For reasearch purposes only!
The DSM IV (Diagnostic and Statistical Manual of Mental Disorders) systems which was published in
1994, represents the official classification system used in the United States for diagnosing
psychological disorders. It gives specific criteria that are used in diagnosis, along with other
information regarding other features that are sometimes seen in people with specific disorders and issues
that are considered differential diagnosis (distinguishing between a primary disorder and other
conditions that may be similar in some ways). All three of the patients in the case studies exhibit
symptoms that can be diagnosed through this system.
One case deals with schizophrenia, another with obsessive-compulsive disorder, and the other with
substance abuse disorder (specifically, substance-induced). However, induced mood disorder could
represent an alternative diagnosis which should be considered. Although the previous diagnosis is the
most appropriate. All three patients exhibit characteristics that enable them to be diagnosed through
the DSM IV classification system.
JAMES CHATTERTON

When considering both the history and presenting symptoms of this patient, it would seem tat the
most appropriate diagnoses would be schizophrenia - paranoid type. An alternative diagnosis of mood
disorder with psychotic features would have to be considered, although this diagnosis seems much less
likely than a primary diagnosis of schizophrenia.
The primary features of schizophrenia fall into a number of categories. Characteristic symptoms
include delusions, hallucinations, disorganized speech, grossly disorganized behavior, as well as
symptoms of affective flattening (e.g., showing a lack of range of emotional response). Patients only
need to show two of these features for diagnosis. Other symptoms include evidence of major social or
occupational dysfunction. This may be reflected in a failure to function at an expected level in terms
of job or school performance, as well as major problems in relating to others in social situations. The
disorder must have lasted for six months or more, and the patient must not show evidence of a number of
other conditions such as mood disorder with depressive features, or substance induced psychotic disorder.
James Chatterton displays a number of features that are highly suggestive of a diagnosis of
schizophrenia. He shows very unusual and “unconventional” behaviors. Indeed, he is said to have had no
friends and displayed an uncharacteristic lack of interest in the opposite sex during his adolescent
years. His problems in social functioning are not only indicated by his unusual behaviors and hid lack
of interpersonal relationships but it is also indicated by the fact that during his senior year his
social functioning declined to the extent that he stopped attending school and displayed a generalized
lack of interest in doing much of anything. Clearly, he shows evidence of social dysfunction.
Perhaps the features most characteristic of schizophrenia are the presence of delusions and
auditory hallucinations. Here it can be pointed out tat the patient had suggested to his cousin that she
should not take her medication, as it was a plot by a religious group to make her sterile. This, along
with his lectures about extraterrestrial is indicative of delusional thinking. Such delusions are of the
type most commonly seen in schizophrenics with paranoid features. It can be noted that, even as a child,
the patient thought other people were talking about him. Other classic schizophrenic characteristics
displayed by this patient include auditory hallucinations, as when he noted that a woman’s voice was
telling him to do things. His tendency to laugh without apparent reason. as though he had heard
something, is also supportive of the presence of auditory hallucinations. The fact that the Mental State
Exam found the patient to be disoriented in terms of not knowing the d!
ate or where he was, also is suggestive of schizophrenia by his lack of appropriate expression of
feelings. All in all, a multitude of features strongly supports a diagnosis of Schizophrenia.
Specifically, schizophrenia - Paranoid Type. It can be noted that the Paranoid type of Schizophrenia is
diagnosed when the patient shows evidence of delusions and other features such as either disorganized
behavior or inappropriate affect (expressions of feelings). His delusions have already been discussed.
Inappropriate affect is suggested by this tendency to laugh inappropriately for no apparent reason. His
“blank” facial expression is also suggestive of “flat” affect. While all of the above strongly support
a diagnosis of schizophrenia, the fact that the patient shows evidence of sleep disturbance, weight loss,
and has made what would be seen as a suicide attempt makes it important to consider that he may display a
mood disorder with psychotic features as these features are all!
suggestive of depression. The primary