Case Study 5: Bryant

Ritualistic behavior - repetitive actions or mental acts that can be characterized by rigidity, stereotypy,
and a lack of rational motivation. (Checking a door multiple times to ensure it's locked, repeatedly
washing or cleaning, having a specific way of making coffee)

Depression - a mood disorder that causes a persistent feeling of sadness and loss of interest

Distrust - to have no confidence in someone or something

Obsessive Compulsive Disorder - is a mental and behavioral disorder in which an individual has intrusive
thoughts and feels the need to perform certain routines repeatedly to relieve the distress caused by the
obsession, to the extent where it impairs general function.

Psychotic symptoms: two weeks

 Disorganized thoughts - A thought disorder is a disturbance in cognition which affects language,

thought and communication.
 Delusion of control - a false belief that another person, group of people, or external force
controls a person's thoughts, feelings, impulses, or behaviors.

Note: not receiving any treatment (not medication or substance)

Treatment course:

 Catatonic Stupor - the person can't move, speak, or respond to stimuli.

 Respiratory infection (blood test and chest x ray) – Blood test, A painless imaging test that
shows the structure of the lungs and heart. Chest x ray, for bacteria and viruses, or to see if your
immune system is fighting an infection.

To treat psychotic symptoms:

 Risperidone - Risperidone, sold under the brand name Risperdal among others, is an atypical
antipsychotic used to treat schizophrenia and bipolar disorder, as well as irritability associated
with autism. It is taken either by mouth or by injection. The injectable versions are long-acting
and last for 2–4 weeks.
 MECT (modified electroconvulsive therapy) - a psychiatric treatment that involves passing a
small electric charge through the brain to trigger a seizure. It's often used to treat schizophrenia
and bipolar disorder, and can also be used as a supplement to antipsychotic treatment.
 Ceftriaxone - treatment of bacterial infections in various locations, such as in the respiratory
tract, skin, soft tissue, and urinary tract.
Case Study 5: Bryant

Thirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors,

depression, and distrust. At the time of admission, prominent ritualistic behaviors and
depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder ( OCD).
Shortly after, psychotic symptoms such as disorganized thoughts and delusion of control were
noticeable. He told the doctors he has not been receiving any treatment, was not on any
substance or medication, and has been experiencing these symptoms for about two weeks.
Throughout the course of his treatment, the doctors noticed that he developed a catatonic
stupor and a respiratory infection, which was identified by respiratory symptoms, blood tests,
and a chest X-ray. To treat the psychotic symptoms, catatonic stupor, and respiratory infection,
risperidone, MECT, and ceftriaxone (antibiotic) were administered, and these therapies proved
to be dramatically effective.

WHAT TO DO:
1. Enumerate all the symptoms of psychopathology that you have noted in the case
presented.
 Prominent ritualistic behaviors ( compulsions)
 Depression
 Distrust
 Delusion of control
 Catatonic stupor
2. Identify a possible/probable diagnosis based on the symptoms manifested.
 Schizoaffective disoder
-Psychotic symptoms for atleast 2 weeks
-Period of mood episode (Depression)
 Comorbidity
 OCD
 Respiratory Infection
 Catatonic stupor

Explanation: The client experienced psychotic symptoms, such as disorganized thoughts and
delusions of control, for about two weeks. The client also presents symptoms of depression,
distrust, and ritualistic behaviors. Clients with schizoaffective disorder have an increased
comorbidity rate for developing anxiety-related disorders, specifically obsessive-compulsive
disorder, which is why the clinicians' initial diagnosis was obsessive-compulsive disorder.
Additionally, the client has also developed a respiratory infection, which can also be a
comorbidity of this disorder.

3. Come up with a psychological assessment plan, List all the psychological tests and
assessment procedures that you are going to employ. Explain your answer.

Psychological Assessment procedures that we are going to employ to evaluate Bryant mental
health are the Following:
Assessment Briefing
 To evaluate the severity of Bryant’s symptoms, understand mental health history, and
most importantly to inform treatment planning.
History Taking
 To gather medical history and present medical conditions
  familial medical history
Clinical Interview/ Clinical Assessment
 Reason for referral
 To gather comprehensive history and current symptoms, and any previous psychiatric
treatments of the client.
Mental Status Examination
 To assess the cognitive functioning, appearance, mood and affect, thought processes,
behavior, thought content, and perceptual disturbances of the client.
Behavioral Assessment/ Observational assessment
 It is important to directly observe the client's behavior to evaluate his engagement,
response to stimuli and any catatonic behaviors.
Cognitive Assessment
 Help to identify any potential deficits that could complicate the treatment.

Psychological Tests:
Personality Test
 Minnesota Multiphasic Personality Inventory (MMPI): This is a widely used objective
personality test that assesses a range of psychological constructs, including clinical
scales related to depression, anxiety, paranoia, and other relevant symptoms. It can help
identify underlying personality traits and potential contributing factors to Bryant's
condition.

 NEO Personality Inventory (NEO PI-R): This test measures the "Big Five" personality
traits: Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and
Neuroticism. It can provide insights into Bryant's personality structure and how it might
influence his behavior and coping mechanisms.
Cognitive Test/Intelligence Test
 Wechsler Adult Intelligence Scale (WAIS): This test is designed to measure overall
intellectual ability and cognitive functioning. It can help assess Bryant's cognitive
strengths and weaknesses, which could be relevant to understanding his symptoms and
treatment response.
 Beck Depression Inventory (BDI): This is a self-report questionnaire that measures
the severity of depressive symptoms. It can help quantify the extent of Bryant's
depression and monitor his progress during treatment.
Projective Test
 Rorschach Inkblot Test: This test involves presenting ambiguous inkblots to the
individual and asking them to describe what they see. The responses are interpreted to
reveal underlying thoughts, feelings, and personality dynamics. This test can provide
insights into Bryant's unconscious processes and potential conflicts that might be
contributing to his symptoms.

Treatment Recommendation:
Considering Bryant's complicated presentation that includes schizoaffective disorder symptoms,
obsessive-compulsive tendencies, and a pulmonary infection, it would be prudent to implement
an all-inclusive approach to his mental health care. Below are some suggested
recommendations:

Pharmacotherapy
  Given that Bryant has shown a positive response to risperidone, it will be important to
continue titrating this antipsychotic as per the instructions of his treating psychiatrist.
Stabilization of psychotic symptoms with an antipsychotic agent, particularly risperidone,
is warranted. If depression persists, antidepressants will be introduced or adjusted. It is
important that these appointments be regular in order to monitor the efficacy of the
medication and avoid negative effects.

 Antidepressants: If depressive symptoms persist, consider introducing an antidepressant

after further evaluation. Selective serotonin reuptake inhibitors (SSRIs) can be effective
for both depression and OCD symptoms.

 Antibiotics (Ceftriaxone): Continue antibiotics as prescribed to treat the respiratory

infection, monitoring for full recovery and potential recurrence.

Psychotherapy
 Cognitive Behavioral Therapy:
This can help Bryant to understand and fight his obsessive thoughts and the compulsive
behaviors that come with them. A specific type, called Exposure and Response Prevention, may
also help in decreasing the severity of this symptom by teaching him how to cope with his
compulsions.

 Supportive Psychotherapy:
This aims at providing a contained and encouraging environment, where he is able to speak
about his anxiety and paranoid tendencies, allowing him to work on developing a therapeutic
alliance that will be helpful in processing his thoughts and feelings.

 Cognitive Rehabilitation Therapy:

In light of his cognitive deficits, which he has mostly presented as disorganized thoughts, CRT
will enhance cognitive processes such as attentional and memory skills and assist him in
performing his management techniques.

Behavioral Therapy
 Exposure and Response Prevention (ERP): This is specifically effective for OCD. Once
Bryant’s psychotic symptoms are stabilized, ERP can help him reduce ritualistic
behaviors gradually by exposing him to anxiety-provoking stimuli without engaging in
rituals.

Follow- up and Continue Monitoring

 It is recommended that follow-up sessions be scheduled on a regular basis in order to
evaluate Bryant’s degree and direction of progress, particularly with respect to his
reactions to medications and any relevant behavioral change. Ongoing assessments will
allow for the monitoring of his depression as well as psychotic symptoms and
compulsion management, ensuring treatment is responsive to his needs.
Assessment Debriefing
  To help Bryant understand the purpose and process of each test, setting clear
expectations and reducing anxiety. It builds a collaborative relationship by explaining
how each step contributes to his treatment, making him feel more informed and involved.
By addressing any questions or concerns upfront, the debriefing creates a supportive
environment that encourages his active engagement in the assessment process.

SUMMARY OF PSYCHOLOGICAL ASSESSMENT PLAN FOR BRYAN

1. Assessment Briefing
2. History Taking
3. Clinical Interview
4. Mental Status Examination
5. Observational Assessment
6. Psychological Test
7. Treatment Recommendation
8. Debriefing