Reference no: EM133897857

Question

She's nowhere near as bad as Alexei." Mr. Ivanovna was talking about his two grown children. At 24 years of age, Alexei had such severe disorganized schizophrenia that, despite antipsychotic medication, he could not put five words together so they made sense. Now Elena, 2 years older than her brother, had been brought to the clinic with similar complaints. Elena was a photographer. She specialized in photographs she took of the countryside near her home. Although she had had a one-woman exhibition in a local art gallery 2 years earlier, she had never yet earned a dollar from her photos. She had a room in her father's small condo, where the two lived on his retirement income. Her brother lived in a supervised group home. "I suppose it's been going on for quite a while now," said Mr. Ivanovna. "I should have done something earlier, but I didn't want to believe it was happening to her, too. "The signs had first appeared about 13 months ago, when Elena stopped attending class at the community college and gave up her three private-pay students. Mostly she stayed in her room, even at mealtimes; she spent much of her time flipping through photos on her phone. Perhaps 8 months earlier she had begun emerging from her room several times each evening, standing uncertainly in the hallway for several moments, then opening the front door. After peering up and down the hallway, she would retreat to her own room. Her father finally brought Elena for evaluation because he noticed she was opening the door much more frequently. In the past month, she had reenacted this ritual dozens of times each evening. Twice, her father thought he heard her mutter something about "Victor." When he asked her who Victor was, she only looked blank and turned away.

Victor was an instructor at the college. Some months earlier, one afternoon when her father was out, he had come to the condo to help her with "some special lighting techniques". Although they had ended up kissing, lying on the kitchen floor, she had spent most of that time explaining why she felt she should not be on the floor. He left heartbroken, and she never returned to the college. Not long afterward, Elena "realized" that Victor was hanging about, trying to see her again.

She would sense his presence just outside her door, but each time she opened it, he had vanished. This puzzled her, but she couldn't say that she felt depressed, angry, or anxious. Within a few weeks she started to hear a voice quite a bit like Victor's, which seemed to be speaking to her from the photographic printer she had set up in the tiny second bathroom. "It usually just said the 'C word,' " she explained in response to a question. "The 'C word'?" "You know I see you."

Several times in the past several weeks, Victor had slipped through her window at night and climbed into her bed while she slept. She had awakened to feel his presence. By the time she had fully awakened, he would be gone. The previous week when she went in to use the bathroom, the head of a large snake-emerged from the toilet bowl and lunged at her. She lowered the lid on the animal's neck and it disappeared. Since then, she had only used the toilet in the hall bathroom.

Elena was a slender woman with a round face and watery blue eyes that never seemed to focus. Unblinking and calm, Elena sat with her hands folded in her lap. Although she volunteered almost nothing, she answered every question clearly and logically, if briefly. She was fully oriented and had no suicidal ideas or other problems with impulse control. Her affect was as flat as one of her photos. She would describe her most frightening experiences with no more emotion than she would make a bed.

List the specific signs and symptoms the client presents with. Remember to include high-risk issues if indicated

Supporting your final diagnoses, use the DSM-5-TR to list each criterion with an example of how each is met

Briefly discuss how you eliminated three relevant differential diagnoses not listed in the criteria in question two.

Write out the Diagnosis with any specifiers; provide the ICD10 code;

Severity Level: _______

Briefly explain the severity level:

List and briefly justify any Z codes relevant to the diagnosis/treatment plan

Briefly note any potential sociocultural issues that impact your assessment of this case.