Case Presentation

Course: Clinical Psychology

Presented by: Noor Ul Huda
Presented to: Ma’am Sarah Anthony
 Summary
• 55 years old
• Admission to F.H almost 20 years ago
• Been readmitted back and forth.
• Assessed for grandiosity, suspiciousness, aggression, irritability, excessive
consumption of smokes and junk food.
• High probability of 297.1 (F22) Delusional Disorder, Severe.
• The lifetime prevalence is 0.2%
 Identifying Data

Name: M.A.
Age: 55 years
Sex Male
No of siblings 6
Birth order 3rd
Family system: Joint
No. of Sessions: 3
Initial Date Seen: 25th-April-2019
Last Date Seen 2nd-May-2019
 Source and Reason for Referral

• Fountain House Rehabilitation Center

• Provisional formulation- devise a management plan.
Presenting Complaints
 Brief History
• 20 years ago.
• Excessive smoking, consumption of junk food
• Uncontrolled aggression
• Diabetes mellitus in 2000.
• Self Talk and Self Laugh
• Paranoid and suspicious
• Speech became irrelevant and deviated from the reality.
• Delusions of Grandiosity
• Wife refused to live with him.
 Personal, Family, Sexual History

• Long history of treatment

• Shared memories from childhood of friends and
family
• Manifestation of guilt due to impulsivity
• Interested in drawing
• Avoided questions regarding sexual history
 Provisional Formulation
• Delusional Disorder on the basis of delusions of grandiosity and persecution
while hallucinations are absent.
 Assessment

Behavioural Clinical
MSE (BABS) (Y-BOCS)
Observation Interview

Frequency Rapport To rule out

Behavioural Delusionality
& Intensity Building OCD

Baseline
Corroboratin Cognitive
pre Client’s Reliable
g Functionin
interventio Information Insight Score
g
n
 Case Formulation

Delusional
Disorder

Genetic Cognitive

Psychodynamic
 Case Formulation
• Genetic: Cummings (1985) notes that a range of neurological circumstances can
induce psychosis are particularly those that affect the limbic system, temporal lobe,
caudate nucleus. He also states that dopaminergic excess or reduced cholinergic
activity also predispose to psychosis. Moreover, limbic dysfunctions lead to
inappropriate perception and paranoid delusion formation.
• Psychodynamic: Avoidances can be tied to the psychodynamic perspective
indicating that the client has repressed feelings. His excessive consumption of
smoking and junk food are indicative of a fixation in oral stage. Oral personalities
are more likely to engage in oral behaviours (Barlow, Durand, & Stewart, 2009)
• Cognitive: Maher (1974) offers a cognitive account of delusions which
emphasized disturbances of perception. He proposed that a delusional
individual suffers from primary perceptual abnormalities, seeks an
explanation which is then developed through normal cognitive mechanism,
the explanation (i.e. the delusion) is derived by a process of reasoning that is
entirely normal.
 Proposed Management
• Psycho-education
• Free Association
• Cognitive Behavioural Therapy
• Token Economy
 Expected Outcome
• Family will be more understanding and supportive
• Client’s consciousness and avoidance
• Stress management resulting from delusional beliefs
• Change maladaptive thought patterns
• Self-control over urge to smoke and consume junk food.

• American Psychiatric Association. • Goodman, W. K., Price, L. H.,
(2013). Diagnostic and statistical
manual of mental disorders (5th ed.).
Arlington, VA: Author.
• Barlow, D. H., Durand, V. M., & Stewart,
S. H. (2009). Abnormal psychology:
An integrative approach. Toronto:
Nelson Education
• Cummings, J. L (1985) Clinical
Neuropsychiatry. New York, Grune
and Stratton.
• Eisen, J.L., Phillips, K. A., Baer, L. &
Beer, D. A. (1998) The Brown
Assessment of Beliefs Scale:
Reliability and validity. American Journal
of Psychiatry. 155, 102 108.
References
Rasmussen, S. A., Mazure, C.,
Fleischmann, R. L., Hill, C. L.,
Heninger, G. R. & Charney, D. S.
(1989a). The Yale- Brown
ObsessiveCompulsive Scale. I.
Development, use, and reliability.
Archives of General Psychiatry, 46,
1006-1011.
• Maher B.A.( 1984) Delusional thinking
and perceptual disorder. Journal of •
Individual Psychology. 30, 98–113.
• Oconnor, K., Stip, E., Pélissier, M.,
Aardema, F., Guay, S., Gaudette, G., . .
. Leblanc, V. (2007). Treating
Delusional Disorder: A Comparison
of Cognitive-Behavioural Therapy
and Attention Placebo Control. The
Canadian Journal of Psychiatry, 52(3),
182-190.
doi:10.1177/070674370705200310
• Paris, J. (1996). Social Factors in the
Personality Disorders. A Biopsychosocial
Approach to Etiology and Treatment.
Cambridge, UK: Cambridge
University Press.
Wincze, J. P., Leitenberg, H., & Agras, W.
S. (1972). The effects of token
reinforcement and feedback on the
delusional verbal behavior of chronic
paranoid schizophrenics. Journal of
applied behavior analysis, 5(3), 247–262.
doi:10.1901/jaba.1972.5-247
Thankyou for your attention. House is open for
discussion.