MULTI AXIAL EVALUATION

BY GROUP 2

CASE

Patient MN is a 28 year old male with a

longstanding history of social isolation, academic
problems and temper outbursts, began to develop
concerns that his 54 year old mother is poisoning
his food. The patients family history is negative
for mental and psychiatric disorders but positive
for a brother with cerebral palsy and mental
retardation. Over the next year, his symptoms
progressed with increased suspiciousness and
fearfulness.

He used to work in a supermarket and was

reported to have argued with his store manager
because according to him the store manager kept
on monitoring him and even installed hidden
video cameras in the store just to see if he is
doing his job properly. He would usually wear cap
and a sun glasses during work because he wants
to hide himself from the cameras.

He started to hear voices saying that he was no

good and should stop working. He became
agitated at work and gets infuriated if customers
start to ask him and began talking strangely to
customers that they too were being monitored
and being followed by the manager and they
should also wear something to hide their identity.
A week after their argument, he was laid off from
his job because of constant arguing with the
manager.

At home, he keeps on complaining that their food

had a strange smell and refuse to eat the food
that his mother prepared. His parents also
observed bizarre behavior, including talking and
yelling to himself, perseverating that his store
manager had been following him even at home
and that his parents are trying to poison and kill
him because he was no good and his parents
would want only to take care of his sick brother .

Patient is a smoker and an occasional drinker but

is negative for substance abuse. His bizarre
behavior exacerbated that he no longer eat nor
drink.

Developmentally, Patient MN is a product of a

full-term pregnancy. No developmental delayed
was noticed. As a young child and an adolescent,
he tended to be quiet and socially awkward. He
doesnt associate with other people and has no
history of dating. He repeated 8th grade and had
a difficulty catching up with their lessons at
school. He eventually asked his parents that he
would like to stop studying, didnt finished ninth
grade and just work.

He has no medical problems and his immunizations were up to

date according to his mother.
He was then brought to the nearest hospital because he refuse
to eat and drink.
Upon initial assessment, no expression nor emotion can be seen
in his face when you try to talk to him and his voice seems
monotonic while crossing his hand over his chest. He only
replies to the question being asked. He was wearing a dirty
sweatshirt and a baseball cap on day with oily hair almost
touching his shoulders. His eyes were sunken and lips were
cracking which are obvious signs that the patient was really
dehydrated. He cant maintain eye to eye contact with the
interviewer and seemed like his eyes were observing the place.
His mother decided to confine him the hospital for further
assessment and management.

SCHIZOPHRENIA

It is a group of disorders with heterogenous

etiologies and it includes patients whose clinical
presentations, treatment response and courses of
illness vary.

SCHIZOPHRENIA

Signs and symptoms are variable which includes

changes in:
Perception
Emotion
Cognition
Thinking and
Behavior

SCHIZOPHRENIA
Now referred to as SCHIZOPHRENIA
SPECTRUM.
Schizophrenia spectrum and other psychotic
disorders include shcizophrenia, other psychotic
disorders and schizotypal (personality) disorder.
They are defined by abnormalities in one or more
of the following five domains: delusions,
hallucinations, disorganized thinking (speech),
grossly disorganized or abnormal motor behavior
(including catatonia) and negative symptoms.

SCHIZOPHRENIA
DSMIV-TR FIVE SUBTYPES:
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual

SCHIZOPHRENIA
DSM-5 no longer uses these subtypes but they are
listed in the 10th revision of ICD.

MULTIAXIAL EVALUATION
Multi axial evaluation is no longer used in DSM5.
DSM-5 moved to a nonaxial evaluation. They
combined the former Axes I, II, III, with separate
notaions for psychosocial and contextual factors
(AXIS IV) and disability (AXIS V).

MULTIAXIAL EVALUATION
F20.9 Schizophrenia
F22 - Delusional Disorder
Axis II
F60.0 - Paranoid Personality Disorder
Social isolation as defense
mechanism
Axis III
NONE

Axis I

MULTIAXIAL EVALUATION
Axis IV Unable to finish 9th grade,
Sick Brother,
Unemployment
Axis V SAPS score-94

SANS score-85

NON AXIAL EVALUATION

F20.9 Schizophrenia with F22 Delusional

disorder; F60 Paranoid Personality Disorder,
Social isolation as defense mechanism related to
sick brother, unable to finish the ninth grade and
recent unemployment.