Capella PSY6210 Case Study of Ben Psychotic Disorder Part 3 Review

Case Study of Ben (Part One)

Ben is a 46-year-old computer scientist at a large university. In recent weeks, his wife has noticed that he has been "different." He is being seen on your service at the local hospital, where you are asked to evaluate him.

Ben is a hostile interviewee. He does not want to talk to you, and has made it clear that he is here against his will. In recent weeks, according to his wife, Cindy, he has been moody, irritable, and increasingly inappropriate in his actions and comments. For instance, Cindy tells you that last Friday night at a neighborhood party, he went up to an attractive young neighbor and, after asking if she was having as good a time as he was, put his hand on her breast. She reacted furiously, and Ben seemed surprised at her reaction. The young woman's husband pushed Ben away, and Ben became furious and struck the man. Cindy is embarrassed and says Ben has never been like this before now. In the past, she says, he has always been kind and respectful, "even a little shy."

Yesterday morning, Ben began to eat his breakfast cereal with his fingers. Cindy says he left for work much later than usual and seemed to be having a hard time organizing his briefcase, his keys, and so on. "Lately, he has been making all kinds of plans and then just not following through on them, which is so unlike him. He has always been real careful, real well-organized, and when Ben makes plans, he always keeps them." But yesterday, after Ben left the car running in the driveway and took the bus to work, Cindy became alarmed. She called their family doctor, who sent Ben to the hospital for this evaluation.

Cindy says nothing has happened to Ben that might explain his change. Ben admits he has had lots of work stress lately, "because of my goddamn boss's stupidity." He is surly. He snaps at his wife, "What do you mean, nothing has happened? You idiot, what about that asshole boss of mine?" His wife is embarrassed at his crude language. When you ask Ben if anything else has gone wrong lately that might explain his irritability, he snaps, "Isn’t that  enough?" but then considers the question. He starts to speak, then seems distracted by something on your bookshelf and shrugs his answer off.

Cindy mentions that about six months ago, Ben was in an auto accident in which his car rear-ended the vehicle in front of him. Ben, who was a passenger, hit his head on the rear-view mirror. Ben was taken to the emergency room for an X-ray, which had negative findings. Cindy was instructed to monitor him for 24 to 48 hours for any signs of brain injury, but nothing appeared. Other than a slight headache, Ben was his normal self the next day. The irritability and erratic behavior did not start until about five days ago, nearly six and a half months after the accident. No other traumas were noted.

Ben works 50 hours a week for a software company, earning about $130,000 per year. He has always had excellent reviews and never missed a promotion. He is close friends with many coworkers and always had a lot of friends. He is still close with a number of his high school and college friends, and frequently calls old neighbors on the telephone. "Everybody likes Ben,” says Cindy. “That is why I was so shocked by what he did last Friday and by how he’s started swearing and acting so . . . gross.”

Cindy and Ben met and married about 23 years ago. It is the first marriage for both of them, and Cindy says it has always been a good marriage. "We had some fights a few years ago, a kind of rough spot. Everybody goes through that. I think Ben got a bit over involved with one of the women at work, but we got through that okay. That was maybe 10, 11 years ago." Ben laughs and says, "Over involved? I wish I'd a stuck it to her, goddamn it! She was something!" His tone is lecherous.

Cindy says there has never been any separations or talk of divorce. "Nothing was ever that troubling; just a few arguments," she says. Their sex life has always been fine, and they have "lots of fun" when they go out together, which they have done weekly, until last Friday.

Ben did very well in high school and college, earning nearly straight As and a spot on the Dean's list nine times in college. He graduated with honors and landed the best job out of anyone in his class. His parents are still alive, living in Arizona. Neither is in great health, but there is nothing seriously wrong. Ben and Cindy travel to Phoenix to see them twice a year and everyone gets along well. Cindy says she has heard no particularly bad stories about Ben's childhood, and he agrees. He is still close with his only brother, who is three years older. At this point, Ben stands up and asks you who you are and why you are here. You explain, and he seems relieved. He had seemed slightly anxious. You inquire, but he waves you off.

Cindy says Ben had had a couple of glasses of wine at the party, but he has not had a drink since Friday night. Usually, he drinks two or three glasses of wine on a weekend, and perhaps one glass each evening with dinner. He has never had a drinking problem, according to Cindy. Ben refuses to answer, but a check of his medical records later confirms Cindy's information.

Ben also has had a remarkably healthy life. Except for a tonsillectomy when he was nine and the surgical removal of an impacted wisdom tooth, Ben has had no injuries, no illnesses, and no accidents resulting in any health problems. He takes no medication, not even aspirin. He does not get headaches. He is not overweight; in fact, he jogs four miles each day and feels in good health, he says. He smirks briefly at you and says, "You could use a few miles a day, Doc.” When Cindy reacts, he snaps at her, "Oh, get with it, baby!"

 

 

Case Study of Ben, Part Three

Instructions: Respond to the discussion in u07d2 for this scenario separately. DO NOT MIX THE SCENARIOS OF Ben Part 2 and Ben, Part 3.  When you respond to this scenario, assume that you never saw Ben, Part 2.

Part 3

You ponder the case of Ben, and conclude that you have more questions than answers. You again interview Ben and his spouse. In the course of this second interview, you learn the following:

•             Cindy has spoken to Ben's siblings and learned that Ben had an episode like this while in college. His behavior was erratic and peculiar, and he eventually assaulted his college roommate, believing that the roommate worked for the KGB. It took about eight months for the situation to go from initial symptoms to the assault, and the symptoms escalated rapidly toward the end. Ben was placed on some type of medication by the college psychiatrist, but since Ben would not discuss it, the siblings knew no more. They reassured her that, "Oh, Ben is just fine. It was growing pains at college, being away from home for the first time." The siblings stated there was no mental illness in the family, except for Uncle Mo, who "had a little case of the nerves." Cindy later learned that Uncle Mo died in a state hospital for the mentally ill, where he had spent 14 years.

•             In retrospect, Cindy says that early in their marriage, Ben had a huge fight with his department head, whom Ben believed was plagiarizing his work. They moved across country for another job as a result. Ben triumphantly told her that he had evidence of the plagiarism when the last two articles both of them had published began with the same letter of the alphabet.

•             Cindy recently came across some journals Ben had been keeping. She was troubled by them, but decided not to bring them to the interview, because "so much of it was nonsensical. How could it be useful?"

•             Finally, Ben and his wife both confirmed that after the accident, all the medical tests suggested by the physician were run, and the physician concluded that Ben suffered no medical effects from the accident. They bring the medical reports, including reports of various brain scans, which document this.

 

 

Review the Case Study of Ben, Part 3. Imagine now that you had not seen Part 2 but instead, after Ben Part 1, you read Part 3. For your initial post in this discussion, submit your response to these questions:

Describe how the new information alters the picture presented in the original case study. Before posting, you might want to review Ben Part 1, the case you discussed last week (u06d2).

Describe your new diagnostic hypotheses, and justify your conclusions.

What further diagnostic evaluation do you believe is warranted?

Book:

Pearson Education. (2017). MyPsychLab for abnormal psychology (17th ed.) [Access card]. Boston, MA. Pearson. ISBN: 9781323615799.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSMâ?5 criteria. Journal of Traumatic Stress, 26(5), 537–547.

Koerner, K., Kohlenberg, R. J., & Parker, C. R. (1996). Diagnosis of personality disorder: A radical behavioral alternative. Journal of Consulting and Clinical Psychology, 64(6), 1169–1176.