Psychology

Summary of Bens History
Ben is a 52-year old male working for a postal company for 22 years. Ben was an only child. His father, a janitor, died when he was 18, while his mother was a homemaker. Ben got lots of attention from them, but claims that they were  different and weird  like him. He even mentions that his aunt was institutionalized several times. Ben is unmarried and never developed permanent relationships with women because making social advances with them is a thing that he avoids. However, he fulfills his sexual needs with the use of prostitutes. Ben directs his energy into walking every night for at least five hours. Ben attends church and participates in community activities though others find him a bit  odd.

Despite this, they have appreciated Ben and find no problems with him. However, for the past two years, Bens co-workers noticed a gradual change in him. His social interactions is inappropriate and confused Ben smiles when angry, and feels agitated and distressed when others are happy. One day, when Ben makes a delivery for a store, he accidentally hands a box over a pedestrian on the street, saying that  This is a gift from Jesus -- please keep it with you always.  Ben is unable to recall the incident the following day. Soon after, Bens co-workers teases him, weakening his self-esteem and ability to perform well. Since then, Ben is cautious to avoid errors he routinely double-checks the deliveries in every stores and confirms that the right box is delivered. Ben admits that sometimes he hears voices telling him that he is making an error.

Ben also spends spare time watching TV and building plastic military models. For the past six months, Ben has been cautious. At night, he double checks the locks on his house, saying that his neighbors dislike him and want to break into his house. To avoid potential threatening phone calls, Ben disconnects his telephone line. He also stopped walking recently and claims that the streets are dangerous. Ben insists that he suffers from liver cirrhosis, although medical tests prove negative. He claims that he can feel his liver rotting inside his body - a thought that seem to originate after watching a TV program regarding alcohol side effects.

Diagnosis
Based from the diagnostic criteria of DSM-IV-TR, Ben has a paranoid schizophrenia, a common type of schizophrenia (Axis I). For a person to be diagnosed with schizophrenia, heshe must exhibit at least two of the following symptoms catatonic behavior, negative symptoms, grossly disorganized, delusions, disorganized speech or hallucinations (APA Diagnostic Classification, n.d.). The disturbances in thought processes and behavior should last for six months, and each symptoms should be displayed for a period of one month. However, the APA Diagnostic Classification (n.d.) claimed that if an individual has recurring auditory hallucinations or strongly held delusions, it is enough to make the diagnosis.

People with paranoid schizophrenia, on the other hand, experiences auditory hallucinations and delusions, while other symptoms are not prominent. Ben has auditory hallucinations since he hears celebrity voices telling him he is commuting errors. According to Leo  Chiu (1989), hallucination is a perception that appear when internal events are mistakenly perceived by an individual as an external one. Aside from hallucinations, Ben is also seen to have delusions, including persecution and grandeur. Bens delusion of grandeur are evident when he said to a pedestrian This is a gift from Jesus -- please keep it with you always, and when he avoided several events that he thought was threatening showed his delusions of persecution. According to Morrison  Baker, (2000) Delusion of persecution is the result of an individuals inability to comprehend with others, and thus, thinking that others want to harm himher. Accordingly, when delusions are strongly held by an individual, it can already confirm a diagnosis of paranoid schizophrenia (Morrison  Baker, 2000). Another form of delusion that Ben manifests is somatic delusion, which is evident when he said that he is suffering from liver cirrhosis. Somatic delusions is a false perception of having strange occurrencesperceptions toin the body. However, in cases such as paranoid schizophrenia, somatic types of delusions are not as prevalent as grandeur and persecution (Morimoto et al., 2002).

Aside from paranoid schizophrenia, Ben can also be diagnosed with SPD or schizotypal personality disorder. SPD belongs to Axis II of the DSM-IV-TR multiaxial system. As stated in the APA Diagnostic classification (n.d.), SPD has a diagnostic criteria including ideas of reference, odd beliefsmagical thinking with effect on behavior, odd speech and thinking, unusual perceptual experience, odd appearance, flat inappropriate affect, excessive social anxiety and lack of primary support group.

Taking a look at Bens history, he had problems in building relationships with the opposite sex. He also has an odd behavior as stated by his neighbors. Ben even claimed that he and his parents was  weird and different.  In regards to having inappropriate affect and ideas of reference, Ben, according to his co-workers,  smiles when angry, and feels distressed and agitated when everyone is happy.  Bens social interactions are also confused and inappropriate, indicating ideas of reference.

There are many similarities in the symptoms of paranoid schizophrenia and SPD. In a study conducted by Bergman et al., (1996), the subjective experiences of individuals with SPD and schizophrenia are similar in many ways, but there are some inconsistencies and differences between the two. In Bens case, his ideas of reference are associated with delusion of persecution   a criteria that does not belong to SPD (Bergman et al., 1996).  Also, SPD symptoms do not occur when episodes of schizophrenia is present (APA Diagnostic Criteria, 2000). Bergman et al. (1996) stated that the onset of SPD appears during childhood, while Bens symptoms appeared during middle adulthood. Although Ben had a difficult time with women, his ability to interact with others can be positive. His neighbors did not report any problems with him, and he was also active in church and community programs.  Therefore, Ben cannot be diagnosed with SPD since he do not manifest excessive negativism, odd speech and thinking, and immobility. In addition, Ben is positive of delusions of persecution and grandeur, and auditory and somatic hallucinations.

With regards to Axis III of the DSM-IV-TR, also known as the acute physical disorders and medical symptoms (APA Diagnostic Classification, n.d.), Ben cannot be diagnosed in this criteria. This can be evident when the medical results revealed that his liver is normal, although he insists of having liver cirrhosis.

For Axis IV, or the psychosocial and environmental  problems contributing to the disorder, there were no definite problems presented by Ben. Also, it was not mentioned in Bens history if he is living with some friends or relatives. On the other hand, Ben said that he was an only child, unmarried, and that his father died when he was 18. With these factors, it can be considered that the lack of support from primary groups (eg. friends, relatives, parents) may have contributed to the occurrence of Bens paranoid schizophrenia.

Brief summary of Bens case based from DSM-IV-TR diagnostic criteria
On Axis I, it was evident that Ben suffers from schizophrenia, particularly paranoid subtype. Ben does not fit in Axis II, though his alternative diagnosis can be SPD. Also, Ben cannot be  diagnosed in Axis III, and it was proven with his medical results. With regards to Axis IV, lack of support from primary groups can be considered.

Treatment
Two forms of treatment for paranoid schizophrenia appropriate for Ben are biological therapy and cognitive behavioral therapy (CBT).

Biological therapy uses pharmacological drugs, particularly antipsychotic drugs for schizophrenia. Two types of antipsychotic drugs are first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) (Jones, et al., 2006). FGAs, such as chlorpromazine and haloperidol, are known to treat positive and negative symptoms, but has adverse effects like extrapyramidal symptoms (EPS) and sedation. SGAs (eg. Clozapine), on the other hand, are more prescribed than FGAs since it has little or no known adverse effects, but is more expensive than FGAs (Jones, et al., 2006).

SGAs can be prescribed for Ben since it treats positive and negative symptoms of schizophrenia with no adverse effects. Ben shows positive symptoms (hallucinations and delusions), but his financial income should also be considered before the prescription of SGAs because it is said in the history that Ben worked as a postal company driver for 22 years. Although it is not said if he had allergic reactions to certain type of drugs, his medical history should be assessed prior to the prescription. In a certain study (Falkai et al., 2006), it is said that patients with schizophrenia must adhere to the biological treatment regimen given to himher since non-compliance may aggravate the condition. Therefore, Ben must follow the treatment plan after the prescription of SGAs to him.

Another form of treatment advisable to Ben is the CBT, which is used to treat positive symptoms (hallucinations and delusion) as well as improve social functioning and self-esteem (Turkington et al., 2006). According to recent studies, CBT along with antipsychotic drugs, is now considered as an appropriate treatment regimen for schizophrenia (Turkington et al., 2006). It is obvious that Ben has delusions and auditory hallucinations, and his social functioning and self-esteem was also aggravated after a particular incident in his job. Therefore, CBT combined with antipsychotics (SGAs) is the best treatment regiment for him.