John Baxter

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Note: This is the case from last year, and is not exactly as presented. For modifications, see below.

The patient is a 20 year-old, single male living with his family in London (parents, younger sister). He is a first year college student taking Hotel and Restaurant Management. The patient has been brought to the emergency room by his mother: "My son's been acting so strange... I'm worried about him"...Tonight threw the radio at a wall after some loud yelling".

For two months the patient has been hearing the radio speaking to him. It is either complimentary or threatening to him. The patient is convinced that the radio announcer is part of "new movement" against the government and against him. Also, the patient thinks that blue cars parked on street or driving down road are "surveilling" him. Therefore the patient has often avoided sleep "to keep an eye on them". John has heard his name called intermittently for about 8 months.

For the past 30 months, John has been experiencing progressive deterioration in academics (from B+ to C-). He has also been distancing himself from friends so that now he is a "loner". The patient is not taking part in family activities and has lost interest in sports and stamp collecting which were long-time activities of pleasure. The patient is progressively spending more of his time in his room. For approximately 6-8 months he has become involved in mild to moderate cannabis use.

The patient was a "blue baby" at birth due to umbilical cord wrapping around neck but has been healthy up to now. A maternal aunt has been diagnosed as having schizophrenia. As a baby, John exhibited late developmental milestones and was "shy" as a child. He was interested and performed well in school until grade 11 when the present deterioration began. He has no romantic relationships. His parents have been experiencing marital turmoil over the past three years. John's long-term goal is to own a restaurant.

Modifications

  • Name may not be the same (??)
  • Does not believe that he ever needed treatment
  • Is violent and assaults people when paranoid
  • Attacked his father in the following scenario:
    • His father saw a billboard describing symptoms of paranoia or psychosis, and called the mental health people. They said that they would be able to assess him at South Street. The father told the son the day before that they would be going, but this apparently did not register with the son until they turned onto South Street. The son then jumped out of the car and tried to get into the trunk, which would not open. At this point, he proceeded to beat his father, and was taken to the hospital for assault
  • He was treated against his wishes, and insisted on being released. After being released, he badly beat a 9-year old girl sitting on the front steps of his building and three police officers who tried to arrest him.

Objectives

  • Do hallucinations occur in non-mentally-ill people and, if so, when?
  • Discuss the relationship between substance use (abuse?) and schizophrenia or, more broadly, mental illness.
  • Discuss broad causes of homelessness. Is mental illness more prevalent in the homeless? If so what type of mental illness?
  • Are psychotic disorders more prevalent in some populations, cultures, societies, than others?
  • What are some strategies for coping and adapting that a schizophrenic patient can use? Can these significantly improve functioning (maintaining a job, for example)?


  • Discuss issues of confidentiality with regards to younger (but still legal) patients whose parents are heavily involved in care