Question

Brian is a 26-year-old male who has received psychiatric care for the last 7 years. At the time that he initially began treatment, his mother took him to the emergency room because he was extremely agitated and was talking to voices that only he could hear. He was also convinced that an old enemy from high school was spying on him and plotting to poison the well that his family used for drinking water. According to his mother, Brian had been showing these behaviors and concerns for the last couple of months, but they had gotten considerably worse over the previous week. She also noted that in the preceding months, Brian had been less and less likely to spend time with his friends, or with her.

Over the last year, Brian had been much better; however, he does still continue to hear voices a couple of times a day. He also developed exaggerated worries that he may have contracted the HIV/AIDS virus and that his mother may be planning to harm him in some way. These thoughts are extremely distressing to him, and he reports that he spends the majority of the day thinking about these possibilities. He also notes that because of these thoughts, he has felt quite down and blue. He has not been eating very much and has been sleeping more than usual. He also states that he feels like he has had less energy over the last year and that it has been difficult to concentrate on anything other than his bothersome thoughts. He says that the only thing that helps to calm him is drinking beer in the late afternoons and evenings. He reports that he will typically have a 6-9 beers before falling asleep. Brian would like to cut down on his drinking, but the few times that he has tried, he became shaky and irritable and found himself drinking again to stop these symptoms.  
Brian reports having very few friends but does recognize his mother as a supportive figure in his life. The majority of his time is spent at home watching television; however, he was recently hired to help maintain the grounds of his mobile home community over the weekends. He hopes that this job will help him fill his time and serve as a first step toward gaining full time employment.

Using the DSM-5 system, give Brian a diagnosis.

In no more than 5 sentences, describe how a cognitive behavioral therapist would treat Brian’s primary psychological disturbance.

Answer 1

Based the DSM-5 system, as Brian is having; Delusions; Hallucinations, Disorganized thinking and extremely disorganized or abnormal behavior, his diagnosis should be; Schizophrenia.

Cognitive behavioral therapy for schizophrenia procedure outline includes;

1.     Developing a therapeutic alliance that is based on the patient’s perspective

2.     Developing an alternative explanation of the symptoms of schizophrenia

3.     Reducing the impact of both the positive and negative symptoms

4.     Offering alternatives to the medical model for addressing medication adherence