in particular, a son
should emulate and revere his father. Mr. McClary became gravely ill when Bill was 12 years
old, and Bill remembered wishing that his father would die. His wish came true. Years later, Bill
looked back on this sequence of events with considerable ambivalence and regret.
Bill could not remember having any close friends as a child. Most of his social contacts
were with cousins, nephews, and nieces. He did not enjoy their company or the games that other
children played. He remembered himself as a clumsy, effeminate child who preferred to be alone
or with his mother instead of with other boys.
He was a good student and finished near the top of his class in high school. His mother
and the rest of the family seemed certain that he would go on to college, but Bill could not decide
on a course of study. The prospect of selecting a profession struck Bill as an ominous task. How
could he be sure that he wanted to do the same thing for the rest of his life? He decided that he
needed more time to ponder the matter and took a job as a bank clerk after graduating from high
school.
Bill moved to a small efficiency apartment and seemed to perform adequately at the
bank. His superiors noted that he was reliable, though somewhat eccentric. He was described as
quiet and polite; his reserved manner bordered on being socially withdrawn. He did not associate
with any of the other employees and rarely spoke to them beyond the usual exchange of social
pleasantries. Although he was not in danger of losing his job, Bill’s chances for advancement
were remote. This realization did not perturb Bill because he did not aspire to promotion in the
banking profession. It was only a way of forestalling a serious career decision. After 2 years at
the bank, Bill resigned. He had decided that the job did not afford him enough time to think
about his future.
He was soon able to find a position as an elevator operator. Here, he reasoned, was a job
that provided time for thought. Over the next several months, he gradually became more aloof
and disorganized. He was frequently late to work and seemed unconcerned about the reprimands
that he began receiving. Residents at the apartment house described him as peculiar. His
appearance was always neat and clean, but he seemed preoccupied most of the time. On occasion
he seemed to mumble to himself, and he often forgot floor numbers to which he had been
directed. These problems continued to mount until he was fi red after working for 1 year at this
job.
During the first year after finishing high school, while working at the bank, Bill had his
first sexual experience. A man in his middle forties who often did business at the bank invited
Bill to his apartment for a drink, and they became intimate. The experience was moderately
enjoyable but primarily anxiety provoking. Bill decided not to see this man again. Over the next
2 years, Bill experienced sexual relationships with a small number of other men as well as with a
few women. In each case, it was Bill’s partner who took the initiative. Only one relationship
lasted more than a few days. He became friends with a woman named Patty who was about his
own age, divorced, and the mother of a 3-yearold daughter. Bill enjoyed being with Patty and her
daughter and occasionally spent evenings at their apartment watching television and drinking
wine. Despite their occasional sexual encounters, this relationship never developed beyond the
casual stage at which it began.
After he was fi red from the job as an elevator operator, Bill moved back into his
mother’s apartment. He later recalled that they made each other anxious. Rarely leaving the
apartment, Bill sat around the apartment daydreaming in front of the television. When his mother
returned from work, she would clean, cook, and coax him unsuccessfully to enroll in various
kinds of job-training programs. His social isolation was a constant cause of concern for her. She
was not aware of his bisexual interests and encouraged him to call women that she met at work
and through friends. The tension eventually became too great for both of them, and Bill decided
to move in with Colleen, her husband, and their three young children.

Case Study 4 SCHIZOPHRENIA

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Case Study 4 SCHIZOPHRENIA

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San Pedro College

Graduate School Studies

II. IDENTIFYING INFORMATION

Mother’s Occupation: Do have a job but not clearly specified

High School Age

III. REASON FOR REFERRAL

IV. PROBLEMS AND SYMPTOMS

 Difficulty in in clearing thoughts or return to concentration

 There is marked dominance whenever he wants to persuade things regarding his

 There is marked impairment in his level of consciousness

 There were also no ideas of reference nor ideas of influence

VI. CASE OVERVIEW

VII. PRELIMINARY DIAGNOSIS

1. Delusions. He believes that a group of conspirators had secretly

He thought he overheard a conversation in the next

5. Negative symptoms (i.e., diminished

symptoms (or less if successfully treated)

1 month (or less if successfully treated).

Multiple episodes, currently in full

Coding note: Use additional code 293.89

of schizophrenia can be made without

Justification Fully satisfied. The diagnostic criteria for

VIII. DIAGNOSTIC FEATURES

IX. CONTRIBUTORY AND CAUSAL FACTORS

Culture-Related Diagnostic Issues Cultural and Socioeconomic factors must

difficult by linguistic variation in narrative styles across cultures. The assessment of

Hostility and aggression can be associated with schizophrenia, although

Currently, there are no radiological, laboratory, or psychometric tests for the

Neurological soft signs common in individuals with schizophrenia include

complex movements; left-right confusion; and disinhibition of associated movements. In

Significant disturbances were present in Bill’s case especially with Hallucinations

XI. ETIOLOGY AND PREVALENCE

Environmental. Season of birth has been linked to the incidence of schizophrenia,

Genetic and physiological. There is a strong contribution for genetic factors in

The lifetime prevalence of schizophrenia appears to be approximately 0.3%-0.7%,

XII. DEVELOPMENT AND COURSE

XIII. RISK AND PROGNOSTIC FACTORS

Genetic and physiological. There is a strong contribution for genetic factors in

Approximately 5%-6% of individuals with schizophrenia die by suicide, about 20%

XIV. DIFFERENTIAL DAGNOSIS

Schizoaffective disorder. There were no major depressive or manic episode occur

Schizophreniform disorder and brief psychotic disorder. Bill’s symptoms persisted

Schizotypal personality disorder. Subthreshold symptoms that weren’t associated with

Obsessive-compulsive disorder and body dysmorphic disorder. Prominent obsessions,

Autism spectrum disorder or communication disorders. There were no presentation

productive with his major areas of functioning. In

SHORT-TERM GOALS THERAPEUTIC INTERVENTION

impairment as well as the efficacy of

improving social interaction skills Peer Intervention (e.g., Summer Treatment

to cope with stress and identify early warning

Reporter: Eman Claudette J. Eng

Topic: Schizophrenia Spectrum and other Psychotic Disorders

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