multiaxial evaluation of schizo

7/23/2019 Multiaxial Evaluation of Schizo

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MULTI AXIAL EVALUATIONBY GROUP 2


2/17

CASE

Patient MN is a 28 year old male with a

longstanding history of social isolation, academic

problems and temper outbursts, began to develop

concerns that his 54 year old mother is poisoning

his food. The patients family history is negativefor mental and psychiatric disorders but positive

for a brother with cerebral palsy and mental

retardation. Over the next year, his symptoms

progressed with increased suspiciousness andfearfulness.


3/17

He used to work in a supermarket and was

reported to have argued with his store manager

because according to him the store manager kept

on monitoring him and even installed hidden

video cameras in the store just to see if he isdoing his job properly. He would usually wear cap

and a sun glasses during work because he wants

to hide himself from the cameras.


4/17

He started to hear voices saying that he was no

good and should stop working. He became

agitated at work and gets infuriated if customers

start to ask him and began talking strangely to

customers that they too were being monitoredand being followed by the manager and they

should also wear something to hide their identity.

A week after their argument, he was laid off from

his job because of constant arguing with themanager.


5/17

At home, he keeps on complaining that their food

had a strange smell and refuse to eat the food

that his mother prepared. His parents also

observed bizarre behavior, including talking and

yelling to himself, perseverating that his storemanager had been following him even at home

and that his parents are trying to poison and kill

him because he was no good and his parents

would want only to take care of his sick brother .


6/17

Patient is a smoker and an occasional drinker but

is negative for substance abuse. His bizarre

behavior exacerbated that he no longer eat nor

drink.


7/17

Developmentally, Patient MN is a product of a

full-term pregnancy. No developmental delayed

was noticed. As a young child and an adolescent,

he tended to be quiet and socially awkward. He

doesnt associate with other people and has nohistory of dating. He repeated 8thgrade and had

a difficulty catching up with their lessons at

school. He eventually asked his parents that he

would like to stop studying, didnt finished ninthgrade and just work.


8/17

He has no medical problems and his immunizations were up to

date according to his mother.

He was then brought to the nearest hospital because he refuse

to eat and drink.

Upon initial assessment, no expression nor emotion can be seen

in his face when you try to talk to him and his voice seems

monotonic while crossing his hand over his chest. He only

replies to the question being asked. He was wearing a dirty

sweatshirt and a baseball cap on day with oily hair almost

touching his shoulders. His eyes were sunken and lips were

cracking which are obvious signs that the patient was reallydehydrated. He cant maintain eye to eye contact with the

interviewer and seemed like his eyes were observing the place.

His mother decided to confine him the hospital for further

assessment and management.


9/17

SCHIZOPHRENIA

It is a group of disorders with heterogenous

etiologies and it includes patients whose clinical

presentations, treatment response and courses of

illness vary.


10/17

SCHIZOPHRENIA

Signs and symptoms are variable which includes

changes in:PerceptionEmotion

CognitionThinking andBehavior


11/17

SCHIZOPHRENIA

Now referred to as SCHIZOPHRENIA

SPECTRUM.

Schizophrenia spectrum and other psychotic

disorders include shcizophrenia, other psychotic

disorders and schizotypal (personality) disorder.

They are defined by abnormalities in one or more

of the following five domains: delusions,

hallucinations, disorganized thinking (speech),

grossly disorganized or abnormal motor behavior(including catatonia) and negative symptoms.


12/17

SCHIZOPHRENIA

DSMIV-TR FIVE SUBTYPES:

- Paranoid

- Disorganized

- Catatonic- Undifferentiated

- Residual


13/17

SCHIZOPHRENIA

DSM-5 no longer uses these subtypes but they are

listed in the 10threvision of ICD.


14/17

MULTIAXIAL EVALUATION

Multi axial evaluation is no longer used in DSM-

5.

DSM-5 moved to a nonaxial evaluation. They

combined the former Axes I, II, III, with separate

notaions for psychosocial and contextual factors

(AXIS IV) and disability (AXIS V).


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Axis I F20.9 Schizophrenia

F22 - Delusional Disorder

Axis II F60.0 - Paranoid Personality Disorder

Social isolation as defensemechanism

Axis III NONE


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Axis IV - Unable to finish 9thgrade,

Sick Brother,

Unemployment

Axis V - SAPS score-94 SANS score-85


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NON AXIAL EVALUATION

F20.9 Schizophrenia with F22 Delusional

disorder; F60 Paranoid Personality Disorder,

Social isolation as defense mechanism related to

sick brother, unable to finish the ninth grade and

recent unemployment.

multiaxial evaluation of schizo

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