Name:  F.I

Age: 50 years

Examiner: Aqsa Ayub

Case No: 02

 

Identifying Information:

F.I is a 50 years old, married Urdu speaking, Muslim male. He is fifth born among two sisters and four brothers. He belongs to middle socio-economic status family with joint setup. He is uneducated and unemployed. He got married in Lahore and has five children. He is separated from his wife since 5 years.

Referral Sources and Presenting Problems:
F.I has been reffered by Dr. Noor Fatima (Psychologist) at Fountain House Hospital, Lahore for psychological assessment. His presenting problems include: persecutory delusions, auditory hallucination, and poverty of speech.

Interview information:
F.I’s informant (elder brother) reported that client’s problem started seven years ago. He took him to the Fountain House Hospital for treatment. He had satisfactory relationships with his siblings but unsatisfactory relationships with his wife. He was not happy with his wife. His wife was ahl-e-hadees and he was ahl-e-sunnat because of which there were conflicts among them. He reported that his wife tried to kill him many times. She tried to poison his food and tried to use amulets in order to kill him. He ran off 9 times from his home because he thought his wife was going to kill him. Moreover, he was convinced that his wife hired someone to kill him.

He had difficulty falling asleep. He engaged in self-talk, self-laugh and suspiciousness. He also had low mood. He had poor appetite. His speech was very difficult to understand, and he hardly used some words to explain his problem. He also had social anxiety as he felt fearful while communicating with others. He claimed that an old man whispers in his ears. Furthermore, he stated that people usually see the image of Prophet Muhammad (PBUH) in his eyes.

He did not have any friends and was only close to his mother, but his mother died a year ago from heart attack. His relationship with his father was also satisfactory who also died because of a heart attack. He was working at his father’s shop before his symptoms appeared and his condition got worse after his father’s death. His brother decided to admit him in fountain house for treatment. He is currently taking medication for his symptoms which includes donresp 4 mg, xtine 12.5 mg, steric 2 mg, and kempro 5 mg.

Tests Administered:

  1. Mini Mental Status Examination…………………………..………(MMSE)
  2. Bender Gestalt Test……………………………………….…………(BGT)
  3. Human Figure Drawing Test………………..…………….……….(HFD)
  4. Rorschach Inkblot Test……………………………………………..(ROR)

Behavior during testing sessions:
Throughout assessment sessions he faced difficulty in maintaining his attention and concentration. He sat in one pose and showed flat expression. He was uncooperative and got distracted easily. He had blunt effect and showed minimum level of alertness. He spoke with lack of spontaneity and responded with brief controlled sentences throughout the session. His volume was low, and tone was rigid. His thought process was not satisfactory as he was switching from one story to another regarding how his wife tried to kill him. His thought content provided the information related to the delusions of persecution as he had a belief that his wife wants to kill him. He also reported auditory hallucinations i.e. (a saint is communicating with him. The client had no insight and judgement about his problem. He took enough time to perform on tests as he took a lot of time to comprehend the instructions given by the examiner.

Psychological Evaluation:
F’s scores on mini mental status examination (MMSE), indicates severe cognitive impairment. His orientation was impaired as he was unable to answer the questions like what is the year, date or day?. He was also unable to count backwards or spell WORLD backwards. Furthermore, he was unable to remember the names of three things he was told earlier. He had clear impairment and required 24-hour supervision. His gait was clumsy and he was sitting in a straight posture. He was not making eye contact and seemed rigid. His attention was mostly on the surroundings and he had the attitude of suspiciousness.

Client’s score on BGT, a psycho-neurological test indicates that he is suffering from brain impairment due to which there is manifestation of symptoms. His problem is organic and he needs psychiatric help.
Projective analysis reveal that he is sufferings from auditory hallucinations. He is an immature and paranoid personality. He has affection deprivation and conflict over interpersonal relationships. Moreover, the client is also having ideas of reference and feeling of inadequacy. Furthermore, he has insecurity, sexual conflicts, aggression and low self-esteem.

Projective analysis further revealed that the client views his world in stereotyped Manner and has a poor contact with reality. He is detached, aloof and poorly adjusted to his environment. The client has difficulty in cognitive shifting which leads to inflexibility and rigidity in thought process. Furthermore, he is suffering from, serious maladjustments and intellectual deterioration due to brain damage. It further suggests that he does not use his intellectual potential and tries to give socially desirable responses. He is a highly defensive and constricted person who is inflexible and faces difficulty accepting and adjusting to change.

Furthermore, analysis revealed that he inhibits his emotions and denies his basic needs. He usually withdraws from his interpersonal relations as well.

Diagnosis:

297.1(F22) Delusional Disorder, Persecution Type.

Prognosis:
Based on overall evaluation, general health, intellectual level, available resources, family’s cooperation, and severity of problem his prognosis seems to be less satisfactory.

Recommendation:

There is a potential role for psychological therapies such as cognitive behavioral therapy (CBT) in the treatment of delusional disorder. Treatments with medications and psychosocial therapy can also help manage the condition. Once psychosis recedes, in addition to continuing medication psychological and social interventions are important. These may include:

  • Individual psychotherapy: which can help the person recognize and correct the underlying thinking that has become distorted.
  • Cognitive-behavioral therapy (CBT):helps the person learn to recognize and change thought patterns and behaviors that lead to troublesome feelings.
  • Social skills training: this focuses on improving client’s communication and social interactions and improving the ability to participate in daily activities.
  • Family therapy: this provides support and education to families dealing with delusional disorder and can also help families deal more effectively with a loved one who has delusional disorder, enabling them to contribute to a better outcome for the person.
Examiner

Aqsa Ayub

Internship Supervisor

Dr. Shabana shahid Khan

Student of BS Psychology Clinical psychologist