Something to his neighbor. The doctor focuses on

Something different
was probably happening around this event, and careful detailing of the
experience might reconstruct the link between symptoms, assault, stress, and
personal history. Highlighting the emergence of stress and personal history in
the elaborated story can possibly help Mr. Simpson “normalize” the
experience and take some personal responsibility for it.

The
process will highlight the patient’s rational capacities and strengths which
will show, it provides models for successful coping in the future, and it does
so without getting into contentious debates about the “reality” of
the patient’s experiences.
! J% n/ ( r% b1 J% IMr.
Simpson, situation might be harder to focus on the event bringing him into
treatment because of his recent assault of the elderly neighbor who operated
one of the “voice machines.” Despite countless days and nights filled
with harassing voices and plots, he lost control only this once.

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The
doctor will remain nonjudgmental and focused on how the patient successfully
coped with his delusional and hallucinatory “experiences” in his
everyday life for the last 5 years. These experiences are not labeled as
psychotic but are dealt with as real enough to Mr. Simpson that he probably
struggled many times to keep from doing what he ultimately did to his neighbor.
The doctor focuses on the times Mr. Simpson was successful in that struggle and
what he did to achieve that control.

Mr.
Simpson may not see his delusions and hallucinations as a problem, but no
matter how intensely paranoid he may be about the police, unlike his other
persecutors, they are real. His major problem is not being able to have the
will to get better completely. He doesn’t seem to have the will to take
medication because when he seems to do well he stops taking his medication
again after being released from the hospital. I’m still unaware if his body has
become “resistant” to received various antipsychotic drugs but, if so, he
should go and get extra help.
3 H, i! W$ L” o3 V$ {: `0 v7 {! n            The process of engagement is often
hard, unrewarding, and sometimes scary. The latter, especially, should never be
ignored. The aggressive patient requires great care and some experience for
one-to-one interactions to be safe. The maintenance of mutual respect,
firmness, and an undistorted awareness of one’s own anxiety are all strongly
recommended. Limit setting, ranging from verbal remonstrance to meeting in the
presence of readily available help, to the use of restraints, to timely
termination of a volatile session, can be instituted as the situation dictates.
If Mr. Simpson takes up the offer, an opening into his life and experiences may
be created.

On the
other hand, there are two positive prognostic elements about Mr. Simpson, his
law degree and his affect are still intact. He has a few negative symptoms that
a schizophrenia patient would have such as, lack of motivation, negative
thoughts such as suicide, and poverty of speech. Regardless, of Mr. Simpson’s
illness he seems to live an organized life. He also seems to be alone most of
the time but, mentally not so alone because of the delusions and hallucinations
he has. He probably denies responsibility for the precipitating assault, but,
his behavior has added a real problem to his delusional ones, and it could be
the key to “locking” him into an adequate trial of treatment for the
first time in his life.

Mr.
Simpson’s overall prognostic potential is slim if the goal is symptomatic and
functional recovery. His expected future course is likely to be an extension of
his course over the last 20 years. Mr. Simpson assaulting an elderly female
neighbor might signal further deterioration. If deterioration continues, his
prospects for living outside of a long-stay asylum or jail will diminish
drastically. On the other hand, the past 5 years have seen only one
hospitalization, suggesting that his disorder could be mellowing. ” R- F” r5 Y# e’ V! oThis
means the patient’s clinical history, symptoms, and severe functional deficits
leave little doubt as to the diagnosis of Paranoid Personality Disorder
(premorbid) with schizophrenia, and there are no reasonable differential
diagnostic entities to consider as he has not been free of psychotic symptoms
for many years.

2 N& i( r. l$ e# J1 c: b+ j8 kMr.
Simpson is a very stubborn paranoid patient that has become one of the most
challenging persons any psychiatrist will ever treat. Mr. Simpson has been
hospitalized 12 times, the longest stay being 8 months.  During the hospitalizations he has received
various antipsychotic drugs. Although outpatient medication has been
prescribed, he usually stops taking it shortly after leaving the hospital. The
patient’s symptoms are continuous, and his deficits in reality testing are
particularly severe. He is totally disabled functionally with regard to work
and social interactions. After 20 years of active psychosis and 12
hospitalizations.4 D+ 4 g+ ?; v&
`” m

 After that, 2 S. y1 e) O& ~. Q& E* XMr. Simpson got a job as
an investment counselor at a bank, which he held for 7 months. However, he was
receiving an increasing number of distracting “signals” from
co-workers, and he became more and more suspicious and withdrawn. It was at
this time that he first reported hearing voices. He was eventually fired and
soon thereafter was hospitalized for the first time, at age 24. He has not
worked since. This event helps the diagnosis to be confirmed by the marked
disturbance in his work and social functioning and the absence of a sustained
mood disturbance or a general medical condition or use of a substance that can
account for the disturbance.) ) V: ?+
@3 Y7 % P/ i6 R / S) |3 w6 f2
s6 V$ x4 p’ uAll of Mr. Simpson’s delusions and hallucinations seem to
involve the single theme of a conspiracy to harass him. 

Throughout
the years, his delusions have become increasingly complex and bizarre when his
thoughts about his neighbors being actually actors increased. He thought that his
thoughts were being monitored, and that a machine will give him erotic dreams
in his head especially about “black women.” In addition, he has prominent
hallucinations of different voices that harass him. 9 M’ ^4 Y  e* n% Y  E1 Mr. Simpson
symptoms present de, s- P: H: Y7 flusions
and prominent hallucinations which are the characteristic of psychotic symptoms
of Schizophrenia in the DSM 5 criteria. He clearly shows that his academic
performance in school declined dramatically, and he was asked to leave and seek
psychiatric care which he didn’t because he probably believed he was fine.

Another
example, is when a girl he was dating broke off the relationship with him, he
believed that she had been “replaced” by a look-alike. He called the
police and asked for their help to solve the “kidnapping.” According
to the DSM 5 criteria of Paranoid disorder, this means Mr. Simpson suspects
without sufficient basis, that others want to make fun of him, deceive and is
very preoccupied about loyalty with people he knows.

Based
on Mr. Ben Simpson case it states he is a single, unemployed, 44-year-old
Caucasian man brought to the emergency room by the police for striking an
elderly woman in his apartment building. In my perspective, Mr. Simpson should
be diagnosed with Paranoid Personality Disorder (premorbid) with schizophrenia subtype
because, his symptoms apparently began with hallucination and when he was the
age of 22 during his first year of law school. Mr. Simpson developed distrust
and suspiciousness of others because of his hallucinations. For example, he
gradually became more and more convinced that his classmates were making fun of
him because, he noticed that they would snort and sneeze whenever he entered
the classroom.