Alcohol-related to psychosis, found to be consistent with alcohol
dependency, alcohol, intoxication, and alcohol withdrawal. According to the
Diagnostic and statistical manual (5th Edition), the psychosis due to alcohol
use, without any other mental illness, diagnosed as substance-induced disorders
(Hendricks, 2017). According to the recent data around 3-4 per cent alcoholic
abusers
experience psychosis. Alcoholic hallucinosis and alcoholic paranoia are two uncommon types of alcoholic induced psychotic disorder (Hendricks, 2017). These types have been seen in patients who have years of heavy and severe drinking.The current case study provides an understanding of the assessment of alcohol-induced psychosis. Furthermore, the case formulation has also been generated to describe the predisposing, precipitating and maintaining factors of the client's problems, that would assist in making clinical decisions regarding the management or intervention plan.
experience psychosis. Alcoholic hallucinosis and alcoholic paranoia are two uncommon types of alcoholic induced psychotic disorder (Hendricks, 2017). These types have been seen in patients who have years of heavy and severe drinking.The current case study provides an understanding of the assessment of alcohol-induced psychosis. Furthermore, the case formulation has also been generated to describe the predisposing, precipitating and maintaining factors of the client's problems, that would assist in making clinical decisions regarding the management or intervention plan.
Case
The client was 52 years
old man with weak physic; he was wearing a hospital dress. The client was
referred by the psychologist of PIMH for the assessment and management of suicidal
idealisation, drug abuse, hallucination, and hopelessness.
Assessment
Before the implementation of assessment modalities, the history of the client has been taken, which indicated the client has a conflicting inclination towards women, soldiers, teachers and family. The assessment of the
client was done through.
• Behavioural Observation
• Clinical Interview
• Reinforce identification
• Thematic Apperception
Test
• The subjective Rating
scale for delusions
Behavioural
observation. Behavioural Observation was carried out to assess the client
interest, abilities and appearance, his verbal and non- verbal cues.
Behavioural Observation is
a systematic way of recording the observable responses of behaviour (Pellering,
2014).
The rationale of Behavioral
Observation was to assess the client nonverbal behaviour, her posture gesture,
hygienic condition and how he communicates with others without verbal
communication. The client was observed during the session, in the playground
and pairs.
The client was a middle-aged
man with weak physic. He sat anxiously on a chair and continuously rubbing of
touching his feet. The content of his speech was not relevant; he was giving
extra details for each question and denying the use of drugs and their harms as
well.
Among hospital fellow, he
was not observed to be social. While he was sitting between them, but not
talking to them and after some time he went to a corner and sat here the rest
time.
The findings of the
observation showed that he was not social and hopeless about his future.
Clinical interview.
The clinical interview was carried out to assess the client problem and
conflicting issues which lead toward drug abuse, suicidal idealisation and
hallucination.
A clinical Interview is
the main tool of gathering information from client, parents, and other
informants (Raynold 2014). Clinical Interview was done to assess the client own
insight about his illness and problems which was very helpful to understand his
problems. The client had no insight about the harms of a drug; rather it’s a
source of energy for the client.
Reinforcer
identification. The reinforce
identification was used to assess the reinforce of the client.
Reinforcement is a
process in which the occurrence of behaviour is followed by a consequence that
increases the future probability of behaviour (Millitenberger, 1997).
The reinforcer of the
client was an appreciation for being a nobleman. As the client always said that
prayers are the only source of success and he always advises everyone for that.
So when at this point appreciation was given to him he feels good and talks in
more energetic ways.
The secondary
reinforcer of the client was his future. When the client stops taking part in
the discussion, so the only thing which energetic he was a discussion about his
future successful life.
Thematic
Apperception Test. TAT was used to assess the hidden conflict about family,
women teacher and soldiers. TAT is a projective test design to let a person
respond to ambiguous stimuli, reveal the hidden and internal emotions (Harvard,
1943).
Card 1. The client
was shown the first card, in which a child was sitting on a chair and reading
a book which was lying on the table when the client was asked to make a story
about that picture what you can see in this picture.
The client said a child was
sitting sad and alone, he was thinking about his future, he wanted to study, but
no one is helped him. He was looking at a map to discover the border of
Pakistan. He wanted to become an energetic man; he was finding a way to get
energy.
The client was looking at his childhood in
that picture; he told the same story which happened in his childhood. Three
conflicts were being assessed through interpretation; the first one was his
loneliness, ambition about the study, and victimisation of Pakistani soldiers.
One more thing was observed
that he had a cognitive error as he generalised all his story to other people
and he had been an ambitious person, but no desire could be fulfilled by him.
The client explained the border of Pakistan by saying that he had been pay duty
on the border of Pakistan, had worked with the soldiers, they teased the client
a lot by giving him an excess of work.
Card 2, 9MB. After
observing his conflict towards soldiers, the client was shown the card of
soldiers.
According to a
client, it was a picture of English film; all more solid was lying on the floor
to deceive Pakistan, Pakistani people will think that they die when they come
near to them, they will suddenly attack to them. It was reported by the client
that they have decided how to control Muslims and their way of living.
The client was overly
affected by politics and soldiers. He
often talks about them and claimed that he was in touch with them.
Card 3, 12 M. The
client was shown a card of women and men. The client sad that women were
thought to deceive the man, and the man n the picture was trying to keep happy
her kid's mother and siblings.
The client had an affair with women who left her due to lack of
financial support from the client, later on, he was divorced by her wife. After
these two incidents, that client developed the schema that all women are
wicked, and then he started blaming all women for her all failure as he thinks
that her aunt was responsible for her drug addiction.
It was also revealed
that the client had been disturbed due to wife and mother disputes.
Card 4, 7 BM. A card
of two male was shown to the client, according to the client they were
father-son in relation. They were thinking about a battle which was about to
start in Pakistan. The father and son were making a plan to save Pakistan from
British attack.
The client was overly
involved or affected by politics, but the exact phenomena could not be
examined.
Subjective ratings of
Beliefs. The subjective rating scale was used to take his belief about his
family and social circle. Subjective rating scales are measurement tools for
assessing the sequence or rating of phenomena (Splieger, 2013).
Table 2
The subjective rating of the client about his enemies are listed
below
Beliefs Subjective Rating
(1-10)
Mother enemy 8
Teacher enemy 10
Aunt black magic 10
Misconceptions about female
10
Qualitative Interpretation. According to the client he was not supported by his family,
he was working from childhood, his mother used him for money in spite of cold,
and she used to send him for work. He rated his mother as her enemy at eight
numbers out of 10.
According to the
client, his teacher did not support him in the study; rather he used to send
him for paying duty on the border of Pakistan. It was reported by the client
that his failure in educational and occupational life purely disturbed by his
teacher. He rated him on 10 out of 10 number as an enemy of his failure.
It was reported by
the client that he got to indulge in drugs due to the black magic which was
used by her aunt. She was jealous of all men. She was responsible for her
divorce. He rated her at 10 out of 10
numbers as an enemy of her marital life.
Case Formulation
The formulation was done according to the bio, psycho, social
model. According to the bio model, the maternal cousin of the client was
suffering from psychiatric problems. The literature suggests that the genetic
susceptibility in developing psychosis or bipolar disorder among family
members(Owen, Craddock, & Jablensky, 2007). The recent data provide
evidence regarding genotype and psychopathology (Owen, Craddock, &
Jablensky, 2007).
According to the social
model, the client belongs to low socioeconomic status, and he has eight
siblings, so the basic needs of the child were not fulfilled, which left a
negative impact on client’s mind. Consequently, the client had to start his job
in early childhood, which created a feeling of helpless in the client, or it
was a triggering factor of the problem. A study showed that three social
factors associated with drug abuse; socioeconomic status (SES), homelessness
and incarceration, and SES is often conceptualised as a root cause of drug
abuse (Mental health service, 2007). Higher of siblings, lack of support from
family and educational issues also disappointed the client, and he started
feeling negative about his family. The studies provide substantial data, which
indicates the higher number of children causes emotional and psychological
distress among siblings due to deprivation of needs (Karmaus, & Botezan,
2002). Another triggering factor was client divorced, and his girlfriend also
made him socially isolated, and he started cursing women by saying that ‘’all
women are wicked and they just love money’’. The latest studies reported that
the divorcee, unhealthy marital and romantic relationship with spouses distort
the thinking pattern and leads to isolation, low self-esteem and substance
abuse. Then the only comfort for was client was his elder sister but after her
death and later on, parents death made him feel like he was alone in the world
and became the victim of automatic negative thoughts and hallucination of
persecution. The death of the beloved becomes a trauma for the patient that
leads to drug abuse and psychosis. Then he overly started abusing drugs, which
affected his social functioning. Literature suggested that the death of a
family member is an important factor that leads to distorted thinking and
unhealthy health habit, such and smoking and drug dependency (Hemovich, &
Crano, 2009).
According to psycho model
as the client has eight siblings, so he was not attended appropriately and
being neglected by parents who created low self-esteem and feeling of
hopelessness among the client. All these were a risk factor for the problems of
the client. According to a recent study, the deprivation and lack of support
are the negative predictors of self-esteem and drug abuse (Hemovich, &
Crano, 2009). The client was discharged twice after getting recovery but
readmitted due to relapses. The client was being criticised for all his
failures and psychopath was became a tag for him. The tag of disability and mental
are the radical taboos of every society. The prejudices against the mental
health patients are mandatory to reduce for the better mental, physical health
of the patients (Shakespeare, 2013). The protective factors are client own
insight about his failure and believe in the Grace of God., as he knows
everything is possible if prayers should be regularly offered. The client
acceptance for his illness will be helpful in his management plan. Jacob (2016)
concluded that insight predicts positive outcomes and mental health.
Diagnosis. 305.00
(F10.20) Alchololic use disorder, moderate. Other factors; V61.03 (Z63.5)
disruption of a family by separation or divorce, V62.3 (Z55.9) Academic and
educational problem.
Prognosis
The client hygienic
condition and self-care was appropriate, but he was mentally weak, and over
Burdon with stressors, he was unable to face the stressful situation that
causes his relapses, so it could be hypothesised that the client prognosis was
poor.