Saint Joseph’s-Detroit Psychiatric Institute
Mathers, Marshall B. Dates of Evaluation: 5/19/2000
Case No: 43,518 5/20/2000
Building No.: 9
Admission Date: 5/23/2000 Date of Report: 5/21/2000
PURPOSE FOR EVALUATION
This is the first inpatient admission for this married, unemployed, white 27 year old male, who has nine years of formal education. He was admitted due to multiple psychotic features, persecutory delusions, multiple misanthropic and asocial tendencies, and possible depression. This current evaluation’s purpose is to screen for possible psychosis, asociality, misanthropy, persecution complex, possible paranoia and/or depression.
Tests administered are as follows:
Mental Status Examination
Review of Prior Medical Records
This patient participated in two and a half (2.5) hours worth of testing and a one and a half (1.5) hour long diagnostic interview. Tests were administered by Krystofv Czerwinski, M.S. and interpreted by Logan Chambers, M.A..
Mathers’s has encountered a multitude of family-related problems. His relationship with his mother is spiteful and damaged, he has murder fantasies about his wife, Kim, the uncle whom he was very close to died in 1991, and his father left the family when he was only two years old. The only positive relationship he seems to have is with his daughter, Hailey. However, Mathers is less concerned with being a good role model than he is simply protecting her. Mathers has little to no friends or people whom he relates to, and expresses discontent with many people, and mankind as a whole. He has no serious criminal offenses on his record, but has committed crimes such as burglary and domestic abuse-related assault and has threatened to murder various people over the course of time. Although it is unclear if he is racist, he is highly homophobic and misogynstic.
In addition to having an alcohol abuse problem, Mathers has openly admitted to seriously abusing hardcore intravenous and pill-shaped drugs. He has not attended drug and/or alcohol rehabilitation, and expresses no desire to.
Staff has, as a whole, noted that he has a negative demeanor. He has stated that he has no desire to be here, and has only grudgingly cooperated with all tests, interviews, and medication regiments. He is currently taking 9 mgs of Diazepam (Valium) three times per day, 20 mgs of Fluexotine (Prozac) and 25 mgs of Chlorpromazine every eight hours.
MENTAL STATUS EXAMINATION
Results of mental status examination revealed an unaware individual who showed evidence of detachedness regarding his evaluation, although he tracked conversation well. The patient was casually dressed, but ungroomed. Orientation was slightly intact for person, time and place. Eye contact was not appropriate. He slouched and fidgeted about in his seat. Speech functions were appropriate for volume, rate, and fluency, despite a few paraphrasic errors. Vocabulary and grammar skills were suggestive of below average intellectual functioning.
The patient's attitude was bitter and uncooperative. His mood was detached and uncaring. Affect was appropriate to verbal content and showed broad range. His memory functions were intact with respect to long and short term memory in pertinence to factual information and event. His thought process was sporadic, hate-oriented, and at times, in denial. Content revealed evidence of delusions, some suicidal/homicidal ideation, but little to no paranoia. Evidence of perceptual disorder was not present. His level of personal insight was excellent, despite being unable to identify his current diagnosis. Social judgment is highly skewed, as evidenced by homophobic and misogynistic sentiments, a seeming inability to judge right from wrong, disrespect towards staff and other patients on the ward and by detached manner in which he approaches his lack of cooperation in regard to the goals laid out by staff.
RESULTS OF EVALUATION
The patient tests positive for psychosis, asociality, misanthropy, persecution complex, and depression. The patient tests negative for paranoia.
Results of psychological evaluation reveal an extended history of alcohol abuse and drug abuse, a psychotic disorder characterized primarily by asociality and misanthropy. The current clinical presentation represents a severe form of psychosis that has been developing presumably since the patient developed cognitive thinking. Currently, the patient appears psychotic, depressed, asocial, and misanthropic. He lacks the sufficient motivation, capacity, or social aptness to use external sources to assist in his depression, and insufficient internal motivation to cope with his various issues. The patient is attempting to cope with his illnesses using extreme guardedness and withdrawal. In recent months he has shown signs of extreme aggression and violent intention and is believed to be a physical risk to himself and/or others at present. In order for the patient to adapt, cope, or overcome his illnesses, people who know him should support him and seek out building a healthy relationship with him. Due to his asociality and misanthropy, group interventions will yield little to no progress, and it is recommended that he participate in individual therapy sessions instead. Once his detachedness has been removed or relaxed, efforts to explore psychosocial issues would be more successful and beneficial. Moreover, it would be helpful to the patient to explore the history of his substance abuse problems, and he should attend rehabilitation once his asocial and misanthropic tendencies fade and his guardedness is relieved.