Psychosis Case Study Transcript

Chief complaint. Evelyn Mann is a 24-year-old African-American female, presenting to the clinic reporting, "I see lots of spiders crawling on my body and hands and legs, but no one else can see them. I feel them on my arms and legs. I think they're attracted to the hamburgers." History of present illness: onset, diagnosed one year ago after first psychotic break. Voices returned recently, as well as tactile and visual hallucinations of spiders on legs and feet.

Presents with disheveled appearance. Flat effect, tangential speech, reports visual and tactile hallucinations daily. She reports audio hallucinations and states she hears incomprehensible speech of three voices. Location: is distracted and performing poorly at work. Misses work and is often late and unable to concentrate at home with family or when alone.

Duration: symptoms are continuous. Auditory hallucinations returned about six weeks ago and have drastically increased. Tactile and visual hallucination returned about five weeks ago and have gradually increased. Characteristics: hears three voices talking to her. A good voice, a mean voice, and a third that is just blubber. Reports the mean voice is making derogatory comments. Denies command voices.

Aggravating: when in public places is very suspicious that others can hear her thoughts and possibly whispering about her. Has become agitated, chaotic, fearful, and yelled at strangers in public. Relieving: she is distracted for a while with music or a movie. Seroquel PO worked adequately for almost a year, then the patient felt she was well enough to stop Seroquel.

Temporal: worse in the AM after waking. Severity: outbursts at times when responding to voices or suspicious of others. Whispers constantly to answer voices.