Running head: CASE STUDY TWO 1
Case Study Two
Kirsten Lee Ann Sheridan
Liberty University
CASE STUDY TWO 2
Case Study Two
I. Key Issues
A. Jacob presents with multiple key issues which are implicated throughout this case
study. Below are the key issues presented and exhibited by Jacob. These key issues
are recorded in order of significance with explanation for their important, organized
arrangement as though Jacob presents with multiple key issues, they further vary in
severity and magnitude.
1. Jacob’s initial key issue that reflects as his most significant key issue are
his responses; delusions, hallucinations, disorganized thinking (speech),
grossly disordered or abnormal motor behavior (including catatonia), and
negative symptoms. Jacob’s responses are of utmost importance as they have
been exhibited for a significant amount of time, have been on-going and are
escalating.
2. The second important key issue is that of Jacob’s aunt. This (she) presents
as the second important key issue as Jacob’s aunt has been in and out of
psychiatric hospitals over the years due to erratic and bizarre behavior. This
further reflects potential genetic causation (as to Jacob’s recent and escalating
responses as well as similarity to his exhibiting and heightening of these
responses.
3. The third key issues that reflected significance was that of Jacob’s age.
This is presents as an important key issue as responses like those exhibited by
Jacob will usually and often manifest and present within an age range that also
CASE STUDY TWO 3
includes Jacob’s age (i.e. older adolescents to adulthood, if also exhibiting a
mental disorder).
4. Fourthly and finally, the last important key issue is that of Jacob’s
exposure to stressors. This is chosen as an important key issue as it potentially
could be triggering some of his responses.
B. The above reflects the importance and significance of Jacob’s key issues. They are
arranged with a weight of how they should be attended to. Based on that and Jacob’s
first important key issue, immediate treatment needs to be implemented to intervene,
address, assist, support, and ultimately stabilize Jacob and his escalating responses
(i.e. potential hospitalization, medication management). Secondly, Jacob’s second
significant key issue regarding his aunt and potential genetic causations need to be
considered and receive urgent intervention to further treat and support Jacob in
receiving the therapeutic support his aunt may have also has received to achieve
stabilization (during the times she spend outside of psychiatric facilities). Jacob’s
third key issue, his age, presents and reflects as a typical age such responses may
manifest and present within an individual and should be significantly considered a
successful treatment outcome. Lastly, Jacob’s forth presenting key issue, his exposure
to stress, also needs to be naturally considered to further assist in a satisfactory
treatment outcome. Following the prioritization of the shared order of key issues,
these are also recommendations, in order of priority, to satisfactorily achieve
successful treatment outcomes for Jacob; initially implement a biological treatment
approach, secondly begin psychological treatment approaches, thirdly carry out social
treatment approaches, and fourthly (after satisfactorily engaging in and achieving the
CASE STUDY TWO 4
other treatment approaches), engage in spiritual treatment approaches (as this may
also be a presenting trigger for Jacob that needs to be considered upon his initial in-
take session and addressed throughout treatment accordingly, but could be utilized as
a strong intervention later in his treatment) (i.e. stabilize and keep safe; potential
hospitalization and medication management, implement appropriate strategies,
supports, connect and engage with other CMHR as necessary, and plausible
integration through a spiritual approach).
II. Diagnostic Impressions
A. In considering Jacob’s presenting key issues and exhibited responses that have been
reflected throughout this case study and the DSM-5 manual, Jacob’s displayed issues
and responses further reflect that these would all be associated with the DSM-5
(2013) category “Schizophrenia Spectrum and Other Psychotic Disorders.” It would
then present as appropriate that Jacob then be diagnosed with “Schizophreniform
Disorder” (295.20, F20.81) as he meets four out of the four diagnostic criteria for this
disorder (A., B., C., and D.) according to the DSM-5 (2013). Further referencing to
the DSM-5 (2013) regarding this disorder, Jacob meets the diagnostic criteria for this
fully as he matches diagnostic criteria for “A” through exhibiting five out of five
symptoms associated under this diagnosis, fits criteria “B” through his displayed
episode of the disorder for longer than one month, but less than six months, satisfies
criteria “C” as schizoaffective disorder and depressive or bipolar disorder can be
ruled out, and fulfills criteria “D” as his symptoms cannot be attributed to the
psychological effects of a substance and/or other medical condition. Based on these
and what’s reflected in the DSM-5 (2013), he further presents with good prognostic
CASE STUDY TWO 5
features as he presents with onset of prominent psychotic symptoms within four
weeks of the first noticeable change in usual behavior or functioning; confusion or
perplexity; good premorbid social and occupational functioning; and absence of
blunted or flat affect, with catatonia (293.89/F06.1: satisfies three out of the twelve
psychomotor features associated with catatonia; stupor, negativism, and mannerism),
and with significant and escalating severity. Thus, ultimately satisfying and fulfilling
all necessary diagnostic criteria and specifiers for this disorder and making it the most
appropriate diagnosis for Jacob; 295.40 (F20.81) with a presence of comorbidity of
293.89 (F06.1).
Although this presents as the most appropriate diagnosis for Jacob, differential
diagnoses were also considered. These were those of and according to the DSM-5
(2013) “other mental disorders and medical conditions” and “brief psychotic
disorder.” However, these can be concisely eliminated as exhibited and satisfied
diagnostic criterion reflects otherwise. These were eliminated accordingly as and
based on the DSM-5 (2013), no other mental and medical conditions associated with
other disorders are the cause for Jacob’s disorder and diagnosis regarding the
differential diagnosis of “other mental disorders and medical conditions,” and there is
significant duration of time present which continues to be of presence regarding the
differential diagnosis of “brief psychotic disorder” and its duration of less than a
month.
B. Other than the above shared comorbidity; 295.40 (F20.81) with 293.89 (F06.1), and
in further considering this case study and Jacob’s responses, diagnosis, and disorder,
no other disorders or diagnoses present currently.
CASE STUDY TWO 6
III. Treatment Recommendations
A. In further consideration of Jacob’s diagnosis, multiple treatment recommendations
should be considered and then implemented to assist him in addressing and maintain
his health. This can be done through the implementation of appropriate,
recommended treatment approaches and satisfactorily achieving the objectives and
goals associated with these. For example, an initial goal for Jacob should be that he
be stabilized through implemented biological and psychological methodologies,
objectives, strategies, and interventions (assist in achieving stabilization and coping
through his disorders affects). A second goal should be that once stabilization and
therapeutic bonds have been achieved, Jacob reengage in and achieve social relations
and skills through the practice of and engagement in psychosocial methodologies,
objectives, strategies, and interventions (assist in achieving and exhibiting appropriate
and healthy social skills, again). A third goal for Jacob should his ability to
satisfactorily identify with and utilize healthy, natural supports through assisting him
in identifying with healthy, natural supports and in connecting him to further/other
CMHR if/as necessary (assist in continued participation in effective, therapeutic
options to further promote contending to his disorder and its symptoms). A fourth and
final goal for Jacob should be the achieving of integrating spirituality back into his
life through integrative methods, objectives, strategies, and interventions (assist in
having a healthy relation with his religion again through further promoting of his and
God’s ability to handle his “disorder”).
The following are more detailed treatment approaches for Jacob, his diagnosis and
disorders, and his goals;
CASE STUDY TWO 7
1. Biological and psychological treatment (being combined as they were
accordingly and recommended above) approaches can be implemented for
Jacob through potential hospitalization/s, medication management, and
psychosocial treatments (such as training and reinforcement of skills, analyses
and treatments that are family based, and that of therapy, specifically
Cognitive Behavioral Therapy) (Kring and Johnson, 2018). These can assist
Jacob in achieving stabilization, forming healthy bonds through engagement
in therapy, and learning how to healthily regulate his responses and cope
through his symptoms associated with his disorder and diagnosis.
2. One social treatment approach for Jacob can be participating in social
skills training as this will assist him in being able to handle a variety of
interpersonal circumstances associated with his disorder and diagnosis (Kring
and Johnson, 2018). Also, in combination with such a treatment approach,
support from family and friends socially can offer aid to him as such has
assisted individuals with similar diagnoses in coping through and with Jacob’s
diagnosis and disorder (Kring and Johnson, 2018). Another social treatment
approach can be the involvement in group therapy with individuals whom
have similar diagnoses as engagement in group therapy can offer positive
group variables through the reinforcement and identification of and with these
curative factors; instillation of hope, universality, imparting of information,
altruism, corrective recapitulation of primary family group, development of
socializing techniques, imitative behaviors, interpersonal learning,
cohesiveness, catharsis, and existential factors (Gladding, 2016). Ultimately,
CASE STUDY TWO 8
these could assist Jacob in normalizing his disorder and diagnosis and
reestablishment of his social skills and social relations and their dynamics.
3. Another treatment approach (associated with psychological, biological,
psychosocial treatment approaches) that can implemented for Jacob is to assist
him in identifying with and utilizing healthy, natural supports through
assisting him in identifying with healthy, natural supports and in connecting
him to further/other CMHR if/as necessary based on his needs following his
satisfactorily achievements of the above treatment approaches. These
treatment approaches could also potentially incorporate this approach as an
“end goal” as in doing so will assist Jacob in ultimately being prepared to
cope through his mental disorder and diagnosis effectively, efficiently, and
confidently. For example, psychologically, appropriate therapy (i.e. group,
individual) can remain in place, biologically, medication management can be
continued and monitored accordingly by supports (i.e. psychiatrist, family),
and psychosocially, social skills and engagements can be reinforced and
monitored appropriately also by supports (i.e. therapist, family).
4. A final treatment approach to consider is that of a spiritual treatment
approach and through the integration of spirituality back into Jacob’s life. This
can be approached and achieved through integrating theological approaches
with respect to empirical approaches as (and as Christians) it has been
recognized as a truth that “empiricism has drastically improved our
understanding of schizophrenia” (Entwistle, 2015, p. 107). Integration and
relation of one of Jacob’s pasts interests and strengths (his religion) with
CASE STUDY TWO 9
empiricism (his experiences with his disorder and diagnosis) will assist him in
being able further receive the support he may need, cope through his disorder
and diagnosis, and engage in past, normal psychological and psychosocial
strengths of his. Ultimately, promoting his emotional, behavioral, and spiritual
health.
B. Based on the treatment recommendations and approaches shared, improvements
regarding Jacob and in association with his disorder and diagnosis will be evidenced
by significant regression and de-escalation in his responses, effective commitment
and participation in medication management and therapy accordingly, ability to cope
through and regulate his symptoms healthily, engagement in appropriate social skills
and relations across his settings, capacity to identify with and continue to utilize his
appropriate supports as necessary, and a healthy reestablishment of and reengagement
with his religion/spirituality.
CASE STUDY TWO 10
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders:
DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association Publishing.
Entwistle, D. N., (2015). Integrative approaches to psychology and Christianity (3rd ed., p. 107).
Eugene, OR: Cascade Books.
Gladding, Samuel, T. (2016). Groups: A counseling specialty (7th ed.). United States of America:
Pearson Education, Inc..
Kring, A.M., & Johnson, S.L. (2018). Abnormal psychology: The science and treatment of
psychological disorders (14th ed.). Hoboken, NJ: John Wiley & Sons.
CASE STUDY TWO 11
IV. Key Issues
A. The following is a list of key issues involved in the case study. These are listed in the
order of importance. A rationale is given for how they are prioritized. Mr. Boyle
presents with many key issues which are reflected within this case study. Below is a
list of key issues presented and exhibited by Mr. Boyle. The key issues listed below
are organized by their significance of effect, seriousness, and importance.
1. The most important key issue is ____. The reason this is chosen first is
that it affects____. The initial and most significant key issue regarding Mr.
Boyle and this case study is his recent heated interaction with the school
board. This presents as the most significant key issue as it has put his job as
principal in jeopardy. Thus, potentially triggering loss of his career, income,
marriage, family, et cetera which could be further triggering his array of other
emotions and responses (i.e. his increasing irritability, aggression, suspicion,
distrust, control, and depression, difficulties and challenges, and substance
use).
2. Xxx A second important key issue presented and exhibited by Mr. Boyle
are his responses. Mr. Boyle presents and exhibits concerning responses
through his reflected behaviors of difficulty in getting along with others where
he has recently become more aggressive through being more irritable and
argumentative with his wife, his peers, and his school’s staff and personnel,
and continued strict, distrustful and apprehensive interactions with his
children, always facing difficulties making friends and trusting others, always
CASE STUDY TWO 12
having been a suspicious person which is increasing (paranoia surrounding the
idea that he believes the school board, school staff and personnel, and former
parents are conspiring against him), his self-centeredness and conceitedness
(egotistic through believing he deserves a raise, reflecting a sense of
entitlement across his settings, and that everyone is simply jealous of him), his
recent escalation in drinking alcohol (substance use through binge drinking
and denial regarding this being an issue), and his recent and increasing
feelings of somberness, hopelessness, and helplessness. This is chosen as
secondary key issues as Mr. Boyle’s responses are significantly impacting and
affecting his entire life, and those in it, and will continue to if not intervened
promptly and addressed accordingly.
3. Thirdly as an important key issue, Mr. Boyle’s marriage is at risk for
divorce, as his wife shared to him that she will leave him based on his
difficulties and challenges interacting with others. This is chosen as an
important key issue as it could be triggering other issues and responses
presented and exhibited by Mr. Boyle and could also produce further concerns
and matters for Mr. Boyle, his life, family, career, et cetera.
4. A final significant key issue to consider is that of Mr. Boyle’s potential
exposure to trauma as he reported he came from a very poor family. This is
chosen as an important key issue as it has been affecting and impacting his
entire life which he reinforced, and may continue to, negatively, if support is
not provided and the potential trauma addressed accordingly.
CASE STUDY TWO 13
B. The specific order of the priority of the issues listed above will contribute to Kristen’s
recovery… The first reason this prioritization will be of benefit Kristen is that…Link
your rationale to what you believe outcomes of treatment should be for this client.
How will your order of priority contribute to a successful outcome for the client? The
shared list above regarding Mr, Boyle’s key issues presenting in this case study are
listed and organized, as shared, based on their significance of effect, seriousness, and
importance. These are also organized because of how they are affecting his mental
and physical health, and if supported and addressed accordingly and in order,
successful and satisfactory treatment outcomes can be achieved. With that, the first
key issue needs to be addressed immediately as this is essentially triggering and will
continue to trigger further regressive responses and outcomes for Mr. Boyle and his
life (family, career, mental and physical health, et cetera). To approach this and
prevent further altercations and escalations, intervening here and addressing this issue
initially could assist in a successful outcome for Mr. Boyle and his life (family, career,
mental and physical health, et cetera) through receiving appropriate treatment (i.e.
psychotherapy). Secondly, the second key issue then needs to be addressed as Mr.
Boyle’s responses are also regressing and significantly impacting and affecting
impacting his life (family, career, mental and physical health, et cetera) and will
continue to without receiving appropriate treatment to assist in achieving a successful
outcome. To address Mr. Boyle’s escalating and regressing responses and behaviors,
appropriate objectives, strategies, and interventions need to be implemented to
stabilize him through the provision of and engagement in appropriate treatment (i.e.
identifying with, practicing, and acknowledging healthy social skills, coping
CASE STUDY TWO 14
mechanisms, grounding skills, reality versus nonreality, parenting strategies, et
cetera) which could assist him in achieving a successful outcome. Following this, Mr.
Boyle’s third presenting key issue needs to be addressed to assist him in saving his
marriage and preventing divorce as the loss of his wife and children to an extent (for
example, weekend visitations), whom present as natural supports in his life, and the
effects from divorce could further prompt other significant, regressive responses and
life experiences. To achieve a successful outcome regarding this key issue and to
prevent further regressive responses and life experiences for Mr. Boyle and his
family, interventions and treatment approaches such as engaging in family therapy
could assist with this key issue. In doing so, a potential satisfactory outcome could
present through helping the healing process of Mr. Boyle, his family, and his life.
Lastly, the fourth presenting key issue that needs to be addressed is Mr. Boyle’s
potential exposure to trauma when he was growing up. This presents with importance
and significance and should be addressed it in doing so, could assist in Mr. Boyle in
addressing his past, preventing future regressive responses, and changing some of his
responses and behaviors he presents and exhibits now (and has throughout his life).
To achieve a satisfactory outcome regarding this key issue, further intervention and
treatment should be put into action once Mr. Boyle’s other key issues have been
efficiently and effectively addressed. While his potential exposure to trauma may
reflect and be causation for Mr. Boyle’s responses throughout his entire life, the most
recent increasing, regressive responses need to be addressed first and Mr. Boyle
stabilized before uncovering his potential exposure to trauma. In doing so and being
CASE STUDY TWO 15
mindful of this, a successful treatment outcome could be achieved while also through
the engagement and implementation of further psychotherapy.
V. Diagnostic Impressions
A. Given the information presented in the case study and the criteria presented in the
DSM5, the category that best fits the features presented in the case study is _____ and
the specific diagnoses is _________. The reason for this conclusion is that the
diagnostic criteria for _____is…Provide rationale for diagnosis. Also, give
consideration to differential diagnostic considerations. In other words, what disorders
in this category or other closely related categories were considered? Why could this
not be any of those disorders? You may want to consider here theories of normal and
abnormal personality development. Also, consider systemic and environmental
factors that affect human development, functioning, and behavior.
B. Be sure to consider other disorders in addition to the main disorder. Is there more than
one diagnosis? Provide rationale for diagnosing any additional disorders.
VI. Treatment Recommendations
A. In further conceptualizing this clinical case, three goals have been set for Kristen.
One of the goals of therapy will be to form a therapeutic alliance with Kristen (almost
always a first goal). The second goal is to reduce overall _____to help her maintain
healthy daily functioning in all areas of life. Another goal is for Kristen to learn…
These goals are tied to several interventions. Below is a list of treatment
recommendations that will be of most help for Kristen. Employing a multidisciplinary
CASE STUDY TWO 16
approach of the biological, psychological, social, and spiritual aspects should help
promote healing.
1. Xxx (cite sources for each treatment option offered)
2. Xxx
3. Xxx
4. Xxx
B. Based on my clinical judgement, the factors that would indicate improvement is when
Kristen…
