Case Study

1. The Case of Anna
Abnormal Psychology 401

2. Anna is a 21 year old, Caucasian female from Los Alamos, NM. Anna comes to care
after being found playing “tag” with cars on the highway. She appears pale,
emaciated, withdrawn and psychotic. Spectators claim that Anna ran out from
the side of the road and was laughing hysterically and running after cars
and touching them. She was attempting to punch windows and knock off mirrors
of passing cars. She is extremely slender, almost anorexic but the deputy
attending states it took 3 large grown men to hold her down and get her off
the road.
Deputy reports that Anna lives alone in an apartment with minimal furnishings
and stated he found only coke, chips and candy in her refrigerator. Anna’s
mother lives on the other side of town and is a foster parent, with Anna being
her only child. Anna’s mother, Laverne, states that she lost control of Anna
when she was about 15 and when she turned 17, she let the young girl move out
and live on social security she received from her father’s death. Laverne admits
that she rarely checks on Anna and states that ever since Anna was a young
child she often ate only chips, plain baked potatoes, water or coke and
nothing else because she feared that everything was poisoned. Anna reports
that she hears voices. “They make me laugh, they’re funny”. Anna denies any
visual hallucinations but is obviously unnerved, unable to stay still and
asks to sleep. Anna walks a short distance, lays down and goes to sleep.
Anna refuses to eat and states she only wants Cheetos and a baked potato. Anna
states she has never had a menstrual cycle and does not know what puberty is.
Laverne does not know where or how her daughter has been surviving for the past
two years or so. She claims that Anna took medications when she was younger but
cannot recall the names of the medications now or what they were for. Laverne
states she knows one medication is for asthma. Anna reports that she hates her
mother then cries and says she loves her and misses her and wants to go home. She
complains of headaches, feeling tired, thirsty and then she becomes
extremely hyperactive and aggressive. During her bouts of aggressiveness she
appears to be swinging her arms and trying to hit someone or something that is
not visible to anyone else in the room.
Anna is considered an adult and Laverne never took her for any type of
psychological testing or assessment as a child; therefore Anna can sign herself
in and out of treatment as she pleases and can refuse treatment. She, however,
poses a threat to herself and the community. There appears to be several issues
that are preventing Anna from functioning normally and will require some
cooperation on her part or at least direct observation.

3. Assessment Tools
• Structured Clinical
Interview
• Medical Testing
• Psychological Testing
• Mental status exam
• SASSI

4. Presenting Symptoms
• Psychosis
• Gustatory Hallucination
• Auditory Hallucinations
• Aggression
• Loss of Volition
• Amenorrhea

5. Patient’s Chief Complaints
• Anna reports she has never had a
menstrual cycle and that she
doesn’t know what puberty is.
• Anna reports she hates her mother
then cries and says she loves her
and misses her and wants to go
home.
• Anna complains of headaches,
feeling tired, thirsty and then
she becomes extremely hyperactive
and aggressive.

6. Possible Diagnosis
Undifferentiated
Schizophrenia

7. Schizophrenia
• At least two of the
following symptoms, each
present for a significant
portion of the time during
a one-month period:
– Delusions
– Hallucinations
– Disorganized speech
– Grossly disorganized or
catatonic behavior
– Negative symptoms
• Functioning markedly below
the level achieved prior to
onset.
• Continuous signs of their
disturbance for at least
six months, at least one
month of which includes
symptoms in full and active
form (as opposed to
attenuated form)

8. AXIS I
– Schizophrenia
Type 1: Positive
Symptoms
• Hallucinations
– Auditory
– Possible visual
• Bizarre behavior
• Confused thinking
• Inappropriate affect
– Schizophrenia
Type 2: Negative
Symptoms
• Experiences avolition
• Social withdrawal
• Gustatory
hallucinations

9. AXIS II
• Deferred

10. AXIS III
• Amenorrhea
• Possible Anorexia

11. AXIS IV
• Primary Support:
– Neglect as a child
– Estrangement
– Removal from home
– Death of family
member
• Social
Environment:
– Lives alone
– Inadequate social
support
• Housing Problems:
– Inadequate housing
• Economic Problems
– Inadequate finances

12. AXIS V
(GAF)
• Anna falls between 11 and 20 on
the scale due to the auditory
hallucinations she is been
having and her psychotic
episodes for which she was
taken to the hospital.

13. Possible
Diagnosis for Anna
AXIS I: !Undifferentiated Schizophrenia, Acute !
AXIS II: !Deferred!
AXIS III: !Amenorrhea!
! ! !Possible Anorexia!
AXIS IV: !Primary, Social, Housing, Economic !
AXIS V: !GAF: 11 - 20!

14. Theoretical Model
• Biological Model
– Biochemical
• Dopamine
• Cognitive Model

15. Treatments and Therapy
• Antipsychotic Drugs
– Psychopharmacology
• Cognitive-Behavioral
Therapy
• Family Therapy
• Family Psychoeducational
Therapy

16. Hollow Face Illusion

17. Questions?