In order to make a diagnosis for the client, I will be using the 5Ps method of case formulation, with the
given information to analyze the behavior of the client. All of this information will aid me in making a
diagnosis for the client, which will also help to make me better equipped to suggest an effective and
useful treatment for the client.
01. Presenting problem
The first symptom that was noted was a decline in has academic performance a year after he switched to a
different school. Along with this, he also had a deterioration in his handwriting, with an irritable and sad
behavior shown. He had been engaging in fist fights and other undesirable behavior in school. It was seen
that he preferred to take part in activities that allowed him to be by himself rather than having to socialize
with others. He also resented eating with his family, this was yet another thing he preferred to do alone.
After this, over the period of a year, even after he had been meeting with a private psychiatrist, he started
to hear voices in his head. he started to suspect that his family members were colluding with the voices in
his head, trying to tease him. He shown signs of insomnia, staying up away at night muttering to himself
and shouting and people who were not there. He further showed sign of further deterioration in his
socialization and his self-care. Further, he showed significant weight gain after he was put back on
medication, showing poor compliance, leading to a relapse and frequent aggressive episodes. After he
was put on high levels of mediation, he showed a remarkable change in physical features, such as an
elongated face and large years. He continued to show aggressive and violent behavior, along with talking
and laughing to himself, with an irritable mood, laconic speech and a lack of insight into his illness.
02. Predisposing factors
In this section we pay attention to the biological factors in the family’s history. We check to see if there is
anyone in the client’s family who’s been diagnosed with any psychological problems or any other
sicknesses that could explain the client’s behavior. We would also look into the levels of serotonin,
dopamine and other hormones of his family members to see if any of these levels are unnatural. However,
in this case study, we have not gotten any of this information. Therefore, in order to assess this, we would
have to conduct further research, such as interviewing his parents and close family.
03. Precipitating factors
I believe that there are three main precipitating factors for the client’s behavior. The first one is the
aggressive and abusive behavior that his father showed him because he believed he was disciplining the
client by doing so. The second trigger was the fact that marital problems, along with the domestic
violence his father showed his mother led to their divorce. The last and final trigger was moving and then
switching schools. I believe that this was the last straw that led to the client’s behavior. As the case
explains, he showed no symptoms prior to this and grew up as a child, attaining all the require
developmental milestones at the right time/age.
04. Perpetuating factors
The first perpetuating factor seen is the fact that after he was put on medication and there was a positive
improvement seen, the diagnosis he was given was deferred and he had to be taken off his medication. I
believe that although the case study says that it was gradually tapered and stopped, it may have not been
as gradual as it should’ve been. It also could’ve been that his body started to rely on it during those 2
months and didn’t react well to it being taken away. Another factor that maintained the problem was that
he dropped out of school. Although changing schools was a trigger for his behavior, this is not something
that can be undone. Another big change such as not going to school anymore, led to him not having to
socialize at all and only led to the problem getting worse. The final perpetuating factor is that he was put
on medication again, even after he clearly reacted badly to it. He showed weight gain and poor
compliance due to his medication and rather than cutting back, they gave him even larger amounts of
various types of medication (divalproex sodium 1500 mg/day, aripiprazole 30 mg/day, trifluperazine 15
mg/day, olanzapine 20 mg/day, and lorazepam injection as and when required) which continued to an
increase in his symptoms. This is why I believe that this is another factor that helps to maintain the
problem, rather than fix it.
05. Protective factors
Lastly, we come too the protective factors, the factors that help to make the situation better for the client.
Which in this case could’ve been seen as the support he got from his family and his psychiatrist. When he
moved to his maternal grandparent’s home, it may have been hard but at this house he had a support
system with people who cared about him and were there for him. The person who gave him the most
amount of support was his mother, when she knew something was wrong, she got him a private
psychiatrist and tried to get him admitted, rather than giving up on him. This can be seen as a protective
factor, his psychiatrist, as well as the medication he was on (p to 400 mg/day for nearly 2 months) helped
to reduce his irritability and aggression. This is another protective factor that most likely made it easier
for the client to deal with his illness, as well as the symptoms he showed.
Diagnosis:
After conducting this case formulation, my diagnosis is that the client has schizophrenia. Schizophrenia is
often referred to as a type of psychosis. Symptoms of schizophrenia include hallucinations and delusions.
This could explain the voices the client hears and him thinking that his family is colluding with the voices
in his head. The reason for this is that people with schizophrenia aren’t always able to tell real0life apart
from their thoughts. There is no definitive cause of schizophrenia yet. Research has led us to believe that
it’s a combination of psychical, biological and environmental factors that lead people to be more likely to
develop schizophrenia, some are more prone to the disease than others, for these people, a stressful or
traumatic event of some kind could lead them to develop schizophrenia. I believe that this is what the
client suffers from.
Treatment:
The client has been through a lot of medication over the past few years and he’s still so young. Through
the case study, I can see that every time he was given medication, the outcome was different. The first
time he was given medication by his psychiatrist, he responded well to it. Taking him off the medication
seemed to cause some issues. The next two times that he was given medication, he gained a lot of weight
the first time and showed extreme changes in his physical features the second time. So far, I believe that
all of his experiences with medication have been negative, which is why my recommended method of
treatment is to take him through a detox for about a month – under psychiatric care, as a safety measure –
to make sure that all that medication is out of his system, and after that, thrice a week, I recommend that
the client attend family therapy. I would suggest that the first few sessions would be for the client on his
own, for the psychiatrist to really understand where the client is coming from. Once both, the client and
the psychiatrist are ready, we can move to family therapy with the parents, out of the three sessions a
week, one will be with the client and his mother, the second day that week, with the client and his father
and the third day that week with just the client to make sense of what was spoken about in the previous
two sessions and discuss what the client would like to address in the next two sessions. I recommend
doing this for about two months/9 weeks (27 sessions in total, 9 sessions with each parent and 9 alone),
and then move to just two sessions a week. One with both parents and one alone for another month and
then continue with one session a week with both his parents for another 3 months.
This should be under review and we would need to reassess the position of the patient in 6 months, once
the recommended treatment has concluded. Here, we will assess the improvement of the client and then
re-evaluate the necessity of further treatment.
